Strategies For Integrating Death Education Into Asynchronous Online Counselor Training, Kara E. Wolff

Journal of Technology in Counselor Education and Supervision

Online counselor education has grown exponentially, with a greater number of courses being offered in an asynchronous format. This presents challenges and opportunities for counseling training in death education, a subset of grief counseling. Death anxiety and death avoidance can result in counselors-in-training's disengagement with strictly didactic materials in this area. Instead, death education must offer opportunities for experiential processing and personal reflection to be effective. Specific teaching strategies that foster the development of death acceptance and death competence within asynchronous online counselor education courses are offered.

Supporting Nurse Practitioner Autonomy: A Policy Proposal To Advance Hospice Np Scope, Lauren Hochart

Doctor of Nursing Practice Final Manuscripts

The Nurse Practitioner (NP) profession has achieved many advancements in its autonomy and scope of practice in the last 61 years since becoming a recognized advanced practice registered nursing role. However, some areas of healthcare still limit the NPs ability to practice autonomously even though it is within their scope of practice. This is notable in the subspecialty of hospice care with regards to certifying a terminal diagnosis as part of eligibility determination for a Medicare beneficiary to be able to receive covered hospice services. This health policy paper reviews current hospice regulations and provides evidence to support the benefits …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Brain Donation Programs Now Perhaps At Risk Of Losing Funding Are Key To A Huntington's Disease Cure A Family's Story, Kenneth P. Serbin Phd

At Risk for Huntington's Disease

No abstract provided.

Improving Equity In Women's Stroke Outcomes, Lindsay M. Warner

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project is to review research-based evidence evaluating the inequities in women’s stroke research and treatments and how this effects women’s stroke outcomes. This paper sought to identify current recommendations for improving sex equity for women’s stroke research and identify further areas of policy change to ensure that women’s health outcomes are prioritized in this historically underrepresented population.

Background: An area of critical importance to society is the significant cause of gender-based inequity in healthcare and research. Historically medical research has primarily involved males and the findings have been …

Increasing Advance Directive Completion: A Future Initiative For All, Hilda A. Lince

Doctor of Nursing Practice Final Manuscripts

Abstract

Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.

Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE …

The Use Of Systemic Inflammatory Response Syndrome (Sirs) Criteria By Nurses In The Nursing Home Setting To Identify Sepsis, Edwin Tobbee Y. Arceo Jr

Doctor of Nursing Practice Final Manuscripts

Background: Sepsis is a life-threatening organ dysfunction caused by an infection. In the United States, treating sepsis costs approximately $23 billion annually, making it the most expensive condition treated in hospitals. Severe infections in nursing homes are estimated to occur in one to three million cases annually. Infections in nursing homes are on the rise, and the cost of hospitalization due to sepsis is increasing dramatically. Diagnosing sepsis is often delayed in nursing homes.

Purpose of the Project: This project aims to train nursing home nurses to use the SIRS screening tool to identify potential sepsis cases early and administer …

Promoting Community Health And Wellness Through Arts And Nature-Based Interventions: A Literature Review, Tessa Tinkler, Laura Deitrick, Richard W. Hurt Iii, Connelly Meschen

Arts and Culture

This literature review covers two areas of nonprofit work that are traditionally underfunded yet potentially impactful for improving social determinants of health: engagement with the arts and connecting with nature.

“Shoes Enthused”: The Application Of An Evidence-Based Practice Podiatry Consultation And Footwear Education In Older Adults Living With Diabetes, Alissa Kathleena Gray, Razel Bacuetes Milo

Doctor of Nursing Practice Final Manuscripts

Background: Poorly fitted footwear contributes to falls in older adults living with diabetes, a population that experiences a baseline increased risk for falls in the presence of diabetic peripheral neuropathy. Despite this, baseline data reveals that 72% of older adults wear poorly fitted shoes with suboptimal shoe features¹.

Purpose of Project: Adhering to current evidence-based practice guidelines, the two goals of this project were to educate older adults with diabetes on the characteristics of properly fitted footwear and to increase access to properly fitted shoes via a podiatry consultation. Subsequently, the increased number of optimal footwear will decrease …

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Education Program To Increase Compliance With Advance Directive Completion In A Primary Care Setting Among Filipino Americans, Genalin Paglingayen

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This evidence-based practice project aimed to provide an education program to Filipino Americans in their preferred language (English or Tagalog) to improve compliance with Advance Directive (AD) completion in a primary care setting. Educating them about AD empowers patients with their decision-making about their health in situations where they are incapacitated and unable to make sound decisions. Moreover, it will eliminate the decision-making problem for family members.

Background: An advance directive is a document that empowers patients to convey their wishes to their healthcare provider when they can no longer decide for themselves. Evidence suggested that …

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 …

Mother Nature On The Run: The Sec, Climate Change Disclosure, And The Major Questions Doctrine, J. Robert Brown, Jr.

San Diego Law Review

The Securities and Exchange Commission (SEC or Commission) has proposed a rule that addresses the disclosure needs of investors with respect to climate change. The proposal would require that public companies tell investors about the risks to their business associated with climate change and explain the system and strategy of governance for monitoring those risks. In addition, the proposal would mandate the disclosure of certain greenhouse gas emissions.

