Digital Commons Network^™

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Hospital Acquired Pressure Injury Prevention: A Quality Improvement Project, Sukhjit Dhillon

Master's Projects and Capstones

Abstract

Hospital Acquired Pressure Injuries (HAPI) can be costly for the hospitals and devastating for the patients. Most pressure injuries are considered preventable, but despite that a lot of Americans die from pressure injury related complications each year. Hospitals spend billions of dollars on pressure injuries which can be used for other treatments. A quality improvement project was created to address these concerns and improve patient care. There were 5 cases of HAPIs on the telemetry/stroke unit prior to the start of this project. Interventions were created to improve the outcome. After careful review of the related literature, HAPI prevention …

Transformational Relationships: Re-Framing Impact In Faith-Based Social Service Organizations, Sonja E. Schappert

Master's Projects and Capstones

Theories of change and logic models are the industry standard foundation for impact evaluation. However, half of all nonprofits do not use these models due to resource constraints or the perception that their work does not fit into a model. This is especially true in relationship-based programs, such as those in faith-based social services. This Capstone examines the influence of relationship theory on a faith-based organization’s impact. The research methodology included deductive, action-based research with a foundational literature review focused on nonprofit planning and evaluation theory and social science theory. Then a total of 6 expert interviews were conducted, 3 …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …

Transformational And Transactional Leadership Outcomes On The City Of Oakland By Demographics, Jason W. Mitchell

Doctoral Dissertations

This study utilized a quantitative method, using surveys of workers in the public sector in the City of Oakland to determine the barriers that make it difficult to manage performance and tackle complex issues of that organization. Further, this study delved into the possibility for these leaders to create transactional or transformational environments in this sector. The goal was to find issues that make it difficult for public-sector executives to lead effectively; that is, the goal was to discern factors that prohibit executives from delivering high-quality and efficient services to the public and developing change management. This survey is vital …

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Multilingual Museums: A Proposal To Increase Linguistic Diversity In Contemporary Art Museums, Jennifer Cha

Master's Projects and Capstones

The U.S. population is becoming more ethnically, racially, and linguistically diverse. It is estimated that by the year 2050, the U.S. will shift to a majority-minority population, meaning that the total minority population will become the majority of the U.S. population. But while the U.S. is diversifying, the current museum visitorship demographic is not representative of or on track to measure up to these changes in the future. If museums are valuable civic spaces with several associated health, social, and educational benefits, and a large percentage of the population have low-English proficiency and cannot access the information, then there is …

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 …

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, leadership development, …

Mission Enactment And Strategic Enrollment Management At Jesuit Universities, Drew Roberts

Doctoral Dissertations

The larger neoliberal environment that is driving all of higher education has left Jesuit universities and their leadership to face two problems. First, the ability for Jesuit universities to uphold their social justice inspired mission and offer an affordable and accessible liberal education is being threatened because they are pricing out those they seek to serve. Second, there is a growing disconnect between the espoused mission of Jesuit universities and the decisions that their leaders and administrators make to run the enterprise.

This explanatory case study seeks to understand the ways senior-level strategic enrollment officers at Jesuit universities experience and …

Improving Quiet-At-Night On A Telemetry Unit: Introducing A Holistic Sleep Menu Intervention, Christian Karl Antonio

Master's Projects and Capstones

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, …

Reducing Patient Harm From Catheter Associated Urinary Tract Infections: A Quality Improvement Project, Grace Cooper

Master's Projects and Capstones

Abstract

Problem: The Institute of Medicine’s seminal report on patient safety, To Err Is Human led to widespread effort to improve the safety of patients. Healthcare-associated safety problems, which include healthcare-associated infection (HAI), account for far more considerable morbidity and mortality than “never events”. The first harm to be addressed as part of the “No Preventable Harms” campaign was catheter-associated urinary tract infection (CAUTI).

Context: The microsystem is a 20-bed mixed medical surgical intensive care unit. Unit assessment at the beginning of the quality project indicated that there were 2 CAUTIs attributed to the unit in a span of 6 …

Improve Effectiveness In Trauma Teamwork, Ginger Miramontes

Master's Projects and Capstones

On average, each Ventilator-Associated Event (VAE) is anticipated to increase the length of stay in the Intensive Care Unit (ICU), resulting in potential adverse events and cost to the organization. The Center for Disease Control (CDC) defines VAE as the increase of daily minimum positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) values, after a baseline period of patient stability or improvement on the ventilator (CDC, 2018). Standard endotracheal tube designs have led to the incidence of VAE because of the accumulation of subglottic secretions in the trachea. Untreated VAE can later result in Ventilator Associated Pneumonia (VAP). …

Prospectus For Improving Measure Ii Scores Of Hospice Visits When Death Is Imminent In The Hospice Item Set, David Ainsworth

Master's Projects and Capstones

Abstract

Problem: Center for Medicare Services (CMS) created a new quality measure pair to collect data on hospice visit patterns by a registered nurse in the last three days of life (Measure I), and at least two visits by a social worker, home health aide, licensed vocational nurse or spiritual counselor in the last seven days of life (Measure II). A hospital-based hospice organization created a quality improvement project to address this problem and improve both parts of the measure pair, but special emphasis was placed on improving Measure II, as initial data revealed the …

Musculoskeletal Disorders In Healthcare Workers, Josephine Lauer

Master's Projects and Capstones

Musculoskeletal Disorders (MSD) are one of the leading causes of disability in hospital nurses and nursing aids and is a high cost problem in the healthcare industry. Working in a complex environment of an acute medical floor where repetitive nature of patient handling, can lead to musculoskeletal injuries for healthcare workers. This is evidenced by work-related injuries in hospitals nearly doubling compared to private industry and hospitals are one of the most hazardous work environments in the country. Musculoskeletal injuries of healthcare workers are an ongoing problem which requires investigation due to high risk of reoccurrence. This is especially true …

Building The Business Case For Clinical Nurse Leader Integration Into A Hospital Staffing Model, Shelley Johnson

Doctor of Nursing Practice (DNP) Projects

The Clinical Nurse Leader (CNL) is a newer role in the nursing profession. This generalist Registered Nurse (RN) role was designed to help address fragmented healthcare delivery and care coordination, emphasize and facilitate evidence-based practice, and improve patient quality outcomes at the microsystem level (AACN, 2011). This paper describes a Doctor of Nursing Practice (DNP) project that took place from January through December 2017 focused on making the business case to incorporate CNLs into a hospital staffing model. The CNLs focused on reducing hospital acquired infections (HAIs). The CNLs’ work reduced HAIs by 48% in 2017 as compared to 2016 …

Reducing Inter-Unit Patient Report Delays And Transfer Times, Natalya Marinov

Master's Projects and Capstones

Inter-unit coordination is essential in preventing a bottleneck in patient flow and its resultant stresses to staff, hindering quality patient care, and wasting time. The Medical-Surgical Unit (MSU) and Post Anesthesia Care Unit (PACU) struggle to establish efficient patient report times and transfers. Preliminary data demonstrated report delays attributed to an arduous workload and overburdened MSU nursing staff. The project’s objective focuses on reducing nurse-related report time delays by 10%, increasing understanding and teamwork, promoting proactive thinking to manage workflow efficiently, improving patient flow, and improving the inter-unit relationship between MSU and PACU. Increasing awareness and reducing transfer times are …

Admission Criteria For The Pediatric Acute Care Unit To Reduce Length Of Stay In The Emergency Department, Peter G. Campbell

Master's Projects and Capstones

Abstract

The primary objective as outlined in this prospectus is to develop pediatric admission criteria to reduce length of stay (LOS) in the emergency department for patients being admitted to the pediatric acute care unit. The pediatric acute care unit is a 25-bed licensed bed at a tertiary hospital in San Francisco serving patients from 1 day to 21 years of age. Methods included both qualitative and quantitative data to determine relevance of quality improvement project related to LOS, patient safety, patient satisfaction, and nurse to physician communication. Data collected indicated that average LOS in the ED was significantly higher …

Bearing Witness To The Lived Experience Of Chinese Exclusion: An International Baccalaureate Inquiry Unit For Critical Literacy Through Photovoice, Wesley Schoenherr

Master's Projects and Capstones

This field project used Kurasawa (2007)'s action-theoretical framework of "modes of practice" for human rights, together with Ewald (2012)'s "Memories of Past Centuries" unit to create an outline of an inquiry unit for a Humanities course within the International Baccalaureate's MYP. As the intended students are at IB schools in Xi'an, China, bearing witness to the lived experience of Chinese Exclusion at the Angel Island Immigration Station was chosen as the content.

Improvisation And Leadership Development: Understanding Improvisational Theater Arts As Leadership Skills, Jack Skalican

Doctoral Dissertations

Leadership development is immersed in a philosophical struggle. Past efforts at developing leaders have missed a set of skills important to the role of today’s leaders. Since Frederick Taylor invented the practice of scientific management, the study of management and leadership has largely focused on traits, practices, and behaviors that conform to this model such as planning, analysis, control, and monitoring. Missing in this focus, however, are less transactional leadership skills like intuition, improvisation, and creativity. As a result, organizations have begun drawing on improvisational theater skills as one answer to fill this leadership development gap.

This case study focuses …

Perceptions Of Primary School Principals In Singapore About Their Role As Justice Agents, Kit Wah Antonia Teng

Doctoral Dissertations

Justice in school is central to both the Catholic church and the government of Singapore. Both institutions have expectations of principals as justice agents to serve the needs of every student by means of equality and equity in educational provision to all students. There is limited research on how principals of Catholic and government primary schools in Singapore perceive their role as justice agents and how they fulfill this expectation.

This qualitative research examined the experiences of primary school principals in Singapore in their enactment of educational leadership for justice. Of the 10 principals interviewed, 4 were principals of Catholic …

An Investigation Into Full Range Leadership And Leadership Development Methods In Public Parks And Recreation Organizations In California, Heather Vilhauer

Doctoral Dissertations

As current public parks and recreation organizational leaders age and retire, it will become important for qualified professionals to be prepared to fill these positions. A study by Hurd and McLean (2004) examined the perceived competencies of CEOs in public park and recreation organizations. Leadership and management were rated as the most important competencies for CEOs. However, these perceived competencies are not only for the CEOs; all professionals employed in parks and recreation, from administrative leaders to direct service providers, must demonstrate leadership to succeed in their positions (Russell, 2005). Thus, it is crucial for parks and recreation organizations to …

Access Without Equity: Institutional Logics Of University Middle Managers And Valuing Diversity, Emerald Templeton

Doctoral Dissertations

Institutional barriers to Black student success (e.g. a history of exclusion, inaccessibility, and inequity) that exist at the undergraduate level, persist at the graduate level. Though traditionally marginally students have gained access to predominantly and historically White colleges and universities, Black graduate students continue to be marginalized by institutionalized oppression and inequitable structures. When the values, attitudes, and beliefs of individual actors who serve these students are at odds with an institutional mission of equity and inclusion, misalignment and competing priorities emerge. This study seeks to understand the logics university middle managers use in operationalizing equity and inclusion, specifically, in …

Improved Communication For Safer Patient Care: The Implementation Of Sbar, Amanda Dowden

Master's Projects and Capstones

This Clinical Nurse Leader (CNL) quality improvement project aims to improve the consistency of intradepartmental communication between Urgent Care Center (UCC) staff, through standardized SBAR patient hand-offs. The aim is to improve; (1) the consistency and clarity of patient hand-offs, (2) staff experience and satisfaction with communication during hand-offs, and (3) prevent adverse patient outcomes resulting from poor communication. As a safety net hospital, traditionally serving a predominately underserved, and underinsured, multicultural demographic, the UCC is designed to alleviate the Emergency Department (ED) of non-emergent patient encounters, providing a cost effective alternative, whilst adhering to Emergency Medical Treatment and Labor …

Applying Agile Project Management To Art Museums: A Proposal For Implementing A Generalist Scrum Master, Vincent Sulit

Master's Projects and Capstones

This capstone project examines organizational change, along with its challenges, through case studies in museums and businesses in the private sector, subsequently providing a possible solution for museums to adapt to the current global market economy through the use of Agile Project Management (Agile). I cite recent case studies of art museums implementing Agile for digital product development. This project proposal aims to introduce Agile outside of digital departments, including Exhibitions and Education, with the goal of developing better visitor-centered offerings from museums. This may be achieved through the proposal of a job description for a new museum position of …

Improving Nurse Proficiency: Breastfeeding And The Opioid-Dependent Mother And Infant Diagnosed With Neonatal Abstinence Syndrome (Nas), Lauren Mountanos

Master's Projects and Capstones

Management of the opioid-dependent mother-infant dyad is complex. Evidence suggests breastfeeding may decrease the severity of NAS symptoms, delay its onset, and decrease the need for pharmacologic treatment (Macmullen et al., 2014). Therefore, education of nursing staff on the benefits of breastfeeding for opioid-dependent dyads will enable them to safely recommend breastfeeding for long-term health (Pritham, 2013). The Clinical Nurse Leader (CNL) project, “Improving Nurse Proficiency: Breastfeeding and the Opioid-Dependent Mother and Infant Diagnosed with Neonatal Abstinence Syndrome (NAS)” aims to globally increase the number of infants diagnosed with NAS discharged on breast milk by 10% by June 30, 2018. …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

Implementing Risk Tools To Prevent Hospital Readmission, Tara O'Connor

Master's Projects and Capstones

Implementing Risk Tools to Prevent Hospital Readmission

Tara O’Connor

Abstract

Background: Readmission reduction is one of the most important opportunities for reducing cost in today’s health care system.

Global Aim: To operationalize risk tools to reduce hospital readmissions by 5 percent by the end of 2017.

Project Aim: To develop new transitions program (TP) processes that operationalizes the risk tools and ensures 70 percent of all readmission risk score patients referred receive a post discharge phone call within 48 hours, and are assessed for their risk of medication management issues as part of their initial assessment, by August 1^{st, …}

Implementing For Success And Sustainability, Michele Paulo

Doctor of Nursing Practice (DNP) Projects

Nurses, including those with additional education and training as professional development specialists, face challenges to implementing evidenced-based practice changes effectively and efficiently. Nurse bedside performance can drift away from evidence-based practice (EBP) and revert to methods previously taught when the strategy, planning and implementation lacks resources to support sustainable change. While knowledge and skills attainment are important, they do not ensure the successful transition in practice change at the point of care. An intervention has been developed that integrates several evidence-based implementation concepts and frameworks into a single framework named the Identify and DRIVE framework. Additionally, the Identify and DRIVE …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …