Medicine and Health Sciences Commons^™

Fieldwork Summary Report-World Health Organization, Anna Cross

Master's Projects and Capstones

My fieldwork experience took place at the World Health Organization in Geneva, Switzerland, where I completed over 420 hours of practical experience. My fieldwork focused in the field of mental health, working on disorders management (psychosis, depression and suicide) and evidence-based research, but more specifically focusing on schizophrenia, premature death in severe mental disorders, and maternal mental health. Although my fieldwork focused within these areas, for the purpose of this final report, I have opted to focus on my contributions to the research around schizophrenia and premature death within severe mental disorders. Specifically, I contributed to multiple fact/information sheets for …

An Evaluation Of Mammography Rates For Women, 50-74 Years Old, At The San Francisco Department Of Public Health, Kimberly Litts

Master's Projects and Capstones

This paper explores the efforts of the San Francisco Department of Public Health (SFDPH) and San Francisco General Hospital (SFGH) to increase their overall mammogram screening rate to 76.7% by June 2015 in order to receive funding from the federal government. The target population is women within SF DPH’s primary care program, 50-74 years old, and overdue for a mammogram.

The literature reports there are health disparities among women who receive mammograms and how breast cancer affects them. African American women have the highest mortality rates and women of color are more likely to be diagnosed at a later stage, …

Advantages And Limitations Of Anesthesia And Sedation Practices Used Among Acute Ischemic Stroke Patients During Endovascular Revascularization Therapy, Margaret Korzewski

Doctor of Nursing Practice (DNP) Projects

In order to safely and efficiently perform endovascular revascularization procedures among acute ischemic stroke (AIS) patients, general anesthesia or sedation is often required. However, anesthesia management during these procedures varies significantly worldwide and the procedural logistics have not been established yet. At some institutions AIS patients are intubated and paralyzed, while at other facilities, there is no routine protocol. In 2011 the University Hospital used “action nurses” (critical care float pool nurses) to provide pharmacological paralysis with sedation for intubated AIS patients under direct supervision of the neurointerventionalist. However, clinical outcomes among AIS patients undergoing endovascular procedures were poor. Exclusive …

Anxiety In The Classroom Setting: Early Detection Of Signs And Symptoms, Lisa A. Rauch

Doctor of Nursing Practice (DNP) Projects

The Surgeon General (2000) estimates that up to 13% of children experience symptoms of anxiety. Since virtually all children attend school, and this environment challenges children in various modalities that are likely to produce anxiety, schools are an excellent environment to detect early signs and symptoms of anxiety. When available, school nurses are well positioned to provide primary and secondary prevention to students identified with signs and symptoms of anxiety.

The aim of this project is to identify if increasing teacher’s knowledge results in and increased ability to recognize early signs and symptoms of anxiety, and report concerns more rapidly, …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Design And Implementation Of A Sustainable, University-Based, Emergency Medical Response Service, Octavia A. Mandel Struve

Doctor of Nursing Practice (DNP) Projects

Collegiate-based emergency medical services (EMS), designed primarily to provide pre-hospital basic life support and emergency services, are venues by which nurses and other healthcare professionals, with an understanding of community health and social network issues, can maximize health promotion objectives for university and college campus communities. These EMS systems also provide vital support to city and county emergency services and promote positive community relationships with neighboring areas. They can provide excellent opportunities for students to develop critical skills for success in the healthcare and business world. The sustainability and vibrancy of collegiate-based EMS systems are primarily related to impact, benefit …

Improv To Improve Interprofessional Communication, Team Building, Patient Safety, And Patient Satisfaction, Candace A. Campbell

Doctor of Nursing Practice (DNP) Projects

The purpose of this process improvement project was to implement a test of change within a healthcare team utilizing applied improvisational exercises (AIEs), and to lay the groundwork for more effective inter- and intra-professional communication.

Literature review: AIEs have been shown to facilitate individual participant communication strengths through a process of un-learning certain common behavioral habits, and learning new habits that assist in creating and expanding closed-loop communication. Such un-learning and learning enriches the participant’s awareness of the environment and encourages participant adaptability through positive group interactions.

Method: An all-day AIE seminar/workshop was conducted with members of two healthcare teams …

First-Year Male Students' Adherence To Traditional Male Gender Roles And Their Attitudes Toward Bystander Approach Behaviors To Stop Sexual Assault, Kamal M. Harb

Doctoral Dissertations

Sexual assault on university campuses may affect any person at any time. However, university-aged women are disproportionally affected by it, with 25% of women reporting being assaulted on campus, and 84% to 97.8% of them perpetrated by young, heterosexual men known to the victim. To curb sexual assault on the university campus, research studies have advocated for the bystander approach. It encourages bystanders (observers) to intervene and ultimately stop a potentially dangerous situation in which a friend or stranger may experience a sexual assault. Despite its popularity, research studies evaluating the bystander approach have reported, at best, modest success with …

Exploring The Experiences Of Latina/Os In Graduate Health Science Programs: A Qualitative Study, Mijiza Malane Sanchez

Doctoral Dissertations

This qualitative study conducted at a Northern California university explored how six Latino/a health science professionals navigated their academic trajectory. The six participants identify as Latino/a and shared their journeys to the health sciences. This study examined how participants utilized their community cultural wealth to navigate the complexities of campus climate during their pursuit of a graduate or professional degree in the health sciences. Research data included narratives from in-depth interviews with the six participants and a focus group.

The key findings of this study illustrate the profound significance of mentorship in the pursuit of health science careers. This study …

Growing Up With Hiv In Kisumu, Kenya: Participatory Action Research With Young People Living With Hiv, Zoe Alexis Hobbs Marinkovich

Doctoral Dissertations

Forty-one percent of new HIV infections are in young people between the ages of 15-24 (Masquillier, et al., 2012). In addition to new infections, advances in medications are now making it possible for children born with HIV to survive into adolescence and adulthood (Bland, 2011; Gray, 2010). Due to the growing population of youth living with HIV, there is an increased need for adolescent-appropriate care and intervention. While many studies have examined the role of education in preventing HIV transmission for HIV-negative youth in the Sub-Saharan context, few have focused on the education and experiences of young people living with …

Biochemical Assay Optimization And Computational Screening Efforts To Identify Potential Luxs Inhibitors, Keeshia Q. Wang

Master's Theses

Quorum sensing (QS) is a process of coordination of bacterial gene expression in response to cell population. System two QS is regulated by the small signaling molecule autoinducer-2 (AI-2) and is implicated in the infectious behaviors of various bacterial species. AI-2 is biosynthesized from S-ribosylhomocysteine (SRH) by the enzyme LuxS and induces interspecies cell-to-cell communication. Inhibition of LuxS would therefore inhibit interspecies QS. Herein, a search for novel molecular species that will competitively bind with SRH in the LuxS binding site is performed in silico. Computational screening results are then validated in vitro using an optimized LuxS inhibition …

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Innovative Approach To New Nurse Residency, Meaningful Use And Health Care Reform, Pamela V. Stanley

Doctor of Nursing Practice (DNP) Projects

The project’s aim was to examine the financial impact of replacing registered nurse (RN) travelers, RN registry and RN overtime with new graduate RNs. Newly graduated RNs are often viewed by hospital administrators as a more costly staffing resource. This project contributes knowledge regarding the potential cost savings with the utilization of a centralized float pool incorporating new graduates. In addition, it contributes a novel idea for reducing organizational costs of implementing an electronic medical record with the utilization of new graduates as super users.

A new graduate program, which incorporated the use of a formal preceptor and mentoring program, …

Improving Value Based Purchasing Through The Implementation Of The Clinical Nurse Leader Role: The Chief Nursing Officer’S Case For Change, Leanne M. Hunstock

Doctor of Nursing Practice (DNP) Projects

The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical …

The Design, Implementation And Evaluation Of A Technology Solution To Improve Discharge Planning Communication In A Complex Patient Population, Susan M. Manfredi

Doctor of Nursing Practice (DNP) Projects

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges.

Following a …

Transforming The Journey For Newly Licensed Registered Nurses: A Community Based Transition-To-Practice Program In Ambulatory Care Settings, Cathryn A. Halford Dnp

Doctor of Nursing Practice (DNP) Projects

Abstract

In response to the job shortage for newly licensed registered nurses (RNs), transition to practice and residency programs have been established in many areas of the country including the San Francisco Bay Area. The programs were designed as demonstration projects to assist new graduates by increasing their competence, confidence, and skills, and their employability. Evidence from new graduate programs suggests that the programs provide an important bridge that is necessary for the critical transition from classroom to clinical practice and from newly licensed RN to qualified nursing professional. The University of San Francisco (USF)

Transition-To-Practice (nurse residency) program in …

The Creation And Implementation Of Interprofessional Simulation Leadership Scenarios, Angeline C. Delucas

Doctor of Nursing Practice (DNP) Projects

Healthcare is in a historical state of change creating an era that requires superior leadership skills. Leaders face burgeoning challenges in a competitive environment ensconced in reform. Today’s dynamic healthcare environment demands that nurse and interprofessional leaders be astute in a variety of areas including: fiscal responsibility and accountability, organizational politics, interpersonal skills, human resources, communication, conflict resolution, and emotional intelligence. Some areas such as fiscal management are considered hard skills, or skills which can be taught, while others such as conflict resolution are referred to as soft skills, or skills that are learned through experience. Though soft …

Influencing Change In Healthcare Providers: Communication Strategies For A New Era In Healthcare, Ceonne Raasikh

Doctor of Nursing Practice (DNP) Projects

Effective provider communication is the key to patient engagement. However, many providers are not able to effectively communicate with patients, in part due to low health literacy. Evidence in the literature supports the use of specific strategies aimed at improving communication with patients. The purpose of this quality initiative was to influence providers to adopt new communication strategies with their patients. Pharmacists, nurses and physicians were invited to participate in a free, full-day, educational event. During the event providers were alerted to the issue of health literacy and provided communication strategies to improve patient comprehension and engagement. Following the presentation, …

Improving The Implementation Of The Acute Care Nurse Practitioner (Acnp) Role: Development Of Acnp Role Implementation Guidelines, Megan Elizabeth Liego

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act (PPACA) and the Value Based Purchasing (VBP) initiative, hospitals and the health System have rolled out a strategic goals of focusing on meeting the VBP objectives and standardizing care within their hospitals. To help meet these goals and improve patient care, many hospitals have looked toward the implementation of the acute care nurse practitioner (ACNP) role in the hospital setting. There is a lack of guidelines, though, on how to implement the ACNP role. This has led to several barriers, which have created variation in practice and outcomes across …

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

The Role Of Dax-1 In Regulating Pluripotency In Mouse Embryonic Stem Cells, Anthony Torres

Master's Theses

The orphan receptor Dax-1 is highly expressed in pluripotent embryonic stem (ES) cells and shows a correlative reduction in expression as these cells differentiate. While it is known that Dax-1 is expressed in pluripotent mouse ES cells, the precise function of Dax-1 in these cells is not as well understood. Recent studies employing RNA interference (RNAi) to specifically reduce the expression of the Dax-1 gene in mouse ES cells found that upon the knock down of Dax-1, ES cells differentiated. These findings indicate that Dax-1 functions in a novel role in the maintenance of a relatively undifferentiated state in ES …

A Comparison Of Two Teaching Methods For Pediatric Medication Administration: Multimedia And Text-Based Modules, Renee Granados

Doctoral Dissertations

A Comparison of Two Teaching Methods for Pediatrics: Multimedia and Text-based Modules to Teach Pediatric Medication Administration

Nurse educators are in a position to design and develop effective methods that consider the cognitive structures and how the mind processes information to teach pediatric medication content to nursing students. The majority of methods teaching medication administration use only one mode: the visual mode. One mode to present leaning material does not take advantage of the additive effects of using two modes to present learning material.

The purpose of the study was to compare the effectiveness of two teaching methods to present …

Cultural Traditions And The Reproductive Health Of Somali Refugees And Immigrants, Nancy S. Deyo

Master's Theses

Millions of Somalis began fleeing their country in 1991 to escape the civil war. The largest Diaspora of Somali refugees in the United States currently reside in Minnesota. Utilizing a qualitative research approach, four focus groups with 25 Somali women, two focus groups with 12 Somali men, one focus group with Somali religious leaders and seven in-depth interviews with American healthcare professionals were conducted in Minneapolis to help develop culturally sensitive reproductive health programs for Somali mothers. Twenty key distinctions between Somali cultural traditions and Western medicine were identified. For many Somali women, prenatal care is a new concept. There …

Adoption Of Innovation: Impact Of Rituximab (Rituxan®) Faster Infusion On Oncology Nurses' Perceptions, Practice, And Resource Utilization, Keith Dawson

Doctor of Nursing Practice (DNP) Projects

The translation of advances in clinical research into clinical practice in a manner that provides benefits while reducing potential harm is a challenge within the health care delivery system. Data from a phase III multicenter clinical trial led to the 2012 US Food and Drug Administration (FDA) approval of a 90-minute infusion of rituximab (Rituxan) starting at Cycle 2 for patients with non-Hodgkin’s lymphoma who did not experience a Grade 3 or 4 infusion-related adverse event during Cycle 1. The 90-minute rituximab faster infusion will result in a significant change in how nurses in the United States have been administering …

Recognition Of Compassion Fatigue Among Medical-Surgical Nurses: The Provision Of Education To Manage The Effects, Kandace Woodruff

Doctor of Nursing Practice (DNP) Projects

The Institute of Medicine (IOM) (2010) recommends that healthcare organizations make the “recruitment and retention of qualified nurses a priority”. The ability to comply with the recommendation is fraught with challenges. Nurses are required to care for patients across the age span with varying medical complexities. There are work related stressors which are inherent to the care of a more acutely ill patient population. The tenuousness produced by this type of environment can predispose the nurse to a stress induced phenomenon known as, Compassion Fatigue. The literature is abounding with information related to compassion fatigue among various nursing specialties. However, …

A Gap Analysis Of Nursing Systems And Practices In Malaysia: Culturally Appropriate Interventions To Advance Nursing, Chenit Ong-Flaherty

Doctor of Nursing Practice (DNP) Projects

This project comprises a gap analysis of differences between American and Malaysian nursing programs, and additionally, proposes culturally appropriate interventions for Malaysian nursing to adopt American nursing models. The gap analysis was conducted on nursing systems and practices in Malaysia undertaken to identify the differences between Malaysian and American nursing, and the influences that affect Malaysian nursing. The aim is to facilitate the use of the American Nurses Credentialing Center (ANCC) Pathway to Excellence Practice Standard #4: Orientation Prepares New Nurses for the Work Environment, and #6: Professional Development is Provided and Used. The proposal of culturally appropriate interventions as …

Creating An Interactive Dnp Project Repository:A Model For Change, Sara D. Guido Dr.

Doctor of Nursing Practice (DNP) Projects

The creation of systems that can provide bridges to information technology requires rethinking old ways of doing business. In the past, individual universities and colleges would accommodate theses and dissertations on their library sites. Some of these sites are public and can be accessed by everyone, while some require university-specific affiliation.

This project aims to apply knowledge and skills related to information systems and technology. With the growth of the DNP clinical doctorate programs, and final outcome projects there is a need for specialized DNP database for a new method of data entry and retrieval for DNP’s. The creation of …

Presence In Nursing Practice: A Critical Hermeneutic Analysis, Alicia Laurel Bright

Doctoral Dissertations

Research Topic

Presence, although it involves action at times, is a humanitarian quality of relating that is ethically generated and has real-world implications for both patient and nurse. It is an interpersonal process characterized by sensitivity, holism, intimacy, vulnerability, and adaptation to unique circumstances that results in enhanced mental wellbeing for nurses and patients, and improved physical wellbeing for patients. Knowing and being with are foundational to being present.

Theory and Protocol

This research is grounded in critical hermeneutics and follows an interpretive approach to field research and data analysis (Herda 1999). This orientation places the researcher and participants in …