Medicine and Health Sciences Commons^™

Reducing Pressure Ulcers In Emergency Department Boarding Patients, Youa Yang

Nursing and Health Professions Faculty Research and Publications

CRMC is a level one trauma and teaching hospital in Fresno, California. CRMC’s emergency department (ED) is licensed for 84 beds. When hall beds are added this ED can go up to 110 beds. CRMC sees over 9,000 patients a month. Due to an increase in hospital census and length of stay, this ED has a daily average of 30 inpatients boarding. In December of 2018, this ED had one hospital acquired pressure ulcers (HAPU). Barriers to preventing HAPU’s in the ED are rooms that are not big enough to accommodate hospital beds, inexperienced new nurses who are unaware of …

Strengthening The Advanced Practice Clinician Workforce Pipeline Through Preceptor Education And Support, Tarina Levitt-Trujillo

Doctor of Nursing Practice (DNP) Projects

Problem: The Advanced Practice Clinician (APC) workforce pipeline is dependent on clinical training opportunities. Clinician providers are encouraged to precept students but rarely are offered support tools to ensure a successful process. Lack of adequate support can result in a suboptimal outcome for the APC students.

Context: Clinician preceptors in a large healthcare organization looking to build a robust APC pipeline to support future patient populations.

Interventions: Preceptor materials were developed and delivered to clinical preceptors to help them successfully precept advanced practice clinician students during their clinical rotations. This material consisted of 20 microlearning modules to help clinicians …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Effect Of Education About Pediatric Immunization Schedule And Vaccine Administration On Family Medicine Clinic Providers And Clinical Staff Knowledge And Confidence, John Matthew Derfelt

Doctor of Nursing Practice Scholarly Project

Significance: In this original research, the purpose of this project is to compare and promote increased pediatric immunization knowledge among healthcare providers and clinic staff of a family medicine clinic. In turn, there is greater compliance with the Centers for Disease Control and Prevention’s (CDC) recommended immunization schedule and adherence to vaccinations against the 17 vaccine-preventable diseases.

Methods: This exploratory pilot case study surveyed 34 individuals by using an educational tool with information regarding the current CDC-recommended pediatric vaccination schedule. Prior to reviewing the educational material, the participant tested their baseline knowledge about vaccination scheduling and immunization administration. …

Patient Perspectives: Four Pillars Of Professionalism, Laura Yvonne Bulk, Donna Drynan, Sue Murphy, Patricia Gerber, Roberta Bezati, Sacha Trivett, Tal Jarus

Patient Experience Journal

Professionalism is a core component of healthcare practice and education; however, there is often not a consistent description of professionalism, and current definitions lack a key perspective: that of the patient. This study aimed to deepen understandings of patients’ perspectives on how professionalism should be enacted by healthcare providers. Using a phenomenological approach informed by constructivist theory, the study team conducted semi-structured interviews and focus groups with 21 patients to ascertain their views on professionalism. Data analysis was conducted using a constant comparative approach wherein initial analysis informed subsequent data collection. Participant themes fell into four pillars of professionalism: taking …

Fathers' Experiences With Their Premature Infants Or Unhealthy Neonates, Lisa Cummings

Dissertations

Author: Lisa Cummings PhD RN

Fathers’ Experiences with Their Premature Infants or Unhealthy Neonates

Purpose and Background/Significance: Fifteen million babies worldwide are born prematurely each year, impacting a multitude of fathers. The importance of an early close father-infant relationship has been identified as central for the development of the child. Fathers influence on a child’s emotional and cognitive development and their physical well-being and health. Many times, the Neonatal Intensive Care Unit (NICU) is the initial contact environment between a father and his premature infant. Studies have shown that the NICU can be a stressful environment for parents, producing emotional …

What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico

Kitsum Li

Introduction Recently, educators advocated for interprofessional education to better prepare entry-level healthcare workers for efficient, effective, and respectful teamwork to lower the cost of healthcare and improve the delivery of collaborative quality patient care. This article describes the results of an educational program evaluation of an interprofessional class (IPC) taught over a five-year period between nursing and occupational therapy (OT) departments at a small private university.

Methods During the IPC sessions, a small group of nursing and OT students observed a simulated patient care scenario in which a nursing and an OT student provided care related to their respective discipline. …

Statistical Methods Useful In Clinical Simulation And Medical Education Scholarship, Zuber D. Mulla, J. Hector Aranda, Donovan Rojas, Sanja Kupesic Plavsic

Marshall Journal of Medicine

The objective of this paper is to introduce selected statistical and epidemiologic topics that are of interest to interdisciplinary teams of healthcare quality professionals, educators, technical staff, and researchers who participate in clinical simulation scholarship. Four research vignettes in the setting of a hypothetical clinical simulation training workshop are presented. The first vignette illustrates the utility of exact logistic regression when analyzing a small dataset. The second underscores the importance of using an appropriate method to account for the repeated measurement of an outcome. The third illustrates the use of the intraclass correlation coefficient to measure inter-rater reliability. The final …

What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico

Occupational Therapy | Faculty Scholarship

Introduction Recently, educators advocated for interprofessional education to better prepare entry-level healthcare workers for efficient, effective, and respectful teamwork to lower the cost of healthcare and improve the delivery of collaborative quality patient care. This article describes the results of an educational program evaluation of an interprofessional class (IPC) taught over a five-year period between nursing and occupational therapy (OT) departments at a small private university.

Methods During the IPC sessions, a small group of nursing and OT students observed a simulated patient care scenario in which a nursing and an OT student provided care related to their respective discipline. …

Death Of The Clinic: Trans-Informing The Clinical Gaze To Counter Epistemic Violence, Diana E. Kuhl

Electronic Thesis and Dissertation Repository

This case study research (Patton, 2002, 2014; Flyvberg, 2006) has grown out of an awareness of deep resistance from the psy disciplines to trans-informed epistemologies as a source of legitimate knowledge (Tosh, 2015, 2016; Winters, 2008). It focuses on examining how the closure of The Gender Identity Clinic (GIC) for Children and Youth at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, Canada, signaled a paradigm shift from the ‘treatment model’ to the ‘affirmative model’ with respect to clinical approaches for supporting trans and gender diverse children and youth. As such the case study involved tracing the …

Development And Validation Of A Tool For Measuring The Professional Identity Of Nursing Students: The Q-Ipei / Le Développement Et La Validation D’Un Instrument De Mesure De L’Identité Professionnelle Chez Les Étudiantes Infirmières : Le Q-Ipei, Eric Tchouaket, Dominique Houle, Dominique Therrien, Catherine Larouche, Annie Denoncourt, Pascale Reny

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: The various pressures on nurses in their practice environment, given the complexity of care, have exposed the confusion around the role definition and level of professional identity (PI) of future nurses. To support them in their practice, it is important throughout their education to know their commitment, representations, and sense of identity with respect to their future profession. To our knowledge, there is no measurement tool in the literature that can be used to measure the PI of nursing students throughout their education, given its complex multidimensional nature.

Objective: Based on a framework that takes into account …

Full Program: A Call For Research That Begs To Be Translated Into Practice, Sigma Region 15

2019 Sigma Region 15 Nursing Research Symposium

Full program for 2019 Sigma Region 15 Nursing Research Symposium: A Call for Research that Begs to Be Translated into Practice.

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Aurora Family Medicine Residents

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Ota Students’ Perceptions Of An Inter & Intraprofessional Level I Experience In Morocco, Julia Sablom, Otas, Sophia Mascaro, Otas, Jeanne M. Coviello, Otd, Otr/L

Department of Occupational Therapy Posters and Presentations

• Cultural immersion experiences provide students with authentic, real-life opportunities to engage with clients serving as a powerful tool to enhance students’ global perspectives of occupation (Humbert, Burket, Deveney, & Kennedy, 2012).
• Interprofessional & intraprofessional education provides students with an increased understanding of the unique knowledge, skills, scope, function, & roles within their own & among other disciplines (IEC, 2011; Jung, Salvatori, & Martin, 2008).

Cultural Competency In Latinoamerican Countries: From A Hispanic Resident Perspective, Ivania T. Irby Md

Psychiatry

No abstract provided.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …

Medical Marijuana Policy Reform Reaches Florida: A Scoping Review, Khadesia Howell, Alexandria Washington, Paula M. Williams, Arlesia L. Mathis, John S. Luque

Florida Public Health Review

Background: Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients. Purpose: This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Strengthening Safety Culture By Leveraging The Daily Management System, Suneela Nayak, Mark Parker, Erin Graydon Baker, Amy Sparks, Ruth Hanselman, Stephen Tyzik, Sydney Green

Operations Transformation

STRENGTHENING SAFETY CULTURE BY LEVERAGING THE DAILY MANAGEMENT SYSTEM

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operations Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Glenda Sundberg, FNP-CS, APNP

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Electronic Cigarette Health Education Interventions, Kaitlyn Skryd

Grace Peterson Nursing Research Colloquium

Purpose: To determine the effective teaching strategies and interventions aimed at discontinuing the use of e-cigarettes amongst the adolescent population. This information would be useful to community health experts, healthcare providers, teachers (especially health educators), and parents.

Research Question: Will education interventions from health care providers regarding the harmful health effects of electronic cigarettes to American adolescents (aged 10-19) impact the incidence of everyday e-cigarette smokers?

Research Design: An integrative literature review was used to determine the most effective educational approaches to use towards reducing e-cigarette use in the adolescent population.

The Influence Of Nurse Image On The Future Of Nursing, Alexandra Armada

Grace Peterson Nursing Research Colloquium

Background: Nurse image as perceived by society is outdated, inaccurate, and leads to the lack of interest in pursuing the profession. Contributing factors to this lack of interest in nursing could be explored by researching what resources are available to prospective nurses.

Objectives: The purpose of this literature review is to explore the implications that current overall nurse image (NI) has on the future of the nursing profession, by analyzing existing resources available to prospective nurses.

Methods: This integrative literature review utilized the matrix method by Judith Garrard to organize and synthesize the data. A data comparison of the data …

Embedding Interprofessional Activities With Physical Therapy And Athletic Training Students In Shared Professional Course, Katie Sniffen, Anthony P. Breitbach, Erick Briggs, Leslie Hinyard

International Journal of Health Sciences Education

Introduction and Background: Interprofessional education (IPE) is outlined in many health professions education standards creating an increased demand for its inclusion in already crowded curricula with limited faculty and financial resources. The Interprofessional Education Collaborative (IPEC) developed “Core Competencies for Interprofessional Collaborative Practice” that outline a framework for meaningful IPE experiences. Case-based learning activities have been used to foster improvements in interprofessional role clarity, communication, and rapport among student groups. The authors describe one trial of incorporating interprofessional and team work activities in a shared professional course and report on student learning outcomes in the context of IPEC competencies.

Course …

Students’ Knowledge And Attitudes: An Interprofessional Education Workshop And Experience, Patricia Davidson, Scott Heinerichs, Melissa Reed, Elizabeth Grillo, Christine Thomas, Gopal Sankaran, Neil Curtis, Nadine Bean

International Journal of Health Sciences Education

Background: Interprofessional Education (IPE) can improve teamwork among future healthcare professionals, but the academic structural environment can be a barrier to its implementation.

Methods and Results: Students from seven professional programs (athletic training. exercise science, nursing, nutrition, public health, social work, and speech-language pathology) participated in a two-part IPE program consisting of: a web-based education module and an in-person interactive workshop. Students were administered a deidentified pre/post survey to assess changes in their knowledge and attitudes toward IPE. A total of 54 students participated in both components with 46 students completing both surveys. After participating in the IPE …

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Jessica Kram, MPH

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …