Medicine and Health Sciences Commons^™

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 …

Implementing An African American Cultural Awareness Program For Skilled Nursing Facility Staff, Adekemi T. Adedipe

Doctor of Nursing Practice (DNP) Projects

Background: Patient care is most effective when patients and providers establish a therapeutic connection in a cultural context. Nurses’ lack of awareness of a cultural context for patient care impairs establishing a therapeutic provider/patient relationship, with care of lesser quality and poorer health outcomes as consequences.

Local Problem: Staff at a Northern Californian skilled nursing facility (SNF) caring for African American patients with mental illness lacked self-awareness of the cultural context of care. Staff did not consider cultural constructs of care in treating patients and developing care plans.

Methods: Educational intervention to increase the cultural competence of a skilled …

Environmental And Occupational Health Risks: Educating Undergraduate (Adn-Bsn) Nursing Students For Safer Practice, Dorinda A. Mercado

Doctor of Nursing Practice (DNP) Projects

Background: Globally, adverse health effects, including deaths and disabilities, occur from living or working in unhealthy domains where exposure to environmental and occupational hazards exists. A multitude of these hazards are present in clinical settings in the healthcare environment where nurses care for patients and risk ongoing exposures to toxic substances.

Problem: Environmental and occupational health education is rarely included in the standard undergraduate nursing curriculum, contributing to a deficit among nurses in environmental health awareness and knowledge.

Methods: The study design was a pre/post evaluation of a single cohort (n=32) of undergraduate nursing students to assess environmental and occupational …

Effects Of Leadership Education And Mentoring For Assistant Nurse Managers, Karen T. Descent

Doctor of Nursing Practice (DNP) Projects

Background: Nurse manager knowledge and leadership styles influence quality of care, patient satisfaction, staff engagement, and retention. Dissatisfaction with the assistant nurse manager (ANM) role can lead to high job turnover with negative influences on patient satisfaction, quality of care, workforce engagement, and achievement of organizational goals.

Local Problem: Two hospitals and one free-standing ambulatory surgery unit of a large integrated healthcare organization experienced high ANM turnover due to role dissatisfaction, ANM frustration with low-quality care in the units they oversaw, and patient satisfaction metrics below the 65th percentile. The regional healthcare system leadership team recognized the need to increase …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

Community Health Worker Program: Adverse Childhood Experiences And Early Childhood, Arelis Sandoval

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) negatively affect childhood development and long-term health outcomes. Latino children face multiple adversities and social determinants of health compounded by ACEs. Community Health Workers (CHWs) have access to work with families to improve resilience and mitigate the effects of ACEs in this population.

Local Problem: In the Central Valley of California, CHWs provide support and resources to a largely Latino population with increased poverty rates, low educational attainment, lack of health insurance, and many chronic health issues, putting families at a higher risk for ACEs exposure. CHWs need further training to apply ACEs knowledge to …

Improving Health Outcomes For Lgbtq+ Youth Through Provider Education, Marissa Simko

Doctor of Nursing Practice (DNP) Projects

Background and Problem: LGBTQ+ adolescents and young adults (ages 12-25 years) are known to have higher rates of physical and mental health concerns compared to heterosexual and cisgender youth. Within the LGBTQ+ youth community, rates of suicidality, substance misuse, homelessness, and STIs are higher than in the general population. LGBTQ+ youth have greater challenges accessing healthcare and higher rates of healthcare discrimination. This paper presents a quality improvement project focused on improving evidence-based practices in LGBTQ+ healthcare through the development and implementation of a LGBTQ+ youth centered educational workshop for healthcare providers.

