Medicine and Health Sciences Commons^™

Impact Of Parental Stress On Asthma Management Behaviors And Health Outcomes: A Longitudinal Analysis Of Inner City School-Aged Children, Amanda Constance Green

Graduate Doctoral Dissertations

Background. Asthma is a prevalent chronic condition with excess disease burden in school-aged, minority children from low income inner-city communities. Conceptualized within a nursing and socio-ecological framework, the purpose of this secondary analysis of a prospective study of inner-city school-aged children with asthma (School Inner-City Asthma Study [SICAS]) was to examine associations between characteristics of children and parents, parents stress, parent asthma management behaviors (AMB) and child asthma outcomes, including emergency (ED) visits for asthma, missed school and asthma control.

Methods. The sample included 351 school-aged children (7.9 years old, SD= 1.9 years; 53.0% male; 95.7% minority). Parents reported their …

Relationship Of Specialty Diets To The Severity Of Symptoms Associated With Autism, Rachele Lee

Nursing Capstones

No abstract provided.

Transitional Care To Reduce 30-Day Heart Failure Readmissions Among The Long-Term Care Elderly Population, Shantha Franks

Seton Hall University DNP Final Projects

Throughout the nation, there is an increased focus on reducing preventable hospital readmissions. This initiative started with the Patient Protection and Affordable Care Act (PPACA) (CMS, 2014), which sets forth certain provisions for Medicare spending. Hospitals with higher than usual readmission rates, especially in terms of preventable readmissions, are receiving reductions in Medicare reimbursements (Stone & Hoffman, 2010, CMS, 2014). Congestive Heart Failure (CHF) or Heart Failure (HF) is recognized as a primary cause of 30-day hospital readmissions. Causes of HF readmission include inadequate patient education and planning for discharge, inappropriate medication reconciliation, and poor or inadequate follow-up in the …

Implementation Of A Wellness Program To Address Health Disparities In A Vulnerable Population, Patricia Clark Pappas

Seton Hall University DNP Final Projects

Purpose: The purpose of this project was to implement a Wellness program to address the health disparities in a vulnerable population. The population targeted was a local population that was served at a mental health facility for socioeconomically disadvantaged. The program focused on improving knowledge of cardiovascular health, empowerment and communication skills. Significance: The significance of the project is the improvement in ones wellness by provision of education, empowerment and communication skills. The attaining of these skills can translate into other areas of wellness and improved health outcomes. Populations at risk due to socioeconomic and racial differences can …

Initiating A Bystander Awareness Program At A State University, Kristine B. Sparks

Seton Hall University DNP Final Projects

Crime in schools, colleges and universities is a troublesome social problem. It affects not only those involved in the criminal incident, but it also inhibits societal growth and stability. To address this issue, the Campus Sexual Violence Elimination Act (SaVE Act) of 2013 requires that colleges participating in federal student aid programs must provide “primary prevention and awareness programs” for new students and employees, as well as ongoing crime prevention and awareness campaigns. Implementation was mandated to be started by October 1, 2014. Most prevention programs teach students how to avoid situations, abusive behaviors and potential attacks. This project initiates …

Improving Patient Care Outcomes To Reduce Recurrent Admissions Of Patients With Chronic Obstructive Pulmonary Disease, Lisa Maria Friedrich

Seton Hall University DNP Final Projects

Purpose:Transitional care is time-limited, with the goal of ensuring safety and health continuity for at-risk patients with chronic obstructive pulmonary disease (COPD) as they move from one setting to the next. An acute care episode of COPD ranges from relatively healthy adults to adults with multiple chronic conditions or those in the end-of-life phase. The primary quality concern of an urgent need to improve health care is in response to the gaps of sufficient experience to manage patients with COPD, leading to hospital readmissions. Implementation of standards of care for the improvement of health-related quality of life (HRQL) of COPD …

Early Prevention Of Pressure Ulcers In The Emergency Department, Marie Fagan

Seton Hall University DNP Final Projects

Purpose: Pressure ulcers characterize a major health problem in clinical practice, which in turn, can have an impact on quality of life and health care costs (Dugaret, Videau, Faure, Gabinski, Bourdel-Marchasson & Salles, 2012). Pressure ulcers can develop during treatment regardless of the setting. They develop in long term facilities, family homes and hospitals. The purpose of this DNP project was to ensure patient health and safety by educating the primary emergency room nurses to at-risk individuals presenting to the Emergency Department and to initiate early intervention strategies. Significance of the Project: Until recently, there has been very little literature …

Improving Patient Safety Through Accurate Medication Reconciliation, Dominique Watt

Master's Projects and Capstones

Medication errors due to incorrect medication reconciliation are a very present and serious problem in our microsystem. As an preop/postop outpatient unit, we see an average of 50 patients daily and perform medication reconciliations regularly. The problem is our nurses perform this task inconsistently and often incomplete, leading us to potential medication errors. During my CNL project, I worked with a committee of staff champions and developed a standard work guide for nurses to use in order to effective reconcile patient medications. We used fishbone diagrams, audit tools, surveys and led regular discussions in our huddles in order to develop …

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Decreasing Risk Of Delirium With Early Progressive Mobility, Donna J. Larson Mrs.

Master's Projects and Capstones

Abstract

The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. This project took place in two, 12-bed critical care units. One is a cardiovascular, medical, surgical intensive care unit and the other is a neurotrauma critical care unit. The methods for implementation included writing the management of pain, agitation, and delirium policy based upon the recommended bundle from the Society of Critical Care Medicine referred to as the ABCDE bundle. As part of this bundle, the progressive mobility policy was revised so that a physician …

Improving Patient Satisfaction, Wait Times, And Access To Care In A College Health Setting; Expanding The Rn Role As Prescribing Agent With Standardized Procedures, Kimberly D. Perris

Master's Projects and Capstones

The CNL theme for this project is Nursing Leadership, Advocate for the Profession and is inspired by the Institute of Medicine’s call for all nurses to work to the maximum scope of their practice. The specific aim was to demonstrate RN confidence working independently, and proficiency using one RN protocol to provide hormonal contraception with an overall aim of improving patient satisfaction and access to care. This project took place in a rural university student health center where family planning and contraception services are the number one service provided.

The RN visit project has been multidisciplinary and collaborative in creating …

Using A Strategic Model For Professional Development: The Importance Of Evidence-Based Competencies As A Foundation For Professional Practice., Peggi B. Winter

Doctor of Nursing Practice (DNP) Projects

Abstract

A nursing professional practice model (PPM) is designed to provide a framework for how nursing practices, communicates, leads, collaborates, and provides the highest quality of care as we navigate the complex healthcare system. An infrastructure for learning, competency, and performance needs to be integrated into this model as a foundation for accelerating business and clinical initiatives, promoting standardization, and sharing successful practices. It is now, more than ever, a necessity to have a well-trained, highly competent nursing workforce. Simply having the knowledge and the skill to do a job is insufficient; rather, it is implied that a competency has …

Impetus To Transform: Essential Nursing Leadership Development Through Simulation, Mary J. Mette

Doctor of Nursing Practice (DNP) Projects

Abstract

A nurse manager’s ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting, as well as the culture present in the organization as a whole. The aim of this Doctor of Nursing evidence-based change in practice project was to create an educational modality that supported training nurse leaders through innovation and creative problem solving in today’s acute healthcare setting.

A survey was administered to 48 frontline managers in a Northern California healthcare system to access the gaps and voids in their ability to integrate …

The Role Of A Psychiatric Mental Health Nurse Practitioner As Part Of A Mobile Health Unit For The Homeless Population, Joan Alviar Fraino

Doctor of Nursing Practice (DNP) Projects

An estimated 2.3 to 3.5 million people are homeless in the U.S., often living with chronic medical and mental illnesses. The underserved population, such as the homeless, continues to experience gaps in services, resulting in poor healthcare outcomes and readmission to the hospital setting. They often present in crisis through the emergency room, contributing to an already overburdened healthcare system. Increased spending and overutilization of healthcare services continues to rise in the United States (U.S.). Due in part to advancements in technology and expanded health insurance coverage, American healthcare continues be one of the most expensive commodities in the U.S. …

Development And Implementation Of A Violence Risk Assessment Tool, Mira Aidasani-Diwata

Doctor of Nursing Practice (DNP) Projects

The purpose of this quality improvement project was to provide a means to effectively assess patients as they are admitted to the hospitals and to effectively communicate a patient’s violent tendencies within the healthcare setting. Workplace violence is a serious problem that affects all healthcare professionals. Although serious assaults and homicides attract more media attention, the majority of workplace violence consists of non-fatal assaults. Nurses, aides, and patient care technicians suffer the most non-fatal assaults resulting in injury. Due to the growing incidence of assault and injury among healthcare workers, some states are calling for additional study on workplace violence. …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

Fnp Led Mobile Health Services For The Homeless Population, Tenzin D. Lama

Doctor of Nursing Practice (DNP) Projects

A small percentage of the U.S. population uses the greatest portion of the healthcare services. Homeless people are often such a group of “super-utilizers” of the healthcare system. Due to multiple medical and psychosocial conditions, people experiencing homelessness face numerous barriers to accessing healthcare, thus leading increased utilization of hospitals and emergency departments (EDs) services. Many of these events are preventable through improved primary care interventions. The literature on Respite/Recuperative Care, Transitional Care, and Mobile Health interventions have shown effectiveness in providing safe and quality care to homeless individuals during the critical transitional period post hospital discharge while also reducing …

Patient-Reported Outcomes Screening For Improved Patient Wellness: A Cancer Center Initiative, Alison Morris

Doctor of Nursing Practice (DNP) Projects

Background: People experiencing serious illness have significant unmet physical, emotional, social and spiritual needs. The Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional wellbeing and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to (a) implement electronic screening of every cancer patient by their second oncology visit, (b) design processes for ongoing assessment and intervention of need(s), and (c) develop measurable and sustainable evaluation metrics to ensure that palliative care needs are met. Methods: In June 2015, we launched electronic collection of patient-reported outcomes (PROs) using the Patient Reported …

Depression Screening And Early Intervention On The Post-Stroke Patient, Marco Oliver Dugan Lopez

Doctor of Nursing Practice (DNP) Projects

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

Preoperative Education: A Patient-Centered Care Approach, Gia L. Wendt

Master's Projects and Capstones

Abstract

This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education …

Improving Patient Medication Reconciliation Participation And Compliance Through Education, Maria Elena Herrera

Master's Projects and Capstones

Abstract

The healthcare world is complex. At the center of this world are patients and their safety. Medication knowledge and medication reconciliation compliance are factors that influence patient’s safety and their overall health outcomes. This project explores the theme of patient safety by examining the relationship between patient education and health outcomes. The microsystem, located in the heart of San Francisco, is an outpatient clinic specializing in patients with renal impairment that each diverse and unique. A pre-implementation survey found that only 38% of patients were bringing their medications to appointments. A goal of improving compliance to 50% by December …

Increasing Hpv Awareness And 3-Dose Series Compliance Among The Female Population (Ages 11-26) In A Community Health Clinic, Vanessa Orozco

Master's Projects and Capstones

Abstract

The overall goal of this project was to increase HPV 2nd and 3rd dose compliance rates by a combined 10% among the female adolescent population (ages 11-26). This was to be achieved by implementing EBP follow-up calls to not only schedule appointments but also to serve as a reminder for patients to come into previously scheduled appointments. This project was chosen as prior clinic and organization-wide meetings had delineated compliance rates at just 7%. There were various methods employed to implement this project including an initial microsystem assessment, which entailed a Root Cause Analysis, Process Mapping, SWOT analysis, Cost-Analysis, …

Enhancing Education Of Medication Side Effects To Improve Patient Outcomes, Kyle R. Woolley

Master's Projects and Capstones

Patient satisfaction scores regarding how effectively staff educates patients about possible side effects of new medications are not consistently above the national average at a large metropolitan hospital in California (MHC). The results of these patient satisfaction scores shed light on the need for evidence-based strategies to improve a patient’s perception of the medication education provided to them. The basis of the incentive to improve care is ultimately increased safety and better patient outcomes. From the Root Cause Analysis, it became apparent that a few common barriers need to be addressed, but the one most frequently reported by everyone that …

Reducing Clabsi In The Nicu With Iv Tubing Competency, Tessa A. Toscano Ms

Master's Projects and Capstones

Central line-associated bloodstream infection (CLABSI) is a significant problem in a Level IV neonatal intensive care unit (NICU) on the West Coast of California. A clinical nurse leader (CNL) student joined a team consisting of the unit’s nursing manager, nursing educator, clinical nurse specialist (CNS), and CNS student. Literature review highlighted the association between the development of CLABSI and the practice of changing central line intravenous (IV) tubing. Five interviews of nurses and 15 observations of nurses performing IV tubing change revealed practice variations within six major steps of the procedure. The team revised the IV tubing change policy to …

Exploring The Factors Of Persistence For African American Senior Nursing Students, Yolanda Nelson

Theses and Dissertations

African American nursing students experience commonalities within their college experience. Often these students may be faced with challenges, barriers, and/or struggles that may place a hindrance on their success in meeting their educational goals. This qualitative study used a phenomenological approach to explore African American female nursing students perceptions of faculty-student relationships and its implications for persistence. Four African American female nursing students and two nursing faculty agreed to participate in this study. This research study offers an examination of past and present research regarding the history of African American nursing students, health disparity, social justice and diversity within the …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …

Building A Framework For Professional Nursing Practice Across The Continuum Of Care, Elizabeth S. Bigby

Doctor of Nursing Practice (DNP) Projects

Nursing professional practice models are designed to unite and align nurses under one vision, set of values, and a professional practice model. The goal of this project was to implement and enculturate a professional practice model of nursing with assistant nurse managers and leaders across the continuum of care at an urban medical center and associated ambulatory medical offices. Staff engagement has been shown to improve satisfaction and decrease turnover and implementation and enculturation of a professional practice model improves engagement. The target population was nurse managers and leaders as they needed to embrace professional practice before the project was …

Implementing Emergency Bedside Backpacks In The Nicu To Improve Patient Outcomes, Melissa M. Garcia

Master's Projects and Capstones

Abstract

Planning for a disaster, by implementing a unit specific disaster plan, has become an essential recommendation for Neonatal Intensive Care Units. Emergent situations have resulted from past natural disasters proving the need for additional planning when it comes to units with fragile populations. Research has shown instituting a specialized disaster plan, increases patient safety resulting in improved patient outcomes. This prospectus aims to implement emergency bedside backpacks as the first step in the development of a NICU specific disaster plan. These backpacks are meant to be an addition to the current hospital emergency plan, with the goal being to …

Alarm Management: Electrocardiographic Lead Management, Dale Elaine Dominguez Ms.

Master's Projects and Capstones

Abstract

Alarm Management: Electrocardiographic Lead Management

Quality improvement and safety that incorporates the Clinical Nurse Leader (CNL) competency of putting in place quality improvements plans that are bases on evidence, analysis, and risk anticipation is the thesis for this project. The associated problem is the myriads of electrocardiographic (ECG) alarms that alert staff to patient issues each day. Of those alerts, 88% to 90% are false or do not require immediate attention (Sendelbach & Jepsen, 2013). The high numbers of false alerts cause staff to become desensitized to the sound. This desensitization may cause staff not to respond to a …