Charting The Course: Improving Psychotropic Medication Documentation Through Staff Education To Promote Patient Safety And Cms Compliance, Anne J. Bertram Rn

Master's Projects and Capstones

The University of San Francisco master’s level nursing program culminates with a clinical nurse leader (CNL) quality improvement project. The objective of this project is to reinforce the program’s didactic CNL classes by allowing students the opportunity to design, implement, and analyze a quality improvement project in a microsystem. SETTING: Skilled nursing facilities often prescribe psychotropic medications to help manage residents’ behavioral and psychological symptoms. Due to the possibility of side effects and increased sedation, there are concerns for patient safety and quality of life. Inadequate management of these patients and symptoms compromises patient safety and breaches state and federal …

Improving Chemotherapy Patients' Confidence And Preparedness Through Dual-Format Teaching, Jasmine Esther Aminpour, Harshpreet Kaur, Ana Ruvalcaba, Sarah Muwanas

Master's Projects and Capstones

Section I: Abstract

Objective

Chemotherapy initiation is widely recognized as a period of heightened anxiety and cognitive overload for oncology patients, often limiting their ability to retain essential information during traditional one-time, nurse-led education sessions (Gucuyener & Karabacak, 2025; Howell et al., 2020). This quality improvement (QI) project sought to address gaps in comprehension, preparedness, and digital engagement within an outpatient oncology infusion microsystem by integrating evidence-based digital chemotherapy education with structured follow-up support.

Aim

The project aimed to determine whether a nurse-guided walkthrough of a digital chemotherapy education platform, paired with standardized follow-up calls, would improve patient comprehension, confidence …

Enhancing Patient Safety In A Skilled Nursing Facility With A Post-Fall Huddle Protocol: A Quality Improvement Initiative, Evelin Yajaira Dominguez Dominguez

Master's Projects and Capstones

Objective To implement a post-fall huddle guide at a San Francisco Bay Area skilled nursing facility to address the 75 resident falls that occurred over an eight-month period. The literature emphasized the positive impact of huddles on staff communication, awareness, and collaboration which ultimately created a safe environment. Aim By November 4, 2025, the overall fall rates among patients in a San Francisco Bay Area SNF will decrease by 25%, from 4.8 falls per 1,000 patient days to 3.6 falls per 1,000 patient days. Methods Pre-implementation and post-implementation surveys were completed by LVNs and CNAs to assess knowledge of post-fall …

From Incomplete To Impactful—Finalizing Unfinished Nursing Projects In Nart And Polypharmacy For Lasting Improvement, Paula Thanh Nhat Pham, Armine Lianna Chamichyan, Anastasia Yerofeyeva, Stelene Alexis Tragus

Master's Projects and Capstones

This quality improvement project addressed the problem of incomplete or unsustained clinical initiatives at a long-term care facility by introducing Kotter’s Change Model, an evidence-based framework designed to support and sustain lasting improvements in clinical practice. Within the context of a religious-based residential community for older adults with complex chronic needs, the objective was to strengthen the facility’s capacity to implement and sustain change more effectively. By using two previously unfinished initiatives, the NaRT triage tool and Polypharmacy management process, the project applied Kotter’s model to evaluate how structured change strategies can improve staff engagement, leadership alignment, and long-term project …

Beyond Compliance: How Targeted Education Improves Psychotropic Medication Documentation And Patient Safety In Skilled Nursing Facilities, Dyani Williams

Master's Projects and Capstones

Psychotropic medications are routinely prescribed in skilled nursing facilities to manage behavioral and psychological symptoms, but inadequate documentation poses risk to patient safety and leads to regulatory noncompliance. Objective: This project aimed to improve nursing staff knowledge and confidence in documenting psychotropic medication use in order to safeguard patient safety and follow Center for Medicare and Medicaid Services (CMS) guidelines. Aim: A targeted education session and standardized flowsheets were developed to enhance documentation adherence and staff confidence in psychotropic medication administration. Methods: To assess knowledge, comfort, and adherence to documentation standards a pre- and post-intervention survey were administered to nursing …

A Visual Nudge Toward Safer Skin: Reducing Hospital-Acquired Pressure Injuries (Hapi) At The Bedside, Iris Quach

Master's Projects and Capstones

Objective: With the increasing prevalence of hospital-acquired pressure injuries (HAPIs) among trauma patients at Highland Hospital, a quality improvement initiative was developed as a call to action. The overarching goal of this project was to design and implement a Quality Assurance and Performance Improvement (QAPI) intervention that was both feasible and cost-effective to address existing gaps and disparities during hospitalization at Highland Hospital, part of Alameda Health System in the Bay Area. Aim: The project aimed to evaluate whether a bedside visual cueing system could strengthen nursing compliance with pressure-injury prevention protocols and improve the consistency of communication among interdisciplinary …

Looking At Labels, Examining Values: Knowledge, Narrative, And Multilingualism In American Art Museums, Mary Mitchell

Masters Theses

Object labels are key components of the knowledge production networks in American museums. But despite their sustained use in the Western museum field since the late nineteenth century, museum labels are not frequently regarded as valuable sources in scholarship on museum history and practices. In this thesis, I reposition labels in art museums as objects of value that should be studied for their important role in producing and disseminating knowledge. What can we learn about art museums by looking closely at their labels—specifically about those institutions’ values? How do labels reveal the hierarchies of value that art museums construct between …

Factors Influencing The Re-Emergence Of Vaccine-Preventable Diseases Using The Social Ecological Model: A Scoping Review, Glenda Dorina Rodriguez Lenarduzzi

Master's Projects and Capstones

Abstract

Background.

Several factors contribute to the resurgence of vaccine-preventable diseases, affecting coverage rates and vaccine uptake during recent outbreaks. The pandemic has underscored how crucial it is to comprehend vaccine literacy, as this understanding influences people's perspectives and behaviors toward vaccination, particularly in their approaches to problem-solving and decision-making.

Objective.

The present study conducts a scoping review of research on the impact of vaccine literacy and vaccine uptake on the re-emergence of vaccine-preventable diseases in the United States, framed by the social ecological model (SEM).

Design.

PubMed and Google Scholar were utilized as online databases to identify papers published …

Shattering The Silence: The Path To Maternal Equity In Texas, Karah Renfroe

The Scholar: St. Mary's Law Review on Race and Social Justice

The Black maternal mortality crisis reflects the persistence of institutionalized racism embedded in the U.S. healthcare system. In Texas, Black women account for just 11% of births yet represent 31% of maternal deaths—a mortality rate more than twice that of their white counterparts. This staggering disparity has persisted, even as statewide initiatives have improved maternal outcomes for non-Black women. This Comment situates the current crisis within a broader historical continuum: from the coerced medical experimentation on enslaved Black women by figures such as J. Marion Sims, through the codified racism of the Jim Crow era, to present-day inequities ingrained in …

Strategies To Streamline Patient Appointments In Specialty Outpatient Care, Adama Drammeh

Walden Dissertations and Doctoral Studies

Abstract Outpatient addiction treatment centers face significant challenges from inefficient appointment scheduling systems that contribute to high no-show rates, delayed care, and weakened organizational performance. These barriers affect more than daily operations; they disrupt the flow of treatment, increase patient disengagement, and place additional strain on limited healthcare resources. For patients navigating substance use disorders, a missed appointment may jeopardize continuity of care and undermine recovery efforts. This integrative review explored strategies to improve scheduling efficiency and enhance patient engagement in outpatient addiction care. A systematic search of recent U.S. studies was conducted and appraised using the Johns Hopkins Evidence-Based …

Successful Strategies For Sustaining Women-Owned Businesses Beyond 5 Years, Antoinette Stowers-Lewis

Walden Dissertations and Doctoral Studies

A lack of successful strategies can lead to a high failure rate among small businesses. Women small business owners often express concerns about identifying successful strategies, which research shows are a key predictor of business sustainability. Grounded in entrepreneurship theory and participative leadership theory, the purpose of this qualitative pragmatic inquiry was to identify and explore the successful strategies that some women small business entrepreneurs use to sustain their businesses beyond 5 years. The participants were five women small business owners from different sectors in the East Coast region of the United States who had sustained their businesses beyond 5 …

Pavements And The Urban Heat Island Effect: A Network Analysis Of Research Trends And Knowledge Structure, Fouzieh Rouzmehr, Saman Jamshidi

Architecture Faculty Research

The urban heat island (UHI) effect is one of the most pressing challenges associated with rapid urbanization. It arises primarily from the replacement of natural vegetation with impervious surfaces, alterations in surface energy balance, and heat emissions from human activity. Mitigating these drivers has become a global priority, particularly in fast-growing cities. Pavements play a central role in UHI intensification due to their large surface coverage, low albedo, and capacity to retain heat. This study adopts a bibliometric approach to systematically map the knowledge structure and research trends in pavement-related UHI studies. A dataset of 834 publications from Web of …

Food, Fitness, And Filipino Culture: Evaluating And Reimagining Chronic Disease Interventions For Filipino Americans Through The Pen-3 Framework, Juliana Mastro

Master's Projects and Capstones

Filipino Americans experience high rates of chronic diseases such as diabetes and hypertension. This paper reviews nutrition and exercise interventions targeting this population through the strengths-based PEN-3 cultural framework, focusing on cultural identity, relationships and expectations, and cultural values. It identifies effective strategies that engage these cultural components, and highlights gaps such as limited research on Filipino-American health outcomes. Recommendations include family-centered approaches, culturally relevant activities like tinikling dance, and community-driven online healthy recipe archives to promote positive health behaviors. These culturally informed strategies aim to improve self-efficacy, support lasting health behavior change and reduce chronic disease prevalence nationwide.

Enhancing Documentation Accuracy And Nurse Handoffs Through Virtual Reality In A Pediatric Perianesthesia Unit, Alicia G. Fregoso

Master's Projects and Capstones

Setting: The pediatric perianesthesia unit (pre-operative and post-anesthesia care unit). Problem: Gaps in perianesthesia documentation contribute to poor handoff communication, leading to adverse events and increased hospital costs. Additionally, inconsistent documentation reduces clarity and consistency during handoffs. Context: Staff in the microsystem reported low confidence scores with required OP-Time documentation, inconsistent workflows, and I-PASS handoff expectations. These factors contribute to incomplete charting and a lack of standardization across providers. Interventions: A two-part educational intervention was conducted, consisting of eight sessions. The first component is a Virtual Reality (VR) simulation that demonstrates an accurate perianesthesia I-PASS handoff. The second component is …

Improving Doula Visibility And Integration In The Labor & Delivery Unit Through The Implementation Of Creative Standardized Visual Strategies, Ninna Alessandra Arcena Acebedo

Master's Projects and Capstones

Objective: The 22-bed, Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post- implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for four weeks, …

Increasing Nursing Staff Confidence And Documentation Compliance For Psychotropic Medication Use, Ei Chit Paing

Master's Projects and Capstones

Objective: Psychotropic medications place a high risk for side effects such as confusion, dizziness, falls, and death in older adults above age 65 (Seifert et al., 2024). Educational training on appropriate psychotropic drug use to nursing staff is linked to a decrease in penalties (Jung et al., 2021), side effects, and an increase in staff knowledge in caring for patients with behavioral and psychological symptoms (Pinazo-Clapés et al, 2020). Aim: Facility A in Northern California is currently non-compliant with the Centers for Medicare and Medicaid Services (CMS) guidelines for appropriate psychotropic use due to limited staff understanding of regulations and …

Agpat2 Acts At The Crossroads Of Lipid Biosynthesis And Drp1-Mediated Er Morphogenesis, Yoshihiro Adachi, Mauricio Torres, Allen H Hunter, Woo Jung Cho, Meixia Pan, Xianlin Han, Guangwei Du, Ling Qi, Miho Iijima, Hiromi Sesaki

Faculty, Staff and Student Publications

The morphology of the endoplasmic reticulum (ER), characterized by central sheets and peripheral tubules, is controlled by membrane-shaping proteins. However, the role of lipids in ER morphogenesis remains elusive, despite the ER being the major site for lipid synthesis. Here, by examining the role of eighteen phosphatidic acid (PA)-generating enzymes in ER morphology, we identify lysophosphatidic acid acyltransferase 2 (AGPAT2) as a critical factor in mouse and human cells. AGPAT2 produces PA in the glycerophospholipid/triacylglycerol biosynthesis pathway, and its mutations cause congenital generalized lipodystrophy. We find that AGPAT2-generated PA drives ER tubulation through gene knockout, 3D structural analysis by FIB-SEM, …

Nurses’ Voices In Prevention: Evaluating Enhanced Bedside Signage To Reduce Hospital-Acquired Pressure Injuries, Jorge Pinzon Figueroa

Master's Projects and Capstones

Abstract

Objective: Hospital-acquired pressure injuries remain a patient safety concern despite standard practice of nurses’ prevention protocols (National Pressure Injury Advisory Panel, 2022). Barriers include: inconsistent two-hour repositioning, documentation burden, inadequate staffing, lack of visual cues of patient risk level, and inconsistent compliance with the overall comprehensive prevention bundle (Agency for Healthcare Research and Quality, 2023).

Aim: HAPIs occur within two adult medical-surgical and telemetry units at a tertiary hospital. In response, staff were surveyed on potential interventions, resulting in the production of a visual cuing system.

Methods: Pre- and post-surveys were conducted on the two medical-surgical units to assess …

Improving Dka Protocol Adherence In The Emergency Department, Anjolaoluwa Lawani

Master's Projects and Capstones

Problem There was inconsistency in implementation of the DKA protocol by nurses in the emergency department at the Hospital A. Only 58% of the nurses reported feeling comfortable following the DK protocol, and 84% of the nurses described the DKA order set as confusing. Context Hospital A is a large magnet-recognition hospital system in the Bay Area. The emergency department at Hospital A averages about 12 DKA patients per quarter. Intervention Education sessions were held during pre-shift cuddles across day and night shifts to clarify the DKA protocol and answer any questions or nurses may have. Measures Baseline surveys and …

An Axe To The Funny Bone: Curated Instability And Horror-Comedy Intersections In American Storytelling, Samantha Box

Masters Theses

Funny. Terrifying. Subversive.

Horror-Comedy twists and bites at the intersection of two incredibly reactive genres— with both Horror and Comedy being well known for the political and social discourses they embody and reinvent through story. While prevalent in American popular culture, scholarly analysis of this hybrid space barely exists beyond a small number of Film Studies investigations. Despite this lack, Horror-Comedy works continue to be successfully produced. This thesis unpacks the vibrant relationship between fear and laughter in contemporary American storytelling through Horror-Comedy, maintaining a focus on structural dynamics and the audience-disarming results of simultaneously applying horror and humor to …

Is Public Website Design An Administrative Burden? The Case Of Snap, Guangli Zhang, Stephen Roll, Mathieu Despard

Center for Social Development Research

How do websites for public-benefit programs affect access to benefits?

This brief examines the state websites for the Supplemental Nutrition Assistance Program (SNAP), investigating whether there is a relationship between site design and experience of administrative burdens in SNAP. The authors examine page design using Google’s Lighthouse service and draw upon data from the Workforce Economic Inclusion and Mobility Survey of a nationally representative sample of 2,511 low-wage U.S. workers to examine administrative burdens in SNAP. Data from the U.S. Department of Agriculture are used to investigate the relationship between SNAP page design and SNAP quality-control measures. The finding suggest …

How The Intake Of Pulses May Impact Metabolic Disorders And Dementia Risk: A Narrative Review, Lisa Michelle Belzer Salinas, Maricarmen Marroquin, Mariana Mendez, Isabel Omaña-Guzmán, Juan Carlos López-Alvarenga

Health & Biomedical Sciences Faculty Publications

We present a narrative review focusing on pulses’ geographical origin and distribution, their impact on human evolution and history, and their influence on human health. Pulses, including dry peas, beans, and lentils, are renowned for their richness in chemical antioxidants. Despite containing antinutrients, processing techniques preserve their health advantages. Epidemiological research has consistently demonstrated that the consumption of pulses is associated with favorable effects on metabolism. This evidence is further supported by molecular and clinical research, which has elucidated potential nutrigenomic mechanisms and effects on gut microbiota composition underlying their health benefits. However, the literature lacks randomized controlled clinical trials …

Effects Of Communication Boards On Improving Communication In Assisted Living Care Facilities, Koleen Beatrice Arribas

Master's Projects and Capstones

Problem: A Residential Care facility utilizes paper charting causing limited access to vital information such as code status, allergies, and/or diet for those caring for the resident.

Context: Exceptional charting only when a resident’s condition changes may not provide enough vital information for the caregiver to administer medication or provide proper support during an emergency, such as the resident’s DNR status.

Interventions: A communication board was placed in a secure space near the nurses’ station with key resident information. Nurses would huddle at the board at before the change of shift and make updates as necessary.

Measures: Staff input in …

Improving Pressure Injury Prevention With Educational Programs For Caregivers And Nurses, Michella B. Kahanding

Master's Projects and Capstones

Problem: Pressure injuries are preventable with adequate interventions and knowledge by healthcare staff; however, skilled nursing facilities struggle with pressure ulcer prevention (PUP). Patient suffering and associated costs with treating these injuries are considerable.

Context: Staff education in knowledge regarding PUP is lacking, and annual PUP education is ineffective in reducing the number of pressure injuries in these facilities.

Interventions: Staff education on prevention strategies includes education, pre- and post-knowledge assessments, return demonstration and product use will be implemented

Measures: Results from the baseline knowledge of appropriate PUP in caregivers, pre- and post-test for knowledge retention, teach back techniques to …

Language Attrition As A Social Process, Or Barzilay

Master's Projects and Capstones

Language attrition is a process in which the gradual decline in proficiency of a language occurs when another language becomes more prominent among individuals, families, and broader societies. This shift often occurs not by choice but by necessity, as speakers are expected to adapt to the other language in educational settings, for employment, and to conform to societal pressures in their new environments. Although language attrition is often described as an individual loss of proficiency, contemporary research reveals a far more complex picture—one shaped by factors that determine which languages are valued and which fade into obscurity. These forces collectively …

Improving Efficiency In Volunteer Onboarding, Madeline Ly Bredehoft, Samantha Nicole Contreras

Master's Projects and Capstones

Project Access, a nonprofit organization serving residents of affordable housing communities, depends significantly on volunteers and student interns to deliver health, education, and employment programming. The current onboarding process lacks standardization, resulting in inconsistent training quality, delayed volunteer readiness, increased staff workload, and reduced engagement and retention. This quality improvement (QI) project aims to address these deficiencies by developing and implementing a standardized onboarding toolkit. The toolkit will include orientation modules, a learning agreement, defined deliverables, and digital resources to facilitate communication and clarify expectations. The project is guided by a PICOT question focused on efficiency and engagement, a structured …

Improving Interdisciplinary Communication And Collaboration With The Standardization Of Doula Care Through An Informatics Tool, Shela Le

Master's Projects and Capstones

Objective: The 22-bed Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post-implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for a month, a post-survey assessed these …

Optimizing Electronic Health Record Workflow To Improve Flu Vaccinations In A Primary Health Clinic, Xzalyn Arianah Hernandez

Master's Projects and Capstones

Among the Latinx population influenza vaccination rates remain disproportionately low due to vaccine hesitancy, misinformation, limited access to healthcare, and socioeconomic barriers. Influenza related hospitalizations and deaths have risen in recent years as rates continue to drop across all age groups, as a result of this issue. This quality improvement project aims to increase staff satisfaction and flu vaccination rates among Latinx patients by the implementation of a more efficient workflow process. Different interventions were designed to address workflow inefficiencies and medical assistant dissatisfaction. These interventions included 1) integrating the Immunization Clinic function in EPIC to streamline flu vaccine documentation …

Reducing Hospital-Acquired Pressure Injuries Through Targeted Nurse Education On The Braden Scale And Skins Bundle, Sarah Nicole Farkas

Master's Projects and Capstones

Objective: Hospital-acquired pressure injuries (HAPIs) continue to rise nationally despite overall reductions in other hospital-acquired conditions. This project sought to address gaps in nurse knowledge, inconsistent prevention practices, and workflow barriers contributing to HAPI development on a Trauma Medical-Surgical Unit (Unit A). Aim: This project aims to decrease the number of HAPIs on the Trauma Medical Surgical Unit by 11%, from nine HAPIs to eight HAPIs, following implementation of nurse education on the proper use of the Braden Scale and the SKINS Bundle from October 6, 2025, to November 14, 2025. Methods: A pre-intervention survey was administered to identify baseline …

A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron

Master's Projects and Capstones

Objective: This quality improvement project was implemented in an urban community health clinic primarily serving low-income and Latinx patients. Factors such as demographics, socioeconomic status, health, and transportation contribute to low U.S. influenza vaccination rates (Chen et al., 2020), while EHR training can improve provider satisfaction and efficiency (DiAngi et al., 2019). This microsystem faced inconsistent workflow processes, limited EHR training, and documentation errors that contributed to low staff satisfaction rates and influenza vaccination rates. An average of 11.4% of patients received a flu vaccine in October 2023 and 2024. Medical assistants (MAs) completed a pre-intervention survey indicating that 35% …