Deported Veterans: The Unintended Consequences Of “Good Moral Character”, Jonathan Deras

Master's Theses

The purpose of this research is to argue that U.S. immigration policy, specifically the 1996 IIRIRA (also known as IIRAIRA), needs to change regarding the legal treatment of immigrant U.S. military veteran deportees due to the following concepts. The first concept is to articulate how the criminalization of immigration, and how the military system intersects to facilitate the Deportation of U.S veterans. A key concept in this analysis is the standard of “good moral character” set by the U.S. government that enlistees need to meet to be accepted into the military; this standard is also used against immigrant veterans during …

Diversity: Lack Of African American Presence In Nursing Leadership, Dawn Carroll

DNP Qualifying Manuscripts

Aim. The purpose of this manuscript is to synthesize the literature on the paucity of African Americans in nursing leadership, the importance of inclusion, and the barriers to advancement.

Background. The nursing workforce does not reflect the population served. Minorities remain underrepresented in nursing and nursing leadership despite efforts to close the diversity gap.

Evaluation. The literature reviewed examined the lack of diversity in nursing and nursing leadership, perceived barriers to career advancement, and current efforts to diversify nursing leadership. Nine peer-reviewed, critically appraised studies are included.

Key Issues. Ensuring the nursing workforce represents the patient population served can …

The Reality For Minorities Exploring Nurse Executive Leadership Roles: An Integrated Review, Trarina Harris

DNP Qualifying Manuscripts

While nurses in direct patient care are serving a growing minority population, nurse executives are not racially representative of the patient population. This integrated review sought to understand the benefits of formal mentorship. Results included 2 themes: increasing diversity and self-efficacy through formal mentorship. The themes are explored in the literature. Implications for organizations and leaders will be discussed.

Using Simulation For Oncology Nursing Competency Evaluation In Hospitals, Dana N. Littlepage

Doctor of Nursing Practice (DNP) Projects

Problem: Hospitals in an integrated health system, are experiencing low levels of oncologic admissions to their medical surgical units. This is creating a challenge for the organization to maintain nursing competencies for this subset of patients.

Context: In low volume, high risk acute care environments, where chemotherapy is to be provided, seasoned registered nurses grapple with maintaining their competencies, professional confidence and feeling safe enough to administer, monitor and care for this patient population (Muehlbauer, Parr, & Perkins, 2013). The purpose of this project was to ensure that both new and seasoned acute care oncology nurses have access …

The Importance Of Nutrition Education As A Recovery Component For Individuals With Severe Mental Illnesses, Emily Martinez

Master's Projects and Capstones

In efforts to challenge the Western medicine’s determination of nutrition as a holistic approach, this paper represents the intent for mental health facilities in California to improve or implement nutrition education curriculum by enhancing interprofessional teams with dietitians as an important component of recovery for severe mental illness patients. There is concrete evidence proving that individuals who are in facilities recovering from mental illnesses have benefited from optimal nutrition consumption. Nutrition education has become a component among the toolbox of recovery options, but unfortunately it is not encouraged enough. Pharmaceutical companies advertise drug therapy as the most effective way to …

Oral Chemotherapy: Safe Handling In The Home, Cynthia Huff

DNP Qualifying Manuscripts

Background: According to the National Institute for Occupational Safety and Health (2016), oral anticancer agents (OAC) are hazardous drugs (HD) and require the same safe handling interventions in the home setting as in controlled health care environments. The use of a safe handling checklist for OAC administration is a way nurses can provide safe handling education to patients and caregivers and assess for understanding and competency for critical tasks. Effective home management strategies outlining caregiver protections, proper storage, administration of OACs, spill clean-up, and waste disposal could reduce exposure risks to toxic agents.

Objective: To present a safe-handling checklist …

A Compelling Case For Evidence-Based Practice Mentor Development Programs: An Integrative Review, Stacy Alves

DNP Qualifying Manuscripts

Background: In 2008, The Institute of Medicine (IOM) set a goal that by 2020, 90% of healthcare decisions would originate from the best evidence available. This goal remains intangible for many organizations. Despite reporting quality and safety as a top organizational priority, a survey of 276 Chief Nurse Executives (CNEs) found that only roughly 50% of the CNEs said that EBP was practiced in their hospitals only “somewhat” or “not at all” (Melnyk, Gallagher‐Ford, Thomas, Troseth, Wyngarden, Kzalacha, 2016). Many organizations struggle to systematically integrate EBP into practice (Melnyk et al., 2018; Warren et al., 2016a). The Advancing Research and …

Usp <800> Compliance: A Hazardous Drug Safe Handling Ppe Toolkit For Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP <800> Standards will represent …

Safety Huddles: A Safety Net For Nurses Amid The Covid-19 Pandemic, Miranda Saint-Louis

DNP Qualifying Manuscripts

In March 2020, our 31-bed geriatric medical unit was designated the first COVID-19 unit in a teaching hospital located in a New York City COVID-19 hot zone. At the time, little was known about SARS-CoV-2 and the disease it caused. We needed to find a way to keep them calm, assure their safety, and provide competent and compassionate patient care in a situation where best practices had not yet been established. The concepts from this article can be applied to provide support staff in any crisis. Providing a safety net for staff enables a focus on life-saving patient care without …

Improving Clinical Communication And Collaboration Through Technology, Michelle Machon

Doctor of Nursing Practice (DNP) Projects

Problem: Over the last 30 years, clinical communication methodologies in healthcare have evolved to become such disparate systems that they lead to confusion, wasted time, and clinician dissatisfaction. The Joint Commission (2016) reports up to 78% of sentinel events in hospitals are linked to communication failures, which have obvious implications for hospital systems in the quality and safety of their current communication systems.

Context: The purpose of this project was to determine the effectiveness of implementing a unified clinical communication technology platform in an acute care hospital setting and to make recommendations from that implementation to the organization’s larger health …

Improving Nurse Engagement Through Unit Practice Councils: A Literature Review, Pavna Sloan

Doctor of Nursing Practice (DNP) Projects

Problem: According to The Advisory Board Company, nurses are the least engaged group of healthcare employees (The Advisory Board Company, 2014). This finding concerns healthcare organizations because those with a high percentage of disengaged nurses have increased nurse turnover rates and decreased patient satisfaction and safety scores (Kutney-Lee et al., 2016). Shared governance, in the form of the Unit Practice Councils (UPC), is a model healthcare organizations implement to increase nurse engagement. A review of the current literature is needed to evaluate if the model is effective.

Purpose: The purpose of this article is to provide a comprehensive literature …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Implementing Simulation In Icu New Graduate Nursing Orientation: Introducing Two Practice Innovations, Aiza Quinday Msn

Master's Projects and Capstones

A change project involving the use of innovative wearable simulation technology was integrated into the 12-week new graduate nurse ICU training program at one community hospital in Northern California. Project implementation was interrupted by the Covid-19 pandemic, so only the first pilot training session was conducted. Initial results from this training session suggest that the simulation training had a positive impact on the nurses’ ability to assess patient breath sounds and to recognize and treat a rapidly deteriorating patient. This training session also allowed the project team to identify additional areas of skill assessment and opportunities for improvement for the …

Reducing Hospital Acquired Pressure Injuries Through A Standardized Prevention Bundle, Austin Lee Stoker

Master's Projects and Capstones

Abstract PROBLEM: Currently healthcare acquired pressure injuries (HAPIs) in the United States result in significant and unnecessary costs along with lost revenue for healthcare facilities. These costs are estimated to be between 9.1 and 11.6 billion dollars annually. Pressure Injuries (PIs) are directly associated with decreases in patient outcomes and are deemed preventable incidents. HAPI prevention can mitigate this clinical and financial problem for patients and organizations. CONTEXT: Unnecessary patient harm related to four HAPI occurrences in the last quarter on the 2B Medical Surgical Telemetry Unit in an integrated managed care delivery system continue to be of concern. Adherence …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

A Systems Approach To Increase The Icu Nursing Workforce During A Pandemic, Jennifer Mendenhall

Master's Projects and Capstones

A Systems Approach to Increase the ICU Nursing Workforce During a Pandemic

Abstract

In early March 2020 an intensive care unit (ICU) patient died of COVID-19 in an integrated healthcare system hospital in Northern California. Data from China and the CDC indicated that more healthcare members would require intensive care and could overwhelm the 21 acute care hospital macrosystem. A microsystem pilot program to upskill peri-anesthesia care unit (PACU) RNs to care for ICU patients was initiated. Concurrently the upskill pilot program was reviewed by macrosystem nursing leadership. Over a three-week period, the program was standardized, disseminated and implemented across …

An Innovative Approach Using Virtual Sitter Video Monitoring For Fall Reduction In The Medical-Surgical Microsystem, Roman Kutu

Master's Projects and Capstones

Abstract

Problem: Although many fall prevention protocols have been utilized across hospital settings, the patient fall rate in one acute care medical-surgical microsystem continues to be a significant safety problem. Despite many safety precautions, including external bed and chair alarms, twelve falls were recorded in 2019, and fifteen falls occurred in this unit's 2020 fiscal year.

Context: Despite identifying risk factors for falls and employing several fall prevention protocols, patient falls are the most common adverse and challenging patient safety event for hospitals. One of the most common interventions to reduce falls has been the utilization of in-person sitters; …

#Leadershipaccelerated: A Coach Mindset Focused Leadership Development Program, Diane Rindlisbacher

Doctor of Nursing Practice (DNP) Projects

Problem: Developing leaders to lead in environments that are dynamic, complex, and ambiguous is an area of focus for healthcare leaders. How leaders lead and how organizations develop leaders is tied to the outcomes they achieve (Development Dimensions International [DDI], 2019; Moldoveanu & Narayandas, 2019; Till, Dutta, & McKimm, 2016). To create a climate of trust and safety where teams succeed requires leaders to embed key attributes and competencies into their day-to-day work.

Context: A leader’s ability to create a climate of trust and safety and to adopt and apply a coach mindset to their work is intended to help …

An Online Self-Directed Learning Module For Regional Stroke Survey Success, Winchell Rodriguez Kuttner

Doctor of Nursing Practice (DNP) Projects

The lack of a standardized education for stroke coordinators focusing on The Joint Commission (TJC) standards and requirements in preparation for the stroke program disease-specific care (DSC) certification survey every two years has led to undue added stress prior to survey. The development of tools and resources has been identified to address the current educational gap in stroke coordinator orientation. This project addressed the gap by creating an online, self-directed learning module to assist the stroke coordinators in knowledge acquisition of the stroke standards and requirements.

A stroke coordinator plays a critical role in stroke care delivery. An educational module …

Illicit Substance Use In Acute Care Hospitals: Creating A Safe Environment, Christina Sanford

Doctor of Nursing Practice (DNP) Projects

Problem: In January 2019, a medium-sized acute care hospital in Northern California reported new safety concerns related to patients using illicit substances in the hospital.

Context: Leaving the hospital AMA is an increasing problem in acute care hospitals among patients who use illicit substances, with a rate of 25% to 30% (Ti & Ti, 2015). Grewal et al. (2015) conducted a study of over 1,000 illicit substance users who had experienced a hospitalization, where 43.9% reported use of illicit substances while in the hospital.

Intervention: The project was the creation, implementation, testing, and evaluation of multiple interventions to improve …

Identification Of Victims Of Human Trafficking: Leading Change Through A Global Pandemic, Connie Clemmons-Brown

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was …

A Performance Improvement Nursing Fellowship To Enhance Timely Access To Care, Cheryl Reinking

Doctor of Nursing Practice (DNP) Projects

This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient …

Implementing Virtual Sitters To Reduce Falls And Sitter Costs, Asia Quovadis Williams Plahar

Doctor of Nursing Practice (DNP) Projects

The setting for this DNP project was a 326-bed, suburban hospital in Northern California that was facing challenges with preventing falls with injury and rising sitter costs. Between May 2018 and June 2019, there were four sentinel events related to falls with significant injuries. This hospital was financially impacted by the growing cost of the expanding sitter program caused by the rising elderly patient population, with demographics requiring one-to-one, in-person sitters to observe them visually. There is ample research demonstrating the utility of video monitoring systems to improve patient safety by reducing falls, enhancing staff safety by reducing workplace injuries …

Creating A Thriving Informatics Culture, Nicholas Webb

Doctor of Nursing Practice (DNP) Projects

Nurses thrive best when they are empowered to make decisions that can positively impact healthcare delivery. Knowledge and application of nursing informatics principles can influence clinical, quality, operational, and financial outcomes in ways that were not available in previous professional nursing generations.

If nursing informatics is the solution, what is the problem? A survey regarding use and attitudes about nursing informatics was taken of chief nurse executives (CNEs) at an integrated, not for profit healthcare system in the Northern California region, where the author oversees the electronic health record (EHR). The results were surprising. Half said they did not know …

Valley Fever: Education For Primary Care Providers And Allied Health Care Professionals, Michelle Elizabeth Bergen

Doctor of Nursing Practice (DNP) Projects

Valley Fever: Educating Primary Care Providers and Allied Healthcare Professionals

Abstract

Problem: Coccidioidomycosis (cocci), informally Valley Fever (VF), infects the lungs with the fungal spore coccidioides. It is prevalent in areas where soil disturbance occurs. Currently, there are no related educational or standardized guidelines exist for primary care providers (PCPs) in California’s Central Valley, where VF is highly endemic (Centers for Disease Control and Prevention, 2018).

Context: A Doctor of Nursing Practice project educational program for PCPs and allied healthcare workers (AHWs) at the Adventist Health Central Valley Network (AHCVN) clinics. The project aimed to educate PCPs to …

Development Of A Disaster Preparation Toolkit To Improve Community Resilience, Tiffany Wong

Doctor of Nursing Practice (DNP) Projects

Problem: Natural and man-made disasters happen in all communities and negatively impact the health and safety of populations. Vulnerable populations, such as older adults with comorbidities and disabilities or those aging in place, face greater challenges and have specific needs when faced with disasters. The physical, psychosocial, and cultural characteristics of older adults place them at greater risk during disasters. Emergency preparedness is necessary to build and improve community resilience, as well as to ensure older adults aging in place have the necessary supplies and support to respond to a disaster. Without a proper action plan, recovery efforts during disaster …

Preceptor As Frontline Leader Utilizing Emotional Intelligence, Dwanette Judkins

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem - This paper describes a DNP project implemented in an acute care hospital in 2020. The hospital implemented a nurse residency program, with an evidence-based preceptor role development (PRD) component, which proved to be beneficial in growing the nursing workforce and building infrastructure; however, nurse turnover increased.

Context – Preceptors expressed feeling unsupported and not valued. The nurse executive team recommended the recognition committee expand its efforts to develop strategies to develop frontline leaders by building preceptor resiliency and increase retention. Preceptor development could positively impact the nursing workforce.

Intervention - The DNP student, was the executive sponsor …

Pre-Conception Screening Tool, Nnenna Abaeze

Doctor of Nursing Practice (DNP) Projects

Problem: Sexually active women between the ages of 14 and 44 are at risk of pregnancy. This risk puts these women at high rate of unintended pregnancies.

Purpose: Currently, there is a nationwide initiative, Healthy People 2030, to reduce the rate of unintended pregnancies. Pre-conception screening is a method of mitigating this concern. Women typically receive pre-conception screening from an obstetrician, whom they visit during their annual well woman visit. The primary care setting is unique because women typically visit a primary care provider more frequently than their obstetricians. Every visit to a primary care provider is an …

Transformational Leadership For Frontline Leaders, Marta L. Hudson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Transformational leadership (TL) represents the gold standard of leadership styles in contemporary healthcare organizations. The transformational leader's ability to motivate, influence, stimulate, inspire, and attend to followers' individual needs is an antecedent to job satisfaction, quality, and patient safety. The project aimed to improve TL constructs among frontline leaders (managers and assistant nurse managers). Based on the results of a needs assessment, these frontline leaders were provided an opportunity to improve their TL style.

Context. Leadership development is a strategic priority for a medium-sized medical center in a healthcare system in Northern California. Frontline leaders within patient care …