Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

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 …

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 …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Nurse-Led Education On Oral Chemotherapy Medications, Carmen Lucia Glick Alonso

Master's Projects and Capstones

Problem: Breast cancer is one of the leading causes of cancer death among women in the United States. Annually, around 264,000 breast cancer cases are diagnosed in women and 2,400 in men (Centers for Disease Control and Prevention, 2022). According to the American Cancer Society, the risk of a woman in the United States being diagnosed with breast cancer in their life is around 13% (2022).

Context: Along with a cancer diagnosis comes the need to introduce patient education about new oral chemotherapy treatments. As a treatment team member, the oncology nurse plays a vital role in this …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Implementation Of Staff Education To Standardize The Use Of Positions During The First Stage Of Labor, Minh Chau T. Phan

Master's Projects and Capstones

This project aims to educate labor and delivery (L&D) nurses on effective laboring positions that can aid fetal descent during the first stage of labor. In an L&D unit of a south Bay Area County hospital, there is a lack of standardization of knowledge and practices on laboring positions among the nursing staff. Evidence shows that upright positions and frequent mobility are effective in shortening the duration of labor and minimizing unnecessary cesarean deliveries. Based on the evidence, a project was implemented using verbal education of evidence-based laboring positions. An educational handout was also provided along with a recorded video …

Standardizing Perinatal Mental Health Interventions: A Guide For The U.S., Maile Lauren Robles

Master's Projects and Capstones

The term perinatal individual refers to women and other individuals who are pregnant or who have been pregnant within the last 12 months. Every year, in the United States there are 700 pregnancy-related deaths and 10% are due to mental health causes including death by suicide. Mental health conditions including but not limited to anxiety, depression, substance use disorders, and post-traumatic stress disorder affect one in five perinatal individuals throughout the United States. This increases perinatal morbidity, hospitalization costs, and economic burden nationwide.

After 43 days postpartum, mental health conditions are the second leading cause of death. The United States …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Jared Maxwell Talsky

Master's Projects and Capstones

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department …

California's Master Plan For Aging, Health Reimagined: A Case For Seniors To Age-In-Place, Remonia A. Bowie

Master's Projects and Capstones

Abstract

In 2021 Worldwide, communities face a singular yet common challenge; and this is the significant aging of their senior adult populations. Current evidence from the literature suggests that older adults prefer to stay in their homes as they age. However, the facilitators and challenges older people encounter in realizing their aging goals have been inadequately addressed by the current body of literature given the projected increase in the number of older people in the United States preferring to age from their homes. Aging adults are vulnerable to daily frustration, which could negatively impact their aging process. However, knowledge of …

Introducing A New 12 Week Education & Simulation Program To Optimize Financial Performance Of Nurse Managers, Melissa Hathcoat

Master's Projects and Capstones

Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and …

Understanding The Significance Of Virtual Support During Global Pandemic In Young Adults Diagnosed With Hepatitis C, Veronika Arkhipova

Master's Projects and Capstones

Hepatitis C is a viral infection that attacks the liver and leads to inflammation. In recent years, the prevalence of hepatitis C infections among 20 and 30 years of age has increased by 300 percent, and between 30 and 39 years by 400 percent. Due to the global coronavirus pandemic, people diagnosed with Hepatitis C have lost access to mental health services and resources, including in-person meetings with support groups. Since most states enforced stay-at-home order, many community centers, non-profit organizations that work with Hepatitis C patients and the affected population provide limited to no access to support group meetings …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara

Master's Projects and Capstones

Purpose: Stigma and discrimination in health care settings contribute to health disparities for transgender and non-binary (TGNB) people. Evidence suggests that a lack of training on the care for transgender and non-binary TGNB patients in medical school curricula has contributed to providers feeling unprepared to provide quality care for this population. Health care providers have the opportunity to play a key role in the reduction of health disparities for TGNB patients.

Methods: Twenty-five health care providers completed the eight-module digital training program. Pre- and post-tests assessed provider knowledge, self-efficacy, preparedness, and behavior. Paired samples t-tests were conducted to compare pre-and …

Improving Discharge Medication Education On A Sepsis Unit: A Quality Improvement Project, Kayla Melton, Maria Noguez, Fabiola Lopez, Jillian Eisenberg, Deanna Lee

Master's Projects and Capstones

Ineffective discharge education plays a role in increased readmission rates, adverse drug events, and worsened patient outcomes post-hospitalization. When combined, the resulting financial burden on America’s healthcare system is exorbitant, as is the physical and mental toll on unsuspecting patients. To close the current gaps in discharge teaching, this project is incorporating the teach-back method and utilizing updated medication handouts.

Starting on the sepsis unit of a large, local medical center – the Clinical Nurse Leader (CNL) interns employed assessment tools to identify areas for improvement. The data revealed rushed, incomprehensive discharge medication education and reflected in low HCAHPS scores …

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …

Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel

Master's Projects and Capstones

Improving Knowledge and Attitude of Primary Healthcare

Givers Towards Vulnerable Populations

Kimberly Shankel

University of San Francisco

Abstract

Problem

This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.

Context

The site for this quality improvement project is a small suburban hospital …

Educational Prevention Program Of Surgical Site Infections (Ssi), Carena Leung

Master's Projects and Capstones

Surgical site infections (SSI) cause negative health care effects to patients and hospitals. SSI is one of the most common types of healthcare-associated infections (HAI) accounting for 31% among hospitalized patients (Centers for Disease Control and Prevention [CDC], 2012). It is associated with prolonged length of stays (LOS), higher morbidity and mortality, and increased healthcare costs. The purpose of this quality improvement project is to decrease SSI rates by enhancing patient education and engagement in preoperative care and hygiene before surgery. In a metropolitan pediatric hospital, a microsystem analysis of the preoperative unit was conducted before generating the SSI Prevention …

Reduing Hospital Readmissions: Ideal Discharge Planning For Heart Failure Management, Chun Mei Chen, Chun Mei Chen

Master's Projects and Capstones

Abstract

The objectives during this project were to achieve by the end of 2018 an overall reduction of 25% in HF readmissions within 30 days. By identifying root causes of readmissions and using needs assessment within the microsystem, literature highlights the elements defining interventions that can be used to improve transitions of care and reduce avoidable HF hospital readmissions. A plan was developed for integrating an evidence-based practice, IDEAL Discharge Planning, along with engaging patients and families at bedside from the first day of admission until discharge to more effectively assist staff in providing patient-centered education and self-care skills. The …

Cancer Survivorship: Promoting A Lifetime Of Health, Janelle Coleman-Smith

Master's Projects and Capstones

Abstract

Introduction Cancer survivors can face post-cancer treatment effects that need addressing throughout their care trajectory. Education provided to stakeholders and patients will be beneficial in preventing fragmented care, increasing patient satisfaction, and expanding ongoing supportive clinical survivorship care. Methods An adapted Dr. Joanne Lester survivorship needs survey was given to n=7 post-cancer treatment patients within a northern California cancer patient advisory committee. The survey results were analyzed to identify common underserved chronic long-term survivorship needs. Based on the data, an evidence-based educational component was included within a booklet to enhance future survivorship care. Additional surveys were sent to stakeholders …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

Supporting Nurse Education In The Implementation Of A Pediatric Delirium Assessment Protocol In The Pediatric Intensive Care Unit, Lucy Camarena, Rn, Bsn, Cnl, Cpn, Phn

Master's Projects and Capstones

Delirium has historically been under studied, more so in the pediatric population, despite its long term effects on patients’ health. The deficit in knowledge of delirium leads to an increase in hospital stays and unnecessary unit expenses. My intention with this change project is to increase the awareness of delirium in the pediatric delirium by providing an educational intervention to the PICU nurses. After conducting a root cause, SWOT and cost analysis, I determined that successful education of the PICU nurses about delirium could substantially decrease its incidence. Using Ronald Lippitt’s Change Theory and the CNL competencies as guides I …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Quality Management: A Global Case Study In Organ Transplantation, Cassie L. Rodriguez

Master's Projects and Capstones

Every year the US and European countries face an epidemic of organ failure from a multitude of reasons: cancer, genetic predisposition, exposure to harmful chemicals in home or surrounding areas or through drinking, drugs and smoking. Another problem faced, is the ratio of organ donors to organ recipients. Over 121,000 patients are on the waiting for an organ transplant, and a fraction of those waiting will die because of time. The Hanover Medical school and department of quality management, have created an integrated approach to organ transplant avenues. Quality management is a systematic guide for organ transplantation that allows all …

Reinforcing Teach-Back Method Regarding Pain Management For Non-Verbal Patients And Their Families, Renee Krystle Doll Lazaro

Master's Projects and Capstones

Pain has been known to have physiologic, psychologic and emotional consequences. Education in pain management has been part for standard care for nurses. The purpose of this study was to reinforce teach-back techniques with nurses when delivering pain management education with non-verbal patients in order to improve patient outcomes in the adult ICU. By using the teach-back method, the nurse will be able to hone a more collaborative approach in dealing with pain, encourage autonomy and include the patient/family in making informed decisions regarding treatment for pain. Reinforcement regarding teach-back was focused on teaching points, and rewording teach-back cues to …

Enhancing Education Of Medication Side Effects To Improve Patient Outcomes, Kyle R. Woolley

Master's Projects and Capstones

Patient satisfaction scores regarding how effectively staff educates patients about possible side effects of new medications are not consistently above the national average at a large metropolitan hospital in California (MHC). The results of these patient satisfaction scores shed light on the need for evidence-based strategies to improve a patient’s perception of the medication education provided to them. The basis of the incentive to improve care is ultimately increased safety and better patient outcomes. From the Root Cause Analysis, it became apparent that a few common barriers need to be addressed, but the one most frequently reported by everyone that …

Health Education: An Unmet Needs For Refuges, Zahra Goliaei

Master's Projects and Capstones

Abstract:

The International Rescue Committee (IRC) is one of the organizations that serves refugees and asylums arriving into the United States. Each year between 4 to 500 individuals will resettle in Oakland through the IRC. However, after relocation, these individuals need information about life in the new country , community resources , and social services especially health care system in the country. Life pressures during the resettlement process, along with the language barrier and poverty usually lead to a less healthy diets and lifestyles. During the time, these factors will put refugees at the risk of obesity and later, chronic …

In-Patient Self-Management Diabetes Education, Amy Matthews

Master's Projects and Capstones

The diabetes program strives to provide diabetes self-management education to the in-patient with diabetes. The specific aim is to improve and standardize diabetes education for the inpatient with diabetes by June 2015. The microsystem is a medical surgical unit for patients 18 years and older who present with diabetes as either a primary diagnosis or secondary diagnosis. Fifty percent of the diabetes patients on this unit are ages 65-89 years old, twenty nine percent are ages 50-64. The unit has 32 beds and is filled to capacity ninety five percent of the time. The fishbone diagram revealed our microsystem lacked …