Innovation Through An Academic Practice Partnership: A New Clinical Nurse Leader (Cnl) Implementation Model, Nancy P. Taquino

Doctor of Nursing Practice (DNP) Projects

Problem

The IOM reports (1999, 2001) were catalysts for development of a new nursing role - the Clinical Nurse Leader (CNL). Academic practice partnership models are needed to integrate the CNL role in health care systems.

Context

A large integrated health care system in Northern California and a university Clinical Nurse Leader (CNL) program initiated a formal academic practice partnership, establishing a hospital based MSN CNL program.

Intervention

A CNL implementation model was developed that includes (a) academic practice partnership advisory charter; (b) academic practice partnership roles (MSN CNL program director, MSN CNL faculty liaison, and hospital-based CNL …

Development Of A Toolkit To Enhance Nursing Education Of Veteran Health Concerns, Carlee Y.S. Balzaretti

Doctor of Nursing Practice (DNP) Projects

Abstract

U.S. Veterans are a vulnerable patient population, more prone to health disparities as compared to the general population. There are 21.8 million Veterans currently in the United States, with the majority receiving their healthcare outside of the Veteran Health Administration. Veterans form a culture that is steeped in military tradition and it is essential that healthcare providers have knowledge regarding this vulnerable population to provide care that is culturally appropriate. In response to the Veteran healthcare crisis, the Department of Veteran Affairs initiated the Veteran Affairs Nursing Academy Partnership (VANAP), a joint venture between VHA medical centers and schools …

Exploration Of Factors Affecting Nurse Faculty Use Or Resistance To Online Education, Lisa M. Harless

Nursing Theses and Dissertations

The substantial increase in online nursing program enrollment demands that nurse educators be adept in the delivery of online education; however, a significant challenge exists in how to deliver practice-based nursing education in the online environment. Teaching online requires a change in the traditional role of the educator accompanied by the effective use of online learning technologies. Some studies suggest that faculties remain pessimistic to online delivery of education and do not participate, yet few objectively examine variables that influence resistance or use. Included in this dissertation are two manuscripts. The first manuscript defines resistance and addresses prominent concerns associated …

Using Multi-Modal Education In A Public Health System To Increase Rates Of Cervical Cancer Screening, Christina Nardi

Doctor of Nursing Practice (DNP) Projects

While Papanicolaou (Pap) screening has been implemented since the 1950’s, and is linked to decreased rates of cervical cancer, national screening rates are still below the national target screening rate. In Contra Costa County (CCC), the current cervical cancer screening rate is 50.92% (Contra Costa Health Services [CCHS], 2016a). This is far below the national goal of 93% and the first benchmark of 54.33% needed in order to receive state funding under the California Department of Health Care Services (DHCS) Medi-Cal 2020 waiver. The Medi-Cal 2020 waiver has a 5-year Public Health Incentives and Redesign in Medi-Cal (PRIME) program requiring …

Optimizing Engagement In The Acute Care Setting: A Nurse Driven Staffing Model, Denise D. Fall

Doctor of Nursing Practice (DNP) Projects

Health care is on the threshold of major reform. Central to this reform will be the ability to maximize patient outcomes and resource allocation. The delivery of nursing care is essential to these concepts. Nursing care delivery impacts both patient outcomes and labor costs. Every aspect of care delivery has changed over time: length of stay, acuity, payment methodologies, documentation, technology, and regulatory requirements. Yet the model by which we allocate resources to the bedside is based on an archaic notion and forecasting model around one variable. The development of effective nurse staffing strategies will ensure those delivering care are …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Combating Childhood Obesity With Provider Education: A Quantitative Study, Trina Larery

Doctor of Nursing Practice Scholarly Project

The study included an educational program to providers and nurse practitioner students in order to evaluate whether an increase in knowledge and accuracy occurred based on knowledge of evidenced-based responses to specific indicators of childhood overweight and obesity. It assessed the providers’ knowledge and sought to evaluate if increased knowledge occurred after an educational program presentation. Following the educational program, a follow-up survey was distributed via email to assess the providers self-reported perceived practice change six weeks after the education.

Part one measured if an increase in knowledge of the 5210 components, correct laboratory testing, and assessment of comorbidities occurred. …

Chlorhexidine Gluconate Bathing In Hospitalized Patients: Reducing Barriers And Increasing Compliance Rate, Maria R. Dominguez

Master's Projects and Capstones

The organization-wide implementation of Chlorhexidine Gluconate (CHG) bathing protocol is one of many measures used to help reduce hospital-acquired infections (HAI) at the 30-bed, Medical-Surgical Specialties and Palliative Care Unit. CHG bathing compliance rate for the unit for the week of August 14-20 was 82.9%, with a 40.4% refusal rate. This is below the 90% desired performance rate. The purpose of this project is to identify the barriers to CHG compliance and to implement interventions that will aid in reducing these barriers and increase CHG compliance rate. Patient declining was identified as one of the main barriers to CHG bathing. …

Breast Cancer-Related Lymphedema In Hispanic Women: A Phenomenological Study, Juanita C. Acebedo

Nursing Theses and Dissertations

Objective: This study explored the lived experience of Hispanic/Latino women dealing with BCRL.

Participants: A convenience and purposive sampling of 13 Hispanic women, 42-80 years old with diagnosed breast cancer-related lymphedema for over one year, were recruited December 2015 – April 2016.

Methods: Using interpretive phenomenology, Hispanic women with BCRL were individually interviewed using open-ended questions to explore common themes experienced by this particular ethnic group. Sampling continued until data saturation was met. Recruiting took place through four health care practices in south Texas. Data consisted of field notes, researcher journaling, recorded audio interviews, and the respective transcriptions. Data analysis …

Developing An Electronic Health Record Training Program For New Employees, Crystal D. Figlietti

Doctor of Nursing Practice (DNP) Projects

In May 2015, an electronic health record (EHR) was implemented at an urban, long-term care facility. This facility is part of the county Department of Public Health (DPH) and was one of the last locations to implement the designated EHR system. The unique nature of the facility compared to the smaller, health care centers within the DPH network necessitated development of a customized training and onboarding program for new employees. It was not possible to duplicate an existing training program. The registered nurse (RN) informaticist assigned to the EHR used data from nursing staff surveys and information collected through a …

Lactation Clinic: Improving Patient Lactation Support, Iana Johnson

Master's Projects and Capstones

Despite the numerous health benefits and recommendations that breastfeeding is the optimal method for nourishing infants, many still choose other ways to feed their babies during the first year of life. This project considers the initiation and future implementation of a Lactation Clinic as an additional patient support service provided in the inpatient and outpatient settings. A Failure Modes and Effects Analysis (FMEA) was conducted in an effort to evaluate and eliminate “what could go wrong” before such an establishment becomes operational. The Risk Priority Numbers (RPNs) from the analysis reveal the lack of use (RPN 50) and streamlining (RPN …

Standardization Of Body Imaging Huddle In Radiology, Margaret M. Browne Mcmanus

Master's Projects and Capstones

Mag Browne McManus

Clinical Nurse Leader Abstract

University of San Francisco

Abstract

Communication amongst healthcare providers is critical to reducing errors, and in procedural areas, the huddle can be used to standardized communication amongst the team before the beginning of interventional procedures (Goldenhar, Brady, Sutcliffe, Muething, & Anderson, 2013). Prior to the implementation of the revised huddle, a staff survey indicated none of the staff were satisfied with the current process. The objectives of the standardization of the body imaging huddle in the department of radiology were to increase staff satisfaction by 15% and reduce the time from patient arrival …

Educating Nurses On The Use Of Bedside Mobility Assessment Tool (Bmat) Through E-Learning/Online Education Module, Wei Li Lee

Master's Projects and Capstones

Background Hospital setting is reviewed the most hazardous workplace comparing to other industries. Nursing assistants and orderlies have the high risk of work-related injury. The study found that the top reason that causes the injuries was due to over-exertion or bodily reaction.

Aim State of California requires hospitals to implement a Safe Patient Handling and Mobility (SPHM) policy as part of an injury and illness prevention program (Department of Industrial Regulations, 2016). Bedside Mobility Assessment Tool (BMAT) is the latest evidence based practice, reliable and valid tool, which helps nurses to assess the patients’ current and ongoing mobility and to …

Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones

Master's Projects and Capstones

When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.

The purpose of this project was to gain a comprehensive understanding of the current handover process of …

The Effects Of A Preceptor Coaching Intervention On Use Of Clinical Judgment By New Graduate Nurses, Sue A. Schuelke

Theses & Dissertations

This work attempts to evaluate a preceptor intervention on the development of critical thinking/clinical judgment from the new graduate’s point of view as well as from the preceptor’s point of view. Manuscript 1 is a systematic review of the literature related to preceptor’s interventions and its effect on clinical judgment. Manuscript 2 describes the results of focus group interviews of preceptors and the viewpoint on clinical judgment and related concepts. Results of a pilot study: The effects of a preceptors coaching on new graduates clinical judgement, is reported in Manuscript 3. Each section includes an overview of each manuscript, a …

Approach To Safety Improvement: Focusing On Better Care (Fall Prevention In Medical Surgical/Intermediate Care Unit), Jose Fox Caballes Jr

Master's Projects and Capstones

Patient safety is one of the major concern of any healthcare provider during their patient’s hospital stay. This project addressed the steady trend of fall incidences compared to last fiscal years’ data of an average of 4 falls per month. This trend created urgency to envisioned a plan for solutions to prevent this circumstance from happening. This Clinical Nurse Leader led a project in creating a process in identifying all patients that are high risk to fall (HRTF) prior to their admittance or transfer to Medical Surgical/Intermediate Care Unit and throughout their hospital stay until they are discharged. In addition, …

Ihss: Repackaging Consumer Information, Deloras N. Puran

Master's Projects and Capstones

Currently, qualified Californians with disabilities and aging individuals can receive consumer-directed care through the IHSS program. Despite the strong demand for the program, new consumers are still struggling to begin their service after enrollment.

This study assisted San Francisco In Home Supportive Services Public Authority to understand how new consumers can navigate the IHSS program services after enrollment. Focus group and semi-structured in-depth interviews were conducted to gather feedback from consumers regarding what type of information would they need after enrollment, and how would they want to receive the information. Based on the feedback, written and virtual deliverables were designed …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Increasing Patient Satisfaction And Decreasing Hospital Readmission Due To Deep Venous Thrombosis By Providing Anticoagulation Education For Orthopedic Patients, Margaret Gniewosz

Master's Projects and Capstones

Abstract

Improving Process on Oral Anticoagulant Education for Orthopedic Patients

The aim of this project is to improve anticoagulation education for orthopedic patients to increase patient satisfaction. The microsystem for this project is a medical-surgical (MS), 50-bed unit in a medium size hospital. Because orthopedic patients are at high risk to develop DVT postoperatively, proper anticoagulants and anticoagulation education is an important aspect of patient care. By implementing a well-designed and easy-to-read patient handout on anticoagulants with instructional script for nurses will empower patients to achieve higher level of anticoagulant knowledge and in result, increase patient satisfaction. A preliminary round …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Improving Pain Reassessment And Documentation Through Nurse Education, Reina Batto

Master's Projects and Capstones

The aim of the CNL Internship Project is to improve quality of patient care and pain management through improved pain reassessment and documentation. The project is to be implemented in the surgical unit of a community hospital in the California Bay Area. The unit has a maximum capacity of 38 beds and is staffed by 47 RNs and 4 LVNs. A nurse survey was conducted to assess the needs of the staff and the unit, and an education plan was created for the unit. Educational materials, including: highlighted academic articles, posters, handouts, and small posted reminders at nurse computers were …

The Effects Orthostatic Hypotension Has On Falls: A Study Done In San Francisco With The Patient Population Of The Veterans Affairs Hospital, Sherry A. Ballard Ms.

Master's Projects and Capstones

The Effects Orthostatic Hypotension has on Falls: A Study Done in San Francisco Represented

Population of the Veterans Affairs Hoapital

The global AIM of this project is to Identify patients that are at risk for Orthostatic Hypotension (OH) with in the first 24 hours of addmission. It was identified that 50% of the falls over the last 4 quarters at the VA were OH related. The patients were not identified as a fall risk and over half of them had fallen multiple times. After performing a nursing survey online, a SWOT analysis, and a Root Cause Analysis using a fishbone …

Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin

Master's Projects and Capstones

For the past 15 years, major organizations such as the World Health Organization (WHO), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. federal government have been committed to shifting mental health services from the medical model of care to the recovery-oriented model of care (Moller & McLoughlin, 2013). However, not all identified recovery-oriented practices have been fully implemented throughout mental health services, specifically in acute care settings. In 2015, San Mateo Medical Center’s acute psychiatric nursing staff completed McLoughlin’s (2005) Recovery Self-Assessment- Registered Nurse (RSA-RN). Data showed that 34% of nursing staff did not believe that the nurses …

The Development, Implementation, And Evaluation Of A Transgender Health Resource Bundle, Lovejeet Kaur

Doctor of Nursing Practice (DNP) Projects

Transgender populations experience disproportionate social and health disparities that can negatively impact quality of life. Healthcare barriers due to gender based discrimination and lack of medical insurance and culturally competent providers contribute to low levels of access to preventative health care screenings, resulting in sub-optimal health outcomes. The unique health circumstances of transgender individuals have been understudied in the literature. As a result clinicians are often under-informed of their specific health maintenance needs and screening guidelines. To help address this disparity, a Doctor of Nursing Practice (DNP) student at the University of San Francisco facilitated the collaborative assessment, development, implementation …

Transforming Self And Systems Through Implementation Of A Caring Coach Leader Program, Priscilla Javed

Doctor of Nursing Practice (DNP) Projects

Assistant nurse managers and nurse managers, often referred to as middle managers, have a direct impact on daily hospital operations, clinical work environments, delivery of high quality safe patient care, and patient outcomes. The stressful demands of this role have caused turnover rates to soar above the national average on some of the inpatient hospital units. Instability of nursing management oversight negatively effects staff job satisfaction and delivery of high quality safe patient care. In reviewing the organizations initial orientation program for transitioning middle managers into their new role, it was missing the supportive guidance of a coach. A Caring …

Nursing Student Work-Study Internship: Partnering To Bridge The Education-To-Practice Gap, Jonalyn M. Wallace

Doctor of Nursing Practice (DNP) Projects

Abstract

Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the …

Examining Patient Outcomes Of Telemedicine In Rural Emergency Departments, Jessica R. Dalton

Doctor of Nursing Practice Scholarly Project

Increasing shortages of primary care physicians has resulted in the use of family nurse practitioners for staffing of rural Emergency Departments (ED) throughout the United States. Although the majority of these Family Nurse Practitioners have not been formally trained in emergency medicine, they are placed in the role. The specific aim of this study is to examine if using telemedicine in the rural emergency department will improve patient outcomes, decrease transfers, and decrease mortality. This study’s project design is a retrospective chart review of Emergency Department patients at Wilson Medical Center from April 2015 to April 2016 where telemedicine was …

Moral Distress, Leadership Integrity, Ethical Climate And Turnover Intent In Critical-Care Nurses, Desha L. Johnson Makiya

Nursing Theses and Dissertations

Objectives: To determine what relationships exist between moral distress, perceived leadership integrity, ethical climate, and turnover intent among adult critical care nurses and the moderating effect of leadership integrity and ethical climate on moral distress and subsequent turnover intent; to obtain a richer and fuller understanding of how critical care nurses experience moral distress within the context of critical care work.

Participants: Adult critical care nurse members of AACN (n=254), 22-70 years old, recruited February – March 2016.

Methods: A Qualtrics survey posted on the AACN eNewsline included the moral distress scale-revised, perceived leadership integrity scale, hospital ethical …

Identifying The Complexity Of Bipolar Disorder, Brandie Marie Stiles

Dissertations

Bipolar disorder is a complex illness that is difficult to correctly diagnosis and treat. Experts estimate that a correct diagnosis and treatment for bipolar disorder may be delayed for up to 7-10 years after symptoms become problematic. The primary purpose of this study was to identify the complexity of diagnosing bipolar disorder, including diagnostic patterns, recommended treatment, and patient response. A focused ethnography, including in-depth interviews and a retrospective chart review, were completed to answer the research questions: 1) What is the nature of the experience of receiving a diagnosis of bipolar disorder? 2) What are the diagnostic and treatment …