Medicine and Health Sciences Commons^™

Remembering Time, Jonathan Carey

Capstones

My parents were dressed in their Sunday best, heading to a church revival. I was 12 and still the baby of the family, so staying home alone was out of the question. My grandmother Lillian, who preferred to be called Nana, came to babysit me. She relished a little time away from the doldrums and senior citizen gossip that engulfed the high-rise building where she lived,five minutes from my house in Petersburg, Virginia. That evening, as the sounds of “The Young and the Restless” echoed through the house, I tiptoed downstairs to give Nana a playful scare.

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

Safety Culture And Fall Prevention: A Collaborative Effort, Cecilia Cortina

Seton Hall University DNP Final Projects

Patient falls in the United States (US) range from 700,000 to one million annually and one third of those falls can be prevented (Du Pree, Fritz-Campiz & Musbeno, 2014). Twenty to 30% of falls are moderate to severe (Schimke & Schimke, 2014). As of 2009, The Joint Commission’s (TJC) (2015) Sentinel Event databank held 465 reports of hospital falls with injury; deaths that resulted in those injuries were reported as 63 percent. Common denominators resulting in patient falls with injury are poor assessment, lack of communication, failure to follow protocols, insufficient training and supervision, staffing levels, unsafe environments and lack …

A Quality Improvement Initiative Aimed At Reducing Complications Related To Iv Fluid Administration In The Acute Care Setting, Katherine Connolly

Seton Hall University DNP Final Projects

Purpose: The purpose of this quality initiative is to bridge the gap between evidence and practice related to the management of intravenous (IV) fluids in the hospital setting and to increase awareness regarding important quality issues, highlighting the critical role of nurses in effecting change in the health delivery system.

Significance of Project: The administration of IV fluids is one of the most common interventions in the hospital setting. The associated complication rate is higher than previously believed. Adverse effects impact recovery time, length of stay, cost, patient safety and survival. Related complications are largely preventable and unmet educational needs …

A Resident-Centered Dementia Care Staff Education Project To Reduce Challenging Behaviors At A Long-Term Care Facility, Margaret Huryk

Seton Hall University DNP Final Projects

Frequent use of antipsychotic medication (APM) for behavioral and psychological symptoms of dementia (BPSD) persists at high levels in long- term care (LTC) facilities despite extensive evidence of modest clinical benefits, serious adverse effects, public health advisories and a national initiative to improve dementia care. There is a gap between best-practice evidence and actual clinical practice related to pharmacological and nonpharmacological care for persons with dementia (PWD) and BPSD and/or neuropsychiatric symptoms (NPS) of dementia. The literature shows that clinicians often ignore FDA (Food and Drug Administration) warnings, CMS (the Centers for Medicare and Medicaid Services) initiatives and expert opinion …

Feasibility Study For Rural Health Clinic, Cynthia A. Noble

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Cindy Noble

The purpose of this study was to determine the feasibility of a rural health clinic in the Adair, Oklahoma area. A mixed-mode survey was sent to 2,890 households within a certain zip code for the Adair community and surrounding area. A link for the survey was also included so the survey could be accessed on line. The total number of surveys returned was 88. The respondents of the survey did show a willingness to use healthcare clinic if one were available in Adair, Oklahoma. The surveying also showed that the majority …

Delayed Umbilical Cord Clamping: A State Of The Science, Landynn E. Ouellette

Senior Honors Projects, 2010-2019

The purpose of this paper is to explore the state of the science related to delayed versus early umbilical cord clamping. This interprofessional change in practice and protocol needs to take place within obstetric practice, which can be made up of obstetricians, midwives, nurse practitioners, and nurses. Patients must be educated by their providers so that they can better understand the care being performed. A search of the literature published through PubMed was conducted using the key phrases delayed umbilical cord clamping (DUCC), benefits of delayed cord clamping, and umbilical cord protocols. The search yielded 133 titles, which was limited …

Using Community Health Workers In Collaboration With Nurse Case Managers In Effecting Change In Quality Of Life For Heart Failure Patients, Patra Hull Reed

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

This project was designed to evaluate the effectiveness in improving the quality of life among heart failure patients with the addition of the role of Community Health Worker (CHW) to a current continuum case management model. The study also addressed the increased need for more appropriate and cost-effective chronic care management for heart failure patients. Hospitals and healthcare systems are being challenged to find innovative ways to decrease readmissions, decrease unnecessary emergency room visits, increase patient adherence, and manage chronic disease, all improving the patient’s overall quality of life. Studies show that approximately 76% of heart failure patients have a …

Procedural Sedation: Policy, Practice & Knowledge, Jennifer A. Martin

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Diagnostic and invasive procedures performed outside of the operating room with nurse- administered procedural sedation are increasing. As procedural sedation practice national guidelines are evolving, there are inconsistent state regulations and a great deal of variability in staff training. These challenges lead to potential knowledge gaps and practice variation that create unsafe patient environments. A local hospital has continued to experience near miss events when procedural sedation is administered. In an attempt to investigate this issue and create improved practice, an organizational policy analysis was conducted. The aims of this project were to: 1) analyze current hospital policy content compared …

Shared Decision Making For The Appropriate Use Of Antibiotics For Respiratory Tract Infections, Kristina Blyer

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Objective- Determine the effectiveness of shared decision making to 1) increase decisional comfort with the appropriate use of antibiotics for respiratory tract infections and 2) maintain antibiotic prescribing rates at current levels.

Participants- English speaking college students age 18 and over diagnosed with a respiratory tract infection in the general medical clinic of a university health center from August 31, 2015-May 6, 2016.

Methods- Pre- and post-intervention surveys used to measure decisional conflict of students. Intervention included staff training in shared decision making and the use of a decision aid in clinical practice.

Results- Students who received routine care …

Implementing Post-Hospital Interprofessional Care Team Visits To Improve Transitions Of Care And Decrease Hospital Readmission Rates, Stacy M. Baldwin

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Today’s healthcare climate is comprised of a population of patients who are more complex, presenting with multiple comorbidities, and requiring frequent hospitalizations. It is imperative for acute care and primary care landscapes to bridge silos and form collaborative relationships to ensure safe and effective transitions of care from hospital to home. An interprofessional, post hospital follow-up clinic is one approach that can be utilized to improve transitions of care and decrease preventable hospital readmissions.

Purpose: The purpose of the project's discharge clinic was to improve transitions of care and decrease thirty day hospital readmission rates. The primary objective of …

Segregation Or Integration: Exploring The Interprofessional Collaboration Of The Sexual Assault Response Team-A Pilot Study, Phyllis E. Adams

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The Sexual Assault Response Team (SART) has been functioning since the early 1970’s with little research on the dynamics of the members’ interprofessional collaboration practice. A current gap in the literature is research specific to the assimilation of the disciplines within the SART and the collaborative practice of the SART. The purpose of this project study is to clarify the 12 subscales of Interprofessional Collaborative Practice (motivation, role expectations, personality style, professional power, group leadership, communication, coping, social support, organizational culture, organizational aims, organizational domain, and organizational environment) and explore how each profession perceives these subscales. The sample participants were …

A Systematic Review Of Complimentary Therapies To Treat Symptoms Of Post-Traumatic Stress Disorder In The Aftermath Of Domestic Abuse, Jordan A. Meeks, Saida Byrami

Senior Honors Projects, 2010-2019

Objectives: Explore the impact of intimate partner violence (IPV) on the health of female survivors. Identify complementary therapies that alleviate symptoms of psychological health impacts of IPV on women’s health.

Method: An exhaustive search of published, peer reviewed literature on complementary therapies and IPV was conducted. Databases included PubMed and CINAHL. Each article reviewed was published between the years of 2002 and 2016. The initial search produced 112 articles, abstracts of all studies were reviewed and studies were included if they addressed; a) complementary and alternative therapies, b) post-traumatic stress disorder, anxiety, and depression and, c) the impact of IPV …

Improving Quality And Efficient Communication Between Providers And Nursing - A Psychiatric Sbar Tool (Psych), Karen Lee Richards

Master's Projects and Capstones

IMPROVING QUALITY AND EFFICIENT COMMUNICATION BETWEEN

PROVIDERS AND NURSING - A PSYCHIATRIC SBAR TOOL (PSYCH)

Karen Richards

University of San Francisco

Abstract

Effective communication is the cornerstone of providing safety and quality healthcare. However, nursing and providers often share information inequitably, as these disciplines are trained differently regarding communication. Providers are taught to be brief, accurate and focused while nurses are taught to be descriptive and holistic. These differences have led to disparity in the sharing of valuable patient information, subsequently leading to increased frustration, inefficiency, and medical errors. Multiple studies provide evidence that poor communication is a major contributor …

Exploring The Experience Of Foster Parents As They Care For Children Who Are Making The Transition From The Hospital Into The Foster Home, Maximilian Veltman

Nursing ETDs

This study explored the perceptions foster parents have about their work as caregivers of foster children who are hospitalized and then discharged from the hospital into a foster home. The numbers of children in foster care nationwide has decreased over the past 25 years, yet the proportion of children in foster care who have significant health conditions has increased dramatically (Wang, Edelstein, Waldinger, Lee & Bath, 2011). There has also been significant attrition of qualified foster parents who are able to care for foster children with significant health needs (Pecora, Whittaker, Maluccio, Barth & DePanfilis, 2009; Vig, Chinitz & Shulman, …

Improving Provider Compliance Of The Naepp 2007 Asthma Guidelines Through The Electronic Health Record (Ehr) In A Pediatric Primary Care Practice, Tiffany L. Kidd

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The Expert Panel Report -3 (EPR3) NAEPP 2007 evidence-based clinical asthma guidelines were developed to provide evidence-based high-quality patient care that leads to improved outcomes. A literature review showed that healthcare providers do not routinely follow the asthma guidelines. The purpose of this project was to develop and implement an evidence-based asthma electronic health record (EHR) template in a pediatric office to improve provider compliance to the guidelines resulting in improved outcomes for children with asthma. The study was conducted over a period of four months from January - April 2016. An EHR asthma protocol template and training for providers …

Examining The Implementation Of The Patient-Centered Recovery Model In Psychiatric Nursing, Nicole K. Rossi

Senior Honors Projects, 2010-2019

The Recovery Care Model is the recommended evidence-based model for delivering holistic, patient-centered care for mental health clients. The model is a more therapeutic approach than the traditional medical model and upholds the ideas that psychiatric clients are more than just their illness, should be respected as unique individuals, and provided with hope and empowerment in their care while being given the opportunity for informed and autonomous decision-making. Although research has shown support for the Recovery Care Model, its implementation has not been fully accomplished in all psychiatric facilities. Of all of the members of the health care team, nurses …

Impact Of Nurse Fatigue And Nursing Handoffs On Patient And Nurse Safety, Melody A. Seitz

Nursing Theses and Dissertations

In healthcare today, patient safety continues to be a major concern. Nurse fatigue from long work shifts and inadequate patient handoffs may lead to errors and near errors that harm patients and nurses. The intent of this study was to fill a gap in understanding the effect shift length has on patient safety and maternal newborn nurses’ personal safety. A cross sectional survey design was administered via Qualtrics, a web-based online software program. Participants included two groups of maternal newborn nurses. One group worked 8-hour shifts (N = 70) and the other group worked 12-hour shifts (N = 151). Statistical …

Building Allas: Creation Of An Asthma And Allergies App, Benjamin J. Cochran

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to determine the potential need for an app to allow patients to self-manage their asthma and allergies. Through a substantial literature review, the need for an app as well as a desire for this population to manage their disease was demonstrated. Determination was made to have three separate components to create an all-inclusive app, an education component, an asthma tracker, and a personalized allergy profile. The app was storyboarded before being sent to providers and small focus group for proof of concept and functionality of components. The app, ALLAS, was constructed and housed on …

Educational Needs Of Nurses For Wound Care, Stephanie Adee

Doctor of Nursing Practice Scholarly Project

The purpose of this study was to conduct a needs assessment of registered nurses’ knowledge base and attitudes toward wound care and to be able to customize a wound assessment tool to meet those needs. The visual assessment is an essential part of wound care and performing accurate assessments can lead to making the correct diagnosis, starting appropriate treatment timely, and discharging patients sooner. There are over five million patients suffering from chronic wounds and more cases are added yearly. The nurses need a tool to assist them in their daily assessments. This study utilized an anonymous survey of 23 …

Quality Of Death People With Terminal Illnesses Are Turning To An Age-Old Method To End It All: Self-Starvation, Kazi E. Awal, Alyssa Pagano

Capstones

Voluntarily stopping eating and drinking (VSED) is getting more attention in the medical community. Though physician assisted dying legislation passed in two more states in 2016--there are now 7 states where it is legal--the practice, where doctors prescribe a lethal dose of sedatives so that terminally ill patients can end their own lives, is inaccessible to many. But fasting to death is a way for patients suffering from terminal illnesses or other debilitating diseases to end their lives on their own terms that is legal everywhere. As extreme as it sounds, research shows the process can be made comfortable with …

Promoting An Increase In Preceptors For Nurse Practitioner Students By Providing The Necessary Tools For Preceptorship, Sonja K. Albright, Sonja Albright

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to confirm the difficulties and barriers to precepting nurse practitioner students found in the literature by conducting a focus group with nurse practitioners who were currently precepting and some who were not. Participants were volunteers at a 4-State APN Conference in Joplin, Missouri. The group did confirm the barriers to precepting noted in the research. The most common theme noted during the group was that nurse practitioners felt ill-prepared to precept nurse practitioner students, a concept also noted in the literature. A Voiceover PowerPoint presentation was created based on the research and concepts discussed …

The Effects Of A Preceptor Coaching Intervention On Use Of Clinical Judgment By New Graduate Nurses, Sue A. Schuelke

Theses & Dissertations

This work attempts to evaluate a preceptor intervention on the development of critical thinking/clinical judgment from the new graduate’s point of view as well as from the preceptor’s point of view. Manuscript 1 is a systematic review of the literature related to preceptor’s interventions and its effect on clinical judgment. Manuscript 2 describes the results of focus group interviews of preceptors and the viewpoint on clinical judgment and related concepts. Results of a pilot study: The effects of a preceptors coaching on new graduates clinical judgement, is reported in Manuscript 3. Each section includes an overview of each manuscript, a …

The Use Of Electroacupuncture For Cervical Ripening In Pregnant Women, Becky A. Nauta

Theses & Dissertations

The purpose of this study was to compare cervical ripening outcomes, based on Bishop scoring methodology, of pregnant women receiving usual care treatment (UC) with those receiving electroacupuncture plus UC. A sample of 36 pregnant women completing their 39^th week of gestation was randomized into one of the two groups. The women in the UC group continued to meet with their provider on a weekly basis until delivery. The women in the electroacupuncture plus usual care group met with their provider on a weekly basis and also received electroacupuncture treatments: three in the 39th gestational week and two in …

Ihss: Repackaging Consumer Information, Deloras N. Puran

Master's Projects and Capstones

Currently, qualified Californians with disabilities and aging individuals can receive consumer-directed care through the IHSS program. Despite the strong demand for the program, new consumers are still struggling to begin their service after enrollment.

This study assisted San Francisco In Home Supportive Services Public Authority to understand how new consumers can navigate the IHSS program services after enrollment. Focus group and semi-structured in-depth interviews were conducted to gather feedback from consumers regarding what type of information would they need after enrollment, and how would they want to receive the information. Based on the feedback, written and virtual deliverables were designed …

Nonpharmacological Approaches In Dementia Care, Gay Lynn Warren

Master's Projects and Capstones

The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to …

Minimizing The Inappropriate Use Of Physical Restraint, Shiela Marie C. Telmo

Master's Projects and Capstones

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower …

Increasing Patient Satisfaction And Decreasing Hospital Readmission Due To Deep Venous Thrombosis By Providing Anticoagulation Education For Orthopedic Patients, Margaret Gniewosz

Master's Projects and Capstones

Abstract

Improving Process on Oral Anticoagulant Education for Orthopedic Patients

The aim of this project is to improve anticoagulation education for orthopedic patients to increase patient satisfaction. The microsystem for this project is a medical-surgical (MS), 50-bed unit in a medium size hospital. Because orthopedic patients are at high risk to develop DVT postoperatively, proper anticoagulants and anticoagulation education is an important aspect of patient care. By implementing a well-designed and easy-to-read patient handout on anticoagulants with instructional script for nurses will empower patients to achieve higher level of anticoagulant knowledge and in result, increase patient satisfaction. A preliminary round …

The Effects Orthostatic Hypotension Has On Falls: A Study Done In San Francisco With The Patient Population Of The Veterans Affairs Hospital, Sherry A. Ballard Ms.

Master's Projects and Capstones

The Effects Orthostatic Hypotension has on Falls: A Study Done in San Francisco Represented

Population of the Veterans Affairs Hoapital

The global AIM of this project is to Identify patients that are at risk for Orthostatic Hypotension (OH) with in the first 24 hours of addmission. It was identified that 50% of the falls over the last 4 quarters at the VA were OH related. The patients were not identified as a fall risk and over half of them had fallen multiple times. After performing a nursing survey online, a SWOT analysis, and a Root Cause Analysis using a fishbone …

Evaluation Of The Nursing Handoff Process From Emergency Department To In-Patient Unit, Yana Marutyan

Master's Projects and Capstones

Handoff, or transition in care, is known to be a danger point in the patient care process for a long time. Ineffective communication during handoff is one of the most common identified cause of catastrophic or sentinel events in hospitals (The Joint Commission, 2015). Emergency department (ED) to in-patient unit handoff is particularly vulnerable to medical errors due to high workload, time constraints, different approaches to patient care, and lack of established relationships between care providers (Ong & Coiera, 2011; Hilligoss & Cohen, 2012).

The purpose of this project was to examine and review a current process of ED to …