Medicine and Health Sciences Commons^™

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Implementation Of Staff Education To Standardize The Use Of Positions During The First Stage Of Labor, Minh Chau T. Phan

Master's Projects and Capstones

This project aims to educate labor and delivery (L&D) nurses on effective laboring positions that can aid fetal descent during the first stage of labor. In an L&D unit of a south Bay Area County hospital, there is a lack of standardization of knowledge and practices on laboring positions among the nursing staff. Evidence shows that upright positions and frequent mobility are effective in shortening the duration of labor and minimizing unnecessary cesarean deliveries. Based on the evidence, a project was implemented using verbal education of evidence-based laboring positions. An educational handout was also provided along with a recorded video …

Nurse-Led Education On Oral Chemotherapy Medications, Carmen Lucia Glick Alonso

Master's Projects and Capstones

Problem: Breast cancer is one of the leading causes of cancer death among women in the United States. Annually, around 264,000 breast cancer cases are diagnosed in women and 2,400 in men (Centers for Disease Control and Prevention, 2022). According to the American Cancer Society, the risk of a woman in the United States being diagnosed with breast cancer in their life is around 13% (2022).

Context: Along with a cancer diagnosis comes the need to introduce patient education about new oral chemotherapy treatments. As a treatment team member, the oncology nurse plays a vital role in this …

Empowering Nurses To Recognize Post-Stroke Depression In The African American Community, Deidra Frisbie, Robin Simon

Doctor of Nursing Practice Projects

African Americans (AA) have the highest prevalence of stroke and death compared to other racial groups in the United States. Post-stroke depression (PSD) affects approximately 1/3 of all stroke patients and is underdiagnosed in the African American community.

Aim: By using a mHealth mobile app and a Psychiatry provider list at discharge, PSD can be identified, and interventions initiated, thus decreasing the sequela of PSD in AA.

Methods: Nurses were provided education on PSD, expressions of depression in African-Americans, cultural humility, implicit bias, and the importance of the nurse's role in developing a therapeutic relationship.

Results: Quantitative analysis revealed the …

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

One Man's Pregnancy Story, Yvonne S. Marquez, Paige A. Perez

Capstones

Pregnancy is a challenging time for anyone. For LGBTQ people there are unique obstacles that make it especially difficult to navigate a medical system that was not built for them. Finn Schubert is trans and six months pregnant. He’s loving the experience but stressed by insurance claim denials, concerns for his safety, and medical incompetence.

This capstone project includes a 20-minute documentary, text, and a photo essay.

Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey

Doctoral Projects

Improper positioning of patients in the lateral decubitus or prone positions can lead to significant complications, including but not limited to: airway and invasive line loss, physiologic derangements, soft tissue injury, and peripheral nerve injuries (PNI) (Barash et al., 2017; Butterworth et al., 2018). Chui et al.’s (2018) analysis found that PNIs accounted for 12% of anesthesia malpractice since 1990, making PNIs costly. PNIs effects are not limited to cost and result in increased lengths of stay, increased pain levels, and decreased quality of life (Wojtkiewicz et al., 2015). The massive effect poor positioning can have requires that the anesthesia …

Objective Structured Clinical Examination For Intraoperative Hypotension And Hypertension Management, Andrew Mcginity, James David Ingram

Doctoral Projects

Managing intraoperative hypotension and hypertension is a non-technical skill anesthesia providers need to maintain patient safety. Upon transitioning from didactic training to clinical training, SRNAs may find it difficult to manage a patient’s blood pressure intraoperatively. The ultimate consequence of the delayed or improper treatment of intraoperative blood pressure perturbations is end-organ damage at the patient’s expense. Unintentionally causing a patient harm will lead to an SRNA losing confidence in their abilities. This OSCE is intended to increase SRNA confidence and competence regarding intraoperative hypotension and hypertension management before entering the clinical arena.

The hypotension and hypertension management tools and …

Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett

Nursing | Senior Theses

Background

Within labor and delivery, every birth is different. Alarmingly, the U.S. has the highest maternal mortality rate, including death during labor, among developed countries (World Health Organization, 2022). Many maternal deaths may be preventable.

In the U.S., the use of forceps, vacuum-assisted birth, episiotomies, and emergency C-sections are common for women during childbirth. Even though some laboring positions may assist birthing more than others, there often is resistance to allowing various positions due to outside influences, including societal norms, hospital management, and healthcare professional training. Women in labor are vulnerable and look to their nurses for support during the …

Addressing Interprofessional Competence In Interpretation Of Electronic Fetal Monitor Tracings, Susan H. Hébert

Doctoral Dissertations

Interpretation of electronic fetal monitor (EFM) tracings is a critical clinical practice skill nurses and physicians perform during the intrapartum stage of pregnancy. However, if performed inaccurately can potentially jeopardize the well-being of the neonate. This risk is present because if concerning EFM tracings are not interpreted accurately, preventative care interventions to promote the well-being of the unborn child do not occur. The project was initiated by completing a scoping literature review on the methods for training and evaluating EFM interpretation competence, which revealed current EFM interpretation training and evaluation methods are lacking. A concept analysis defined nurse competence in …

Identifying Cultural Biases And Understanding Health Care Disparities For Lgtbq+ Patients, Jevon Nelson

Nursing | Senior Theses

Understanding the health disparities within the LGBTQ+ population, will consist of educating Nurses and other healthcare providers cultural competence for this population, along with proposing certain educational training programs for all the medical professionals. There’s not only an implicit bias but also lack in quality of healthcare due to the personal reasons that healthcare providers may have, along with certain stigmas that creates an infringement on healthcare for this specific population. Members of the LGBTQ+ community will continue to have one of the highest amounts of health care disparities due to the lack of cultural incompetence if nothing is done.

Health Care Transition Experiences Of Youth With Intellectual Disabilities In A Post-Secondary Inclusive Program, Faith Duensing

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Between the ages of 18-21 years old, youth and young adults make the transition from pediatric to adult health care. While it may be an easy and seamless transition for some, that is not always the case, especially for youth and young adults with disabilities. Youth with disabilities experience several distinct health disparities compared to their peers without disabilities and these can be carried over to impact their health care transition (HCT) process. The purpose of this study was to learn more about the HCT experiences of young adults with disabilities and their families to learn and develop ways that …

Understanding The Role Of Faculty Advising In Graduate Allied Healthcare Profession Programs As Practitioners Transition To Professor, Lillie Marie Barnett Thomas

Electronic Theses and Dissertations

Individuals in allied healthcare professions continue to see growth in all areas, including clinical practice and higher education. Leaders at the university level, alongside leadership within allied healthcare accreditation bodies for disciplines like athletic training, occupational therapy, physical therapy, and speech-language pathology, maintain the need to grow the professions through master’s and doctoral degree programs. With the growth, many working practitioners move from clinical practice to academia with little to no experience or understanding of higher education and all the responsibilities of the job. This quantitative research study used a purposive sampling of allied healthcare professionals across the United States …

Operations, Compliance, & Leadership In Dme At Dasco, Andrew Caddas

Masters Theses/Capstone Projects

The practicum experience was completed with DASCO H.M.E., LLC primarily in their corporate office from August through November 2022. I worked with Ann Cornelius, VP of Operations, to learn more about the industry and the role of home medical equipment in patient care. The areas of focus included Sales & Business Development, Compliance, Branch Operations, and Supply Chain.

Early And Progressive Mobility: A Program Implementation Strategy For High Acuity Patient Care Locations, Stefani Poland

Student Scholarly Projects

Despite an increase in the promotion of early progressive mobility, its decrease in hospital-acquired complications and improvement of patient outcomes, there remains a reluctance in staff commitment to daily evaluation and implementation. This is largely due to the fact nurses or other interprofessional staff are the primary individuals responsible for this change in process. A lack of confidence in staff to correctly identify patients that meet criteria and anxiety regarding the safe transfer or mobilization of patients, particularly in high acuity settings have been identified as major barriers. The PICOT question that guided this program development of a CBO toolkit …

Utilization Of A Multimodal De-Escalation Class To Improve Staff Confidence When Caring For Behaviorally Escalating Patients, Tara B. Neuner

Graduate Theses, Dissertations, and Capstones

Workplace violence is a common challenge seen in the healthcare settings across the world. This problem is steadily increasing in all types of hospitals, including a level one trauma center located in an urban area. There has been a steady rise in the number of assaults and workplace violence reported from bedside staff at this hospital. The leadership of the organization formed a work group to help combat the workplace violence and staff assaults that were occurring. In this process, a behavior response team was created to help nursing staff with escalating behavior in patients, and to help de-escalate the …

Using Social Media To Examine Disabled Veterans’ Adaptive Sports Lived Experience At The National Veterans’ Wheelchair Games, Heather Harding

Graduate Theses, Dissertations, and Capstones

Considered the world’s largest annual rehabilitative wheelchair games event for Veterans in the United States, the National Veterans Wheelchair Games (NVWG or the Games), co-hosted annually by the Department of Veterans Affairs and Paralyzed Veterans of America, is a long-standing event that offers a view into how adaptive sports and recreational activities can impact Veterans with disabilities. This hermeneutic phenomenological qualitative study sought to discover if the Veteran athletes, who participated in the NVWG between 2017 and 2021, described their lived experiences through the lens of their public social media posts on Instagram, and if so, what can be gleaned …

The Effects Of An Interprofessional Education Video On Dermatologists’ Understanding Of The Role Of The Dermatology Certified Nurse Practitioner, Danielle Elaine Spelich

Doctoral Projects

Dermatology-certified nurse practitioners (DCNPs) have validated knowledge of a dermatology core curriculum and have at least 3,000 hours of formal or informal dermatology training (Dermatology Nurse Practitioner Certification Board [DNPCB], n.d.a). With their standardized education and training, DCNPs are meeting the benchmarks set out by dermatologists. Subsequently, DCNPs have become the new gold standard for dermatology advanced practice registered nurses (APRNs).

However, there is no mention of DCNPs by the American Academy of Dermatology (American Academy of Dermatology [AAD], 2022), and personal experience with dermatologists is that they lack knowledge about DCNPs. This lack of knowledge could create an impasse …

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Standardizing Perinatal Mental Health Interventions: A Guide For The U.S., Maile Lauren Robles

Master's Projects and Capstones

The term perinatal individual refers to women and other individuals who are pregnant or who have been pregnant within the last 12 months. Every year, in the United States there are 700 pregnancy-related deaths and 10% are due to mental health causes including death by suicide. Mental health conditions including but not limited to anxiety, depression, substance use disorders, and post-traumatic stress disorder affect one in five perinatal individuals throughout the United States. This increases perinatal morbidity, hospitalization costs, and economic burden nationwide.

After 43 days postpartum, mental health conditions are the second leading cause of death. The United States …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

Postpartum And Pediatric Education Program For Mothers, Lacie T. Ellithorpe

Department of Occupational Therapy Entry-Level Capstone Projects

My capstone experience included the focus area(s) of Clinical Practice Skills and Education. The aim of this capstone project was to create an ergonomic education program to address new motherhood and their occupations of health management and maintenance, sleep and rest, breastfeeding and other baby care, community mobility, and leisure. My Capstone Mentor was Dr. Kari Rasmussen, OTD, OTR/L. Becoming a new mother is considered a major life event, due to significant role changes that impact a mother’s everyday occupations. The population I served was new and expectant mothers in order to provide ergonomic education as they relate to the …

Improving Postpartum Depression Literacy: A Quality Improvement Initiative, Ashton Neal

Nursing (graduate) Student Scholarship

Background: Postpartum depression (PPD) is associated with increased healthcare costs, decreased levels of productivity, and negative patient outcomes, collectively affecting babies, women, and society. Women are at an increased risk for mortality and morbidity if postpartum depression is left untreated. Postpartum depression literacy improves patient outcomes.

Problem: Women may fail to effectively recognize the signs and symptoms of postpartum depression, due to inadequate postpartum education and lower health literacy levels.

Methods: A formalized postpartum depression education program was implemented online to mothers attending a postpartum adjustment support group in the spring of 2022 and compared to usual …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

Genetics And Genomics Education Among Physician Assistants, Wesley Patterson

All Dissertations

This dissertation comprises five chapters to describe genetics and genomics education among physician assistant/associate (PA) students and practicing PAs. Chapter I introduces the gap in supply and demand of genetic services, the need for non-genetics healthcare providers to fill the gap, and the PA profession as a solution.

Chapter II is a rapid literature review that summarizes the available literature regarding genetics and genomics education for PAs. A paucity of literature exists to describe the current state of PA genetics-genomics education. The few studies retrieved describe content being taught in PA programs, the number of genetics-genomics contact hours PA students …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Copd Care Bundle Implementation And Readmission Rates, Petronellah Mupereri

Nursing (graduate) Student Scholarship

Background: Chronic obstructive pulmonary disease (COPD) exacerbations cause a significant economic and social burden by increasing hospital readmissions and contributing to untimely death.

Problem: COPD “care bundles” consist of hospital-specific education and interventions aimed at decreasing the incidence of COPD exacerbation and subsequent readmission. The effective use of care bundles empowers patients to take ownership of their disease and seek early intervention with signs of worsening symptoms. Unfortunately, implementation of COPD care bundles is inconsistent and contributes to preventable, costly sequela.

Methods: A thorough literature review found evidence supporting the use of a COPD care bundle to decrease 30-day readmission …

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …