Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

Improving Quality And Efficient Communication Between Providers And Nursing - A Psychiatric Sbar Tool (Psych), Karen Lee Richards

Master's Projects and Capstones

IMPROVING QUALITY AND EFFICIENT COMMUNICATION BETWEEN

PROVIDERS AND NURSING - A PSYCHIATRIC SBAR TOOL (PSYCH)

Karen Richards

University of San Francisco

Abstract

Effective communication is the cornerstone of providing safety and quality healthcare. However, nursing and providers often share information inequitably, as these disciplines are trained differently regarding communication. Providers are taught to be brief, accurate and focused while nurses are taught to be descriptive and holistic. These differences have led to disparity in the sharing of valuable patient information, subsequently leading to increased frustration, inefficiency, and medical errors. Multiple studies provide evidence that poor communication is a major contributor …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Transforming Self And Systems Through Implementation Of A Caring Coach Leader Program, Priscilla Javed

Doctor of Nursing Practice (DNP) Projects

Assistant nurse managers and nurse managers, often referred to as middle managers, have a direct impact on daily hospital operations, clinical work environments, delivery of high quality safe patient care, and patient outcomes. The stressful demands of this role have caused turnover rates to soar above the national average on some of the inpatient hospital units. Instability of nursing management oversight negatively effects staff job satisfaction and delivery of high quality safe patient care. In reviewing the organizations initial orientation program for transitioning middle managers into their new role, it was missing the supportive guidance of a coach. A Caring …

Development Of A Toolkit To Enhance Nursing Education Of Veteran Health Concerns, Carlee Y.S. Balzaretti

Doctor of Nursing Practice (DNP) Projects

Abstract

U.S. Veterans are a vulnerable patient population, more prone to health disparities as compared to the general population. There are 21.8 million Veterans currently in the United States, with the majority receiving their healthcare outside of the Veteran Health Administration. Veterans form a culture that is steeped in military tradition and it is essential that healthcare providers have knowledge regarding this vulnerable population to provide care that is culturally appropriate. In response to the Veteran healthcare crisis, the Department of Veteran Affairs initiated the Veteran Affairs Nursing Academy Partnership (VANAP), a joint venture between VHA medical centers and schools …

Nursing Student Work-Study Internship: Partnering To Bridge The Education-To-Practice Gap, Jonalyn M. Wallace

Doctor of Nursing Practice (DNP) Projects

Abstract

Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the …

Developing An Electronic Health Record Training Program For New Employees, Crystal D. Figlietti

Doctor of Nursing Practice (DNP) Projects

In May 2015, an electronic health record (EHR) was implemented at an urban, long-term care facility. This facility is part of the county Department of Public Health (DPH) and was one of the last locations to implement the designated EHR system. The unique nature of the facility compared to the smaller, health care centers within the DPH network necessitated development of a customized training and onboarding program for new employees. It was not possible to duplicate an existing training program. The registered nurse (RN) informaticist assigned to the EHR used data from nursing staff surveys and information collected through a …

Optimizing Engagement In The Acute Care Setting: A Nurse Driven Staffing Model, Denise D. Fall

Doctor of Nursing Practice (DNP) Projects

Health care is on the threshold of major reform. Central to this reform will be the ability to maximize patient outcomes and resource allocation. The delivery of nursing care is essential to these concepts. Nursing care delivery impacts both patient outcomes and labor costs. Every aspect of care delivery has changed over time: length of stay, acuity, payment methodologies, documentation, technology, and regulatory requirements. Yet the model by which we allocate resources to the bedside is based on an archaic notion and forecasting model around one variable. The development of effective nurse staffing strategies will ensure those delivering care are …

Using Multi-Modal Education In A Public Health System To Increase Rates Of Cervical Cancer Screening, Christina Nardi

Doctor of Nursing Practice (DNP) Projects

While Papanicolaou (Pap) screening has been implemented since the 1950’s, and is linked to decreased rates of cervical cancer, national screening rates are still below the national target screening rate. In Contra Costa County (CCC), the current cervical cancer screening rate is 50.92% (Contra Costa Health Services [CCHS], 2016a). This is far below the national goal of 93% and the first benchmark of 54.33% needed in order to receive state funding under the California Department of Health Care Services (DHCS) Medi-Cal 2020 waiver. The Medi-Cal 2020 waiver has a 5-year Public Health Incentives and Redesign in Medi-Cal (PRIME) program requiring …

Innovation Through An Academic Practice Partnership: A New Clinical Nurse Leader (Cnl) Implementation Model, Nancy P. Taquino

Doctor of Nursing Practice (DNP) Projects

Problem

The IOM reports (1999, 2001) were catalysts for development of a new nursing role - the Clinical Nurse Leader (CNL). Academic practice partnership models are needed to integrate the CNL role in health care systems.

Context

A large integrated health care system in Northern California and a university Clinical Nurse Leader (CNL) program initiated a formal academic practice partnership, establishing a hospital based MSN CNL program.

Intervention

A CNL implementation model was developed that includes (a) academic practice partnership advisory charter; (b) academic practice partnership roles (MSN CNL program director, MSN CNL faculty liaison, and hospital-based CNL …

The Development, Implementation, And Evaluation Of A Transgender Health Resource Bundle, Lovejeet Kaur

Doctor of Nursing Practice (DNP) Projects

Transgender populations experience disproportionate social and health disparities that can negatively impact quality of life. Healthcare barriers due to gender based discrimination and lack of medical insurance and culturally competent providers contribute to low levels of access to preventative health care screenings, resulting in sub-optimal health outcomes. The unique health circumstances of transgender individuals have been understudied in the literature. As a result clinicians are often under-informed of their specific health maintenance needs and screening guidelines. To help address this disparity, a Doctor of Nursing Practice (DNP) student at the University of San Francisco facilitated the collaborative assessment, development, implementation …

Doula Support As A Means To Improve Birth Outcomes For Minority Women, Christina Bao Ngoc Thich

Master's Projects and Capstones

Ethnic minorities such as African Americans, American Indians, Hispanics, Laotions, Hmongs, and Alaskan Natives have higher rates of cesarean delivery, pre-term birth, fetal demise, perinatal laceration, and congenital abnormalities than their white counterparts. Continuous labor support by way of doula care has been recommended for all pregnant women as a means to prevent adverse birth outcomes. Despite this, the population most in need of such support in unable to access doula services due to low socioeconomic status, availability of services, and cultural inaccessibility. This paper focuses on my capstone experience with UCSF and Roots of Labor Birth Collective as we …

Lactation Clinic: Improving Patient Lactation Support, Iana Johnson

Master's Projects and Capstones

Despite the numerous health benefits and recommendations that breastfeeding is the optimal method for nourishing infants, many still choose other ways to feed their babies during the first year of life. This project considers the initiation and future implementation of a Lactation Clinic as an additional patient support service provided in the inpatient and outpatient settings. A Failure Modes and Effects Analysis (FMEA) was conducted in an effort to evaluate and eliminate “what could go wrong” before such an establishment becomes operational. The Risk Priority Numbers (RPNs) from the analysis reveal the lack of use (RPN 50) and streamlining (RPN …

Increasing Patient Satisfaction And Decreasing Hospital Readmission Due To Deep Venous Thrombosis By Providing Anticoagulation Education For Orthopedic Patients, Margaret Gniewosz

Master's Projects and Capstones

Abstract

Improving Process on Oral Anticoagulant Education for Orthopedic Patients

The aim of this project is to improve anticoagulation education for orthopedic patients to increase patient satisfaction. The microsystem for this project is a medical-surgical (MS), 50-bed unit in a medium size hospital. Because orthopedic patients are at high risk to develop DVT postoperatively, proper anticoagulants and anticoagulation education is an important aspect of patient care. By implementing a well-designed and easy-to-read patient handout on anticoagulants with instructional script for nurses will empower patients to achieve higher level of anticoagulant knowledge and in result, increase patient satisfaction. A preliminary round …

Educating Nurses On The Use Of Bedside Mobility Assessment Tool (Bmat) Through E-Learning/Online Education Module, Wei Li Lee

Master's Projects and Capstones

Background Hospital setting is reviewed the most hazardous workplace comparing to other industries. Nursing assistants and orderlies have the high risk of work-related injury. The study found that the top reason that causes the injuries was due to over-exertion or bodily reaction.

Aim State of California requires hospitals to implement a Safe Patient Handling and Mobility (SPHM) policy as part of an injury and illness prevention program (Department of Industrial Regulations, 2016). Bedside Mobility Assessment Tool (BMAT) is the latest evidence based practice, reliable and valid tool, which helps nurses to assess the patients’ current and ongoing mobility and to …

Chna: The Role Of The Hospital In Addressing Specific Community Health Needs, Yesmina L. Zavala

Master's Projects and Capstones

The Patient Protection and Affordable Care Act (ACA) added a requirement for nonprofit hospitals to keep their tax-exempt status under the Internal Revenue System Code 501(c) 3. This code requires all nonprofit hospitals to complete Community Health Needs Assessment (CHNA) reports every three years and must include input from community stakeholders and underserved individuals representing the low-income, minority and chronically ill population.

In addition to the CHNA, implementation strategies are required to be executed in the geographic areas served in order to meet the identified prioritized needs from the CHNA. Oftentimes, CHNAs are difficult to conceptualize and operationalize within the …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones

Master's Projects and Capstones

When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.

The purpose of this project was to gain a comprehensive understanding of the current handover process of …

Mental Health Workout: Lifting Stigma, Jeremy Bambery

Master's Projects and Capstones

Mental illness affects one out of every five Americans between the ages 13-18, and it is estimated that two-thirds of these individuals will not seek treatment due to the stigma associated with having a mental illness or mental health issue (National Alliance on Mental Illness). Access to information and the ability to talk openly without fear will aid in creating a stigma free future. The goal of this project is to supply high school students in the San Francisco Bay Area with information regarding the stigma associated with mental health and mental illness via videos that will be used as …

The Application Of The Literature Review Appraisal Toolkit On Environmental Health Systematic Reviews, Kristen M. Davis

Master's Projects and Capstones

Environmental health systematic reviews have long been of poor quality when comparing them to clinical health systematic reviews. The main reason for the poor quality of environmental health systematic reviews is the lack of a specific protocol. The University of California-San Francisco’s Program for Reproductive Health and the Environment has, because of the discrepancy, created a protocol specific to conducting environmental health systematic reviews. The protocols efforts would be futile without a nonbiased way to evaluate systematic reviews and therefore the protocol used. The Literature Review Appraisal Toolkit is a valuable tool created to navigate and evaluate the credibility of …

Minimizing The Inappropriate Use Of Physical Restraint, Shiela Marie C. Telmo

Master's Projects and Capstones

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower …

Discharge Prospectus, Cynthia Y. Vasquez

Master's Projects and Capstones

Background and Purpose:

The goals of the project are to improve the efficiency of the discharge process, to increase bed availability, to decrease readmission rates, and to increase patient satisfaction through implementation of multidisciplinary huddles.

Methods:

The intervention of the huddle took place on a medical-surgical unit at UC Davis Medical Center in the local Sacramento area serving various Medical Services.

This was a prospective pre- and post-quality intervention by utilizing HCAPHS survey, electronic medical record, RN surveys, and discharge data collection.

Results:

Discharges were increased from 15% to 23%. Currently, data is up-to-date for nine months but the project …

Evaluation Of The Nursing Handoff Process From Emergency Department To In-Patient Unit, Yana Marutyan

Master's Projects and Capstones

Handoff, or transition in care, is known to be a danger point in the patient care process for a long time. Ineffective communication during handoff is one of the most common identified cause of catastrophic or sentinel events in hospitals (The Joint Commission, 2015). Emergency department (ED) to in-patient unit handoff is particularly vulnerable to medical errors due to high workload, time constraints, different approaches to patient care, and lack of established relationships between care providers (Ong & Coiera, 2011; Hilligoss & Cohen, 2012).

The purpose of this project was to examine and review a current process of ED to …

Geographical Incidence Of Antimicrobial Resistant Gonorrhea, Christofer A. Rodriguez

Master's Projects and Capstones

Evolving throughout the last century, Gonorrhea has become a superbug, becoming difficult to treat. As the second most commonly reported notifiable disease, gonorrhea rates have been increasing, despite efforts in prevention and treatment. Populations at risk are mainly MSM and FSW. In 2015, men’s gonorrhea rates in the United States were higher compared to women, at 140.9 and 107.2 per 100,000 population, respectively. Illinois has consecutively had higher rates of infection compared to the US, at 133.5 per 100,000 population compared to the US rate of 123.9 per 100,000 population. The surveillance of gonococcal isolate resistance to current antimicrobials began …

Patient Care Sitter Reduction And Fall Safety Improvement, Timothy J. Bock

Doctor of Nursing Practice (DNP) Projects

The financial constraints imposed upon operational budgets by the frequent use of patient care sitters is well known among hospital leadership. Despite the high labor costs associated with direct and continuous observation, this intervention is routinely deployed by frontline care teams in an effort to preserve patients from harm, particularly from accidental falls. This reality creates an opportunity where significant budget savings can be achieved by supplanting the use of patient care sitters with more effective fall prevention strategies. This quality improvement (QI) project implemented a non-psychiatric sitter reduction and fall prevention initiative in two high volume adult acute care …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Nonpharmacological Approaches In Dementia Care, Gay Lynn Warren

Master's Projects and Capstones

The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to …

Chlorhexidine Gluconate Bathing In Hospitalized Patients: Reducing Barriers And Increasing Compliance Rate, Maria R. Dominguez

Master's Projects and Capstones

The organization-wide implementation of Chlorhexidine Gluconate (CHG) bathing protocol is one of many measures used to help reduce hospital-acquired infections (HAI) at the 30-bed, Medical-Surgical Specialties and Palliative Care Unit. CHG bathing compliance rate for the unit for the week of August 14-20 was 82.9%, with a 40.4% refusal rate. This is below the 90% desired performance rate. The purpose of this project is to identify the barriers to CHG compliance and to implement interventions that will aid in reducing these barriers and increase CHG compliance rate. Patient declining was identified as one of the main barriers to CHG bathing. …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Vitamin D, Calcium And Blood Pressure In The U.S., Sarah Bean

Master's Projects and Capstones

Vitamin D and calcium have received increased attention for their potential roles in improving cardiovascular health. The active form of vitamin D, 1,25-hydroxyvitamin D (25[OH]D), may influence blood pressure by increasing gastrointestinal calcium absorption. The objectives of this study were to first examine the association between blood pressure and blood serum 25(OH)D levels, and then explore the interaction between 25(OH)D, calcium intake, and blood pressure. Cross-sectional analysis featured 24,844 U.S. adults aged 20-80 years from three cycles of the National Health and Examination Survey (NHANES 2001-2006). Linear regression models were used to determine the adjusted association of 25(OH)D categories with …