Opioid use disorder (OUD) is a chronic, complex health condition that continues to be a growing problem in the general population, and this increase is paralleled in pregnant women. Pregnancy is a time when women with OUD may be ready to begin a journey of recovery. OUD has both maternal and fetal implications. The safest way to begin recovery during pregnancy is with the initiation of either buprenorphine or methadone to prevent symptoms of withdrawal which can increase risk of fetal harm.

Both medications have the added benefit of being safe to use during lactation. There is a minimal amount of either medication that is found in breastmilk. Breastfeeding during medication assisted recovery (MAR) is linked both to improved maternal and neonatal outcomes, and improved bonding. Often women who are engaged in MAR are unaware of the benefits of breastfeeding initiation and exclusivity. Mothers may perceive breastfeeding as a danger to their baby based on misinformation and bias. Initiation of individualized and nonjudgmental breastfeeding education to women beginning an inpatient MAR program can improve maternal understanding of the benefits of exclusive breastfeeding and increase intention to exclusively breastfeed.

Routine cervical cancer screening has significantly decreased the mortality rate of cervical cancer. Today, cervical cancer predominantly affects those who are rarely or never screened. Government programs are in place to provide cervical cancer screening at little to no cost, yet screening rates remain suboptimal.

This project evaluated an evidence-based intervention to increase cervical cancer screening among underserved women in a federally qualified health center (FQHC). Female patients ages 21 to 65 years without history of hysterectomy (n=1,710) were sent reminders to their phones through the electronic health record (EHR). The message included educational material about the screening process and an announcement regarding government aid for free or reduced cost screening.

The number of patients who made an appointment after receiving the message was assessed two months later. In total, 156 responses were collected, and 28 patients made an appointment for screening. The most frequently observed category of Ethnicity was Hispanic/Latina (n = 24, 86%). The most frequently observed category of Insurance was Title X (n = 13, 46%). The observations for Age had an average of 41.04 (SD = 9.93). Using an EHR communication function to send motivational reminders has shown some promise for increasing cervical cancer screening, thereby reducing cervical cancer mortality among the underserved.

Pregnancy is a specific time in a woman’s life filled with complex changes in health, including the oral cavity. During this time, dental and perinatal care teams can be influential in helping women initiate and maintain essential habits to improve health and prevent adverse outcomes. There is research evidence that dental providers are reluctant to treat dental problems during pregnancy. Barriers to practice identified by dentists include lack of education, time, financial constraints, and concern for the safety treating pregnant women. Factors that facilitate dental care for pregnant women include purposeful assessment, referrals from prenatal providers, and continuing education for dental team members.

Multiple organizations recommend the treatment of oral health conditions during pregnancy to promote health and prevent pregnancy complications. In order to promote community-based partnerships in a healthcare system, dentists are encouraged to develop an intentional plan to increase collaboration with other members of the women’s healthcare team. Prior to developing a system wide intervention to improve access to dental care during pregnancy, dental team members were surveyed to identify barriers and facilitators which promote or hinder care in their practice. The data acquired will be used to inform the design and implementation of an intervention to specifically meet the needs of patients and providers in that system.

Women in recovery from substance use disorders (SUD) face significant barriers to achieving reproductive well-being (RWB) and disproportionately experience unintended pregnancy. Unintended pregnancy can have serious consequences in this population. Equity-informed approaches promote the integration of reproductive health care (RHC) with recovery programs to improve both access to and quality of RHC. Arizona’s largest SUD recovery program, Crossroads, Inc. recently opened an on-site, integrated primary clinic offering RHC. A one-month pilot demonstration of One Key Question (OKQ), a pregnancy desire screening tool, was implemented with fidelity at Crossroads to identify clients with RHC needs and offer care.

IRB exempt status was obtained through Arizona State University. All female-bodied clients aged 18-49 were screened following routine admission assessments. The Institute for Healthcare Improvement Triple Aim model based on Self-Determination Theory and Motivational Interviewing was used to prioritize client autonomy. The client experience of care was measured using an adapted Interpersonal Quality of Family Planning scale. The magnitude of needs and desires were summarized with descriptive statistics. Sixty-three clients were screened with OKQ. Needs were identified in 97% of clients. Of those clients, 98% accepted referrals. Ninety percent of items measuring the client experience of care were rated as “excellent.” OKQ provided an efficient structure for person-centered screening and referral conversations to integrate RHC in a large SUD recovery program with excellent care experiences reported by clients.

The human papillomavirus (HPV) is a sexually transmitted infection (STI) that is associated with several types of cancer and genital warts. No cure exists for those currently infected with HPV, but a vaccine is available that can prevent the virus and development of cancers associated with HPV. Military servicemembers are at a high risk for contracting HPV; it is one of the most common STIs among active duty service members. The health consequences of HPV can impact a servicemember’s military readiness. The HPV vaccine is not required for military servicemembers, but it is offered free of charge. HPV vaccination rates among military service members remain relatively low.

The purpose of this evidence-based project was to increase the level of knowledge about HPV, improve health beliefs regarding HPV, increase HPV vaccine intention, recommendation, and uptake. Using the Health Belief Model as an organizing framework, a population targeted eight-minute education video on HPV and HPV vaccination was developed. It was implemented at an outpatient military treatment facility located in the southwest United States over a 6-week period, to newly reported service members. Participants included 116 military service members aged 18 to 45. A pretest and posttest questionnaire were used to assess the impact of the intervention. HPV level of knowledge increased significantly from pretest to posttest mean scores were 3.00 to 4.39 respectively (p < .001). HPV vaccine intention increased from 62% to 66% (p = .739). HPV vaccine recommendation increased from 62% to 85% (p < .001).

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.

Seclusion and restraint (SR) continue to be used in psychiatric settings when a patient is a harm to self or others despite growing concern and calls to eliminate the practice due to its harmful, potentially life-threatening effects on patients. The purpose of this evidence-based project was to assist a hospital in the southwestern United States decrease their seclusion and restraint rates among their adolescent patients. Trauma-informed care approaches have been shown to significantly reduce the incidence of SR in inpatient settings.

The nurses and behavioral health technicians (BHTs) received a two-hour trauma-informed care training in November of 2019. SR rates three months pre-training and post-training were compared. In the three months prior to the training, SR rates averaged 23.4 events per 1000 patient days. Comparatively, the three months after the training SR rates averaged 19.5 events per 1000 patient days. This shows a clinically significant decrease in SR rates after the TIC training. This evidence-based project (EBP) highlights the need to address this problem and gives an intervention option that can reduce harm for patients and address the needs of healthcare organizations seeking to improve patient care.

The mentor role can help support the experienced nurse practitioner (NP) enhance a sense of belonging and commitment to the organization; however, NPs identify barriers of time, dedication, and lack of knowledge about mentoring. Current mentoring programs in Arizona are sporadic and formal training for the mentor is even more limited. In this project, an online training intervention to develop mentorship skills was provided for experienced NPs who viewed three video sessions of 20-25 minutes each. The topics (Open Communication & Accessibility; Mutual Respect & Trust; Independence & Collaboration) focused on developing key mentoring competencies identified from the literature. Participants did not report a significant increase in their mentoring skills after the video sessions, but they identified useful individual outcomes. Participants identified the need to formalize the experience with objectives for both the mentee and mentor and recommended seeking out the novice NP to build a mentoring relationship.

The project outcomes led to several recommendations. To support ongoing mentor relationships, organizations may need to push training out to their experienced NPs on the role of the mentor. Mentors who do not self-identify for remediation or training may need organizations to provide the training and not make it optional. Community and professional organizations like the Arizona Board of Nursing, Arizona Nurses Association and others could create training modules utilizing multiple platforms to reach NPs in rural and urban parts of the state. Finally, further projects are necessary to identify the most effective modalities when delivering training.

Obtaining a comprehensive sexual health history is an important part of the patient history taking process and is essential to providing high-quality, patient-centered, and accessible healthcare. Information gathered from the sexual health history guides delivery of appropriate education about prevention, counseling, treatment, and care. A federally qualified health center (FQHC) reported that they did not have a standardized comprehensive sexual health history taking process. To address this concern, a literature review was conducted to survey current evidence regarding both patient and healthcare provider perspective on sexual health history taking. While it is recommended for a sexual health history to be performed routinely, both healthcare providers and patients have reported sexual health is not discussed at most visits.

The findings led to the initiation of an evidence-based project implementing a comprehensive sexual health history taking tool at the FQHC. The tool assists in obtaining a comprehensive sexual history and provides an understanding of the sexual practices of the patients. If healthcare providers become aware of the sexual practices of their patients, they are better able to provide evidence-based education that could lead to better health outcomes. The participants reported they liked being asked about their sexual health, did not find the questions too personal, and reported the questionnaire addressed their sexual health concerns, and was worth their time. Taking a comprehensive sexual health history is a fundamental skill that all healthcare providers must strive to improve for the general health of their patients and the community.