Matching Items (19)

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Improving Glycemic Control in Patients with Type 2 Diabetes Through Formal Education

Description

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

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Date Created
  • 2020-04-30

The Effects of Modifiable Risk Factor Video Education on Self-Efficacy in Adults with Atrial Fibrillation

Description

Atrial fibrillation, also known as Afib or AF, is the most common irregular heart rhythm among the United States adult population. Atrial fibrillation is characterized by an abnormal fibrillation of

Atrial fibrillation, also known as Afib or AF, is the most common irregular heart rhythm among the United States adult population. Atrial fibrillation is characterized by an abnormal fibrillation of the upper chambers of the heart, known as the atria. When left chronically untreated, this condition may lead to insufficient systemic blood flow or the formation of blood clots. Atrial fibrillation has many modifiable risk factors, meaning contributing habits and practices within the patient's control that may worsen the condition. Communication of these modifiable risk factors to patients with atrial fibrillation is important in improving patient quality of life and for reduction of disease symptoms. The motivation for this study was to convey the potential of improved disease process by lifestyle modification to patients with atrial fibrillation.

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Date Created
  • 2017-12

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Improving Diabetes by Improving Diabetes Education in Primary Care

Description

Diabetes is a leading cause of morbidity in the world. About 42 million people worldwide have
diabetes. Poorly managed diabetes leads to long term complications and mortality. Diabetes self-management education

Diabetes is a leading cause of morbidity in the world. About 42 million people worldwide have
diabetes. Poorly managed diabetes leads to long term complications and mortality. Diabetes self-management education (DSME) has been effective in preventing or delaying complications.The purpose of this project is to implement a diabetes self-management education (DSME)
program in primary care and to evaluate its impact on glycemic control and diabetes knowledge in a selected group of adults 18 years or older in a community-based practice.

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Created

Date Created
  • 2018-05-01

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Advance Directive Advocacy: Empowering Homeless Clients to Express Their End-of-Life Wishes

Description

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.

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Created

Date Created
  • 2016-05-07

Health Promotion Education for Overweight and Obesity in Adults with Endocrine Disorders

Description

Purpose: The purpose of this project was to implement health promotion education for overweight and obese adults with endocrine disorders. The overarching goal was to change dietary intake and improve

Purpose: The purpose of this project was to implement health promotion education for overweight and obese adults with endocrine disorders. The overarching goal was to change dietary intake and improve exercise to reduce the incidence, prevalence, and impact of comorbidities associated with obesity.

Background/Synthesis: Obesity is a significant epidemic facing the nation today with multiple impacts on the national healthcare system. There is often an association between obesity and endocrine disorders such as type 2 diabetes and prediabetes. Both obesity and diabetes cost the nation billions of dollars annually in healthcare costs. Evidence shows that lifestyle modifications related to nutrition and physical activity are effective in weight reduction and prevention of chronic disease, especially when given by a healthcare provider.

Methods: Fifteen adult patients at an endocrinology office in Arizona received individual counseling using the teach-back method focusing on health promotion behaviors through nutrition and exercise with a two-week follow-up phone call. Short-term outcomes measured in this project included changes in dietary intake and exercise behaviors through a pre- and post-test adapted from an obesity-screening tool developed by Greenwood et al. (2008).

Outcomes/Results: Participants were primarily Caucasian and Hispanic, married, female, average age of 50 years, average BMI of 34.5, and some college education. There was a statistically significant increase in health promoting behavior on posttest scores (M=66, SD=6.23, range=58-76) compared to pretest scores (M=61, SD=4.72, range=50-66), t(14)=-2.55, p=0.023.

Conclusions and Implications: Overall, patient health promotion behaviors increased with this educational intervention. Clinical implications include a potential decrease in patient comorbidities related to overweight and obesity. Implications for the greater healthcare system include decreased comorbidities, utilization of healthcare resources, and costs associated with overweight and obesity. Future recommendations would include determining weight and BMI changes over a longer period of time for even better outcome measures.

Keywords: obesity, obese, overweight, health promotion, health education, diet, exercise, nutrition

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Created

Date Created
  • 2016-05-06

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Health Literacy Education: For Parents of Children Preschool Aged and Younger

Description

Purpose: The purpose of health literacy education is to increase an individual’s understanding of health and use of the healthcare system. Low health literacy is associated with misuse of healthcare

Purpose: The purpose of health literacy education is to increase an individual’s understanding of health and use of the healthcare system. Low health literacy is associated with misuse of healthcare resources and misunderstanding of healthcare teaching. Education has demonstrated efficacy in improving health literacy. A personalized educational program was provided to parents of Head Start children, offered in Spanish and English, and at a 3rd to 5th education level.

Design: Using an established program for health literacy education, a Doctor of Nursing Practice project was implemented. The effect the program had on increasing the health literacy of participants over a period of 4 weeks was examined. The predominately, Latina participants received three hours of instruction based upon the health literacy book “What to do When Your Child Gets Sick”.

Setting and Subjects: The educational program took place in a large, urban county in the Southwestern United States with 24 parents of preschool age children in Head Start.

Intervention: The educational program contained three hours of classroom instruction utilizing PowerPoint® presentation, demonstration, and teach-back techniques on how to care for a child’s healthcare needs.

Measures and Analysis: Pre-, post- and telephone surveys were used to assess the impact of the health literacy educational program. Wilcoxon and Freidman tests were used to interpret the results.

Results: Despite no significant increases in health literacy post implementation, participants’ remarked that they felt the class was helpful and wanted to share the information with friends and family. They appreciated the program and wanted more educational opportunities.

Conclusion: Advanced practice nurses must acquire understanding, cultural sensitivity, and assess the needs of the community when implementing health literacy educational projects.

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Created

Date Created
  • 2017-05-02

Diabetes Self-Management Education Through Technology

Description

The purpose of this project was to evaluate the utilization of a smartphone application for diabetes self-management education (DSME) into a family practice office. Cochrane review of technological options for

The purpose of this project was to evaluate the utilization of a smartphone application for diabetes self-management education (DSME) into a family practice office. Cochrane review of technological options for DSME identified the smartphone as the most effective option. All patients with diabetes presenting in a family practice office for appointments with the clinical pharmacist or the physician were asked if they would participate in the project if they met the inclusion criteria including the diagnosis of diabetes, owning a smart-phone, and over 18 years old. Exclusion criteria were pregnancy, end-stage kidney disease, or use of an insulin pump.

The goal was to enroll at least 10 patients and have them utilize the smartphone application Care4life for education and blood glucose tracking. HbA1c, heart rate, blood pressure, weight, and body mass index were collected at the initiation of the trial in addition to a demographic survey. A survey was obtained at the end of the trial. Ten patients were enrolled in the project; 50% women. One patient discontinued participation after enrollment. Six patients returned their surveys.

The feedback was primarily positive with individuals liking the text messaging reminders and ability to track their matrix (blood pressure, blood glucose, weight, medication adherence, exercise). Continued utilization of the smartphone application within the practice is likely for those patients who enjoy the technology as a reminder. Further opportunities for implementation would be in a hospital setting where patients face a delay post discharge for an appointment with a diabetes educator. Additionally, due to the complexity of the disease this application could be used to educate caregivers.

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Created

Date Created
  • 2017-05-05

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Education and Self-efficacy of Probiotic Use in Patients with Chronic Gastrointestinal Symptoms

Description

Functional GI disorders are categorized as a group of chronic symptoms that are considered to have no abnormalities that can account for patient’s illnesses. Included in this category are those

Functional GI disorders are categorized as a group of chronic symptoms that are considered to have no abnormalities that can account for patient’s illnesses. Included in this category are those patients with irritable bowel syndrome. Functional GI issues are an important public health concern as they are becoming increasingly more common; they can be disabling and can cause significant socioeconomic burden in regard to health care costs, productivity and disability. There is strong evidence that probiotics have the potential to reduce IBS symptoms. Unfortunately, probiotics are underutilized in the clinical setting.

The purpose of this project is to increase knowledge and self-efficacy in patients with functional GI symptoms regarding the use of probiotics for symptom management. Patients in an outpatient GI practice in Southwestern United States with chronic functional GI symptoms were shown an educational video regarding the origins and benefits of using probiotics to manage chronic symptoms. Knowledge of probiotics, self-efficacy and willingness to utilize probiotics was measured by asking participants to complete a modified Health Belief Model survey before and after viewing the video. Patient demographics were collected. There were 75 participants (n=75) who participated in the project with a mean age of 40.3 years (SD=15.41), 85% female and 15% male. Wilcoxon signed rank test were used to analyze changes in paired data with significant improvements in self-efficacy (Z=3.93, p< .01), benefits of probiotic use (Z=4.33, p<.01) and decreased barriers to probiotics use (Z=-4.31, p<.01). After participants viewed the educational video, 95% of patients indicated they would try probiotics (CI 95%, p<.01) versus 65% of patients who would try probiotics before viewing video. In conclusion, education regarding using probiotics to manage functional GI symptoms improved patient’s self-efficacy and their willingness to use probiotics to manage their symptoms. Keywords: probiotics, GI disorders, diarrhea, IBS, constipation, abdominal pain, self-efficacy.

INCREASED EDUCATION AND SELF-EFFICACY IN PROBIOTIC USE:
Education and Self-efficacy of Probiotic Use in Patients with Chronic Gastrointestinal Symptoms
Functional gastrointestinal (GI) disorders are categorized as a group of chronic symptoms that are considered to have no structural or biochemical abnormalities that can account for patient’s illness. Included in this category are those patients diagnosed with irritable bowel syndrome (IBS). IBS is chronic GI disorder characterized by abdominal pain accompanied by altered bowel function, gas and bloating without the presence of organic disease (Mapel, 2013). Functional gastrointestinal symptoms typically include complaints of long-standing issues (greater than 3 months) of diarrhea, abdominal pain, constipation, gas and bloating.

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Created

Date Created
  • 2017-05-04

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Effective Utilization of HealthCare Resources: An Educational Intervention for Adult Patients

Description

Over the last ten years, a dramatic increase in Emergency Department (ED) visits has been prominent. Non-emergent chief complaints, such as repeat chronic care needs, are causing increased ED visits.

Over the last ten years, a dramatic increase in Emergency Department (ED) visits has been prominent. Non-emergent chief complaints, such as repeat chronic care needs, are causing increased ED visits. The underutilization of primary care resources has been correlated with the overutilization of emergency care resources. ED overutilization is having a negative rippling effect on the ability of the US healthcare system to care for patients. Emergency department personnel and other resources are strained, leading to overcrowding and decreased quality of care. Health insurance and provider accessibility has been linked to the high rates of ED usage by adults age 18 – 64, with the highest rates seen in those under public health coverage, such as Medicaid, compared to those who were uninsured. To encourage primary care visits and discourage non-emergent ED usage, the United States health system includes patient education on the appropriate ED use, higher-copayment as financial disincentives, and encouragement of provider-patient relationships with Primary care providers (PCP). The public health clinics, including Federally Qualified Health Centers, provide patient education on the appropriate use of PCP versus ED resources, and offer extended office hours during evenings and weekends; trimming the rate of non-emergent ED visits can significantly reduce health care costs.

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Created

Date Created
  • 2019-05-04

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Improving Postpartum Follow-Up Through Enhanced Prenatal Education and Concurrent Scheduling with a One-Month Well Baby Visit

Description

Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects.

Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.

The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.

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Created

Date Created
  • 2017-05-01