Medicine and Health Sciences Commons^™

Prevention Of Vaccine-Preventable Diseases Through Information And Education At The California Department Of Public Health, Vaisali M. Patel

Master's Projects and Capstones

Immunizations are one of the most important developments in the twentieth century towards the prevention of infectious diseases. Vaccinations against communicable diseases have helped reduce morbidity and mortality all over the world. Despite having numerous vaccines that protect individuals from serious and deadly diseases, vaccination rates in the United States remain at an all-time low. The Information and Education section of the Immunization Branch within the Division of Communicable Disease Control at the California Department of Public Health (CDPH) focuses on working with local health departments, primary care providers, immunization coalitions, and other statewide organizations to increase the rates of …

Improving The Hcahps Score For Pain Well Controlled, Uwaezu J. Umeh

Master's Projects and Capstones

This project took place on a Renal/Endocrine unit of a northern California Hospital. As observed on this unit, pain was not well controlled and this caused the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) score for ‘pain well controlled’ to be low. Hence, this project sought to address the underlying reasons why pain was not well controlled and to proffer solutions to raise the HCAHPS score to at least 65% from an average of 55%. In order to find the root causes, the nurses were surveyed, the patients and certified nursing assistants (CNAs) were interviewed, and a 24-hour …

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient outcomes and nurse satisfaction by minimizing the avoidable interruptions that occur during medication administration. The microsystem is a pediatric and adult medical-surgical overflow unit at a large, urban teaching hospital in Northern California. A series of surveys for nurses and patients and observations of medication administrations were conducted to assess barriers during mediation administration. It was determined phone calls interrupt a nurse the most during medication administration. Interruptions leave the medication administration process vulnerable to errors because it disrupts the nurse’s workflow and thought process. Because most pediatric medication …

Ebola Response: A Summary Of Field Work Project, Jeffrey A. Schmidt Mr.

Master's Projects and Capstones

While epidemics and disease outbreaks are not uncommon world wide, the most recent outbreak of Ebola Virus Disease (EVD) has been the largest outbreak of the disease and the most wide spread in history. The outbreak has caused international concern and was declared a public health emergency of international concern by the World Health Organization (WHO) in August of 2014. Since the outbreak started there have been a total of 15,351 confirmed, probable and suspected cases of EVD reported in six affected countries including Guinea, Liberia, Mali, Sierra Leone, Spain and the United States. There have been 5459 reported deaths …

Relocation Of Orc To Or2, Svetlana N. Schopp

Master's Projects and Capstones

The goal of this Clinical Nurse Leader (CNL) internship project was to maintain safety and quality of care of obstetric (OB) patients undergoing Cesarean Sections (C/S) after operating room for cesarean sections (ORC) is relocated from obstetric unit to the main operating room (OR). The microsystem will accomplish this through effective teamwork, clear interdisciplinary communication, collaboration, and standardization of processes involved. The institution is a not for profit rural health care facility and is a designated Critical Access Hospital; it is located in Northern California. A general obligation bond was passed in 2007 to fund seismic upgrades. Old OB unit …

Improving Nurse Education On Research Informed Consent, Tina Rasooli

Master's Projects and Capstones

As the number of human participants in clinical trials continues to grow, it is increasingly imperative that research nurses are educated about valid research informed consent to improve patient outcomes. As patient advocates, nurses must be aware of the components and principles of valid informed consent in order to protect the rights, safety, and wellbeing of their patients as human subjects. The research nurse must also be aware of their available resources and who to contact if they suspect a problem or a lack of patient comprehension of the study. In order to address these needs, an evidence-based performance improvement …

Improving Patient Outcomes And Nurse Satisfaction By Reducing Avoidable Interruptions During Medication Administrations, Roberta Howard

Master's Projects and Capstones

Medication administration is an important part of nursing duties in acute-care settings. The nurse is responsible for prioritizing safe quality care when administering medications but errors do occur. This project addressed interruptions as one of the challenges of safe medication administration. The aims of this project are 1) to determine a standardized medication administration process 2) to identify perceived and actual interruptions on the unit and 3) to address and reduce the avoidable interruptions of calls, pages and call lights at the nurse station. The purpose of this project is to improve patient outcomes, nurse satisfaction and nurse workflow by …

Improving Influenza Vaccination Rates Through Nursing Journal Clubs, Lily Yan

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient compliance with the flu vaccine for the 2015 fiscal year. Currently the project is set at a teaching hospital in Northern California on the Abdominal Transplant Unit. Participants include six staff nurses who care for End Stage Renal Disease (ESRD), End Stage Liver Disease (ESLD) and abdominal transplant patients. To address the barriers to vaccination, specifically patients’ fear of adverse effects, nursing journal clubs (NJC) were implemented on the unit to educate nurses about the current research on flu vaccination for this patient population. As the facilitator, the CNL …

Impact Of Improving Throughput In The Emergency Department, Katherine J. Edrington

Doctor of Nursing Practice (DNP) Projects

The purpose of this project was to evaluate the patient experience in the emergency department (ED) and in the inpatient setting while correlating increased throughput and patient outcomes at a suburban Acute Care facility in Ohio. The culture in the organization has lacked accountability and ownership of the patients. The ED admitted length of stay (ALOS) was 358 minutes in the beginning of 2013. For the first time in the organization’s history, the ED ALOS is now typically less than the recommended benchmark of 300 minutes. A report of findings among ED’s surveyed showed the ALOS best practice is 244 …

The Design And Implementation Of A Grief Support Program In A Faith-Based Setting, Susan Mortell

Doctor of Nursing Practice (DNP) Projects

Although grief itself is not a pathological condition, adequate support before and after loss can prevent grief becoming unresolved or complicated. Complicated grief (CG) is often diagnosed when severe bereavement symptoms persist over six months following a loss, and it affects an estimated 3-25% of the general population (Fujisawa, Kato, Miyashita, Nakajima, Ito, & Kim, 2010). Complicated grief can result in longstanding psychological issues such as depression and substance abuse.

One group that is at particular risk for CG is older lesbian, gay, bisexual and transgender (LGBT) individuals. This population is significantly represented in Most Holy Redeemer Catholic Church (MHR) …

The Creation And Implementation Of A Transgender Cultural Competence Nursing Education Toolkit, James Bl Donovan

Doctor of Nursing Practice (DNP) Projects

Healthcare disparities in the transgender populations have been linked to lack of healthcare provider cultural competence (IOM, 2011; Bradford et al., Harbin et al., 2012; Eliason, Dibble, & DeJoseph, 2010; Lim, Brown, & Jones, 2013). Prior research has identified that healthcare providers receive little, if any, transgender cultural competence training during their formal education. A survey of nursing educators at the University of San Francisco School (USF) of Nursing and Health Professions suggested that few educators are providing transgender content or understand the unique healthcare needs of that population. A literature review concluded that little is known about the best …

Development And Implementation Of A Succession Plan For The Nursing Department In A Community Hospital, Nadine Mariotti

Doctor of Nursing Practice (DNP) Projects

This project identifies nursing leadership vacancies in a community nursing department and assisted in the planning and implementation of a succession framework to fill the gaps in the nurse leadership population. Aging nurse leaders are leaving the profession and thus are creating gaps which need to be filled (Stichler, 2008). The unavailability of respective schools and negative perceptions of nurses regarding the healthcare sector leads to the lack of interest in the nursing profession (Nelsey, Brownie, 2012). Factors contributing to burn-out in nursing departments affect the intentions of nurses to leave and lower satisfaction towards their profession. The proposed succession …

Narrowing The Qsen Competency Gap In New Graduate Registered Nurses, Marty Mayhew

Doctor of Nursing Practice (DNP) Projects

This intervention is an evidence based, change of practice, quality improvement project that evaluates achievement of the six Quality and Safety Education for Nurses (QSEN) competencies of new registered nurse graduates. No intervention with a similar focus was found in an extensive review of the literature. The participants included 16 new graduate registered nurse hires enrolled in a new graduate RN residency program at Tucson Medical Center located in southern Arizona. The Nursing Quality and Safety Self Inventory^© (NQSSI^©) was used to identify practice gaps perceived by the new RN graduates related to the six QSEN competencies. …

Implementing An Evidence Based Foot Assessment Protocol For Use By Nurses Caring For Adult Diabetic Patients Seeking Care In The Thanh Nhan Hospital Endocrinology Department, Amy Ly

Doctor of Nursing Practice (DNP) Projects

The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam.

Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed.

The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Using An Educational Module And Simulation Learning Experience To Improve Medication Safety, Barbara Lynn Durham

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice project was to provide nurses with an experiential learning opportunity, using simulation, to identify and report near miss events during the medication administration process related to patient-controlled analgesia (PCA) usage. Despite extensive in-service training on a Medical/Surgical (Med/Surg) floor in an acute care hospital, inconsistent, inaccurate and incomplete documentation with use of the new PCA pumps continued to be problematic. A conceptual framework of just culture was used with the quality improvement method of the Plan-Do-Study-Act (PDSA) cycle for testing change. Medication safety education was a valid andragogical strategy to decrease rates …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

Transitional Care Services: A Nurse-Led Quality Improvement Project, Debra Conroy-Mccue

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA) and a national requirement for health care providers and systems to deliver care that is safe, outcome driven, and cost effective, Dignity Health (DH) as part of the hospital engagement network (HEN) launched an initiative called the “No Harm” campaign to reduce all-cause avoidable hospital readmissions. The project, led by a Doctorate of Nursing Practice (DNP) student and readmission team, sought to achieve a 20% reduction in preventable readmissions by December 2014. After having achieved initial success in implementing transitional care services for patients with heart …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Improving Women’S Health Services By Adding Long-Acting Reversible Contraceptive Methods Into Primary Care-Focused Student Health, Shu-Chen Jennie Cheng

Doctor of Nursing Practice (DNP) Projects

Often resulting from inconsistent contraceptive use, unintended pregnancy among young women between ages 18-24 continues to be an issue in the United States. Long-acting reversible contraceptives, including intrauterine contraceptives and the subdermal contraceptive implant, are safe, effective, long-acting, easily reversible, and non-user dependent contraceptive methods, yet currently are greatly underutilized. Most of the contraceptive methods are provided at our student health services except for the highly effective long-acting reversible contraceptive methods. As family nurse practitioners and health care providers, it is essential to integrate this service into primary care-focused college student health clinics by providing evidence-based information to clinical providers …

Implementation Of A Helicobacter Pylori Test And Treat Program In Rural Nepal Facilitated By A Nurse Practitioner Doctor Of Nursing Practice Comprehensive Project Report, Shelley Bloom

Doctor of Nursing Practice (DNP) Projects

There are 30 million people in Nepal, 85% live in rural areas and have access to 15% of health care resources. This deficit in health care resources is supplemented by services provided by non-governmental organizations who organize short-term medical missions. At a rural Nepalese health post 45% of the patients complained of abdominal discomfort. As the prevalence of helicobacter pylori is 50-90% in Southeast Asia, the patients believed that they had helicobacter pylori.

In resource-poor communities, there is a gap between best practices and the care delivered. To decrease the gap in one rural Nepalese health post, a Nurse Practitioner …

Innovative Workforce Plan: Recently Graduated Nurses As Super Users For Ehr Implementation In A Multi-Hospital Organization, Katherine L. Bullard

Doctor of Nursing Practice (DNP) Projects

A regional health system’s decision to rapidly implement a new electronic health record (EHR) in order to meet Stage 2 meaningful use requirements led to a need for innovative cost-containment strategies. Tapping the local pool of unemployed newly graduated nurses as half the required super user workforce leveraged the technology skills of novice nurses registered nurses as trainers of experienced nurses in five hospitals. The novel workforce migrated from hospital to hospital, thereby reducing the number of experienced nurses reassigned to super user duties in each hospital. This strategy also reduced the amount of contract labor required to backfill nurse …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

Oligomerization, Conformational Stability And Thermal Unfolding Of Harpin, Hrpzpss And Its Hypersensitive Response-Inducing C-Terminal Fragment, C-214-Hrpzpss., Pradip K Tarafdar, Lakshmi Vasudev Vedantam, Rajeshwer S Sankhala, Pallinti Purushotham, Appa Rao Podile, Musti J Swamy

Department of Biochemistry and Molecular Biology Faculty Papers

HrpZ-a harpin from Pseudomonas syringae-is a highly thermostable protein that exhibits multifunctional abilities e.g., it elicits hypersensitive response (HR), enhances plant growth, acts as a virulence factor, and forms pores in plant plasma membranes as well as artificial membranes. However, the molecular mechanism of its biological activity and high thermal stability remained poorly understood. HR inducing abilities of non-overlapping short deletion mutants of harpins put further constraints on the ability to establish structure-activity relationships. We characterized HrpZPss from Pseudomonas syringae pv. syringae and its HR inducing C-terminal fragment with 214 amino acids (C-214-HrpZPss) using calorimetric, spectroscopic and microscopic approaches. Both …

Improving Medication Administration And Patient Outcomes By Decreasing Avoidable Interruptions, Polly Nghiem

Master's Projects and Capstones

This Clinical Nurse Leader (CNL) project took place at a level I trauma center in the San Francisco Bay Area, on a 34-bed Medical Surgical, Behavioral Medicine and Acute Care for the Elderly (ACE) Specialty Unit. The goal was to improve the adverse events made during medication administration, which in turn reduces medical error costs and improves patient outcomes and patient safety. A review of the literature revealed several key points: (1) Medication errors are increasingly recognized as a significant, but preventable problem in our health care system, (2) Interruptions are implicated as a cause of clinical error, (3) Medication …

Gender, Smoking And Tobacco Reduction And Cessation: A Scoping Review, Joan L. Bottorff, Rebecca Haines-Saah, Mary T. Kelly, John L. Oliffe, Iris Torchalla, Nancy Poole, Lorraine Greaves, Carole A. Robinson, Mary H. H. Ensom, Chizimuzo T.C. Okoli, J. Craig Phillips

Nursing Faculty Publications

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our …

The Effects Of A Pre-Workout Supplement On Collegiate Track Athletes' Sub-Max Bench Press, Hannah Stroud-Lusk, Valerie Kirk, Jo Sharp, David Lenhardt

Exercise Science Senior Research Projects

The use of prework out supplements in athletes has been increasing as athletes try to get more of an edge on their competition. Our research looked at the effect of taking Muscle Pharms preworkout supplement Assault in collegiate track athletes. We did this by having them preform a sub-max bench press. We found that there was no significant difference between the placebo and Assault.

Emergency Preparedness On An Inpatient Hospital Unit, Hailee Marie Barnes

Master's Projects and Capstones

This paper will discuss the implementation of an emergency preparedness quality improvement project conducted by a University of San Francisco Clinical Nurse Leader (CNL) student on an inpatient cardiac unit, Unit H, at an urban teaching hospital in Northern California, Hospital B. An assessment of the current state of emergency preparedness, a diagnosis of Unit H’s area of greatest needs, the details of planning and implementing the quality improvement as well as the final evaluation will be discussed. The nursing process will be used for the structure of this paper as it was used as the structure of this project. …