Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

A Guide To Vaccine Policy Change At A National Level, Janelle Bird

Doctor of Nursing Practice Final Manuscripts

Abstract

Health policy is in a near constant state of improvement. In order to solidify those improvements, health policy requires assistance from the upcoming generations of healthcare workers to push for those changes. Due to the outdated vaccination policy in the American Nurses Association (ANA), many states continued to issue exemptions based upon unsupported religious preferences. This helped to worsen the outbreak of measles in 2018-2019. The Previous ANA Policy on Vaccinations as of July 21, 2015 stated the ANA supports immunization exemptions only for the following reasons: Medical contraindications and Religious beliefs. Educate and train future health care professionals …

Health Disparities Associated With Pre-Existing Cardiovascular Disease And Telemedicine Interventions During Covid-19 Pandemic: Best Practice Review With Recommendations, Barbara Mae Madriaga

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to review research-based evidence brought forth by other researchers and scientists. The first goal was to determine current health care disparities associated with COVID-19 and pre-existing cardiovascular disease. The second goal was to determine current recommendations of COVID-19 and pre-existing cardiovascular disease. The third goal was to determine the use of telemedicine during this pandemic for cardiovascular interventions.

Background: In the United States, heart disease has been the leading cause of death for most racial and ethnic groups. The COVID-19 pandemic has revealed deeply rooted inequities …

My Arduous, Lucky, And Enlightening Journey Since My Mother's Death From Huntington's Disease 15 Years Ago, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

A Veteran Neurologist’S Book Offers Tools For Navigating The 'Turbulent World' Of Huntington's Disease, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Bettering The Best Interest Test: End-Of-Life Treatment Decisions For Young Children, Cassandra Dougherty

San Diego International Law Journal

The Comment will compare the laws governing end-of-life care for minors in the United Kingdom, Israel, Australia, and the United States; it will explore cases like Tinslee’s that have illustrated the disagreements between guardians and physicians over end-of-life treatment decisions for critically ill children, and it will focus on two prominent British cases. The Comment will examine the historical influences and motivations of the diverse legal schemes and how different legal systems address the relevant issues. It will conclude by proposing a model standard.

Parts I and II will explore the two pivotal concerns in determining who should make the …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Nienke Sahelijo Bsn, Rn, Dnp-Fnp Student, Kori Fitzgerald Dnp, Fnp-C, Joseph F. Burkard Dncs, Crna

Doctor of Nursing Practice Final Manuscripts

Objectives: Palliative care services constitute a vital part of the oncology treatment plan. Much of the suffering associated directly with cancer itself or as a result of treatments can be mitigated with the early incorporation of palliative services. Unfortunately, access to palliative care remains elusive due to a lack of qualified providers. This evidence-based project was implemented in an effort to address gaps in care for advanced cancer patients. The goal was to provide telehealth visits for follow-up of stable patients to manage symptoms and psychosocial challenges with equivalent or improved satisfaction as compared to their last in-office visit …

Peer-Led Education Expedites De-Prescribing Proton Pump Inhibitors For Appropriate Veterans, Mary H. Bowman

Doctor of Nursing Practice Final Manuscripts

Costly proton pump inhibitors (PPIs) have been widely prescribed since the 1990’s for prevention and treatment of ulcers and gastroesophageal reflux disease (GERD). Evidence published since 2012 demonstrates risks associated with taking PPIs longer than eight weeks. Primary care providers (PCPs) mostly de-prescribe PPIs for persons not meeting criteria for long term use. Many patients resist discontinuation.

A three-month evidenced based practice (EBP) education project was conducted by a nurse practitioner to improve PCP peer de-prescribing successes with appropriate patients in an outpatient California based veteran Primary Care Clinic. Fifteen PCPs were pretested about usual care practices between two comparable …

Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

Empowering Newly Diagnosed Patients With Hypertension In Reducing Complications Through Self-Managed Care, Ana Pacis

Doctor of Nursing Practice Final Manuscripts

Background: High blood pressure affects millions of people, including children and adults. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 3 adults or approximately 75 million American adults are affected with high blood pressure. High blood pressure often does not cause any signs and symptoms, which is why it is also known as the “silent killer,” and many people are not aware that they have elevated blood pressure (AHA, 2017). If high blood pressure is not controlled, it can lead to other heart diseases such as stroke. It can also cause other health problems, …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Transforming Clinical Care Through Sexual Wellness Education For Community College Students, Chelsea Ovanek

Doctor of Nursing Practice Final Manuscripts

Abstract

Title: Transforming Clinical Care Through Sexual Wellness Education for Community College Students

Statement of the Problem: Unintended pregnancy remains a serious public health challenge throughout the world (World Health Organization [WHO], 2018). College-aged students continue to be a vulnerable population for this health issue, with estimates that 1 in 5 women will give birth before age twenty and 80% of those pregnancies unintended (Guttmacher Institute, 2019). Despite the statistics, approximately 40% of college students have received formal education on unintended pregnancy, sexually transmitted infections (STIs), or effective contraception use (Diedrich, Klein, & Peipert, 2017). According to the World Health …

Aid-In-Dying Nonprofits, Taimie Bryant

San Diego Law Review

In the United States, where “assisting suicide” is illegal under the great majority of state laws, nonprofit aid-in-dying organizations play important roles in legal reform and client service to those who choose to hasten death when experiencing irremediable existential and physical suffering at the end of life. Legal pathways to aid in dying rest on respect for individual autonomy in end-of-life decision-making, but they are freighted with concerns about risks to individuals who may be vulnerable to transient depression, the influence of others, and internalized beliefs that they have become a burden.

This Article explores how nonprofits use different laws …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

Medical Board Of California, Mason Bettencourt, Betsy Gopinath

California Regulatory Law Reporter

No abstract provided.

Implementing A Trigger-Based Model For Early Palliative Care Consultation On A Medical Oncology Floor, Hsiu Jan Chen

Doctor of Nursing Practice Final Manuscripts

Background: A systematic review by Wendlandt et al. (2012) showed that 84% of the providers referred their patient to palliative care (PC) at a very late stage for uncontrolled symptom management. Significant barriers included a lack of training, lack of recognized referral criteria, lack of a referral protocol. A delayed PC referral can result in prolonging patient suffering from symptom distress, avoidable laboratory work in addition to unnecessary aggressive medical treatment.

Purpose of Project: This Evidence-based Practice pilot project is aimed to facilitate an early PC consultation on an oncology medicine floor by implementing a Palliative care (PC) …

Pilot Implementation Of A Comprehensive Pain Assessment In An Oncology Clinic, Lauren Botta

Doctor of Nursing Practice Final Manuscripts

Purpose/Aims: This project implemented an algorithmic approach to assess pain, functionality, and psychosocial states in newly diagnosed cancer patients. This was accomplished through utilization of a validated pain assessment tool. The tool’s purpose was to identify high-risk patients for Emergency Department (ED) visits or unanticipated hospital admissions (UHA), within a second-year fellow Hematology/Oncology clinic.

Primary aims included: (a) aggregating demographic data to determine the profile of a high-risk patient seen within this clinic, (b) determining those referred to and who followed up with symptom specialists or the ED, and (c) identifying barriers for the next iteration of the project. …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Kori Fitzgerald Bsn, Rn, Phn, Fnp/Dnp Student

Doctor of Nursing Practice Final Manuscripts

Title: Utilization of Telehealth for Palliative Care Follow-up Visits

Background: A vital part of cancer management is the implementation and integration of palliative care, to prevent and relieve suffering and to improve quality of life for patients with serious chronic illness. However, access to palliative care services continues to be inadequate. There is a nationwide shortage of skilled palliative providers and the supply is insufficient to meet the growing demand.

