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Diabetes Management Knowledge and Behavior Change Amongst At-risk Women

Description

Background: People with diabetes are at greater risk for comorbid cardiovascular disease, end stage organ damage, disability, and early death. There is substantial evidence that individualizing self-care education, such as eating a healthy diet, greatly improves diabetes management. Objective: The purpose of this paper is to review the…

Background: People with diabetes are at greater risk for comorbid cardiovascular disease, end stage organ damage, disability, and early death. There is substantial evidence that individualizing self-care education, such as eating a healthy diet, greatly improves diabetes management. Objective: The purpose of this paper is to review the outcomes of a diabetes education program offered to underserved women in the Southwestern United States. Methods: Four weekly nutrition classes were individualized and taught at a nonprofit organization in the southwest United States. Behavior change was measured using the Summary of Diabetes Self-Care Activities (SDSCA) tool. Classes were advertised via the center’s monthly class calendar and fliers. A total of nine participants (N=9) came to every class and took the SDSCA survey before and after class instruction. Results: Descriptive statistics and two 2-tailed t-tests with the critical value set at p<0.05 were used for data analysis. The participants were Hispanic women, most between the ages of 40-49, and had an income between $0-14,000. The mean difference between the variables of both general diet and specific diet pre and post-tests were significantly different from zero. The assumptions of normality and homogeneity were met. The results of both two-tailed paired sample t-tests were significant suggesting the means of general and specific diet pre-tests were significantly lower than the means of the general and specific diet post-tests. Discussion: The assumptions of normality and homogeneity were met and the results were significant. The pre-intervention scores for both categories were statistically significantly lower than the post-intervention scores for both categories. Thus, the desired outcome of helping clients within the organization modify, adapt, or change self-care behaviors related to diet was met.

ContributorsGandee, Marisol (Author) / Chiffelle, Rochelle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2022-04-26

Strategies for Help in Crowded Emergency Rooms

Description

Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated,…

Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated, triage-based CS administration and determine the effect on overall length of stay (LOS). Methods: For this quality improvement initiative, ED nurses at a large, freestanding, children’s emergency department in the southwestern United States were given education on inclusion and exclusion criteria for nurse-initiated CS in ED triage. Time to CS administration, LOS, and whether the ED nurse or provider ordered the CS were evaluated through chart reviews of patients presenting with a chief complaint of difficulty breathing. These metrics were compared to charts from the previous year during the same timeframe to evaluate for improved timeliness of CS delivery. Results: Time to CS administration decreased from a mean of 98.6 minutes to 57.6 minutes. LOS decreased from an average of 259.3 minutes to 169.6 minutes. The effect of timely CS on LOS was significant for December p =.003, January p =.002, and February p = <.001. Conclusion: A streamlined process for CS delivery to pediatric patients experiencing an asthma exacerbation can enable providers to achieve efficient and effective care in the ED and decrease a patient’s overall LOS.

ContributorsBain, Ilyssa D. (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-23

Can You See Me? Primary Care Provider Education to Satisfy the Visually impaired

Description

Vision impairment has affected 2.2 billion people globally, with 12 million people affected in the United States; more than 700,000 Californians experience visual impairment or blindness (VI/B). Causes of VI/B can be prevented with early identification and intervention. This project aims to identify perspectives of the VI/B, use this insight…

Vision impairment has affected 2.2 billion people globally, with 12 million people affected in the United States; more than 700,000 Californians experience visual impairment or blindness (VI/B). Causes of VI/B can be prevented with early identification and intervention. This project aims to identify perspectives of the VI/B, use this insight to build and improve the knowledge/skills of the primary care provider (PCP). A quantitative study, utilizing the Theory of Interpersonal Relations alongside the Star Model of Knowledge Transformation, incorporated pre-intervention questionnaires for the VI/B and the intention of pre- and post-intervention questionnaire for the PCP. After consenting, the VI/B completed the Patient Satisfaction Questionnaire-18 (α = 0.87) and Visual Functioning Questionnaire-25 (α = 0.95) surveys via telephone. An interventional video discussing visual acuity and screening, legal blindness versus visually impaired, leading causes of blindness, common ophthalmic drops and their side effects, helpful hints, and resources for the visually impaired was created. Deidentified results were analyzed with descriptive analysis and Pearson correlation. Currently, 30 voluntary, consented VI/B members have completed the pre-surveys. The overall average patient satisfaction score was 46.73 with financial aspect and communication with the most positive evaluation. Unfortunately, their PCPs have not responded. The PCP questionnaire will be distributed to the ophthalmologist partner’s healthcare organization. The needs of VI/B community are poorly identified and addressed in primary care; thus, the educational video was created to address the perceived gaps. Improved provider knowledge and enhanced patient care can enhance patient satisfaction with the delivery of care.

