Date of Award


Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)




Hector R. Morales, DNP, APRN, PMHCNS-BC


Jeff Gainok, DNP, APRN, CRNA


Disease or a lesion of the somatosensory system can cause neuropathic pain, a common condition seen in most primary care settings, including my adult correctional setting. I became aware of this fact after completing a 10-day Reflective Practice Log (RPL). After a literature review, the recommended intervention, Duloxetine 30 mg daily for seven days with follow-up in seven days. In my practice, I prescribed Cymbalta 30 mg daily for 30 days. I used self-reporting as the neuropathic signs and symptoms along with pain severity. The literature recommended the use of a numeric rating scale of 0-10 for pain assessment and the Leeds Assessment of Neuropathic Symptoms and Signs with a score of twelve and greater as a screening tool for neuropathic pain. The Plan Do Study Act quality improvement method and Rosswurm and Larrabee's Model for change to Evidence-Based Practice translational framework were used in this project.

After the approval from my correctional facility and receiving IRB approval from The University of Texas at El Paso, I began my Doctor of Nursing Practice (DNP) Quality Improvement Project. Using the Leeds scale, six patients met the criteria, and I prescribed Duloxetine 30 mg daily for 7 days. On follow-up, patients were re-evaluated with the numeric rating scale for those meeting criteria; the Duloxetine increased to 60 mg daily for 7 days with no improvement in pain control and was scheduled for follow-up in 7 seven days. The outcome was favorable for all the patients except one who switched to alternative medicine due to the Duloxetine reported adverse effects. Two patients met the outcome goal of 2-3 -point reduction on the NRS. Two other patients had a point decrease of pain and a point increase.

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