Medicine and Health Sciences Commons^™

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

Transitional Care Services: A Nurse-Led Quality Improvement Project, Debra Conroy-Mccue

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA) and a national requirement for health care providers and systems to deliver care that is safe, outcome driven, and cost effective, Dignity Health (DH) as part of the hospital engagement network (HEN) launched an initiative called the “No Harm” campaign to reduce all-cause avoidable hospital readmissions. The project, led by a Doctorate of Nursing Practice (DNP) student and readmission team, sought to achieve a 20% reduction in preventable readmissions by December 2014. After having achieved initial success in implementing transitional care services for patients with heart …

Employee Engagement In The Pacu, Michelle Spadaro

Master's Projects and Capstones

A clear vision is a powerful tool that can help advance employee engagement within nursing units. There is a great need for a compelling vision for the operation of a safe, efficient, equitable, effective, and patient centered healthcare delivery system. It is crucial to identify what actions are needed to achieve this vision and what realistic strategies are necessary for success. The purpose of this vision statement is to achieve excellence in nursing by establishing a common identity and direction that responds to an ever-changing healthcare environment. The project was conducted on a 25 bed peri-operative and post anesthesia care …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

With no designated cardiovascular step-down unit at Phoenix Children’s Hospital, patient transitions to acute care are inconsistent following admission to the Cardiovascular Intensive Care Unit (CVICU). We aim to improve CVICU patient continuum of care through transferring patients to a step-down telemetry unit starting October 13^th, 2014 exemplified by a 95% patient satisfaction of care provided by January 1^st, 2015. The progression of the project was influenced by Lippitt’s theory, which includes seven phases in the change process. To accommodate post CVICU patients, the acute care unit was transformed to include cardiac monitors, telepacks, a central …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

Improving Medication Administration And Patient Outcomes By Decreasing Avoidable Interruptions, Polly Nghiem

Master's Projects and Capstones

This Clinical Nurse Leader (CNL) project took place at a level I trauma center in the San Francisco Bay Area, on a 34-bed Medical Surgical, Behavioral Medicine and Acute Care for the Elderly (ACE) Specialty Unit. The goal was to improve the adverse events made during medication administration, which in turn reduces medical error costs and improves patient outcomes and patient safety. A review of the literature revealed several key points: (1) Medication errors are increasingly recognized as a significant, but preventable problem in our health care system, (2) Interruptions are implicated as a cause of clinical error, (3) Medication …

An Evidence-Based Approach To A Replacement Hospital Training Curriculum, Mark D. Beck

Doctor of Nursing Practice (DNP) Projects

Creation of a training and educational curriculum for a new or replacement facility is daunting in its own right, but without a repository of organizational knowledge cataloging the transfer of tacit to explicit knowledge from the organizations previous library of facility openings, the task becomes Herculean, with as many tasks and cast of characters as the original myths. Navigating the shoals, eddies and tides of the various aspects of this project revealed the need for a comprehensive knowledge management solution to training that is coupled with healthcare design principles and initiatives. This purpose of the DNP project is about the …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Prevention Of Hiv Mother-To-Child-Transmission In Sub-Saharan Africa, Sidik Abdul-Mumuni

Master's Projects and Capstones

The transmission of HIV infection from an HIV-positive mother to her child during labor, pregnancy, breastfeeding or delivery is termed as mother-to-child HIV transmission (WHO, 2013 report on HIV). A range of 15-45% infection transmissions are possible when no intervention strategies are put into place. Globally, goals and initiatives have been set to combat this issue as well as speeding up the interventions and achieve possible transmission rates of levels less than 5% and total elimination of new infant HIV infections by 2015 (WHO, 2013 report on HIV). In 2011, 57% of pregnant women living with HIV in low and …

Hospital Staff Registered Nurses’ Perception Of Horizontal Violence, Peer Relationships, And The Quality And Safety Of Patient Care, Christina Purpora, M. A. Blegen, N. A. Stotts

Nursing and Health Professions Faculty Research and Publications

Objective: To test hypotheses from a horizontal violence and quality and safety of patient care model: horizontal violence (negative behavior among peers) is inversely related to peer relations, quality of care and it is positively related to errors and adverse events. Additionally, the association between horizontal violence, peer relations, quality of care, errors and adverse events, and nurse and work characteristics were determined.

Participants: A random sample (n=175) of hospital staff Registered Nurses working in California.

Methods: Nurses participated via survey. Bivariate and multivariate analyses tested the study hypotheses.

Results: Hypotheses were supported. Horizontal violence was inversely related to peer …

Advantages And Limitations Of Anesthesia And Sedation Practices Used Among Acute Ischemic Stroke Patients During Endovascular Revascularization Therapy, Margaret Korzewski

Doctor of Nursing Practice (DNP) Projects

In order to safely and efficiently perform endovascular revascularization procedures among acute ischemic stroke (AIS) patients, general anesthesia or sedation is often required. However, anesthesia management during these procedures varies significantly worldwide and the procedural logistics have not been established yet. At some institutions AIS patients are intubated and paralyzed, while at other facilities, there is no routine protocol. In 2011 the University Hospital used “action nurses” (critical care float pool nurses) to provide pharmacological paralysis with sedation for intubated AIS patients under direct supervision of the neurointerventionalist. However, clinical outcomes among AIS patients undergoing endovascular procedures were poor. Exclusive …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Design And Implementation Of A Sustainable, University-Based, Emergency Medical Response Service, Octavia A. Mandel Struve

Doctor of Nursing Practice (DNP) Projects

Collegiate-based emergency medical services (EMS), designed primarily to provide pre-hospital basic life support and emergency services, are venues by which nurses and other healthcare professionals, with an understanding of community health and social network issues, can maximize health promotion objectives for university and college campus communities. These EMS systems also provide vital support to city and county emergency services and promote positive community relationships with neighboring areas. They can provide excellent opportunities for students to develop critical skills for success in the healthcare and business world. The sustainability and vibrancy of collegiate-based EMS systems are primarily related to impact, benefit …

Disseminating An Evidence-Based Course To Teach Self-Management Of Auditory Hallucinations, M Buffum, Robin Buccheri, L Trygstad, G Dowling

Nursing and Health Professions Faculty Research and Publications

This multi-site project extended course dissemination of the 10-session Behavioral Management of Auditory Hallucinations Course to U.S. Department of Veterans Affairs (VA) mental health outpatient settings. The VA Quality Enhancement Research Initiative (QUERI) model and Rogers' theory of diffusion of innovations served as the theoretical framework. The course was taught to mental health professionals using teleconferencing, electronic media, and monthly conference calls across 24 VA mental health outpatient sites. Twenty course leaders provided feedback. One hundred percent reported being better able to communicate with patients about their voices and 96% reported improved understanding of the voice-hearing experience. Thirty-three course participants …

Health Needs And Service Areas In Illinois: An Examination Of 10 Mlps, Dhrubajyoti Bhattacharya, Emily Benfer, Allyson Gold, Latasha Barnes, Woody Thorne

Nursing and Health Professions Faculty Research and Publications

Medical-legal partnerships (MLPs) secure the health-related needs of an affected patient-client by identifying upstream determinants of health for which the law provides a remedy. Some healthcare professionals have noted key activities of MLPs, including the provision of legal assistance, educating providers about social determinants of health, and advancing policy change by addressing existent laws and regulations that may impede the maintenance of good health.1 Although these efforts are essential, they do not fully capture the potential of MLPs to serve as a locus of research and intervention to strengthen the evidence base to advance individual and population health. Across the …

Clinical Leadership And Asymmetric Information: The Impact Of Physician Advice On Smoking Cessation, Courtney Keeler

Nursing and Health Professions Faculty Research and Publications

A knowledge gradient exists between experts in a given field and consumers of that knowledge. When the need arises, not knowing the best path, an average individual typically relies on the advice of an expert. Given the steep knowledge gradient between patient and provider, clinicians play an essential role in the clinical setting, acting as both a health leader and a health facilitator; however, this asymmetric information implies that clinical providers face an acute pressure not only to advise but to advise correctly. This paper explores the importance of physician advice within the context of smoking cessation, addressing two specific …

Trauma And Violence Exposure Among Asian American And Pacific Islander Children, Dhara Thakar Meghani, Pratyusha Tummala-Narra, Asian American Psychological Association

Nursing and Health Professions Faculty Research and Publications

No abstract provided.

Nonviolent Communication Training Increases Empathy In Baccalaureate Nursing Students: A Mixed Method Study, Marcianna Nosek, Elizabeth Joy Gifford, Brendan Kober

Nursing and Health Professions Faculty Research and Publications

Background: Ineffective communication among healthcare team members is associated with decreased collaborative efforts and adverse patient outcomes. The impact of empathy on collaboration with colleagues and patient interaction has been previously demonstrated. Studies have yet to measure the impact of (Nonviolent Communication [NVC]) on empathy in nursing students.

Purpose: The purpose of this mixed methods study was to test a communication intervention (NVC) with baccalaureate student nurses to examine its effect on empathy.

Methods: A mixed methods single group pre/post test design incorporating the Interpersonal Reactivity Index (IRI) to measure empathy was used. A paired samples t test was calculated …

Creating A Strategic Partnership For Educating Nurse Practitioner Students About Sexual Health, Stefan Rowniak

Nursing and Health Professions Faculty Research and Publications

Sexual health is an essential and often neglected component of primary care. Nurse practitioners are ideal members of the healthcare team to be providing sexual health information, diagnoses, and treatments. Unfortunately, this is an area that has been lacking in the education of all healthcare providers. This paper describes a program that incorporates sexual health into the curriculum for nurse practitioner students through collaboration between the university school of nursing and the local health department. Given the increasing shortage of clinical sites and the need to train nurse practitioners to be competent in the delivery of sexual health, this is …

Clinical Nurse Leaders In The Community: Building An Academic Faculty Practice Partnership, Chenit Ong-Flaherty

Nursing and Health Professions Faculty Research and Publications

The Affordable Care Act (ACA) emphasis on preventive care and primary health has given community organizations and outpatient care environments renewed attention. Nursing has been offered the opportunity to lead healthcare into a new era. One of the two new nursing programs to be given life in this movement is the Clinical Nurse Leader (CNL). The CNL is a graduate level educated nurse who specializes in healthcare systems leadership, a facilitator of care in the complex healthcare environments of today. They are equipped to see the wider and broader perspective of things, assess needs, research the best interventions for problems …