Digital Commons Network^™

An Implementation Of Combined Fecal/Gastric Occult Blood Testing In The Emergency Department, Desiree Long

Master's Projects and Capstones

Problem: The gastrointestinal occult blood test is a point-of-care (POC) test used to detect the presence of occult (hidden) gastrointestinal bleeding via stool or gastric contents. Existing fecal and gastric occult blood point-of-care (POC) testing requires separate and unique sampling cards and developer, respectively. Separate fecal/gastric tests are less definitive and take longer than a combined test. Fecal/gastric testing can be improved and more effective using a combined testing mechanism.

Context: This project includes the microsystem of the emergency department, which involves groups of medical professionals, such as groups of clinicians and staff working together with a shared clinical goal …

Enhancing Compliance Rates: The Impact Of Implementing A Bed Bath Bundle, Lizeth Rosales, Destinee Unabia, Dennisse Espinoza, Nicole Razi, Russell Hall

Master's Projects and Capstones

Abstract Problem: Bed baths are routine bedside procedures offered in hospitals to support patients'

cleanliness and promote comfort and overall well-being. This bedside procedure represents fundamental care provided by healthcare professionals. Ensuring proper bed bathing compliance in the healthcare setting of a medical-surgical observation and telemetry unit has been significantly challenging. After thorough monitoring of the unit, key factors contributing to low bed bath compliance include time constraints, staffing shortage, and barriers specific to patients and staff. The evidence-based interventions to improve bed bath compliance include a bed bath bundle emphasizing teamwork and effective communication, as identified through an extensive …

Fall Risk Identification And Reduction Among The Gerontological Population At A Long-Term Care Facility, Esther A. Lowe, Breanna Cates, Lisa James, Ashley Samson, Jowel Ochoa, Matthew Ng

Master's Projects and Capstones

Abstract

Problem: Data obtained from the facility from February 2022 to July 2023 showed that there were a total of 110 falls at the facility with 51% resulting in injury. The facility also lacked a standardized fall assessment tool with minimal follow up after fall incidents.

Context: A microsystem assessment of the geriatric population at the long-term care facility indicated the need for a standardized fall risk screening tool to accurately assess patients.

Interventions: A staff presentation was created highlighting the high rate of falls at the facility as well as to educate on the implementation of the Morse Fall …

The Right People In The Wrong System: Examining The Tension Between Nonprofit Individuals And Organizational Structure, Erin Vong

Master's Theses

Nonprofit organizations pursue missions of social good while still operating within the confines of systems of oppression, creating a tension between organizational values and operational success. Previous research focuses on the micro-level role of individuals and the macro-level role of ideologies that create these tensions for nonprofit workers in these spaces. Through a qualitative case study, this thesis seeks to uncover the meso-level role of organizational structures in the experiences of nonprofit workers. The research questions that guided this case study were (a) How does one organization present equitable working conditions for its staff? (b) How do staff at this …

Interest Convergence And Neoliberalism: Effects On Entry-Level Staff Of Color Who Perform Diversity, Equity, And Inclusion In Higher Education, Jesse N. Avila

Master's Theses

Higher education was not originally built to benefit people of color. Diversity, equity, and inclusion (DEI) are many ways in which universities seek to change higher education. However, higher education has a staff retention problem and is at risk of losing more than half of its current workforce. Retention problems also impact entry-level staff of color who perform DEI in universities. Through a lens of interest convergence and neoliberalism, this qualitative study gathered the experiences of entry-level staff of color who perform DEI in student affairs, looked at how their experiences are shaped by the structures of the university, and …

Predicting The Risk Of Falling With Artificial Intelligence, Ann Aquino

Doctor of Nursing Practice (DNP) Projects

Predicting the Risk of Falling with Artificial Intelligence

Abstract

Background: Fall prevention is a huge patient safety concern among all healthcare organizations. The high prevalence of patient falls has grave consequences, including the cost of care, longer hospital stays, unintentional injuries, and decreased patient and staff satisfaction. Preventing a patient from falling is critical in maintaining a patient’s quality of life and averting the high cost of healthcare expenses.

Local Problem: Two hospitals' healthcare system saw a significant increase in inpatient falls. The fall rate is one of the nursing quality indicators, and fall reduction is a key performance indicator …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Shirley Chen

Master's Projects and Capstones

Problem: This project was implemented to decrease patient fallout rates through timely compliance with sepsis management according to the SEP-1 bundle. The SEP-1 bundle is already implemented in the emergency department. However, a microsystem assessment indicated barriers are preventing the achievement of the SEP-1 bundle milestones.

Context: This 16-bed emergency department (ED) at an urban Bay Area hospital provides 24-hour emergency services to individuals who suffer from medical injuries, accidents, and other serious health conditions. A random audit of the electronic health system (EHS) revealed that this emergency department consistently fails to meet the sepsis management time goals by 90%. …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Educating Labor And Delivery Nurses On Evidence-Based Birthing Positions To Promote Fetal Descent During First And Second Stage Labor, Sophia Nguyen

Master's Projects and Capstones

The goal of this project was to increase confidence of labor and delivery nurses in utilizing evidence-supported birth positions during the first and second stages of labor in order to aid in fetal descent and labor progression. Current statistics demonstrate climbing trends in cesarean deliveries, which have been associated with increased maternal morbidity and mortality. One nurse intervention that can reduce failure to progress, a main contributor to cesarean sections, is the use of various evidence-supported maternal birth positions such as ambulation, assisted squat, sitting, backwards sitting, lunging, throne, side-lying with peanut ball, hands-and-knees, and throne position. This evidence-based practice …

Increasing Compliance Through Nurse Education On The Bundle, Zachary Harrison-Evans

Master's Projects and Capstones

In an effort to decrease complications and events connected to sepsis in the ED, there is room for improvement with relation to sepsis care and compliance rates. Timely sepsis management and gains in compliance/adherence rates are hindered by SEP-1 fallouts and requirements related to knowledge gaps concerning sepsis bundle procedures, nurses' attitudes about implementing the protocols, and disparities in nurse/physician order sets. It has been determined that the use of standardized protocols and order sets are not being utilized. This is a process gap and a critical area for improvement. Inadequate fluid and lactate documentation, a lack of education, and …

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, …

United States Pharmacopeia (Usp) <800> Standards: Increasing Compliance Of Safe Handling And Proper Administration Of Usp General Chapter <800> Drugs, Katelyn N. Sinclair

Master's Projects and Capstones

Problem: United States Pharmacopeia (USP) developed a set of standards to minimize exposure risks to patients, healthcare workers, and the environment when preparing, handling, and administering hazardous drugs (HDs) known as USP <800> HDs. The guidelines became effective December 1, 2019, but additional information is needed to ensure healthcare personnel are complying with the standards.

Context: Two medical surgical units from Hospital A were included in this project. Currently mandatory online modules about USP <800> standards are provided annually to every healthcare worker, but it is unknown if the policies and procedures are being followed appropriately.

Interventions: Active and passive observations as …

Reducing The Risk Of Central Line Associated Blood Stream Infection With Chlorhexidine Gluconate Education, Scarlett Ocon

Master's Projects and Capstones

Problem: A nosocomial central line-associated bloodstream infection is a preventable infection that is costly and potentially fatal. In order to combat bloodstream infections chlorhexidine gluconate wipes have been used as antiseptic. Medical surgical units do not have accessible CHG for bathing purposes. In addition, the staff lacks knowledge of how to use CHG wipes. The current standard bathing practice on this unit consists of using soap and water or disposable washcloths spontaneously without a predetermined time. The aim of this quality improvement project is to educate the registered nurses (RNs) and certified nurse assistants (CNAs) on the benefits of daily …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

Psychosocial Distress Screening For Patients With Cancer: A Value-Based Approach To The Integration And Delivery Of Holistic Care, Candy Cheung

Doctor of Nursing Practice (DNP) Projects

Background: Patients with cancer (PWC) have a high prevalence of experiencing psychosocial distress as they bear the burden of the disease. Emphasis is needed on psychosocial care, as the COVID-19 pandemic negatively impacts mental health. Psychosocial distress screening is considered a standard practice by the National Comprehensive Cancer Network (NCCN), which recommends using the validated Distress Thermometer (DT) as a screening tool.

Local Problem: The DNP project ambulatory infusion clinic (AIC) site does not have a standardized distress screening tool for staff. There was a lack of awareness of an existing non-validated distress screening and little to no intervention or …

Integrating Culturally Tailored Interventions To Increase Cervical Cancer Screening: A Quality Improvement Initiative In A Primary Care Clinic, Marife Centeno Solomon

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: While the incidence of cervical cancer in the US has significantly decreased due to the utilization of vaccination and screening tests, Asian, Native Hawaiian, and other Pacific Islander women consistently have the lowest rate of cervical cancer screening, making them at risk for undetected cervical cancer disease.

Problem: The low cervical cancer screening uptake can be attributed to a knowledge deficit about cervical cancer and its screening and the importance of early detection. Being an immigrant and with limited English proficiency can hinder women of Asian, Native Hawaiian, and other Pacific Islander from getting screened for cervical …

Stop The Bleed And Seize Control: Educating Emergency Department Staff On Maternal Hypertension And Hemorrhage, Mayra A. Portillo-Guerra

Master's Projects and Capstones

Problem: A Not-for-Profit Hospital accredited by the Joint Commission was fined for not having a current policy or procedure set in place for the treatment of obstetric emergencies. This quality improvement project implemented a simulation and a training video to prepare Emergency Department (ED) nurses and clinical staff for the awareness of preeclampsia and postpartum hemorrhage (PPH).

Context: This quality improvement project was implemented in two different Emergency Room locations for this Not-for-Profit Hospital. One of the campuses does not have a Labor and Delivery (L&D) unit while the other one does. The overarching goal is to increase awareness of …

Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland

Doctor of Nursing Practice (DNP) Projects

BACKGROUND: Millions of nurse practitioners (NP), physician assistants (PA), and registered nurses (RN) are optimistic that their current employers will help them reach their full potential. One area that can add value to the hospital and empower employees to work to the full scope of their practice, and utilize the skillsets like that of an NP, is to train these providers to support medical device equipment in the operating room instead of relying on medical device representatives (MDRs) of medical device companies.

METHODS: Training NPs, PAs, or RNs how to support neurological medical device equipment will better utilize the skillset …

Feminist Catholic Organizational Identity: A Phenomenological Study Of Charism In The Lay Educator Of A Notre Dame De Namur Learning Community, Kathleen Barrera Quiazon

Doctoral Dissertations

The Catholic schools of women’s religious congregations in the United States possess a distinctive Catholic identity, owed in great part to the charism of their founders and the feminist worldview that emerged in the sisters’ mission, communal narratives, and ministries. With the decline of women religious across the country, schools and congregations ask questions for the future of that identity in the hands of lay educators. As with many religiously sponsored schools, the Sisters of Notre Dame de Namur and their lay partners in education are engaged in these critical questions for their own learning communities across the country.

This …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Aidet And Commit To Sit Implementation In The Outpatient Surgical Setting, Olivia V. Meehan

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET and commit to sit to improve communication and increase the patient satisfaction of an outpatient surgery microsystem. The microsystem’s patient satisfaction is assessed, and it is currently scoring below the reach goal of 85^th percentile. The detractors from their overall score mainly stem from the patient not feeling listened to, informed, or updated on the timeline. AIDET and commit to sit are ideal tools for addressing those deficits.

Context: The microsystem being addressed is an outpatient surgery unit that specialized in general surgery for the pediatric population. The pediatric population that the …

Improving Medication Administration Safety In A Correctional Facility With An Electronic Medication Administration System, Rosalinda Salazar

Master's Projects and Capstones

Problem: According to the World Health Organization (2020), medication errors are one of the leading causes of injury and avoidable harm in health care globally.

Context: The county jail houses approximately 700 inmates/patients on a daily basis, and the potential for error when administering medications is high as medications are prepared manually using a paper medication administration record.

Interventions: The jail began using an electronic health record/barcode administration system on October 19, 2020.

Measures: Unusual occurrence reports related to medication errors were reviewed. The time frame included 6 months before electronic implementation, and 6 months after implementation.

Results: Unusual occurrence …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

New Technologies And Nursing Communication: Literature Review And Future Directions, Yan Tian

Nursing Communication

This article reviews literature on the role of new technologies in nursing communication. Review of nursing literature suggests that research on new technologies in the nursing field covers various aspects of nursing communication including nursing education, communication among nurses, and nurse-patient communication, while review of communication literature indicates that research in the field of communication on this topic focuses mainly on patient-provider communication through telemedicine systems. Meanwhile, communication scholarship focuses more on technologies such as videophones and web-based communication systems, nursing scholarship covers a variety of technologies ranging from the traditional AAC tools to various Internet-based technologies such as virtual …

Growth Begins From Within: How Internal Transparency Influences Organizational Learning, Wesley J. Cheung

Master's Projects and Capstones

Ample research exists that focuses on organizational learning in the context of program efficiency and outcomes, and organizational transparency in the context of governance and compliance. The purpose of this research is to further explore the relationship between organizational learning culture and the commitment to internal transparency, specifically pertaining to the internal members across multiple levels of an organization. This paper includes a literary review of previous research, an outline for the methodology used for this research, qualitative data analysis of 10 expert interviews, a discussion of the results and findings, and the exploration of present and future implications and …

Maximizing Mobility In The Icu, Stephen Kupiec

Master's Projects and Capstones

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. …