Purpose of Project: Implementing telehealth visits with palliative care patients with advanced cancer at the UCSD Moores Cancer Center has the potential to maintain patient satisfaction with …

Exploring, Examining, And Explaining How Participatory Governance Adds Value To Saudi Foundations’ Philanthropic Strategy, Afnan E. Koshak

Dissertations

Foundations’ flexibility, given their independence from fundraising imperatives, competition forces, and accountability pressures, enables them to invest in long-term, high-risk, multi-level experiments to deal with the increasingly complex societal problems. This flexibility, coupled with the growing role philanthropy plays in promoting social welfare across the world, is arguably what makes studies that focus on foundations’ philanthropic approaches of utmost importance.

There is a mounting interest among scholars in the governance of foundations, the systems and processes concerned with ensuring the overall strategic direction of organizations. Influenced by agency and stewardship theories, an increasing number of studies address such topics as …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

The Lived Experience Of Spiritual Well-Being Amongst Informal Caregivers Of Persons With Dementia On Palliative Care Living At Home, Michael Baumgardner

Dissertations

Title. The Lived Experience of Spiritual Well-Being Amongst Informal Caregivers of Persons with Dementia on Palliative Care Living at Home.

Purpose.This study explored the lived experience of spiritual well-being amongst informal caregivers of a person with dementia who were living at home and enrolled in palliative care.

Background. Patients with dementia comprise the third leading diagnosis in palliative care patients and many receive informal care from family members. Palliative care improves quality of life in patients and their informal caregivers. However, little is known about spiritual well-being in the setting of caregiving of persons with dementia on palliative care. …

2019 Causes Count: The Economic Power Of California's Nonprofit Sector, California Association Of Nonprofits, The Nonprofit Institute, University Of San Diego

State of Nonprofits in California

California’s nonprofits bring more than $40 billion into California each year from out-of-state sources, and one in every 14 California jobs is at a nonprofit.

Like the inaugural Causes Count report in 2014, this “Causes Count 2.0” report summarizes the noteworthy size, variety, diversity, activities, accomplishments, and overall magnitude and importance of California’s nonprofit sector.

The research was conducted by The Nonprofit Institute at the University of San Diego, working alongside Calnonprofits staff. The research involved finding and scrutinizing many different sources of data to create this synthesized exposé of the breadth, depth, and strength of California’s nonprofit sector.

Policymakers, …

Medical Board Of California, Angela O'Hara, Debra Jorgensen

California Regulatory Law Reporter

No abstract provided.

2019 Pathways And Intersections In The Military Lifecycle: How San Diego Supports The Military And Veteran Connected Community, Kim D. Hunt, Mary Jo Schumann, Lisa Walker

Military

This report, prepared by the Caster Center, is an asset mapping and ecosystem project in collaboration with SDMFC and SDVC. This report outlines the military lifecycle and is the result of community conversations throughout San Diego County.

Helping God Get On With It All, Maddison S. Nelson

Lindsay J. Cropper Creative Writing Contest

No abstract provided.

Evidence-Based Strategies For Reducing Post-Discharge Hospital E.R. Visits And Patient Initiated Calls In The Post Craniotomy Population, Homira Feely

Doctor of Nursing Practice Final Manuscripts

Evidence-based Strategies for Reducing Post-discharge E.R. Visits and Patient Initiated Calls in the post Craniotomy Population

Homira Feely, NP

Katherine Curran, BSN

Joseph Burkard, DNSc, CRNA

University of San Diego

OBJECTIVE

Health-care professionals are generally compassionate and well-meaning, but the infrastructure in which they function often has made the continuum of care between hospitals, outpatient settings and patients’ homes far from seamless. The result is a persistently high rate of emergency room visits and hospital readmissions within 30 days of a patient’s discharge – an avoidable pattern that has cost the U.S. health system tens of billions of dollars over …