Implementation Of A Community Health Worker (Chw) Training Program To Improve Birth Outcomes, Emiko Maruri, Trinette Radasa, Jo Loomis

DNP Qualifying Manuscripts

Background

Those who have ever been affected by an adverse childhood experience (ACE) have a greater likelihood of having poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss.

Problem

Latina women have been identified by the Centers for Disease Control (CDC) as those most affected by ACEs. The direct relationship is that Latinas therefore have poor birth outcomes.

Context

For this project, The Save the Children organization in partnership with the University of San Francisco Doctorate of Nursing Practice students and Community Health Workers (CHWs) of the Central Valley of California …

Mental Health Services: Improving Utilization In Homeless Populations, Gurdeep Mann

DNP Qualifying Manuscripts

Emergency shelters provide a unique location to offer easily accessible services for unhoused individuals experiencing mental distress and serious mental illness. Housing First interventions do not improve mental health or social integration. It is important to consider alternative approaches to providing care for homeless individuals. This integrated review was undertaken to evaluate existing evidence of interventions that improve mental health awareness and utilization of mental health services among unhoused populations living in shelters. Assertive outreach is an important strategy that was shown to improve effectiveness of mental health programs in shelters; reconnect individuals with family; and help with psychological integration. …

Improving Elementary Nutrition Education Curriculum In San Francisco - A Program Analysis Of The Food Education Project, Audrey N. Chang

Master's Projects and Capstones

Childhood obesity and food insecurity are problems within San Francisco, California. The purpose of this program analysis is to assess the Food Education Project (FEP), which is one of many projects addressing nutrition education and the long-term public health impact is to solve the problems of food insecurity and childhood obesity. Through primary data collection, students shared their honest feelings about food and were able to openly discuss what they know and do not know about food. A literature review was conducted through research from various databases from the University of San Francisco to identify not only current interventions but …

The Heart And Soul Of Engagement In The Float Pool Team, Kymberly Dexter

Master's Projects and Capstones

Problem: The assistant nurse manager (ANM) role is considered an entry-level management position and is not intended as a permanent career role. The unintended consequence is that there is a high rate of organizational turnover, making it challenging to build and retain a solid, cohesive, and productive team.

Context: A new manager of a float pool team in a 166-bed community hospital found that with little financial investment, a significant impact is made by holding a safe space for listening to the ANM team and designing education and training around what is most important to frontline managers.

Interventions: A baseline …

The Effect Of Standardized Patient Education On 30-Day Hospital Readmissions For Heart Failure Patients In The Outpatient Setting, Lurie Dimalanta

Master's Projects and Capstones

Problem: Heart failure (HF) is the second leading condition of hospital readmissions. Evidence shows that patient education on self-care and disease management can help reduce and prevent 30-day hospital readmissions. Registered nurse case managers (RN CMs) can help improve patients' ability to self-manage their condition and prevent 30-day hospital readmissions by applying a standard approach to patient education.

Context: The Integrated Care Management (ICM) is an outpatient department that provides post-discharge patient calls. The ICM RN CMs utilized various HF patient education tools for patient teaching. The organization’s HF task force developed health-literate patient resources to be used …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Implementing A Health Services Google Classroom In A High School Setting, Christina M. Wilkinson

Master's Projects and Capstones

Abstract

Problem: The present study investigated the use of Google Classroom and the impact of providing students with basic self-care information on nurse office visit times.

Context: A School nurses are often responsible for multiple schools and a large population of students. These demands pose challenges for school nurses to appropriately serve the student population.

Interventions: Disseminate basic health information on self-care to students via Google Classroom.

Measures: The outcome measure is to make nurse’s office visits less than ten minutes. The data source being chart reviews and the target is 80% of students. The process measure is to increase …

Reducing Hospital-Acquired Pneumonia By Educating Patient Care Technicians On Route Bundle Care Measures, Munroop K. Thiara

Master's Projects and Capstones

Hospital-acquired pneumonia (HAP) is an infection of the lungs that can lead to severe and sometimes fatal outcomes. HAP can be prevented by oral care interventions, but without proper patient care, treatment can be very expensive. Evidence-proven HAP preventative measures such as the ROUTE bundle and increased patient mobility can significantly lower the risk of pneumonia as well as prevent additional hospital costs. Hospital X is a private nonprofit health care organization in the urban suburbs of a large Northern California city with a current HAP rate of 2.3 and with targeted goals of 2.0. By creating a project that …

United States Pharmacopeia General Chapter <800>: Improving Safe Handling And Administration Of Hazardous Drugs, Courtney Clark

Master's Projects and Capstones

Problem: This quality improvement project is dedicated to increasing the safe handling and administration of United States Pharmacopeia (USP) General Chapter Hazardous Drugs (HDs) within the Medical/Surgical unit to minimize the risk of exposure to patients, healthcare personnel, and the environment.

Context: The quality improvement project was implemented in two Medical/Surgical units in Hospital A in the San Francisco Bay Area. The patient population of these units has the highest receipt of HDs outside of a traditional Hematology/Oncology unit.

Intervention: The proposed intervention is the use of active and passive observation to assess compliance with USP protocols within the two …

Improving Safe Handling And Administration Of Usp<800> Hazardous Drugs Within The Medical-Surgical Unit, Pavlo Karaputa

Master's Projects and Capstones

Nurses comprise the largest proportion of healthcare providers who make contact with Hazardous Drugs (HDs) during multiple types of clinical activities and have a risk of exposure. Hazardous drugs (HDs) are a class of pharmaceuticals that pose serious health risks to individuals who handle them, including organ toxicity, reproductive and developmental defects, infertility, miscarriage, genetic toxicity, cancer, and even death. This project was implemented in a hospital system within Northern California, on two units that serve medical-surgical, oncology, geriatric, and transplant patients. The Medical Surgical microsystem at this hospital comprises a small group of professionals such as registered nurses (RNs), …

Improving Home Health Nurses' Knowledge Of Heart Failure Self-Care Management, Nenette Hoffman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure results in life-altering and devastating illnesses, predominantly among older adults. Heart failure management is complex, and requires patients and their caregivers to actively monitor symptoms and sufficiently understand care management to maintain health-promoting behaviors. While home health nurses have the primary role as patient educators of their patients with heart failure, evidence from the literature indicates that nurses lack sufficient knowledge to fulfill this role.

Local Problem: Nurses’ inadequate knowledge of heart failure self-care management has been associated with insufficient patient education, the inability of patients to perform heart failure self-care management, worse clinical outcomes, and …

Diabetes Prevention And Management Education For Punjabi-Sikh Older Adults, Mandeep K. Gill

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: South Asians from Bangladesh, Pakistan, and India have a higher prevalence of diabetes than the general global population and are also more susceptible to developing diabetes due to biological and lifestyle factors. The South Asian diet is high in refined grains and monounsaturated fatty acids, increasing the risk of diabetes.

Local Problem: Congregants of a Sikh gurdwara (place of worship) lacked knowledge of diet and lifestyle in relation to preventing and managing diabetes. Many senior congregants have been diagnosed with diabetes or are at high risk of developing the disease.

Methods: Knowledge of diabetes prevention and management were …

Decreasing Seclusion And Restraint Events Among Clients Within An Inpatient And Crisis Stabilization Behavioral Health Facility, Karen Lee Richards

Doctor of Nursing Practice (DNP) Projects

Background: Despite global shifts in behavioral health treatment, changes regarding use of seclusion and restraint (S/R) continues to be extremely slow. Local Problem: Increasing S/R events and subsequent staff injuries and financial burden. Methods: A quality improvement project providing education in trauma-informed care (TIC), sensory modulation (SM), and S/R debriefing (S/RD). Interventions: Education and training for S/RD, TIC, and SM using a variety of materials and methods over a 6 to 12-month period was provided to staff within a 16-bed inpatient adult psychiatric health facility (PHF) and a crisis stabilization unit (CSU). Because of positively affecting the use of S/R, …

Engaging Rural Providers About The Potential Of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs, Joshua M. Cleary

Doctor of Nursing Practice (DNP) Projects

Abstract

This paper describes a DNP project that was designed to address the issue of rural mental telehealth implementation barriers. One of the main barriers to rural telehealth programs has been a technical infrastructure incapable of adequately hosting the telehealth programs. Low-Earth orbit (LEO) internet technology has emerged as a way to solve the rural telehealth conundrum by offering an improved rural technical infrastructure. An integrated review was completed based on the following PICOT question: In rural providers, how does an educational outreach compared to no educational outreach affect provider adoption of new technologies? The evidence showed educational sessions as …

Oleoresin Capsicum Gel: Enhancing Safety For The Home Health Clinician, Lilly Dickens

Doctor of Nursing Practice (DNP) Projects

Problem: Home health clinicians (HHC) are at high risk for workplace violence. Providing necessary health care alone in unpredictable and remote environments are associated with poor outcomes from physical violence. Background: Pepper spray is known for its active ingredient, oleoresin capsicum (OC), as a self-defense tool. OC gel is used worldwide as a non-lethal incapacitating agent. There is an opportunity to expand workplace violence prevention (WPV) in home health by training and allowing HHCs to carry OC gel. Intervention: This DNP QI project implemented a safety intervention for HHCs, including nurses, aides, medical social workers, physical therapists, occupational therapists, and …

Impact Of Montessori-Based Dementia Programming On Engagement And Affect Of Older Adults With Dementia, Meredith S. Sheppard

Master's Projects and Capstones

The COVID-19 pandemic has profoundly impacted the Adult Day Services program and Adult Day programs across the country. As the Adult Day Services program transitions to an in-person format, goals within the organization include developing appropriate programming, increasing group size, and keeping clients entertained. The framework guiding this quality improvement project is Montessori-Based Dementia Programming ® (MBDP). This project aims to increase client engagement, decrease client anxiety, and decrease staff workload. This will be measured by a self-developed staff workload survey, the Menorah-Park Engagement, and the Affect rating scale. Implementation of MBDP at the Adult Day Center did not meet …

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 …

Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong

Master's Projects and Capstones

The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …

Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura

Master's Projects and Capstones

Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit

Abstract

Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.

Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.

Intervention: Review of …

Standardizing Handoff Report In A Medsurg Telemetry Floor, Brandon Tyler Thompson

Master's Projects and Capstones

Problem: Hospital A’s 9^th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths …

Decreasing Hospital Acquired Pneumonia In Adult Patients By Patient Care Technicians: Education With A Focus On Oral Care And Tooth Brushing, Amanda Nicole Lee

Master's Projects and Capstones

Hospital acquired pneumonia’s (HAPs) are unfortunate and preventable events quality improvement efforts should focus on. At a Northern California Hospital, there was an unmet HAP rate goal of 2.3 (20 out of 8795 patients) against a target goal of 2. This increase in HAP rates, both non-ventilated and ventilated was a call to action to reduce HAP to the target goal. The quality improvement project specifically aimed to reduce HAP rates on medical-surgical units through an ultra-brief refresher on the hospital validated and endorsed ROUTE bundle. The education focused on oral care completed by the patient care technicians (PCT’s). The …

Reducing The Risk Of Central Line Associated Blood Stream Infection With Chlorhexidine Gluconate Education, Scarlett Ocon

Master's Projects and Capstones

Problem: A nosocomial central line-associated bloodstream infection is a preventable infection that is costly and potentially fatal. In order to combat bloodstream infections chlorhexidine gluconate wipes have been used as antiseptic. Medical surgical units do not have accessible CHG for bathing purposes. In addition, the staff lacks knowledge of how to use CHG wipes. The current standard bathing practice on this unit consists of using soap and water or disposable washcloths spontaneously without a predetermined time. The aim of this quality improvement project is to educate the registered nurses (RNs) and certified nurse assistants (CNAs) on the benefits of daily …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Implementation Of Staff Education To Standardize Use Of Positions During The First Stage Of Labor, Kelsey Jo Koch

Master's Projects and Capstones

The aim of this project was to assess whether supplemental education on labor positioning for Labor and Delivery nurses would increase the nurses’ confidence in utilizing patient positioning to promote fetal descent and progress labor. Previous research suggests that upright, mobile positions during the first stage of labor have various benefits, including reduced cesarean rates, shorter lengths of labor, and less epidural usage. However, a major barrier to maximizing these benefits is a gap in knowledge among Labor and Delivery nurses, resulting in inconsistent use of various positions. This improvement project addresses this problem at a large community hospital in …

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 …

Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le

Master's Projects and Capstones

Problem: The USP General Chapter <800> guidelines protect healthcare workers from hazardous drugs (HD) and are enforceable by hospital regulatory organizations. Hospitals should increase their safe handling and administration of these drugs to be compliant and protect their workers. This quality improvement project aimed to improve nurse compliance with the safe handling of USP <800> drugs on the medical-surgical microsystem within 16 weeks.

Context: This clinical nurse leader (CNL) quality improvement project was implemented on two medical-surgical microsystems in a San Francisco Bay Area hospital system.

Interventions: The team conducted passive observational data collection and active observation in the form of a …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Impact Of Pcts In The Prevention Of Hap Through A Route Bundle With An Emphasis On Oral Care And Positioning The Patient Out Of Bed And In A Chair, Melissa Ray

Master's Projects and Capstones

Background: Hospital Acquired Pneumonia (HAP) is a leading cause of most hospital-acquired infections among surgery patients who are hospitalized and bed-bound for more than 48hrs. The occurrence of HAP is associated with increased hospital stays and cost of care. However, its occurrence can be reduced by oral care. In this regard, this project aimed to decrease the incidence of HAP on the 3^rd, 4^th, 6^th, and 7^th floors on the Medical Surgical and ICU units of the Northern California Hospital.

Methods: To achieve the aim above, the project utilized methods namely …

Mentoring Infection Preventionists: An Infection Prevention Practice Fellowship Program, Sejal Naik

DNP Qualifying Manuscripts

Background: The COVID-19 pandemic created enormous demands on infection preventionists (IPs). It seriously taxed IPs and required hiring new IPs to support these demands. It is highly competitive to hire experienced IPs, and it can take up to two years for new IPs to demonstrate proficiency before pursuing their certification. A gap analysis revealed that current infection prevention (IP) programs did not provide formal training or mentoring.

Methods: The fellowship program will use the Association for Professionals in Infection Control and Epidemiology (APIC) competency model to train and build IP competency. The APIC accelerated training program will provide training to …