Graduation Semester and Year

2014

Language

English

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Sharolyn K Dihigo

Abstract

Asthma is a serious chronic inflammatory health condition of the airways that causes many Americans to experience distress {Agency for Health Care Research and Quality [AHRQ], 2009). Asthma prevalence over the age of 16 has become particularly concerning. It is a costly disease that has increased drastically in recent decades (AHRQ, 2009). Many factors cause our nation to collectively attempt to improve the quality of care for these individuals. The primary goal is to treat the underlying inflammation and manage daily symptoms. Regardless of national recommendations, health care providers experience challenges with compliance. In one study, all primary care providers and specialists surveyed (N = 512) were providing suboptimal asthma care related to national asthma guidelines (Rance, O'Laughlen, & Ting, 2011). Many publications indicate that health care providers have a lack of understanding regarding the National Heart, Lung, and Blood Institute's National Guidelines (NHLBI) (Crim, 2000). This small descriptive study was conducted over a 12-week period during the summer of 2014 in a suburban college health center in Arlington, Texas. An evidence-based educational intervention based upon NHLBI guidelines was provided to all front office staff, registered nurses (RNs), and providers. Additionally, a system procedural change (adding a blank asthma action plan in out guides) was implemented. The out guide is a colored folder that is assigned to each provider that provides patient's name and identification number. The out guide is patient specific. A medical record review was completed for all eligible medical records for individuals with a diagnosis of asthma that met inclusion criteria (N = 34). After the study period, provider adherence and level of compliance with the completion of asthma action plans {AAPs) was analyzed and measured. Thirty patients from the sample met the inclusion criteria for the chart review for the 12- week study period. Level of compliance was determined to be high with 25 out of 34 records with entirely completed AAP (73.5%). When comparing advanced practice registered nurses (APRNs) compliance compared to medical doctors (MD), APRNs compliance was better for all three areas measured. Long-term health conditions require placing emphasis on self-care related to management and treatment. Educating health care providers regarding the significance of an AAP according to evidence-based practice will contribute to their comfort level and increase adherence. In a study by Kaferle & Wimsatt (2012), greatest improvement was found with clinics that instituted asthma education, clinical reminders, and registered nurse engagement. Evidence-based practice is rapidly replacing the traditional health care decision prototype previously experienced (Melnyk & Fineout-Overholt, 2011). The Doctorate of Nursing Practice (DNP) role consists of synthesizing evidence and implementing best practices in the clinical setting. The educational intervention and system procedural change in this quality improvement project allowed the leadership role of the DNP to positively influence provider adherence with the use of AAPs.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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