Digital Commons Network^™

Medical Board Of California, Kayla Watson, J. D. Fellmeth

California Regulatory Law Reporter

No abstract provided.

The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz

Dissertations

Background: Quality of life is an important concept of increasing significance for the healthcare in the United States, especially when taken in perspective of the aging population. Low-income, urban dwelling older adults are challenged in a number of ways that may negatively impact their QOL. This unique group is prone to report lower QOL, therefore, interventions targeted to improve QOL are timely. The purpose of this study was to describe the effect of mantram repetition (MR) on QOL in a sample of low-income, urban dwelling older adults.

Methods: A quasi-experimental pre-posttest study was conducted using a sample population of low-income …

Examining The Relationships Between Ethnicity, Palliative Care And Readmissions In The Heart Failure Population, Deanna Johnston

Dissertations

Specific Aim: The aim of this dissertation is to analyze the relationships between ethnicity, palliative care consultation and readmissions in the heart failure population at a community hospital that serves a large diverse population.

Background: Hospitals struggle with preventing readmissions. There are many interventions that can be implemented to help prevent readmissions, and Palliative Care (PC) is one of those interventions. PC has many benefits including symptom management, improved communication through the healthcare continuum, understanding of illness and treatment options, and can be provided in conjunction with curative treatments. Heart failure is one of the most common readmission diagnoses. …

Power To The Patients: A Heart Failure Transitions Of Care Program In A Heart Resource Center, Katherine Nicole Oxina Padiernos Bsn, Rn, Dnp Student, Scot Nolan Dnp, Rn, Cns, Ccrn, Teri Armour -Burton Phd, Cnml, Ne-Bc, Colleen Austel Nadeau Bsn, Rn, Chfn

Doctor of Nursing Practice Final Manuscripts

Background: In the United States an estimated 5.7 million adults have heart failure (HF), costing $30.7 billion annually. National HF readmission rates have remained high at 21.3%. After an extensive literature review, the purpose of this project was to incorporate teach back methods, self care education, resource accessibility, and increased post-discharge contact through an outpatient heart failure transitions of care program.

Methods and Results: Prior to discharge, HF patients were recruited and given a pre-test Self Care of Heart Failure Index (SCHFI). A DNP student and progressive care unit registered nurses provided discharge education utilizing a Healthy Heart Tracker booklet …

Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky

Doctor of Nursing Practice Final Manuscripts

Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).

Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, …

Orthopedic Nurse Practitioner As A Subspecialty: A Case Study, Debra M. Palmer

Dissertations

Purpose: The overall purpose of this study was to describe the ONP role by exploring how and why NPs are utilized in orthopedic health care settings. Two problems associated with the evolving ONP role were addressed: the concomitant decrease in the supply of and increased demand for orthopedic patient care services and the nursing profession’s unmet challenge to keep pace with that increased demand and protection of the public and nursing profession through credentialing of ONPs and programs providing certification and training for ONPs.

Approach: This study employed a single-embedded case study research approach to answer the research questions and …

Barriers And Perceptions To Obtaining Palliative Care In The Emergency Department, Jacqueline Lucille Saucier

Dissertations

Background:

Purpose: This study explored barriers and perceptions of providing palliative care services while patients are in the emergency department (ED) in order to increase the>likelihood of caregivers to elicit palliative care methodologies for patients with chronic illness, who are not necessarily at the end of life, but rather who are identified through repeated visits to the ED.

Design and Methods: A mixed methods approach was used to explore the barriers and perceptions of providing palliative care services in the ED. By using a qualitative approach, evidenced by grounded theory, this study explored the barriers and perceptions of providing …

2017 Food, Friendship, And Health: Working Together To Serve Seniors In North County San Diego, Michelle Ahearne, Meghan Kelly, Mary Jo Schumann

Seniors

This report, prepared by the Caster Center, is a three-year evaluation of the North County Senior Connections Thyme Together Food Truck Lunch Program.

Improving Self-Care Management In Heart Failure Patients, Sible Rebello

Doctor of Nursing Practice Final Manuscripts

This evidence-based project aimed to improve self-care and decrease the 30-day readmission rates in cardiology clinic heart failure (HF) patients. Thirty-day HF readmission rates, pose a financial burden to hospitals and consistent patient engagement and education in self-care among HF patients can decrease health care utilization, reduce mortality and improve quality of life. Patients received HF education during the first post-discharge clinic visit followed by weekly telephone calls. The Self-Care of Heart Failure Index (SCHFI) was administered to assess baseline knowledge of the self-care and reevaluated at the end of 30 and 90 days. None of the participants were readmitted …

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

Improving Advance Directive Completion Rates Through Advance Care Planning, Erica Shadae Koeppen, Joseph Burkard, Ellen Ward

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice (EBP) project is to assess the effectiveness of a multimodal intervention to increase advance care planning discussions (ACP) and advance directive (AD) completion rates.

Background: Advance care planning (ACP) and advance directives (AD) is the ongoing discussion and recording of patient preferences and goals of care in the event they lose the capacity to speak for themselves. The Center of Disease Control and Prevention (CDC) estimates that 70% of Americans are without ADs. Centers for Medicare and Medicaid Services (CMS) reimburses for advance care planning consultations. ACP has improved multiple outcomes including higher …

Creating A Palliative Care Referral To Improve Quality Of Life In Heart Failure Patients, Johnny Garcia

Doctor of Nursing Practice Final Manuscripts

Background: A transitional care program was developed at a southern San Diego hospital to guide patients dealing with heart failure from an inpatient to an outpatient setting to decrease hospital readmissions. Although, very successful with a quarterly readmission average of 9%, patients that are considered end-stage heart failure categorized by ejection fraction less than 30% and have greater than one visit in a thirty day period do not qualify for transitional care. These patients’ readmission rates average 50%. The literature shows that patients who will not significantly improve within six months would benefit from palliative and hospice care, thus a …

The Never-Ending Quest For Clarity Amidst Uncertainty: Hospital M&A And Antitrust Scrutiny, Ross E. Bautista

San Diego Law Review

Although critics say hospitals justify mergers in the same way as they did during the M&A boom of the 1990s, these critics frequently link the current wave of mergers with the purpose of becoming more integrated and efficient to achieve the level of cost savings and improved quality that the United States and patients currently require. However, the results from hospital consolidation remain uncertain because of the limited and mixed evidence about its impact on quality of care and price. Part I of this Article discusses the recent surge in hospital M&A activity. Part II brings some clarity by discussing …

Physician-Assisted Suicide: Removing Residency Requirements In The U.S. To Comport With An International Right To Health, Alexi Silverman

San Diego International Law Journal

In 1948, the UN General Assembly passed a resolution, known as the International Bill of Human Rights. The Bill contains the Universal Declaration of Human Rights, articulating a human right to health. A subsequent treaty, the International Covenant on Civil and Political Rights states that “every human being has the inherent right to life.” Furthermore, the International Covenant on Economic, Social and Cultural Rights protects access to healthcare. However, these treaties do not explicitly recognize a “right to die,” leaving the decision of whether to allow euthanasia and physician-assisted suicide within the discretion of individual countries.

With this international background …

Usd Magazine Fall 2016, University Of San Diego

University of San Diego Magazine (1992- )

From the President; Contents; Torero News; Torero Athletics; Extraordinary Moments; Hints of Hope in the Middle East; The Road to Sainthood; Alumni Update; Class Notes; Global Changemakers

Transitions To Assisted Living Within A Continuing Care Retirement Community, Judith H. Scott

Dissertations

Purpose/Aims: The purpose of this study was to explore the lived experience of older single women who moved from their independent homes to the assisted living setting, both situated within a Continuing Care Retirement Community (CCRC).

Rationale: Anecdotally, CCRC transitions have been viewed as either one dreaded possible step toward the end of life or a supportive place to open a new chapter in older adults’ lives. However, no studies have actually examined this experience among older single women, who comprise a large proportion of people making this transition.

Background: Older adults move to assisted living within a CCRC when …

As He Lay Dying: Fda And Huntington’S Disease Families Meet To Ponder Potential Treatments, Kenneth P. Serbin

At Risk for Huntington's Disease

No abstract provided.

Usd Magazine Fall 2015, University Of San Diego

University of San Diego Magazine (1992- )

Editorial License; Torore News; Torero Athletics; By Leaps and Bounds; Not Afraid to Get His Feet Wet; Beyond the Title; Alumni Update; Class Notes; Major Milestone

Usd Magazine Summer 2015, University Of San Diego

University of San Diego Magazine (1992- )

Get Involved; Torero News; Faith in Action; Torero Athletics; Taking Care; The Best and the Brightest; Alumni Update; Class Notes; Changemaker Summit

Managing End-Of-Life Pain Using A Rectal Medication Administration Device, Yen T. Kim

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project was to improve end-of-life pain management among hospice patients using a rectal medication administration device (RMAD).

Background: Approximately 1.5 to 1.6 million patients received hospice services in 2013 (National Hospice and Palliative Care Organization, 2013), and almost 75% of terminally ill patients experience pain during the dying process (Fink & Gates, 2010). Patients are often unable to tolerate oral pain medications at the end of life. Rectal administration of medication is an appropriate alternative for these patients. The rectal route has several benefits including low cost, consistent and predictable absorption of medications, ease of …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

A Phenomenological Study Of Health Professionals’ Perceptions Of Good And Bad Pediatric Hospital Deaths, Self-Care Needs And Lingering Distress, Carmen Nichole Spalding

Dissertations

The death of a child is devastating. Although death is a part of every life, a child dying seems out of order in current times and in the context of Western Healthcare. Health professionals (HP) caring for dying children frequently report suffering. In the past four decades, HP have been concerned with providing a “good death” for patients at the end-of-life (EOL). While studies have shown what a good death includes in elderly patients in various settings, few studies have examined what constitutes a good death for pediatric patients within the hospital setting. No studies were found examining healthcare workers …

The Patient Experience As Rated By Consumers, Barbara Jean Kelley

Dissertations

The purpose of this research project is to identify the key drivers in patients’ satisfaction. Specifically, the factors that patients consider when assigning a numeric rating (0-10) to their overall hospital stay. The overall satisfaction question is significant because it is considered to be the “top box” question. The top box question is the patientrated experience measure reported to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in determining the compensation a facility receives for reimbursement in the Value Based Purchasing model. The results of this study have a financial implication for healthcare, as well as in the delivery …

Vista: February 19, 2015, University Of San Diego

USD Vista (1965-)

No abstract provided.

The Respiratory Distress Observation Scale (Rdos), Pain, And Agitation, Karen Reavis

Dissertations

The Respiratory Distress Observation Scale (RDOS) is relatively new and has not been extensively evaluated. The purpose of this study was to, a) explore the incidence and severity of respiratory distress in the cognitively impaired adult patient on mechanical ventilation, b) examine the relationships between respiratory distress, pain, and agitation in that same population and, c) compare the differences in RDOS scoring results at a 1 minute versus 3 minute observation period. This study had Institutional Review Board approval and took place in a large metropolitan medical intensive care unit. Our subjects consisted of 148 cognitively impaired adults on mechanical …

There Is Another Way: The Life Of Galia Golan Of Israel, Claire Doran

Kroc IPJ Research and Resources

In the following pages, you will find narrative stories about a Woman PeaceMaker, along with additional information to provide a deep understanding of a contemporary conflict and one person’s journey within it. These complementary components include a brief biography of the peacemaker, a historical summary of the conflict, a timeline integrating political developments in the country with personal history of the peacemaker, a question-and-answer transcript of select interviews, and a table of best practices in peacebuilding as demonstrated and reflected on by the peacemaker during her time at the Kroc Institute for Peace and Justice.

Galia Golan of Israel knows …

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Delirium Rate And Risk Factors In Palliative Care Outpatients And Caregiver Coping Strategies, Sarah Deur Livermore Phd, Fnp

Dissertations

Background: Delirium causes suffering and in terminal illness undermines important goals to die at home. Improved knowledge about delirium among palliative outpatients can lead to improved patient outcomes through early identification and treatment in the home. Conversely, a missed diagnosis leads to costly hospital admissions, and is the most common reason to seek long-term care placement (Breitbart & Alici, 2008). Medicare stresses the importance by listing it as a common cause of falls among non-reimbursed hospital events. Prior evaluation of outpatient delirium rate was 14% among demented community dwelling elders (Steis, Evans, et al., 2012a). It is hypothesized that frail, …

Professional Quality Of Life And Emergency Department Nurses' Communication Patterns, Elvira Dominguez-Gomez Phd

Dissertations

The purpose of this mixed methods embedded design study was to examine relationships between compassion satisfaction, burnout, compassion fatigue/secondary trauma, and perceived levels of communication difficulty in emergency room nurses employed at a health care system. Quantitative data was collected from a purposive sample of 43 emergency room nurses using the Professional Quality of Life Scale (ProQOL), the Silencing Response Scale, and a demographic form. The study's embedded qualitative component was participants' experiences with traumatic cases in the emergency room. Qualitative data was collected via telephone interview with 10 emergency room nurses obtained from a subset of the original sample …