ContributorsVillayuran, Diane R. (Author) / Moffett, Carol (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-29

Benefits of Medically Assisted Treatment in Opioid Use Disorder

Description

Introduction: For 2019 in the U.S. opioid overdose deaths neared 50,000 people. Increasing the number of Medication Assisted Treatment (MAT) programs available for the population is important to address this crisis (NIDA, n.d.). Objective: To evaluate if MAT improves retention rates for those with opioid use disorder (OUD) for…

Introduction: For 2019 in the U.S. opioid overdose deaths neared 50,000 people. Increasing the number of Medication Assisted Treatment (MAT) programs available for the population is important to address this crisis (NIDA, n.d.). Objective: To evaluate if MAT improves retention rates for those with opioid use disorder (OUD) for one Arizona organization’s (AZOrg) seven treatment facilities. Methods: ASU IRB approval obtained, and de-identified data were abstracted from the electronic records of AZOrg, for a year, March 2020 to February 2021. The data included patient age, sex, date of admission, length of stay, substance abused, and if MAT (buprenorphine, naltrexone, Methadone) was prescribed. Intellectus statistical package was used for analysis. Results: Among 3261 patients with a mean age of 35.81(18-82) years, 1528 (46.85%) were admitted for OUD that included 371 (24.28%) females, 686 of whom (44.9%) received MAT. For those treated with MAT mean length of stay was 35.78 (SD 30.34) days compared to a mean of 27.46 (30.79) days for those without MAT treatment. This finding was significant, for all forms of MAT, based on a two-tailed Two-Tailed Independent Samples t-Test test, p<.001. Discussion/Conclusion: Increasing awareness about OUD and MAT is needed when providing care to patients with OUD. Providing organization-specific information regarding MAT benefits can enhance the adoption of this intervention and aid in the recovery of those being treated for OUD. This analysis did not include the possible confounding factors such as a history of incarceration, duration of OUD before admission, or structural differences of individual facilities.

ContributorsChevelwala, Turab (Author) / Moffett, Carol (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-29

Making an Impact on Skin Cancer Prevention and Strategies for Sun Safety

Description

Skin cancer is the most prevalent form of cancer diagnosed in America. No formal educational program for skin cancer prevention and sun safety previously existed at a Southwest University. As a result, a sun safety educational intervention sought to address this gap. For this co-ed young adult population, an education…

Skin cancer is the most prevalent form of cancer diagnosed in America. No formal educational program for skin cancer prevention and sun safety previously existed at a Southwest University. As a result, a sun safety educational intervention sought to address this gap. For this co-ed young adult population, an education video outlining sun safety measures was developed and delivered. An evidence-based review of the literature supported the intervention design inclusive of pre-and post- descriptive surveys, distributed via Survey Monkey. Data collected included sun safety behaviors, intent for behavioral change, and attitudes towards sun safety. Twenty-eight students completed both the pre-and post-survey. Based on the findings, it is clear that students are more likely to adhere to sun-safe behaviors following this video-based education, potentially decreasing their risk of skin cancer development.

ContributorsPope, Kristen (Author) / Moffett, Carol (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-29

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 DSME identified the smartphone as the most effective option. All patients with diabetes presenting in a family practice office 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.

ContributorsSchaub, Kate (Author) / Moffett, Carol (Thesis advisor)

Created2017-05-05

Interprofessional Collaboration in Management of Type 2 Diabetes with Attention to Social Determinants of Health

Description

Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of…

Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.

The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).

The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.

