Medicine and Health Sciences Commons^™

An Approach To Increase Education In The Flu Vaccination Clinic Process, Koki Guangxi Inlow, Lucy Dale, Devante Lindsey, Nancy Tran Manalo, Elena Teresa Cleary

Master's Projects and Capstones

The Health Ministries Program, located in Orange County, is supported by a large faith-based community hospital and provides community resources such as flu vaccinations that are overseen by the Faith Community Nurse (FCN). In collaboration with the program, University of San Francisco (USF) nursing students researched and developed an implementation of a multi-purpose educational flyer to increase education and better streamline the process at flu vaccination clinics throughout Orange County faith-based organizations. Research shows that many individuals still do not get vaccinated due to misconceptions, misinformation, and lack of knowledge on the importance of flu vaccinations. The cost of flu-related …

Assessment Of Structural Competency In Baccalaureate Nursing Students: A Descriptive Study, Elle J. Del Gallo

Senior Honors Projects, 2010-2019

Cultural competence has been investigated extensively in nursing education to better prepare nurses to care for individuals of diverse backgrounds. While developing cultural competence is important to address individual care needs, it may not address the social and structural factors that influence health. Structural competency describes the ability to assess not only cultural factors that affect health disparities, but also structural inequalities and stigmas that can alter a patient’s presenting symptoms and risk for certain diseases.

Transitions Of Care: Raising Awareness And Improving Identification Of The Social Determinants Of Health, Stephanie Le

Master's Projects and Capstones

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care.

Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Improving The Rate Of Hand Hygiene Immediately Before And After Wound Care In The Street Nurse Microsystem, Amanda Ramos Sandoval

Master's Projects and Capstones

The street nurse team of Sacramento, CA provides many services to patients who are experiencing homelessness, including a substantial amount of wound care. While the street nurses were performing hand hygiene (HH) prior to and after wound care, they would often not be performing it immediately prior and post-wound care. Because the nurses hike to their patients (who are living on the streets or in out of the way camps) the street nurses would often perform hand hygiene while at their cars prior to going to the patient and again when they returned to their cars after performing wound care. …

A Nurse Practitioner-Led Group Advance Care Planning Program In An Independent And Assisted Living Community, Alexander Bustos

DNP Qualifying Manuscripts

It has been well documented that the majority of people want to spend their last days in the comfort of their own homes, free of pain, and off any dependent machine. , However, the majority of people have not documented these wishes or talked with their family or provider about end of life care (Hamel, Wu, & Brodie, 2017). The Patient Self Determination Act (PSDA), which took effect on December 1, 1991, was enacted to raise awareness and promote discussions between patients and providers about end of life (EOL) healthcare decisions. The primary care nurse practitioner is in a prime …

Managing Childhood Obesity In A Primary Care Clinic, Linda Nnajiofor

Doctor of Nursing Practice

Background: Childhood obesity and overweight have increased health burdens on health care systems, and contribute to chronic diseases such as diabetes, heart disease, asthma, and cancer. Childhood obesity is very complex for healthcare providers to manage in primary care settings.

Purpose: To improve childhood overweight and obesity approach and management in a selected primary care practice (Clinic A) in a large east Texas urban community.

Objectives: 1. Increase the percentage of children and adolescents ages 2 to 19 years seen in Clinic A, who received adequate weight management and obesity counseling, to 75%. 2. Increase the number of referrals to …

Addressing Barriers To Maternal Healthcare For Marshallese Islanders In Northwest Arkansas: An Internship Experience, Victoria Richardson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The Marshallese community is a rapidly growing population in Northwest Arkansas. Approximately 12,000 people migrated from the Marshall Islands and settled in the state of Arkansas due to the signing of the Compact of Free Association (COFA) in 1986. Although the population in Northwest Arkansas is experiencing rapid growth, there are significant health disparities that coincide with it. Due to vast cultural differences, language barriers, low economic status, and political barriers, the Marshallese community suffers from prenatal health inequalities and poor maternal and fetal outcomes, including low birth-weight infants, premature births, and increased infant mortality. During my internship, I provided …

Improving Residential Asthma Assessment Strategies Within A Low Socioeconomic Community, Monica Ramirez

Doctor of Nursing Practice

Background: Nationally, there are currently 6 million children under the age of 18 with asthma. There are a variety of social determinants and in-home environmental triggers that can contribute to the development of or exacerbation of asthma in children. Therefore, it is important to recognize and improve the needs of children with asthma in older homes and in households with a lower socioeconomic status.

Aim: The aim of this project was to decrease the number of in-home environmental asthma triggers within at-risk homes in San Antonio, Texas.

Purpose: The purpose of this evidence-based practice project was to improve asthma outcomes …

Developing A Training Program For Omaha Metro Area Sexual Assault Nurse Examiners Caring For Individuals With Developmental Disabilities, Emily Blanchard

Capstone Experience

Individuals with developmental disabilities experience many barriers to healthcare and are at a substantially higher risk for sexual assault and trauma. There is a need for more inclusive and collaborative healthcare policies, practices, and education to guide healthcare providers during their encounters with individuals with developmental disabilities as patients, especially during forensic examinations following sexual assault and trauma. In the Omaha metro area, physical therapists at the Munroe-Meyer institute provide clinical services in a transdisciplinary program that refer victims of sexual violence to local health systems’ Sexual Health Nurse Examiners (SANEs).

There is an existing service gap for individuals with …

Addressing The Problem Of Sterile Drug Injecting Supply Acquisition For People Who Inject Drugs., Barbra Ann Cave

Electronic Theses and Dissertations

This dissertation contains five chapters, including three manuscripts, covering harm reduction and some of the challenges people who inject drugs (PWID) face in their effort to reduce the risk of injection drug-related harms through sterile injecting supply acquisition and use. Chapter One discusses some background related to PWID and provides an overview of the issues addressed in this dissertation. Chapter Two includes a literature review covering the harm reduction concept, important aspects of syringe exchange programs as a harm reduction tool, and the social determinants of health model as a potential tool for future research. Chapter Three is a two-phase …

The Impact Of Direct Nursing On Patient Engagement To Improve Medication Adherence, Shelley Moore

Electronic Theses and Dissertations

This study examined the impact of direct nursing care on patient engagement and medication adherence within the practice setting of specialty pharmacy. It investigated the problem statement, “Among patients with specialty pharmacy dispensed medications, will direct interaction with nurses impact patient engagement and improve medication adherence?” Patient engagement in healthcare is a growing area of knowledge for the effectiveness of care. The research uncovered patient engagement as a predictor of improved medication adherence through effective direct nursing involvement. Methods to measure engagement were the utilization of the ACE™ Altarum Consumer Engagement (ACE) Measure™. By using a proven, researched tool to …

Recovery Following Proximal Humerus Fracture, Azar Varahrami Vigeh

Electronic Thesis and Dissertation Repository

There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

The Implementation Of An Open Source Electronic Medical Record At A Faith-Based Community Clinic, Gabri Warren

Graduate Theses, Dissertations, and Capstones

Faith-based nursing and healthcare is increasingly gaining popularity as the industry looks to minimize costs and improve health outcomes. Historically, qualitative studies have not shown the extent to which individuals and communities are impacted by health initiatives initiated by faith institutions. Healthcare technology can help support the specialty by providing increased quantity and quality data to analyze. Traditional, proprietary EMRs are too costly; however, open source systems offer a low cost, and easily modifiable option to non-profit, or smaller organizations. The data collected by an open source system allows organizations to improve the care that patients receive, and helps guide …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Exploration Of Knowledge And Skills Development Among Community Health Workers In Rwanda, Schadrack Ngabonziza

Electronic Thesis and Dissertation Repository

Community Health Workers (CHWs) are individuals who are selected and trained to provide healthcare services in the community. To be effective, they need ongoing training opportunities to gain knowledge and skills to perform their tasks. This study used descriptive qualitative methods to explore how Animatrice de Santé Maternelle (ASM)-CHWs working in select regions of Rwanda gained and enhanced their knowledge and skills to support maternal and newborn health care. Thematic analysis was used to analyze data from 110 ASM-CHWs and ten supervisors of CHWs. The analysis yielded two main themes. 1) Formalized training among CHWs, which included the subthemes of …

Academic Nursing: Time To Joint The Street Medicine Movement, Jennifer King

DNP Qualifying Manuscripts

Academic based street medicine programs are springing up across the United States to provide critical points of access to persons experiencing homelessness. This innovative specialty care practice was developed by Dr. Jim Withers in 1992. His vision of increasing access to care by bringing healthcare to the streets is a proven solution to improve outcomes while building trust with the larger mainstream healthcare system. Street medicine programs provide teaching learning opportunities for medical professionals. The majority of street programs internationally are founded by medical schools. Nursing schools are well suited to begin street medicine programs and provide immersive experiences for …

Implementation Of A Self-Care And Wellness Educational Program Addressing Job Stress Among Child Protective Service Workers, Natonya Murray

Doctoral Projects

Job stress attributed to secondary exposure to trauma and the high work demands put child protective service workers at high risk of developing physical and psychological health problems. The purpose of the project was to develop and implement a self-care and wellness educational program addressing job stress among child protective service workers (CPS) guided by Substance Abuse and Mental Health Science Administration’s (SAMSHA, n.d.b) educational toolkit, Promoting Staff Wellness and Preventing Vicarious Trauma and other Work Force Concerns, the Centers for Disease Control and Prevention’s (CDC, 2019c) section on Adverse Childhood Experiences, and the National Council for Community Behavioral …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Examining Opportunities To Increase Flu Vaccine Uptake On College Campuses Through Pharmacy Partnerships, Kristi Hargrave

Electronic Theses and Dissertations

The purpose of this project was to examine a university health clinic’s influenza vaccination program in a suburban city in a western U.S. state, and to explore the effects of partnering with a local pharmacy to overcome billing issues. A program evaluation was conducted to identify the potential barrier of cost for students. The health clinic was not set up to bill private health insurance for students; therefore, if students wanted to get a flu shot, they had to pay out of pocket for it. A pilot program was created in conjunction with the program director, partnering with the local …

Std Education Among African American Women: An Educational Improvement Initiative, Marqueta V. Abraham

Electronic Theses and Dissertations

Research reveals there is a knowledge gap facing African American women regarding sexual health education, specifically sexually transmitted diseases. The Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) was used to assess participants’ knowledge and attitudes regarding sexually transmitted diseases. The STD-KQ self-assessment was administered to African American women and utilized to develop a 45-minute education seminar to bridge the knowledge gap. After an education seminar was held, a posttest was administered to test the women’s knowledge and to determine their level of awareness. Using a paired-samples t test, the researcher found an overall increase in awareness of the types of sexually …

The Lived Experience Of Spirituality In The Lives Of Caribbean Men, Camille A. O. Hamilton

Dissertations, Theses, and Capstone Projects

This is a qualitative phenomenological study exploring the lived experience of spirituality in the lives of English-speaking Caribbean men, aged 40-60 years old, living with chronic illness and residing in the United States. In this study Caribbean men living with chronic illness are asked to reflect on their lived experiences and evolution of the experienced phenomenon of spirituality. A purposive sample of eleven English-speaking men from the Caribbean, living with chronic illness were recruited and interviewed for this study. Max van Manen’s 1997 Methodological Structure of Human Science Research was used as the phenomenological guide. The exploration uncovered 4 essential …

Cultural Aspects Of End Of Life Advance Care Planning For African Americans: An Ethnonursing Study, John Collins

Electronic Theses and Dissertations

Introduction: Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are impacted by demographic variables, cultural distinctives related to patient autonomy, mistrust of the healthcare system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. End of Life (EOL) advance care planning (ACP) promotes patient and family centered care. The purpose of this study was to identify culturally based meanings, expressions, and traditions of EOL ACP and decision making among African Americans, to better understand and provide culturally congruent nursing …

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Tuberculosis, Jessica Puri

Nursing Student Class Projects (Formerly MSN)

Tuberculosis (TB) is a curable disease that claims the lives of millions each year. TB is an airborne disease spread by inhaling droplets of the tubercle bacillus. There are two different types of TB related conditions; latent TB infection and active TB disease. During latent TB, an individual inhales droplets of tubercle bacillus but the immune system can fight off this infection. However, once droplets of tubercle bacillus penetrate the alveoli, and colonization of droplets multiply, latent TB transitions into active TB disease (Katanekwa & Dahlback, 2016, p. 9). TB is typically found in the lungs but can also develop …

Implementation Of An Evidence-Based, Electronic Clinical Algorithm To Improve Screening, Evaluation, And Referral Of College Students For Depressive Symptoms And An Evaluation Of Differences Based On Sexual Orientation And Gender Identity Data, Chris Webb

Graduate Theses, Dissertations, and Capstones

The purpose of this project was to improve the screening, evaluation, and referral of college students (LGBTQ+/Heterosexual) for depressive symptoms through the implementation of an evidence-based, electronic clinical algorithm. There is evidence in the literature indicating that there are increased mental health disparities among college students and the LGBTQ+ population. The prevalence of depressive symptoms among university students is higher than the general population, requiring university student health centers to implement enhanced screenings for depressive symptoms and identification of depression predictors. Prior to implementation of this project, a student health clinic in the Southeastern part of the United States used …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

A Rural Telehealth Objective Structured Clinical Examination, Devon Schlottach

Dissertations

Problem Rural healthcare consumers experience increased health disparities, especially when accessing health care. The use of telehealth to improve access has become an essential competency for nurse practitioner (NP) students. This study evaluated NP students’ confidence and competence of rural social determinants of health (rSDOH) before and after a telehealth simulation.

Methods A descriptive, cohort design was used to review NP students’ pre- and post-surveys, written case studies, and a video-recorded telehealth OSCE for a patient living in a rural area.

Results Student self-rated knowledge of rural health care did not improve despite didactic learning and simulation (z = …

Management And Support Of Uninsured Patients With Diabetes Type Ii Within A Nurse Managed Clinic, Emma Spencer

Dissertations

The purpose of the project was to improve the quality of care for the uninsured, Type II Diabetics residing in a Midwestern urban underserved community. Community Health in Partnership Services (CHIPS) was a nurse-managed clinic, located in that area, that sought to lessen the burden of being uninsured. An annual fee of $35.00 allowed an uninsured community member access to a variety of different health care providers including specialists. In order to utilize this health care team efficiently, it was necessary to implement nurse-led care coordination for patients diagnosed with Type II Diabetes. This quality improvement project followed the Plan …