Medicine and Health Sciences Commons^™

Abrupt Changes In Learning Platforms During A Pandemic, Nicole Nelson, Katie M. Villont

Nursing Masters Papers

The purpose of this secondary analysis is to explore academic nurse educators’ perceived changes to accommodate learning for undergraduate (UG) nursing education in the early months of the COVID-19 pandemic. The objective of this secondary analysis is to investigate three research questions: what perceived changes are needed to accommodate learning, what are new/revised teaching innovations applied for undergraduate (UG) students during the pandemic that may be used post-pandemic, and what are concerns about UG students who will enter the workforce following the pandemic.

Increasing Continuous Positive Airway Pressure Compliance With Various Telemedicine Interventions: An Integrated Literature Review, Tracy Partington

Doctor of Nursing Practice (DNP) Projects

Aims and Objectives. This literature review's objective was to synthesize evidence from previously published literature on telemedicine interventions' effectiveness on CPAP (Continuous Positive Airway Pressure) therapy compliance.

Background. It is estimated that 22 million Americans suffer from a form of Sleep Apnea (SA), and those up to 80 percent of the cases of moderate to severe Obstructive Sleep Apnea (OSA) are undiagnosed (Sleep Apnea, n,d). The first-line therapy for OSA is CPAP. However, CPAP therapy is associated with low compliance rates.

Design. Systematic review.

Method. A multi-database literature search was conducted to identify published literature between 2009 and 2020. …

Infusing Evidence-Based Practice Into The Cayman Islands Health Services Authority Nursing Culture, Melissa Ring

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: James Madison University and Cayman Islands Health Services Authority (HSA) entered into a collaborative agreement the summer of 2020. There was a lack of organizational structure surrounding implementation and systemization of evidence-based practice (EBP) models and a disconnect between nurse manager knowledge and EBP implementation within HSA.

Methods: The population for this evidence-based project was 21 HSA nurse managers from the inpatient setting. Pre-intervention survey results informed organizational readiness, nurse manager knowledge and ability to implement, and guided the intervention that included the creation and implementation of a website toolkit for EBP. An EBP model was selected for nursing. …

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …

An Evidence-Based Project: Exploring Nurse Manager Communication Competencies And Skill Development, Micaela Ross

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Evidence supports effective communication skills as essential for patient safety and organizational success. Evidence is also clear regarding ineffective communication and its negative impact. The purpose of this project was to determine an area of communication skill development needed among nurse managers of the participating island hospital and support positive change in knowledge, understanding, and ability to use effective communication skills. The aim was to improve communication skills among these nurse managers.The objectives were to determine a specific skill need, provide a focused educational intervention, and evaluate skill improvement. Pre-intervention survey results revealed a self-identified priority of effective communication …

A Call To Create: Poetry As Healing And One Nurse’S Self-Discovery, Kim Cornett Henry, Kim Cornett Henry

English Theses

Florence Nightingale’s vision for nursing has changed greatly in the past one hundred and fifty years, with nursing’s identity replaced with an emphasis on science over caring. The fast-paced, technologically sophisticated environments, designed to meet the declining health of an American public, have resulted in nurses who are being pulled away from nurse-to-patient caring acts and the reasons they felt called to become nurses. These changes have had detrimental psychological and emotional effects on nurses and are especially evident in Intensive Care nurses. Expressive writing as poetry, autoethnography, and participation in vibrant writing communities offer nurses experiences for healing, voice, …

Loneliness, Interpersonal Goals, Life Satisfaction, And Subjective Well-Being In Older Adults, Francesca C. Ezeokonkwo

Electronic Theses and Dissertations

Background: Loneliness is detrimental to health and is linked to numerous physiological and psychological problems. People across the age spectrum can be affected by loneliness at one point or another in their lives; however, older adults are disproportionally affected.

Aims: This study investigated the effect of interpersonal goals (compassionate and self-image goals), life satisfaction, and subjective well-being on loneliness in older adults and the influence of demographics and social support. The Ecosystem-Egosystem Theory of Social Motivation served as the theoretical framework.

Design and Method: This descriptive cross-sectional correlational study used the 2016 Health and Retirement Study. Participants were 65 years …

Investigating Relationships Between Diabetes Distress, Diabetes Self-Care Behaviors, Intention To Use And Actual Use Of A Personal Health Record Within 30 Days Of Hospital Discharge In Persons With Type 2 Diabetes, Khaliah Fisher-Grace

Electronic Theses and Dissertations

Background: Diabetes distress (DD) is defined by emotional and behavioral challenges caused from diabetes and its management. Diabetes self-care behaviors can be compromised by DD. Personal Health Record (PHR) use has been associated with improvements in HbA1c, blood pressure, and LDL-C, but the relationship between DD and PHR use is unknown. Aims: 1) to determine differences between sociodemographic variables and intention to use and actual use of PHR in hospitalized persons with Type 2 Diabetes Mellitus (T2DM), 2) to investigate the relationship between DD, intention to use a PHR and actual use of a PHR within 30 days of hospital …

Diabetic Education In An Uninsured Patient Population, Amanda Whistler

Doctor of Nursing Practice Projects

Abstract

Patient education is an important factor in the management of Type 2 Diabetes. Successful outcomes can be causally related to proper patient education. Many times, patients are left with more questions than answers about their newly diagnosed condition. Some groups of patients are affected by prediabetes and diabetes more than other groups. Differences in health status or access to health care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. This is a major concern in the United States for health care providers.

A spreadsheet was used to record the blood glucose levels of each …

Assessing Moral Distress And Substance Use Among Nurses In The Time Of Covid-19 To Improve Patient Safety, Lauren Childers

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The COVID-19 pandemic has brought rapid changes, increased stress, and ethical challenges to nurses across the globe. These factors may place nurses at increased risk for developing moral distress and substance use disorder. This stress can also increase nurse vulnerability to substance use. Previously there was little evidence about the rates of moral distress and substance use disorder among nurses during the COVID-19 pandemic. The primary objective of this evidence-based project was to describe levels of moral distress and substance use among nurses in a community hospital during the COVID-19 pandemic and to make recommendations for interventions to improve nurse …

Careless, Brenna Holland

Capstones

About This Project

I began working on this project six months ago, but my interest in the home care industry can be traced much further back. In the mid-aughts, my grandfather was diagnosed with Alzheimer’s. Hoping to live independently for as long as possible, he sought out the help of an in-home health aide. It was then that he learned he fell into a coverage gap; one that, even today, prevents many Americans from accessing home care services.

Faced with two options—father-son cohabitation or an institution—my grandfather moved in with my family, where he slipped into a catatonic depression prompted …

Implementation Of Cervical Cancer Screening Protocol (Ccsp): A Quality Improvement Project, Emilee Lenhart Hawk

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background and significance: Cervical cancer is the fourth most commonly occurring cancer in women and the eighth most commonly occurring cancer overall (WCRF, 2020). Papanicolaou (Pap) testing is the primary screening for cervical cancer. In the past 40 years the number of cases and deaths from cervical cancer has decreased significantly, resulting from cervical cancer screenings (CDC, 2021). Healthy People 2030 reports to increase the proportion of females ages 21-65 who receive a cervical cancer screening based on the most recent guidelines. The 2030 target is 84.3%. Human papillomavirus (HPV) is a virus that is transmitted through sexual contact …

Optimizing Postpartum Care By Ongoing Care Coordination Initiatives (Cci) In Screening And Management Of Postpartum Depression (Ppd) Among Clients In An Obgyn Practice: A Quality Improvement Project., Jennifer Broussard

Doctor of Nursing Practice (DNP) Manuscripts

Background: Postpartum depression (PPD) is defined as physical, emotional, and behavioral changes that occur after the birth of a child. Postpartum depression is complex and a mix of physical, emotional, and behavioral changes (Cleveland Medical Clinic, 2018). Postpartum depression screening is of high importance at a comprehensive postpartum visit. The consequences of a patient suffering postpartum depression can be serious and early recognition and interventions improve outcomes for the patient as well as the infant. Problem: There is a lack of screening for PPD among postpartum clients and this period is critical for the mother and the infant (American College …

Program Evaluation Of Adolescent Intervention Program (Aip): Substance Abuse Education Program For At Risk Adolescents, Shanea Clancy

Doctor of Nursing Practice (DNP) Manuscripts

The purpose of this project is to evaluate the effectiveness of the Adolescent Intervention Program (AIP), a faith-based drug and alcohol recovery program for teens. This is an alternative to jail program. Nearly 1 in 10 Americans, 12 years or older (20.1 million people), have a substance use disorder (SUD), involving alcohol or illicit drugs (National Center for Drug Abuse Statistics, 2019). The average age of first-time alcohol or substance use is 13 years old and nine out of ten addictions start in the adolescent years (National Center for Drug Abuse Statistics, 2019). Adolescents with first-time drug and alcohol arrests …

Program Evaluation Of The Rapid Response System Prior To And During A Covid Surge, Sarah Born

Doctor of Nursing Practice (DNP) Manuscripts

Between the years 2004-2008, the Institute for Healthcare Improvement (IHI) and The Joint Commission made a recommendation for healthcare facilities nationwide to implement rapid response systems (RRS). Rapid response systems consist of four limbs: recognition and alert (afferent); response and providing timely patient management (efferent); delivering support and oversight (administrative), and monitoring the RRS patient outcome data (quality improvement). The intent of implementing RRS was to increase patient safety and outcomes within the acute care setting. The following question (PICO) formed the basis of the project: “How does the current rapid response system workflow compare to the rapid response system …

Reducing Opioid Related Deaths And Improving Rehabilitation Access Through The Elk Grove Village Cares Program: A Program Evaluation, Rebecca Barron

Doctor of Nursing Practice (DNP) Manuscripts

Abstract The goal of the Elk Grove Village Cares program is to decrease the deaths and overdoses of those who abuse opioids through harm reduction strategies and provide access to treatment. The article is a program evaluation of the Elk Grove Village Cares program. Surveys, interviews and the synthesis of program data is used to evaluate the efficacy of program activities. Results: The rate of death from opioid use has decreased an average of 1.7 deaths since program implementation in 2018. Law enforcement officers (LEO) and the community responded similarly to many survey questions regarding attitudes surrounding addiction. Within the …

Improving Care Of Children With Acute Decompensated Heart Failure (Adhf) Through Implementation Of A Heart Failure Communication Checklist & Discharge Plan, Dana M. Schneck

Doctor of Nursing Practice (DNP) Manuscripts

Background: Children admitted to the hospital with ADHF have been identified as a low volume high complexity population with high morbidity and mortality rates. Hospitalizations are fraught with prolonged lengths of stay and frequent readmissions prompting increased resource utilization and significant healthcare costs. Pediatric collaborative learning networks, such as the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) seek to close quality gaps by engaging multidisciplinary multi-institutional teams along with patients and caregivers to share expertise, experience, and data prompting translation of evidence into higher quality, safer, cost-effective care.

Methods: A13-item pediatric-specific Heart Failure Communication Checklist (HFcc) and Heart Failure Discharge …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Improving Patient Hand-Off Communication By Utilizing The Situation-Background-Assessment-Recommendation (Sbar) Tool Between The Perioperative Services Departments, Maureen Mijares

Master's Projects and Capstones

Problem: The Situation-Background-Assessment-Recommendation (SBAR) patient handoff communication is required when the patient is transferred from one department/unit to the next phase of care. There is no standard SBAR utilized within the perioperative services departments.

Context: There are three types of patient handoff communication utilized in the perioperative services departments; Electronic Health Record (EHR), paper form, and verbal via phone.

Intervention: A standardized SBAR patient handoff communication tool to provide a framework to improve patient handoff communication between nurses within the perioperative services departments.

Measures: The outcome measure for this process improvement project is defined as the number of patient handoff …

Preventing Pressure Injuries On Patients Undergoing Treatment With Extracorporeal Membrane Oxygenation (Ecmo), Hediyeh Shakeri

Master's Projects and Capstones

One of the top National Patient Safety Goals by The Joint Commission is to prevent hospital-acquired pressure injuries, which is reiterated by Centers of Medicare and Medicaid as a valuable metric in determining the quality of patient care and safety as well as hospital performance. The Agency for Healthcare Research and Quality reports over 2.5 million patients affected by hospital-acquired pressure injuries per year, costing between $9.1-$11.6 billion per year with the cost of individual patient care ranging from $20,900 to 151,700 per pressure injury (Agency for Healthcare Research and Quality, 2014). Approximately 30% of these cases are related to …

Motivated2move: Icu Liberation And Early Progressive Mobility In Ventilated Patients, Leslie S. Bigler

Master's Projects and Capstones

The Motivated2Move: ICU Liberation and Early Progressive Mobility in Ventilated Patients project was implemented in a 24-bed intensive care unit (ICU) in a 241-bed general care, stroke certified not-for-profit community hospital in northern California. The primary purpose of this project was to educate the nurses on the structure and implementation of the Society of Critical Care Medicine’s evidence-based ICU Liberation (ABCDEF) Bundle (Society of Critical Care Medicine, n.d.). A secondary purpose of this project was to coordinate an early progressive exercise and mobility protocol for all ventilated patients. The primary goal of the project is 100% compliance with the ICU …

Patient Coordinated Care Response Team, Joshua Fox

Master's Projects and Capstones

Section I: Abstract

Problem: Communication between medical professionals and patients is a critical element to patient satisfaction and safety. The 2020 patient overall satisfaction scores for the local Roseville hospital were 73%. These data demonstrated an opportunity to enhance processes and the culture at the local Roseville hospital to meet the communication needs of its patient population.

Context: A patient coordinated care response team was developed to improve communication for newly diagnosed cancer patients or other life-altering diagnosis patients.

Interventions: A survey was completed to establish the current state of patient satisfaction with communication practices with healthcare providers in the …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Decreasing Maternal Breastfeeding Dissatisfaction During The Night Shift Related To Lactation Support, Robyn Caston

Master's Projects and Capstones

Abstract

Problem

This paper will discuss the Clinical Nurse Leader (CNL) project's specific aim: to decrease maternal dissatisfaction during the night shift related to lactation support in a high-risk maternal department.

Context

Research has shown that adding lactation support improves the decision to exclusively breastfeed and increases the duration. Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization, UNICEF, and the American Academy of Pediatrics. Many studies about lactation support have demonstrated the health benefits to mothers and their infants.

Interventions

A baseline survey will …

It’S Hapi Hour: An Action Plan On Preventing Hospital-Acquired Pressure Injuries, Emira Maureen A. Romero

Master's Projects and Capstones

Hospital-Acquired Pressure Injuries (HAPIs) are detrimental to both the hospital and the patient as they are costly, painful, and can lead to further infection and an increased length of stay. Although this problem is seen across the country, this action plan focuses on a microsystem (i.e. medical-surgical telemetry unit) in Hospital A in the San Francisco Bay Area. The target population includes medical-surgical telemetry patients at high risk for HAPIs (i.e. Braden score <18, moisture/mobility scores <2, patients with devices at risk for device-related pressure injuries). The proposed intervention is an evidence-based HAPI prevention bundle that includes utilization of wound care champions and turn teams, increasing attendance of daily huddles, implementing a standardized algorithm for escalation and documentation, and reinforcement of evidence-based HAPI prevention measures. Effectiveness of this bundle will be measured through chart audits, nursing questionnaires, and staff interviews. These measures will be conducted 12 months post-implementation and findings will be compared to the baseline data in order to investigate whether there is a reduction in HAPI incidence. Since this project is currently in the Study phase of the proposed Plan, Do, Study, Act (PDSA) cycle, this action plan concludes with recommendations of how the team can continue to move forward in addressing the project’s specific aim.

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …