Community Health Worker Program: Adverse Childhood Experiences And Early Childhood, Arelis Sandoval

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) negatively affect childhood development and long-term health outcomes. Latino children face multiple adversities and social determinants of health compounded by ACEs. Community Health Workers (CHWs) have access to work with families to improve resilience and mitigate the effects of ACEs in this population.

Local Problem: In the Central Valley of California, CHWs provide support and resources to a largely Latino population with increased poverty rates, low educational attainment, lack of health insurance, and many chronic health issues, putting families at a higher risk for ACEs exposure. CHWs need further training to apply ACEs knowledge to …

Save The Children Community Health Worker Program – Adverse Childhood Events Prevention, Jieun Lee

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur between the ages of 0 to 17 in which are directly associated, in a dose–response manner, to many of the most common and serious health problems in the United States.

Local Problem: 62% of California residents have experienced at least one ACE, and 16% have experienced at least four ACEs. ACEs are linked to nine of the ten leading causes of death in the United States Adults with four or more ACEs are 37.5 times more likely to attempt suicide, 3.2 times more likely to have chronic lower respiratory …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

The Dedicated Education Unit: Increasing Capacity And Confidence, Heather Marie Van Housen

Doctor of Nursing Practice (DNP) Projects

Background: In the American Association of Colleges of Nursing (AACN) 2020 annual survey, nursing schools turned away 66,274 entry-level applications to baccalaureate nursing programs in the United States due to a faculty shortage and clinical placement sites (AACN, 2021).

Local Problem: Hospitals need more qualified nurses to meet community needs. The need for clinical faculty and additional clinical placement sites disrupts the workforce pipeline through local nursing schools. A new approach to clinical education is needed to prepare more students for the growing complexities of independent nursing practice.

Methods: Dedicated Education Unit (DEU) implementation to expand pre-licensure nursing student clinical …

Determining Care Delivery Model Feasibility Using Discrete-Event-Simulation, Tanya Scott

Doctor of Nursing Practice (DNP) Projects

Background: The need for inpatient pediatric psychiatric services to address the growing issue of pediatric mental health in a multi-state integrated hospital enterprise is straining the system’s capacity to provide timely mental health care.

Local Problem: Lack of access to specialty pediatric psychiatric treatment for dual diagnosis medi-psychiatric care management is a patient quality and safety issue. Insufficient capacity contributes to longer emergency room boarding times and inpatient length of stay for patients who have a mental illness.

Methods: Use of digital simulation methodology to analyze the behavior of a dynamic event-driven care delivery workflow and to optimize quality patient …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Mental Health Services: Reaching The Homeless, Gurdeep Mann

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Serious mental illness (SMI) and substance use disorder (SUD) are two common findings among the majority of those experiencing homelessness in the Stanislaus County.

Local Problem: Emergency shelters typically do not provide mental health services on-site, however, a collaboration between First Behavioral Health Urgent Care Center (FBH) and We Care Program Turlock (WCPT) was established to provide mental health services on-site.

Method: The WCPT case manager as part of a Doctor of Nursing Practice (DNP) quality improvement project implemented Assertive Outreach Model interventions to increase utilization of mental health services and established long-term relationships.

Interventions: Frequent contact with …

Improving Patient Safety For Surgical Clearance: A Preop One Stop Shop, Anna Benedictos

Doctor of Nursing Practice (DNP) Projects

Problem: Medical clearance is required for patients scheduled for surgery, also known as “patient optimization.” Ineffective and inefficient patient optimization is a major contributor to surgery postponements, procedure cancellations, and patient dissatisfaction.

Context: Ambulatory care clinics often lack resources to medically clear patients prior to scheduled surgery. Poor surgical optimization continues to occur on the same day of surgery, resulting in case cancellation or delay in a suburban, 169 bed community hospital with 9 operating rooms and approximately 500 surgical procedures per month.

Interventions: A nurse-led PreOp One Stop Shop (POSS) utilized a standardized checklist to perform preoperative surgical assessment. …

Implementing An Infant-Driven Feeding Practice Model, Ann P. Nguyen

Doctor of Nursing Practice (DNP) Projects

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF).

The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature …

Improving Health Outcomes For Lgbtq+ Youth Through Provider Education, Marissa Simko

Doctor of Nursing Practice (DNP) Projects

Background and Problem: LGBTQ+ adolescents and young adults (ages 12-25 years) are known to have higher rates of physical and mental health concerns compared to heterosexual and cisgender youth. Within the LGBTQ+ youth community, rates of suicidality, substance misuse, homelessness, and STIs are higher than in the general population. LGBTQ+ youth have greater challenges accessing healthcare and higher rates of healthcare discrimination. This paper presents a quality improvement project focused on improving evidence-based practices in LGBTQ+ healthcare through the development and implementation of a LGBTQ+ youth centered educational workshop for healthcare providers.

Methods: This project was organized in …

Trauma-Informed Treatment For Alcohol Use Disorder: Improving Long-Term Recovery, Aline M. Bales

Doctor of Nursing Practice (DNP) Projects

Background: This DNP project aimed to assess the feasibility of implementing trauma-informed care to Ria Health's telehealth AUD MAT recovery treatment model for patients with co-occurring PTSD, targeting high relapse rates due to cravings. Trauma-informed care addresses traumatic histories that can potentiate emotional dysregulation leading to maladaptive coping responses manifesting as cravings with addiction memory.

Methods: An integrated review assessed the prevalence of co-occurrence of AUD and PTSD, assessed interest in Ria Health patients, patients recruited from Ria Health if they mentioned cravings, offered concurrent trauma-informed care with medicated assisted treatment for 16-20 sessions, trauma-informed care used Polyvagal Theory techniques …

School-Based Development And Implementation Of An Educational Toolkit, Chantel M. Kilford Ms

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice is to increase knowledge and confidence among healthcare providers and teachers within a high school setting by providing an educational tool kit about behavioral disorders in children. The disorders that will be focused upon are conduct disorder, oppositional defiant disorder, and common co-morbidities of these disorders. There will be education about an appropriate childhood, evidence based mental health assessment tool that assesses childhood mental health, including how to score the tool and interpret the results. Evidence suggests that healthcare providers and teachers are not confident or knowledgeable about identification, assessment, and behavioral …

Educating Novice Nurses And Nurse Practitioners About Military Sexual Trauma Screening, Alyssa D. Freeman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Military sexual trauma prevalence has continually increased over the past 25 years. Exposure to sexual trauma, violence, and abuse result in notable health consequences. The Veterans Health Administration has led the integration of universal Military Sexual Trauma (MST) screening and training. Purpose: The purposes of this project were to educate novice nurses and nurse practitioners about MST and to increase their knowledge and comfort in MST screening techniques. Methods: Following an educational session, a pre- and post-study design was used to evaluate improvement in knowledge and comfort screening for MST. Thirty-two participants including PBRNR Nurse Residents, …

Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

A Toolkit To Adequately Screen Pregnant Women For Depression And Thus Increase Screening In An Outpatient Obstetrical Clinic, Katherine Doherty

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal depression is a common health complication during pregnancy. Untreated depression among perinatal women is associated with adverse health outcomes for infants and mothers. Screening during the perinatal time period is needed to identify and treat depression and to prevent adverse health outcomes.

Purpose: The purpose of this clinical project is to equip health care providers with the knowledge and tools needed to screen pregnant women for depression and thus increase the amount of screening done in an outpatient obstetrical clinic.

Methods: An evidenced- based educational tool kit was developed to increase provider knowledge of perinatal depression …

Shared Decision Making For Primary Care Patients With Medical Complexities, Cori B. Fappiano

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Outcomes Of Directly Observed Therapy In People Living With Hiv Who Experience Homelessness And Substance Use Disorder, Mara C. Clawson

Doctor of Nursing Practice (DNP) Projects

Background: Antiretroviral directly observed therapy, in which nurses or other allied health professionals provide patients with daily medication, is an evidence-based solution for viral load suppression in people living with HIV who experience homelessness. Purpose: This quality improvement project aimed to assess the outcomes of antiretroviral directly observed therapy at one urban clinic caring for people living with human immunodeficiency virus who experience homelessness and substance use disorder. Methods: Data was collected from the electronic health record for the antiretroviral directly observed therapy patient cohort (n = 33); 10 of them were surveyed. Fisher exact tests determined nonrandom associations between …

Mindfulness Training In A Pediatric Practice With Adolescents And Young Adults, Rebecca Brady

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Access to support for behavioral and mental health in adolescents and young adults difficult. Depressive symptoms go unrecognized which can lead to severe symptoms, hospitalizations, and suicides. The lack of mental health services challenge the management of depression in this age group. Mindfulness may be a helpful tool in supporting mental health. Purpose: The purpose of this project was to improve depression symptoms among youth through engagement in mindfulness activities. Methods: A pre/post-intervention approach was used to measure the effectiveness of a synchronous, online educational platform to guide participants in mindfulness activities. Practice sessions were utilized based on …

Enhancing Transgender Informed Healthcare For Nursing Students: An Educational Intervention, Olivia Bass

Doctor of Nursing Practice (DNP) Projects

Background: Limited teaching of transgender related healthcare competencies is seen in baccalaureate nursing curriculum, resulting in inadequate preparation of healthcare providers to care for this population of patients. This discord can prevent transgender patients from seeking healthcare and affect access to needed services. Purpose: The purpose of this DNP project was to educate accelerated Bachelor of Science in Nursing students at an institute of higher education on providing culturally responsive healthcare for transgender patients. Methods: An in-person educational intervention focused on improving clinical and cultural knowledge for transgender patients was implemented and evaluated. A pre-intervention survey and post-intervention survey …

Implementation Of An Acne Management Smartset To Guide Primary Care Providers’ Management Of Acne Patients, Emily Thomas

Doctor of Nursing Practice (DNP) Projects

Background: Primary care providers (PCPs) commonly refer adult acne patients to dermatology due to lack of confidence in treatment initiation and maintenance, resulting in delayed patient care, limited access to dermatology appointments, and an ongoing knowledge gap within the primary care setting. Purpose: To support PCPs with acne diagnosis and treatment recommendations by hosting acne education sessions and implementing an Acne Management SmartSet for acne treatment. Methods: The DNP student held acne education sessions during staff meetings at two primary care sites, then disseminated surveys to participants to determine if the education session and SmartSet were clinically useful. Data pertaining …

Screening For Opioid Use Disorder In Emergency Department Observation Unit Patients, Kendra M. Cull (Lehman)

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Opioid use disorder (OUD) is an issue that impacts the healthcare system daily, and has been declared a national public health concern Purpose: The purpose of this DNP Quality Improvement (QI) project was to screen patients aged 16 and older for Opioid Use Disorder (OUD) who presented to the Emergency Department Observation Unit (ED OBS) in a Urban Academic Medical Center regardless of chief complaint. The goal of this project was early identification of OUD and rapid referral to outpatient resources to facilitate recovery compliance. Methods: The QI project utilized a registered nurse led screening …

Diabetes Prevention And Management Education For Punjabi-Sikh Older Adults, Mandeep K. Gill

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: South Asians from Bangladesh, Pakistan, and India have a higher prevalence of diabetes than the general global population and are also more susceptible to developing diabetes due to biological and lifestyle factors. The South Asian diet is high in refined grains and monounsaturated fatty acids, increasing the risk of diabetes.

Local Problem: Congregants of a Sikh gurdwara (place of worship) lacked knowledge of diet and lifestyle in relation to preventing and managing diabetes. Many senior congregants have been diagnosed with diabetes or are at high risk of developing the disease.

Methods: Knowledge of diabetes prevention and management were …

Decreasing Seclusion And Restraint Events Among Clients Within An Inpatient And Crisis Stabilization Behavioral Health Facility, Karen Lee Richards

Doctor of Nursing Practice (DNP) Projects

Background: Despite global shifts in behavioral health treatment, changes regarding use of seclusion and restraint (S/R) continues to be extremely slow. Local Problem: Increasing S/R events and subsequent staff injuries and financial burden. Methods: A quality improvement project providing education in trauma-informed care (TIC), sensory modulation (SM), and S/R debriefing (S/RD). Interventions: Education and training for S/RD, TIC, and SM using a variety of materials and methods over a 6 to 12-month period was provided to staff within a 16-bed inpatient adult psychiatric health facility (PHF) and a crisis stabilization unit (CSU). Because of positively affecting the use of S/R, …

Engaging Rural Providers About The Potential Of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs, Joshua M. Cleary

Doctor of Nursing Practice (DNP) Projects

Abstract

This paper describes a DNP project that was designed to address the issue of rural mental telehealth implementation barriers. One of the main barriers to rural telehealth programs has been a technical infrastructure incapable of adequately hosting the telehealth programs. Low-Earth orbit (LEO) internet technology has emerged as a way to solve the rural telehealth conundrum by offering an improved rural technical infrastructure. An integrated review was completed based on the following PICOT question: In rural providers, how does an educational outreach compared to no educational outreach affect provider adoption of new technologies? The evidence showed educational sessions as …

Improving Home Health Nurses' Knowledge Of Heart Failure Self-Care Management, Nenette Hoffman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure results in life-altering and devastating illnesses, predominantly among older adults. Heart failure management is complex, and requires patients and their caregivers to actively monitor symptoms and sufficiently understand care management to maintain health-promoting behaviors. While home health nurses have the primary role as patient educators of their patients with heart failure, evidence from the literature indicates that nurses lack sufficient knowledge to fulfill this role.

Local Problem: Nurses’ inadequate knowledge of heart failure self-care management has been associated with insufficient patient education, the inability of patients to perform heart failure self-care management, worse clinical outcomes, and …

Oleoresin Capsicum Gel: Enhancing Safety For The Home Health Clinician, Lilly Dickens

Doctor of Nursing Practice (DNP) Projects

Problem: Home health clinicians (HHC) are at high risk for workplace violence. Providing necessary health care alone in unpredictable and remote environments are associated with poor outcomes from physical violence. Background: Pepper spray is known for its active ingredient, oleoresin capsicum (OC), as a self-defense tool. OC gel is used worldwide as a non-lethal incapacitating agent. There is an opportunity to expand workplace violence prevention (WPV) in home health by training and allowing HHCs to carry OC gel. Intervention: This DNP QI project implemented a safety intervention for HHCs, including nurses, aides, medical social workers, physical therapists, occupational therapists, and …

Advancing Treatment For Opioid Use Disorder In A Rural Emergency Department, Jill M. Wabbel

Doctor of Nursing Practice (DNP) Projects

Background: The opioid epidemic escalated in the United States due to the availability of prescription opioids, heroin, and synthetic opioids like fentanyl. Unfortunately, access to treatment is not always accessible, especially in rural communities with limited resources.

Local Problem: Tehama County is a rural county in northern California with limited access to treatment for opioid use disorder. The local Emergency Department (ED) and primary care-based Medication-Assisted Treatment (MAT) clinic collaborated to increase access. However, services remain under-actualized due to limited understanding of MAT best practices, stigma related to substance use within the ED culture, and poor articulation between the ED …

Educating Providers Without Prescriptive Authority About Psychopharmacology Basics: Bridging The Interdisciplinary Work Among Psychotropic Prescribers And Psychologists, Olivia Ceja

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the fund of knowledge among psychologists, licensed clinical social workers, and talk therapists in outpatient psychiatric settings by educating clinicians about psychopharmacologic basics and the role and work of a psychiatric nurse practitioner during group supervision meetings. This can help bridge the gap of psychopharmacologic knowledge between mental health providers with and without prescriptive authority.

Problem: Evidence shows that psychologists with non-prescribing capabilities are not often trained or educated about the very medications that their clients are often taking. Currently, psychotropic medication education is not a standard aspect …

Improving Colorectal Cancer Screening In Primary Care, Bushra Iqbal

Doctor of Nursing Practice (DNP) Projects

Colorectal Cancer (CRC) is the second leading cause of cancer related deaths in the U.S., although it is preventable with adequate routine screening. Medically underserved minorities and immigrants require screening program awareness in their respective communities. The incidence of CRC remains markedly high despite the screening modalities among various populations. In the United States (U.S.), there were approximately 147,950 reported CRC diagnoses, 53,200 deaths, and over 35.2 cases per 100,000 in California alone reported in 2020 (Siegel et al., 2020). Healthcare providers can prevent colorectal cancer (CRC) through adequate routine screening. Various screening practices are widely implemented in primary cases …

Community Health Worker Program - Substance Use Disorder In Pregnancy, Alicia Claire Kletter Dnp

Doctor of Nursing Practice (DNP) Projects

Background Substance use disorder (SUD) in pregnancy is a concern for mother, baby and community. Healthcare policies are increasingly calling for diversification of the workforce to meet healthcare needs. Community health workers (CHWs) are understood from the literature to be effective at bridging the gap between patient and healthcare provider, especially for vulnerable populations. Local Problem California’s Central Valley is majority Latinx and faces challenges from poverty, lack of medical resources, unemployment and SUD at rates which are higher than other communities. Combine SUD with pregnancy and the need for robust social connections, psychological support, and physical healthcare become even …