College of Nursing and Health Science
Permanent URI for this communityhttps://hdl.handle.net/1969.6/12
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Browsing College of Nursing and Health Science by Department "Nursing and Health Sciences"
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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 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 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 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.