Doctor of Nursing Practice Project Reports
Permanent URI for this collectionhttps://hdl.handle.net/1969.6/87118
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Item Occupational health nurses’ self-efficacy in implementing smoking cessation interventions for workers: a manufacturing company quality improvement project(2018-08) Thornberry, Amy Janell; Thornberry, Amy Janell; Sefcik, Elizabeth; Peck, Jessica; Garcia, Theresa J.; Peck, Jessica; Garcia, Theresa; Garcia, TheresaThe purpose of this study was to improve the delivery and quality of care to smokers at work who are poorly motivated to quit and to explore the concepts of self-efficacy for enhancing this care process within a manufacturing company. This quality improvement (QI) project aimed to educate occupational health nurses (OHN’s) by providing them with theory-based training and incentives to recruit poorly motivated smokers. Nurses practiced their skills in worker health promotion recruitment and motivational interviewing (MI) with smokers who had previously declined smoking cessation counseling. As the project evolved, theory-based applications brought OHN’s and smokers together in a new paradigm resulting in positive changes for both the OHN’s self-efficacy and smokers’ stages of change toward quitting. Paired t-tests detected statistically significant difference in OHN’s pre-and post-intervention self-efficacy scores (t(4) = -4.46, p < .001); d = 2.92) and smokers’ pre-and post-intervention stage of change toward quitting scores (t(10) = -9.07, p < .001); d = 2.09) suggesting the education intervention and motivational interviewing intervention were extremely effective in increasing OHN self-efficacy and smokers’ stage of motivation to change. Results from this pilot project indicate smokers who are poorly motivated toward quitting can be successfully recruited and counseled using motivational interviewing techniques, while simultaneously improving OHN self-efficacy toward helping these patients. Secondary findings revealed success in an innovative recruitment method of flipping the nurse-patient relationship from nurses helping patients to patients helping nurses.Item A vivar! A plant-based diabetes prevention pilot program for older Hispanics in South Texas(2018-08) Niles, Patricia Soliz; Niles, Patricia Soliz; Bell, Eva; Day, Cristi; Garcia, Theresa J.; Day, Cristi; Garcia, Theresa; Garcia, TheresaPurpose: A community-oriented culturally sensitive plant-based nutritional pilot program for older South Texas Hispanics was designed to determine if participation in a three-month plant-based diabetes prevention program would result in healthy dietary changes. Method: A pre-test post-test diabetes prevention initiative was designed to promote healthy nutrition and discover changes in dietary knowledge and behavior. Results: Statistically significant increased knowledge (t(21) = -3.43, p = .003) and self-reported consumption of plant-based foods (t(21) = -5.42, p = .000) was discovered existing surveys and project director designed questionnaires in a convenience sample of 22 older Hispanics who attended two adult recreational centers in Laredo, Texas. Conclusions and Implications for Practice: Collaborative health projects can be provided within community infrastructures that may positively impact the health of individuals by increasing knowledge and adopting lifestyle dietary changes. Further research is needed to explore gender variations and longitudinal outcomes.Item A prospective quality improvement project using a mammography risk assessment tool to increase screening mammogram use with low-income Hispanic women(2018-08) Walker-Smith, Tammy L.; Walker-Smith, Tammy L.; Baldwin, Sara; Murphy, Christina; Dyess, Susan; Murphey, Christina; Dyess, SusanMurphy, Christina; Dyess, SusanBreast cancer is the second leading cause of cancer mortality among U.S. women. Hispanic women experience a lower 5-year survival rate of 79% compared to 91% among non-Hispanic White women. The purpose of this DNP project was to design an evidence-based quality improvement (QI) project to improve the screening mammogram completion rates by implementing concurrent educational and clinic referral tool systemic strategies in a primary care clinic. Medline, CINAHL, and the Cochrane Collection, databases were used to identify key studies between 2013-2018 that addressed the disparity of low-income Hispanic women, and evidence-based practice breast cancer risk assessments based on risk factors and current screening guidelines. The evidence-based tools used were the Breast Cancer Risk Assessment Tool and the National Health Interview Survey, available in English and Spanish. Once the tools triggered a nurse referral, health providers determined if a screening mammogram order was needed. This provided a systematic change process for early detection and improved screening