Digital Commons Network^™

Panel: Climate Change And Climate Justice, Alice Kaswan, Michael B. Gerrard, Monica Esparza, J.B. Ruhl

Faculty Scholarship

This article is a transcript of a panel discussion from the 2022 Richmond Public Interest Law Review's Symposium on Environmental Justice.

How Agencies Can Better Regulate For Racial Justice, Olatunde C.A. Johnson

Faculty Scholarship

On his first day in office, President Joseph R. Biden signed an executive order to advance racial equity throughout the federal government by taking a “systematic approach to embedding fairness in decision-making,” redressing inequities, and advancing equal opportunity in agency policies and programs.

This order is an important step. President Biden’s executive order promises new, proactive engagement by the administrative state to promote racial equity and other dimensions of inclusion in agency programs. But federal administrative agencies have played a key role in structuring racial segregation and sustaining racial inequality in housing, health care, access to transit, and wealth. President …

The Legal Origins Of Catholic Conscientious Objection, Jeremy K. Kessler

Faculty Scholarship

This Article traces the origins of Catholic conscientious objection as a theory and practice of American constitutionalism. It argues that Catholic conscientious objection emerged during the 1960s from a confluence of left-wing and right-wing Catholic efforts to participate in American democratic culture more fully. The refusal of the American government to allow legitimate Catholic conscientious objection to the Vietnam War became a cause célèbre for clerical and lay leaders and provided a blueprint for Catholic legal critiques of other forms of federal regulation in the late 1960s and early 1970s — most especially regulations concerning the provision of contraception and …

Increasing Perioperative Nurse Knowledge Of Preoperative Urine Pregnancy Testing: A Quality Improvement Project, Brooke K. Hall

Master's Theses and Capstones

Background: Nurses in the perioperative environment are responsible for assessing patients prior to undergoing surgery. Preoperative urine pregnancy testing is utilized to determine the pregnancy status of patients. Various risks of anesthesia and surgery exist for pregnant patients and the fetus. The perioperative nurse must be knowledgeable about these risks and ensure preoperative urine pregnancy tests are obtained when appropriate.

Local Problem: Within this microsystem, a gap in knowledge of perioperative nurses related to the nature and significance and institutional policy for preoperative urine pregnancy testing was identified.

Aim: The aim of this project was to increase knowledge of preoperative …

Improving Disinfectant Cap Use On Central Lines In The Icu To Reduce Patient Risk For Clabsi: A Quality Improvement Project, Tali Cherim

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention …

Addressing Job Satisfaction In Nursing Staff Through Mindfulness: A Quality Improvement Project, Abigail Isenberg

Master's Theses and Capstones

Background: As the single largest group of healthcare professionals, comprising a workforce of over 4 million in the United States, keeping nurses satisfied in their positions is a vital component of providing quality patient care (Perry et al., 2018). It is estimated that 68% of nurses will experience significant job dissatisfaction at a point in their career (Ayalew et al., 2018). Mindfulness practice, specifically Mindfulness-Based Stress Reduction (MBSR) is a recognized tool to lower work-related stress and increase job satisfaction of nursing staff (Henry, 2014).

Local Problem: The state of the specific microsystem had been high levels of dissatisfaction among …

Optimizing Cardiovascular Patient Education At Discharge, Olivia Marciano

Master's Theses and Capstones

Background: Without a clear understanding of proper discharge instructions or a lack of educational material, patients may leave the hospital feeling conflicted as to what to do. In 2021 a research study noted that patients who do not have enough information prior to discharge have decreased compliance, decreased patient safety, increased risk of hospital readmission, and poor overall satisfaction (DeSai, Janowiak, Secheli, et. al., 2021). This quality improvement project sought to increase patient knowledge related to exercise and nutrition following a cardiovascular event that led to a hospital admission.

Methods: For the purpose of this quality improvement project, the PDSA …

Reducing Patient Handoff Inadequacies Using An Electronic Medical Record Based Standardized Handoff Tool In The Critical Care Unit, Mariah E. Needham

Master's Theses and Capstones

INTRODUCTION: Inadequate handoff communication is a contributing factor in sentinel events and adverse patient outcomes. Research has shown that the use of a standardized handoff tool can improve quality of handoff communication. This quality improvement (QI) project sought to standardize handoff and reduce the risk of adverse patient outcomes by utilizing the I-PASS handoff tool available in the electronic medical record (EMR).

AIM: The aim of this quality improvement project was to improve the accuracy of nurse-to-nurse patient handoffs.

METHODS: The outcomes measured by the post-intervention survey were the number of reported handoffs received with omissions, the percentage of staff …

Reduction Of Order-To-Scan Times To Increase Patient Throughput And Improve Patient Outcomes: A Quality Improvement Project, Jason Harrington

Master's Theses and Capstones

Background: Throughput is a key metric for both the emergency department and the hospital system. Diagnostic tests, such as CT scans, can lead to a large delay in patient throughput which can negatively impact patient satisfaction and patient outcomes. Finding ways to reduce delays in CT scan acquisition can positively impact patient satisfaction and patient outcomes.

Aim: The specific aim of this quality improvement project was to decrease the amount of time it takes to complete abdominal CT scans with IV contrast once ordered from 61 minutes to below 35 minutes by July 1^st, 2022

Methods: Plan was …

Implementing A Patient-Centered Education Intervention To Reduce Incidence Of Chemotherapy-Induced Oral Mucositis (Om) Among Inpatient Chemotherapy Patients: A Quality Improvement Project, Annika K. Hamilton

Master's Theses and Capstones

Oral mucositis (OM) is a common and costly complication of chemotherapy cancer treatment resulting in high costs and poor outcomes and experiences for chemotherapy patients. At the site of this quality improvement (QI) project, the quality and content of the oral care patient education for chemotherapy patients is inconsistent. The aim of this project was to improve oral care completion and knowledge by 20% among inpatient chemotherapy patients and in turn reduce incidence of chemotherapy-induced OM. A pre-intervention survey was distributed to eight eligible patients to assess baseline oral care completion and knowledge. Patients were provided with an oral care …

Promoting Inpatient Sleep Quality Through The Distribution Of A Sleep-Kit Upon Admission: A Quality Improvement Initiative, Monicka Puchlopek

Master's Theses and Capstones

Background: Hospitals are expected to provide a quiet and calm environment for the promotion of rest, healing, and well-being for their patients. Excess hospital noise levels and disturbances severely interfere with patient sleep and overall patient satisfaction.

Local Problem: Patients have discussed inability to sleep, need for sleeping medications, and lack of appetite due to hindered sleep following admission. An increase in patient withdrawal and decrease in level of participation in the plan of care has recently been observed.

Method: This project followed the Plan-Do-Study-Act (PDSA) framework to facilitate a rapid intervention implementation and change cycle. In addition, the Richards …

Enhancing Patient Safety By Promoting The Use Of The Electronic Medication Administration Record During The Preparation Of Injectable Medications: A Quality Improvement Project, Michael Ferrone

Master's Theses and Capstones

Background: Patient safety is a top priority for registered nurses (RNs) while caring for individuals in the healthcare setting. Of the various responsibilities of an inpatient RN, administering injectable medications pose significant risks to patients if done incorrectly. Given these known risks, the RNs of an inpatient medical-surgical microsystem were studied during the process of preparing these medications.

Local Problem: Through observations (N = 20), it was noticed that 13 (65%) of the preparations were done at a location referred to as the nurse server counter. This is problematic since this location does not provide the RN with access …

Increasing Patient Satisfaction With Noise Reduction On Medical Surgical Units: A Quality Improvement Project, Chennah Sharpe

Master's Theses and Capstones

Background: Noise has been linked to negative impacts on patient’s rest, length of stay (LOS), the immune system’s ability to fight infections, pain and anxiety levels, and readmission rates. Quality improvement projects in non-intensive care units are needed to determine major causes of noise and factors which impact patients’ rest, perception of noise, and satisfaction with medical-surgical unit care.

Aim: The global aim of this quality improvement project was to increase medical-surgical patients’ satisfaction by reducing the impact of noise in their inpatient stay. The specific aim was to increase the percent of patients, who responded Always to the Hospital …

Ophthalmic Nursing Education: The Key To Unlocking Patient Access To Retina Services, Jacob P. Mcginnis

Master's Theses and Capstones

Background: Ophthalmology, the medical field dedicated to the human eye and visual system infrequently uses nurses due to a lack of nursing knowledge about ophthalmology.

Local Problem: An ophthalmic microsystem in the Northeastern United States is experiencing increased demand for services and decreased access to their retina section. The microsystem does not utilize nurses in the clinic because of education and training barriers. The specific aim of this quality improvement (QI) project is to increase nursing knowledge about ophthalmology from baseline to an overall passing score of 80%.

Methods: This QI project sought to see if registered nurses could …

Standardizing Nursing Hand-Off Report Using I-Pass On A Behavioral Health Unit: A Quality Improvement Project, Sarah Pennisten

Master's Theses and Capstones

Background: Deficient or ineffective communication in clinical hand-off has been established by prominent international health organizations as a significant cause of adverse clinical events, compromising clinical safety, an ongoing common problem for healthcare professionals and institutions. Existing literature unanimously called for improvement in hand-off communication to improve patient outcomes and recommended beginning such efforts by building various types of structure into hand-off (McCloughen et al., 2008).

Aim: The aim of this quality improvement project was to improve clinical communication among nurses transferring care of patients in acute psychiatric care.

Methods: Utilizing the Plan, Do, Study, Act framework over a total …

Improving Breastfeeding Establishment By Reducing The Use Of Bottles And Artificial Nipples With Medically Needed Supplementation In Full-Term Breastfed Infants: A Quality Improvement Project, Sara Fazzi Garcia

Master's Theses and Capstones

Background: Breastfeeding has long been strongly recommended by national and international organizations as a prevention of many common and chronic diseases. Baby-Friendly Hospital Initiative (BFHI) was developed to motivate hospitals to protect, promote, and support breastfeeding. This Quality Improvement (QI) project aims at supporting the continuation of the Baby-Friendly designation at the organization is being implemented, by focusing on reducing the use of bottles and artificial nipples for medically necessary supplementation for full-term breastfed newborns.

Methods: The Plan-Do-Study-Act (PDSA) framework was utilized to guide this quality improvement project.

Intervention: Educational posters on the interference of the use …

Let’S Get Moving To Reduce Falls: Nurses Increase Patient Mobilization After Brief Training, Thomas Langley

Master's Theses and Capstones

BACKGROUND: Patients in hospitals are at a high risk for falls. There are many reasons for this, but one common reason is that patients in hospitals spend a lot of time being inactive. The less time patients spend being mobile, the less capable they are of maintaining mobility and the more likely they are to fall. During the first two years of the COVID-19 pandemic, Wildcat Hospital experience their fall rates increase two- to three-fold on inpatient units.

METHODS: This quality improvement project was guided by the Plan, Do, Study, Act (PDSA) framework to improve nurse knowledge of mobility and …

Decreasing Delays Within The Perioperative Unit Caused By Cases Of Hypoglycemia Through Nursing Continuing Education: A Quality Improvement Project, Jesse Bardis

Master's Theses and Capstones

No abstract provided.

Improving Patient Engagement And Adherence Utilizing Home Blood Pressure Monitoring Equipment: A Quality Improvement Project, Katelyn Fournier

Master's Theses and Capstones

To combat uncontrolled hypertension, a quality improvement project was designed that aimed to increase patient recorded self-care measures such as maintenance, management, and monitoring. By increasing both education and supplying volunteers with a free electronic home blood pressure monitor (HBPM) it was predicted that positive changed behaviors surrounding self-care would occur and subsequently, a reduction in average blood pressure. To examine this, results from Dickson’s Self-Care of High Blood Pressure Inventory (SC-HI V3) and blood pressure measurements were recorded and analyzed for average trends. Results from the improvement proved effective as self-care values well surpassed the 10% goal that was …

Quality Improvement Initiative Through Staff Development: Using Education To Increase Preoperative Handoff Communication, Victoria L. Mcgovern

Master's Theses and Capstones

Abstract

Background: Handoff communication is essential for patient safety, especially in the perioperative setting as a critical care environment. Preoperative communication between operating room nurses and preoperative room nurses was suboptimal in a local microsystem as evidenced by pre-intervention data collection where 82% of cases did not participate in handoff, 11% with partial adherence of policy and only 7% in full adherence. The global aim of this project was to improve the handoff communication between the preoperative nurse and operating room nurse in the surgical day center (SDC) within the chosen microsystem to promote patient safety and positive patient outcomes. …

Combating Burnout And Building Resilience Within Icu Nurses: A Quality Improvement Project Based On Mindfulness And Self Care, Emily Evans

Master's Theses and Capstones

No abstract provided.

Associations Of Short And Medium Chain Saturated Fatty Acids And Dairy With Cognitive Functioning In The Boston Puerto Rican Health Study, Sophie M. Kenny

Master's Theses and Capstones

Cognitive decline is a major public health concern. Evidence suggests that Hispanic/Latino adults, specifically Puerto Rican adults, in the US are at a higher risk of developing dementia or cognitive decline due to the high prevalence of risk factors, including cardiovascular disease and diabetes. Emerging evidence suggests that specific dietary fatty acids, short and medium-chain-length saturated fatty acids, that are found in dairy may be beneficial for cognitive function. However, there are limited observational studies examining the effects of SMCSFA and dairy on cognitive function in Hispanic/Latino adults. We examined the cross-sectional and prospective associations between SMCSFA and dairy consumption …

Accommodating Parents, Joshua Gupta-Kagan

Faculty Scholarship

The child protection legal system is supposed to work towards the reunification of parents and children in foster care through individualized services to help parents raise their children safely. But that legal system has long been criticized for frequent and severe invasions into the family integrity rights of parents with disabilities and their children, treating parental disabilities as grounds for permanent separation instead of individual characteristics to be accommodated. Several years ago, it seemed that the law was turning. In 2015, the U.S. Departments of Health and Human Services and Justice issued joint guidance stating that the Americans with Disabilities …

Judicial Minimalism In Lower Courts, Thomas P. Schmidt

Faculty Scholarship

Debate about the virtues and vices of “judicial minimalism” is evergreen. But as is often the case in public law, that debate so far has centered on the Supreme Court. Minimalism arose and has been defended as a theory about how Justices should judge. This Article considers judicial minimalism as an approach for lower courts, which have become conspicuous and powerful actors on the public law scene. It begins by offering a framework that disentangles the three basic meanings of the term “judicial minimalism”: decisional minimalism, which counsels judges to decide cases on narrow and shallow grounds; prudential minimalism, which …

Mindful Debiasing: Meditation As A Tool To Address Disability Discrimination, Elizabeth F. Emens

Faculty Scholarship

Antidiscrimination law is at a critical juncture. The law prohibits formal and explicit systems of exclusion, but much bias nonetheless persists. New tools are needed. This Article argues that mindfulness meditation may be a powerful strategy in the battle against disability discrimination. This Article sets out eight reasons that disability bias is particularly intractable. The Article then draws on empirical, philosophical, and scholarly sources to identify mechanisms through which mindfulness meditation can address these dynamics. The Article concludes by presenting concrete doctrinal implications of bringing mindfulness to bear on disability discrimination. This Article thus contributes to the established fields of …

Credit, Crises And Infrastructure: The Differing Fates Of Large And Small Businesses, Todd Baker, Kathryn Judge, Aaron Klein

Faculty Scholarship

This Essay sheds new light on the importance of credit creation infrastructure in determining who actually receives government support during periods of distress, and who continues to benefit after the acute phase of a crisis and the government’s formal support programs come to an end. The pandemic revealed, and the government’s response accentuated, meaningful asymmetries in the capacities of small and large businesses to access needed funding.

At first glance, it would seem that small businesses benefitted more than large ones from the government’s pandemic-support programs, as more government funds flowed into small businesses. Yet closer inspection of the range …

The Institutions Of Family Law, Clare Huntington

Faculty Scholarship

Family law scholarship is thriving, with scholars using varied methodologies to analyze intimate partner violence, cohabitation, child maltreatment, juvenile misconduct, and child custody, to name but a few areas of study. Despite the richness of this discourse, however, most family law scholars ignore a key tool deployed in virtually every other legal-academic domain: institutional analysis. This methodology, which plays a foundational role in legal scholarship, focuses on four basic questions. Scholars often begin empirically, identifying the specific legal, social, and economic institutions that shape an area of legal regulation. Beyond descriptive accounts, scholars analyze how authority is and should be …

The Institutional Mismatch Of State Civil Courts, Colleen F. Shanahan, Jessica K. Steinberg, Alyx Mark, Anna E. Carpenter

Faculty Scholarship

State civil courts are central institutions in American democracy. Though designed for dispute resolution, these courts function as emergency rooms for social needs in the face of the failure of the legislative and executive branches to disrupt or mitigate inequality. We reconsider national case data to analyze the presence of social needs in state civil cases. We then use original data from courtroom observation and interviews to theorize how state civil courts grapple with the mismatch between the social needs people bring to these courts and their institutional design. This institutional mismatch leads to two roles of state civil courts …

Election Law Localism And Democracy, Richard Briffault

Faculty Scholarship

American federal and state elections are largely run by local officials. Although election law is almost entirely determined by the federal government and the states, elections are actually conducted by thousands of different county and city elections offices. This decentralization of election administration has often, and fairly, been criticized as resulting in undesirable interlocal variation in the application of election rules, inefficiency, and racial discrimination. Yet, in 2020, local election administration, particularly in large urban areas, was a source of strength. Local officials proved to be resilient, innovative, and attentive to local conditions. The record-high turnout in the face of …

West Virginia V. Environmental Protection Agency: The Agency's Climate Authority, Michael B. Gerrard, Joanne Spalding, Jill Tauber, Keith Matthews

Faculty Scholarship

On February 28, 2022, the U.S. Supreme Court heard oral arguments for the landmark West Virginia v. EPA case, involving the scope of powers delegated to the U.S. Environmental Protection Agency (EPA) through the Clean Air Act. The Court’s decision will affect administrative law, and could have major consequences for environmental law, particularly the Agency’s power to regulate greenhouse gas emissions and take action on climate change. On March 1, the Environmental Law Institute hosted a panel of leading experts to discuss the case, the arguments, and what form the decision may take. Below, we present a transcript of that …