Methods: This project was organized in …

Decreasing Seclusion And Restraint Events Among Clients Within An Inpatient And Crisis Stabilization Behavioral Health Facility, Karen Lee Richards

Doctor of Nursing Practice (DNP) Projects

Background: Despite global shifts in behavioral health treatment, changes regarding use of seclusion and restraint (S/R) continues to be extremely slow. Local Problem: Increasing S/R events and subsequent staff injuries and financial burden. Methods: A quality improvement project providing education in trauma-informed care (TIC), sensory modulation (SM), and S/R debriefing (S/RD). Interventions: Education and training for S/RD, TIC, and SM using a variety of materials and methods over a 6 to 12-month period was provided to staff within a 16-bed inpatient adult psychiatric health facility (PHF) and a crisis stabilization unit (CSU). Because of positively affecting the use of S/R, …

Engaging Rural Providers About The Potential Of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs, Joshua M. Cleary

Doctor of Nursing Practice (DNP) Projects

Abstract

This paper describes a DNP project that was designed to address the issue of rural mental telehealth implementation barriers. One of the main barriers to rural telehealth programs has been a technical infrastructure incapable of adequately hosting the telehealth programs. Low-Earth orbit (LEO) internet technology has emerged as a way to solve the rural telehealth conundrum by offering an improved rural technical infrastructure. An integrated review was completed based on the following PICOT question: In rural providers, how does an educational outreach compared to no educational outreach affect provider adoption of new technologies? The evidence showed educational sessions as …

Implementing A Diabetic Foot Care Program In A Virtual Primary Care Clinic, Zahra Naderi Asiabar

Doctor of Nursing Practice (DNP) Projects

Abstract

Background

Healthcare professionals (HCPs) have a key responsibility in delivering preventative and early intervention diabetes foot management within primary care. Diabetic foot ulcers (DFUs) are a major complication of diabetes and can lead to amputations and other wound issues.

Comprehensive care and treatment of diabetes are most effective when patients can access a supportive connection with providers. Before the pandemic, there were many reasons to utilize a technology-based distance approach to health care. The coronavirus pandemic in 2019 prompted additional reasons for the transition to distant care.

Problem

The yearly screening of a virtual foot exam on patients with …

Providing Hypertension Education For African Immigrants At A Southern California Congregation During The Covid-19 Pandemic, Esther Oshunluyi

Doctor of Nursing Practice (DNP) Projects

Providing Hypertension Education for African Immigrants at a Southern California Congregation During the COVID-19 Pandemic

Abstract

Background: Hypertension (HTN) is one of the major risk factors for cardiovascular disease and the prevalence is highest among African Americans (AAs) (American Heart Association, 2017). The difference in the management and outcomes of HTN between African Americans and Whites is most disparate with lack of education being a major contributor to uncontrolled HTN among African Americans, especially among African Immigrants (Lackland, 2014).

Problem: According to church leadership at the project setting, the majority of their adult African Immigrant population is believed to have …

Providing Hypertension Education To African Immigrants At A Southern California Congregation During The Covid-19 Pandemic, Esther Oshunluyi

Doctor of Nursing Practice (DNP) Projects

Objective: To review methods that could contribute to improved knowledge of hypertension among African immigrants at a California congregation. The difference in the management and outcomes of hypertension between African Americans and Whites is most disparate in cardiovascular disease, with lack of education documented as a major contributor for African Americans (Lackland, 2014) and African immigrants (Turson-Ocran et al., 2020). African Americans differ slightly in culture, health, and migration history from Africans who are 21st century immigrants from Africa (African immigrants); however, there are more similarities than differences between them (Terrazas, 2009). This brief report will describe a Doctor of …

Prevention Of Abusive Head Trauma Using An Educational Program For Parents/Caregivers, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The National Center on Shaken Baby Syndrome reports that 1,300 abusive head trauma (AHT) cases occur in the USA each year, a quarter of which are fatal. Injuries are caused by impact, shaking, or both and result in intracranial and spinal damage, retinal hemorrhages, fractures of the ribs and other bones. AHT case rates in the community involved in this project had a 22% increase of AHT from 2018 to 2019.

Context: A practice improvement project involved the implementation of an AHT educational program targeted at parents/caregiversreceiving care services at a children’s hospital pediatric well-child clinic located in …

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 …

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 …

An Education Program For Novice Nurses To Increase Case Management Knowledge, Emily Trefethen

Doctor of Nursing Practice (DNP) Projects

Problem: Heart failure (HF) is a chronic disease where the heart cannot deliver an adequate amount of blood that the body requires. HF is one of the costliest cardiovascular diseases plaguing public health in the United States (Go et al., 2014). HF is the main reason for hospitalizations in adults and a leading contributor to the rise in healthcare costs. Approximately 25% of Medicare patients are readmitted within 30-days of discharge (Go et al., 2013). To address excessive hospital readmissions, the Centers for Medicare and Medicaid Services (2019) initiated the Hospital Readmissions Reduction Program in October 2012 to reduce Medicare …

Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish

Doctor of Nursing Practice (DNP) Projects

Continuous Glucose Monitoring and Diabetes Management During Pregnancy

Abstract

According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …

Unaddressed Challenges For The “Most Honest And Ethical Profession:” A Pilot Study Of Web-Based Learning Strategies To Prevent Moral Distress, Kelly Straight

Doctor of Nursing Practice (DNP) Projects

Background: Nurses and nurse practitioners (NPs) face greater responsibility to address the ethical challenges that present during the course of patient care, due to advances in medical technology and pharmaceutical innovation, and because of widening disparities within the U.S. healthcare system. These ethical questions, which arise during the course of routine patient care, are increasing in both number and complexity in nearly every patient care setting. Even with codified ethical standards, unresolved and/or ongoing ethical questions and dilemmas pose further issues such as the development of moral distress. This pilot project was designed to help NPs and other healthcare workers …

Caring Science Education: The Essence Of Professional Practice For The Registered Nurse, Linda C. Ackerman

Doctor of Nursing Practice (DNP) Projects

Problem: Hospitals have moved from caring, healing environments to business or economic models of caring institutions that focus on census instead of on patients and on technology instead of on touch or human connection (Watson, 2006).

Context: As nurse leaders, we have an obligation to create an environment of authentic, professional, human caring practices within our organizations. Caring science empowers nurses to balance the art and science of clinical judgment by engaging and collaborating with the patient and their family, focusing on the needs of the whole person, honoring the unique perception of health and healing, and engaging them to …

Adopting Complex Case Management Competencies, Phyllis Stark

Doctor of Nursing Practice (DNP) Projects

Improving disposition management of complex hospitalized patients is crucial to the success of acute care facilities. Most hospital patients discharge in less than 5 days, but there is a cohort of complex patients whose length of stay far-exceeds the norm (Centers for Medicare and Medicaid Service Website, n.d.). Today’s case managers are focused on patients who are discharging today or tomorrow in order to keep hospital census cycling through. This phenomenon known as “throughput” drives daily operations and is a measure of success. When case managers are faced with complex patients whose length of stay measured in weeks, months, or …

A Quality Improvement Project To Implement Shared Medical Appointments For The Management Of Type 2 Diabetes In Latino Patients, Denisse Maldonado

Doctor of Nursing Practice (DNP) Projects

Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource …

Enhancing Health Literacy Using Teach Back Method To Increase Patient Adherence To, Tram Mendoza

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy is a complicated and perplexing topic for those not trained in the medical field. Patients possess pieces of health literacy to some degree, while some have none at all. Limited health literacy can pose a very threatening risk on a patient’s well-being, interfering with their self-care and health maintenance, possibly creating more obstacles for the patient if health instructions and education are not clearly understood. This can lead to increased health expenditures due to treating the effects of poor health maintenance in addition to emergency room visits that may have not been necessary had the patient understood …

Enhancing Nutrition Education For School Aged Children; A Preventive Health Measure And Quality Improvement Project, Fanny M. Powell

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of the DNP project was to improve nutritional knowledge of the adolescents at Kings Canyon Unified School District while also improving their perceived ability to choose healthy food. This project was enveloped in a larger community outreach mission utilizing a free school-based clinic for the purposes of providing sports physicals to students and health screening and physicals to the community. Additionally, nurse practitioner students engaged in a cultural immersion experience through clinical rotations in Central Valley.

Methods: Adolescent students who registered for the clinic watched a nine-minute nutrition video, created by the DNP student, while waiting …

Hepatitis C Treatment In High Risk Patients: Implementation Of A Successful Community Focused Program, Annie Pedlar, Jodie Sandhu Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Projects

Background: The city of San Francisco boasts a high rate of hepatitis C infection (HCV) among IV drug users indicating the need for a hepatitis C treatment program. It is estimated that over two-thirds of people who are actively infected with HCV are IV drug users (EndHepCSF, 2017), and in 2017 the San Francisco Department of Public Health (SFDPH) estimated that there are 22,500 active people who inject drugs (PWID) in SF (SFDPH, 2017). With the presence of a wide population of IV drug users in SF there is an identified need for intervention to treat this high-risk patient …

Promoting Transgender Cultural Awareness And Sensitivity Through Education: It Starts With A Pronoun, Jacob Adkison

Doctor of Nursing Practice (DNP) Projects

Background: Health and social disparities affect the quality of life of transgender and gender nonconforming people in a negative manner as opposed to that of their cisgender counterparts (James et al., 2016). Gender discrimination, the lack of medical insurance, and a shortage of culturally competent providers contribute to some of the healthcare barriers in this population. The absence of supportive education for healthcare practitioners for providing culturally sensitive care impacts the transgender and gender nonconforming persons’ desire to seek routine health maintenance due to stigma, which can result in poor health outcomes (Bauer et al., 2009).

Methods: To help fill …

Enhancing Health Literacy Using Teach Back Method To Increase Patient Adherence, Tram Mendoza

Doctor of Nursing Practice (DNP) Projects

Health literacy is an important component of successful health care delivery and relies on both individual and systemic factors to achieve. For individuals not trained in the medical field, health literacy can be a complicated and perplexing web of information to navigate. Patients can have varying degrees of health literacy affecting their understanding of health conditions, especially the elderly, immigrants, minorities, and the low-income populations. Limited health literacy can pose risks on a patient’s well-being, interfere with their self-care and health maintenance, and possibly create obstacles for the patient if health instructions are not clearly understood. One proven model of …

Decreasing Environmental Health Risks In The Philippines: Implementation Of A Culturally Appropriate Screening Tool, Alyssa Samson

Doctor of Nursing Practice (DNP) Projects

Objectives: The purpose of this DNP project was to increase the knowledge of environmental health risk factors in the Philippines among nurses and doctors located within that healthcare system. The overall goal was to educate providers on local environmental health risks, provide training for the use of a screening tool (Tagalog Environmental Health and Safety Assessment Tool [TEHSAT]), and provide resources aimed at increasing screening of at risk populations and provide opportunities for education and health promotion.

Methods: This project included a two-part educational training session. The first part included a preliminary presentation on environmental health and the use of …

Utilizing Tiger Competencies To Improve Informatics Practice, Kwun Ying M. Fung

Doctor of Nursing Practice (DNP) Projects

Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) …

A Success Story In Shifting The Paradigm Together : Partnership Between Service And Education In Building An Onsite Clinical Nurse Leader Program, Enna Edouard Trevathan

Doctor of Nursing Practice (DNP) Projects

Access to advanced academic preparation has been an important consideration in the design of educational programs for the working professional nurse. Nursing education has a history of developing and implementing strategies to respond to their needs beyond the traditional, on campus classroom setting. Nursing programs were early adopters of distance learning technologies, from the first two-way audio, one-way video classes, to satellite, two-way video classes to the recent proliferation of web-based programs. However, an innovative alternative is proposed - bringing the course work to the employment setting and designing the program to be responsive to the learning needs of the …