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Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison

Doctor of Nursing Practice Scholarly Projects

Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle

Doctor of Nursing Practice Scholarly Projects

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Reducing Inpatient Falls Utilizing Multimodal Standardized Patient Education: An Evidence-Based Practice Project, Sheryl Almandrez

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: This project aims to utilize multimodal standardized patient education as an evidence-based practice intervention to reduce inpatient falls.

Background: In 2022, Kaiser Foundation Hospital (KFH) San Diego had 116 falls. Inpatient falls with injury account for the second-highest Joint Commission (TJC) sentinel event and California Department of Public Health (CDPH) adverse events. These injuries include lacerations, subdural hematoma, subdural hemorrhage, hip fractures, and wrist fractures. The Centers for Medicare and Medicaid Services (CMS) have also stopped reimbursing hospitals for the care provided after patients have sustained a fall with injury.

The project was implemented at KFH-San Diego …

Dm Education On Lifestyle Modification To Improve Dm Knowledge Retention And Self-Care Confidence, Jinyoung Sanchez

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: The purpose of this evidence-based practice project was to provide diabetes education to improve diabetes knowledge and self-care confidence for patients with type 2 diabetes admitted to a tertiary hospital in San Diego. First, this study was to assess their DM knowledge and self-confidence before the education was provided. Second, based on the initial assessment and the education on lifestyle modification, 3 months of follow up was assessed to see if the education had been effective. Third, the study was to determine if the education also improved the self-confidence in managing diabetes on their own.

Background: Uncontrolled diabetes …

Enhancing Newer Nicu Nurse Confidence With Resuscitation Through High-Fidelity, In-Situ Crisis Resource Management, Karen Rose

Doctor of Nursing Practice Final Manuscripts

Neonatal resuscitation is a low-volume, high-risk occurrence. Given the infrequency of resuscitation, newer neonatal intensive care unit (NICU) nurses may have little to no exposure to neonatal resuscitation events. This can lead to a lack of confidence in resuscitation skills, contributing to burnout, poor patient outcomes, and the potential for nursing turnover. This evidence-based practice project, guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, focused on enhancing the perceived confidence in neonatal resuscitation skills among newer NICU nurses. To achieve this, multidisciplinary, high-fidelity, in-situ neonatal resuscitation crisis resource management (CRM) simulated events were implemented. …

Care Of The Critically Ill Nontrauma Patient: Improving Emergency Department Readiness And Patient Care Through The Implementation Of A Dedicated Resuscitation Bay, Martha H. Buck Rn, Bsn, Tcrn

Doctor of Nursing Practice Final Manuscripts

Current best practice among emergency departments worldwide includes the maintenance of a dedicated resuscitation space. This practice allows for team members and equipment to be ready at a moment’s notice to provide care to a patient in need of lifesaving interventions. This evidence-based performance improvement project seeks to implement this standard of care in a busy, urban emergency department in Southern California.

Prior to this study, patients at this facility were placed in the next available care space, without the maintenance of a dedicated resuscitation area for critically ill patients. Survey data evaluating staff levels of perceived readiness to care …

A Multimodal Approach: Implementing Omm For Spinal Surgery Patients' Pain And Anxiety, Summer Barnes

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to encourage thorough assessment of pain and anxiety prior to spinal surgery in order to identify the need for implementation of additional modalities, such as osteopathic interventions for pain and anxiety management. It is pertinent that as holistic providers we address this populations often missed psychological distress and ineffective pharmacological pain regimens to promote better patient outcomes.

Background: Research says there are approximately 1.62 million instrumented spinal procedures performed annually in the United States. Spinal surgery is not uncommon, and neither is the chronic pain and …

Keep Our Children Smiling: Fluoride Varnish Education In The Pediatric Primary Care Setting, Isabella Mortola

Doctor of Nursing Practice Final Manuscripts

Background: Dental caries is the most common chronic childhood disease. In early childhood, it is associated with many negative factors such as pain, loss of teeth, and impaired growth. Fluoride varnish (FV) is a protective resin coating treatment that is reimbursable by most insurances and is recommended by the American Academy of Pediatrics (AAP), United States Preventative Services Task Force (USPSTF), and the American Dental Association (ADA) due to its high efficacy in preventing dental caries. FV is a low-cost treatment that can be easily applied in 1-2 minutes during a well-child visit in the primary care setting, where children …

Implementing An Abnormal Involuntary Movement Scale At An Outpatient Mental Health Clinic, Amanda Ghamsari

Doctor of Nursing Practice Final Manuscripts

Background: Movement disorders caused from psychotropic medications affect an estimated 500,000 people in the United States. These disorders bring an added cost for treatment to the patient, cause emotional distress, and may hinder daily life. Overall health and additional medication costs were increased for these patients by $25,879 per patient per year compared to patients without a movement disorder.

Purpose of Project: To address the issue, the team of mental health providers at an outpatient clinic assess their mental health patients at start of care and at follow up visits utilizing the Abnormal Involuntary Movement Scale. With the goal of …

Impact Of Mindfulness Education And Resources On Stress In Parents Of Children With Autism Spectrum Disorder, Jacqueline James

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to reduce stress levels of parents of children with autism spectrum disorder (ASD) by teaching them mindfulness practices and education on free and accessible methods to integrate mindfulness into their daily lives, as well as the benefits of mindfulness in reducing stress and improving psychological well-being.

Parents of children with ASD experience high levels of stress and numerous research studies support the use of mindfulness techniques to reduce stress levels in adults. The participants in this project included mothers who have at least one child with ASD who attend the Thompson Autism and Neurodevelopmental …

Human Trafficking And Resources Provision In The Ed, Kathryn Patrick

Doctor of Nursing Practice Projects

Human trafficking is both a human rights violation and a national health crisis. Despite nearly 165,000 identified cases in the United States since 2007, studies hypothesize that many more victims remain undetected despite up to 88% of trafficked persons interacting with the healthcare system during the time they are being trafficked. The lack of identification of these victims has often been attributed to healthcare providers' lack of knowledge regarding human trafficking indicators and lack of confidence in how to address trafficking situations when they are encountered. Emergency department care providers of a 500-bed central Illinois hospital received education and resource …

Analyzing The Cognitive Complexity Of The Questions On The Advanced Placement Computer Science Principles Exam, Lauren Zirpoli

Seton Hall University Dissertations and Theses (ETDs)

This convergent parallel mixed methods study with qualitative and quantitative content analysis was conducted to analyze and describe the cognitive complexity of the publicly released Advanced Placement Computer Science Principles Exam questions compared to the language of higher-order thinking found in research literature. Hess’ Cognitive Rigor Matrix was used to determine the frequency and percentage of questions categorized as higher-order thinking within each cell of the matrix. The qualitative method consisted of content analysis of the language of each question analyzed, followed by deductive coding, and culminated with categorizing the depth and type of thinking required on Hess’ Cognitive Rigor …

Initiating Access To Palliative Care Earlier In Pediatric Oncology Patients, Anita Sharma

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Pediatric oncology patients should be referred to palliative care early but despite research indicating the clear benefits, there is still a delay in referring patients. One of the reasons include lack of understanding amongst providers on what palliative care is. Palliative care provides symptom management, emotional support and helps the patient and family with difficult decision making.

Objectives: This project aimed to increase the number of early referrals to palliative care. The Pediatric Palliative Care Screening Tool (PaPas) was utilized to help identify the triggers which should prompt the referral.

Methods: A chart review of patients diagnosed with …

Unlocking The Potential Of Peripartum Handoff: Standardizing Nurse Knowledge Exchange (Nke), Kiana Killian

Master's Projects and Capstones

Problem The absence of a structured and standardized handoff during patient transfers may result in the unintentional omission of patient information, medical errors and adverse events. No standardized bedside handoff process, referred to as Nurse Knowledge Exchange (NKE), was observed in Hospital A’s peripartum mesosystem during patient transfers from the Labor and Delivery (L&D) unit to the Postpartum unit. Context Hospital A is a medium-sized urban hospital located in Northern California. The peripartum mesosystem includes 21 postpartum rooms and nine laboring rooms. Intervention Through the recruitment of stakeholder engagement, review of literature supporting evidence-based practices, and a mesosystem assessment, a …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Increasing The Optimal Usage Of The Gad-7 And Phq-9 Screening Tools To Better Detect Co-Occurring Disorders In An Alcohol Use Disorder Clinic, Lauren Swansick

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Co-occurring disorders include substance use disorders and mental health conditions. These disorders affect 21.5 million individuals. Mental health screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), are effective in screening individuals for depressive and anxiety mental health conditions within addiction settings.

Problem: Of those with an anxiety disorder, 20-40% will be diagnosed with an alcohol use disorder (AUD). Depressive disorders are the most common mental health conditions that can occur alongside an AUD. A literature review revealed that the PHQ-9 and GAD-7 are used in addiction treatment settings; however, not as …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Empowering Nurse-Driven Removal Of Indwelling Urinary Catheters In The Surgical Intensive Care Unit: A Quality Improvement Project, Ellen Ruby Hann

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

Improving Prolonged Antibiotics Education In A Pediatric Unit, Zerena S. Silva Villamonte

Master's Projects and Capstones

Problem Children’s Hospital A's incidence report tool, iCares, demonstrates that 50% of the issues related to prolonged intravenous (IV) antibiotics are categorized as administration issues. This leads to the medication being delivered at the wrong time or rate. Having these issues increases patient length of stay, increasing hospital costs. Context The microsystems for this quality improvement project include inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s Hospital A is a 361-bed San Francisco Bay Area hospital. Interventions The Clinical Nurse Leader students implemented a presentation defining prolonged IV antibiotics, their rationale, and a video demonstrating the correct …

Increasing Awareness And Communication To Decrease Catheter Days In The Surgical Intensive Care Unit, Kamila Fortney

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Increasing Adherence To A Nurse-Driven Removal Protocol To Reduce Indwelling Urinary Catheter Days, Hannah K. Brosnan

Master's Projects and Capstones

Problem

Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs.

Context

The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area.

Interventions

Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …