Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

Educating Pediatric Registered Nurses On The Administration Of Prolonged Intravenous Antibiotics, Kasandra Rezler

Master's Projects and Capstones

Abstract

Problem According to Children’s Hospital A's incident reporting system, 50% of problems related to prolonged intravenous antibiotics were classified as administration issues. When mistakes are made in this process, the antibiotic is then delivered at the wrong rate or the wrong time, which is problematic. Additionally, findings from a needs assessment survey highlight a critical need for targeted interventions, such as an educational video, to reduce administration errors associated with prolonged IV antibiotics. Context Within Children’s Hospital A, the microsystems targeted by this quality improvement project consist of inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

Reducing Barriers To Timely Indwelling Urinary Catheter Removal, Huyen T. Nguyen

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 …

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 …

Standardizing Nurse Knowledge Exchange In The Peripartum Mesosystem, Gabrielle Ann Romena

Master's Projects and Capstones

Problem Handoff report is a significant source of medical error, as reported by the Joint Commission. As it stands, Hospital A’s peripartum mesosystem has no standardized policy regarding the Nurse Knowledge Exchange (NKE) process. Context Hospital A is an urban tertiary care medical center in San Francisco, with its peripartum mesosystem divided into two floors with a total of 35 dedicated beds. Intervention Stakeholder engagement, literature review, and mesosystem analysis identified potential barriers to bedside NKE. To address the identified causes, the project implemented a standardized handoff guide and staff education. Measures The outcome measured was comprehensiveness of NKE as …

Pain Assessment And Reassessment Documentation Improvements In Medical-Surgical Units, Alicia Espinoza

Master's Projects and Capstones

Problem Pain management is essential when providing quality care, and adequate documentation of pain assessment and reassessment with administration of opioid pain medications by nurses is necessary for patient safety and satisfaction. Context Nurses play a pivotal role in providing safe and effective administration of opioid pain medication and documentation of pain assessments. This quality improvement (QI) project aimed to increase opioid medication administration assessment and documentation compliance rate for nurses to 90% or greater in two medical-surgical units. Intervention A knowledge check survey was utilized to assess nurse understanding of required data needed to document, and timing for documentation …

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Educating Inpatient Pediatric Registered Nurses On The Setup And Administration Of Prolonged Intravenous Antibiotics And The Reduction Of Medication Errors, Kiara Hayden

Master's Projects and Capstones

Problem The acute care unit microsystem of a California children’s hospital encounters issues involving the incorrect set up and administration of prolonged intravenous (IV) antibiotics and medication errors, such as delivery at the wrong rate or time. These problems can result in negative patient health outcomes, delayed healing, antibiotic resistance, and increased length of hospital stay and costs. Context A collaborative quality improvement (QI) project was launched to target the pediatric population of this particular microsystem. The aim of this project was to standardize prolonged IV antibiotic practices, disseminate knowledge while using evidence-based practice (EBP), and improve patient outcomes. Interventions …

Reducing Indwelling Urinary Catheter Days: Improving Interdisciplinary Communication In A Surgical Intensive Care Unit, Karen M. Wong

Master's Projects and Capstones

Problem Urinary catheter nurse-driven removal protocols (UCNDRPs) are evidence-based algorithms that promote the timely removal of indwelling urinary catheters (IUCs) and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers hinder consistent implementation of the UCNDRP, resulting in delayed IUC removal and increased risk of CAUTIs. Context This quality improvement project was conducted in a 16-bed surgical intensive care unit (SICU) in an academic medical center in the San Francisco metropolitan area. Interventions Urinary catheter reminder posters displaying the duration of IUC days were placed at the bedside to prompt interdisciplinary communication about IUC indication and removal. An email detailing 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 Opioid Pain Pre-Assessment And Reassessment Documentation Rate In Medical-Surgical Units, Hae Rim (Helen) Hwang

Master's Projects and Capstones

Problem The fifth vital sign, pain, requires proper pain management in hospital settings, often involving opioids with significant risks of adverse reactions. Appropriate pain assessment and management is vital to ensure safe medication administration and mitigate potential adverse reactions.

Context This quality improvement (QI) project aimed to enhance opioid assessment and documentation rate above 90% compliance in two medical-surgical units, with a focus on bedside nurses. Nurses play a key role in administering and documenting pain assessments, a practice crucial to managing patient safety and effective pain management specific to opioid use.

Intervention A baseline survey provided nurses’ understanding on …

Improving Nurse Support Of Patient Satisfaction Surveys Through Team Huddle Education, Matthew Price

Master's Projects and Capstones

Problem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. Intervention To address this gap in care, an educational presentation using literature evidence in support …

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 …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …