Medicine and Health Sciences Commons^™

Expanding Labor Support Education To Nurses Caring For Women In Labor, Ana L. Viera-Martinez

Doctoral Projects

The ability to provide emotional and physical support to a patient during one of the most significant moments of her life is a privilege afforded to intrapartum nurses who attend to laboring and delivering mothers. Labor support improves birth outcomes, reduces cesarean birth rates, and decreases anesthesia use. More labor support education needs to be made available to intrapartum nurses. Within the hospital context, this quality improvement (QI) project investigated the effects of educating intrapartum nurses about labor support and providing them with hands-on training. Surveys, including the Self-Efficacy Labor Support Scale, were as given pre- and post-education to evaluate …

Improving Breastfeeding Rates Through Education, Julianna Youssef

Doctoral Projects

Background: Breastfeeding is beneficial for newborn babies, but there are many challenges that new mothers face that prevent them from exclusively breastfeeding.
Objective: To evaluate if re-educational training in RN’s and LVN’s is an effective way to increase the exclusive breastfeeding rates in the hospital setting.
Methods: We utilized a pretest/post-test quasi-experimental design and had the goal sample size was about 50 nurses. The nurses were given an educational PowerPoint at a monthly staff meeting. Pretests were given to the staff immediately before and posttests two weeks later. Additionally, exclusive breastfeeding rates were monitored for the three months before the …

A Retrospective Evaluation Of Pain Management Of The Postpartum Inpatient After Birth, Ronda Harden

Doctoral Projects

A multimodal plan of care to manage pain can effectively help reduce the risk of opioid dependency and addiction. The concerns about the rise in the rate of new persistent opioid use among women exposed in postpartum indicate a need for a practice change in managing pain after birth. This retrospective study evaluated the impact of implementing a multimodal plan of care in treating the pain of the postoperative postpartum patient. A notable finding was that fewer milligrams of opioids were administered after a practice change. The mean total was significantly different between the pre-and post-group, with a higher percentage …

Game-Based Refresher Training For Registered Nurse Providers Of Neonatal Resuscitation, Renee Billner-Garcia

Doctoral Projects

Based on evidence suggesting resuscitation provider knowledge and skill decay can occur as soon as four weeks post-training, the American Heart Association (AHA) recommends more frequent resuscitation refresher training. While current resuscitation training and education practices center on simulation training, its cost in terms of supplies, equipment, and personnel may be creating barriers to increasing the frequency of refresher training. This quality improvement project implemented a game-based, refresher training for registered nurse providers of neonatal resuscitation with a focus on improving the time to initiation of positive pressure ventilation (PPV) per Neonatal Resuscitation Program (NRP) guidelines. Using commonly available free …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Implementation And Evaluation Of A Registered Nurse Pre-Eclampsia Education Program Within A Women's Urgent Care Center, Amber Vetter

Doctoral Projects

Pre-eclampsia can be a serious development for both mother and fetus during pregnancy. Increased mortality and morbidity rates have been shown in women diagnosed with pre-eclampsia. Higher education for registered nurses on a Women’s Urgent Care (WUC) center will help diagnose the mother more quickly and inevitably receive treatment sooner leading to better outcomes for the birth of her newborn. The educational tools used in the study were a pre-and post-test and an educational video for the registered nurses to watch. A retrospective chart review before and after the intervention will help to see if there is any decrease in …

Improving Nurses’ Provision Of Neuroprotective Care In The Nicu: A Quality Improvement Project, Tammi Reeves-Messner

Doctoral Projects

Infants born prematurely (less than 37 weeks’ gestation) require specialized medical and nursing care to survive. Most of these babies require some form of respiratory, cardiovascular, thermal, and nutritional support as their bodies are not yet physiologically mature enough to handle these basic functions on their own. These supports include basic care such as diaper changes and feeding as well as life-saving interventions which include ventilation, intravenous nutrition, thermal regulation, and vasoactive medications. Depending on their gestational age or their diagnoses, they may require higher levels of support, such as nitric oxide gas delivered via a ventilator (Lai et al, …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Assessment Of Intrapartum Nurses' Beliefs Related To Birth Practices, Janice Scaggs

Doctoral Projects

Intrapartum nurses’ beliefs influence nursing behavior and nursing interventions during labor and birth. Assessing these beliefs in a regional hospital in the Southeastern United States was the focus of the doctoral project. Before the project, there was no objective data that assessed individual nurse’s beliefs and birth practices in the labor and delivery unit, or among the nursing staff as a whole. A knowledge gap existed in understanding if the nursing culture valued, promoted, and supported intended vaginal birth. Nursing leadership recognized that the overall cesarean birth rate and primary cesarean birth rate in the hospital were similar to State …

Evaluating The Experience Of Patient And Provider Satisfaction In Participation In A Hybrid Virtual Perinatal Care Model In A Private Practice Setting, Gretchen Ann Delong Nelson

Doctoral Projects

Improving access to health care in general and to appropriate prenatal care specifically are two leading health indicators (LHI) as designated by Healthy People 2020 (U.S Department of Health and Human Services, 2010). The California Department of Public Health (CDPH) also prioritizes minimizing health disparities that prevent women from entering into prenatal health care (CDPH, 2019). In Fresno county, transportation to specialty care such as perinatal care has been identified as a barrier (CDPH, 2017). The American College of Obstetricians and Gynecologists (ACOG) and The American Academy of Pediatricians (AAP) have identified a standard of fourteen to sixteen visits for …

Developing Lactation Support In A Primary Care Pediatric Office, Charlotte Minnema

Doctoral Projects

Background: Breast milk is known to be the best nutrition for infants, and experts recommend to exclusively breastfeed through the first six months of life and provide breastmilk through at least the first year of a child’s life (American Academy of Pediatrics, 2012). The United States is currently not achieving its breastfeeding goals set out in Healthy People 2020 by the US Department of Health and Human Services (U.S. Department of Health and Human Services, 2014). The integration of Internationally Board-Certified Lactation Consultants (IBCLC) into primary care pediatrics offices has been shown to increase all breastfeeding rates (Witt, Smith, Mason, …

Pilot Study Of A Breastfeeding Support Training Program Designed Particularly For Infants With Common Congenital Anomalies And Defects, Gretchen Nelson Ezaki

Doctoral Projects

The American Academy of Pediatrics (American Academy of Pediatrics [AAP], 2018), the World Health Organization (World Health Organization [WHO)], 2018), and The March of Dimes (March of Dimes, 2016) recommend exclusive breastfeeding for the first six months of life. In 2014, 79% of women in the United States began breastfeeding their infants, but only 40.7% and 18.8% continued breastfeeding exclusively at three and six months respectively (Centers for Disease Control and Prevention, 2017). This doctoral project promotes breastfeeding by creating and testing simple teaching algorithms for training registered nurses to support breastfeeding, including for infants with trisomy 21, congenital heart …

An Implementation Toolkit For Increasing Breastfeeding Sustainability, Regina Kirwin

Doctoral Projects

Introduction: African American women have the lowest rates of breastfeeding in the United States compared to other racial and ethnic groups (DHHS, 2016). Peer support increases breastfeeding rates (Shakya, 2017). An evidence-based implementation toolkit will provide key stakeholders the information and skill development needed to successfully implement and sustain peer support programs geared toward increasing breastfeeding rates for African American women in West Michigan. The purpose of this paper is to disseminate the quality improvement process used to develop an evidence-based toolkit guided by a secondary data analysis from research data collected in a previously implemented peer mentor program.

Objective: …

Retrospective Analysis Of Obstetric Sepsis Screening, Holly A. Champagne

Doctoral Projects

This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, …

Obstetric Nurses’ Perceived Barriers To Immediate Skin To Skin Contact After Cesarean Birth, Joelene Sarmiento Balatero

Doctoral Projects

Despite the strong evidence supporting immediate skin to skin contact (SSC) after birth, research suggests that patients who undergo cesarean births do not have the same opportunities for SSC as patients who undergo vaginal births. There are limited studies regarding provider attitudes surrounding the practice of immediate SSC after cesarean birth. The aim of this research was to understand obstetric nurses’ perceived barriers to immediate SSC after cesarean section.

An exploratory qualitative design was used for the project. The semi-structured, open-ended interviews were conducted via video conferencing. Conventional content analysis methods were used to analyze the data, which yielded the …

Perceptions Of Chinese Women Coming To The United States To Give Birth: Birth Tourism, Juanita Childs Jaramillo

Doctoral Projects

Birth experiences and perceptions vary greatly among different cultures. There has been an increase in Chinese women who specifically come to the United States (US) to give birth to their child and return back to their native country after being cleared at the postpartum checkup. This practice is known as birth tourism. The aim of this study is to explore the perceptions of childbirth and postpartum experiences among Chinese birth tourists. Twelve women self-identifying as Chinese, between the ages of twenty-four and thirty-eight, who came to the US to give birth to their child, and who were able to read …

Parturient Safety: Proper Positioning Education Prior To Neuraxial Anesthesia, Christina Joy Young

Doctoral Projects

In the United States, 61% of parturient patients elect neuraxial anesthesia for labor pain (Koyyalamudi et al., 2016). The incidence of postdural puncture headache is estimated up to 81% following accidental dural puncture-especially in pregnant women receiving elective epidurals (Ragab & Facharzt, 2014). Although the combined rates of complications for spinal and epidural anesthesia are low (2.78%) (American Society Anesthesiologists, 2014), patient safety is extremely important and should be addressed by the overall healthcare system. The purpose of this project assessed a willingness to change which focused on the CRNAs incorporation of proper positioning education prior to neuraxial anesthesia into …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Efficacy Of Intravenous Ondansetron In Relieving Nausea/Vomiting And Pruritus Post Epidural Administered Opioids In The Obstetric Patient, Benjamin Stephen Butler

Doctoral Projects

One prominent side effect in the use of a neuraxial anesthesia is pruritus, with an incidence in the obstetric patient of 60-100% (Kumar & Singh, 2013). Another side effect of an epidural placement is nausea and vomiting. Nausea and vomiting occurs frequently during the progress of labor and is difficult to determine an incidence that is related to epidural opioid administration (Chestnut, Wong, Tsen, Ngan Kee, Beilin, & Mhyre, 2014). A review of literature was performed and established evidence that ondansetron is effective in reducing incidence of pruritus in intrathecal administered opioids for cesarean sections in the obstetric patient. No …

Therapeutic Listening Communication In Children With Autism And Hyperacusis, Jennifer Margaret Hughes

Doctoral Projects

Hyperacusis, or auditory hypersensitivity, is defined as abnormally sensitive hearing and in some cases an extreme sensitivity, where normally tolerated sounds are perceived as excessively, even painfully loud. This is a debilitating condition for children with autism, causing activity limitations and participation restrictions, also leading to peer isolation and habitual sound avoidance behaviors.

This research explores a means of modifying the auditory environment of a child with hyperacusis in a safe, effective way for the purpose of improving attention span and facilitating learning. The small pilot study (n=4) was a single-subject, multiple-baseline design, conducted with school-aged children in the special …

Pediatric Nurse Practitioner Home Visitation Is Associated With A Decrease In Home Care And Healthcare Utilization Errors In High Risk Infants, Rupalee Patel

Doctoral Projects

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants' care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at …

Heath Care Providers’ Perceptions Of The Reproductive Challenges And Experiences Among Asian Indian Women Living In Silicon Valley, Olga Alexandra Libova

Doctoral Projects

Objective: To identify common reproductive challenges among Asian Indian (AI) women living in Silicon Valley as perceived by healthcare providers (HCP). Design: A 71-item investigator-developed survey Setting: The survey was available on-line to all HCPs in California Santa Clara county, 75% of respondents were affiliated with El Camino Hospital Mountain View. Participants: Convenience sample of 78 respondents: 34% mother-baby nurses, 24% labor-delivery nurses, 21% OB/GYNs, 7% CNMs, 14% other HCP; 89% female; 55% Caucasian, 24% Asian. Methods: Likert-type scales comparing prevalence of certain reproductive challenges among AI women and women from other race-ethnic groups and openended questions regarding HCPs’ experience …

Perceived Barriers To Skin To Skin Care From Maternal And Nurse Perspectives, Rachel Alexandra Napoli

Doctoral Projects

The purpose of this doctoral project is to provide foundational data for a skin-to-skin (STS) policy at a community hospital. Two surveys were used to determine the barriers to STS. One survey was given to the nurses electronically in the maternal/child department and the second survey was given to the mothers who delivered at the same hospital during Fall2014. Following data collection, focus groups were formed. The groups consisted of volunteer nurses who reviewed the results of the surveys and developed preliminary data for a STS policy. The three identified barriers to STS by both nurse and maternal surveys were …

Implementation Of Interprofessional Education And Physician Order Set Improves Compliance With Early Recognition And Treatment Of Maternal Sepsis, Lori Susan Olvera

Doctoral Projects

Septic shock is rare in pregnancy; however, sepsis remains an important contributor to maternal mortality. The perinatal patient can appear deceptively well before rapidly deteriorating to septic shock. There is a need for protocols regarding early recognition and management of maternal sepsis. The Surviving Sepsis Campaign developed guidelines to provide guidance for the clinician caring for patients with severe sepsis or septic shock. The purpose of this doctoral project was to evaluate compliance with early goal directed therapy before, during, and following the implementation of a standardized physician order set and interprofessional education for nurses and physicians in the perinatal …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Impact Of Cue-Based Feeding Protocol On Premature Infants' Outcomes And Hospital Length Of Stay, Diana Michele Easley Cormier

Doctoral Projects

The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants' feeding outcomes, and decreased the infant's length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic …