Digital Commons Network^™

Accessing Mental Health Services As An Undocumented Individual: Policy Recommendations For The State Of California, Lorena Mosqueda

Master's Projects and Capstones

Undocumented individuals are subject to stressors that may exacerbate existing mental health problems or proliferate new mental health illnesses. Due to unjust historical and current institutional and systemic policies the undocumented population accesses mental health services at a rate far below the general population. As a result, this vulnerable community is left with untreated mental health conditions and is further entrenched in a cycle of inequity. In an effort to address this alarming reality we based a review of relevant literature to identify recommendations to increase access to mental health services among the United States undocumented population. Additionally, a simulation …

Examining Barriers To Receiving Home Care In A Medical Program, Mariah Martinez

Master's Projects and Capstones

Introduction: In Home Supportive Services is a Medi-Cal program serving low-income seniors and adults with disabilities. IHSS clients, or “consumers” are responsible for finding, hiring and supervising their IHSS home care worker. IHSS workers provide services such as feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. This project was created to identify why a high number of IHSS clients have not been able to hire and retain an IHSS care worker. The aim of the study was to understand the consumers interactions with IHSS and identify points at which consumers experience challenges in …

Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel

Master's Projects and Capstones

Improving Knowledge and Attitude of Primary Healthcare

Givers Towards Vulnerable Populations

Kimberly Shankel

University of San Francisco

Abstract

Problem

This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.

Context

The site for this quality improvement project is a small suburban hospital …

Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira

Master's Projects and Capstones

Abstract

PROBLEM: From October 2017 through June 2018 there were 25 patient falls recorded on the 5^th floor medical surgical telemetry unit. Top factors contributing to this high fall rate include: poor patient-centered-care planning, and inadequate set-up for use of technology.

CONTEXT: According to the Joint Commission, 2015, each fall with injury costs $14,000. This estimate doesn’t include the potential indirect costs that account for the long-term effects of injuries such as disability, dependence on others, lost time from work, household duties, and reduced quality of life.

INTERVENTIONS: Staff education was introduced and focused on using a new mindfulness …

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Multilingual Museums: A Proposal To Increase Linguistic Diversity In Contemporary Art Museums, Jennifer Cha

Master's Projects and Capstones

The U.S. population is becoming more ethnically, racially, and linguistically diverse. It is estimated that by the year 2050, the U.S. will shift to a majority-minority population, meaning that the total minority population will become the majority of the U.S. population. But while the U.S. is diversifying, the current museum visitorship demographic is not representative of or on track to measure up to these changes in the future. If museums are valuable civic spaces with several associated health, social, and educational benefits, and a large percentage of the population have low-English proficiency and cannot access the information, then there is …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Homeward Bound: The Struggle Senior Dogs Face To Find Their Fur-Ever Homes, An Exhibition Proposal, Natalia Chavez

Master's Projects and Capstones

For this capstone project, I created a proposal for an exhibition centering around animal rights that focuses on the rights of senior dogs in United States animal shelters. Homeward Bound: The Struggle Senior Dogs Face to Find Their Fur-Ever Homes intends to raise awareness of the difficulties senior dogs face in being adopted from animal shelters, while promoting individuals to be active and engaged participants in actions to support the needs of senior shelter dogs.

Senior dogs have the highest probability of euthanasia in shelters.[1] Shelters and rescue organizations provide much needed assistance to senior dogs, supporting their …

Using Games To Teach English In Chinese High School Classroom, Wenyu Zhu

Master's Projects and Capstones

In the 20th century, English played an important role in international communication as an international language. English is a bridge between countries' economies, cultures, and trade. However, current English education in Chinese high schools is still test-oriented which is ineffective, and students are tired of it. Moreover, teachers also have trouble engaging students in the class. The purpose of this project is to create a curriculum for high school English teachers in China to use games to teach English language skills. Krashen’s (1982) Theory of Second Language Acquisition contains five main hypotheses which support this project. The project includes twenty-three …

Renouncing The Universal Museum’S Imperial Past: A Call To Return The Rosetta Stone Through Collaborative Museology, Anna Volante

Master's Projects and Capstones

In colonial times, Western empires used orientalism to justify and perpetuate colonialism and imperialism over countries that they believed inferior to their own. These imperial powers plundered cultural heritage artifacts from the nations they oppressed and took these objects back to their national museums to be displayed as trophies of subjugation. The ownership of cultural heritage remains a point of contention throughout the field of museum studies. Despite cries for repatriation, these artifacts continue to be housed in universal museums today. One of the most well-known cases is that of the Rosetta Stone, stripped from the city of Rashid, Egypt …

Sustainably Managing Groundwater - Surface Water Interactions Within The Santa Rosa Plain Basin, Rhianna Frank

Master's Projects and Capstones

In this paper, I designed a strategy for implementation of sustainably managing groundwater-surface water interactions in the Santa Rosa Plain Basin in compliance with the requirements set forth by the Sustainable Groundwater Management Act of 2014. The research objectives for this analysis are: (1) to fully examine the requirements of the Sustainable Groundwater Management Act and the implications that implementation will have on the Santa Rosa Plain Basin, (2) to use technical data gathered regionally coupled with related policy design theory to analyze how groundwater and surface water interactions can be managed to meet the requirements set forth in this …

Staff Retention Through Standardized Training Materials In Adult Primary Care Clinic, David Smith

Master's Projects and Capstones

As non-profits, community health clinics face a unique set of challenges. Primary amongst these is a shortage of financial resources. Staff turnover, including Registered Nurses (RNs) and Medical Assistants (MAs), can result in avoidable increased wage costs related to training of newly-hired RNs/MAs (clinical staff). Retention of experienced RNs/MAs can be directly correlated with job satisfaction, the obverse of which is job frustration. The intent of this RN/MA training and orientation project is to ameliorate frustration related to a lack of informational resources and clear competency expectations. Upon completion and implementation, project efficacy will be assessed via four longitudinal measures: …

Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo

Master's Projects and Capstones

Abstract

Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is a …

An Evaluation Of Extended Producer Responsibility (Epr) As A Policy Option For Compostable Plastics In California, Amy Franz

Master's Projects and Capstones

This research project evaluates Extended Producer Responsibility (EPR) in California as a viable option to address the end-of-life management challenges identified for compostable plastics. The evaluation is done in three ways (1) review the main challenges identified for managing compostable plastics against the existing California EPR laws for mercury thermostats, agricultural pesticide containers, carpet, paint and mattresses to look for overlap in issues EPR has been used to address, (2) review compostable plastics in the context of the Product Selection Criteria used by California, (3) Look at the California Framework for setting up an EPR program to lay out what …

Improving Operating Room Turnover Cleaning Communication, Alexander Lao Jr.

Master's Projects and Capstones

Operating room (OR) turnover cleaning is an important part of perioperative workflow for surgical teams, particularly to prevent cross-contamination of infectious pathogens from the surgical environment to staff and patients. Incomplete OR turnover cleaning ultimately leaves vulnerable surgical patients at risk for surgical-site infections (SSIs) and other types of hospital acquired infections (HAIs), which leads to delays in overall operations of the OR. A microsystem assessment at a large metropolitan hospital revealed an issue with incomplete OR turnover cleaning evident by the presence of dirty canisters, filters, and unclean anesthesia machines/work-areas after sterile surgical supplies had already been opened in …

Scheduling Autonomy For Nursing Staff Retention, Gina Fungcharoen, Gina Fungcharoen

Master's Projects and Capstones

It is the obligation of the Clinical Nurse Leader to place their skills up against the pulse of the microsystem they work within. This nursing leader is in a position to observe and react to flaws that affect their specific workforce. This microsystem project will provide an evidence-based perspective on how to improve monthly scheduling within the unit of 4 South, Surgical Intensive Care. The intent is to increase nurse retention as a function of improved scheduling efforts, allowing staff the ability to manage their own exchange of shifts while addressing the daily staffing needs of the unit. Despite efforts …

Improving Teamwork And Timeliness Of Insulin Administration In The Respiratory Rehabilitation Unit, Jessie Ventura

Master's Projects and Capstones

The microsystem assessment conducted by a Clinical Nurse Leader student at an acute care hospital in the Respiratory Rehabilitation Unit (RRU) revealed that two of eight patients were diagnosed with diabetes. The RRU nursing staff was 80% compliant with best practices related to insulin coverage administration within 30 minutes after a point of care blood glucose check. The practice improvement project aims to increase staff awareness and timely administration of insulin coverage by introducing situation monitoring, a core component of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). After baseline data collection, a 30-minute education intervention was …

Improving Quiet-At-Night On A Telemetry Unit: Introducing A Holistic Sleep Menu Intervention, Christian Karl Antonio

Master's Projects and Capstones

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …

Improving Surgical Patient Outcomes Through A Cross-Training Program For The Hybrid Operating Room, Ana Chozet-Griggs

Master's Projects and Capstones

Abstract

Innovations in the treatment of abdominal aortic aneurysms have resulted in the reduction of open surgical procedures and the increased use of minimally invasive procedures known as endovascular aortic artery repairs (EVAR) and thoracic endovascular artery repairs (EVAR). These hybrid procedures integrate the technical skills and resources used in surgical procedures with the technology used for radiological interventions. (Odle, 2011). These procedures are performed in a Hybrid Operating Room (HOR) within the Catheterization Laboratory (Cath Lab) microsystem. A HOR is a surgical operating room that is equipped with interventional radiology imaging and equipment (Taylor, 2017). These high-risk procedures demand …

Early Recognition Of Severe Sepsis, Robin Haynes

Master's Projects and Capstones

Early Recognition of Severe Sepsis Presentation: A Quality Improvement Project

Abstract

Sepsis is a medical emergency. If not treated immediately a patient may quickly progress

to severe sepsis, septic shock and eventually death. The early recognition of severe sepsis

presentation project is an evidence based project for the medical-surgical floor to decrease the

amount of time from early signs of sepsis to treatment of sepsis.

In October 2017, the average hospital compliance for the severe sepsis bundle for the

fiscal year decreased from 80% down to 55%. Further review showed the decrease in

compliance was from the medical-surgical floor nursing …

“Help!" Building Resilience In Nursing School, Kellie Rose Redmond

Master's Projects and Capstones

Background: The nursing shortage is only growing in the United States, and poor nursing student retention is not helping the situation. Resilience must be promoted among nursing students to establish a healthy foundation for when they enter the nursing profession. One method for doing so is through emotional competence training.

Methods: A one-hour workshop to provide an introductory training on emotional competence was offered to 717 Bachelor of Science in Nursing (BSN) students and 30 Master of Science in Behavioral Health (MSBH) students. A needs assessment survey was conducted to determine how the workshop should be structured. After piloting two …

In Home Support For All: A Community Outreach Project, Lily Moll

Master's Projects and Capstones

Abstract

In Home Supportive Services Public Authority (IHSSPA) is a Medi-Cal funded organization that helps the elderly and disabled living in San Francisco find care and support at home. The Public Authority component of IHSS specializes in providing support to their clients or “consumers” when attempting to hire home care workers or “providers.” However, IHSSPA services remain relatively unknown throughout many communities in San Francisco county and there is a need for increased community outreach. To address this problem, communities that are currently underserved by IHSSPA were defined by their zip code. These communities were compared with data indicating which …

Clean Up On Aisle 1: Food Environments In San Francisco’S Mission District, Diana Zamora

Master's Projects and Capstones

Introduction: Underserved communities suffer from poor dietary habits and experience higher rates of chronic conditions mainly due to factors affecting their nutrition and grocery shopping behaviors. Method: A nutritional needs assessment was conducted with participants of the Community Wellness Program, a community resource center, at Zuckerberg San Francisco General Hospital, to assess the perspectives of the participant’s nutrition and grocery shopping behaviors. Interviews were conducted with current members attending cooking demonstrations at the center (n=10). Results: 50% of the participants have struggled to purchase fresh, healthy foods in the past year. Half of the participants stated shopping for …

Creating A More Collaborative Tomorrow: Development Of A Patient Engagement Curriculum For A School Of Nursing And Health Professions, Alicia Digiammarino

Master's Projects and Capstones

Background: Healthcare has been moving steadily toward a patient-centered paradigm that seeks to involve patients more in their own care. Teaching communication skills to future health professionals can increase such patient participation. Despite the shift to patient-centered care, there is almost no training in patient engagement techniques provided to students at the University of San Francisco School of Nursing and Health Professions. Purpose: This project aimed to design and develop a sustainable patient engagement curriculum that meets the unique needs of faculty and students at the University. Methods: Interviews were conducted with eight faculty members to understand …

Health Advocates: Mitigating Social Barriers To Health In A Medical Center, Brenda Ascencio

Master's Projects and Capstones

Santa Clara Valley Medical is one of the busiest emergency departments in California. Patients are coming into the Emergency Department (ED) with needs that could have been prevented if they would have had access or knowledge about preventative measures such as the importance of having health insurance or seeing a primary care physician. In order to decrease the use of ED services for non-medical needs the launching of the Health Advocates Program will help address social determinants of health to an underserved community, including access to safe and affordable housing, food, health services, job training, legal aid and more. The …