mammogram rates for women between the ages of 50-74. The QI project findings addressed evidence-based interventions that improved screening mammogram rates 7.21% in a three-month period. The outcomes discussed in this report provide guidance for new policy considerations and clinical protocols.Item A quality improvement initiative to improve diabetes self-care education for Hispanic older adults using culturally-sensitive, age specific-approach(2018-08) Babalola, Olubanke; Babalola, Olubanke; Sefcik, Elizabeth; Garcia, Theresa J.; Day, Cristi; Garcia, Theresa; Day, CristiGarcia, Theresa J.; Day, CristiIntroduction: The underuse of culturally-sensitive, age-specific diabetes education for older-aged Hispanic people likely contributes to deficits in diabetes knowledge, self-management and glycemic control. This quality improvement initiative applied evidence-based, culturally-competent, age-specific education methods to improve processes and health outcomes in a primary care setting. Methodology: A one-group, pre-test/post-test design was used to conduct this project at a large community clinic in Texas. Hispanic adults > 60 years, with T2DM (n=12) received biweekly classes over 3 months, including healthy Hispanic foods, family involvement, a Spanish interpreter using earphone technology, and interactive, bilingual, large-print materials and tools. Paired samples t-tests were used to compare diabetes knowledge, self-management, and A1C levels, pre- and post-education. Results: There was a significant difference in pre- and post-education outcomes: knowledge (t(11)=-7.969, p=.000; d=2.32), self-management (t(11)= -7.930, p=.000; d= 2.43), and A1C levels (t(11)=6.434, p=.000; d=0.78). Conclusion: Culturally-competent, age-specific education can positively impact knowledge, self-management behaviors, and glycemic values in older-aged Hispanic people.Item Reducing nurse practitioner turnover in home-based primary care:a Department of Veterans Affairs quality improvement project(2018-08) Hughes, Ashley Kate; Hughes, Ashley Kate; Keys, Yolanda; Peck, Jessica L; Garcia, Theresa J.; Peck, Jessica L; Garcia, Theresa; Garcia, TheresaObjective: To identify factors in the Department of Veteran Affairs (VA) Home Based Primary Care (HBPC) program that may contribute to nurse practitioner (NP) retention and decrease provider gaps and access to primary care disparities for veterans. Background: For a Texas VA Medical Center, high and rapid HBPC NP turnover was identified and a program evaluation was conducted to explore factors associated with turnover. Methods: To determine factors with potential to decrease NP turnover, a program evaluation was conducted using the Anticipated Turnover Scale (ATS) and the Misener NP Job Satisfaction Scale (MNPJSS), administered to currently employed, non-supervisory NPs, who had been in HBPC for more than six months. Results: ATS responses reflected 57.1% of the participants intended to stay; however, mean responses to individual questions represented the group was equally divided on intent to leave. Of the 43 MNPJSS questions, 24 were answered as dissatisfied and 19 were answered as satisfied by the group. Conclusions: Recommendations resulting from this program evaluation may help retain NPs in HBPC, reduce organizational costs, and support optimal veteran outcomes.Item Nurse practitioner-led telehealth to improve outpatient pediatric tracheostomy management in South Texas(2018-08) Moreno, Laura; Moreno, Laura; Peck, Jessica L.; Garcia, Theresa J.; Keys, Yolanda; Garcia, Theresa; Keys, YolandaGarcia, Theresa J.; Keys, YolandaPediatric tracheostomy patients are a medically complex population with increased incidence of emergency room (ER) use, hospital readmissions, tracheostomy-associated complications, and caregiver anxiety, especially the 30 days following discharge. The objective of this quality improvement (QI) initiative was to improve access to and quality of care for vulnerable, underserved populations by providing a Nurse Practitioner-led telehealth intervention. Method: This pilot feasibility study utilized a one-group, pre-test, post-test, quasi-experimental, retrospective cohort design in a free-standing pediatric hospital serving underserved populations using the Caregiver Knowledge Checklist, Care Transitions Measures Survey, Telehealth Satisfaction Survey, and Trach Care Behavior Scale. Results: Participants experienced no post-surgical tracheostomy complications or hospital readmissions with improved scores on all survey instruments, resulting in changed department clinical practice guidelines using telehealth. Discussion: Telehealth is effective in managing outpatient tracheostomy patients, supporting caregivers, and refining proficiency caring for tracheostomy-dependent children. Telehealth is accessible, affordable, and effective in improving outcomes.Item Identifying migration flexibility and the environmental factors that influence variation in recruitment success in partially migratory Hawaiian fishes(2019-05) Heim-Ballew, Heidi; Hogan, J. Derek; Portnoy, David; Pollack, JenniferBehavior flexibility during the larval stage influences differential mortality, recruitment, and population dynamics; recruitment is poorly understood, yet important for understanding population persistence. The purpose of this dissertation was to examine fishes for migration flexibility and to identify factors at different spatiotemporal scales that are influential to differential survival within and across populations. I found that four underexplored native freshwater fishes of Hawai‘i exhibited a larval migratory strategy, but many were flexible. One species (Sicyopterus stimpsoni) showed all individuals made a migration, and the others showed 25 – 40 % did not migrate. Next, I examined if migrant (S. stimpsoni) and flexible species (Awaous stamineus) showed lunar rhythmicity at hatching and settlement. Migrants of the flexible species showed more hatching around the full moon and settlement around the new moon, and residents showed the opposite pattern. The divergence in life-history timing appears to be a balance between ecological costs and benefits. Next, I examined the influence of variation in localized conditions on the ratio of migrant to resident contingents (A. stamineus) in adult populations. Residents were least represented when stream flow and nutrients were low; however, the abundance of a common invasive predator showed a negative relationship with resident abundance. Highly urbanized systems may impose such stressful conditions that resident recruitment is diminished, which underscores the importance of stream management to conserve vulnerable native species. Lastly, I examined the frequency of contingents (A. stamineus), larval duration, and growth rates across ENSO. The proportion of migrants was highest during La Niña, and resident proportions were highest during weak La Niña and strong El Niño; once El Niño became very strong, resident proportions decreased. Migrants had faster growth than residents across all growing stages. Migrant growth rates in the early larval stage were highest during El Niño, and pre-settlement growth was highest during La Niña. Resident growth was fastest during neutral conditions. The duration of the early fast-growing period was shortest during El Niño, and the larval duration was longer. These dissertation findings show the importance of evaluating multiple influential scales to understand life-history strategies of individuals, especially those that inhabit multiple ecotypes.Item Identifying barriers to diabetic self-management education for adult Hispanic males(2019-08) Lopez, Hugo; Keys, Yolanda; Garcia, Theresa; Peck, Jessica LThis quality improvement project explores diabetes self-management barriers for adult Hispanic males with type II diabetes mellitus at the Texas A&M Coastal Bend Health Education Center (CBHEC). Since diabetes is one of the leading causes of death for Hispanic persons, especially men with behavioral characteristics associated with machismo, information on barriers preventing adult, Hispanic male attendance at CBHEC would help to improve their program. The director of this quality improvement project administered a Masculine Behavior Scale (MBS) questionnaire, conducted individual interviews, and identified essential elements of the participants’ experience which can be used to improve the CBHEC program. Recommendations were formulated for stakeholders to improve program offerings and encourage attendance of adult Hispanic males with identified barriers and serve as a basis for future projects to improve patient outcomes for the target population.Item Reduce Overflow Incontinence to Prevent Pressure Ulcers in Individuals with Spina Bifida(2019-08) Schumann, Donna Kay; Peck, Jessica; Garcia, Theresa; Baldwin, SaraOverflow incontinence has been directly linked to the development of pressure ulcers in individuals with Spina Bifida (SB). The implementation of a bladder diary and educational session to increase awareness of pressure ulcers and decrease overflow incontinence episodes was selected. This Quality Improvement (QI) project was a quasi-experimental design with pre- /post-intervention evaluation. The setting was Camp That Love Built summer camp at Camp For All in Burton, Texas. The participants included 45 campers with SB, five to 60 years old and 16 staff members. Eligibility was dependent on necessity for intermittent catheterization and attendance of camp for the entire week. All participants received an educational session focused on pressure ulcer prevention. Campers were given a bladder diary to document catheterizations and to assist with adherence to a prescribed catheterization schedule. Staff provided verbal reminders to campers to perform catheterizations. The measurement tools included PUKAT 2.0 pre- and post-test, PUAS, and a bladder diary. PUKAT results yielded score increase more than 10% in 35 of the 61 participants. Overflow episodes recorded on the bladder diary decreased by 81% from 37 episodes on day two to seven episodes on day five. PUAS scores increased 2% from pre- to post- intervention. Educational sessions and implementation of a bladder diary decreased the episodes of urinary incontinence.Item Minimizing Congestive Heart Failure Readmissions from the Nursing Home Through Focused Nursing Education(2019-08) Layton, Priscilla Gail; Sefcik, Elizabeth; Garcia, Theresa; Forgione, BunnyThe purpose of this quality improvement project was to determine if congestive heart failure (CHF)-specific education and protocols for nursing home (NH) staff could improve their knowledge and reduce hospital readmissions through nursing knowledge application for patients 65 years of age or older residing in a nursing home. The project took place in two nursing homes in South Central Texas. The project used a quasi-experimental, two-group, design with retrospective chart review. Nursing CHF knowledge was measured at the intervention (n=15) and control (n=12) facilities using the Nurses’ Knowledge of Heart Failure Education Principles Survey Tool (NKHFEP) pre- and post-education intervention. The education program consisted of a 2.9 Continuing Education unit, Texas Nurses’ Association approved, course on CHF management in the nursing home setting. Chart reviews for hospital readmissions and nursing application of CHF-specific interventions were performed 3-months pre- and post-education program. Nurses at the intervention facility demonstrated improved CHF knowledge when compared to the control group: Treatment M=94, Control M=79.3 (t(25)=4.785, p< .001, d=1.91. Readmission rates decreased at the intervention facility and remained equivocal at the control facility. Nursing documentation of interventions improved at the intervention facility and remained low at the control facility. An evidence-based, CHF-specific educational program provided to front line NH staff of a central Texas NH, significantly improved nurse knowledge and resulted in clinically significant improvements in nurse application of CHF interventions and decreased CHF-related readmissions to the hospital, when compared to a control group.Item Text message alerts to increase adherence to pharmacy pick up rates in Hispanics with type 2 diabetes(2019-08) Casciato, Adrienne Marie; Forgione, Bunny; Rivera, Esmeralda; Silva, Noel; Garcia, TheresaObjective: The plan of this project was to increase refill adherence in this specific population by using text message alerts to prompt medication pick-up from the pharmacy. Background: The Be Well Clinic realized that other methods of patient communication needed to be implemented in order to increase medication refill adherence rates from pharmacies serving Hispanic patients taking oral hypoglycemic medications. Methods: The interventions used in this project included using a text message reminder and participation in a focus group at the end of the project to obtain patient satisfaction regarding reminder systems. Results: Data analysis revealed that the time spent implementing the text message reminder was significantly less than utilizing a phone call; however, the text message reminder did not significantly improve medication refill adherence. Responses to the focus group revealed that participants were positively satisfied with text messaging as a reminder method and both participants preferred text messaging over other reminder methods Conclusions: Recommendations resulting from this project may help staff use less time when reminding patients to pick up their medications from the pharmacy and reduce organizational costs.Item Anticholingeric burden screening and reduction for older adults in long-term care(2019-08) Arredondo, Derek; Garcia, Theresa; Baldwin, Sara; DeGrande, HeatherAnticholinergic (ACH) medication use amongst older adults has been associated with cognitive decline, development of dementia, counteraction of cholinergic dementia treatments, numerous adverse effects and subsequent prescribing cascades. Older adults in long-term care facilities (LTCF) are exceptionally vulnerable to these adverse effects. This quality improvement project implemented an evidence-based ACH cognitive burden screening and reduction program for adults aged 60 and older (N=31) in a south Texas LTCF to maximize cognitive function. Based on ACH medication screenings, reduction recommendations were made to prescribers for 19 residents. A three-group comparative design was used. The 3 groups included: those without recommended ACH reductions (n=12), those with recommendations for reduction which were approved by their prescribers (n=11) and those with recommendations which were not approved (n=8). Cognitive function was measured with the Short-Blessed Test (SBT) and ACH use with the Anticholinergic Cognitive Burden (ACB) scale. The group with approved reduction recommendations had a decreased mean (M ) ACB score (0.73 points lower, p=0.233) and a lower M SBT score (1.82 points lower, p=0.051) at 60-days post-intervention when compared to pre-intervention. Overall, the 31 participants had a significant decrease in M SBT (by 1.06, p=0.026) and a decrease in M ACB (by 0.23, p=0.422) in the same period. Those without any ACH reduction recommendations (n=12), were found to have a significantly increased M ACB, from 0.42 to 1.08 at the conclusion (p=0.013). The application of an evidence-based ACB screening and reduction program decreased ACB and was associated with clinically improved cognitive function in the residents of this facility. These findings were clinically significant and may also provide useful clinical outcome data to support research into, and improvement of, prescribing practices in LTCFs.Item Sbar tailored for mental health intake to improve mental health crisis triage for older adults(2019-08) Brown, Rhonda; Murphey, Christina; Rinehart, Mark; Fernandez, Jose; Platt, AdrienneMental illness is a global crisis. Unfavorable economic, social, and environmental circumstances contribute to lack of quality care in those affected by mental illness. The purpose of this quality improvement (QI) project was to determine if the addition of the Situation Background Assessment Recommendation (SBAR) tool tailored to mental health pre-screening assessment of older adults presenting to the emergency room in mental health crisis improved self-efficacy and communication between the mental health intake professionals and the psychiatrist, and increased accuracy of the preadmission assessments in the geropsychiatric unit at Matagorda Regional Medical Center. The design for this project was a non-randomized, one-group, pre-test/post-test guided design using Plan-Do-Study-Act (PDSA) cycle to improve handoff reporting from the mental health intake professional to the psychiatrist. geropsychiatric admission rate was 50% (n=24) pre-intervention and increased by 13% to 63% post-intervention (n=30). Mental health crisis triage for older adults was improved through the implementation of the SBAR tool tailored to mental health screening and the assessment.Item Improving child obesity screening and management provider practices in a South Texas pediatric clinic(2019-08) Pesina-Garcia, Ashley; Garcia, Theresa; Ajisafe, Toyin; Baldwin, Sara; Keys, YolandaChildhood obesity is an epidemic in the United States (US) and affects nearly one in five school-aged children. Inconsistent provider practice patterns, which often do not adhere to current clinical practice guidelines, can decrease the quality of childhood obesity screening and management. This quality improvement (QI) project implemented a provider education, reminder, screening and referral program to improve screening and management of overweight and obese children, aged 6-12 years old, attending a South Texas pediatric clinic. A comparative two-group, retrospective chart review and descriptive survey design guided the project. Eleven parents were surveyed and 126 charts (from 3 providers) were reviewed (pre-education: n=71; post-education: n=55). Provider practice post-education and reminder system was significantly improved on the use of overweight and obesity diagnosis codes (χ2 (1, N = 126) = 12.77, p<.001), overweight and obese labs ordered by provider (χ2 (1, N=126) = 9.49, p=.002), overweight and obese healthy behavior counseling (χ2 (1, N=126) = 14.14, p<.001), and follow-up visit recommendation (χ2 (1N=126) = 15.88, p<.001). There was no significant difference between groups in provider referrals to a fitness program. The parental survey indicated a significant improvement in child activity and nutrition behaviors patterns pre-provider education compared to post-provider education (Z=-2.805, p=.005, r=.25). A provider education program improved the screening and management practices of providers for children with overweight and obesity in a small pediatric clinic in South Texas.Item Improving lipid screening and management in pediatric primary care through a provider education and reminder program(2019-08) Patel, Stephanie Lyne; Peck, Jessica; Garcia, Theresa; Keys, YolandaThe National Heart Lung and Blood Institute (NHLBI) recommends universal lipid screening (ULS) for 9-11-year-old children. Limited available data suggest less than 50% of primary practice providers are using ULS guidelines (ULSG) appropriately. Insufficient implementation of ULS completion contributes to a failure to identify children aged 9-11 with dyslipidemia and can contribute to early cardiovascular disease. This Quality Improvement (QI) project implemented a provider-focused education intervention and retrospective chart review to increase completion of ULS in children aged 9-11 years old and to improve provider management in a pediatric primary care clinic in Central Texas. A one-group pre-test/post-test design was used. Participants included five physicians, 20 nurse practitioners (NPs), and five physician assistants (PAs). Chart review was conducted on all children aged 9-11 years who presented for well-child checks both three months prior to the intervention (n=911) and three months post-intervention (n=1045). A pre-and post-intervention provider survey was used to measure changes in lipid screening provider knowledge and practices. Providers’ knowledge of and completion of lipid screening increased from 70% to 89%. Utilization of educational sessions increased provider knowledge of ULSG and increased the number of 9-11 year-old children screened for dyslipidemia in this clinic.Item Understading Upper Tropospheric and Lower Stratospheric Temperature Structure Variations over Tropical and Extratropical Precipitation Systems(2019-12) Johnston, Benjamin; Johnston, Benjamin; Xie, Feiqin; Xie, FeiqinXie, Feiqin; Liu, Chuntao; Shinoda, Toshiaki; Starek, Michael; Liu, Chuntao; Shinoda, Toshiaki; Starek, Michael; Shinoda, Toshiaki; Starek, MichaelThe upper troposphere and lower stratosphere (UTLS) is a coupling region in the atmosphere in which air typically has characteristics of both the troposphere and stratosphere. This region is distinct in radiation, dynamics, chemistry, and microphysics, and a strong connectivity amongst these different processes makes it highly susceptible to climate change. Stratosphere-troposphere exchange across the tropopause is an important bidirectional process influencing the chemistry of the UTLS. Deep convection plays a large role in this exchange through the direct convective injection of water vapor into the lower stratosphere, by enhancing thin cirrus cloud presence, and by modulating the ozone budget. Many of these processes are also influenced by the extremely low temperatures at these altitudes. Therefore, understanding the role convection plays in the heat budget of the UTLS is paramount in climate research. In this dissertation, firstly, the UTLS vertical temperature structure changes near deep convection are quantified throughout two tropical regions. Deep convection observed from the Tropical Rainfall Measuring Mission (TRMM) satellite is collocated with high vertical resolution temperature profiles from COSMIC GPS Radio Occultation (RO) satellites along with ERA-Interim reanalysis from 2007 to 2011. A distinct layered structure of upper tropospheric warm anomalies, tropopause-level cool anomalies, and lower stratospheric warm anomalies is observed. The amplitude of temperature anomalies increases for deeper convection, marked by higher 20 dBZ radar echo top heights or colder infrared cloud-top temperatures. UTLS diurnal temperature variation also increases in both regions near deep convection. Secondly, to further examine the relationship between convection and UTLS temperatures, precipitation systems with different sizes, depths, and surface types are analyzed within different synoptic environments throughout the extratropics. Precipitation features (PFs) observed by the Global Precipitation Measurement (GPM) satellite are collocated with nearby GPS RO temperature profiles from 2014 to 2017. PFs are classified as non-deep stratospheric intrusion (non-DSI; more likely to be related to thermodynamic instability) or deep stratospheric intrusion (DSI; related to strong dynamic effects on the tropopause through folding) using potential vorticity. Non-DSI PFs introduce a similar vertical UTLS temperature anomaly structure to the tropics, whereas DSI PFs are mainly associated with major cooling from the mid-troposphere to just above the tropopause. These warm and cool anomalies also display strong seasonal variations from the subtropics to the high latitudes. Additionally, small but deeper non-DSI PFs typically result in lower lapse rate tropopause (LRT) heights, whereas large size but shallower PFs lead to a higher LRT. On the other hand, DSI PFs are almost always associated with large LRT height decreases. Finally, the unique characteristics of the extratropical tropopause are analyzed by illustrating when and where bimodal tropopause height distributions occur and how they relate to different synoptic environments and the occurrence of double tropopauses within individual temperature profiles. Tropopause heights are calculated and analyzed seasonally using COSMIC GPS RO temperature profiles from 2006- 2017. Tropopause bimodality occurs within the subtropics (between 20°-40°) and a distinct seasonality is observed, with bimodality occurring most frequently in winter due to a stronger subtropical jet stream. The region with a bimodal tropopause distribution nearly overlaps with the region that experiences a high frequency of double tropopauses (DTs). DT occurrence frequency is highest in winter along the poleward edge of the bimodal band. However, when analyzing profiles with only a single tropopause identified, bimodality occurs much less frequently and is reduced in meridional extent. These results suggest that seasonal tropopause bimodality is caused by two different factors, as the occurrences of double tropopauses strongly influence the tropical side of the bimodal band while single tropopause profiles that are more tropical in nature strongly influence the poleward side. The results shown in this dissertation display the unique characteristics of the UTLS and the noteworthy impact that both tropical and extratropical precipitation systems have on its thermodynamic structure. Additionally, these results suggest there are intricate relationships between different types of precipitation systems and their properties to the types of temperature anomalies that they produce. This study will enhance the community’s understanding of both tropical and extratropical convection, stratosphere-troposphere exchange processes, and tropopause characteristics.Item A primary care text messaging initiative to improve type 2 diabetes self-management in Hispanic adults(2020-08) Olivares, Lisa PompA; Olivares, Lisa PompA; Loika, Elizabeth; Loika, Elizabeth; Keys, Yolanda; Martinez, Mario A.; Tejeda-Delgado, Carmen; Keys, Yolanda; Martinez, Mario A.; Tejeda-Delgado, Carmen; Martinez, Mario A.; Tejeda-Delgado, CarmenThe purpose of this doctoral project is to improve the quality of care at a primary care clinic through the implementation of a text message intervention via a mobile phone device to improve glycosylated hemoglobin A1C levels, decrease body mass index (BMI), and increase diabetes self-management knowledge in Hispanic adults, aged 20 years or older, and diagnosed with type 2 diabetes (T2DM). A quality improvement (QI) design which included adult men and women with a hemoglobin A1C > 7% in a primary care office was used. T2DM is defined as glycosylated hemoglobin A1C that is greater than, or equal to, 6.5%. The optimal aim for effective control of T2DM is a maintained hemoglobin A1C level less than 7%. Intervention consisted of a power point presentation for the providers on updated management of care for patients diagnosed with T2DM. The results of a chart audit depicted improvement in knowledge and quality of diabetes practices among providers in the primary care clinic over time. The 3- month text messaging program consisted of 25 participants who were given educational material on T2DM. Participants received two text messages daily for 3-months with supportive, educational, and reminder texts regarding T2DM. Pre- and post-intervention measurements for mean hemoglobin A1C levels, DKT2 scores, and BMI were collected. Reductions in hemoglobin A1C measurements and BMI, and an increase in diabetic knowledge were observed. The mean pre- and post-intervention p-values demonstrated that the implementation of a text messaging program was statistically significant. Further investigation is needed for enhancing text message programs, such as the content and method of texting. Diabetic education via text messages has the capability to encourage modifications of one’s daily routine thus reducing modifiable elements that raise one’s chances of diabetes.Item Education and reminder initiative to decrease sexually transmitted infections and increase HPV vaccinations in primary care(2020-08) Pompa, Stacey Crystal; Murphey, Christina; Lee, Kyoung; Martinez, Mario A.; Seidel, StevenSexually transmitted infections (STIs) continue to rise within the United States and within local communities. The adolescent and young adult population accounts for nearly half of the new STI prevalence. All STIs are preventable however only 2 have an available vaccine. Since 2006, HPV vaccinations have been available to prevent the incidence of HPV infections and yet the vaccination rates remain low within the United States. An initial chart review of 50 electronic medical records (EMRs) from patients within that age group revealed these patients had no updated HPV vaccination information on their profiles and were not up to date with the completed HPV vaccination series. A quality improvement project was initiated to improve the STD education and HPV prevalence by providing reminders and administering HPV vaccines and educating patients on each visit about STDs at a local clinic within South Texas. A total of 85 patients between the ages of 13-24 years met the criteria to participate in the project, however 33 were excluded due to decline to participant and/or unable to contact for telephone follow up visit, leaving a total of 52 participants (n=52). The study showed an increase of STI education by approximately 87% after implementing verbal and written education during routine visits in primary care. A total of 47 referrals were discussed with the patients in regards to contacting the health department when opens to receive and completion of the HPV vaccination series. Due to the COVID-19 pandemic, patients were also given the health department’s information in efforts for them to contact and follow up with their HPV vaccination administration and completion of series. The number of vaccinations administered and the completed vaccination series among the participants were unable to be obtained due to the inability of administration from COVID-19.Item Improving Hispanic childhood obesity using an algorithm-based quality initiative in pediatric primary care(2020-08) Potter, Deborah; Garcia, Theresa; Keys, Yolanda; Platt, Adrienne; Bruun, FayeChild obesity is increasing and is considered one of the most serious health concerns of the 21st century. Hispanic children represent the largest group of obese children in the U.S. when compared to other ethnic groups. Health care providers (HCPs) have been recognized as key players in the prevention and treatment of child obesity, yet many studies indicate clinical practice guidelines are not always followed. The purpose of this quality initiative was to improve HCP management, and counseling of overweight and obese Hispanic children between the ages of 6-16 years, by providing an educational session and management tools to pediatric providers in a South Texas clinic. HCPs attended a 30-minute educational session, guided by the American Academy of Pediatrics’ algorithm for childhood obesity management; and the 5210 Healthy Habits Questionnaire was used to assist providers with assessment and counseling of patients and parents. Provider practice changes were compared to the same timeframe a year earlier via chart review. The sample of charts reviewed included 193 children, 51% male, 41% overweight or obese in 2019 and 135 children, 41% male, 47% overweight or obese in 2020; at least 96% identified as Latino/Hispanic and mean age was 10.4 years in both groups. Provider documentation of healthy activities assessment improved 17-25%, healthy habit counseling 12- 21.5%, and referrals to dietitian 6%, post-intervention. Results were promising and trending toward positive practice changes, however greater improvement in HCP practices and patient outcomes may have been realized if the timeline of the project had not been interrupted by competing healthcare priorities due to the COVID-19 pandemic. Providing algorithm-based education and resources for primary care providers in a pediatric clinic can improve practice and has the potential to impact outcomes for overweight and obese Hispanic children.Item A quality initiative to improve primary care self-management education for Mexican American type 2 diabetes patients using a culturally-tailored protocol(2020-08) Harper, Jennifer Nichole; Loika, Elizabeth; Garcia, Theresa; Day, Cristi; Sollito, MichaelType 2 diabetes mellitus is the fifth leading cause of death among the Hispanic population in America. Current data estimates up to 50% of all Hispanics born in 2000 will develop diabetes within their lifetime. Factors leading to diabetes or diabetes related complications in Hispanic patients are low English proficiency, low literacy levels, and cultural influences. A vital component to diabetes treatment is self-care behaviors. Elements vital in providing effective diabetes education should incorporate services that are person-centered, culturally relevant, and responsive to the participants’ needs. The purpose of this quality improvement initiative was to increase clinical compliance with diabetes guidelines to provide timely and culturally competent diabetes self-management education and improve diabetes knowledge, self-management behaviors, and health outcomes in Mexican American patients with diabetes at a primary care clinic in East Texas, using an customized education protocol. The protocol addressed language and literacy barriers, as well as appealing to social norms with the assistance of bilingual translators, educational handouts, and telenovela diabetes educational videos created by the Agency for Healthcare Research and Quality. This quality initiative used a pre-test, post-test design to implement a change in practice instituting an improved protocol for delivering DSME to Mexican American patients with diabetes at project site over a 12-week period. The implementation of the DSME protocol at the project site resulted in a large and statistically significant increase in the frequency and quality of DSME provided by the clinic and improved patients’ knowledge of diabetes and reported management activities.
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