Graduation Semester and Year

2012

Language

English

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Jacqueline L Michael

Abstract

Purpose: To investigate how effectively health care providers in a rural health clinic setting adhere to established clinical practice guidelines (CPGs) concerning breast and cervical screenings as outlined by the American Cancer Society (ACS) and the American College of Obstetrics and Gynecology (ACOG). 2 Methodology: A retrospective chart review of 226 randomly selected medical records of females aged 21 years to 69 years of age during the six month period from April 1, 2011 through September 30, 2011 was performed. Charts were reviewed using an investigator developed medical records review tool for date of last preventive screening, currency of screening, a recommendation for screening, and documentation of a reason for the lack of screening. Additionally, clinic providers were administered a questionnaire to examine their attitudes and beliefs concerning CPGs as well as their perceptions regarding barriers to preventive screenings among rural women. Findings: n = 226. The findings from this retrospective record review reflected that 51.4% of subjects were not current in their mammography screening and 46 % were not current in cervical screenings. Fifty-five subjects who were not current in mammography screening had no documentation of a recommendation for screening. Of the 104 subjects who were not current with their Pap testing, only fourteen (6.2%) received a recommendation for screening. A second purpose of this clinical project was to survey health care providers concerning their views regarding CPGs and perceived barriers in breast and cervical screenings. Results from a health provider questionnaire found the provider participants having mixed feelings concerning preventive screening barriers. Providers agreed that time constraints (66.6%) during routine visits was a factor, while 48% agreed that guideline confusion was an issue. All providers were in agreement that reimbursement was not an influencing factor. Sixty-four percent of providers indicated that patient compliance influenced CPG non-adherence. 3 Implications for practice: Previous research supports that a recommendation from a health care provider is associated with adherence to preventive services for women. Findings from this clinical project indicated that in this particular sample (n = 226), a low percentage of rural women who were not current in their breast (51.4%) and cervical (46 %) screenings, had documentation of having received a recommendation by a health care provider for a preventive screening. Findings also pointed out the need for clearer CPGs, clearer protocols for making recommendations, clearer documentation formats in the medical record, surveillance and monitoring of recommendations and preventive screening compliance, and education of providers and clients concerning changing CPGs. Community and state programs targeted to educate rural females concerning preventive services as well as grants/money to provide low cost breast and cervical screenings may help to increase compliance. Additionally, the findings indicate that there is a need for more education for health care providers concerning preventive maintenance services and the need to allocate more time for preventive care visits. Reducing morbidity and mortality related to both cancers improves the quality of life with early detection. Early initiation of treatment leads to a better prognosis.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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