Medicine and Health Sciences Commons^™

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 …

An Informatics Solution For Operating Room Efficiency, Richard A. Barrow

Doctor of Nursing Practice (DNP) Projects

Problem: For most hospitals, a major cost is the operating room. Inefficiency increases costs and risks for adverse events. An efficient operating room can also be a major revenue generator.

Context: This evidence-based performance improvement project was conducted in a small rural Veteran’s Hospital, which belongs to an integrated health network in Central California. The facility has four operating rooms and is expanding services provided to their patients.

Intervention: The intervention was the use of analytics and evaluations to improve the operating room efficiency by five percent. The use of 3 separate queries which were combined to generate reports and …

Coping With Labor Education For Nurses, Donna Vo

Master's Projects and Capstones

The “Coping With Labor Education for Nurses” education plan is substantiated by data from the California Maternal Quality Care Collaborative (CMQCC) vaginal birth initiative toolkit and other research. Evidence-based data from multiple sources indicates that improving how labor support is offered at the bedside for the laboring patient can potentially decrease cesarean rates, reduce expenses, and increase savings. The objectives of this plan are to improve patient advocacy and the level of labor support interventions labor and delivery nurses will provide for patients to improve patient satisfaction score above 80%, decrease or maintain cesarean rates below 24.9%, and improve patient …

Aim High, Win Big: Optimizing The Or Nurse's Skills To Improve Surgical Outcomes, Ammie Rose Agbuya-Gates

Master's Projects and Capstones

Abstract

Operating room nurses are constantly challenged with new surgical procedures and technology that affect the delivery of safe patient care. A deficiency in skill sets was identified among 50% of OR nurses in this microsystem. A structured scrub training program will improve the performance of novice and advanced beginner nurses to prevent the occurrence of adverse events. This program includes 320 hours of exposure to scrub the top ten procedures of two specialty services after the nurse learns how to circulate. The ability to circulate and scrub is an indication of high performance. It is expected that the OR …

Reducing Intraventricuar Hemorrhage, Nakia Green

Master's Projects and Capstones

Abstract

Global Aim:

Between September 2017 and September 2018 we aim to reduce the rate of grade III and grade IV intraventricular hemorrhage (IVH) in infants less than or equal to 32 weeks gestation, or less than or equal to 1500 grams from 11% to 5%.

Project Aim:

Develop a best practice bundle for the Prevention of Intraventricular Hemorrhage with implementation of best practice of midline head positioning for infants less than or equal to 32 weeks gestation or less than or equal to 1500 grams by October 2017.

Setting:

Level III, 64 bed Neonatal Intensive Care Unit

Quality …

Surgical Site Infection Reduction Through Nasal Decolonization Prior To Surgery, Melissa S. Schmidt

Master's Projects and Capstones

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was …

Homecare Portacath Protocol In Ivig Administration, Cindy Watson

Master's Projects and Capstones

Homecare Portacath Protocol in IVIg Administration

The objective for this CNL internship project was to close a practice gap that was discovered while evaluating my microsystem for system improvements. My microsystem is a medium sized Home Health Agency with a specialty of in home infusion therapy. While evaluating protocols for immunoglobulin (Ig) infusion I found that there was no protocol for the administration of Ig by portacath. After consulting with the Director of Nursing (DON) and my colleagues on the Infusion Team, it was agreed that a current evidence based protocol was needed to close the practice gap. The methods …

Improving Nurse Proficiency: Breastfeeding And The Opioid-Dependent Mother And Infant Diagnosed With Neonatal Abstinence Syndrome (Nas), Lauren Mountanos

Master's Projects and Capstones

Management of the opioid-dependent mother-infant dyad is complex. Evidence suggests breastfeeding may decrease the severity of NAS symptoms, delay its onset, and decrease the need for pharmacologic treatment (Macmullen et al., 2014). Therefore, education of nursing staff on the benefits of breastfeeding for opioid-dependent dyads will enable them to safely recommend breastfeeding for long-term health (Pritham, 2013). The Clinical Nurse Leader (CNL) project, “Improving Nurse Proficiency: Breastfeeding and the Opioid-Dependent Mother and Infant Diagnosed with Neonatal Abstinence Syndrome (NAS)” aims to globally increase the number of infants diagnosed with NAS discharged on breast milk by 10% by June 30, 2018. …

Reducing Turnover Time To Improve Efficiency In The Operating Room, Myrna Jafari

Master's Projects and Capstones

Abstract

The purpose of this project is to improve efficiency by reducing turnover time in the operating room (OR) that can consequently enhance patients’ and physicians’ satisfaction, promote teamwork, and decrease the cost of operating room delays. The increasing trend of turnover time (TOT) requires attention for microsystem improvement in the OR of Santa Rosa Memorial Hospital. The intervention to improve efficiency is to educate the OR team members on roles and responsibilities to establish a standard workflow which can promote accountability and teamwork during the turnover process. Havelock’s theory of change is used as a framework for the action …

Saving The Brain Matter(S): Improving Stroke Outcomes Utilizing A Direct To Ct Workflow, Robert Schambach

Master's Projects and Capstones

Saving the Brain Matter(s): Improving Stroke Outcomes Utilizing a Direct to CT Workflow was a project implemented to improve outcomes for acute ischemic stroke patients arriving at a rural emergency department. The project focused on a revision of the emergency department workflow for acute ischemic stroke patients with an aim of lowering the door to needle time to under sixty minutes. An interdisciplinary team used lean methodology and the PDCA cycle to examine and revise the workflow. The workflow was revised to eliminate testing no longer required under the national clinical practice guidelines for the treatment of ischemic stroke. Within …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Data Aggregation Reporting Tool For Implementation In Home Health Fall Reduction Program, Jose Alberto Cruz

Master's Projects and Capstones

Abstract

Falls are a major preventable problem in healthcare that affects people of all ages but disproportionately affects the frail and elderly. Fall reduction programs play a significant role in reducing falls and fall related injuries and are a critical component in Home Health settings. This project takes place in a home health and hospice services agency. The purpose of the project consisted of aggregating fall data for benchmarking metrics to bring the agency’s Fall Reduction Program closer to compliance with state and national fall prevention guidelines. Two hundred and three fall event reports were analyzed and a problem arose …

Increasing Patient Safety During Medication Administration, Vivien Tso

Master's Projects and Capstones

Medication administration error is one of the crucial medical errors that compromises patient safety in hospitals each day. Direct observations were conducted to assess medication administration (MA) accuracy and practices in order to determine the root cause(s) of errors at a community-based, non-profit hospital. Failure to scan patients’ wristbands, to verbally verify patients’ identity with two identifiers, and to verbally verify patients’ allergies, were some practices that were found to lead to medication administration errors. Implementation tools such as an informative video and reminder signage at bedside computers were piloted at the oncology unit of the hospital to improve nursing …

The Evaluation Of The Effectiveness Of Community-Based Mobile Meal Programs For Low-Income Families, Nicholas Vesom

Master's Projects and Capstones

Food disparity is a continuously prevalent issue in the United States despite the presence of programs, such as the Women, Infants, and Children (WIC) program and the National School Lunch Program (NSLP), to fill gaps in reaching those who are financially inhibited and do not have a sustainable source of nutritionally balanced food. A primary part of the issue that arises is that these types of programs have restrictions on age or only operate during the school year. To assess this issue, the Mountain View Whisman School District (MVWSD), in conjunction with the Stanford University Pediatrics Advocacy Program (SUPAP), initiated …

Ready, Set, Action: Potential Breakthrough Therapy For Treatment-Resistant Depression, Alvin Garlejo

Master's Projects and Capstones

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ideation and behavior. Current psychological and pharmacological treatments have been demonstrated efficacious; however, an ever-growing number of individuals frequently report minimal to no improvement with these treatments; and in some cases, a worsening of symptoms. This inadequacy to treatment is commonly known as treatment-resistant depression. At Kadima Neuropsychiatry Institute, Dr. Feifel treats individuals with treatment-resistant depression with advanced treatments such as TMS and ketamine. During my fieldwork …

Improving Early Sepsis Identification, Stephanie Senda

Master's Projects and Capstones

Sepsis is a serious complication which is initiated by the body’s extreme response to an infection. If sepsis is not identified and treated promptly, it can rapidly lead to tissue damage, organ failure and death. Accounting for high morbidity and mortality rates in the United States, sepsis has become an area of focus within the healthcare spectrum as it is frequently unrecognized and undertreated. The focus of this project is for the Clinical Nurse Leader (CNL) students to evaluate the policies and processes in place within a large metropolitan hospital as well as the hospitals ability to recognize and treat …

Improving Early Sepsis Identification On Inpatient Units, Corrina Lau

Master's Projects and Capstones

Background: On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. Now that care for sepsis patients is a core measure, it is important that all healthcare providers are knowledgeable in how to treat and identify sepsis.

Purpose: The Purpose is to be a “values-driven integrated healthcare delivery system in collaboration with those who share our values.” Patients observed were ages 18-years-old and older from five inpatient units. The professionals in this hospital consisted of a multidisciplinary approach that included, but not limited to, a team …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Quynh-Hoa Nguyen

Master's Projects and Capstones

Retention, competency, job satisfaction, and lateral violence are issues facing the nursing workforce, especially newly licensed registered nurses (NLRNs). The United States is facing a nursing shortage; therefore it is important to develop strategies to retain qualified registered nurses (RNs). The Master of Science in Nursing/Clinical Nurse Leader (MSN/CNL) student team conducted a literature review on how to address these issues. A mentorship program is the proposed intervention to assist novice nurses during their transition into the nursing role. The student team performed a needs assessment through surveys and interviews to gain valuable data on the medical center. The assessment …

Development Of A Nurse Practitioner First Assistant Orientation Program, Romoanetia Lofton

Doctor of Nursing Practice (DNP) Projects

The demand for surgical services continues to increase, creating a strain in our healthcare system and causing increasing backlog hours for the operating room. Allowing nurse practitioners (NP) to function in an expanded role in the perioperative environment requires additional training beyond the generic NP program. With this additional training, the NP can function as a first assistant, providing delegated medical functions in the perioperative environment. An in-house NP registered nurse first assistant orientation program was developed based on the adult learning theory as a conceptual framework combined with the AORN perioperative standards as a foundation. The cost of using …

Teaching A Primary Prevention Falls Program: Using The Stop Elderly Accidents, Deaths, And Injuries (Steadi) Toolkit, Janice Mark

Doctor of Nursing Practice (DNP) Projects

Problem: Falls in the community dwelling older adult (CDOA) are a growing health concern, placing large financial and social burdens. Primary care providers (PCPs) are not engaging in falls assessment and prevention activities due to the lack of knowledge and time. Context: Falls are the leading cause of fatal and nonfatal injuries, and is projected to worsen with the increase in the aging population. STEADI is a fall assessment and prevention toolkit created by the CDC to tackle this problem designed to address the knowledge and practice gaps of PCPs. Interventions: A DNP project was crafted and implemented to train …

An Evidence-Based Implementation Project On High Utilizers In The Emergency Department, Bernadette Martin Ruggles

Doctor of Nursing Practice (DNP) Projects

Abstract

Challenges have been presented to the Emergency Department (ED) over the last several years as the dramatic rise in health insurance enrollment continues. Although, with the Republican bill, the American Health Care Act, changes to Medicaid may alter the health program leaving many uncertainties (Kaplan & Pear, 2017). Evidence reflects EDs are inundated with even more patients taking advantage of the availability of a one-stop shop for their care and treatment. Costs of ED services and resource allocation are rising as a result of these unnecessary visits contributing to a total healthcare expenditure of approximately 17.6% of the US …

Gerontological Community-Academic Partnership For An Msn Internship, Francine Serafin-Dickson

Doctor of Nursing Practice (DNP) Projects

The growing population of older adults beckons nursing education to evolve and prepare the future nursing workforce with skills and knowledge to coordinate care for the community-dwelling older adult (gerontological) population. The purpose of this project is to develop, implement, and evaluate academic partnerships with agencies serving community-dwelling older adults for the Master of Science in Nursing (MSN) Clinical Nurse Leader (CNL) students. The formation of Community-Academic Partnerships (CAP) offers the opportunity for an experiential learning internship in combination with a gerontological curriculum. The curriculum is integrated into the CNL role courses and internship, focusing on person-centered interactions with older …

Leadership Development, Succession Planning And Simulation: A Succession Plan For Organizational Success, Beth Eichenberger

Doctor of Nursing Practice (DNP) Projects

Future executive nurse leaders must be identified and prepared for the challenges of 21st century health care. The literature suggests a lack of existing standardized succession plans for these leaders. Senior leaders are often faced with the complex issue of how to develop and validate the competencies required for these leadership roles (Dyess, Sherman, Pratt, & Chiang- Hanisko, 2016). Therefore, in the absence of a succession plan, creating a leadership development program, which provides a pipeline of new executive leaders, would alleviate this gap. The motivating force is an effort to promote current talent and provide a higher level of …

Float Rns: Unit Specific Tools To Promote A More Positive Float Experience, Tarra Abdullah-Grayson

Doctor of Nursing Practice (DNP) Projects

Despite efforts to transition large portions of primary health care services to more community-based outpatient settings, federal projections say the rising complexity of acute care will increase demand for RNs in hospital settings by 36% in 2020 (American Association of Colleges of Nursing [AACN], 2017). Other projections indicate that by 2025, the U.S. registered nursing shortage will expand to more than 260,000 (Buerhaus, Auerbach, & Staiger, 2009). In an effort to address the ongoing challenges of nursing staff shortages, many hospitals have established a core of internal float pool RNs as a practical and cost effective solution to address the …

Increasing Faculty Knowledge And Empathy Related To Nursing Students With Learning Disabilities, Jodi Kushner

Doctor of Nursing Practice (DNP) Projects

The purpose of this paper is to provide a project overview for the implementation of a disability training module and simulation experience offered to university school of nursing faculty to increase faculty knowledge and empathy related to nursing students with learning disabilities. The number of students with learning disabilities in the postsecondary education setting has tripled in the past decade (Orr & Hammig, 2009). This growing student population makes faculty preparation essential in order to effectively meet the needs of these students. The literature indicated that best practices include disability training, faculty support, student support, inclusive strategies such as Universal …

The Development Of A Cardiovascular Competency Checklist For Chinese Nurses, Amy B. Xiong

Doctor of Nursing Practice (DNP) Projects

Cardiovascular disease is a global issue affecting millions of lives around the world. Today, countries like the U.S. and China have joined forces to take on the global issue. In the U.S., the American Heart Association is the largest organization dedicated to reducing the mortality rate of cardiovascular disease by requiring healthcare services to uphold standard cardiovascular guidelines. Astonishingly, within the last 10 years, the U.S. has reduced their cardiovascular mortality rate by 30%.

This quality improvement project sought to determine the gap between the United States and China’s standard nursing education and practices and to help Chinese nurses achieve …

A Novel Model Of “Remedy And Elimination Of Tuberculosis”, Akanksha Mishra

Master's Theses

Tuberculosis (TB), is one of the top ten causes of death worldwide. TB is commonly linked to poverty and creates poverty as it is the single largest cause of death in the 15-49-year-old age group in South-East Asia (WHO, 2017). It is also linked to the HIV population, and its leading cause of death. TB is effected by socio-economic factors, cultural factors, and health policy. My goal of this dissertation is to identify systematic approaches that shall support the mission set by World Health Organization (WHO): to eliminate TB globally by the year 2050. Measures might include addressing social barriers …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …