Education of Primary Care Providers and Clinical Staff in Identifying At-Risk-Patients for PAD
South University/College of Nursing and Public Health
August 17, 2020
Abstract
Peripheral Artery Disease (PAD) is a health problem related to limited oxygenated blood. It occurs because of the occlusion of arteries and progressive stenosis of the lower extremities (Walker, Bunch, Cavros, & Dippel, 2015). The prevalence of PAD is high in the United States, and the adult population is most affected (Walker et al., 2015). Increased PAD prevalence has a direct impact, not only on the cost of care but also on the patient’s overall quality of life (Walker et al., 2015). The complications of PAD present a significant burden on the healthcare system and patients. Early identification and detection of PAD are necessary to improve the quality of life among people who are affected by the disease. An educational intervention for healthcare professionals will help to enhance the knowledge and level of awareness of PAD screening and screening tools for the early identification of at-risk patients.
The DNP project aims to examine whether education for PAD screenings of at-risk patients for Lower Extremity PAD (Claudication or CLI) improved early intervention time for at-risk patients. The project is a quality improvement project, and a quasi-experimental study was used. An educational intervention was implemented, and pre- and post-test questionnaires were used as measurement instruments in the study. The surveys were used to measure the knowledge of primary care providers and clinical staff before and after the implementation of the educational intervention. The expected outcome is that educational intervention for primary care providers and clinical staff on PAD screening will improve early intervention for at-risk patients.
Keywords: Peripheral Artery Disease, Intermittent Claudication, Primary Care Provider, Clinical Staff
Introduction
Peripheral Artery Disease (PAD) is a chronic and common health problem which results from the occlusion of arteries and progressive stenosis of the lower extremities due to the lack of enough oxygenated blood (Walker et al., 2015). The deficiency leads to the degeneration of nerves and vasculature that cause walking impairment and loss of sensation in the extremities (Walker et al., 2015). Recognition of at-risk patients with lower extremities PAD is important because patients with such vascular diseases are at higher risks of cerebrovascular or cardiovascular problems (Tóth-Vajna et al., 2019). Early identification allows for adequate treatment, which is essential to decrease the related risks and mortality rates (Tóth-Vajna et al., 2019).
The signs and symptoms of PAD may not appear for some time, and patients with the disease may become asymptomatic a long time after the illness starts (Walker et al., 2015). Most PAD cases are often undiagnosed, which increases the need for improved awareness of the disease through education for early clinical signs and symptoms (Walker et al., 2015). Healthcare providers and medical staff need to be educated or trained adequately on the importance of early identification of at-risk patients with lower extremities PAD to improve intervention time (Olin, White, Armstrong, Kadian-Dodov, & Hiatt, 2016).
Definition of the Clinical Problem
Peripheral Arterial Disease (PAD) relates to the clinical manifestation of atherosclerosis, which affects circulation in the extremities, particularly the legs (Walker et al., 2015). The severity of PAD is classified based on time course, symptoms, and anatomical distribution. The disease is prevalent among patients above 60 years old at a rate of 20% (Bailey, Griffin, & Scott, 2014). The approximate number of people with PAD globally is over 200 million, with their symptoms ranging from mild to severe, and the prevalence of PAD increases with age (Bailey, Griffin, & Scott, 2014). The prevalence of PAD also varies across races, with African Americans demonstrating twice the incidence of PAD as compared to Non-Hispanic whites (Shu & Santulli, 2018). The early identification of PAD is pertinent to minimize the severity of the condition.
Background Knowledge/Significance of the Problem
PAD affects most people in the United States, and those with the condition are at higher risks for adverse effects like myocardial infarction, stroke, limb amputation, and even death (Walker et al., 2015). These adverse events commonly result in a poor quality of life. However, most patients with PAD are often not diagnosed and are undertreated due to a lack of awareness, which increases the prevalence rate in the United States (Walker et al., 2015). The current data presented by the National Health and Nutrition Examination Survey shows that about 5.9% of the population in the United States are affected by PAD (Curry et al., 2018). Among the affected people, 8.5 million are adults aged 40 years and older (Afzal et al., 2017).
A 2016 review found that 7% of people with PAD showed intermittent claudication, and about 21% of those with claudication progressed to limb ischemia (Sigvant, Lundin, & Wahlberg, 2016). Walker et al. (2015) explain that the increased prevalence of the PAD poses a significant burden to the patient and the healthcare system, like increased cost of care and reduced quality of life. Undiagnosed PAD can result in health complications for the patient. Rhee and Kim (2015) cite the National Health and Nutrition Examination Survey that was conducted to examine the health complications of undiagnosed PAD. Rhee and Kim (2015) mentioned that in the United States, about 7.1 million (5.9%) of the total population are adults with PAD, and 4.7% of the adult population have health complications of cardiovascular disease.
