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 …

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; …

Improving Quality Of Care Through Discharge Planning, Maria Pasillas

Master's Projects and Capstones

Providing good education for the new mother is key to improving the quality of care for both mom and baby. Since nurses are frontline health care providers who perform the most postpartum education, it is imperative they work to improve discharge education so information provided is consistent, appropriate, and evidence based (Suplee et al., 2016).

The aim of this project is to improve the discharge planning process of a local community hospital utilizing evidence-based research (EBR) with the intent to increase patient satisfaction scores in care transitions to above 65% within 3 months.

The community hospital is a 122-bed acute …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

Creating A Culture Of Teamwork And Communication, Ikjae Yang

Master's Projects and Capstones

This paper aims to explain an innovative strategy for integrating research processes and quality improvement in a medical/ surgical telemetry unit (2 North). The project is targeted to improve health care team communication regarding patient safety to improve patient outcomes. The PICO question guiding this project stated: Does the implementation of TeamSTEPPS during orientation improve communication and teamwork? CINAHL database searched terms "TeamSTEPPS", "new graduate nurses", "communication", "healthcare", "teamwork", and TeamSTEPPS effectiveness. In addition to CINAHL, Google Scholar and PubMed databases were used to narrow down database searches.

The project includes a TeamSTEPPS planning guide that offers the planning organization, …

Prospectus For Mitigating Loneliness During Quarantine For Older Adults In Long Term Care Facilities, Emily Gines

Master's Projects and Capstones

In 2020 as the COVID-19 pandemic resulted in quarantine safety measures and facility closures, facilities that cared for older adults in particular were hit the hardest. Long term care facilities (LTCFs), specifically those that care for older adults with memory care problems, must find ways to provide high-quality, standard care, despite many regulations and changes. Although infection control is an important aspect of care among this population, we must also consider how we can maintain quality of life and social connection. Loneliness is defined as the subjective feeling of being alone or perceived isolation. It can also relate to the …

Exploring Reproductive Oppression Among Undocumented Immigrants In Texas, Darci Phillips

Master's Projects and Capstones

Abstract

Reproductive rights (RR) have been defined as all individuals and couples having the basic right to “decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so” (United Nations Population Division, n.d.). Reproductive justice (RJ) was born from combining reproductive rights with social justice (Ross & Solinger, 2017, p. 9) and goes beyond RR by placing a greater emphasis on access. Access takes other factors into consideration such as the disproportionate number of women of color who cannot afford abortion care or are unable to travel long distances …

Introducing A New 12 Week Education & Simulation Program To Optimize Financial Performance Of Nurse Managers, Melissa Hathcoat

Master's Projects and Capstones

Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and …

Improving Frequency Of Hand Hygiene Education From Providers To Patients, Christopher Sutton, Nancy Moran, Vanessa Hernandez

Master's Projects and Capstones

Hand hygiene compliance is one of the most simplest forms of preventing infection. This paper focuses on improving the frequency and standardizing hand hygiene education to patients delivered by health care professionals from a primary care clinic. The ambulatory suburban community clinic in Oakland primarily serves the underserved population. The target population are the following providers: Physicians, Physician Assistants, Nurse Practitioners, Registered Nurse, Licensed Practical Nurse, and Medical Assistants. A survey was adapted from evidence-based studies, WHO, and CDC to collect data on current hand hygiene education provided to patients from healthcare professionals. An additional survey was given to patients …

Improving Frequency Of Hand Hygiene Education From Providers To Patients, Nancy Moran, Vanessa Hernandez, Christopher Sutton

Master's Projects and Capstones

Hand hygiene compliance is one of the most simplest forms of preventing infection. This paper focuses on improving the frequency and standardizing hand hygiene education to patients delivered by health care professionals from a primary care clinic. The ambulatory suburban community clinic in Oakland primarily serves the underserved population. The target population are the following providers: Physicians, Physician Assistants, Nurse Practitioners, Registered Nurse, Licensed Practical Nurse, and Medical Assistants. A survey was adapted from evidence-based studies, WHO, and CDC to collect data on current hand hygiene education provided to patients from healthcare professionals. An additional survey was given to patients …

An Innovative Contest: A Team Approach To Improving Patient Satisfaction Scores For Medication Side Effects, Jennifer Natsch-Jensen

Master's Projects and Capstones

Problem The Home Healthcare Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey question 14 regarding providers discussing possible side effects is below the organizational goal of 74.1 linear mean in this home health microsystem.

Context According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of patients discharged home from the hospital had an adverse event within the first few weeks of discharge and most are related to medications (AHRQ, 2019).

Interventions An innovative contest was introduced to promote engagement and to use teach-back best practices, including planned discussions with the patient and caregivers regarding name of …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

Aiming For Zero: Creating A Culture Of Safety And Improving Cauti Outcomes In The Microsystem, Shiela Escobar

Master's Projects and Capstones

Abstract

Problem: Catheter-associated urinary tract infection (CAUTI) remains the leading cause of hospital-acquired infection (HAI) despite being preventable. CAUTI increases the length of stay, morbidity, mortality, readmissions, and costs. There is also increasing antimicrobial resistance in pathogens causing CAUTI. Thus, reducing HAIs such as CAUTI should be a priority for every institution.

Context: The microsystem for this CAUTI quality improvement project is a 24-bed adult medical-telemetry unit in an acute care teaching hospital with excessive CAUTI. This project aims to improve the unit’s CAUTI standardized infection ratio (SIR) from a baseline of 2.54 to 1.75 by October 2020. A SIR …

Reducing The Incidence Of Anaphylaxis Events In School Settings, Sabina L. Muresan

Master's Projects and Capstones

Problem: Statistics show in a 2014 nationwide study that a 16% rate of anaphylaxis was reported in over five thousand schools. The anaphylactic reaction occurred between 79-83 % in classrooms and 12-15% in lunchrooms; 19% of the life-threatening reactions occurred on field trips, playgrounds, and other school events. Recent studies identified a knowledge deficit among school personnel when it comes to addressing food allergies.

Context: The microsystem that will benefit from this project is part of a broader educational organization, a School District, in San Jose, Ca. The organization serves over 9000 students with diverse backgrounds, rich in ethnic and …

Three Good Things To Extinguish Caregiver Burnout, Justin Haley

Master's Projects and Capstones

Caregiver burnout is a widespread issue in healthcare and institutions should be increasingly concerned about burnout because of the significant impact on quality of patient care, employee health, and financial stability. Many interventions and studies regarding burnout are focused on improving systems issues or removing negative stressors on caregivers. Although such interventions may be necessary to attempt, comprehensive systems-wide changes can be cumbersome and expensive, while removing negative stressors may be an unrealistic goal in a fast-paced, demanding healthcare environment. The Three Good Things method is an evidence-based, effective, simple, low-cost intervention to improve feelings of caregiver burnout in which …

Standardizing The Bedside Shift Report: Improving Nurse-To-Nurse Communication, Deepi Sahota

Master's Projects and Capstones

PROBLEM: The Community Living Center (CLC) reveals an immense concern on shift-to-shift handoff report. Shift-to-shift report is done in the report room, often times unclear information is given and critical information is not appropriately conveyed.

CONTEXT: The project was implemented on a 50-bed unit at the Veterans Affairs. The improvement project was focused on collaborative partnerships, standardized bedside shift report, and utilization of the SBAR tool. in the prevention of communication errors.

INTERVENTIONS: The SBAR tool was utilized to provide a framework for effective communication between nurses. The CNL facilitated an hour in-service on bedside shift report to nurses …

Decreasing The Fall Rate On A Medical Surgical Unit With An Enhanced Fall Algorithm In The Electronic Medical Record, Natali Sokolovski

Master's Projects and Capstones

This paper summarizes the quality improvement falls prevention project on a Medical-Surgical unit with an Enhanced Fall Algorithm incorporated in the Electronic Medical Record conducted by two Clinical Nurse Leader students of the University of San Francisco.

This project addresses the patient falls events in a San Francisco-Bay Area Hospital on a Medical-Surgical unit. The aim is to decrease the rate of falls on a Medical-Surgical microsystem unit by 50% with an Enhanced Fall Algorithm incorporated into the Electronic Medical Record by June 2021. The patient population consists of general medical surgical patients where many of the patients have an …

In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot

Master's Projects and Capstones

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …

Understanding The Significance Of Virtual Support During Global Pandemic In Young Adults Diagnosed With Hepatitis C, Veronika Arkhipova

Master's Projects and Capstones

Hepatitis C is a viral infection that attacks the liver and leads to inflammation. In recent years, the prevalence of hepatitis C infections among 20 and 30 years of age has increased by 300 percent, and between 30 and 39 years by 400 percent. Due to the global coronavirus pandemic, people diagnosed with Hepatitis C have lost access to mental health services and resources, including in-person meetings with support groups. Since most states enforced stay-at-home order, many community centers, non-profit organizations that work with Hepatitis C patients and the affected population provide limited to no access to support group meetings …

Patient Engagement: A Key Concept To Surgical Site Infection Reduction In Colorectal Patients, Vanessa Strieff

Master's Projects and Capstones

Abstract

Problem: Colorectal surgery is a procedure with one of the highest surgical site infection (SSI) rates; therefore, necessary efforts were implemented to reduce harm (Harris, 2018). Approximately 60% of these surgical infections are preventable (Ban et al., 2017). SSIs can have severe consequences, including extended length of stay, high morbidity and mortality rates, delayed recovery, and high healthcare costs (Harris, 2018). The financial burden of SSI is substantial.

Context: This project aimed to explore opportunities for enhancing patient engagement and awareness of SSI preventive measures. After an extensive microsystem analysis, a knowledge gap in patient education on …

Standardizing The Bedside Shift Report: Improving Communications And Promoting Patient Safety, Chona C. Alforque

Master's Projects and Capstones

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care.

CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ …

Unmasked In The Plandemic: Misinformation During The Novel Coronavirus (Sars-Cov-2) Pandemic, Gil Duran

Master's Projects and Capstones

This paper explores the misinformation phenomena surrounding COVID-19 on social media platforms and its potential impact on the trajectory of the COVID-19 pandemic in the US. It defines the terms misinformation and disinformation and links these to recent political phenomena of “fake news” and political disinformation campaigns. It characterizes the sources of misinformation online and seeks to analyze the psycho-social and cognitive mechanisms of online misinformation spread such as source and message credibility through research on vaccine hesitancy and misinformation online during other global pandemics and resurging epidemics. Network analysis establishes that misinformation online spreads farther and faster than …

Examining The Intersection Of Environmental Justice, Chronic Disease, And Pandemics; How A Mobile Health App Could Improve Health Outcomes And Inform Policy, Jessica Snow

Master's Projects and Capstones

The purpose of this paper is to analyze the intersection of environmental justice, chronic disease and illness, and pandemics. The inequitable distribution of polluting factories, landfills, and hazardous waste sites have been a long-standing concern in the field of environmental justice. Local zoning codes and land use policies have been tools for segregating people and concentrating pollution in low-income communities and communities of color. Many studies have found that pollution varies among racial and minority groups, and the burden of pollution is not one that is evenly shared. Communities of color and low income communities are disproportionately affected by air …

Catheter-Associated Urinary Tract Infection (Cauti) Prevention In Spinal Cord Injury Unit, Golda Nebre

Master's Projects and Capstones

PROBLEM: Hospital-acquired infections (HAI) continuous to be a safety challenge in today’s healthcare systems. Applying a lens to the most common HAIs such as Catheter-associated urinary tract infection (CAUTI) in a Spinal Cord Unit calls for evidenced-based solutions and process improvement. CAUTIs are not only costly and prolongs the patient’s hospitalization, it’s a preventable harm that significantly affects the quality of life of spinal cord injury patients.

CONTEXT: Spinal Cord Injury Unit (SCIU) in VA Palo Alto is a 19-bed capacity inpatient unit where CAUTI rates have been increasing in the recent years. There is a high risk for CAUTIs …