Digital Commons Network^™

Evaluation Of Breastfeeding Interventions To Improve Duration In Women At Risk For Breastfeeding Attrition, Anthonia Anukam

The Corinthian

Children that are optimally breastfed have the healthiest start in life. The World Health Organization and the CDC recommend that mothers optimally breastfeed. Benefits of breastfeeding to children include the receipt of antibodies, reduction of ear, respiratory, and gastrointestinal infections, decreased sudden infant death syndrome, allergies, diabetes, and childhood leukemia. Several research studies have reported a strong positive correlation between breastfeeding and reduced infant morbidity and mortality. Evidence illustrates that the health benefits from breastfeeding are dose-dependent, thus the longer the breastfeeding duration the greater the acquisition of the enumerated benefits. However, premature cessation of breastfeeding less than the WHO …

Analyzing The Cognitive Complexity Of The Questions On The Advanced Placement Computer Science Principles Exam, Lauren Zirpoli

Seton Hall University Dissertations and Theses (ETDs)

This convergent parallel mixed methods study with qualitative and quantitative content analysis was conducted to analyze and describe the cognitive complexity of the publicly released Advanced Placement Computer Science Principles Exam questions compared to the language of higher-order thinking found in research literature. Hess’ Cognitive Rigor Matrix was used to determine the frequency and percentage of questions categorized as higher-order thinking within each cell of the matrix. The qualitative method consisted of content analysis of the language of each question analyzed, followed by deductive coding, and culminated with categorizing the depth and type of thinking required on Hess’ Cognitive Rigor …

Atrial Fibrillation, Julianna G. Perritt, Jennifer Goldsberry

The Corinthian

Atrial fibrillation, also known as A-Fib or AF, is a cardiovascular abnormality that is characterized by an abnormal heart rhythm or muscle contractions in the atria. These abnormalities are a result of disorganized electrical impulses. AF has various causes including, but not limited to, hypertension (HTN), heart surgery, thyroid disorders, heart defects, and acute alcohol ingestion. Persons with AF are often asymptomatic; however, some patients report heart palpitations, chest tightness, shortness of breath, and lightheadedness. A review of literature was conducted in order to determine the availability of risk factors, patient education, and treatment of AF.

Initiating Access To Palliative Care Earlier In Pediatric Oncology Patients, Anita Sharma

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Pediatric oncology patients should be referred to palliative care early but despite research indicating the clear benefits, there is still a delay in referring patients. One of the reasons include lack of understanding amongst providers on what palliative care is. Palliative care provides symptom management, emotional support and helps the patient and family with difficult decision making.

Objectives: This project aimed to increase the number of early referrals to palliative care. The Pediatric Palliative Care Screening Tool (PaPas) was utilized to help identify the triggers which should prompt the referral.

Methods: A chart review of patients diagnosed with …

Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im

Master's Projects and Capstones

In 2024, South Korea surpassed every other nation by becoming the country with the lowest fertility rate (below 0.7%). Population decline will hinder future ability to care for their aging population and although the government and private corporations are investing millions of dollars on developing Artificial Intelligence-Internet of Things (AI-IoT) devices to support the aging, the acceptance levels and the amount of family support required is undervalued. By examining AI-IoT’s current use and role in South Korea’s public health system this paper shows how intergenerational support helps optimize existing procedures and equipment, increases the level of acceptance and use, and …

Dnp Final Report: Addressing Incivility In Nursing Education: An Evidence-Based Practice Project, Michelle L. Forgy

DNP Final Reports

Incivility in nursing education remains a pervasive issue, necessitating effective interventions to address its impact on students and faculty. This project was conducted to address a perceived problem of incivility in a nursing school in northeast Texas. Guided by the Johns Hopkins evidence-based practice model, an evidence search followed by critical appraisal was undertaken to determine the most effective intervention to combat incivility within the nursing school. Because the project included no experimental procedures and did not pose physical or emotional risks to nursing students or faculty, the organizational IRB approved the project. An evidence-based educational session incorporating cognitive rehearsal …

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

Standardizing Nurse Knowledge Exchange In The Peripartum Mesosystem, Gabrielle Ann Romena

Master's Projects and Capstones

Problem Handoff report is a significant source of medical error, as reported by the Joint Commission. As it stands, Hospital A’s peripartum mesosystem has no standardized policy regarding the Nurse Knowledge Exchange (NKE) process. Context Hospital A is an urban tertiary care medical center in San Francisco, with its peripartum mesosystem divided into two floors with a total of 35 dedicated beds. Intervention Stakeholder engagement, literature review, and mesosystem analysis identified potential barriers to bedside NKE. To address the identified causes, the project implemented a standardized handoff guide and staff education. Measures The outcome measured was comprehensiveness of NKE as …

Raising The Bar: Optimizing Peripartum Handoff Through Standardized Nurse Knowledge Exchange (Nke), Kimberly Martinez Rn

Master's Projects and Capstones

Problem Hospital X’s peripartum microsystem has no policy guiding the Nurse Knowledge Exchange (NKE) process. Variability in handoffs during patient transfers could lead to medical errors and adverse events. This quality improvement (QI) project aims to pilot a standardized handoff guide to improve nurse communication and avoid adverse patient outcomes following patient transfers. Context The setting for this QI project was a peripartum mesosystem at an urban hospital located in Northern California with 21 postpartum rooms and nine labor rooms. Intervention The project employed a systematic approach that involved engaging stakeholders, analyzing microsystems, reviewing literature, and analyzing data to identify …

Pain Assessment And Reassessment Documentation Improvements In Medical-Surgical Units, Alicia Espinoza

Master's Projects and Capstones

Problem Pain management is essential when providing quality care, and adequate documentation of pain assessment and reassessment with administration of opioid pain medications by nurses is necessary for patient safety and satisfaction. Context Nurses play a pivotal role in providing safe and effective administration of opioid pain medication and documentation of pain assessments. This quality improvement (QI) project aimed to increase opioid medication administration assessment and documentation compliance rate for nurses to 90% or greater in two medical-surgical units. Intervention A knowledge check survey was utilized to assess nurse understanding of required data needed to document, and timing for documentation …

Educating Inpatient Pediatric Registered Nurses On The Setup And Administration Of Prolonged Intravenous Antibiotics And The Reduction Of Medication Errors, Kiara Hayden

Master's Projects and Capstones

Problem The acute care unit microsystem of a California children’s hospital encounters issues involving the incorrect set up and administration of prolonged intravenous (IV) antibiotics and medication errors, such as delivery at the wrong rate or time. These problems can result in negative patient health outcomes, delayed healing, antibiotic resistance, and increased length of hospital stay and costs. Context A collaborative quality improvement (QI) project was launched to target the pediatric population of this particular microsystem. The aim of this project was to standardize prolonged IV antibiotic practices, disseminate knowledge while using evidence-based practice (EBP), and improve patient outcomes. Interventions …

Improving Prolonged Antibiotics Education In A Pediatric Unit, Zerena S. Silva Villamonte

Master's Projects and Capstones

Problem Children’s Hospital A's incidence report tool, iCares, demonstrates that 50% of the issues related to prolonged intravenous (IV) antibiotics are categorized as administration issues. This leads to the medication being delivered at the wrong time or rate. Having these issues increases patient length of stay, increasing hospital costs. Context The microsystems for this quality improvement project include inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s Hospital A is a 361-bed San Francisco Bay Area hospital. Interventions The Clinical Nurse Leader students implemented a presentation defining prolonged IV antibiotics, their rationale, and a video demonstrating the correct …

Unlocking The Potential Of Peripartum Handoff: Standardizing Nurse Knowledge Exchange (Nke), Kiana Killian

Master's Projects and Capstones

Problem The absence of a structured and standardized handoff during patient transfers may result in the unintentional omission of patient information, medical errors and adverse events. No standardized bedside handoff process, referred to as Nurse Knowledge Exchange (NKE), was observed in Hospital A’s peripartum mesosystem during patient transfers from the Labor and Delivery (L&D) unit to the Postpartum unit. Context Hospital A is a medium-sized urban hospital located in Northern California. The peripartum mesosystem includes 21 postpartum rooms and nine laboring rooms. Intervention Through the recruitment of stakeholder engagement, review of literature supporting evidence-based practices, and a mesosystem assessment, a …

Reducing Indwelling Urinary Catheter Days: Improving Interdisciplinary Communication In A Surgical Intensive Care Unit, Karen M. Wong

Master's Projects and Capstones

Problem Urinary catheter nurse-driven removal protocols (UCNDRPs) are evidence-based algorithms that promote the timely removal of indwelling urinary catheters (IUCs) and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers hinder consistent implementation of the UCNDRP, resulting in delayed IUC removal and increased risk of CAUTIs. Context This quality improvement project was conducted in a 16-bed surgical intensive care unit (SICU) in an academic medical center in the San Francisco metropolitan area. Interventions Urinary catheter reminder posters displaying the duration of IUC days were placed at the bedside to prompt interdisciplinary communication about IUC indication and removal. An email detailing the …

Transforming Peripartum Nurse Knowledge Exchange (Nke) Through A Standardized Handoff Guide, Lillian Quach

Master's Projects and Capstones

Problem: Medical errors and adverse events can result from inconsistent handoffs during patient transfers. As seen in Hospital A’s peripartum unit, there is no formal policy regarding the handoff process, also known as the Nurse Knowledge Exchange (NKE). This quality improvement project aims to introduce a standardized handoff guide to enhance communication and minimize harmful outcomes following patient transfers.

Context: The setting for this project is an urban hospital in Northern California with nine laboring beds and 21 postpartum beds.

Interventions: The project employed a systemic approach involving stakeholder involvement, literature review, and data analysis to identify areas for improvement …

Increasing Opioid Pain Pre-Assessment And Reassessment Documentation Rate In Medical-Surgical Units, Hae Rim (Helen) Hwang

Master's Projects and Capstones

Problem The fifth vital sign, pain, requires proper pain management in hospital settings, often involving opioids with significant risks of adverse reactions. Appropriate pain assessment and management is vital to ensure safe medication administration and mitigate potential adverse reactions.

Context This quality improvement (QI) project aimed to enhance opioid assessment and documentation rate above 90% compliance in two medical-surgical units, with a focus on bedside nurses. Nurses play a key role in administering and documenting pain assessments, a practice crucial to managing patient safety and effective pain management specific to opioid use.

Intervention A baseline survey provided nurses’ understanding on …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

Empowering Nurse-Driven Removal Of Indwelling Urinary Catheters In The Surgical Intensive Care Unit: A Quality Improvement Project, Ellen Ruby Hann

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Increasing Adherence To A Nurse-Driven Removal Protocol To Reduce Indwelling Urinary Catheter Days, Hannah K. Brosnan

Master's Projects and Capstones

Problem

Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs.

Context

The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area.

Interventions

Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Digital Health Literacy, Vaccine Information Sources, And Vaccine Acceptance Among Parents In Ontario: Quantitative Findings From A Mixed Methods Study, Sarah Ashfield, Lorie Donelle Phd, Rn, Fcan, Panagiota Tryphonopoulos, Ève Dubé, Maxwell Smith

Faculty Publications

Parents make important vaccination decisions for their children and many variables affect parents’ decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents’ digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across …

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Nurse-Led Telehealth Visits For Patients With Multiple Sclerosis During The Covid-19 Pandemic And Beyond, Eun Hye Kim

Doctor of Nursing Practice (DNP) Projects

Background: Nearly one million individuals are affected with Multiple Sclerosis (MS) in the United States, and it was estimated the annual economic burden of multiple sclerosis in the U.S. at over $85.4 billion in 2022.

Problem: During the outbreak of COVID-19, the number of nurse-led patient education sessions has decreased due to the conversion of in-person clinic visits to telehealth visits. Despite the widespread use of telehealth for MS patients post-COVID-19 pandemic, limited data is available about the use of nurse-led telehealth visits with a standardized workflow.

Method: A quality improvement project was implemented at the MS clinic in Northern …

Fostering Interprofessional Collaboration In Community College Mental Health Centers: A Quality Improvement Project, Sara Jane Hamilton

Doctor of Nursing Practice (DNP) Projects

Background The worsening mental health rates among college students in the United States highlight the critical need for campuses to have high-quality comprehensive mental health centers (MHC). This necessity is particularly urgent in community college MHCs, which often lack these attributes. Local Problem An MHC within a large California community college recently introduced telepsychiatry services and is considering integrating a Psychiatric Mental Health Nurse Practitioner (PMHNP) into their team. However, knowledge gaps and limited interprofessional education (IPE) may hinder effective collaboration within the team. Methods A comprehensive literature review was conducted to assess current research on IPE, community college mental …

Implementing Diabetic Eye Care Education For Healthcare Professionals, Misun Serena Moser

Doctor of Nursing Practice (DNP) Projects

Background: Diabetic retinopathy (DR) is the most common cause of diabetic eye complications and a leading cause of preventable vision loss in American adults. Skaggs et al. (2017) reported that DR screening prevents vision loss by 95%. The evidence reports that only 60% of people with diabetes have attended the recommended DR screenings (Flaxel et al., 2020). Emerging evidence supports patient education about diabetic eye care and its guidelines by health care professionals (HCPs) as the main facilitator to accomplish this goal (Khair et al., 2020; Moinul et al., 2020). Healthcare professionals are pivotal in encouraging or discouraging DR screening …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …