Medicine and Health Sciences Commons^™

Addressing Informal Caregiver Burnout In The United States: Policies, Interventions, And Recommendations, Michael Blampye

Master's Projects and Capstones

Informal caregiver burnout has been and will continue to be a significant public health concern in the United States, necessitating a comprehensive analysis of initiatives and policies to reduce its negative impacts. This paper provides an overview of existing approaches to address caregiver burnout at the individual, community, and national level, identifying critical gaps in policies and programs. By highlighting successful approaches in other developed countries, this paper presents comprehensive program and policy recommendations to strengthen informal caregiver support systems in the United States. Prioritizing these proposals can guide policymakers in creating a more supportive environment that values the crucial …

Infant Mortality Data: Missing Pieces To Prevention In Lesotho, Jacinda Croissant

Master's Projects and Capstones

Lower-middle-income countries (LMICs) like Lesotho lack complete and quality infant mortality data. Without infant mortality data, it can be challenging to develop public health education, programming, and policies to address preventative infant deaths in specific populations (Rao et al., 2004). A literature review identified strategies to improve infant mortality data in LMICs. Through a community engagement model and digital storytelling, community members can gain awareness, begin an ongoing conversation about local public health issues, and participate in an improved data collection system. Infant mortality is often used as an indicator of health for a population; improved infant mortality data can …

Reducing Heart Failure Readmissions Through Standardized Daily 1:1 Education, Neil R. Carlos

Master's Projects and Capstones

Problem: In 2023, a Northern California hospital's Cardiac Procedure Unit (CPU) admitted 100 heart failure patients, with 24 readmissions primarily due to inadequate self-management education. These admissions cost over $8.4 million, highlighting the urgent need for better patient education to reduce readmissions and healthcare expenses.

Context: A quality improvement initiative was launched in the CPU that handles pre- and post-cardiac care, including for heart failure patients. The unit's focus on urgent care and other priorities resulted in insufficient patient education regarding heart failure.

Intervention: From January to June 2024, the initiative implemented daily personalized teach-back education sessions on self-management. These …

Beat The Clock: Improving First Case On-Time Starts (Fcots) In The Ambulatory Surgery Unit (Asu), Myrna M. Bernardo

Master's Projects and Capstones

Abstract

Problem: A local Bay Area hospital Ambulatory Surgery Unit (ASU) strives to maintain the first case on-time starts (FCOTS) at 90%. Optimal FCOTS compliance enhances operating room (OR) efficiency, resource utilization, and patient outcomes. Data from January 2022 to December 2023 shows that ASU’s FCOTS remains at a monthly average rate of 67%. This project focuses on closing the 23% gap by achieving 73% FCOTS compliance in the first quarter to progressively achieve the unit 90% goal or higher.

Context: The five ASU ORs handle a daily volume of 25-35 cases. An interdisciplinary team conducted a root cause analysis …

Interventions In Treating Ptsd As A Result Of Birth Trauma, Christine Marie Samatra-Montalvo

Master's Projects and Capstones

This paper explores the prevalence, causes, and consequences of PTSD resulting from childbirth, highlighting the need for effective intervention strategies. A systematic review of 25 studies encompassing cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), pharmacotherapy, and support groups was conducted to evaluate their effectiveness. Findings indicate that CBT and EMDR are the most promising treatments, with pharmacotherapy and support groups also providing substantial benefits. However, access to these interventions remains a challenge for certain populations. This paper underscores the importance of tailored, trauma-informed care and suggests that comprehensive maternal mental health programs can significantly improve outcomes for mothers …

Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

The Impact Of Adverse Childhood Experiences And Allostatic Load On Premature Birth Rates: A Literature Review, Roxane J. Scherek

Master's Projects and Capstones

This paper examines the relationship between Adverse Childhood Experiences (ACEs), allostatic load, and the likelihood of women giving birth prematurely in the United States and Canada. I searched multiple databases exploring this association, identifying nineteen articles published between 2004 and 2024. The literature highlights that racism and discrimination are a cause of chronic stress, and that this stress, and implicit bias, are both implicated in preterm birth. While ACEs scores have been found to be associated with preterm birth, the results for allostatic load are mixed. The results suggest that more attention should be paid to mitigating the stress associated …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Sleep To Heal: Creating A Quiet At Night Environment, Victor Marie V. Blardony

Master's Projects and Capstones

Problem: Noise in hospitals disrupts patient well-being, recovery, and satisfaction. A 120-bed community hospital in South San Francisco consistently scored below the national average for nighttime quietness (Medicare, 2023).

Context: Over six months, a multidisciplinary committee launched the Quiet at Night (QAN) Program, focusing on the high-acuity telemetry unit. The program utilized Kotter’s 8 Steps Model and the Institute for Healthcare Improvement Model for Improvement (MFI) to tackle nighttime noise issues.

Interventions: Quiet hours were established from 8:30 p.m. to 6:00 a.m. Patients were provided an “Enhanced Sleep Menu” that included a sleep sound machine and “sleep kits” (eye masks …

Improving Compliance In Missed Visits Documentation, Ma Rosalie Felix

Master's Projects and Capstones

Problem: Within the South Bay Hospice Agency, documentation compliance for missed visits was 68% in the first quarter of 2024, when the national standard should be 100% according to the Centers for Medicare & Medicaid Services.

Context: Inadequate nurse documentation and communication between health professionals can lead to medical errors, poor team communication and suboptimal patient outcomes (Tasew et al., 2019). Therefore, the importance of documentation compliance is imperative. Hospice staff perform scheduled visits for terminally ill patients 1-2 times a week; however, a missed visit can occur when a patient declines it for a variety of reasons.

Interventions: The …

Implementation Of A Daily Engagement System Board (Desb) To Improve Hospital Staff Communication, Catherine Villanueva

Master's Projects and Capstones

Implementation of a Quality Improvement (QI) project to help improve staff communication between shifts at an Inpatient Acute Psychiatric Unit was determined to be of immense need. This unit is part of a large acute medical hospital. Currently, the end of shift report consists of a verbal report along with a robust printed end of shift report consisting of shift related information. This printed end of shift report can have as many as seven to nine pages thus causing information overload and decreases prioritized patient information. Furthermore, missed information or too much information can be provided in the verbal shift …

Interventional Radiology's Exploration Into Artificial Intelligence, Raymond Nguyen

Master's Projects and Capstones

Background: Artificial intelligence (AI) has become more prominent in our daily lives in recent years. This includes various aspects of healthcare. Interventional radiology (IR) is one of these specialties that has taken strides in understanding how AI can be leveraged for patient care. This literature review aims to understand what areas will be most impacted by AI in IR and how it will influence both the patient and interventional radiologist.

Methods: Twenty-six publications from 2019-2024 were selected from PubMed and Scopus. Publications were sourced through a combination of keywords, subject headings (MeSH terms), and citation searching.

Results: This literature review …

Standardizing Documentation Of Patients’ Measurable Decline To Increase Medicare Compliance In The Hospice Setting, Julia A. Gines

Master's Projects and Capstones

Problem: Staff nurses have difficulties standardizing documentation of patients’ measurable decline during the admission and recertification process to justify the need for hospice services. Context: According to Murrin (2016), the average Medicare compliance rate of hospice organizations is 86%. This quality improvement (QI) project aims to increase an outpatient hospice organization’s Medicare compliance rate of 66% to the average, nationwide level through standardization of documentation (Frontz, 2021). Interventions: The proposed intervention is to implement a QI project of the following assessment tools: Palliative Performance Scale (PPS), Functional Assessment Staging Tool (FAST) and Mid-Upper Arm Circumference (MUAC). Clinical nurses will attend …

Secondary Trauma Amongst Emergency Shelter Volunteers: An Intervention To Identify, Assess, And Respond To Secondary Trauma Exposure, Ashlyn K. Yokom

Master's Projects and Capstones

Purpose: Emergency shelter volunteers are experiencing secondary traumatic stress (STS) symptoms during their deployments. The purpose of this paper is to create an intervention that protects the volunteers from developing STS.

Design: Questionnaires were distributed to current and previous emergency shelter volunteers along with conducting interviews. This design allowed important information to be collected that was used to determine the level of STS symptoms experienced by the volunteers.

Trends: Three STS symptoms were focused upon, intrusion, avoidance, and arousal. It was determined that intrusion symptoms were experienced more frequently than avoidance and arousal symptoms.

Summary: It was determined that emergency …

Reducing Compassion Fatigue On A Cardiac Telemetry Unit, Nicole Rocio Garzon

Master's Projects and Capstones

Abstract

Background: Compassion fatigue (CF) among nurses is a significant concern affecting both individual well-being and patient care outcomes. Findings from a 2020 national survey found two-thirds of nurses (62%) struggle with CF and even a high rate for those nurses under the age of 25 years. Through a review of current literature and case studies, the effectiveness of these interventions in reducing stress, enhancing resilience, and improving overall job satisfaction among healthcare professional is examined. Practical implications for implementing these interventions in healthcare organizations are discussed, emphasizing the potential for creating supportive environments that foster emotional and mental well-being …

Addressing The Increased Prevalence Of Gestational Diabetes Among Hispanic/Latino Pregnant Persons In The Central Valley Of California, Kathleen Janise Farrell Wardell

Master's Projects and Capstones

Gestational Diabetes (GDM) is a preventable noncommunicable disease that has been on the rise over the last 60 years. Pregnant persons with gestational diabetes are 10 times higher of acquiring Type 2 Diabetes after pregnancy (Ionannou et al., 2024). There is an urgent need to address this public health threat because of its increase in mortality. To address this complex chronic disease, this literature review explored multi-level interventions using the socioecological model to mitigate GDM in the Central Valley’s, Tulare County. Tulare County is disproportionately affected by chronic diseases like diabetes especially among the Hispanic and Latinx communities. Therefore, it …

Respiratory Syncytial Virus In The United States: A Research Proposal For A Prospective Cohort Study Of Rsv Vaccines, Kenneth D. Chiu

Master's Projects and Capstones

Objective

This paper proposes a phase IV study to estimate the effectiveness of Abryvso and Arexvy in older adults against severe RSV disease. Additionally, the study aims to assess factors involved with low vaccine uptake for these RSV vaccines.

Methods

For the background literature review of this proposal, I conducted a search of the PubMed and CINAHL Ultimate databases for articles on older adults and RSV. I filtered out results within the period of 2020 to 2024 that were publicly available and focused on RSV burden, vaccinations, or knowledge in the United States.

The proposed phased IV study is a …

Improving Firefighter Health Through Education In Sleep Science, Elisabeth J. Filiss

Master's Projects and Capstones

Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefighters’ sleep have been recommended.

This quality improvement project implemented …

Prospectus For Expected Discharge Date Accuracy (Edd) – Prepare To Go, Mary Jane D. Esmilla Msn, Bsn, Rn

Master's Projects and Capstones

Problem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.

Context: A team analysis improved EDD accuracy, patient satisfaction, …

An Initiative To Improve Ssi Bundle Metrics Adherence Specific To Post-Op Warming And Temperature Documentation Practices In The Post-Anesthesia Care Unit, Dorothy Vergel

Master's Projects and Capstones

Abstract

Problem: Over the past year, the department failed to meet SSI Bundle Metrics scores consistently due to process identification failures and documentation lapses.

Context: The post-op warming temperature documentation and practices project focused on addressing critical quality issues related to documentation and education gaps in the post-anesthesia care unit (PACU) microsystem. This project took place in a 249-bed hospital in Northern California, which includes 15 post-surgical bays. The PACU primarily serves patients needing acute care post-surgery, with surgical cases handled, including general surgery, plastic surgery, neurosurgery, orthopedic and spine surgery, vascular surgery, and urology.

Interventions: The design …

Increasing Resiliency In Front-Line Nurse Managers, Adrianne N. Bunyard-Fallquist

Master's Projects and Capstones

Problem

According to Membrive-Jimenez et al. (2020), 29% of nursing managers experience emotional exhaustion due to work overload, conflict mediation, and a lack of support from senior leadership. In a central California hospital, front-line nurse managers struggle to meet organizational goals and support their teams, with 64% indicating dissatisfaction in their roles in fall 2023. This highlights the need to improve job satisfaction and retention.

Context

A large healthcare system in Northern California has implemented Caring Science (Foss et al., 2015) and HeartMath® (HeartMath, 2023) techniques in a rural hospital to improve nurse manager retention and job satisfaction. The project …

Enhancing Teamwork With Cliftonstrengths, Lauren A. Lelaidier

Master's Projects and Capstones

Abstract

Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging.

Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved.

Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one …

Implementing The "Baby Drop Bundle", Natalie Aguirre

Master's Projects and Capstones

Problem: Falls are a preventable type of trauma that may lead to serious injury, prolonged hospital stays, and non-reimbursable costs to the organization. While there are established fall prevention policies for ambulatory patients, infants dropped by their caregivers are largely excluded.

Context: This quality improvement project aims to decrease newborn drops by implementing the “Baby Drop Bundle”. The bundle allows caregivers and bedside providers to partner in creating a safe environment for the patient.

Interventions: The Clinical Nurse Leader (CNL) will provide a brief in-service during the morning safety huddle to introduce the bundle to staff. The bundle includes educational …

Addressing Rural Food Insecurity: A Flexible Approach Using Evidence-Based Practices, Alison Clayshulte

Master's Projects and Capstones

Food insecurity is a major public health problem in the United States that can lead to worse physical and mental health outcomes for millions of Americans. Rural communities struggle with food insecurity at a higher rate, leading to disproportionately higher levels of chronic conditions, obesity, and stress. Food insecurity is a symptom of many factors including underlying social, economic, and institutional obstacles that affect the quantity and quality of available food. Examples of evidence-based programs implemented to address these factors abound, however rural communities have unique challenges that must be considered to ensure programmatic success. This paper explores these challenges …

Reducing Same-Day Case Cancellation By Implementing 72 Hours Preop Phone Calls, Debbie Sharon Centeno

Master's Projects and Capstones

Problem: The increased frequency of same-day surgical cancellations affects patient care quality, causes loss of expenses for patients and facilities, and causes non-compliance with block utilization against regional standards.

Context: A collaborative effort was undertaken to reduce same-day case cancellations in the Ambulatory Surgery Unit (ASU). Patients received preoperative instructions 24 hours before surgery through email or phone call. Data collection revealed that the common causes of same-day cancellations were avoidable reasons (not NPO, patient ill, request for another schedule, no ride), indicating the need for improvement in delivering preoperative phone calls.

Interventions: This included educating preoperative nurses, creating a …

Decreasing Inappropriate Wound Consults, Arpita Hinton

Master's Projects and Capstones

Abstract

Background: This project was centered around the wound nurses and their workload. It also highlighted the opportunity for education for frontline staff. The wound nurses at this northern California hospital are a group of five nurses that support the whole hospital. Usually there are two staffed per day to support a facility that continues to have three to four overflow areas open to accommodate its high census.

Problem: My project focused on decreasing inappropriate wound consults. There are many consults places that do not need the intervention of a skilled wound nurse. These consults lead to time that is …

Optimizing Geriatric Care: A Niche-Driven Daily Implementation Of The 5ms Geriatric Assessment Tool To Minimize Length Of Stay, Lori Ann Aston-Dixon

Master's Projects and Capstones

Abstract

Background: This project's microsystem was a 32-bed medical-surgical telemetry unit at a small community hospital in Marin County. The unit needed a framework that focused on the unique needs of the geriatric population and daily activities that enhanced physical and cognitive activities to mitigate risks for any issues that created a prolonged Length of Stay (LOS).

Problem: The microsystem is a medical-surgical telemetry unit where the average length of stay (LOS) is five days, surpassing the organization's goal of four days. Reducing LOS can enhance patient satisfaction and meet organizational targets.

Context: This project aims to reduce the extended …

Clinical Trial Research Nurse New Employee Onboarding 30- 60 -90 Day Checklist, Arin Alesia Urban

Master's Projects and Capstones

Problem: The clinical trials research management team was plagued with high nurse turnover and poor clinical documentation due to a lack of seasoned clinical research nurses.

Context: A regional clinical trials team serving 22 hospitals within a Northern California not-for-profit health system.

Interventions: Mixed methods were used to inform the development of new employee onboarding for novice clinical trial nurses utilizing a structured 30-60-90-day checklist, improved communication channels, and continuous mentor support.

Measures: Monthly quality queries and quarterly staff turnover rates were tracked. Employee feedback was collected to assess the interventions' impact.

Results: The number of quality queries was reduced …

Improving The Diagnosis And Treatment Of Obstetric Sepsis, Edwije Joseph

Master's Projects and Capstones

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries.

Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community …

Decreasing Incivility Through Improved Communication And Teamwork, Marvin Ernest Tamayo

Master's Projects and Capstones

Problem: Workplace incivility (WI), lateral violence (LV), and bullying in healthcare settings are pervasive issues negatively impacting staff morale, turnover rates, and patient care outcomes. High turnover and low employee satisfaction scores from a September 2023 culture of safety survey signaled a toxic work environment characterized by ineffective communication and unprofessional behavior. Context: A 24-bed telemetry-stroke unit at a 172-bed acute care facility in the North Bay area of San Francisco.

Interventions: The Transtheoretical Model (TTM) of behavior change and the Crucial Conversation frameworks were used to improve staff communication and reduce incivility.

Measures: September 2023 and March …