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2018

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Articles 1 - 30 of 12332

Full-Text Articles in Medicine and Health Sciences

Quality Improvement Initiative Aimed At Reducing Catheter-Associated Infections And Foley Days In The Surgical Setting, Linda D'Antonio Dec 2018

Quality Improvement Initiative Aimed At Reducing Catheter-Associated Infections And Foley Days In The Surgical Setting, Linda D'Antonio

Seton Hall University DNP Final Projects

Purpose: This purpose of this project was to implement a quality improvement initiative

focusing on reducing catheter-associated urinary tract infections (CAUTIs) in the surgical setting of Overlook Hospital Medical Center. The project looked at current literature which discussed evidence-based and best practice used in preventing CAUTIs. The literature was presented to nurses and staff in the surgical setting.

Significance: The significance of the project was to initiate quality improvement by teaching

staff evidence-based and best practice in Foley usage and maintenance to reduce the frequency of

CAUTIs.

Methods: This project employed the methodology of ...


Stroke Clinical Order Pathway Education (Scope) For Apns, Varsha Singh Dec 2018

Stroke Clinical Order Pathway Education (Scope) For Apns, Varsha Singh

Seton Hall University DNP Final Projects

More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across ...


Food Access And Dignity Among University Of Wyoming Students, Alanna Elder Dec 2018

Food Access And Dignity Among University Of Wyoming Students, Alanna Elder

Honors Theses AY 17/18

Because Albany County is the home of the state’s only four-year university, there is a question as to how the student population affects the proportion of county residents considered food insecure. Until now, it has been unclear how many students are struggling to access food. In 2017, a group of University of Wyoming faculty and administrators from the Department of Agricultural Economics, Financial Services, and the Office of Academic Affairs signed up for The Ohio State University’s College Study on Financial Wellness, which included a food security module (Alexander). Surveying 722 undergraduates and using USDA metrics, the researchers ...


Healing Wounds Through Nutrition, Deanna Garza Dec 2018

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound ...


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Caritas Intervention To Reduce Stress And Increase Resilience Among Caregivers, Randy L. Williams Ii Dec 2018

Caritas Intervention To Reduce Stress And Increase Resilience Among Caregivers, Randy L. Williams Ii

Doctor of Nursing Practice (DNP) Projects

Problem

Workplace stress and burnout consistently rank among the highest concerns in surveys of caregivers. A gap analysis was conducted among a group of patient care coordinators and medical social workers. The gap analysis identified a need for tools to address stress, feelings of being overworked, and irritability.

Context

The setting is an acute care trauma facility providing care to general medical–surgical adult patients, cardiac care, pediatrics, and maternal child care. This facility exists within a larger integrated health care system, consisting of more than 20 acute care facilities in Northern California. The participants were patient care coordinators and ...


Medication Error Prevention: Improving Patient Health Outcome, Brigitta Van Ewijk Dec 2018

Medication Error Prevention: Improving Patient Health Outcome, Brigitta Van Ewijk

Master's Theses

Medication administration errors were reported to have an error rate of 60% in early research mainly in the form of the wrong dose, time, or rate. Working conditions were found to be one of the main contributors to these errors. Recognizing and reporting medication errors are key to the implementation of the reduction of this critical health problem (Hughes & Blegen, 2008). DataRay Inc. (n.d.), states that almost one in five medication doses administered in hospitals is given in error. The two most common errors were (1) dispensing medicine at the wrong time (43% of incidents) and (2) omitting a dose (30%). The goal is to increase the nurses’ awareness of the different processes of medication administration and how error-prone these are.

The medication observation will take place during the hours of 0700-1000, and the nurses will use orange vests with “MEDICATION PASS IN PROGRESS; PLEASE DO NOT DISTURB” during the medication administration process for reduction and prevention of interruption. The nurses will be observed for correct use of the electronic health record system (EHR) during the transcription process throughout the day shift (0730-1530).

The result ...


Reexamining Overuse Of Frequent Observation For New Admissions On Psychiatric Units To Increase Nurse/Patient Engagement, Samuel Novela Dec 2018

Reexamining Overuse Of Frequent Observation For New Admissions On Psychiatric Units To Increase Nurse/Patient Engagement, Samuel Novela

Master's Theses

People in California who suffer from mental health conditions are often admitted involuntarily to hospitals on 72 hour psychiatric evaluation holds if they are deemed imminently dangerous to themselves, or others, or are gravely disabled. Observational patient safety checks are performed and based on patient acuity and hospital standards. Variations exist among different clinical settings with regard to best practices and the patient subpopulations that may warrant less frequent safety checks. Nurses experience different levels of satisfaction with regard to frequency of safety checks because there is no national consensus on which subsets of patients may require them. A senior ...


Finding The Narrative In Incident Reports, La'eeqa Aslam Dec 2018

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In ...


Post-Traumatic Stress Disorder Screening Project For Adult Males From The Middle East And Afghanistan, Ricky Norwood Dec 2018

Post-Traumatic Stress Disorder Screening Project For Adult Males From The Middle East And Afghanistan, Ricky Norwood

Master's Projects and Capstones

Current research indicates a significant rise in PTSD signs and symptoms of adult males arriving from the Middle East and Afghanistan. In an effort to increase the awareness of Post-Traumatic Stress Disorder (PTSD) in clinical personnel and adult males from the Middle East and Afghanistan, the Sacramento Refugee Health Clinic implemented a PTSD Screening Project. This project was designed to ensure the maximum number of the adult males from the Middle East and Afghanistan would be appropriately screened for PTSD and provided additional opportunities to meet the mental and acute primary care needs of these patients in an adequate and ...


Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan Dec 2018

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the cost ...


Implementing Ihi Joy In Work Framework To Decrease Turnover Among Unit Leaders, Allison Reid Dec 2018

Implementing Ihi Joy In Work Framework To Decrease Turnover Among Unit Leaders, Allison Reid

Doctor of Nursing Practice (DNP) Projects

Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016).

Context: According to Loveridge, the turnover rates ...


Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock Dec 2018

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The ...


Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright Dec 2018

Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through ...


Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis Dec 2018

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person ...


Health Care Improvement Initiative: Outcomes And Impact Of An Academic-Practice Partnership Between A Large Integrated Health System’S Nurse Scholars Academy And The University Of San Francisco School Of Nursing And Health Professions, Ryan Fuller Dec 2018

Health Care Improvement Initiative: Outcomes And Impact Of An Academic-Practice Partnership Between A Large Integrated Health System’S Nurse Scholars Academy And The University Of San Francisco School Of Nursing And Health Professions, Ryan Fuller

Master's Projects and Capstones

By December 2018, a large integrated health system’s Nurse Scholars Academy (NSA) will have financially-sponsored 64 registered nurses to return to school through a strategic academic-practice partnership program at the University of San Francisco (USF). Referred to as ‘Nurse Scholars,' health system employees elected to return-to-school through NSA. As a five-year initiative, NSA was at risk for not receiving additional funding beyond 2020 without a thorough outcomes analysis that articulated the outcomes to executive leadership.

This health system employs more than 23,000 registered nurses in Northern California (NCAL). The NSA is a region-wide effort to accelerate academic progression ...


Creating A Culture Of Learning: Improving Patient Mobility In A Medical-Surgical Unit, Camille Cabalsa Dec 2018

Creating A Culture Of Learning: Improving Patient Mobility In A Medical-Surgical Unit, Camille Cabalsa

Master's Projects and Capstones

Abstract

PROBLEM: Hospitalization, especially among older adults aged 65 or over, can result in decreased mobility and functional decline. This decreased mobility can lead to accelerated bone loss, falls, increased length of stay, and delirium. In this medical-surgical unit, a pattern reflecting lack of adequate patient mobility has persisted over one year.

CONTEXT: Northwest (NW), a 42-bed community hospital medical-surgical unit- part of an integrated regional health care delivery system, has not been maximizing the mobilization of their patients for the past year based on internal data.The improvement project described in this paper focused on creating a culture of ...


An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain Dec 2018

An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain

Master's Projects and Capstones

Abstract

Problem: This project aims to decrease the discharge time of a patient from the hospital once the discharge order has been written. Current discharge times are averaging over 3 hours, leading to a breakdown in the patient throughput process. A patient survey was conducted to determine the reason for prolonged discharge times. The survey revealed that patients are not aware of their day of discharge, which may lead them to being discharged without transportation home. Many studies conclude that there are improvement opportunities around discharge planning and communication.

Context: This quality improvement initiative takes place in a 26-bed, medical-surgical ...


Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm Dec 2018

Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of ...


Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel Dec 2018

Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel

Master's Projects and Capstones

Improving Knowledge and Attitude of Primary Healthcare

Givers Towards Vulnerable Populations

Kimberly Shankel

University of San Francisco

Abstract

Problem

This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.

Context

The site for this quality improvement project is a small suburban hospital ...


Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira Dec 2018

Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira

Master's Projects and Capstones

Abstract

PROBLEM: From October 2017 through June 2018 there were 25 patient falls recorded on the 5th floor medical surgical telemetry unit. Top factors contributing to this high fall rate include: poor patient-centered-care planning, and inadequate set-up for use of technology.

CONTEXT: According to the Joint Commission, 2015, each fall with injury costs $14,000. This estimate doesn’t include the potential indirect costs that account for the long-term effects of injuries such as disability, dependence on others, lost time from work, household duties, and reduced quality of life.

INTERVENTIONS: Staff education was introduced and focused on using a ...


Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara Dec 2018

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus ...


Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson Dec 2018

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted ...


Defying The Gravity Of Falls On Msu, Alvin Joseph Abad Dec 2018

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be ...


Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu Dec 2018

Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu

Theses & Dissertations

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening ...


Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo Dec 2018

Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo

Master's Projects and Capstones

Abstract

Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is ...


Scheduling Autonomy For Nursing Staff Retention, Gina Fungcharoen, Gina Fungcharoen Dec 2018

Scheduling Autonomy For Nursing Staff Retention, Gina Fungcharoen, Gina Fungcharoen

Master's Projects and Capstones

It is the obligation of the Clinical Nurse Leader to place their skills up against the pulse of the microsystem they work within. This nursing leader is in a position to observe and react to flaws that affect their specific workforce. This microsystem project will provide an evidence-based perspective on how to improve monthly scheduling within the unit of 4 South, Surgical Intensive Care. The intent is to increase nurse retention as a function of improved scheduling efforts, allowing staff the ability to manage their own exchange of shifts while addressing the daily staffing needs of the unit. Despite efforts ...


Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis Dec 2018

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in ...


Ultrasound Use In Resource-Limited Settings: A Systematic Review, Ravindra Gopaul, Gonzalo Bearman, Michael P. Stevens Dec 2018

Ultrasound Use In Resource-Limited Settings: A Systematic Review, Ravindra Gopaul, Gonzalo Bearman, Michael P. Stevens

Journal of Global Radiology

Purpose: Over the past decade, ultrasound (US) machines have become smaller, less expensive, more reliable, durable and user-friendly, making ultrasonography an ideal imaging modality in resource-poor settings. We conducted a literature review to examine the use of ultrasound in resource-limited settings, with emphasis on common applications, barriers to implementation, and impact on clinical decision-making and patient disposition.

Methods and Materials: Literature review. We conducted a PubMed and Cochrane Central search on the clinical use of ultrasound in the developing world. Search terms included ultrasonography, developing countries, resource limited, remote setting, poverty, and low income. Articles from 2000 to 2015 that ...


Penjual-Parfum-Perangsang-Phero-X.Jpg, Zengda Farma Dec 2018

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