African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25–65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient–provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

The doctor of nursing practice (DNP) provides a link between health policy and practice. This article provides an overview of the current legislation influencing the care and management of the nation’s largest, fastest growing, and costliest patient population—those with multiple chronic conditions. The DNP who remains informed and knowledgeable about the legislative changes directing practice and reimbursement will be prepared to demonstrate quality and value in an era of transparency. A brief overview of merit incentive reimbursement and alternative payment models are described as the United States moves toward population-based health.

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

The aim of this study was to understand and describe the experience of diabetes self-management among patients not meeting glycemic control (A1C > 9). Type 2 diabetes mellitus (T2DM) is a complex chronic disease process. Diabetes self-management is equally complex and critical to patient outcomes and quality of life. The components for self-management include: knowledge, skills/abilities, and support. Few studies have reported on the experiences of self-management for patients with T2DM to reach and sustain glycemic control. This study used a qualitative descriptive design. Semistructured interviews were conducted with 13 patients receiving care at a diabetic clinic at a major health-care system in New York City. An interview guide was developed based on diabetes self-management which guided the interviews. All data were analyzed using qualitative content analysis. Initially, three themes that describe each component of diabetes mellitus self-management (DMSM) and impact the patients’ reaching the desired outcome were identified: acceptance of knowledge, motivation for skills and abilities, and variability and vulnerability of support. Further analysis of the three themes led to the identification of an overarching, theme: loss of self. This overarching theme helped to explain the stages of grief illustrated across the themes in the participants DMSM experiences. The participants in this study identified loss of self, and the accompanying grief and grieving process related to the loss of self in response to their T2DM diagnosis. Participants were “stuck” in a stage of loss of self, which presented challenges to acceptance of their diagnosis, barriers to DMSM, and optimizing glycemic control.

This project explored the effect of an automated appointment reminder system (texts/e-mails/telephone calls) on patient attendance at behavioral health appointments in a federally qualified health care agency in Texas. Appointment reminder systems have been shown to improve attendance rates in behavioral health (Clouse, Williams, & Harmon, 2017; Gajwani, 2014; Molfenter, 2013; Whisenhunt, 2014). It was expected that behavioral appointment attendance which in this agency has been historically low, would increase following implementation of an automated appointment reminder system. A retrospective electronic health record review was completed to compare behavioral health appointment attendance rates before and after implementation of an automated appointment reminder system. Data analysis revealed that no-show rates for behavioral health appointments in the previous appointment reminder system (telephone call reminders) and the recently implemented automated appointment reminder system (texts/e-mails/telephone calls) were comparable with rates of 19.4% and 20.0%, respectively. The difference between the rates was not statistically significant suggesting that the automated appointment reminder system was not effective in improving patient attendance at behavioral health appointments.

Traditional timeouts done ineffectively before surgical procedures can result in late blood product requests, inadequate preparation of needed intraoperative apparatus, improper administration of required antibiotics, and operating room (OR) time delays. This clinical concern is important to address because based on current evidence, implementing a Standardized Surgical Checklist (SSC) during timeout can impact patient safety by reducing complications following surgery and can promote good communication and teamwork among the care team. This quality improvement project is aimed to develop, implement, and evaluate the impact of SSC on communication and teamwork among an interdisciplinary surgical care team at Los Angeles County and University of Southern California Medical Center (LAC + USC). The design of this project was a pre- and postinnovation survey. The participants were the members of the interdisciplinary care team who participated in the surgical timeout before and after the innovation was implemented. The surveys consisted of 219 participants. Results from an independent t test demonstrated that the mean improvement score for both communication (t = −3.704, df = 190, p < .001) and teamwork (t = −3.028, df = 184, p = .003) were significantly higher in the postinnovation group than in the preinnovation group. These results indicate that SSC can improve communication and teamwork among providers inside the OR which can potentially lead to a safer delivery of care.

Background: There has been a significant decline in the use of mammography in the Russian immigrant population. Local Problem: Structural barriers to mammography include lack of or insufficient health insurance and distance to medical facilities. Organizational barriers include difficulty communicating with medical staff and navigating health care systems. The strongest mammography intervention is access. Methods: A Breast Health Tea event, small group discussions, and an on-site mammography event were held within this community to provide education about breast cancer and provide on-site screening mammography. Results: Twenty-seven women received the education and returned the questionnaires. Of these 27, 19 had mammograms. Of the 19, 16 had normal/benign results. Three required follow-up. Of the 3, 1 was positive for breast cancer, 1 was benign, and 1 went elsewhere. Conclusions: Providing access to on-site mammography has been shown to be an effective tool to reach communities that otherwise would not have access to these screenings. Advanced practice registered nurses can partner with public and private organizations and remove barriers to access for breast cancer screening in immigrant communities.

Depression affects almost 10% of the adult population in the United States but often goes unrecognized and untreated. The World Health Organization predicts depression soon to be the second leading cause of disability. Recognizing the signs and symptoms of depression and then feeling confident to treat are limitations many primary care providers acknowledge. In this study, significantly more patients were identified as moderately to severely depressed using the Patient Health Questionnaire-9 (PHQ-9) screening tool as compared to the clinic’s usual care practice of patient self-report. This study examines the PHQ-9, an evidence-based screening tool, to assist primary care providers in identifying depression. It also offers evidenced-based algorithms and websites to assist primary care providers with treatment protocols. The purpose of this article is to evaluate whether screening patients for depression using the PHQ-9 questionnaire is an effective tool in identifying patients with depression compared to the clinic’s usual care practice of self-report. Implementing an evidence-based screening tool in the primary care setting assisted identifying those at risk for depression. This study of 200 patients in the primary care setting demonstrated the effectiveness of using the PHQ-9 as an efficient and accurate depression screening tool. Results of this study were chi-square analysis revealed that a significantly higher proportion of patients were newly diagnosed with depression in the study group than in the comparison group, χ²(1, N = 200) = 9.96, p < .01.