Medicine and Health Sciences Commons^™

Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb

Master's Projects and Capstones

In a world that demands the constant requirement of adaptability and technology, the need for ‘hands on the ground’ continues to persist, and perhaps even grow. This research project explores burnout in the healthcare and nonprofit settings, as a pre-existing and ongoing issue, that was brought to centre-stage during the Covid-19 pandemic. The researcher explores the intersections of burnout with workplace culture, person-centered care (PCC), sweat equity and duty-of-care, through expert interviews and literature reviews. Data collected provides an immediate understanding of current workplace cultures and environments for human service providers, in both healthcare and nonprofit sectors. While the data …

Development Of A Nurse Anesthesia Program Point-Of-Care Ultrasound Airway Examination Curriculum, Sarah Elyse Sandheinrich Butler, Colton Phillip Butler

Doctor of Nursing Practice Projects

Airway management is a critical and fundamental skill for anesthesia providers. Point-of-care ultrasound (POCUS) is an up-and-coming assessment technique that can provide critical information about a patient’s airway anatomy and may increase patient safety during anesthesia care. As a result, understanding the appropriate POCUS equipment, techniques, findings, and clinical implications for airway examination can become essential for safe and effective anesthesia practice. This project aimed to develop a clinical airway POCUS examination curriculum with detailed instructions on all aspects of appropriate examination equipment, set-up, technique, and implications for findings. The team designed the curriculum to incorporate it into the host …

Using Curriculum Mapping As A Tool To Align The Information Literacy And Evidence-Based Research Learning Outcomes In Nursing Curriculum, Jane Wu

Library Faculty & Staff Scholarship

This research investigated how to use curriculum mapping as a curriculum-integration tool to identify the components of information literacy (IL) and evidence-based practice (EBP) in the nursing curriculum for the future systematic incorporation of information literacy components in teaching EBP. The primary objective is to strengthen information literacy and evidence-based research competency. The ACRL information literacy framework in Higher Education, Information Literacy Competency Standards for Nursing, EBP Competencies, and the EBP research model were used to provide structure to create a map and crosswalk of information literacy and EBP student learning outcomes. We obtained 59 copies of the nursing undergraduate …

Implementation Of An Implicit Bias Training In A Doctor Of Nurse Practitioner Program, Macdana Selecon

DNP Qualifying Manuscripts

Background: Implicit bias in healthcare delivery is the unconscious prejudice individuals might feel about another person or group. All healthcare providers are susceptible to implicit bias which can negatively influence patient-provider communication. Implicit bias is linked to disparities in maternal health outcomes. According to the CDC, the maternal mortality rate for non-Hispanic Black women is 2.9 times higher than the rate for non-Hispanic White women (Hoyert, 2022).

Problem: Implicit bias (IB) training is not provided in all graduate nursing programs. As a result, graduate nursing students are not prepared to manage IB during clinical rotations and post-graduation, thus, are at …

Using Critical Incident Debriefing After Code Blue Events To Support Registered Nurses, David L. Boyd

Doctor of Nursing Practice (DNP) Projects

Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses

Section I: Abstract

Background: During a code blue event (CBE), the environment becomes highly stressful and intense. Nurses rapidly transition from performing life-saving procedures on their patients to carrying out their usual duties. Without proper debriefing, nurses cannot properly process their emotions leading to increased burnout and secondary traumatic stress (Stamm, 2010).

Local Problem: In 2021, the nurses at Providence Saint John’s Health Center (2021a) responded to 110 CBEs, a 43% increase from 2020. Without a process for critical incident debriefing (CID), these nurses were exposed to trauma …

Trauma-Informed Treatment For Alcohol Use Disorder: Improving Long-Term Recovery, Aline M. Bales

Doctor of Nursing Practice (DNP) Projects

Background: This DNP project aimed to assess the feasibility of implementing trauma-informed care to Ria Health's telehealth AUD MAT recovery treatment model for patients with co-occurring PTSD, targeting high relapse rates due to cravings. Trauma-informed care addresses traumatic histories that can potentiate emotional dysregulation leading to maladaptive coping responses manifesting as cravings with addiction memory.

Methods: An integrated review assessed the prevalence of co-occurrence of AUD and PTSD, assessed interest in Ria Health patients, patients recruited from Ria Health if they mentioned cravings, offered concurrent trauma-informed care with medicated assisted treatment for 16-20 sessions, trauma-informed care used Polyvagal Theory techniques …

Bridging The Gap: Educating Medical-Surgical Unit Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Meara J. Matthews

Master's Projects and Capstones

Problem: Sepsis is a life-threatening response to infection that remains one of the leading causes of death worldwide. Based off results obtained from a pre-education survey of nurses on a medical-surgical unit in a large hospital organization, there is an opportunity to increase knowledge and confidence level regarding sepsis and care of septic patients so that nurses are prepared to detect sepsis early and intervention can begin.

Context: The project is being conducted in a medical-surgical unit at a large hospital organization in Northern California. The data from the survey includes 17 nurses on the unit who completed the pre-education …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Jessica Lee

Master's Projects and Capstones

Sepsis is a deadly condition if not treated promptly and urgently. To help lower the mortality rate from Sepsis, education on Sepsis is essential for nurses at all levels and experience. Opportunity at a healthcare organization in Northern California arose when it was found through a survey that about 6 percent of Medical-Surgical nurses have "expert knowledge" of the sepsis bundle elements. Only about 35 percent of these nurses who reported having "expert knowledge" are confident in treating sepsis patients. A team of clinical nurse leader students implemented a quality improvement project. The project was designed to expand nurses' knowledge …

Therapeutic Gardening For Addiction Recovery, Hugo A. Rivera Lopez

Master's Projects and Capstones

Problem: The use of evidence-based alternative forms of therapy like horticulture therapy and therapeutic gardening is underutilized in substance use recovery programs in the United States. As the country continues to struggle with addiction, it is important that recovery programs look to and incorporate these alternative therapies into official curricula. Currently, 46.3 million individuals living in the United States are living with a substance use disorder (U.S Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, 2022).

Context: The intervention was implemented at an all-male substance use treatment facility in San Jose, CA that houses up …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Leman E. Bush

Master's Projects and Capstones

Abstract

Problem: Sepsis is a life-threatening infection that needs immediate treatment. The ED uses sepsis bundle protocols to treat sepsis but the compliance rates for the order sets are below the institution’s guidelines.

Context: A Centers for Medicare and Medicaid Services (CMS) instituted a sepsis performance measure bundle in 2015 called (SEP-1) to promote cost-effective, high-quality care for septic patients admitted to the Emergency Department (ED) (Wang et al., 2020). The ED in a chosen San Francisco, CA acute care hospital has been experiencing unsteady sepsis bundle compliance rates. Sepsis is caught by 1.7 million American adults per year …

Educating Labor And Delivery Nurses On Evidence-Based Birthing Positions To Promote Fetal Descent During First And Second Stage Labor, Sophia Nguyen

Master's Projects and Capstones

The goal of this project was to increase confidence of labor and delivery nurses in utilizing evidence-supported birth positions during the first and second stages of labor in order to aid in fetal descent and labor progression. Current statistics demonstrate climbing trends in cesarean deliveries, which have been associated with increased maternal morbidity and mortality. One nurse intervention that can reduce failure to progress, a main contributor to cesarean sections, is the use of various evidence-supported maternal birth positions such as ambulation, assisted squat, sitting, backwards sitting, lunging, throne, side-lying with peanut ball, hands-and-knees, and throne position. This evidence-based practice …

Increasing Compliance Through Nurse Education On The Bundle, Zachary Harrison-Evans

Master's Projects and Capstones

In an effort to decrease complications and events connected to sepsis in the ED, there is room for improvement with relation to sepsis care and compliance rates. Timely sepsis management and gains in compliance/adherence rates are hindered by SEP-1 fallouts and requirements related to knowledge gaps concerning sepsis bundle procedures, nurses' attitudes about implementing the protocols, and disparities in nurse/physician order sets. It has been determined that the use of standardized protocols and order sets are not being utilized. This is a process gap and a critical area for improvement. Inadequate fluid and lactate documentation, a lack of education, and …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Amanda H. Tran

Master's Projects and Capstones

Problem: According to a pre-survey collected, approximately six percent of medical-surgical nurses report expert knowledge with the “Inpatient Handoff Sepsis Bundle Checklist,” a checklist that details interventions to be taken when a patient is diagnosed with sepsis. About thirty-five percent of these nurses also report expert confidence levels in caring for sepsis patients. Therefore, there is an opportunity to provide education so that nurses may confidently and competently care for sepsis patients.

Context: A medical-surgical unit at Hospital A affiliated with a large, non-profit, integrated healthcare system located in the San Francisco Bay Area.

Intervention: Create an educational handout to …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Maryellen Barillas, Maryellen Barillas

Master's Projects and Capstones

This project aims to increase the confidence of nurses using birthing positions to aid with mobility to assist with fetal descent and decrease the duration of labor in the first and second stages of labor. Lack of mobility and increased duration of labor are associated with the use of cesarean sections, which is an invasive surgery with potential complications. A knowledge gap in a South Bay Area hospital exists in current evidence-based birthing positions. Recent evidence shows that flexible sacrum positions, which are any upright positions that take the weight off the sacrum, promote vaginal deliveries, and improve birthing outcomes. …

The Use Of Therapeutic Gardening In Addiction Recovery, Sophia Agne

Master's Projects and Capstones

Problem: Numerous recent studies have emerged detailing the benefits of horticultural therapy on mental health and wellness. Despite this, substance use disorder treatment facilities rarely include an outdoor component in their programming. The project seeks to examine the advantages of incorporating therapeutic gardening as a complementary part of addiction treatment.

Context: The microsystem where the study was conducted was at a 32-bed residential substance abuse treatment facility for adult men who have previously been involved in the criminal justice system. The treatment approach employed at the facility aligns with the Integrated Dual Disorder Treatment (IDDT) curriculum, which emphasizes mental health-informed …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis: Bundle Elements, Grace Jenks

Master's Projects and Capstones

Problem: Based on the findings of a pre-survey conducted, it was observed that around 6% of the Medical-Surgical nurses who participated from Hospital A possessed "expert knowledge" of the "inpatient handoff sepsis bundle checklist." The results highlight the potential for educating and boosting the confidence of nurses working in a healthcare organization located in Northern California, enabling them to provide better care for patients afflicted with sepsis.

Context: The microsystem is a Medical-surgical unit situated within Hospital A, which is one of the 21 hospitals located in Northern California. Dr. Theresa Mostasisa conducted a survey on February 15, 2023, …

Increasing Sepsis-Bundle Adherence On A Medical-Surgical/Telemetry Unit: A Quality Improvement Project, Tiffany Liu

Master's Projects and Capstones

Problem: Sepsis is a life-threatening complication of infection that can lead to tissue damage, organ dysfunction, and death. Early recognition and intervention are crucial in the management of sepsis. Delays in sepsis care can lead to adverse health outcomes and even death. Sepsis bundles are guided by evidence-based practice. They serve as guidelines for effective and timely management of sepsis. Adherence to these sepsis bundles is associated with overall improved morbidity and mortality.

Context: This quality improvement project was led by Clinical Nurse Leader (CNL) students from the University of San Francisco. It was implemented at a 244-bed …

Educating Nursing Staff On Evidence-Based Maternal Positioning To Promote Fetal Descent During The First And Second Stages Of Labor, Daniela Gonzalez Acosta

Master's Projects and Capstones

This project aims to educate labor and delivery nurses on evidence-based maternal labor positions that promote fetal descent in the first and second stages of labor. In a labor and delivery unit in the San Francisco Bay Area Silicon Valley region, there is a gap in nurse knowledge relating to labor positions. Evidence supports upright and flexible sacrum positions, along with frequent repositioning promotes shorter labor duration, decreased vaginal tearing, and decreased rate of cesarean section deliveries.

A quality improvement project was conducted through education implementation using evidence-based practices utilizing a PDSA cycle for a semester. Educational content was created …

Improving Patients' Perception Of Pain: An Evaluation Of A Nurse Practitioner-Led Chronic Pain Coaching Group, Suzanne A. Levy

Seton Hall University Dissertations and Theses (ETDs)

Background: The opioid crisis in the United States warrants an improved standard of practice for managing chronic pain. A large body of evidence highlights a positive correlation between health coaching focused on mindfulness-based interventions and its potential to improve the overall well-being of chronic pain patients. Currently, there are limited resources to address these patients' psychosocial needs, and the primary treatment plan consists of pharmacological management using long-term opioids. Project Aim: The 3M Chronic Pain Coaching Model is a 6-week coaching group focused on mindfulness, meditation, and motivation. This quality improvement project aimed to evaluate how a mindfulness-based chronic pain …

School-Based Development And Implementation Of Adolescent Mental Health Educational Toolkits, Chantel M. Kilford Ms

Doctor of Nursing Practice (DNP) Projects

After the onset of the COVID pandemic, there were significant increases of adolescents with anxiety, behavioral and conduct problems. These disorders have devasting individual, social, and economic ramifications and school-based staff play a key role in identification, assessment, and treatment. Evidence suggested that healthcare providers, school counselors and teachers were not confident or knowledgeable about adolescent mental health. The purpose of the change in practice project was to increase knowledge and confidence among school-based healthcare providers, school counselors and teachers by providing an adolescent mental health tool kit. The toolkit focused on disruptive behavior and other prevalent mental health disorders …

Improving New Nurse Manager Orientation And Onboarding Program, Leanne E. Deegenaars

Doctor of Nursing Practice (DNP) Projects

ABSTRACT

Purpose: Identify and adapt the best evidence for nurse manager orientation and onboarding programs into practice. Assess the program's impact on job satisfaction and retention of new Nurse Managers (NMs) and Assistant Nurse Managers (ANMs).

Background: Constant turnover of ANMs and NMs within local and regional facilities is expensive and negatively impacts nursing leaders' work environment, job satisfaction, and patient outcomes.

Local Problem: The lack of formal orientation and onboarding at the focus facility impacts the retention and job satisfaction of NMs. The sunsetting of a regional hub model of new NM orientation and onboarding led to a just-in-time …

Determining Care Delivery Model Feasibility Using Discrete-Event-Simulation, Tanya Scott

Doctor of Nursing Practice (DNP) Projects

Background: The need for inpatient pediatric psychiatric services to address the growing issue of pediatric mental health in a multi-state integrated hospital enterprise is straining the system’s capacity to provide timely mental health care.

Local Problem: Lack of access to specialty pediatric psychiatric treatment for dual diagnosis medi-psychiatric care management is a patient quality and safety issue. Insufficient capacity contributes to longer emergency room boarding times and inpatient length of stay for patients who have a mental illness.

Methods: Use of digital simulation methodology to analyze the behavior of a dynamic event-driven care delivery workflow and to optimize quality patient …

Responding To A Deteriorating Patient: An Educational Intervention For Outpatient Clinic Nurses, Angela N. Ikeme

Doctor of Nursing Practice (DNP) Projects

Responding to a Deteriorating Patient:

An Educational Intervention for Outpatient Clinic Nurses

Background: Dynamic and evolving healthcare practices require nurses to continually acquire knowledge and confidence to provide optimal care. Organizations that recognize nurses’ educational needs and develop strategies to meet them empower nurses to improve the quality and safety of patient care.

Local Problem: The need for a continuing education program to improve outpatient clinic nurses’ knowledge, skills, and self-confidence prompted the implementation of this project.

Method: Single cohort education intervention as a test of change to assess the knowledge and confidence participants acquired in a pre- and …

Responding To A Deteriorating Patient: An Educational Intervention For Outpatient Clinic Nurses, Angela N. Ikeme

Doctor of Nursing Practice (DNP) Projects

Responding to a Deteriorating Patient:

An Educational Intervention for Outpatient Clinic Nurses

Background: Dynamic and evolving healthcare practices require nurses to continually acquire knowledge and confidence to provide optimal care. Organizations that recognize nurses’ educational needs and develop strategies to meet them empower nurses to improve the quality and safety of patient care.

Local Problem: The need for a continuing education program to improve outpatient clinic nurses’ knowledge, skills, and self-confidence prompted the implementation of this project.

Method: Single cohort education intervention as a test of change to assess the knowledge and confidence participants acquired in a pre- and …

Save The Children Community Health Worker Program – Adverse Childhood Events Prevention, Jieun Lee

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur between the ages of 0 to 17 in which are directly associated, in a dose–response manner, to many of the most common and serious health problems in the United States.

Local Problem: 62% of California residents have experienced at least one ACE, and 16% have experienced at least four ACEs. ACEs are linked to nine of the ten leading causes of death in the United States Adults with four or more ACEs are 37.5 times more likely to attempt suicide, 3.2 times more likely to have chronic lower respiratory …

Implementing An Infant-Driven Feeding Practice Model, Ann P. Nguyen

Doctor of Nursing Practice (DNP) Projects

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF).

The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature …

Improving Health Outcomes For Lgbtq+ Youth Through Provider Education, Marissa Simko

Doctor of Nursing Practice (DNP) Projects

Background and Problem: LGBTQ+ adolescents and young adults (ages 12-25 years) are known to have higher rates of physical and mental health concerns compared to heterosexual and cisgender youth. Within the LGBTQ+ youth community, rates of suicidality, substance misuse, homelessness, and STIs are higher than in the general population. LGBTQ+ youth have greater challenges accessing healthcare and higher rates of healthcare discrimination. This paper presents a quality improvement project focused on improving evidence-based practices in LGBTQ+ healthcare through the development and implementation of a LGBTQ+ youth centered educational workshop for healthcare providers.

Methods: This project was organized in …