Medicine and Health Sciences Commons^™

Academic-Practice Partnerships: Building The Post-Pandemic Nursing Workforce, Heather M. Van Housen

DNP Qualifying Manuscripts

As the healthcare industry recovers from the disruption of the COVID-19 pandemic, nursing workforce development across the continuum from entry-level nursing student to faculty development has come into focus as a top priority. This article discusses the benefit of increased academic-practice partnership models to meet the growing demand for registered nurses. These partnerships increase clinical placements for nursing students and provide opportunities for practicing nurses to prepare for a clinical instructor role.

An Educational Intervention To Improve Nurses’ Knowledge And Self-Confidence: An Integrated Literature Review, Angela N. Ikeme

DNP Qualifying Manuscripts

Purpose: To provide educational intervention to improve the knowledge and self-confidence of nurses in ambulatory and urgent care clinics in detecting early deterioration, intervening, and evaluating changes in patient condition using a consistent assessment tool. A review of the organization policy indicated a process to call the medical alert response team (MAR). However, there was no established algorithm for nurses to escalate or implement interventions when they noticed a patient condition change. An informal survey of ten assistant nurse managers in the ambulatory and urgent care clinics asked about their calling process for MAR and what interventions are used yielded …

A New Narrative: Freeing Pediatricians From A Single Story, Tanya Scott, Tanya Scott

DNP Qualifying Manuscripts

An adolescent pediatric patient who presents with psychiatric and medical conditions is subject to a pediatrician's diagnostic acuity, experience with pediatric psych patients, and existing constraints on providing an appropriate course of care. Too often, the psychiatric DRG becomes the pediatrician's single story of the patient, accompanied by subtexts of aggressive behavior, and the pediatrician's own biases about psychiatric patients. The novelist Chimamanda Adichie warns of the dangers of a single story. As a child in Nigeria, Adiche devoured stories. The children were fair-skinned and blue-eyed in the books available to her. As Adiche began to write her own stories, …

Translatina Immigrant Mental Health Wellness: Suggestive Intervention Strategies The City Of San Francisco Should Consider Adopting, Valeria Vera

Master's Theses

Translatina immigrants in the United States often suffer from intersectional traumas due to their race, gender, sexual orientation, religion, and immigration status — putting them in a vulnerable position socially, psychologically, economically, and medically. Due to their positionality in the intersections of migration, criminalization, cissexism, and mental health, they are often more marginalized and have greater needs than communities with privileged sociocultural identities. As a particularly vulnerable group, they need guaranteed access to gender-affirming healthcare that is inclusive of mental health services. Despite Translatinas’ need for mental health services, there exist many barriers making services inaccessible and insufficient in San …

The Use Of Simulation With The School Of Nursing And Health Professions (Sonhp) Prelicensure Students To Support Affirming Practice With Transgender Communities, Genevieve Charbonneau

Doctoral Dissertations

This dissertation investigates how prelicensure nursing students are prepared to address healthcare disparities with transgender patients, specifically through simulation scenarios at the University of San Francisco School of Nursing and Health Professions Simulation Center.

A critical review of current literature reveals how microaggressions against transgender communities create and sustain barriers to equitable healthcare. The qualitative study was designed to explore the lived experience of prelicensure nursing students who are actively seeking to understand the healthcare needs of transgender patients in the San Francisco Bay Area.

This was a qualitative research study including data that suggests that using simulation scenarios featuring …

Usf Jamovi Tutorial Project: Open Education Resource, Aline Hitti, Saera Khan

USF OER Faculty Grant

Jamovi is an open source free software that USF staff, faculty and student can download to carry out any statistical analyses. The current report summarizes the progress made on an Open Education Resource Grant funded project, which aimed to created Jamovi tutorials. In this report, student feedback and faculty reaction are summarized after one semester of using the tutorials created.

Increasing Continuous Positive Airway Pressure Compliance With Various Telemedicine Interventions: An Integrated Literature Review, Tracy Partington

Doctor of Nursing Practice (DNP) Projects

Aims and Objectives. This literature review's objective was to synthesize evidence from previously published literature on telemedicine interventions' effectiveness on CPAP (Continuous Positive Airway Pressure) therapy compliance.

Background. It is estimated that 22 million Americans suffer from a form of Sleep Apnea (SA), and those up to 80 percent of the cases of moderate to severe Obstructive Sleep Apnea (OSA) are undiagnosed (Sleep Apnea, n,d). The first-line therapy for OSA is CPAP. However, CPAP therapy is associated with low compliance rates.

Design. Systematic review.

Method. A multi-database literature search was conducted to identify published literature between 2009 and 2020. …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Implementation Of A Mental Health Environmental Risk Assessment Tool, Alan Le

Doctor of Nursing Practice (DNP) Projects

Background: Patient suicide is a serious safety issue, especially in mental health settings since suicides disproportionately affect psychiatric patients. Environmental hazards are a primary contributing factor in patient suicide cases.

Problem: Mental health staff may lack tools and training to perform proper environmental risk assessments, which is the case at a psychiatric crisis residential center in northern California that utilized no environmental risk assessment tool.

Methods: An environmental risk assessment tool was implemented at the site for four months to increase staff confidence, ability to identify hazards and decrease risk of patient suicides.

Interventions: The Suicide and …

Implementation Of An Acute Care For The Elderly (Ace) Unit In A Community Hospital, Kimberly A. Colonnelli

Doctor of Nursing Practice (DNP) Projects

Background: “Baby boomers” (born between 1946 and 1964) represent 15% of the total population of the United States (Population Reference Bureau, 2019), but 50% of its total healthcare expenses (Mattison, 2021). Growth of this population will have a corresponding rise in demand on healthcare resources. Replication of a geriatric inpatient care model (Palmer et al., 1994) was introduced in a large geographically and ethnically diverse integrated care delivery system.

Problem: The demographic for this small community hospital located in Northern California has a larger percentage of patients over the age of 65 compared to other facilities within this …

Targeting Pre-Operative Booking Processes To Decrease Risks Of "Never Events", Rebecca Lynn Poths, Rebecca Lynn Poths

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Wrong patient, wrong procedure, wrong site, and wrong side surgeries are such egregious errors that are known as “never events.” Root cause analyses can pinpoint a failure yet do little to determine if corrective action has reduced the risk of recurrence.

Context: Monitoring surgical cases prospectively to identify weaknesses that could help identify specific risk factors to avert and move toward zero defects. The setting for this quality improvement project is a >300-bed Level III trauma hospital, where the risk of wrong-site surgeries and lack of standardized processes in the surgical pre-operative booking process was of concern to …

Building Excellence Through Shared Governance And Continuous Process Improvement, Deborah Reitter

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Nursing shared governance in the hospital setting is a well-established structure for shared decision-making between staff nurses and nurse leaders to improve nursing practice, quality of care, and patient safety. Establishing effective, shared governance can take several years: new skills must be acquired, new behaviors accepted, and new professional commitments made. Newcomers to shared governance require support, education, and the opportunity to acquire requisite skills; otherwise, interest, commitment, and achievement of desired outcomes cannot be sustained.

Local Problem: A large hospital in California established a shared governance structure in 2018. Performance gaps between two high-performing Nursing Unit Councils …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

The Effects Of Naloxone Education Among Adults In Alameda County, Patricia Ronnica Tinglin

Doctor of Nursing Practice (DNP) Projects

Fatal opioid overdose is a growing concern in the United States (U.S.). The pharmaceutical companies assured the medical community that opioid pain relievers were not addictive. As a result, providers prescribed them at a significantly higher rate, which led to more extensive use of authorized and unauthorized opioid use before it was realized that they could be highly habit-forming (The U.S. Department of Health and Human Services [HHS], 2019). A growing body of evidence supports providing naloxone education as a means of harm reduction. The quality improvement project aims to implement educational sessions for adult patients seen at East Bay …

Providing Hypertension Education For African Immigrants At A Southern California Congregation During The Covid-19 Pandemic, Esther Oshunluyi

Doctor of Nursing Practice (DNP) Projects

Providing Hypertension Education for African Immigrants at a Southern California Congregation During the COVID-19 Pandemic

Abstract

Background: Hypertension (HTN) is one of the major risk factors for cardiovascular disease and the prevalence is highest among African Americans (AAs) (American Heart Association, 2017). The difference in the management and outcomes of HTN between African Americans and Whites is most disparate with lack of education being a major contributor to uncontrolled HTN among African Americans, especially among African Immigrants (Lackland, 2014).

Problem: According to church leadership at the project setting, the majority of their adult African Immigrant population is believed to have …

Using Simulation To Improve Covid-19 Code Blue Outcomes, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Transcatheter Aortic Valve Replacement: Implementation Of Shared Decision-Making, Liesel Buchner

Doctor of Nursing Practice (DNP) Projects

Background: The setting for this study is the structural heart program of a large healthcare organization in the Greater Sacramento area in California. Aortic stenosis (AS) is the most common cardiovascular valvular disease in the elderly. The treatment of AS is complex and over the last decade, the transcatheter aortic valve replacement (TAVR) procedure has changed the management of this high-risk group and has become the standard of care.

Problem: The structural heart team performs an average of 170 TAVR procedures annually. The program is relatively new, and although it is performing above the national averages for specific program outcome …

Use Of Simulation To Improve Nurse's Response To Covid-19 Code Blue: A Literature Review, Charity Shelton

Doctor of Nursing Practice (DNP) Projects

Background

Healthcare workers in the acute care setting must be ready to respond to emergencies at any given time. The recent COVID-19 pandemic put strains on the healthcare workforce that have brought challenges and new competencies for how healthcare workers safely respond to emergencies. To ensure healthcare workers maintain these competencies, specific training must occur to improve emergency response and outcomes. Specifically, there needs to be training for healthcare workers to respond to COVID-19 code blue emergencies safely and with skilled interventions.

Problem

A code blue in the acute care setting is a medical emergency that requires nurses, physicians, and …

Purposeful Nurse Hourly Rounding: Plan To Decrease Patient Falls During A Pandemic, Robbie Masangkay

Doctor of Nursing Practice (DNP) Projects

Problem: Patient falls remain a critical and persistent safety problem in healthcare today. The prolonged impact of the COVID-19 pandemic raises leadership concerns regarding the safe care of high-risk COVID patients and mitigating the increased stress and potential risks of infection to clinical staff.

Context: This Doctor of Nursing Practice (DNP) scholarly project details implementation of an evidence-based purposeful nurse hourly rounding (PNHR) pilot project designed to decrease the incidence of patient falls on a designated COVID-19 unit.

Measure: A modified PNHR rounding tool was implemented to guide focused elements for key nurse/patient interactions.

Interventions: …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Streamlining Care For Children With Autism Spectrum Disorder, Siavash Rostami Jafarabad

Doctor of Nursing Practice (DNP) Projects

Background: Autism spectrum disorder (ASD) is a chronic and developmental disorder that affects about one out of every 65 children in California, and one in 59 children in the United States. Children with ASD have difficulty communicating and interacting with others, and experience oversensitivity to new stimuli and environments.

Problem: In healthcare settings, children with ASD experience numerous challenges related to lack of adequate knowledge and education of staff regarding ASD, and lack of appropriate environmental and sensory resources which reduce quality of care provided to this population.

Methods: The project took place in a Psychiatric Emergency Services (PES) Unit …

Preparing Nurses In Management Positions For Bedside Care During Times Of Crisis, Trevor Murray

Doctor of Nursing Practice (DNP) Projects

Background

The purpose of this quality improvement project was to increase perceived self-efficacy in performing bedside skills among nurse leaders. As the demand for nurses increased, these leaders anticipated a direct role in providing patient care in the event of a patient surge due to COVID-19.

Problem

Due to the COVID-19 pandemic and Delta variant, hospital nursing leaders were and still are concerned with the challenge of providing enough competent nurses to deliver care. The DNP project prepared nurses who work in leadership roles to take or assist in taking a patient assignment.

Methods

Nurse leaders attended a skills lab …

Regulatory Orientation To Support Transition To Academic Leadership, Annmarie Munana

Doctor of Nursing Practice (DNP) Projects

Background: As pre-licensure nursing education is burdened by levels of regulations and standards, it is important the academic leader understand regulatory compliance and the applicable federal, state, and local rules and laws. At a multi-campus university, the leader’s ability to address regulatory issues is critical to the program’s success.

Local Problem: The university’s campus leader regulatory orientation lacks consistency and standardization of content and resources. This situation results in campus leaders having varying degrees of knowledge and competency ensuring academic regulatory compliance.

Context: Regulatory compliance stems from external influences and multiple layers of regulations and accreditation. The university provides onboarding …

Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this study is to develop and implement a de-escalation toolkit to help improve memory, retention, and utility of de-escalation techniques within an outpatient mental health crisis stabilization unit.

Problem: The aforementioned crisis stabilization unit has elevated rates of patient aggression/violence and staff present with difficulty recalling de-escalation techniques due to the lapse in memory and/or retention.

Methods: The project was introduced to the stakeholders of the crisis stabilization unit and input was obtained on the design and components of the toolkit. Various analyses were conducted to ensure the appropriate implementation of the project.

Intervention: A de-escalation …

Telehealth Appointments To Increase Therapy Compliance In Patients With Mosa, Tracy J. Partington

Doctor of Nursing Practice (DNP) Projects

Background: At the VA Puget Sound Healthcare System, care as usual for patients with a new diagnosis of mild obstructive sleep apnea (MOSA) is a letter directing the patient to call the continuous positive airway pressure (CPAP) clinic to establish ongoing care.

Local Problem: This model has resulted in low therapy compliance and does not afford patients the ability to discuss their diagnosis and treatment options with a licensed healthcare provider. A literature review showed telemedicine interventions increase therapy compliance in patients with MOSA.

Context: The Doctor of Nursing Practice project implemented an evidence-based practice change to improve therapy compliance …