Criqui and Aboyans (2015) explain that adults aged 40 years and overdevelop diabetes mellitus and hypertension. The middle-aged adults with PAD in the United States are mainly Asian American (25%), African American (about 65%), non-Hispanic whites (10%), and Hispanics accounting to 25% with women being the most affected segment of the population (Criqui & Aboyans, 2015).
Schramm and Rochon (2018) establish that the prevalence of PAD is higher with increasing age, and older women are more affected population than men. Approximately 67% of women in the United States have PAD during the menopause period, and the prevalence increases with age (Schramm & Rochon, 2018).
The increased prevalence of PAD in the United States contributes to the high cost of care and management. Scully, DeBord Smith, Arnaoutakis, Semel, & Nguyen (2016) asserted that in the United States, PAD cost is high, with the annual expenditure per patient amounting to $12,702. The increased cost of care for PAD patients is attributed to the high price of medications where a patient spends about $3,025 with an out-of-pocket expenditure of $903 (Scully et al., 2016). Consequently, early PAD screening is essential for timely diagnosis and treatment (Walker et al., 2015).
Local Knowledge of Problem
Regionally, the prevalence of PAD is high in Broward County, Florida, compared to that of the national level (Allison et al., 2015). A study shows that in the southern part of Florida, the prevalence rate is almost 38% of the total population (Allison et al., 2015). The most affected people in the region includes both men and women from different ethnicities which are Cuban Americans (9.1%), South Americans (4.6%), Puerto Ricans (5.9%), Mexican Americans (3.2%), Dominican (4.7%), Central Americans (5.3%), and mixed groups with PAD are approximately 5% (Allison et al., 2015). PAD can be very costly to patients as expenses for the services result in patients spending $331 for Medicare, $280 in Medicaid, and $183 for hospital-based outpatient private insurance cost (Scully et al., 2016). Among those diagnosed with the disease, 25% develop complications of a stroke, heart disease, diabetes mellitus, and hypertension (Criqui & Aboyans, 2015).
Clinical Practice Setting
The clinical setting for the project was a primary care facility, and a general clinic with four healthcare providers and six supporting staff. The facility provided primary care services, including laboratory testing, evaluation of disease symptoms through physical examination, X-ray testing, and prescriptions. In the project, the site personnel included primary care providers and clinical staff who interacted with the researcher through face-to-face communication. The researcher met with the professionals in the setting to plan for and implement the project. The prevalence of PAD in the facility was approximately 40%. The population most affected was men and women aged 40 years and over. More than 20% of patients who were diagnosed with PAD also showed complications of coronary artery disease, diabetes mellitus, stroke, or hypertension.Gap Analysis of Clinical Site
The prevalence of PAD in the United States is alarming, with Southern Florida among the leading states with higher prevalence ranging approximately 38% (Song et al., 2019). From the previously conducted studies, more than 200 million people have PAD globally, with the prevalence increasing with age (Song et al., 2019). However, there is a lack of providers’ education to identify at-risk patients and initiate early interventions in the healthcare facility. Walker et al. (2015) explain that most patients with PAD are often not diagnosed or undertreated, and it is mainly associated with a limited baseline understanding of PAD and its associated risks. There is a need to provide education to improve providers’ awareness of early signs and symptoms of PAD that would help in early identification and treatment of the disease.
Benefit and Expected Outcomes
The expected outcomes for the project are that educational intervention will improve levels of awareness among primary care providers and clinical staff on PAD screening and early identification of at-risk patients. Enhancing the level of awareness among the primary health care providers will also increase the early diagnosis of patients with PAD, which will necessitate the adoption of first or advanced intervention measures before the condition progresses to multifaceted stages. Failure to make an early diagnosis may be risky and challenging to reverse.
Review of the Literature
Relevant studies were obtained from reputable search databases like EBSCOHost, CINAHL, and PubMed. South University Online Library and hand searching the reference list of the related studies were also done to source articles. Different search terms were used to facilitate the retrieval of pertinent studies. The search terms used during the literature search process were as follows: Peripheral Artery Disease, Intermittent Claudication, Educational Intervention, Peripheral Artery Disease Lower Extremities.
The Boolean operators “AND” and “OR” were used during the search process. For example, Screening for PAD AND intermittent claudication, OR Peripheral artery disease of the lower extremities, Peripheral artery disease AND educational intervention, PAD screening, AND education were the dominant search engine terms. During the search process, the total number of articles retrieved was 30; EBSCOHost (5), CINAHL (10), PubMed (10), South University Online Library (3), and hand searching yielded two articles. Inclusion and exclusion criteria were used to find relevant studies that best described the problem in question.
Articles that were published in English, between 2010 and 2019, that focused on PAD and intermittent claudication and educational intervention were included. Based on the exclusion criteria, articles published before 2010, written in a non-English language, and not including PAD, intermittent claudication, and educational intervention for PAD were excluded.
The screening process was done by reviewing the abstract of each article and conducting a full-text reading. Based on the inclusion and exclusion criteria, 26 articles were eliminated because of a lack of validity, and only four reports were eligible for review. The studies include a systematic mixed-studies review (Abaraogu, Dall, & Seenan, 2016), one qualitative research (Gorely, Crank, Humphreys, Nawaz, & Tew, 2015), and two cross-sectional studies (Davies et al., 2017; Haigh, Bingley, Golledge, & Walker, 2013). Two themes, Overview of PAD, Educational intervention, and Importance of Educational Intervention on PAD were identified and discussed in the chapter.
Overview of PAD and Educational Intervention
Peripheral artery disease (PAD) constitutes a health problem such as impaired blood flow in the lower extremity arteries and atherosclerosis (Walker et al., 2015). PAD management with advanced diagnostic and treatment strategies is necessary to improve health outcomes (Morcos et al., 2018). An algorithm for PAD management assists a collaborative approach between the primary care physician and specialty clinicians. This multidisciplinary method has a higher chance of providing optimal care and ensuring ongoing surveillance of patients’ health, which is crucial in improving the quality of care of patients with PAD (Walker et al., 2015). Educational intervention for PAD is essential to improve knowledge and awareness of primary care providers and clinical staff on screening process of PAD and early identification of at-risk patients (Abaraogu et al., 2016; Gorely et al., 2015).
Importance of Educational Intervention on PAD
Many of the studies included focused on patient education, especially the ones diagnosed with PAD (Abaraogu et al., 2016; Gorely et al., 2015). A systematic mixed study review by Abaraogu et al. (2016) establishes that educational intervention is essential to improve the physical activity behavior of patients with intermittent claudication. The study by Abaraogu and colleagues indicates that educational intervention increases the ability of the patient to engage in healthcare practices that would lead to improved quality of life and enhanced health outcomes. A qualitative study by Gorely et al. (2015) demonstrates that intervention on PAD either through group discussions or experiential learning is an evidence-based practice to improve patient’s health outcomes.
The educational intervention is crucial to prevent the progression or delay in the identification of PAD. Similar results were obtained in a cross-sectional observational study by Davies et al. (2017), which indicates that educational intervention on screening procedures is essential to prevent progression and delay in screening for PAD. Improved education for PAD is required as an evidence-based practice for early identification of PAD and to adopt risk modification strategies to minimize PAD progression and reduce the risks of health complications such as cardiovascular diseases.
It is essential to improve the primary care PAD screening for at-risk patients (Davies et al., 2017). Similar results were obtained in a cross-sectional study by Haigh et al. (2013) that examines awareness of PAD among general practitioners (GPs) in terms of the prevalence of PAD screening and screening tools such as the ankle-brachial index (ABI). The study also examines the barriers of PAD screening in a general practice setting. The study finds that the professionals were deficient in PAD screening and screening tools such as ABI. The study recommends that better education for GPs is crucial to increase access to screening tools and enhance early identification and detection of PAD (Haigh et al., 2013).
Summary of Findings
The results from the reviewed studies that examined educational intervention for PAD and screening process for early identification and detection of at-risk patients, limited studies have been conducted on educational intervention for healthcare professionals, which created a gap that this present DNP project seeks to fill. The current DNP project provided the foundation to understand the effectiveness of the educational intervention in knowledge and awareness among healthcare providers on PAD screening and screening tools for early detection and identification of at-risk patients for PAD.
