Digital Commons Network^™

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Standardized Outreach: Increasing Vaccine Uptake In The Latinx Community Through A Standardized Phone Call Process, Vanesa Vazquez

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in several minority communities since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines (Increased risk, 2020). The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake, particularly in the Latinx community. Patients at a community clinic in Oakland, California have made apparent their distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. Most of these patients are Latinx-identifying and are considered more at risk for development of COVID-19 in …

Oakland’S Community Clinic Covid-19 Vaccination Improvement Project, Jesly Esparza

Master's Projects and Capstones

Vaccination hesitancy has been an ongoing issue over the years, but is now an even more serious problem ever since the newly developed Coronavirus (COVID-19) vaccines were released for emergency use. Due to the rapid event of COVID-19, community clinics have not been able to create effective outreach methods to inform patients about the vaccines, thus the vaccination rates have been low. The goal is to increase vaccination uptake in a Latino community clinic in Oakland, California. These patients have shared their distrust in the healthcare system due to racism and their disbeliefs regarding the effectiveness of these COVID-19 vaccines. …

Code Blue: Do You Know What To Do? Increasing Nurse Confidence And Readiness Through In-Situ Mock Code Simulation, Katelyn Nusser

Master's Projects and Capstones

An underprepared nurse is the most dangerous threat to patient survival in the intense and frightening environment of a code blue situation. With basic life support certification required on merely a biannual basis, it cannot be expected that nurses maintain the skills and knowledge without routine application. This quality improvement project proposed the following PICOT question: for medical-surgical nurses, how does in-situ mock code blue training between BLS recertification periods affect nurse readiness and confidence in a code blue situation? Mock code simulations were conducted over a three-week period with an emphasis on hands-on practice as well as teamwork and …

Deai In Nonprofits: Through The Lens Of Museums And Gardens, Brittany Jones

Master's Projects and Capstones

This research works to understand and identify diversity, equity, accessibility, and inclusion (DEAI) practices within nonprofits through the examination of museums and public gardens. Museums and public gardens provide a generous example of nonprofit organizations that must dutifully serve the communities which surround them, as well as examine internal practices and structures. As the momentum of the racial justice movement increased in 2020, following horrific tragedies in the U.S., the work around DEAI is more relevant than ever. Through this research, identification of barriers and challenges which prevent organizations from doing DEAI work is examined. This research is carried out …

The Role And Impact Of The Environment In Shaping The Decisions Of Parents And Alternative Educators In Early Education, Mia Hopkinson

Master's Theses

The purpose of this study was to research parents’ and alternative educators’ perspectives on the role of the educational environment in early education and how this impacts their pedagogical beliefs. The qualitative study explored the following research questions: What do traditional school parents and outdoor alternative parents seek in their child’s early education environment? What shapes parents' decisions on their child’s educational and learning experiences? How do alternative educational leaders and educators understand the role of the alternative environment? How does this impact how they think about education? Interviews were conducted with two traditional parents, two alternative parents and four …

Improving Covid-19 Vaccination Uptake In The Latino Community Through Standardized Outreach, Bianca De La Piedra

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latino community since the approval of the emergency use of the Moderna and Pfizer vaccines. Latino patients from a community health clinic in Oakland, CA have expressed their hesitancy. Only 47% of patients 65 years and older at the community health clinic received the COVID-19 vaccine. With COVID-19 disproportionately affecting this community, focusing on prevention through the uptake of a COVID-19 vaccine is necessary. A microsystem assessment concluded the need for the improvement of patient outreach via calls. This project seeks to examine if standardizing the patient outreach …

Scholarly Manuscript: Deficiencies In Memory And Effective Education Of De-Escalation Techniques In Mental Health Settings, Balraj Bajwa

DNP Qualifying Manuscripts

Objective: To appraise and evaluate evidence recognizing the lack of effective staff education on de-escalation techniques, the impact that this creates on nursing practice, and staff perceptions on de-escalation methods and techniques in acute care inpatient and/or outpatient mental health settings.

Methods: Three databases were searched (CINAHL, PubMed, and PsycINFO) to identify articles/reviews which focused on de-escalation techniques and training. Additionally, five journals were also reviewed to help with the search process. Specific inclusion criteria were used to streamline the search process and to help identify articles/reviews which were primarily focused on the desired objective. Five different articles …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication errors and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. This indicated concerning quality gaps in the unit’s ICU patient handoff processes.

Intervention. The project intervention consisted of an introductory and two follow-up teaching sessions on handoff processes and implementing the I PUT PATIENTS FIRST …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

A Performance Improvement Nursing Fellowship To Enhance Timely Access To Care, Cheryl Reinking

Doctor of Nursing Practice (DNP) Projects

This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient …

Identification Of Victims Of Human Trafficking: Leading Change Through A Global Pandemic, Connie Clemmons-Brown

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was …

Chief Nurse Executive Work Engagement: System Leadership Through A Natural Disaster, Strike, And Pandemic, Ryan Fuller

Doctor of Nursing Practice (DNP) Projects

Problem. In a 21-hospital region of a 39-hospital integrated health system, CNE turnover peaked at 63% (12 CNEs) in 2015. Interviews were conducted in 2019 with 12 CNEs across the region to understand potential issues related to CNE job satisfaction. Responses revealed concerns regarding empowerment, alignment, work-life balance, information transparency/sharing, and recognition. While identifying a solution to address CNE concerns, the organization experienced successive crisis events during a 12-month period that included a record-setting wildfire, multiple labor union strikes, and a novel pandemic. The regional leadership team (RLT) required new approaches to facilitate effective communication during a crisis between the …

#Leadershipaccelerated: A Coach Mindset Focused Leadership Development Program, Diane Rindlisbacher

Doctor of Nursing Practice (DNP) Projects

Problem: Developing leaders to lead in environments that are dynamic, complex, and ambiguous is an area of focus for healthcare leaders. How leaders lead and how organizations develop leaders is tied to the outcomes they achieve (Development Dimensions International [DDI], 2019; Moldoveanu & Narayandas, 2019; Till, Dutta, & McKimm, 2016). To create a climate of trust and safety where teams succeed requires leaders to embed key attributes and competencies into their day-to-day work.

Context: A leader’s ability to create a climate of trust and safety and to adopt and apply a coach mindset to their work is intended to help …

Improving Quality Of Care Through Discharge Planning, Maria Pasillas

Master's Projects and Capstones

Providing good education for the new mother is key to improving the quality of care for both mom and baby. Since nurses are frontline health care providers who perform the most postpartum education, it is imperative they work to improve discharge education so information provided is consistent, appropriate, and evidence based (Suplee et al., 2016).

The aim of this project is to improve the discharge planning process of a local community hospital utilizing evidence-based research (EBR) with the intent to increase patient satisfaction scores in care transitions to above 65% within 3 months.

The community hospital is a 122-bed acute …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

Improving Clinicians’ Access To Patient Education And Va Resource Information, Ella Bermudez

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: In a western US Veterans Administration (VA) hospital system, patient education materials are provider-specific, not standardized, and not located in a central, readily available location.

Context: How does a patient education tool affect the clinicians' delivery of health education in increasing health literacy compared to written information alone in the US veteran population? An integrated literature review was performed using Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases to address the PICOT question above and determine the impact of patient education tools on health literacy and patient engagement. The literature recommended improving patient education for better …

Patient Engagement: A Key Concept To Surgical Site Infection Reduction In Colorectal Patients, Vanessa Strieff

Master's Projects and Capstones

Abstract

Problem: Colorectal surgery is a procedure with one of the highest surgical site infection (SSI) rates; therefore, necessary efforts were implemented to reduce harm (Harris, 2018). Approximately 60% of these surgical infections are preventable (Ban et al., 2017). SSIs can have severe consequences, including extended length of stay, high morbidity and mortality rates, delayed recovery, and high healthcare costs (Harris, 2018). The financial burden of SSI is substantial.

Context: This project aimed to explore opportunities for enhancing patient engagement and awareness of SSI preventive measures. After an extensive microsystem analysis, a knowledge gap in patient education on …

Standardizing The Bedside Shift Report: Improving Communications And Promoting Patient Safety, Chona C. Alforque

Master's Projects and Capstones

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care.

CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ …

Con Confianza: Using Community-Based Participatory Research Principles To Inform Community-Academic Partnership Practices And Build Trust In Hispanic Communities, Sharon Tafolla

Master's Projects and Capstones

Hispanic communities are at disproportionate risk for chronic diseases and researchers have cited the need for further community and culturally informed studies to improve research outcomes to either make treatments and interventions more generalizable or modify them to the needs of Hispanic communities. However, many of the same linguistic and cultural barriers to health care access and utilization also impact the ability for Hispanic groups to participate in research studies. Community Academic Partnerships (CAPs) are positioned to conduct culturally and linguistically competent research in Hispanic communities. For research in Hispanic communities to be effective, CAPs must prioritize practices that build …

A Teaching Plan And Toolkit To Improve Quiet At Night Hcahps Score In A Medical-Surgical Unit, Gabriela Carrico

Master's Projects and Capstones

• Problem: Noise may have undesirable effects on patients, most notably interfering with their sleep at night. Implementing a quiet-time schedule and other evidence-based practices can increase patients’ satisfaction.

• Context: This quality improvement teaching plan was initiated in a 25-bed unit in a large rural community hospital to increase patients’ HCAHPS satisfaction scores for quietness at night. The project involved educating staff members in a medical-surgical unit where patients require constant monitoring. The unit leadership has been concerned about patient-satisfaction scores falling below the 24th percentile.

• Interventions: To meet its goals by the end of the performance year …

The Nonprofit Gender Leadership Gap: Data-Driven Systemic And Inclusive Solutions, Katya Alcaraz-Minnick

Master's Projects and Capstones

The gender leadership gap has maintained its divide throughout world history. There have been positive advancements in gender leadership equity within the political arena and in the for-profit sector, however, it is within the nonprofit sector that the most progress has been made in collapsing the gender leadership gap. Women make up a large percentage of the nonprofit sector’s workforce, so it would seem that the nonprofit sector is poised to lead the economic world to close the gender leadership gap and achieve equity within its top managerial ranks. Research on leadership theories relating to skills, traits, and styles will …

Reducing The Second Victim Phenomenon: Promoting Healing With Caritas Coaching, Shanda N. Whittle

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The second victim phenomenon is one in which healthcare providers use dysfunctional mechanisms, such as anger, projection of blame, or drugs and/or alcohol to cope with serious mistakes in the absence of a healthier means for healing (Wu, 2000). This phenomenon can be caused by adverse events or other personal/professional crises and can lead to healthcare professional absenteeism, leaving the job or leaving the profession altogether (Burlison et al., 2018; Hirschinger et al., 2015).

Context: The second victim phenomenon was identified as a problem within this DNP student’s organization and support was obtained for conducting the project. A …

Team Peru Olympic Decision- Making During Covid-19, Michael Goldman, Raul A. Rosales Zavaleta, Gustavo A. Martín Castillo, Shaun Read

Sport Management

The global spread of the Covid-19 pandemic in early 2020 impacted all 206 states set to compete in the Games of the XXXII Olympiad, originally scheduled to be hosted in Tokyo from July 24 to August 9, 2020. Even before the Olympic and Paralympic Games Tokyo 2020 were postponed to 2021, many of the National Olympic Committees were faced with government-imposed international and domestic travel restrictions, bans on qualifying competitions and tournaments, and even suspected infections among athletes qualified to compete in the Games. Within this environment of substantial uncertainty, national leaders of the Olympic movement were under pressure to …

Expanding Magnetic Resonance Imaging Access For Patients With Cardiovascular Implantable Electronic Devices, Rosalie Geronimo

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with non-conditional cardiovascular implantable electronic devices (CIEDs), which lack magnetic resonance imaging (MRI) components, are unable to undergo MRI.

Context. The Heart Rhythm Society guidelines for patient device management and Centers for Medicare and Medicaid Services requirements for persons with specific expertise in implanted permanent devices to manage CIEDs during MRI spurred policy, procedure and staffing changes.

Interventions. The evidence-based change-of-practice project comprised of workflow development, policy and procedure changes, implementation of required staffing support to manage the CIED during an MRI.

Measures: The outcome measure was to improve access to MRI for patients with CIEDs, measured …

Larc Method Appropriateness In Substance Use Treatment: A Quality Improvement Project For Integrated Care, Malia Johnson Dnp, Fnp, Alexa Curtis Phd, Fnp-Bc, Neda Afshar Dnp, Fnp-C, Msn, Cgrn

Doctor of Nursing Practice (DNP) Projects

Problem: Individuals with substance use disorder (SUD) have disproportionately higher rates of unintended pregnancy when compared to the general population, estimated to be 85% (Heil et al., 2011). Not only are poor maternal and fetal outcomes associated with unplanned pregnancies, but pregnancies in women with SUD are further complicated by additional risks and adverse outcomes (Black & Day, 2016).

Context: Addiction treatment centers and programs are primed with opportunity to offer family planning services, when contact with medical providers is increased for substance use treatment. In response to the opioid crisis and unprecedented rates of unintended pregnancy, this project …

Improving Identification Of Ssi In Snf, Jennifer Teng Yuan Yu

Master's Projects and Capstones

Educational deficit in basic wound assessment can lead to failure to recognize early signs of infection or wound deterioration. Despite many challenges towards wound care, there are potential opportunities to reduce patient injury and clinical outcomes through continuing education. The purpose of this paper is to review literature on current wound care knowledge in nurses and assess existing wound care knowledge in nurses at a skilled nursing facility. A 10-question pre-test wound assessment quiz based on the Bates-Jensen Wound Assessment Tool (BWAT) selected by the Wound Care Coordinator (WCC)/Wound Care Specialist (WCS) was given to 22 nurses: 5 Registered Nurses …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Transitions Of Care: Raising Awareness And Improving Identification Of The Social Determinants Of Health, Stephanie Le

Master's Projects and Capstones

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care.

Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease …

African American Female Law Enforcement Officers' Lived Experiences And Mentoring: A Thematic Narrative, Harold Wilson

Doctoral Dissertations

Black female officers are an underrepresented sub-group of the law-enforcement profession. The bulk of research on women’s policing has focused on the growth of women in law enforcement, barriers, sexual harassment, gender differences, why women are deterred from law enforcement, physical limitations, and instruments used during the recruitment process, and the stress endured after entry into the profession. When looking at Black female officers’ lived experience and perceptions around mentoring; research is lacking. Eight Black female officers from the San Francisco Bay Area participated in this study. Findings revealed that all of the women have faced a recurring sense of …