The SEC’s proposal arrived contemporaneously with the Supreme Court’s announcement of the “major questions” doctrine. A deliberate attempt to limit the authority of the executive branch, the doctrine would restrict agencies from …

Grief Counseling Skills: Supporting Students In A Virtual Residency, Susan F. Branco, Rebecca G. Scherer

Journal of Technology in Counselor Education and Supervision

Grief counseling is an important skillset for professional counselors. Two counselor educators in an online counseling program describe how they incorporated grief counseling coursework within a virtual residency. They followed grief counseling instruction best practices to facilitate skills training with students. The virtual residency also included skills practices, grief counseling role plays, and guest speakers with grief expertise. Wellness considerations to support students throughout the course and residency are also described.

Climate Change And Real Estate In California: Can Climate-Related Risk Be A Required Disclosure For Residential Real Estate?, Lindsey Jacques

San Diego Journal of Climate & Energy Law

This Article will examine whether liability can extend to residential real estate sellers for non-disclosure of climate change related risk. First, this Article will outline current California statutes and common law regarding disclosures of climate change risk to prospective buyers of real estate. Next, this Article will explore potential routes for expanding liability, then will follow with hypotheticals for specific types of climate-related risk. This Article concludes by considering likely outcomes and routes for sellers and their agents to evade such liability should an expansion of liability prove legitimate.

Improving Patient Self-Efficacy, Readiness, And Completion Of Advance Care Planning Documents Using Prepare Documents And Advance Care Planning Group Referral, Marie Vassiliadis

Doctor of Nursing Practice Final Manuscripts

Advance Care Planning (ACP) is an ongoing discussion about medical decision making between a provider, patient, and support person. ACP can also include legal documentation in the form of an advance directive (AD). Nationally, only 36.7% of adults complete any form of AD for end-of-life care. Recently, ACP has become an important quality metric that many organizations are prioritizing. The purpose of this evidence-based project is to improve ACP readiness, self-efficacy, and documentation among patients at an internal medicine clinic using the PREPARE program and referral to an ACP group meeting. PREPARE for Your Care is an online program aimed …

Nursing Education In Complementary Alternative Modalities: A Case Study, Deborah Bird

Dissertations

Purpose: The purpose of this embedded case study was to describe the preparation for and utilization of complimentary alternative modality (CAM) interventions by an experienced Doctor of Nursing Practice (DNP) prepared nurse practitioner (NP) working in an outpatient setting.

Background: Given the widespread use of CAM by the American public and the potential complications involved in combining CAM and standard medical care, a lack of educational preparation in CAM interventions by NPs delivering primary care in outpatient health care settings represents both a potential risk and a missed opportunity to provide holistic patient care. Such a lack of knowledge also …

Use Of Sequential Organ Failure Assessment Among Intensive Care Unit Patients With Septic Shock, Ahlam Aluneizi, Eman Aluneizi, Caroline Etland

School of Nursing and Health Science: Faculty Scholarship

Purpose: Sepsis is a significant cause of mortality in modern intensive care units (ICUs). At Sharp Grossmont Hospital (SGH), sepsis cases increased the patient mortality rate in comparison to other Sharp facilities. Currently, no tools are utilized to identify septic patients at SGH. The study aimed to find out the impact of early consultation of advanced illness management (AIM) and goals of care conversations (GOCC) on reducing the length of stay (LOS) among septic shock patients.

Methodology: Descriptive data were attained based on Electronic Medical Records (EMR) of 39 septic shock patients form which ICU nurses utilize to calculate Sequential …

Wisdom From The Center Of The Heart: The Life And Work Of Pamela Ayo Yetunde So Far, Karma Lekshe Tsomo

Theology and Religious Studies: Faculty Scholarship

In recent years, Dr. Pamela Ayo Yetunde has emerged as a prominent figure in the Black, Buddhist, and queer communities. As I caught a glimpse of her amidst the excited crowds at the Parliament of the World’s Religions in Toronto in 2018, a gathering of 10,000 delegates from 80 countries and nearly 200 religious, spiritual, and Indigenous traditions, her humble free spirit immediately captured my attention. Unpretentious, unaffected by the grandeur of the immense gathering, and unfazed by the power and prestige of the luminary figures assembled there, she flowed through the hallowed halls with confidence and grace. In an …

Adults With Preexisting Diagnosis Of Heart Failure In The Environment Of Coronavirus Disease 2019, Ronald Phillips

Dissertations

Background: Heart disease continues to be the leading cause of death among adults in the United States and other industrialized countries. Heart failure (HF) is a form of heart disease and has become an epidemic with complications and medical care costs increasing at an alarming rate. HF affects more than 5.7 million adults in the United States with an incidence between 550,000 to 670,000 annually, primarily affecting females, African Americans, and adults aged 55 years and older. HF is also associated with a high rate of mortality, estimated to increase, with a risk rate of 13%, 32%, and 64% among …

Does Comfort Care Make You Uncomfortable? Use Of The Cares Tool For End-Of-Life Symptom Assessment And Management, Christina Covington

Doctor of Nursing Practice Final Manuscripts

Acute care nurses caring for end-of-life (EOL) patients often feel unprepared for and undereducated about this high-need population. According to current literature, many nurses lack adequate training in providing EOL care. This project aimed to improve symptom management of dying patients by providing acute care nurses education about EOL symptom assessment and medication use for symptom management. The revised Iowa model, which emphasizes clinician involvement, guided this evidence-based practice project. Sixteen acute care nurses received 30-minute in-person education, consisting of instruction in EOL symptom assessment and management via use of the CARES (comfort, airway, restlessness, emotional, self-care) tool and basic …

Physician Orders For Life-Sustaining Treatment (Polst) Forms In A Primary Care Setting, Elena Johns

Doctor of Nursing Practice Final Manuscripts

Purpose: To increase completed POLST forms among elderly patients aged seventy-seven and older with chronic/debilitating illnesses, by at least 50% in a Primary Care clinic setting, from September 2021 to January 2022. Background: The government pays for over two-thirds of healthcare costs for the elderly aged sixty-five and older. Furthermore, by ages seventy to ninety, medical spending more than doubles. Many elderly and chronically ill patients report that they would prefer less aggressive treatment and more comfort care measures. However, patients also report a lack of knowledge about their end-of-life (EOL) wishes particularly when it comes to completing the Physicians …

Transitions In Palliative Care: Referral Time And Healthcare Utilization In Advanced Stage Colon, Rectal And Lung Cancer Patients., Ann Lawani

Dissertations

Background: Despite lung, colon, and rectal cancer being the leading and third leading cause of cancer-related death among both men and women respectively, few studies have examined Palliative Care Consultation (PCC) on healthcare utilization (HCU) in individuals with advanced stage diagnosis in this disease cohort. Extant research shows advanced stage cancer patients receive aggressive treatments, within the last 30 days of life. Palliative care is linked to less aggressive cancer treatment, and palliative interventions applied early, at diagnosis of advanced cancer, is more favorable for improving symptom and disease management. Patients and family members with early PCC are better informed …

Decreasing Falls On A Locked Inpatient Psychiatric Unit, Terri Fitzpatrick

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project was to implement an RN nursing staff education on the fall risk assessment tool in effort to decrease falls on one adult locked inpatient psychiatric unit. The assumption was that an educational review of the fall risk variables for inpatient psychiatric patients and subsequent initiation of a fall risk care plan would lead to decreased falls.

Background: A fall can be defined as a sudden unintentional change in position causing an individual to descend to a lower level or onto an object, the floor or ground, or another surface with or without injury. Review …

Cultivating Compassion In Catholic Teachings: An Invitation To Relationship With Immigrants And Refugees With Hiv/Aids, Anna Salvestrin

Undergraduate Honors Theses

In 1989 the United States Conference of Catholic Bishops released Called to Compassion and Responsibility. This document, which articulates the official Catholic Church teaching on HIV/AIDS, emphasizes personal responsibility in limiting the spread of HIV and calls for compassion toward the sick. The bishops direct their document to Catholic clergy and parishioners and offer recommendations for government policy and parish actions that affirm human dignity. This thesis argues that the document's recommendations do not adequately consider the experiences of immigrants and refugees with HIV/AIDS and neglect sufficient attention to their lived experiences. In future documents, the bishops should use the …

Deprescribing In The Hospice Population, Who Is Eligible And Who Is Agreeable: A Quality Improvement Project, Ashlee Nicole Smith

Doctor of Nursing Practice Final Manuscripts

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

Bridging The Gap: Utilization Of Telehealth For Heart Failure Patients To Reduce Hospital Readmissions: Best Practice And Recommendations, Shalaine Corbilla

Doctor of Nursing Practice Final Manuscripts

Background: Heart failure is a leading cause of morbidity and mortality in the United States and accounts for a vast number of 30-day hospital readmissions. Within the first 30 days of discharge, patients and caregivers often misinterpret discharge instructions or lack access to providers. During this period, some modifiable symptoms become too difficult to tolerate and patients return to the emergency department for assessment and ultimately readmission for high-risk complications. The Sars-CoV-2 pandemic has added additional barriers for patients to receive care after a hospital discharge.

Purpose: To identify current best practices used for outpatient follow up with …

Standardized Education On Physician Orders For Life Sustaining Treatment (Polst) Conversations, Venessa Oteniya

Doctor of Nursing Practice Final Manuscripts

According to research literature, 15% of Medicare beneficiaries spend more than 7 days in the intensive care unit before they die. These Medicare beneficiaries receive aggressive, life-prolonging medical treatments that might not be in agreement with their wishes. Approximately 13% of SNF residents have improperly completed POLST forms that can result in intensive treatments that patients did not want. One barrier to the lack of POLST completion in SNFs is staff difficulty with understanding and explaining the form, a result of inadequate education.

In August 2020, the San Diego Coalition for Compassionate Care formed an education program to provide virtual …