Implementation Of Implicit Bias Training In A Doctor Of Nurse Practitioner Program, Macdana Selecon

Doctor of Nursing Practice (DNP) Projects

Background: Implicit bias in healthcare delivery refers to the unconscious mental associations healthcare providers make about patients from various social groups. Numerous studies suggest implicit bias contributes to health disparities primarily amongst marginalized groups. Furthermore, patients report a lower quality of communication from healthcare providers with higher implicit racial bias. In 2021, Assembly Bill 1407 (Nurses: Implicit Bias Courses Act) was passed to address the negative impact of bias on patient outcomes and requires California nursing schools to provide implicit bias training for nursing students.

Problem: All graduate nursing programs do not provide implicit bias (IB) training. As a result, …

Implementation Of Fast-Track Triage Process To Improve Ambulance Patient Offloading Time (Apot) In A Psychiatric Emergency Services (Pes) Unit, Oke Augustine Umeugoji

Doctor of Nursing Practice (DNP) Projects

Abstract.

Background.

Ambulance delays in hospital EDs have recently been significant in the United States. This delay has been attributed to emergency department overcrowding, a record number of 911 calls, a shortage of ED staff (doctors and nurses), and poor resources available in the communities as alternatives to an ED visit. Local Emergency Medical Service Authorities (LEMSA) monitor and determine the community standards for measuring ambulance offload delays (AOD), usually in minutes.

Problem.

Lengthy ambulance patient offload times and their subsequent impact on EMS have been significant all around the state of California as well as nationwide. The ambulance delay …

Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik

Doctor of Nursing Practice (DNP) Projects

Developing and Implementing an Infection Prevention Practice Fellowship Program

Abstract

Background: The COVID-19 pandemic placed huge demands on infection prevention programs (Blanchard et al., 2022), seriously taxing a profession already mired with progressively increasing workload and responsibilities (Bryant et al., 2016).

Local Problem: In a rapidly changing environment, infection preventionists (IPs) contend with pandemic surges, emerging infections, and supply chain disruptions. The NCAL Region of an integrated health system experienced IP turnover, and in the absence of a formal training program, newly hired IPs experienced variable to no opportunities to develop their competencies.

Methods: A literature review on infection prevention …

Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan

Master's Projects and Capstones

The purpose of this quality improvement project was to use evidence-based practices to determine if personalized education on disease self-management would lead to improved treatment adherence in a residential facility. The target population consisted of four elderly female patients who had been diagnosed with congestive heart failure (CHF) and were struggling with the self-management of their disease. Contributing barriers to effective CHF self-management were determined using a root cause analysis, and included a lack of educational templates, declining cognitive ability of the residents, and no electronic health record (EHR). Using the Self-Determination theory, the interventions were implemented. Phase one was …

Reducing Hospital-Acquired Pressure Injury In An Inpatient Medical-Surgical Telemetry Adult Unit By Educating And Encouraging Basic Wound Care Prior To Wound Care Consult, See Wai (Amy) Kong

Master's Projects and Capstones

Problem: A medical center in the Diablo Service Area had one of the highest rates in hospital-acquired pressure injury (HAPI), benchmarking with other facilities, with the project unit one of the top offenders. The patients and the medical center both suffered from the harm. Barriers to HAPI prevention included lack of patient turnings, skin assessment, and early standard wound care treatment.

Context: This project focused on the primary care team standardizing early wound care treatment to avoid wound progression.

Interventions: Interventions included re-educating the primary care team on early basic wound care using a standard wound care guideline created by …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Campaigning Beyond: Sepsis Awareness Among Non-Clinical Staff, Cynthia Wong

Master's Projects and Capstones

Problem: Sepsis stands as the foremost cause of illness and death among hospitalized patients globally, yet a considerable number remain oblivious to this critical condition. Based on the pre-implementation survey among non-clinical staff members of an urban hospital, awareness of sepsis must be heightened to ensure swift recognition and response.

Context: The project conducted takes place in five distinct non-clinical departments at a large hospital organization in Northern California. Each department plays an essential role in the holistic and efficient functioning of the organization to provide quality patient care.

Interventions: A sepsis awareness campaign was implemented throughout the month of …

Dodge The Fall: A Newborn Fall Prevention Initiative, Lenora Thompson

Master's Projects and Capstones

Problem: This newborn fall prevention initiative was developed in response to an increase in the number of newborn falls at a Bay Area hospital on the postpartum unit. This hospital had gone six years without a newborn fall but by September of 2023 had three falls on the postpartum unit.

Context: The setting for this newborn fall prevention initiative is an urban, NICU level III Bay Area hospital that provides high-risk obstetric care. This Bay Area hospital has 247 licensed patient beds; 10 beds make up the postpartum unit and 11 beds make up the antepartum unit which serve as …

Lovenox Prophylaxis: Improving Lovenox Nurse Education In A Postpartum Unit, Amy T. Nguyen

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase nurse education about Lovenox

prophylaxis within the postpartum unit to reduce risks of pulmonary embolism among high-risk postpartum women in the postpartum unit. Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the postpartum unit at Hospital X located in the southern Bay Area. This unit accommodates 25 beds and provides care for postpartum mothers after both cesarean section and vaginal births. Intervention: An anonymous pre-intervention survey was distributed to the registered nurses on the unit. Educational handouts were created and distributed to the nurses on the unit. …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Oscar J. Castillo

Master's Projects and Capstones

Problem: The Quality Improvement (QI) Project focused on improving early sepsis management and sepsis bundle adherence among Emergency Department (ED) nurses to decrease sepsis mortality rates and avoidable length of hospital stays (LOS).

Context: A group of Clinical Nurse Leaders (CNL) students evaluated sepsis protocol compliance at Hospital A's ED, which provides critical care for patients with various medical conditions. The CNL students concentrated on patients identified with sepsis for the QI Project.

Interventions: Limitations and time did not allow for the implementation of interventions. Recommendations offered to management included increasing sepsis training biannually and intravenous placement skills, offering sepsis …

Improving Education On Preeclampsia With Non-Severe Features And Frequency Of Assessment Among Nurses In The Maternal-Child Postpartum Unit, Alyssa J. Willsher

Master's Projects and Capstones

Problem: This Quality Improvement (QI) project aims to improve preeclampsia education among nurses and reduce the frequency of preeclampsia assessments among patients(without severe features) (SF) in the Mother-Baby postpartum unit at Hospital A. Nurses often stated that patients are unable to have uninterrupted rest periods with frequent assessments, which research shows is necessary for reducing patient blood pressure.

Context: The QI project is implemented in a 25-bed postpartum unit that cares for women and their newborns in the postpartum period. The unit’s nurse educator and nurse manager requested that the visiting University of San Francisco research group focus on simplifying …

Improving Preeclampsia Education And Assessment Frequency Among Nurses And Patients With Non-Severe Features In A Postpartum Unit, Monica Heredia

Master's Projects and Capstones

Problem: This Quality Improvement project aimed to improve preeclampsia education among Registered Nurses (RNs) and simplify the preeclampsia assessment frequency for patients with non-severe features in the Mother-Baby Postpartum Unit at Hospital Y.

Context: The Quality Improvement project occurred in a 25-bed Mother-Baby Postpartum unit at Hospital Y. The nurse educators at Hospital Y requested that University of San Francisco (USF) nursing students focus on increasing preeclampsia education among nurses and reducing the nursing assessment frequency.

Interventions: Collect quantitative data through observation and hand anonymous questionnaires to the registered nurses and clinical nurse leaders (CNLs) to determine …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Elizabeth Rose Maykel

Master's Projects and Capstones

Problem: In order to lower sepsis morbidity and mortality rates through early recognition and treatment, this quality improvement project sought to raise sepsis awareness and bundle compliance within the Intensive Care Unit.

Context: Clinical Nurse Leader (CNL) students completed a microsystem assessment of the Intensive Care Unit at Hospital X in Northern California. This unit cares for patients with sepsis, organ failure, respiratory failure, different types of shock, acute kidney injury, and traumatic brain injury.

Interventions: The implemented intervention included a refresher huddle on sepsis bundle awareness. Though the intervention was ineffective, the students did offer recommendations …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Efrain Perez Trujillo

Master's Projects and Capstones

Problem: This quality improvement (QI) project aims to optimize early sepsis management and sepsis bundle compliance among Emergency Department (ED) registered nurses in order to reduce the risk of sepsis-related deaths and associated hospital length of stay.

Context: Clinical Nurse Leader (CNL) students conducted a microsystem assessment on the ED at Hospital A, located within the greater San Francisco Bay Area. This microsystem, equipped with 115 nurses and 44 rooms, consists of an acuity of care for urgent to life-threatening medical conditions, including sepsis.

Intervention: Following time constraints, and limitations, implementation of an intervention was not feasible; however, CNL students …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Dodge The Fall: A Newborn Fall Prevention Initiative, Shirley B. Varela

Master's Projects and Capstones

Problem: There has been a rise in In-hospital newborn falls following evidence-based practices such as breastfeeding and rooming that promote mother and baby bonding (Karlsson et al., (2021). U.S. hospitals have approximately 600 to 1,600 newborn falls annually (The Joint Commission [TJC], 2018).

Context: A San Francisco Bay hospital with a postpartum unit experienced three newborn falls as of 2023. The level III neonatal intensive care unit is a high-risk obstetric facility with more than 3,000 births annually. It comprises 21 hospital beds: 10 on the postpartum and 11 on the antepartum floors.

Intervention: Developing and implementing the “Pledge Form …

Mentoring Nurses After Specialty Training Or Orientation In Labor And Delivery, Benjamin Jlopleh Worji

Master's Projects and Capstones

Mentoring Nurses After Specialty Training or Orientation in Labor and Delivery

Abstract

Background: The setting for this project was a northern California hospital-based healthcare system referred to as “Hospital KV.” Hospital KV is a non-profit, integrated hospital that operates to improve the community’s health. Hospital KV’s maternal child health (MCH) department comprises a labor and delivery(L&D) unit, a mother and baby unit (MBU), also referred to as a postpartum unit, and an intermediate nursery (IMN).

Problem: The hospital KV MCH department faced the challenge of a nursing shortage. The nursing shortage was associated with substantial challenges to Hospital KV, its …

Implementation Of A Community Health Worker (Chw) Training Program To Improve Birth Outcomes, Emiko Maruri

Doctor of Nursing Practice (DNP) Projects

Background

Those who have been affected by any adverse childhood experience (ACE) have an increased likelihood of poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss.

Problem

Latina women have been identified by the Centers for Disease Control (CDC) as those most affected by ACEs. Further evidence supports those affected by 2 or more ACEs have poor birth outcomes.

Context

For this project, The Save the Children organization in partnership with the University of San Francisco Doctorate of Nursing Practice (USF DNP) students and Community Health Workers (CHWs) of the Central …

Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso

Master's Projects and Capstones

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.

Context: The endocrinology clinic serves a patient population, …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Nancy Zhu

Master's Projects and Capstones

Problem: Sepsis is a life threatening disease that has caused over a million deaths annually in the nation. Early recognition of sepsis is highly crucial for health care professionals to know to prevent an increase of mortality and morbidity rates. This quality improvement project aimed to increase sepsis bundle checklist awareness to the staff and compliance in the Intensive Care Unit to improve the sepsis cases.

Context: Clinical Nurse Leader students completed a microsystem assessment of the Intensive Care Unit at Hospital X in San Mateo County. This unit cares for patients with sepsis, septic shock, severe sepsis, organ failure, …

Promoting Parent-Child Relationships Through Community-Based Family Wellness Programs To Improve Mental Health In Children, Maria Elena Falcon

Doctor of Nursing Practice (DNP) Projects

Objective: Adverse childhood experiences can affect a child mentally and lead to mental, health, and learning problems later in life. Establishing healthy parent-child relationships through family-oriented programs can promote mental well-being, improve behavior and learning in children and strengthen positive parent-child relationships.

Methods: A systematic electronic search using databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO, contextualized current research on the importance of parent-child relationships and their influence on mental health. The inclusion criteria for the review used were articles in the English language and relevant dates from 2014 to 2021. The key terms used …

The Impact Of High Temperatures On Child Anthropometric Outcomes Worldwide, Natalia A. Cancino Garcia

Master's Theses

High temperatures caused by climate change significantly impact society, including child nutrition. Our research focuses on the impact of high temperatures on the anthropometric outcomes of children aged 1 to 5 in 54 countries worldwide. We analyze the historical climate and anthropometric data to evaluate the effect of high temperature on weight-for-age (WAZ) and weight-for-height (WHZ) in children. Results indicate that high temperatures negatively affect child nutrition, particularly in areas above 20°C, and children in rural areas are more vulnerable. The impact of monthly temperature on child anthropometric outcomes varies across countries, regions, and cultural practices. Economic status alone is …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Teela Sade Miller-Buford

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths and hospital length of stays.

Context: A group of students studying to become Clinical Nurse Leaders (CNLs) evaluated Hospital A's Emergency Department (a clinical microsystem) located in the greater Bay Area. This microsystem provides diverse emergency care for patients with various medical conditions and diagnoses. The CNL students concentrated on patients diagnosed with sepsis for their quality improvement project.

Interventions: Although time constraints prevented the implementation of interventions, the CNL students proposed recommendations …

Decreasing Surgical Complications In Diabetic Patients, Bandana Mahato

DNP Qualifying Manuscripts

Executive Summary

Objective: This manuscript aims to determine if controlling diabetes prior to undergoing low back surgery could decrease complications and disability.

Contexts: Despite the overwhelming information on the complications of uncontrolled diabetes, patients continue to have elevated HgA1C before having surgery. Furthermore, there is a plethora of data showing uncontrolled diabetic patients will have higher complications after surgery, yet patients continue to have elective surgery despite having unchecked diabetes. There are no clear guidelines for primary care providers or surgeons on when they should allow patients to have elective surgery. Therefore, it is vital that HgA1c needs to be …

Implementing Community Health Workers To Improve The Management Of Chronic Non-Communicable Diseases In Children, Julia L. Newell

Doctor of Nursing Practice (DNP) Projects

Background: Childhood obesity, asthma, and untreated mental health conditions are three examples of chronic non-communicable diseases (CNDs) that pose a host of negative consequences later in life. Minority children from low-income families, especially those with environmental disadvantages, face additional risk factors for the development of these diseases. Community health workers (CHWs) are in a unique position to help address these negative health externalities by being attuned with the linguistic, cultural, and socioemotional needs of members of their communities. Research has demonstrated success in CHW-led interventions curtailing the negative impacts associated with these diseases in low-income, minority communities.

Methods: A literature …

Purposeful Rounding For Fall Reduction, Deborah Grant Rn

Master's Projects and Capstones

Objective. The quality improvement project aimed to study the effects of purposeful rounding on falls in a long-term care unit. The focus was on CNAs who provided care for 6 residents each, with a current census of 36 residents in the long-term care setting. Problem. Many of the residents are at risk for falls due to immobility, medication, and environmental hazards (Centers for Disease Control and Prevention, 2022). Context. Research has found that the key reasons residents call for staff include needing to use the bathroom, to address pain, to address positioning, and to address IV pumps and alarms (Studer …

Community Health Worker Program: Chronic Non-Communicable Diseases In Children, Julia L. Newell

DNP Qualifying Manuscripts

Abstract

Background: Childhood obesity, asthma, and untreated mental health conditions, are three examples of chronic non-communicable diseases (CNDs) that pose a host of negative consequences later in life. Community health workers (CHWs) are in a unique position to address these negative health externalities by leveraging linguistic, cultural, and socioemotional connectedness within their communities.

Local Problem: Minority children in the Central Valley of California, face additional risk factors for the development of CNDs. CHWs working in this area require enhanced training on CNDs to improve their practice.

Methods: In partnership with Save the Children (STC), the University of San Francisco (USF) …

Decreased Recovery Time With Postoperative Pain Assessment In A Pacu, Eun Hey Gracie Yoon

Master's Projects and Capstones

Abstract

PROBLEM: Improper postoperative pain assessment increased recovery time in the Post-Anesthesia Care Unit (PACU). Effective pain management is essential to improve the quality of patient care. Adequate pain control decreases readmissions and length of stay, which directly aligns with the institution’s priorities of providing high quality care at an affordable cost.

CONTEXT: ABC Hospital is a non-profit and community-focused regional medical center based in Pasadena, CA, with 5000 employees. It included 619-beds and became an affiliate of C Health System in August 2021. Improper postoperative pain management practices caused delayed length of stay and increased cost of care in …

Nanodiscs: A Novel Approach To The Study Of The Methionine Abc Transporter System, Michael T. Winslow

Master's Theses

Membrane transporter proteins play the vital role of moving compounds in and out of the cell and are essential for all living organisms. ATP Binding Cassette (ABC) family transporters function both as importers and exporters in prokaryotes. MetNI is an E. coli Type I ABC transporter responsible for the uptake of methionine into the cytosol from the cell periplasmic space through the cell membrane to maintain intracellular methionine pools. ABC transporters, like other membrane proteins, are most often mechanistically and structurally studied in vitro, solubilized by detergents. However, detergent micelles may affect the conformational changes of membrane proteins relative to …

Mental Health And Experiences Of Pregnancy Among Black Women And Birthing People With Type 1 Diabetes (T1d), Madeleine E. Marcus

Doctoral Dissertations

This dissertation explored the potential effects of intersections of oppression (i.e., anti-Black racism, diabetes discrimination, and sexism) on mental health and pregnancy experiences among Black women and birthing people with Type 1 diabetes (T1D). Previous studies about pregnancy and T1D have included mainly white, cisgender women. Three participants qualified for inclusion in the present study and participated in semi-structured interviews, which the researcher analyzed using an interpretative phenomenological analysis (IPA) framework. Participants described feeling uncertain about whether aspects of their pregnancy experiences were related to obstetric and/or medical racism. Similarly, participants sometimes seemed uncertain about how racism may affect their …