Purpose: Improve chronic obstructive pulmonary disease (COPD) screening in primary care by implementing Global Initiative for Chronic Obstructive Lung Disease (GOLD) screening criteria.

Background and Significance: Evidence shows primary care providers (PCPs) are not adhering to the GOLD Guidelines for COPD screening.

Methods: Guideline education with pre/post-intervention survey and percent of eligible participants screened.

Results: Pre-intervention surveys (n=10) and post-intervention surveys (n=8) completed. Significant increase in knowledge regarding the CAT score (M score = 11.50, U = 24.000, p<.05). Part 2) 24% (n=6) of participants were screened with the CAT questionnaire.

Conclusions: PCPs are aware of the GOLD Guidelines, but do not always adhere to its recommendations. Future research should concentrate on effective ways to implement the GOLD Guidelines screening recommendations in primary care clinics.

Aim: The purpose of this project was to determine if educating elementary school personnel would improve their knowledge and self-efficacy in caring for students with Cystic Fibrosis (CF) and improve the health and educational outcomes of students with this disease.

Background: Evidence suggests that teachers play a big role in the management of students with chronic illnesses. However, current literature indicates that teachers lack basic knowledge about childhood chronic illnesses and how to manage students with chronic illnesses. Synthesis of evidence indicated that an online CF educational intervention would improve knowledge and self-efficacy among school personnel, thereby improving the health and educational outcomes of students with CF.

Methods: Elementary school personnel in Southern Arizona were asked to do an online pre-survey to evaluate knowledge and self-efficacy, view a short presentation on cystic fibrosis, and complete a post-survey. Parents of students with CF were asked to track 504 plan use and CF related absences. Frequencies were used to evaluate participant demographic data and survey data. The McNemar and Wilcoxon Signed Test were used to analyze survey data.

Results: Analysis showed a statistically significant improvement in perceived knowledge (p = .024) and self-efficacy scores (p = .034). Although survey scores showed an average score improvement between pre-survey and post-survey total scores (p = .212), it was not statistically significant.

Conclusion: Results showed an overall improvement in CF knowledge and self-efficacy among elementary school personnel. These results may provide an opportunity for CF healthcare providers and schools to promote the health and education of students with CF.

Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions, treatment delays, chemotherapy changes, or discontinuation of treatment. Guidelines exist to better prevent and treat CINV. Evidence supports the use of guidelines to prevent CINV, however patients still suffer from CINV often due to a lack of guideline adherence.

Objectives:
The purpose of this project was to increase CINV guideline adherence by increasing knowledge of antiemetic guidelines utilizing an educational intervention for providers and nurses at an outpatient oncology office.

Methods:
A brief educational intervention on CINV and recommended NCCN guidelines was
conducted with providers and nurse (n=6) at an oncology practice in Southwestern United States. An evaluation to assess change in knowledge was performed using a pre and post test format. Statistical analysis was performed using descriptive statistics, McNemar tests and Wicoxan Signed Rank Test.

Findings:
There was a significant effect on knowledge of NCCN antiemetic guidelines (Z=-1.89, p=0.059, mean 2.5) post intervention. There also was a significant impact on likelihood to use guidelines in practice (Z=-1.89, p=0.059, mean 2.5). Increasing awareness and likelihood to CHEMOTHERAPY INDUCED NAUSEA AND VOMITING 3 follow recommended guidelines may improve CINV symptoms in patients undergoing chemotherapy and improve the treatment outcomes for these patients.

Introduction and Background: Drowning is the leading cause of preventable injury death in Arizona for children under five years old. Tailored education has demonstrated efficacy in behavior change and knowledge retention. The purpose of this evidence-based project was to evaluate if tailored education improved knowledge and self-reported behaviors related to pediatric drowning. The Elaboration Likelihood Model provided the framework for this project.

Methods/Experimental Approach: The prospective pilot project was conducted using the Iowa Model of Evidence Based Practice. Parents with children under five years, presenting with low acuity complaints in a pediatric emergency department were approached. A baseline assessment identified high-risk behaviors and a custom education plan was delivered to parents. Outcome variables were measured at baseline and three weeks after initial assessment.

Results: The average parent age was 29 (M = 28.5; SD = 6.35) years. Participant (n=29) responses were analyzed using descriptive statistics. Participants (n = 27, 93%) reported likelihood to change behaviors and 29 (100%) perceived the tailored intervention as relevant. Secondary outcome variables were not measured at three weeks due to a lack of survey response.

Conclusions: Parents reported a high likelihood of behavior change when water safety education was tailored and relevant to their child. The tailored intervention evoked positive interaction and receptivity from parents and suggested a high motivation to make a behavior change. The effect of the intervention could not be tested due to the lack of follow-up and post data collection. The design of this evidence-based project is quantifiable and replicable in a low-acuity setting, which allows for future evaluations of self-reported behavior change and knowledge improvement.

Funding: No sponsorship or financial conflict of interest.

Purpose: The purpose of this quality improvement (QI) project was to assess provider (MD and Neonatal Nurse Practitioners (NNP)) comfort and confidence with Near-infrared Spectroscopy (NIRS) monitoring on Newborn Intensive Care Unit (NICU) patients when provided with an educational teaching session.

Background and Significance: NIRS data can be used in conjunction with standard vital sign monitoring to help clinicians understand blood flow and metabolic demands of organ systems, particularly cerebral, renal, and mesenteric blood flow patterns. A NICU unit in the northwestern US adopted NIRS use on their patients in 2008, however, NIRS monitoring usage decreased over the past 5 years, citing a lack of continued education and comfort interpreting and managing NIRS monitored patients. One patient was monitored with NIRS in the year prior to the QI project.

Methods: A 5 point Likert-Type survey was designed to examine provider comfort and confidence using and interpreting NIRS on NICU patients. No Croanbach’s alpha value exists for the survey as it was purposefully designed for the QI project. An educational presentation on the use and interpretation of NIRS on NICU patients was created and delivered during a formal provider staff meeting. Pre and Post education surveys were distributed electronically to participants and were presented 1 week prior to educational session and 1 month after educational session. IBM SPSS version 23 was used for descriptive statistics, paired t tests, and Wilcoxon test. Significance set to p<0.05.

Results: In total, 18 providers (N=18) were surveyed, and 13 paired survey results (n=13) were received (8 MD and 5 NNP). Paired-samples t tests were calculated to compare the mean total score (TS) for pre/post comfort and pre/post confidence. This was a significant improvement for both comfort (t(11) = -3.13, p=0.010) and confidence (t(11) = -3.37, p=0.006). Wilcoxon test showed a significant increase in the times a provider managed a patient with NIRS (z=-2.762, p=0.006). The number NIRS monitored patients increased from one in the previous year to 15 patients in the 5 months of data tracking, a clinically significant increase.

Conclusions: Providing educational session on previously utilized clinical applications can improve providers comfort and confidence and influence their usage in clinical practice. Future continuing education sessions could be designed for different clinical applications in order to keep clinicians abreast of the current evidenced based applications of advanced clinical monitors.

Over the last two decades, opioid prescription and prevalence has increased to account for over 33,000 deaths per year (Soelberg, Brown, Du Vivier, Meyer & Ramachandran, 2017). This is not only due to overdose, but misuse, abuse, and addiction. The abrupt increase in prescriptions, pills dispensed, and opioid-related deaths have encouraged the involvement of multiple entities.

In 2016, the opioid crisis gained the attention of communities that released guidelines to regulate prescription of opioid pain management. Such entities include the Center for Disease Control and Prevention (CDC), National Institute on Drug Abuse, Agency for Healthcare Research and Quality (AHRQ), Arizona Department of Health Services (AZDHS), and Substance Abuse and Mental Health Services Administration (SAMHSA). Evidence shows that prescribing practices between providers vary. It also shows that providers lack knowledge of appropriate opioid prescribing and management. To address this problem, provider education on an opioid policy is the most effective way to uniform opioid prescribing.

Diabetes mellitus (DM) is a detrimental disease that afflicts approximately 23.6 million Americans and costs $176 billion dollars annually in direct medical expenses (American Diabetes Association [ADA], 2015). Approximately 208,000 children and adolescents with diabetes are under the age of 20 years (ADA, 105; CDC, 2014). Currently, the standard of medical practice in school-aged children and adolescents with type 1 diabetes is to administer insulin after the child or teen has eaten. The most current evidence has demonstrated a decrease hemoglobin A1C (HbA1c) and preference for pre-prandial insulin administration (Cobry et al., 2010; Danne et al., 2003; DePalma et al., 2011; Enander et al., 2012; Luijf et al., 2010; Scaramuzza et al., 2010).

This Doctor of Nursing Practice (DNP) project delivered an educational program for parents of school age children and adolescents with type 1 diabetes and instituted pre-prandial insulin administration as the standard of care in an outpatient pediatric endocrine clinic. Education was delivered in both verbal and written formats. Data collection included weekly blood glucose reports and HbA1c at initial and follow-up sessions. Descriptive statistics were utilized to analyze the data. No post intervention data was able to be collected due to participant drop out. Future directions to promote this practice change are discussed.

The purpose of this project is to look at the relationship between education about Autism Spectrum Disorder (ASD) and knowledge, attitudes and beliefs in adult primary care providers. The project addresses the transition challenges adults with ASD have in finding a primary care provider who is comfortable and competent with ASD. Education was provided to adult primary care providers in a multi-site primary care clinic in a large metropolitan city in the Southwestern United States. The Modified Knowledge/Attitudes/Belief instrument was used. A pre-test was administered prior to the education session, then a post-test and a one-month post-test were given afterward.

The results of the education program showed that attitudes and beliefs increased after the education and continued to increase more in the month following. Knowledge improved after the education session but declined after a month although scores were not back to the pre-education level. Primary care providers who receive education about ASD may be more comfortable in caring for this population and more likely to welcome adults with ASD into their practice. Education for primary care providers is key to improving health outcomes for adults with ASD.

Recommended first-line treatment with atypical antipsychotic medication for management of schizophrenia and other psychotic disorders is contributory to weight gain and associated comorbidities. Beyond comorbid conditions – weight gain can lead to poor self-image, poor compliance and treatment outcomes in an already stigmatized population. Caregivers were selected as participants as they are a primary support in this population. In alignment with the Health Belief Model the purpose of this evidence-based intervention was to increase risk awareness, increase knowledge of strategies to offset risk, increase confidence and self-efficacy and empower health related behaviors among caregivers.

Participants were identified by providers in an outpatient mental health clinic as caregivers of patients prescribed atypical anti-psychotic medications adults aged 18 and above, able to read and understand English, and agree to provide consent. They were asked to:

1. Complete a demographic and knowledge pre-test, gauge perceived knowledge/confidence.
2. View an educational PowerPoint focused on atypical anti-psychotic medications, benefits, risks and strategies to mitigate weight-gain.
3. Complete a knowledge post-test and gauge perceived knowledge/confidence.

Descriptive statistics were used to examine distribution of variables, due to small sample size, Wilcoxon Signed Ranks test was used to compare outcomes. Qualitative data was also gathered to further develop interventions and inform practice. Comparison between pre- and post-test analysis demonstrated improvement in all areas of knowledge, perceived knowledge, and perceived confidence. Statistical analysis demonstrated statistical significance and high practical significance. One-hundred percent of participants recommended the intervention and provided qualitive feedback, and suggestions that may be used to inform practice.

Background: Healthy People 2020, a government organization that sets health goals for the United States, has established the benchmark objective of 70% influenza vaccination coverage. National trends show immunization rates are a dismal 41.7% for the adult population. Persons
experiencing homelessness are a vulnerable population in which access to preventative health care services is lacking. Prevention of acute illness, whenever possible, is crucial to maintaining the health of this population. The purpose of this project is to increase influenza vaccinations through staff education at a homeless clinic.

Methods: Eighty-eight volunteer staff, at a student led homeless clinic, received education on the influenza vaccinations. The education occurred at the first orientation meeting of the fall semester in 2016 and consisted of; the importance of immunizations, goals of Healthy People 2020, and an emphasis on addressing patient objections. The effectiveness of the program
compared the percentage of patients immunized from August - December 2016 to 2015.

Results: Post intervention, 44% of the clinic patients were immunized against influenza,
compared to 18% (pre-intervention). This finding resulted in a statistically significant increase in
vaccinations (Z= -5.513, p= < .001, Wilcoxon signed rank test). Eighty-eight volunteers were
present at the influenza vaccination educational intervention and 82 returned their surveys
(response rate 93%). The average score of the posttest was 96% (range 70-100%).

Conclusions: These findings support staff education on influenza vaccinations as a strategy for
increasing vaccination in the homeless population. Such interventions provide promise to
increase influenza vaccinations, however, they fall short of meeting the goals of Healthy People
2020. Identifying innovative interventions is critical to meet the goals of Healthy People 2020.