Medicine and Health Sciences Commons^™

Asthma Care By Unlicensed Personnel In The Elementary School Setting: A Training Program, Teresa Eligio

Doctoral Projects

This Quality Improvement project (QI) aims to improve the competence and confidence of unlicensed school health staff in identifying asthma symptoms, reading an asthma action plan, asthma care, emergency response, medication delivery tools, and trigger reduction in the school setting. The QI project transpired in an Elementary School District in Los Angeles County, CA. The Project Manager, an asthma instructor trained by the American Lung Association, provided evidence-based Asthma-Basics training for health clerks (HCs), substitute health clerks (SHCs), licensed vocational nurse health clerks (LVN HCs), school office coordinators (SOCs), school office attendance clerks (SOAs), and substitute school office staff (SDO). …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Ntchs© Health Literacy Intervention Pilot Study, Genevieve Evenhouse

Doctoral Projects

This pilot study explored the effectiveness of a validated curriculum called, “Navigating the Health Care System” (NTHCSÓ) in improving the health literacy of high school-aged adolescents in response to the national call to promote knowledge and skills in all ages, and socio-economic and cultural groups to achieve healthier lives. Low health literacy has been shown to greatly affect the quality of lives, health outcomes, and health spending of individuals with and without health conditions across social demographics. High school-aged adolescents are the population of interest of this study due to their developmental milestones which allows for knowledge and skill building …

Human Papillomavirus Vaccine Program, Magdalena Ruiz

Doctoral Projects

Pediatric primary care focuses on maintaining patients’ health, preventing diseases, and assessing children’s developmental milestones. Vaccine administration and disease prevention are key components of a well-child exam for pediatric patients; however, vaccine refusal is an important complication of pediatric patient care. Of particular interest to this researcher is the HPV vaccine which was approved by the Federal Drug Administration and is currently recommended by the Centers for Disease Control and Prevention (2016) for both males and females, beginning at 11 or 12 years of age through age 26 years. The HPV vaccine protects against diseases and cancers caused by the …

Nurses’ Perception Of Discharging The Medically Complex Pediatric Patient, Stacie Camille Licon

Doctoral Projects

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video …

Pilot Study: Program Evaluation Of Peanut Oral Immunotherapy In A Private Clinic, Kinga Olson

Doctoral Projects

The privilege of providing a therapy perceived by patients and families as “life changing” has seasoned physicians describing food oral immunotherapy (OIT) as one of “the most impactful and rewarding thing that they have done in medicine” (Wasserman, Jones, & Windom, 2018). OIT is a medical treatment that allows the immune system to become desensitized to a food to which it may otherwise be allergic. This is not a cure for food allergies but a way to decrease the incidence of anaphylaxis due to accidental ingestion. Living with food allergies can be distressing due to the daily fear of exposures. …

Caring For The Pediatric Neurofibromatosis Type-1 Patient: Improving Nursing Knowledge Through An Innovative Educational Tool, Samantha Ingerick

Doctoral Projects

Standardized nursing education can help equip nurses with appropriate skills needed to care for certain patient populations. Pediatric neurofibromatosis type-1 (NF1) patients have unique health needs, and often seek care at institutions where no NF1 training has been provided. The purpose of this project was to explore existing nursing NF1 knowledge and knowledge perception in a pediatric oncology infusion center within a large bay area children’s hospital, a location where nurses have varied NF1 education and have recently been asked to care for this population. Malcolm Knowles’ adult learning theory was used to design an NF1 educational tool for nurses. …

In Situ Pediatric Mock Codes: The First Five Minutes, Josephine N. Ruiz

Doctoral Projects

The purpose of this quality improvement project was to use in situ simulation-based mock codes to evaluate the effectiveness of participants’ actions and perceived confidence, and to potentially reinforce and improve knowledge retention, skill acquisition, and confidence levels of nursing staff with regards to pediatric emergencies. Simulated drills were evaluated with a tool focused on high-performance teams and team dynamics as outlined by American Heart Association Pediatric Advanced Life Support 2016. Twenty-four simulated drills were conducted from January to February 2019. Each hour-long session was composed of pre-briefing, simulated drill or scenario, and debriefing and took place in empty patient …

Pediatric Patients With Diabetes Transition To Adult Care, Sara Jennings

Doctoral Projects

The purpose of this study was to identify the optimal age to target transition to adult care education for adolescent and young adults (AYA) with Type 1 and Type 2 Diabetes Mellitus (DM) as they transition from pediatric endocrinology providers to adult DM providers. A secondary purpose of this study was to identify if there was a relationship between attendance rate, age, gender, years diagnosed with DM, ethnicity, insurance type, Type of DM, and current county of residence with control of diabetes, measured by glycosylated hemoglobin (HgbA1c). A quantitative study through chart audits was conducted at Valley Children’s Healthcare, VCH, …

Barriers To Providing Quality Care For Pediatric Patients With Autism Spectrum Disorder As Identified By Baccalaureate Prepared Registered Nurses: A Basis To Enhance Professional Practice, Ugo Ndubaku

Doctoral Projects

The increased prevalence of autism spectrum disorder (ASD) foretells that this sector of the population will be accessing health care services in greater numbers; thus, it behooves healthcare providers to prepare for their impending needs. This qualitative study describes the experiences of baccalaureate prepared registered nurses caring for children and adolescents with ASD in order to identify challenges that hinder providing comprehensive and individualized care. A purposive sample of 10 baccalaureate degreed registered nurses (RNs) who have worked or work in the pediatric unit was used to gather rich descriptive experiences. The qualitative data analyses were based on an interpretive …

Perceptions Of Caring In The Pediatric Medically Complex Population, Ivette Becerra-Ortiz

Doctoral Projects

In a hospital system that transitioned from a non-caring science model to a professional practice model based on the Theory of Human Caring/Caring Science, it is important to measure the outcomes of the care delivery transition. In a non-experimental, cross-sectional, correlational, quantitative study the aim was to compare a pre/post-Caring Science model implementation at a pediatric and obstetric medical center, by assessing perceptions of caring in the medically complex pediatric population and in the nurses that care for them.

This study used a convenience sample of 102 pediatric families enrolled in a complex care program, and 23 nurses providing care …

Assessment Of Nurse Behaviors That Influence Care And Maintenance Of Pediatric Oncology Central Venous Catheters, Susan Elizabeth Mckenna

Doctoral Projects

Central venous catheters (CVC) are devices necessary to medically treat pediatric patients diagnosed with conditions such as cancer. Central line associated bloodstream infection (CLABSI) is a complication associated with utilizing a central line. Nurses are responsible for maintaining and complying with strict prevention protocols. The aims of this quality improvement project are to: (a) gain an understanding of perceptions of CLABSI prevention, (b) observe adherence to the CLABSI prevention bundle, (c) measure adherence to the current CLASBI prevention bundle (post-training), (d) identify ways to improve adherence to the CLASBI bundle, and (e) ascertain potential strategies for further compliance efforts. Three …

Improving Teen And Pediatric Provider Communication Through Education And Technology, Kathy A. Connor-Prows

Doctoral Projects

Navigating healthcare can be daunting as an adult, but doing so as a teenager can seem virtually impossible. Until the age of eighteen, parents of children of all ages initiate, schedule, and accompany their children to see their pediatrician for virtually all appointments. Over time, children and their parents develop a special bond with their pediatrician and too frequently, this relationship becomes abruptly severed as their teen turns eighteen years old and is thrust into adult medicine. As healthcare providers, we expect healthcare consumers (including teens) to know how and when to initiate, schedule, and get themselves to an appointment. …

A Pediatric Respiratory Care Curriculum For Emergency Department Nurses, Luzmaria Alcala-Van Houten

Doctoral Projects

As pediatric visits to community hospitals increase, the Institute of Medicine (IOM) and the Pediatric Emergency Care Network (PECARN) recommend that staff be provided improved education, protocols, and resources to improve patient outcomes (Emergency Medical Services for Children, n.d.). Acute respiratory disorders are the most commonly seen complaints in children aged 0–24 months, with an average of 2–4 visits a year. The purpose of this Doctor of Nursing Practice (DNP) project is to create a pediatric respiratory care curriculum for emergency department nurses in the Kaiser Permanente Central Valley Area (CVA) and to have it evaluated by a group of …

Therapeutic Listening Communication In Children With Autism And Hyperacusis, Jennifer Margaret Hughes

Doctoral Projects

Hyperacusis, or auditory hypersensitivity, is defined as abnormally sensitive hearing and in some cases an extreme sensitivity, where normally tolerated sounds are perceived as excessively, even painfully loud. This is a debilitating condition for children with autism, causing activity limitations and participation restrictions, also leading to peer isolation and habitual sound avoidance behaviors.

This research explores a means of modifying the auditory environment of a child with hyperacusis in a safe, effective way for the purpose of improving attention span and facilitating learning. The small pilot study (n=4) was a single-subject, multiple-baseline design, conducted with school-aged children in the special …

Pediatric Nurse Practitioner Home Visitation Is Associated With A Decrease In Home Care And Healthcare Utilization Errors In High Risk Infants, Rupalee Patel

Doctoral Projects

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants' care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at …

Identifying Factors In Medication Non-Adherence In Teens Diagnosed With Juvenile Arthritis: A Pilot Study, Susan Viola Senzaki

Doctoral Projects

Purpose: The purpose of this study was to identify factors that correlate with medication non-adherence in teens diagnosed with juvenile arthritis. Background: The impact of medication non-adherence often begins in childhood where children depend and learn from their care-givers how to manage their health. Children with chronic disorders are among those at risk for a higher medication non-adherence. Juvenile arthritis (JA) is a chronic childhood disorder where often medication non-adherence is an issue. Methodology: This was a mixed-method qualitative and quantitative pilot study. Teens between the ages of 11 – 17 years, with juvenile arthritis were asked to volunteer in …

Outcome Analysis And Quality Improvement For Inter-Hospital Transfers Of Pediatric, Carma Lynn Tobiassen

Doctoral Projects

Pediatric patients who initially present to a community hospital setting can be adequately cared for the majority of the time, in the emergency department (ED), on the pediatric ward (PEDS), and the post anesthesia care unit (PACU). When a pediatric patient is in need of specialized care or is decompensating and becomes critically ill, initial medical stabilization is required and the identification of a critical care bed and admitting physician are needed in a timely manner. Inter-hospital transfers (IHT) of pediatric patients are frequent occurrences, as more and more areas are consolidating their resources and Pediatric Intensive Care beds are …

Developing A Patient Care Standard For Adolescents Based On A Nursing Needs Assessment, Kathryn Blake

Doctoral Projects

Mental health patients often suffer from chronic medical conditions and psychiatric comorbidities requiring frequent emergency, primary care, and acute care visits (Douzenis et al., 2012). Caring for psychiatric patients in acute care hospitals has become an increasing burden on healthcare systems with processes in place to care for acute and critical care patients. Healthcare leaders, providers, emergency departments, and medical/surgical hospitals are straining to provide care for complex patients with acute medical conditions and complex mental health needs (Reiss-Brennan, Briot, Savitz, Cannon, & Staheli, 2010). Caring for children and adolescents with medical and psychiatric problems creates the need for a …

Attention Deficit Hyperactivity Disorder And Mindfulness Practice In Children And Adolescents: A Comprehensive Review Of Evidence-Based Research, Donna Nikander

Doctoral Projects

Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental illness in the United States among male and female children and adolescents between the ages of 3 and 17. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially referred to as mindfulness-based stress reduction (MBSR) and now simply known as mindfulness—and improvements in attention and self-regulation, two major problem areas for ADHD sufferers. Furthermore, recent studies suggest that mindfulness therapies may be effective in reducing symptoms of ADHD in children and adolescents. The purpose of this paper is to review, analyze and synthesize the …

Family-Centered Pediatric Radiation Therapy: A Nurse-Led Quality Improvement Collaboration Model, Elizabeth A. Austin

Doctoral Projects

Problem: Parents of children diagnosed with cancer face a number of physical, emotional, and social hurdles in the race for a cure. Family schedules shift dramatically to accommodate daily radiation therapy treatment appointments. Ambulatory procedure unit nursing staff attempt to teach and interpret the process without the benefit of a family-centered intradepartmental structured communication process to promote safe care with these families.

Methods: Implementation of a structured family-centered interprofessional standard work model to promote interdepartmental collaboration. The project implemented a structured family-centered interview and standard work algorithms to improve the radiation therapy family experience.

Results: A structured, streamlined, interdepartmental interview, …

Reducing "Failure To Rescue" Occurrences: A Pilot Project Incorporating High-Fidelity Simulation During Mock Codes, To Enhance Pediatric Nurses' Clinical Knowledge And Skills, Denise Dawkins

Doctoral Projects

Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

The Experience Of Latino Parents Of Hospitalized Children During Family Centered Rounds, Lisa Ann Walker-Vischer

Doctoral Projects

Problem: Hospitalization of a child is stressful. The parental role is altered and parents have a primary need to receive timely information. Family centered rounds (FCR) provide a mechanism to exchange information and facilitates shared decision making with the medical team while parents advocate for their child's needs. FCR has been linked to increased satisfaction and improved outcomes. A recent study suggests that Latino parents have a suboptimal experience related to language barriers and a lack of empowerment. The purpose of this study is to describe the experience of Latino parents of hospitalized children during FCR in a public safety …

Parental Perceptions Of The Management Of Childern With Type 1 Diabetes At School: A Broader Perspective, Claudia Wilde

Master's Projects

The purpose of this study was to examine parental perceptions related to the care and management of children with Type 1 diabetes at school. Parents of elementary and middle school-age children with Type 1 diabetes completed a survey questionnaire, which included one open-ended question. The questionnaire was developed by the researchers based on original questionnaires by Nabors, Lehmkuhl, Christos, and Andreone (2003) and Lewis, Powers, Goodenough and Poth (2003 ). Permission to use and modify the questionnaires was provided by Nabors and Poth. Results from this study showed a split in parental satisfaction regarding care provided by school personnel in …

Minority Adolescents At Risk For Obesity: Health Behaviors And Perceptions, Linda D. Jones

Master's Projects

The purpose of this study was to examine behaviors related to nutrition and physical activity of inner-city minority adolescents, and their perception of normal weight and overweight. The research study used a descriptive, non-experimental design which had a convenience sample of thirty-seven 8th grade minority adolescents who attended a chartered urban K-8 grade school in Northern California. There were no statistically significant differences in the results, however, over 50% of the students reported not eating the recommended daily servings of fruits and vegetables. Another 68% reported participating more than 30 minutes in exercising or playing sports during physical education class. …

The Relationship Between Perceived And Ideal Body Size And Body Mass Index Among 9th Grade Students In An Urban High School, Irma Orozco

Master's Projects

This study examined the perceptions of actual and ideal body size and how it related to body mass index in 82 ethnically and socioeconomically diverse 9th-graders from an urban high school. The height and weight were measured, and BMI was calculated for each of the 82 participants. Using the Childress Silhouette Scale (CSS), each student self-reported Perceived Actual Self Image (P ASI) and Perceived Ideal Self Image (PISI). The CSS was modified to offer 7 figure drawings that illustrated various examples of underweight, healthy weight, overweight, and obese. Results showed that 54% ofthe students had a healthy weight, 21% were …

Evaluation Of A School Based Disaster Preparedness Program, Sandra Linebarger

Master's Projects

This study evaluated a school based intervention designed to better prepare teachers and staff members in an elementary school to improve their knowledge and confidence of disaster preparedness. Participants included 19 teachers and I 0 staff members of an elementary school in San Mateo County, CA. With hundreds of schools scattered in the communities and the recent disasters in our country there is a growing awareness of the need for disaster preparedness in schools. A pretest-posttest was administered to measure changes in knowledge and confidence following a school based intervention of disaster preparedness education. There was a significant improvement in …

Identifying Catholic School Teachers Attitudes And Perceptions About Death And Grief, Stephania Ann Higdon

Master's Projects

Death and grief are not frequently discussed with children as a normal part of life. Previous studies show that teachers are not comfortable discussing the subject in the classrooms. As a trusted source, school nurses are able to help school staff recognize potential signs and symptoms of death and grief with a student dealing with a loss, providing information, educational resources and support. The purpose of this study was to identify the attitudes and perceptions about death and grief of Catholic School teachers working among elementary school age children kindergarten through eighth grades. A convenience sample of 47 teachers from …