Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Amy Manderscheid

Third Advisor

Kathy Bowers


Native Americans are more likely than white counterparts to be diagnosed with heart disease (Office of Minority Health [OMH], 2017). The scholarly project was conducted in response to the need for improvement in cardiovascular lifestyle interventions for Native Americans and their documentation to meet Government Performance Results Act quality measures. The clinical question addressed was: what is an evidence-based multidimensional approach to improve cardiovascular quality measure documentation in a Native American primary care clinic? The multidimensional interventions included educational sessions for Community Health Representatives (CHRs), a provider education session on appropriate documentation in order to satisfy quality measures, chart review of pre and post intervention education documentation and a five year quality measure sustainability plan. The Health Promotion Theory and Kotter’s Change Model were used to develop and implement the intervention. The results indicated a small increase in heart healthy habits (7.7%) amongst CHRs, and small positive changes in heart healthy knowledge, with a 12.1% increase in knowledge on the first group of questions and a 16.2% increase in knowledge on the second group of heart healthy knowledge questions. The results of the provider intervention were favorable with a 28.3% increase in provider knowledge. Chart review was undertaken to determine if there was a significant difference between documented patient education by providers before and after the session. The results indicated a statistically significant change in properly documented education (p = 0.0198). The intervention was effective with a medium effect size (60%) in terms of increasing documentation of patient education which was the missing link the clinic needed in order to increase capture of cardiovascular quality metrics. The five- year strategic quality plan will help guide organizational stakeholders in the continued attainment of quality measures.

Included in

Nursing Commons