Gordon, Shirley

Clinical question: In parents with children 3-5 years of age with reported behavioral disorder problem behaviors (P), how does implementing a mindful reading strategy with their children, (I) compared to traditional reading or no reading (C) effect parents’ perception of problem behaviors and parent-child relationship (O) within 8 weeks (T)? This quality improvement DNP project examined the effectiveness of an online video parent training program, Mindful Reading Strategy for Parents, created based on the recommendations of Susan Hendler Lederer, PhD (Lederer, 2018). The theory of Nursing as Caring by Boykin & Schoenhofer was used to ground this project in caring (Boykin & Schoenhofer, 2015; Boykin & Schoenhofer, 2019). A convenience sample of three English speaking participants with children aged 4 and 5 with parental reported behavioral disorder problem behaviors were recruited from an outpatient clinic and preschool. They were assessed prior to the video training and 8- weeks after using the Parent Perception Survey and Pre- and Post- Parent Survey. Parents reported improved parental perception of child's behavior, perception of at least one behavioral disorder problem behavior in their child, and perception of parent- child relationship. No changes in child's psychotropic medication regimen post intervention were reported and 66% of parents read to their child at least 4 times per week during intervention. In this project, the Mindful Reading Strategy for Parents training program can have a positive effect on parents’ perception of problem behaviors and parent-child relationship. Implications include increasing parent and provider education of benefits of early intervention of mindfulness embedded reading strategies for children. Based on participant feedback, shortening the video training program may improve parent participation.

Mental health conditions such as depression and/or anxiety can be improved through music therapy. In a few studies of patients undergoing invasive procedures, music therapy appeared to reduce depressive symptoms and anxiety levels (Aalbers et al., 2017; Padam et al., 2017). The objective of this clinical quality improvement project was to evaluate the role of music therapy in reducing the anxiety scores among patient with suspected chronic GERD, achalasia, or dysphagia undergoing an invasive procedure such as an esophageal manometry study. The risks to the participants were no different than patients that are currently receiving standard care. Project participants were recruited from our Neurogastroenterology & GI Motility practice. They were all 18 years of age or older, male or female, and had a diagnosis of chronic GERD, suspected achalasia, or dysphagia.
Patients completed the short version of the State and Trait Anxiety Inventory (STAI) questionnaires (the definitive instruments for measuring anxiety in adults). The objective markers such as vital signs (blood pressure, temperature, heart rate, pulse, and oxygen saturation) were collected before and after the intervention. The focus of data collection was on the essential qualities evaluated by the STAI-State (STAI-S) Anxiety scale, which are feelings of apprehension, tension, nervousness, and worry (Spielberger, 1983). Pre- and post-test scores were analyzed by conducting a paired t-test with the Intellectus statistical program to assess differences in pre- and post-anxiety scores of patients’ receiving “comfort talk” standard care versus music therapy.

A lack of knowledge and involvement in grassroots legislative advocacy among nursing professionals adversely affects nurses’ ability to effectively tackle issues impeding the safe and effective delivery of healthcare. The role of primary care nurses in improving health outcomes includes developing substantial legislative relationships that constructively introduce nurserelated issues that are not adequately recognized or understood by legislators. This DNP quality improvement project sought to assess the effectiveness of a four (4) week legislative advocacy training program on the knowledge of, confidence in, and participation in the legislative advocacy process and local legislative outreach among nurse members of the Florida Nurses Association. Following the four (4) week intervention period, self-reported knowledge and confidence improved significantly evidenced by a reported 77.8% increase in advocacy knowledge and an 81.5% increase in advocacy skills. More than 80% of participants documented confidence in their ability to participate in legislative outreach with a 44% increase in contacting a legislator by email or mail, a 7.4% increase in legislative outreach by telephone, and a 7.4% increase with in-person visits. The results of this study suggest that increasing advocacy training, by incorporating frequent, repetitive sessions over a short period of time, is an effective approach to improving legislative outreach among nurse professionals.

Non-alcoholic fatty liver disease (NAFLD) is a hidden epidemic that is rising to alarming levels worldwide. With no definitive guidelines established for treating this disease, many providers resort to advising their patients to “lose weight” without specific dietary guidance. Providers are lacking the education and tools needed to implement evidence-based treatment that already exists in peer reviewed research. The Mediterranean Diet (MedDiet) is one such evidence-based treatment that can be implemented in a healthcare setting. The goal of this project is to reduce the morbidity associated with NAFLD by giving providers the tools necessary to implement the MedDiet as a specific treatment modality in clinical practice. The project leader evaluated the impact of a MedDiet educational program on providers in their clinical practice and on improving their knowledge, confidence, and ability to manage patients at risk for or diagnosed with NAFLD. The educational program was implemented at a small primary care clinic using a PowerPoint presentation and a brochure on the MedDiet created by the project leader for providers to administer to patients. Results from a questionnaire administered before and after the program revealed providers improved their clinical practice regarding nutritional guidance and providing specific recommendations to their patients on adopting the MedDiet. Furthermore, providers marked increased knowledge, confidence, and ability to manage patients at risk for or diagnosed with NAFLD. The results of this project suggest that providers lack knowledge on the MedDiet and intervening with an educational program increased providers’ ability to implement the MedDiet with their patients.

Medication adherence (MA) has been a problem in healthcare for years. The MA for the purpose of this paper and project MA is defined as Proportion of Days Covered (PDC) of ≥ 80 % when patients fill their prescriptions on time as ordered by their Primary Healthcare Provider (PCP). There are devasting effects of medication nonadherence, which causes preventable deaths, hospital admission, injuries, and rising healthcare costs. Therefore, MA on certain maintenance medications for blood pressure, diabetes and cholesterol are included as a patient care quality measure in the Healthcare Effectiveness Data and Information Set (HEDIS) by the Centers for Medicare and Medicaid Services (CMS) among Medicare Advantage beneficences. PCPs are accountable and responsible for their patients for adherence with those medications. Providers or practices that achieve target scores in HEDIS on MA financially rewarded with bonuses from the health plans that bring extra revenue.
This doctoral project and paper intended to help providers and patients to address MA by implementing the Integrated Multistep Patient-Centered Program (IMPCP) in primary care to find out the effects on HEDIS scores and Medicare Star Rating (MSR). IMPCP was developed to address MA in the local primary care Managed Service Organizations (MSO) in South Florida. This design of this project was quasi - experimental with secondary analysis. Descriptive statistics were used as a method to manage data. In conclusion, the IMPCP improved HEDIS and MSR scores in the local MSO. This paper includes the description IMPCP, results, evaluation, critique, and plan for dissemination.

Antibiotics are some of the most commonly prescribed medications. However, their use is associated with many side effects, one of which is Antibiotic-Associated Diarrhea (AAD). AAD is a common yet underreported side effect of antibiotic therapy that often leads to interrupted or premature discontinuation of antibiotic treatment that may result in a possible increase in long-term complications and other health implications related to AAD. The use of probiotics to prevent AAD and their general positive impact on gut and overall health are well-studied and documented. Providers are generally aware of the recommended best practice regarding probiotic prescribing to prevent AAD. However, many providers fail to implement the recommendations into practice. A common theme among providers is a lack of knowledge as to which probiotics to recommend given the vast choices of possible probiotics available, the length of treatment, or the most favorable time frame for probiotic therapy. To reduce AAD occurrence and improve patient adherence with antibiotic therapy, this doctoral project aimed to improve provider probiotic knowledge and prescribing practices in a South Florida urgent care and a primary care setting.

Recurrent and chronic vaginitis affects women’s self-esteem, sex life and overall well-being. The underestimation of the impact of recurrent and chronic vaginitis on women warrants further research into interventions and treatments. While bacterial vaginosis and vulvocandidiasis are among the most common gynecological diagnoses associated with vaginitis, there is no clear resolution in the literature. The path to finding a treatment plan that provides better and longer lasting relief may lie within the addition of probiotics supplementation. The use of probiotics has been widely explored in topics pertaining to gut health, however creating a more balanced flora of bacteria within the vagina could also lead to advancements in women’s health. This doctoral project was designed and implemented to increase the knowledge of providers and patients about the long-term use of probiotics for vaginal health while decreasing symptomatology at a women’s and family practice in South Florida.