Evidence-Based Practice: Support for Chosen Intervention
Education intervention for PAD and screening was chosen as the evidence-based practice for this DNP project. The educational intervention strategy is an effective process to increase the knowledge and level of awareness of healthcare professionals regarding a health problem and to improve their awareness of clinical practices. Erkin and Aygün (2019) explain that educating healthcare professionals allows them to acquire practical and theoretical knowledge about healthcare conditions. In the project, the intervention used as a simulation-based learning and effective teaching method to improve nurses’ theoretical experience and skills relating to patients’ health conditions. Two studies support that implementing an educational intervention assists the professionals in comparing the relationship between the theory and practice and in applying their skills to improve recognition and management of patient’s health status (Haukedal, Reierson, Hedeman, & Bjørk, 2018)
Problem Diagnosis
In problem diagnosis, a framework to implement the change is developed. The step entails establishing a detailed plan of action, which is distributed to persons who are affected by the problem (Higgins & Bourne, 2018). In the nursing field, the nurse leader and other healthcare personnel identify and diagnose health and related problems. During change implementation, other members of staff who could be affected receive a plan of action and are informed about the need for change to meet to deliberate on how to proceed with the adoption (Mitchell, 2013). Relating to the current capstone project, diagnosing change fits into the capstone project where primary care providers and clinical staff receive an action plan on education intervention for PAD screening. The staff was informed about the need for the intervention to improve early identification of at-risk patients with lower extremities PAD.
Motivation Assessment and Capacity for System Change
Assess motivation ensures that those who are affected by the change are prepared to allow transformation to take place. A solution to the problem may be established to motivate people (Szabla, 2017). Higher motivation is achieved through shared agreement and involving all people during decision making. For example, the nurse administrator may establish the patient’s complaints and cases of a nurse shortage and require all nursing staff to adopt change (Mitchell, 2013). In the capstone project, assess motivation fits the project when it is used where primary care providers and nursing staff are involved in decisions to adopt education intervention on PAD screening.
Resource Assessment and Motivation of the Change Agent
The change agents are personnel tasked with the process of leading change. Szabla (2017) explains that the change agent ensures having enough resources so that the team members meet the qualifications such as stamina, experience, and honesty in providing that the objectives of the change project succeed. The change agent ensures that the team members are well equipped to ensure that the project is completed. This step fits into the capstone project where the change agent is the nurse educator implementing educational intervention on PAD screening. This step also assists in understanding the resource materials used in the education process.
Establishing Change Objective and Strategies
Establishing a change objective and strategic plan entails developing complete steps such as timetables and datelines. The involved parties are assigned duties to ensure that the change takes place (Mitchell, 2013). The change agent is responsible for training and coaching to assist the employees in developing the character and skills that are required to continue and successfully implement the change (Mitchell, 2013). This step is suitable for the project as it assists in ensuring that the timeline for the proposed change initiative is presented. This step provides the time that the educational intervention needs, which is four weeks for the capstone project.
Choosing Roles of Change Agent
Selecting the role of the change agent is an essential phase of the change process. In this phase, change agents take part in managing the staff and supporting change (Szabla, 2017). This step ensures that the team members are encouraged to avoid change resistance. Step 5 of the planned change theory is suitable for the capstone project as it helps the nurse educator to manage the behaviors of primary care providers and nursing staff to accept the change process. This step aims to transform the behaviors of the professionals.
Maintaining the Change
In step six of Lippitts’s change theory, changing the implementation of the nursing process and the maintaining change project is the key focus (Mitchell, 2013). In this step, the teamwork, collaboration, communication, and feedback are the key factors of implementing and maintaining nursing change process. This step fits the capstone project concerning the implementation and supporting educational intervention. The educational levels among providers and nursing staff are examined.
Terminating Relationship as the Change Becomes an Organizational Culture
Step 7 entails evaluating and withdrawing the change agent. In this step, the effectiveness of the change is evaluated to determine if it improves the outcomes (Mitchell, 2013). This step suits the capstone project where the effectiveness of the educational intervention in terms of the level of awareness on PAD screening and early identification of at-risk patients that are evaluated.
Project Design
The proposed project is a quality improvement project that focuses on enhancing the healthcare providers’ capacity, especially the clinical staff, to identify patients at increased risk of developing PAD, encourage early diagnosis of PAD, and effectively manage patients with PAD diagnosis. The project achieved this by establishing an educational tool developed and delivered in PowerPoint to healthcare providers to enhance their awareness of PAD, its pathology, diagnosis, and effectiveness of early management. A quality improvement project focuses and uses appropriate healthcare strategies to improve patient care and safety during the provider practice (White, Butterworth, & Wells, 2017).
The Site and Participant Information
The project’s clinical site is a primary care clinic composed of four healthcare providers and six supporting staff. The facility was a multi-lingual, busy, private practice primarily serving Medicaid and Medicare patients. The clinic specializes in the diagnosis and treatment of patients suffering from chronic diseases such as asthma, hypertension, diabetes, depression, anxiety, HIV, strokes, COPD, and more. In the project, the site personnel, who are primary care providers and clinical staff, interact with the researcher through phone, emails, and RingCentral App for weekly communication and meetings. The researcher had met with the participants through RingCentral and discussed the ongoing project.
Methods
The goal of this quality improvement project is to provide formal education to primary care providers and clinical staff on PAD screening to improve their screening awareness and early identification of patients with PAD within four weeks. The project’s objectives were to educate primary care providers and clinical staff on PAD screening and to enhance the level of awareness among primary care providers and clinical staff on screening procedures and early identification of PAD. Finally, it was to examine whether an educational intervention for screening improves early intervention time for lower extremity PAD among at-risk patients.
At the end of the project, the researcher compared the pre and post data on PAD diagnoses and referrals collected, and a paired t-test assisted in testing the hypotheses and in evaluating the differences between the pre and post data on PAD referrals (Pandis, 2015), and determined the effectiveness of the project.
Procedures
The researcher of the quality improvement project collaborated with the director of the clinic, communicated, and offered PAD guidance over four weeks to the care providers and clinical staff. The researcher collected data on the number of PAD cases that had been diagnosed and treated through medical intervention for the same month of 2019, and referrals for PAD within the clinic. The number of PAD cases diagnosed for the entire four weeks was collected, and an average monthly rate was established, which forms the base data before the intervention. After the intervention (educational PowerPoint), the participants were asked to implement what has been learned. The researcher then collected the number of diagnosed PAD (referrals to a vascular specialist) to establish a monthly average.
The educational PowerPoint concerns approved training about Peripheral arterial disease (PAD). The proposed materials are a PowerPoint (PP), and other IRB approved materials that allow simulation of the screening exercises using such tools as the Ankle-Branchial Index (Guirguis-Blake et al., 2018). The participants’ level of awareness is determined through a questionnaire (The Motivation for Medical Education Questionnaire (MoME-Q) developed by the researcher. The same survey is used at the end of the four weeks, to establish the change (if any) in awareness level as well as to review peripheral logs for the increased referrals to vascular specialists (if any).
Methods
This section provides the instruments to measure the project variables, the procedure to collect data, and data analysis. The cost-benefit analysis and timeline of the project are presented.
Measurement Instruments
A survey tool was used to measure the outcomes or variables of this quality improvement project. Pre- and post-test questionnaires were used and determined the overall scores of the participants. Pre- and post-tests questionnaires were mainly used to examine awareness levels of the chosen participants before and after implementation of the educational intervention (Shivaraju, Manu, Vinaya, & Savkar, 2017; Kalfoss, 2019). The questionnaires helped to determine the effectiveness of the proposed intervention in improving screening and early identification of PAD among at-risk patients (Butterworth, & Wells, 2017).
Data Collection Procedures
Before the researcher collected data for the project, informed consent was obtained from the participants who were adults aged 25 to 65. Instructions on the project were given to them. Data was collected by interviewing and assessing the participants of awareness through the pre-and post-questionnaire. The results of the data collection provided information on the acquired knowledge of PAD. The target intervention was an education PowerPoint presentation given to providers and support medical staff. The educational material included the underlying causes of peripheral arterial disease, at-risk patients, risk factors, prevention, and the impact of early detection and medical intervention. A weekly meeting held via RingCentral meeting app on a similar topic for four weeks.
The researcher collected data on the number of peripheral artery disease (PAD) cases diagnosed and treated through medical intervention from the same four weeks of 2019 to compare referral rates pre- and post-test. The researcher reviewed the findings to established a monthly average of the number of patients with PAD who require referrals to vascular specialists.
Additionally, the researcher asked the participants to complete a brief questionnaire before viewing an educational PowerPoint. The selected primary care providers and clinical staff completed self-reported post-test questionnaires with multiple-choice questions. Their responses and the number of increased PAD referrals of four weeks were used to examine their awareness levels during the start and after implementation of the intervention. The effectiveness of the educational intervention was determined by comparing pre- and post-survey results of each participant and the increased new PAD referrals.
According to Barker et al., 2015, observation is a useful data collection design as it allows the researcher to learn the feelings and emotions of the research subjects. For that reason, an observational Clinical Log for Peripheral Artery Disease (PAD) is provided to the practicum site for the referrals coordinator to record patients diagnosed with PAD and the patients with PAD who are referred to a vascular specialist. During the period of data collection, this clinical log was a helpful approach that aided the researcher in gathering actual data from the clinic.
The pie charts depict the ages, gender, and other demographics of ten participants in this study. The subjects include both genders (male and female) of various educational levels (MD, PA, NP, RN, LPN, and MA). The first observation is that there are more females (7) than males (3). Also, the age group of participants over the age of 40 (3) is more than the other age groups. Finally, there are more NP than all the different demographics in the study. The following graphs explore the number of referrals before and after viewing the PowerPoint by these participants based on their knowledge of PAD.
Data Analysis
Quantitative data used an open-ended clinical log, and the referral coordinator recorded the number of times the participants identified, diagnosed, and gave referrals to at-risk-patients for PAD. Logs were reviewed weekly and collected at the end of the four weeks. Data collection, interpreted, and discussion of findings presented as the final part of the project.
Descriptive statistics
A paired T-test was performed to compare the number of referrals of the participants before and after the PowerPoint, as shown on the histograms below. The bar graph represented the scores of each participant before and after the Educational PowerPoint (PP). The score (1-10) is assigned based on the correct answer before and after. The display showed that, in most cases, the participants tended to score lower before watching the PowerPoint. The mean difference of the referrals before the intervention was 0.30, and the mean after was 0.60. The results showed that there was a significant difference between the number referrals before and after the educational PowerPoint (PP), which suggests that after the participants watched the PP on PAD, they were more likely to identify the symptoms and referred patients for treatments.
Pre-and Post-Survey Questionnaire Scores
Before Viewing Educational PowerPoint
After Viewing Educational PowerPoint
The differences between the pre-and-post PowerPoint watching are differentiated as follows. In the first histogram, there are eight participants with no referral, one participant with one and another one with two referrals. Each bar in the histogram represents the number of referrals. There are eight participants with 0 referral; therefore, the first histogram shows a pattern of skew right because there are more zeros.
Similarly, the second histogram for post-PowerPoint is skewed to the right because six participants had zero referral, two participants with one referral each, and two other participants with two referrals each. After the study, the number of referrals increased by 50% compared to three in 6/2019 to six in 6/2020.
Implications for Clinical Practice Based upon the Results of the Project
Educational interventions have significant implications on clinical practice based on the results of the study. Researchers realized an incredible improvement in clinical outcomes for PAD patients’ courtesy of increased awareness. All the stakeholders, including health practitioners and clinical staff, were aware of the symptoms, which lead to early identification of patients at risk. Most importantly, identified patients with PAD conditions were able to receive a referral to a specialist for early intervention and treatment before their condition worsened. Therefore, educational interventions played a significant role in identifying, screening, diagnosing the disease, and improving health outcomes. As a result, scholars must focus on this study to promote research and development. The intervention will ensure health care professionals are adequately educated about the conditions, and the appropriate measures are taken into consideration to curb its prevalence across clinical practices.
Strengths and Limitations of the Research Study
The strengths of the study were the opportunity for the participants to improve their awareness of early identification and detection of the at-risk patient on PAD. The participants were motivated and voiced their appreciation for enhancing their knowledge of the disease. The survey questionnaire tool was useful and appropriate in obtaining essential information about the participants’ level of awareness before and after the educational PowerPoint, as evidence by the increased number of referrals. Other strengths identified in the project where all the participants were providers and staff of the practicum site. There were three significant limitations of the study. First, the sample size was too small because the presumed number of participants was 15; however, only ten responded due to employee layoffs. Second, the number of patients decreased due to the pandemic. Third, is the time COVID-19, had a significant limitation on the study, for it affects the sample size and the mode of interaction with the participants. Lastly, the time frame was short. The researcher only had four weeks to complete the project. Although the participants were aware of the project’s time frame, it still put a strain on them to complete the study tasks on time. In all, the project was practical for it enhanced the participants’ level of awareness of PAD.
Conclusion
Peripheral artery disease (PAD) is a highly prevalent disease that requires effective management and treatment strategies. Educational intervention is a practical approach to manage the disease. The current research proved this statement by implementing an intercession for PAD screening. It targeted primary care providers and clinical staff, demonstrating that the proposed approach improves the early detection of PAD and the identification of at-risk patients. The DNP essentials that were firmly related to this study were the essential VI; Interprofessional Collaboration for Improving Population and Patient Optimal Outcomes, which met through the collaboration with medical providers and clinical staff. DNP Essential VII; Clinical Prevention and Population Health for Improving the Nation’s Health was met through healthcare professional education intervention in regards to peripheral artery disease to detect and identify at-risk patients ’population for PAD. However, the project timeframe was too short to assess its sustainability. Nonetheless, the researcher hopes to share this study with other primary care providers, healthcare providers, and health care establishments through future publications to achieve optimum health outcome for patients with PAD.
Appendix A: Informed Consent
Appendix B: Survey Questionnaires
Appendix C: Educational Intervention (PowerPoint)
Double Click on The Picture Below to View PowerPoint on Peripheral Artery Disease
Appendix D: Gantt Chart for Project Timeline
Week 1 Week 2 Week 3 Week4
1-Proposal approval—
2-Evaluating educational intervention
1-Data collection—
2-Pre-test and
Analysis of outcomes
collected PAD referrals
Post-test and
Analysis and final diagnoses, referrals of outcomes
1-Discussion of project findings
2-Presentation of findings
References
Abaraogu, U. O., Dall, P. M., & Seenan, C. A. (2016). Patient education interventions to improve physical activity in patients with intermittent claudication: a protocol for a systematic mixed-studies review. BMJ Open, 6(5), e011405.
Afzal, N., Sohn, S., Scott, C. G., Liu, H., Kullo, I. J., & Arruda-Olson, A. M. (2017). Surveillance of Peripheral Arterial Disease Cases Using Natural Language Processing of Clinical Notes. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2017, 28–36.
Afzal, N., Sohn, S., Scott, C. G., Liu, H., Kullo, I. J., & Arruda-Olson, A. M. (2017). Surveillance of Peripheral Arterial Disease Cases Using Natural Language Processing of Clinical Notes. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2017, 28–36.
Allison, M. A., Gonzalez, F., 2nd, Raij, L., Kaplan, R., Ostfeld, R. J., Pattany, M. S., … Criqui, M. H. (2015). Cuban Americans have the highest rates of peripheral arterial disease in diverse Hispanic/Latino communities. Journal of Vascular Surgery, 62(3), 665–672. doi:10.1016/j.jvs.2015.03.065
Barker, C., Pistrang, N., & Elliott, R. (2015). Research methods in clinical psychology: An introduction for students and practitioners (3rd ed.). Chichester, West Sussex: Wiley Blackwell.
Allison, M. A., Gonzalez, F., 2nd, Raij, L., Kaplan, R., Ostfeld, R. J., Pattany, M. S., … Criqui, M. H. (2015). Cuban Americans have the highest rates of peripheral arterial disease in diverse Hispanic/Latino communities. Journal of Vascular Surgery, 62(3), 665–672. doi:10.1016/j.jvs.2015.03.065
Barker, C., Pistrang N., & Elliott, R. (2015). Research methods in clinical psychology: An introduction for students and practitioners (3rd ed.). Chichester, West Sussex: Wiley Blackwell.
Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation Research, 116(9), 1509–1526. doi:10.1161/circresaha.116.303849
Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation Research, 116(9), 1509–1526. doi:10.1161/circresaha.116.303849
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … & Landefeld, C. S. (2018). Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US preventive services task force recommendation statement. JAMA, 320(2), 177-183.
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … & Landefeld, C. S. (2018). Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US preventive services task force recommendation statement. JAMA, 320(2), 177-183.
Davies, J. H., Richards, J., Conway, K., Kenkre, J. E., Lewis, J. E., & Williams, E. M. (2017). Primary care screening for peripheral arterial disease: a cross-sectional observational study. British Journal of General Practice, 67(655), e103-e110.
Erkin, Ö., & Aygün, Ö. (2019). Effects of an education intervention on nursing students’ knowledge and attitudes regarding skin self-examination and skin cancer risks. Journal of Nursing Research, 1-9.
Gorely, T., Crank, H., Humphreys, L., Nawaz, S., & Tew, G. A. (2015). “Standing still in the street”: Experiences, knowledge and beliefs of patients with intermittent claudication- A qualitative study. Journal of Vascular Nursing, 33(1), 4-9.
Haigh, K. J., Bingley, J., Golledge, J., & Walker, P. J. (2013). Barriers to screening and diagnosis of peripheral artery disease by general practitioners. Vascular Medicine, 18(6), 325–330. DOI: 10.1177/1358863X13505673
Haukedal, T. A., Reierson, I. Å., Hedeman, H., & Bjørk, I. T. (2018). The impact of a new pedagogical intervention on nursing students’ knowledge acquisition in simulation-based learning: a quasi-experimental study. Nursing Research and Practice, 1-10.
Higgins, D., & Bourne, P. A. (2018). Implementing Change in an Organization: A General Overview. Scholarly Journal of Psychology and Behavioral Sciences, 1(1), 7-18.
Jelani, Q. U., Petrov, M., Martinez, S. C., Holmvang, L., Al-Shaibi, K., & Alasnag, M. (2018). Peripheral Arterial Disease in Women: An Overview of Risk Factor Profile, Clinical Features, and Outcomes. Current Atherosclerosis Reports, 20(8), 40. doi:10.1007/s11883-018-0742-x
Kalfoss, M. (2019). Translation and adaption of questionnaires: a nursing challenge. SAGE Open Nursing, 5. https://doi.org/10.1177%2F2377960818816810
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37
Morcos, R., Louka, B., Tseng, A., Misra, S., McBane, R., Esser, H., & Shamoun, F. (2018). The evolving treatment of peripheral arterial disease through guideline-directed recommendations. Journal of Clinical Medicine, 7(1), 9-18.
Olin, J. W., White, C. J., Armstrong, E. J., Kadian-Dodov, D., & Hiatt, W. R. (2016). Peripheral artery disease. Journal of the American College of Cardiology, 67(11), 1338–1357. doi:10.1016/j.jacc.2015.12.049
Olin, J. W., White, C. J., Armstrong, E. J., Kadian-Dodov, D., & Hiatt, W. R. (2016). Peripheral artery disease. Journal of the American College of Cardiology, 67(11), 1338–1357. doi:10.1016/j.jacc.2015.12.049
Pandis, N. (2015). Comparison of 2 means for matched observations (paired t test) and t test assumptions. American Journal of Orthodontics and Dentofacial Orthopedics, 148(3), 515–516. doi:10.1016/j.ajodo.2015.06.011
Rhee, S. Y., & Kim, Y. S. (2015). Peripheral arterial disease in patients with type 2 diabetes mellitus. Diabetes & Metabolism Journal, 39(4), 283-290.
Rhee, S. Y., & Kim, Y. S. (2015). Peripheral arterial disease in patients with type 2 diabetes mellitus. Diabetes & Metabolism Journal, 39(4), 283-290.
Robinson, L. (2009). A summary of diffusion of innovations. Enabling Change, 5(10), 1-7
Schramm, K., & Rochon, P. J. (2018). Gender differences in peripheral vascular disease. Interventional radiology, 35(01), 009-016
Schramm, K., & Rochon, P. J. (2018). Gender differences in peripheral vascular disease. Interventional Radiology, 35(01), 009-016
Shivaraju, P. T., Manu, G., Vinaya, M., & Savkar, M. K. (2017). Evaluating the effectiveness of pre-and post-test model of learning in a medical school. National Journal of Physiology, Pharmacy and Pharmacology, 7(9), 947-951.
Sigvant, B., Lundin, F., & Wahlberg, E. (2016). The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. European Journal of Vascular and Endovascular Surgery, 51(3), 395-403.
Sigvant, B., Lundin, F., & Wahlberg, E. (2016). The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. European Journal of Vascular and Endovascular Surgery, 51(3), 395-403.
Sommerbakk, R., Haugen, D. F., Tjora, A., Kaasa, S., & Hjermstad, M. J. (2016). Barriers to and facilitators for implementing quality improvements in palliative care–results from a qualitative interview study in Norway. BMC Palliative Care, 15(1), 61-76.
Song, P., Rudan, D., Zhu, Y., Fowkes, F. J., Rahimi, K., Fowkes, F. G. R., & Rudan, I. (2019). Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. The Lancet Global Health, 7(8), e1020-e1030.
Song, P., Rudan, D., Zhu, Y., Fowkes, F. J., Rahimi, K., Fowkes, F. G. R., & Rudan, I. (2019). Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. The Lancet Global Health, 7(8), e1020-e1030.
Szabla, D. B. (2017). Ronald Lippitt: The master of planned change. The Palgrave Handbook of Organizational Change Thinkers, 765-785.
Tóth-Vajna, Z., Tóth-Vajna, G., Gombos, z., Szilágyi, B., Járai, Z., Berczeli, M., & Sótonyi, P. (2019). Screening of peripheral arterial disease in primary health care. Vascular Health and Risk Management, 15, 355-363
Tóth-Vajna, Z., Tóth-Vajna, G., Gombos, z., Szilágyi, B., Járai, Z., Berczeli, M., & Sótonyi, P. (2019). Screening of peripheral arterial disease in primary health care. Vascular Health and Risk Management, 15, 355-363
Walker, C. M., Bunch, F. T., Cavros, N. G., & Dippel, E. J. (2015). Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clinical Interventions in Aging, 10, 1147–1153. doi:10.2147/CIA.S79355
White, M., Butterworth, T., & Wells, J. S. (2017). Healthcare quality improvement and ‘work engagement’: Concluding results from a national, longitudinal, cross-sectional study of the ‘productive ward-releasing time to care’ program. BMC Health Services Research, 17(1), 510. doi:10.1186/s12913-017-2446-2
YALÇINKAYA, A., ÇANKAYA, M. N., ALTINDAĞ, Ö., & TUAÇ, Y. (2017). Investigation for the Robustness of Significance Level When the Normality Assumption in Hypothesis Tests is Violated. Gazi University Journal of Science, 30(2), 247–259.
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