ContributorsTorres, Julia Patricia (Author) / Moffett, Carol (Thesis advisor)

Created2018-04-27

Breast Cancer Screening in Uninsured Women

Description

Breast cancer is one of the leading causes of cancer-related deaths among women in the United States. Uninsured women are less likely to receive breast cancer screenings, more likely to be diagnosed at an advanced stage, and more likely to have poorer outcomes following a breast cancer diagnosis (Abdelsattar et…

Breast cancer is one of the leading causes of cancer-related deaths among women in the United States. Uninsured women are less likely to receive breast cancer screenings, more likely to be diagnosed at an advanced stage, and more likely to have poorer outcomes following a breast cancer diagnosis (Abdelsattar et al., 2016; Akinlotan et al., 2021; Ko et al., 2020; & Ntiri et al., 2018). Women in underserved communities often experience socioeconomic barriers which impact obtaining preventative screenings, such as mammograms. Lack of patient navigation, transportation, and financial concerns interfere with obtaining breast cancer screening (Akinlotan et al., 2021 & Miller et al., 2019). Through the intervention of mobile mammography, uninsured women in underserved communities can be reached and access to screening mammograms can be achieved (Stanley et al., 2017 & Vang et al., 2018). Two mobile mammography events were hosted at the project site which provided 35 women with screening mammograms. All scheduled mammogram time slots at the events were filled and completed. Offering mobile mammography to this population has the potential to increase breast cancer surveillance.

ContributorsGlessner-Vallee, Paula (Author) / Santerre, Jennifer (Thesis advisor) / College of Nursing and Health Innovation (Contributor)

Created2023-04-26

Impact of Hospital Care on Exclusive Breastfeeding: Education to Bridge the Gap

Description

Introduction: The objective of this study is to emphasize the significance of exclusive breastfeeding (EB) and investigate methods to encourage and sustain it within a hospital environment. Using the self-efficacy theory, the study seeks to improve the current support system for breastfeeding mothers and their families. Methods: The project was…

Introduction: The objective of this study is to emphasize the significance of exclusive breastfeeding (EB) and investigate methods to encourage and sustain it within a hospital environment. Using the self-efficacy theory, the study seeks to improve the current support system for breastfeeding mothers and their families. Methods: The project was approved by the university IRB and facility IRB; guidelines were maintained. The project takes place in a non-profit organization in the southwestern United States. Education was conducted at a required staff meeting for Women and Infant Services (WIS) floor about supporting breastfeeding mothers. A pre- and post-education Breastfeeding Knowledge Scale (BKS) survey was performed, effectiveness was measured using a two-tailed t-test. The reliability of the BKS scale is 0.83 and the validity of the scale is reported to be strong. The hospital measures the EB rates of patients that are greater than 37 weeks gestation without need for neonatal intensive unit care and the mom requests to breastfeed. Results: The goal was 42% rate of EB in the first 48 hours after birth. After education the average rate of EB was 39.6%, lower than the goal but higher than the 33.7% rate before education. A two-tailed paired sample t-test (n=27) was used for BKS and the results were significant based on an alpha value; thus, showing significant knowledge gain. Conclusion: Consistent staff education improves breastfeeding support for moms in the hospital, leading to successful exclusive breastfeeding. This project benefits various settings, such as pediatric, postpartum, labor and delivery, and pediatric offices.

ContributorsHudson, Jennifer (Author) / Esperas, Amanda (Thesis advisor) / College of Nursing and Health Innovation (Contributor)

Created2023-04-26

Improving the Identification of Depression in Pediatric Primary Care

Description

Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized…

Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized tool improves detection, diagnosis, and management of depression and other mental health illnesses. Method: The Patient Health Questionnaire—modified for adolescents (PHQ9-A) was administered to all eligible adolescents, ages 12-18, during an annual well visit for a period of 6 weeks. Lewin's Change Theory guided a system change in the electronic health record, and the questionnaire results were documented and provided to the pediatric provider at the time of the appointment. A chart review was conducted to determine whether all eligible patients were administered the questionnaire and if a depression diagnosis or mental health referral had been made. Results: Out of 76 eligible well visits, 65 (86%) patients completed the PHQ9-A. The average score was 5.29 (SD = 6.49) with a maximum score of 25. Out of those that completed screening, 11 (17%) had a positive PHQ9-A score resulting in 8 referrals to mental health services and 2 mental health diagnoses in the clinic.

ContributorsCoomer, Meagan (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)

Created2023-04-27