Medicine and Health Sciences Commons^™

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Impact Of Temperature On Children’S Nutrition: A Comparative Study Of Three Ecological Regions Of Nepal, Prakriti Shakya

Master's Theses

Nutrition obtained during the growth period of childhood significantly influences long-term well-being and overall productivity, ultimately contributing to the economy of a society. However, weather shocks can wreak havoc by damaging crops, changing yields of important crops and disrupting market access, which directly impacts the food intake of both adults and children. When these adverse events occur during childhood, short term and long term inadequacy in nutrition as well as disease incidence can cause malnutrition leading to stunted growth and cognitive impairment that may persist into adulthood, affecting the labor market and increasing health expenditure. To address this issue, we …

The Impact Of Female Political Leadership On Intimate Partner Violence In India, Khushboo Patel

Master's Theses

Abstract:

This study employs an instrumental variable approach to examine the impact of female political leadership on women’s experiences of Intimate Partner Violence (IPV). It finds that in rural areas with more female leaders, incidents of sexual and psychological IPV increase. The analysis investigates the drivers behind this impact, revealing that entrenched gender norms and expectations, such as a husband’s preference for more sons, may exacerbate IPV. Additionally, despite the increase in female leaders, attitudes toward violence remain largely unchanged. These findings highlight the need for research and policy initiatives that not only encourage female political participation but also specifically …

Matrilineal Ethnic Affiliation And Female Empowerment: Investigating Attitudes Towards Female Autonomy And Health In Ivorian Households, Martine Hind Stølan

Master's Theses

Kinship structure is a fundamental aspect of anthropology, however, there is still a gap in literature on its impact on economic research, particularly regarding female autonomy and health. This study aims to address this gap by examining the influence of matrilineal ethnic affiliation on attitudes towards female autonomy and health within Ivorian households. Using data from the 2011 IPUMS Demographic and Health Survey for the Ivory Coast, using female responses, this study investigates the complex dynamics shaping attitudes towards female autonomy and access to health care. Analysis on these aspects is done using ordinary least squares (OLS) and logistic estimations. …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Unlocking The Potential Of Peripartum Handoff: Standardizing Nurse Knowledge Exchange (Nke), Kiana Killian

Master's Projects and Capstones

Problem The absence of a structured and standardized handoff during patient transfers may result in the unintentional omission of patient information, medical errors and adverse events. No standardized bedside handoff process, referred to as Nurse Knowledge Exchange (NKE), was observed in Hospital A’s peripartum mesosystem during patient transfers from the Labor and Delivery (L&D) unit to the Postpartum unit. Context Hospital A is a medium-sized urban hospital located in Northern California. The peripartum mesosystem includes 21 postpartum rooms and nine laboring rooms. Intervention Through the recruitment of stakeholder engagement, review of literature supporting evidence-based practices, and a mesosystem assessment, a …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Increasing Opioid Pain Pre-Assessment And Reassessment Documentation Rate In Medical-Surgical Units, Hae Rim (Helen) Hwang

Master's Projects and Capstones

Problem The fifth vital sign, pain, requires proper pain management in hospital settings, often involving opioids with significant risks of adverse reactions. Appropriate pain assessment and management is vital to ensure safe medication administration and mitigate potential adverse reactions.

Context This quality improvement (QI) project aimed to enhance opioid assessment and documentation rate above 90% compliance in two medical-surgical units, with a focus on bedside nurses. Nurses play a key role in administering and documenting pain assessments, a practice crucial to managing patient safety and effective pain management specific to opioid use.

Intervention A baseline survey provided nurses’ understanding on …

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Nurse-Led Telehealth Visits For Patients With Multiple Sclerosis During The Covid-19 Pandemic And Beyond, Eun Hye Kim

Doctor of Nursing Practice (DNP) Projects

Background: Nearly one million individuals are affected with Multiple Sclerosis (MS) in the United States, and it was estimated the annual economic burden of multiple sclerosis in the U.S. at over $85.4 billion in 2022.

Problem: During the outbreak of COVID-19, the number of nurse-led patient education sessions has decreased due to the conversion of in-person clinic visits to telehealth visits. Despite the widespread use of telehealth for MS patients post-COVID-19 pandemic, limited data is available about the use of nurse-led telehealth visits with a standardized workflow.

Method: A quality improvement project was implemented at the MS clinic in Northern …

Increasing The Optimal Usage Of The Gad-7 And Phq-9 Screening Tools To Better Detect Co-Occurring Disorders In An Alcohol Use Disorder Clinic, Lauren Swansick

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Co-occurring disorders include substance use disorders and mental health conditions. These disorders affect 21.5 million individuals. Mental health screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), are effective in screening individuals for depressive and anxiety mental health conditions within addiction settings.

Problem: Of those with an anxiety disorder, 20-40% will be diagnosed with an alcohol use disorder (AUD). Depressive disorders are the most common mental health conditions that can occur alongside an AUD. A literature review revealed that the PHQ-9 and GAD-7 are used in addiction treatment settings; however, not as …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Empowering Nurse-Driven Removal Of Indwelling Urinary Catheters In The Surgical Intensive Care Unit: A Quality Improvement Project, Ellen Ruby Hann

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Educating Inpatient Pediatric Registered Nurses On The Setup And Administration Of Prolonged Intravenous Antibiotics And The Reduction Of Medication Errors, Kiara Hayden

Master's Projects and Capstones

Problem The acute care unit microsystem of a California children’s hospital encounters issues involving the incorrect set up and administration of prolonged intravenous (IV) antibiotics and medication errors, such as delivery at the wrong rate or time. These problems can result in negative patient health outcomes, delayed healing, antibiotic resistance, and increased length of hospital stay and costs. Context A collaborative quality improvement (QI) project was launched to target the pediatric population of this particular microsystem. The aim of this project was to standardize prolonged IV antibiotic practices, disseminate knowledge while using evidence-based practice (EBP), and improve patient outcomes. Interventions …

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

Improving Prolonged Antibiotics Education In A Pediatric Unit, Zerena S. Silva Villamonte

Master's Projects and Capstones

Problem Children’s Hospital A's incidence report tool, iCares, demonstrates that 50% of the issues related to prolonged intravenous (IV) antibiotics are categorized as administration issues. This leads to the medication being delivered at the wrong time or rate. Having these issues increases patient length of stay, increasing hospital costs. Context The microsystems for this quality improvement project include inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s Hospital A is a 361-bed San Francisco Bay Area hospital. Interventions The Clinical Nurse Leader students implemented a presentation defining prolonged IV antibiotics, their rationale, and a video demonstrating the correct …

Increasing Awareness And Communication To Decrease Catheter Days In The Surgical Intensive Care Unit, Kamila Fortney

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Increasing Adherence To A Nurse-Driven Removal Protocol To Reduce Indwelling Urinary Catheter Days, Hannah K. Brosnan

Master's Projects and Capstones

Problem

Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs.

Context

The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area.

Interventions

Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Improving Nurse Support Of Patient Satisfaction Surveys Through Team Huddle Education, Matthew Price

Master's Projects and Capstones

Problem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. Intervention To address this gap in care, an educational presentation using literature evidence in support …

Reducing Barriers To Timely Indwelling Urinary Catheter Removal, Huyen T. Nguyen

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Raising The Bar: Optimizing Peripartum Handoff Through Standardized Nurse Knowledge Exchange (Nke), Kimberly Martinez Rn

Master's Projects and Capstones

Problem Hospital X’s peripartum microsystem has no policy guiding the Nurse Knowledge Exchange (NKE) process. Variability in handoffs during patient transfers could lead to medical errors and adverse events. This quality improvement (QI) project aims to pilot a standardized handoff guide to improve nurse communication and avoid adverse patient outcomes following patient transfers. Context The setting for this QI project was a peripartum mesosystem at an urban hospital located in Northern California with 21 postpartum rooms and nine labor rooms. Intervention The project employed a systematic approach that involved engaging stakeholders, analyzing microsystems, reviewing literature, and analyzing data to identify …

Standardizing Nurse Knowledge Exchange In The Peripartum Mesosystem, Gabrielle Ann Romena

Master's Projects and Capstones

Problem Handoff report is a significant source of medical error, as reported by the Joint Commission. As it stands, Hospital A’s peripartum mesosystem has no standardized policy regarding the Nurse Knowledge Exchange (NKE) process. Context Hospital A is an urban tertiary care medical center in San Francisco, with its peripartum mesosystem divided into two floors with a total of 35 dedicated beds. Intervention Stakeholder engagement, literature review, and mesosystem analysis identified potential barriers to bedside NKE. To address the identified causes, the project implemented a standardized handoff guide and staff education. Measures The outcome measured was comprehensiveness of NKE as …

Pain Assessment And Reassessment Documentation Improvements In Medical-Surgical Units, Alicia Espinoza

Master's Projects and Capstones

Problem Pain management is essential when providing quality care, and adequate documentation of pain assessment and reassessment with administration of opioid pain medications by nurses is necessary for patient safety and satisfaction. Context Nurses play a pivotal role in providing safe and effective administration of opioid pain medication and documentation of pain assessments. This quality improvement (QI) project aimed to increase opioid medication administration assessment and documentation compliance rate for nurses to 90% or greater in two medical-surgical units. Intervention A knowledge check survey was utilized to assess nurse understanding of required data needed to document, and timing for documentation …

Reducing Indwelling Urinary Catheter Days: Improving Interdisciplinary Communication In A Surgical Intensive Care Unit, Karen M. Wong

Master's Projects and Capstones

Problem Urinary catheter nurse-driven removal protocols (UCNDRPs) are evidence-based algorithms that promote the timely removal of indwelling urinary catheters (IUCs) and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers hinder consistent implementation of the UCNDRP, resulting in delayed IUC removal and increased risk of CAUTIs. Context This quality improvement project was conducted in a 16-bed surgical intensive care unit (SICU) in an academic medical center in the San Francisco metropolitan area. Interventions Urinary catheter reminder posters displaying the duration of IUC days were placed at the bedside to prompt interdisciplinary communication about IUC indication and removal. An email detailing the …

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Transforming Peripartum Nurse Knowledge Exchange (Nke) Through A Standardized Handoff Guide, Lillian Quach

Master's Projects and Capstones

Problem: Medical errors and adverse events can result from inconsistent handoffs during patient transfers. As seen in Hospital A’s peripartum unit, there is no formal policy regarding the handoff process, also known as the Nurse Knowledge Exchange (NKE). This quality improvement project aims to introduce a standardized handoff guide to enhance communication and minimize harmful outcomes following patient transfers.

Context: The setting for this project is an urban hospital in Northern California with nine laboring beds and 21 postpartum beds.

Interventions: The project employed a systemic approach involving stakeholder involvement, literature review, and data analysis to identify areas for improvement …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Educating Pediatric Registered Nurses On The Administration Of Prolonged Intravenous Antibiotics, Kasandra Rezler

Master's Projects and Capstones

Abstract

Problem According to Children’s Hospital A's incident reporting system, 50% of problems related to prolonged intravenous antibiotics were classified as administration issues. When mistakes are made in this process, the antibiotic is then delivered at the wrong rate or the wrong time, which is problematic. Additionally, findings from a needs assessment survey highlight a critical need for targeted interventions, such as an educational video, to reduce administration errors associated with prolonged IV antibiotics. Context Within Children’s Hospital A, the microsystems targeted by this quality improvement project consist of inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s …

Enhancing Nurse Awareness Of A Stroke Patient Satisfaction Survey And Their Significance In Practice, Amanda Dao

Master's Projects and Capstones

Problem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. InterventionTo address this gap in care, an educational presentation using literature evidence in support …