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The Struggle For Self-Determination: A Comparative Analysis Of East Timor And Western Sahara, Emma Baratta

Honors Theses

Self-determination is accepted as an international right of all people, yet in many cases it still takes decades of struggle to achieve it. Through comparative analysis of the selfdetermination and independence struggles of East Timor and Western Sahara, conclusions can be drawn as to why some former colonies are able to achieve these goals while others do not. In order to better understand the challenges associated with self-determination, I evaluate the two cases based on four overarching factors which influence the process: statehood criteria and imagined community status, colonialism and occupation, presence of natural resources, and international recognition. I argue …

A Public Health Ethics Approach To Substance Use Disorder, Adele Flaherty

Electronic Theses and Dissertations

The goal of the dissertation is to undertake an analysis of substance use disorders that focuses on a public health ethics perspective. The ethical argument focuses upon justifying the use of harm reduction and is primarily concerned with the current opioid crisis. While substance abuse/misuse over the course of history has been identified as a public health concern, this dissertation presents substance use disorders over the course of the lifespan, examining various contexts in which it can affect daily living and health outcomes. It achieves this by analyzing substance use disorders through the lens of the socioecological model of public …

Ethel Mae Hunter

African American Funeral Programs

No abstract provided.

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 …

Targeting Nstemi Readmissions: Education To Protect The Hearts Of Our Patients, Gisha Gireesan

Master's Projects and Capstones

Section I: Abstract

Problem: January and February 2021 data showed a rise in readmissions for the NSTEMI population. This is significant as 2020 had a readmission rate of 5.6% and 7.3% in 2019. This sudden increase in readmissions within the first two months of the year is a cause for concern and immediate action is needed.

Context: 2020 had a reduction in cardiac catheterizations due to the multiple canceled cases during the COVID 19 pandemic. As the cases were being rescheduled along with new cases in 2021, the institution experienced an uptake in readmissions.

Interventions: The staff of department 220 …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Servant Leadership Impact: Practical Insights For The Nonprofit Sector, Michael Ohaneson

Master's Projects and Capstones

In an environment often focused on sustainability and doing more with less, this project examines the effectiveness of servant leadership on organizations and individuals in the nonprofit sector. This capstone focuses on a comparative analysis of information collected via literature review and incorporates responses from interviews conducted with experts in the field of servant leadership. The project includes practical implications for the nonprofit sector.

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Specialty Palliative Care: A Quality Improvement Project, Leticia Ries

Master's Projects and Capstones

Abstract

Problem: Patients identified on the regional database as specialty palliative care (SPC) patients with congestive heart failure (CHF) have not been consulted annually, as expected by evidence-based practice.

Context: Twenty-three percent of patients with a life-limiting illness on the SPC registry were seen year to date. Patients with CHF are vulnerable populations who benefit from an SPC consult to address quality of life, frequent admissions, and suffering.

Interventions: A rapid experiment of two interventions was evaluated for a solution approach. An electronic report identifying hospitalized registry patients and a standardized triage process were the critically assessed interventions to mitigate …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Improving Patient Hand-Off Communication By Utilizing The Situation-Background-Assessment-Recommendation (Sbar) Tool Between The Perioperative Services Departments, Maureen Mijares

Master's Projects and Capstones

Problem: The Situation-Background-Assessment-Recommendation (SBAR) patient handoff communication is required when the patient is transferred from one department/unit to the next phase of care. There is no standard SBAR utilized within the perioperative services departments.

Context: There are three types of patient handoff communication utilized in the perioperative services departments; Electronic Health Record (EHR), paper form, and verbal via phone.

Intervention: A standardized SBAR patient handoff communication tool to provide a framework to improve patient handoff communication between nurses within the perioperative services departments.

Measures: The outcome measure for this process improvement project is defined as the number of patient handoff …

Reducing Implicit Bias: Evaluating Cultural Humility And Mindfulness Practices In The Perinatal Microsystem, Charlene Johnson

Master's Projects and Capstones

Problem: In one perinatal microsystem, an assessment revealed 49 reported events that alleged perceived bias occurred over a one-year period. This project aims to address implicit bias and educational solutions to improve communication and create a culture of humility and equity.

Context: The setting was an urban hospital within a large non-profit healthcare organization. The improvement team included registered nurse champions, obstetrical technicians, midwives, physicians, managers, and an educator.

Intervention: A virtual interactive education session for a multidisciplinary volunteer group (n=18) was introduced followed by five weekly follow-up discussions. The education focused on translating the cultural humility …

Increasing Organizational Chemotherapy Competencies, Ruth Manuel Monsalud

Master's Projects and Capstones

Problem: Despite its 21 facilities in Northern California, the organization has limited capability to administer chemotherapy infusion, resulting in both provider and patient inconveniences due to lack of qualified chemotherapy-certified nurses.

Context: The cost of interfacility transfers for 1 year were over $1.7 million, not including decreased provider and patient satisfaction.

Interventions: 12 staff nurses on 6S unit will complete a two-phase individualized training program and earn an Oncology Nursing Society Fundamentals of Chemotherapy Immunotherapy Administration provider card to ensure adequate coverage for patients requiring chemotherapy administration during their hospital stay.

Measures: Training existing nurses in chemotherapy was encouraged. Another …

Preventing Pressure Injuries On Patients Undergoing Treatment With Extracorporeal Membrane Oxygenation (Ecmo), Hediyeh Shakeri

Master's Projects and Capstones

One of the top National Patient Safety Goals by The Joint Commission is to prevent hospital-acquired pressure injuries, which is reiterated by Centers of Medicare and Medicaid as a valuable metric in determining the quality of patient care and safety as well as hospital performance. The Agency for Healthcare Research and Quality reports over 2.5 million patients affected by hospital-acquired pressure injuries per year, costing between $9.1-$11.6 billion per year with the cost of individual patient care ranging from $20,900 to 151,700 per pressure injury (Agency for Healthcare Research and Quality, 2014). Approximately 30% of these cases are related to …

Patient Coordinated Care Response Team, Joshua Fox

Master's Projects and Capstones

Section I: Abstract

Problem: Communication between medical professionals and patients is a critical element to patient satisfaction and safety. The 2020 patient overall satisfaction scores for the local Roseville hospital were 73%. These data demonstrated an opportunity to enhance processes and the culture at the local Roseville hospital to meet the communication needs of its patient population.

Context: A patient coordinated care response team was developed to improve communication for newly diagnosed cancer patients or other life-altering diagnosis patients.

Interventions: A survey was completed to establish the current state of patient satisfaction with communication practices with healthcare providers in the …

Standardization Of Bedside Shift Report In Pediatrics, Edwin Tadeo

Master's Projects and Capstones

Problem: In the pediatric setting, the change-of-shift report does not traditionally happen at the bedside. Medical error is a significant health challenge in the healthcare system, with substantial effects on patient safety, including disability or death. Failure of effective communication during the hand-off process contributes to approximately 30% of all malpractice claims. Furthermore, inadequate hand-offs have been shown to contribute to 1,744 deaths and $1.7 billion in malpractice costs over five years (Joint Commission, 2017).

Context: The microsystem setting for this improvement project is a 32-bed pediatric unit in Northern California. It was concluded that the organization could support any …

Enhanced Recovery After Surgery: Effectiveness Of Real Time Data Tracking Tools, Alatia S. Jentons

Master's Projects and Capstones

Enhanced Recovery after Surgery (ERAS) has been proven by evidence to lower both recovery time and postoperative complication rates while also being cost-effective. It is a new recovery process that consists of several bundles in order to meet adherence. The hospital site where this project was conducted was at a Northern California Medical Center which provides care for in-patient postoperative, urgent and non-urgent cases. On our assigned units, we identified the potential for improvement after observing a lack of standardization of real-time charting for ERAS. This resulted in retro data, which is not an effective way to collect data when …

Mdma And Mouth Ulcers, Y Lin

Peninsula Dental School

Sir, 3,4-methylenedioxymethamphetamine (MDMA), otherwise known as ecstasy, is an illicit drug which is consumed for recreational use. In addition to systemic complications, it can also present with a variety of oral side effects. Patients may first present to their primary care practitioners before being referred acutely onwards to an oral and maxillofacial surgery or oral medicine department for further investigations and management, which has been our experience here in a secondary care setting. I would like to raise awareness about these oral manifestations and the management options that can be provided.Xerostomia can occur which should subside after approximately 48 hours. …

Layered Architecture For Internet Of Things-Based Healthcare System: A Systematic Literature Review, Somayeh Nasiri, Farahnaz Sadoughi, Afsaneh Dehnad, Mohammad Hesam Tadayon, Hossein Ahmadi

School of Nursing and Midwifery

Internet of Things (IoT), known as a new paradigm, has shown to have a significant role in healthcare domains including remote vital sign monitoring systems, physical activity tracking, early disease diagnosis, and prevention of disease risks. Therefore, designing an integrated healthcare system based on Internet of Things is highly dependent on designing a layered architecture pattern. However, there are no comprehensive studies on Internet of Things layered architecture in the healthcare industry. The purpose of this study was to identify and scrutinize different types of layered architecture of Internet of Things in healthcare in terms of functions, and technologies. We …

Air Quality And Mental Health: Evidence, Challenges And Future Directions, K Bhui, J Newbury, R Latham, M Ucci, Z Nasar, B Turner, C O'Leary, Hl Fisher, E Marczylo, P Douglas, S Stansfeld, S Jackson, S Tyrrel, A Rzhetsky, R Kinnersley, P Kumar, C Duchaine, F Coulon

School of Biomedical Sciences

No abstract provided.

Clabsi Prevention In The Icu-A New Approach, Shannon M. Hicks

Master's Projects and Capstones

Abstract

The Center for Disease Control and Prevention (CDC) emphasizes that the primary cause of preventable deaths and disabilities among hospitalized patients in the United States are hospital-acquired infections (HAIs). Based on the CDC surgical site infection monitoring, common infections include central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and catheter-associated urinary tract infections. This paper primarily focuses on the problem of CLABSI, with an aim to reduce the net occurrences of CLABSIs in the intensive care unit (ICU) through the interventional use of SecurePortIV skin adhesive during the insertion of central lines. Although few researchers have examined the implication of …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Post Cesarean Surgical Site Infection Reduction Through Vaginal Preparation, Jennifer M. Jaime

Master's Projects and Capstones

Abstract

Problem: The increasing rates of surgical site infections (SSIs) after cesarean delivery have a negative impact on patient morbidity, mortality, postoperative fevers, trauma, and hospital costs.

Context: Interventions are a necessity for this population however, there is lack of preventative practice utilized in the labor and delivery unit to reduce the rates of post cesarean SSIs.

Interventions: The preventative evidenced based practice of vaginal preparation with 10% povidone-iodine was implemented on women in the operating room before their cesarean procedure. Educational materials such as informative presentations, videos, and posters were created to educate nursing staff on the implementation of …

Reducing Maternal Falls On A Postpartum Unit Through Staff Education, Kathleen Benjamin

Master's Projects and Capstones

There have been 23 documented falls on the maternity unit at Hospital A over the past three years. This fall rate is above the national average, making the reduction of falls on the postpartum unit a priority to maintain the hospital’s Magnet status and improve patient safety. Data analysis related to contributing factors of falls and staff education on best ambulation practices has the potential to decrease the number of maternal falls on the targeted microsystem population of the postpartum unit. This quality improvement project conducted a fall audit on each documented fall case, performed an environmental survey of the …

Evidence Based Repositioning Strategies To Improve Pressure Injury Rates, Ivan E. Dorsey

Master's Projects and Capstones

Pressure injuries (PI) affect approximately 1-3 million people in the United States annually, and amount to 3-11 billion dollars in yearly healthcare costs (Mondragon et al., 2021; Padula & Delarmente, 2019). In veterans who seek care, especially the elderly (>65 y/o), pressure injuries are particularly devastating because they increase hospital costs and lengthen stays (Stroupe et al., 2011). In light of these statistics, the aim of this project was to decrease PI rates in veteran patients through the implementation of evidence-based practice. This project was conducted on a medical/surgical telemetry unit with 18 beds at a Northern California hospital …

Reducing Hospital Readmission Rate In Chf Patients Through Early Individualized Patient Discharge Education, Anthony Ensah

Master's Projects and Capstones

The term congestive heart failure (CHF) is a chronic condition that occurs in a person when the heart stops doing its normal activity of pumping blood to the rest of the body for the body. Heart failure normally occurs when the heart can no longer pump (systolic) or fills (diastolic) pressure adequately to the body. Because heart failure is one of the leading causes of death in the United States this project was conducted on one of the Northern California San Francisco Bay- Area hospitals to assess patients understanding and knowledge on the presenting signs and symptoms of heart failure …

Coyote Management In San Francisco, Matthew Greer

Master's Projects and Capstones

As cities in North America grow, coyotes have become progressively more important species in urban ecosystems. Moreover, as coyotes increasingly use these urban spaces, human-coyote conflicts have become more common, creating a need for new management strategies. This paper will explore how the city of San Francisco could create a new coyote management plan for its highly visible coyote population. San Francisco has had a persistent coyote population since the early 2000s (Todd, 2018). Currently, the coyote population is close to 100 individuals and is still growing (J. Young, Presidio Trust, pers. comm.). To explore this topic a literature review …

Discharge Nurse Role Implementation: Improving Discharge Timeliness And Patient Outcomes, Diamond Faith Chu

Master's Projects and Capstones

Problem: The Discharge Nurse (DN) Role Implementation project aims to reduce the delay in the discharge process and patient length-of-stay. With the current microsystem discharge process, there are observed barriers to timely discharge related to various discharge tasks and interdisciplinary communication methods.

Context: This project was implemented in a metropolitan hospital within Northern California, on a unit that serves medical-surgical, oncology, and geriatric patients. There are 35 registered nurses (RN’s), eight certified nursing assistants, one charge manager, one assistant charge manager, one clinical nurse leader, and four clinical nurse specialists (oncology).

Interventions: The intended aim of this project is to …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Establishing Quiet Hours In Long-Term Care: A Quality Improvement Project, Heather Battaglia

Master's Projects and Capstones

Problem: Sleep disturbances in long-term care residents are associated with falls, behavioral problems, and increased mortality rates, yet long-term care facilities are traditionally noisy environments at night. Designated quiet hours have been shown to improve patient sleep as well as decrease stress levels in nurses.

Context: In a skilled nursing facility that provides care for military veterans with complex medical and psychosocial needs, signage exists that indicates to be quiet between 10:00 p.m. and 7:00 a.m., but no defined guidelines were available for staff to observe.

Interventions: Standards for quiet hours were established and posted throughout the microsystem. Lecture-style teaching …