Medicine and Health Sciences Commons^™

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

Epacs: Epigenetic Regulators That Affect Cell Survival In Cancer., Catherine Murari

Theses & Dissertations

Cyclic adenosine monophosphate (cAMP) is a second messenger responsive to many external stimuli, playing an important role in cellular gene expression, metabolism, migration, differentiation, hypertrophy, apoptosis and secretion. All of these cellular functions are important in many diseases including cancer. Most of its effects were initially attributed to the classical protein kinase A (PKA) protein, but cellular functions such as proliferation and migration were found to be PKA independent and dependent on the newly discovered exchange proteins directly activated by cAMP (EPACs). EPACs are single polypeptides that primarily function as guanine exchange factors (GEFs) for Rap proteins that allow the …

Designing A Care Delivery System Through Interprofessional Coordinated Care In A Medical Neighborhood Setting, Diane P. Kelly

Doctor of Nursing Practice (DNP) Projects

Abstract

The Patient Protection and Affordable Care Act (2010) has two significant aims: to improve the quality of healthcare and in doing so, to lower the cost of healthcare. The Centers for Disease Control and Prevention (CDC) reports that chronic health conditions, such as diabetes, hypertension, cardiovascular disease, and mental health, which in 2005 affected nearly one of every two Americans, continues to increase (CDC, 2010). Chronic health conditions and lack of access to care are both national and local concerns. These challenges will require the exploration of new models for the delivery of care, as needs shift over time …

Using A Strategic Model For Professional Development: The Importance Of Evidence-Based Competencies As A Foundation For Professional Practice., Peggi B. Winter

Doctor of Nursing Practice (DNP) Projects

Abstract

A nursing professional practice model (PPM) is designed to provide a framework for how nursing practices, communicates, leads, collaborates, and provides the highest quality of care as we navigate the complex healthcare system. An infrastructure for learning, competency, and performance needs to be integrated into this model as a foundation for accelerating business and clinical initiatives, promoting standardization, and sharing successful practices. It is now, more than ever, a necessity to have a well-trained, highly competent nursing workforce. Simply having the knowledge and the skill to do a job is insufficient; rather, it is implied that a competency has …

A Population Health Approach For Community Health Improvement, Sandra Gregg

Doctor of Nursing Practice (DNP) Projects

Providence Health & Services (Providence), a not-for-profit Catholic health care system serving five western states, established an organizational vision of Creating healthier communities, together (Providence Health & Services, 2014). This vision served as the catalyst for the alignment of divisional initiatives to positively impact community health status. To effectively achieve its vision, the organization committed to the incorporation of population health principles in the development of an infrastructure to expand the reach and impact of community investments, along with the establishment of effective processes for inter-divisional collaboration and compliance with community benefit mandates. Thus, in 2015, Providence established a community …

Impetus To Transform: Essential Nursing Leadership Development Through Simulation, Mary J. Mette

Doctor of Nursing Practice (DNP) Projects

Abstract

A nurse manager’s ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting, as well as the culture present in the organization as a whole. The aim of this Doctor of Nursing evidence-based change in practice project was to create an educational modality that supported training nurse leaders through innovation and creative problem solving in today’s acute healthcare setting.

A survey was administered to 48 frontline managers in a Northern California healthcare system to access the gaps and voids in their ability to integrate …

The Role Of A Psychiatric Mental Health Nurse Practitioner As Part Of A Mobile Health Unit For The Homeless Population, Joan Alviar Fraino

Doctor of Nursing Practice (DNP) Projects

An estimated 2.3 to 3.5 million people are homeless in the U.S., often living with chronic medical and mental illnesses. The underserved population, such as the homeless, continues to experience gaps in services, resulting in poor healthcare outcomes and readmission to the hospital setting. They often present in crisis through the emergency room, contributing to an already overburdened healthcare system. Increased spending and overutilization of healthcare services continues to rise in the United States (U.S.). Due in part to advancements in technology and expanded health insurance coverage, American healthcare continues be one of the most expensive commodities in the U.S. …

Development And Implementation Of A Violence Risk Assessment Tool, Mira Aidasani-Diwata

Doctor of Nursing Practice (DNP) Projects

The purpose of this quality improvement project was to provide a means to effectively assess patients as they are admitted to the hospitals and to effectively communicate a patient’s violent tendencies within the healthcare setting. Workplace violence is a serious problem that affects all healthcare professionals. Although serious assaults and homicides attract more media attention, the majority of workplace violence consists of non-fatal assaults. Nurses, aides, and patient care technicians suffer the most non-fatal assaults resulting in injury. Due to the growing incidence of assault and injury among healthcare workers, some states are calling for additional study on workplace violence. …

The Creation And Implementation Of Guidelines For The Appropriate Termination Of Patient-Provider Relationships, Rowena D. Nolasco

Doctor of Nursing Practice (DNP) Projects

Primary care providers have terminated patient-provider relationships when they deem them no longer therapeutic. Healthcare providers are increasingly considering this an acceptable practice. However, the criteria for this decision remain unclear. As providers discharge challenging or difficult patients from their practices, questions to support this decision arise. Discharged patients face displacement and healthcare is disrupted. This project will (a) describe problematic patient-provider relationships and its effects, (b) identify possible alternatives to the firing of patients, (c) list appropriate reasons for termination, and (d) present recommended procedures to avoid allegations of medical abandonment. The project's product is an Appropriate Discharge or …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

Fnp Led Mobile Health Services For The Homeless Population, Tenzin D. Lama

Doctor of Nursing Practice (DNP) Projects

A small percentage of the U.S. population uses the greatest portion of the healthcare services. Homeless people are often such a group of “super-utilizers” of the healthcare system. Due to multiple medical and psychosocial conditions, people experiencing homelessness face numerous barriers to accessing healthcare, thus leading increased utilization of hospitals and emergency departments (EDs) services. Many of these events are preventable through improved primary care interventions. The literature on Respite/Recuperative Care, Transitional Care, and Mobile Health interventions have shown effectiveness in providing safe and quality care to homeless individuals during the critical transitional period post hospital discharge while also reducing …

Patient-Reported Outcomes Screening For Improved Patient Wellness: A Cancer Center Initiative, Alison Morris

Doctor of Nursing Practice (DNP) Projects

Background: People experiencing serious illness have significant unmet physical, emotional, social and spiritual needs. The Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional wellbeing and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to (a) implement electronic screening of every cancer patient by their second oncology visit, (b) design processes for ongoing assessment and intervention of need(s), and (c) develop measurable and sustainable evaluation metrics to ensure that palliative care needs are met. Methods: In June 2015, we launched electronic collection of patient-reported outcomes (PROs) using the Patient Reported …

Depression Screening And Early Intervention On The Post-Stroke Patient, Marco Oliver Dugan Lopez

Doctor of Nursing Practice (DNP) Projects

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

The Rho Gtpases Rac1, Cdc42, And Rhoa Regulate App Transport To Lysosomes And Aβ Production, Justin K. Chiu .

Electronic Thesis and Dissertation Repository

Alzheimer’s Disease (AD) is characterized by Beta-Amyloid (Aβ) plaques within the brain. Aβ peptides are produced by the cleavage of Amyloid Precursor Protein (APP). Our lab has previously discovered a novel pathway for APP internalization mediated by ADP-ribosylation factor 6 (Arf6). This pathway resembles macropinocytosis, transporting cell surface APP directly to lysosomes, a possible site for Aβ production. We set out to characterize the effectors downstream of Arf6. In SN56 and N2A cells we co-transfected HA-tagged APP (to label cell-surface APP) with compartment markers, to visualize APP trafficking. We used dominant negative and constitutively active mutants, pharmacological inhibitors, and siRNA …

Improving Patient Medication Reconciliation Participation And Compliance Through Education, Maria Elena Herrera

Master's Projects and Capstones

Abstract

The healthcare world is complex. At the center of this world are patients and their safety. Medication knowledge and medication reconciliation compliance are factors that influence patient’s safety and their overall health outcomes. This project explores the theme of patient safety by examining the relationship between patient education and health outcomes. The microsystem, located in the heart of San Francisco, is an outpatient clinic specializing in patients with renal impairment that each diverse and unique. A pre-implementation survey found that only 38% of patients were bringing their medications to appointments. A goal of improving compliance to 50% by December …

Increasing Hpv Awareness And 3-Dose Series Compliance Among The Female Population (Ages 11-26) In A Community Health Clinic, Vanessa Orozco

Master's Projects and Capstones

Abstract

The overall goal of this project was to increase HPV 2nd and 3rd dose compliance rates by a combined 10% among the female adolescent population (ages 11-26). This was to be achieved by implementing EBP follow-up calls to not only schedule appointments but also to serve as a reminder for patients to come into previously scheduled appointments. This project was chosen as prior clinic and organization-wide meetings had delineated compliance rates at just 7%. There were various methods employed to implement this project including an initial microsystem assessment, which entailed a Root Cause Analysis, Process Mapping, SWOT analysis, Cost-Analysis, …

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 …

The Effect Of Body Mass Index On Graft Function And Kidney Transplant Outcomes, Morgan Galle

Theses & Dissertations

Background: When determining eligibility for kidney transplantation, body mass index (BMI) is often a debatable criterion for transplant due to the clinical indication, an elevated BMI has adverse effects on kidney transplant outcomes. There is a current gap in research on the effect BMI has on kidney transplant outcomes.

Purpose: The purpose of this study was to determine the role BMI plays in post-kidney transplant clinical outcomes including delayed graft function, new onset diabetes after transplant, wound complications, hospital length of stay, albumin, and readmissions to the hospital from initial hospitalization and at six months following kidney transplantation. The primary …

Evaluation Of Upper Airway Changes Following Surgical Removal Of The Adenoids Using 3-D Cone Beam Ct, Christopher C. Schultz

Theses & Dissertations

Purpose: The purpose of this study was to evaluate the changes in volume, cross-sectional area and depth of the upper airway following the surgical removal of the adenoids.

Materials and Methods: 16 patients were diagnosed with hypertrophic adenoids and referred for surgical removal. Pre-surgical and post-surgical CBCT scans were taken on each patient. Volume measurements of the total airway, oropharynx and nasopharynx were recorded. In addition, cross-sectional areas and airway depths at the posterior nasal spine (PNS) and cervical vertebrae 2 were recorded. 15 patients diagnosed with no or mild adenoid hypertrophy were treated as the control group. The controls …

Alarm Management: Electrocardiographic Lead Management, Dale Elaine Dominguez Ms.

Master's Projects and Capstones

Abstract

Alarm Management: Electrocardiographic Lead Management

Quality improvement and safety that incorporates the Clinical Nurse Leader (CNL) competency of putting in place quality improvements plans that are bases on evidence, analysis, and risk anticipation is the thesis for this project. The associated problem is the myriads of electrocardiographic (ECG) alarms that alert staff to patient issues each day. Of those alerts, 88% to 90% are false or do not require immediate attention (Sendelbach & Jepsen, 2013). The high numbers of false alerts cause staff to become desensitized to the sound. This desensitization may cause staff not to respond to a …

Decrease Arrival To Ct Time To Improve Stroke Outcomes, Curt Peterson

Master's Projects and Capstones

Abstract Final

The specific goal of the project is to decrease the arrival to t-PA treatment times to <45 minutes in > 50% of the cases. The decreased treatment time will prove to shorten the average length of stay on average by two days (Audebert & Sobesky, 2014). The goal will be accomplished by decreasing the arrival to computerized tomography (CT) scan completion time by at least 20%. The specific population of patients will be all stroke alert arrivals to the process’s microsystem via EMS, an Advanced Primary Stroke Center in Sacramento California. Root Cause Analysis, Strength, Weakness, Opportunity, Threat (SWOT), and Plan, Do, …

Reducing Clostridium Difficile, Norabel V. Zafra

Master's Projects and Capstones

This CNL project aims to reduce the number of laboratory identified Clostridium Difficile Infections (CDI) events by 20% by December 2015. This CNL projects focuses on reducing CDI in an 8 unit bed specifically designated for medically ill geriatric patients above 70 years old residing in the West Texas region. A majority of the geriatric patients living with multiple co-morbidities require maximum assistance with activities of daily living and medication management. The geriatric patients will be discharge to a skilled nurse facility, long-term acute care, rehabilitation, independent living, or home with home health. A variety of methods such as reinforcing …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

Antiviral Peptide Nanocomplexes As Potential Therapeutics For The Treatment Of Infectious Diseases, Jinjin Zhang

Theses & Dissertations

Hepatitis C Virus (HCV) is recognized as a major burden in global public health, which can be further exacerbated by several cofactors such as human immunodeficiency virus (HIV). Currently, there is no vaccine for HCV. The emergence of potent and highly specific direct-acting antivirals (DAA) has marked a new era in HCV therapy, however, the remaining issues like affordability, genotype dependency, and potential resistance still necessitate the development of additional therapeutic approaches to be used instead or in combination with DAA.

Recently, the antiviral peptide C5A (in our studies designated as p1) and its cationic derivative p41 have been identified …

Exploring The Factors Of Persistence For African American Senior Nursing Students, Yolanda Nelson

Theses and Dissertations

African American nursing students experience commonalities within their college experience. Often these students may be faced with challenges, barriers, and/or struggles that may place a hindrance on their success in meeting their educational goals. This qualitative study used a phenomenological approach to explore African American female nursing students perceptions of faculty-student relationships and its implications for persistence. Four African American female nursing students and two nursing faculty agreed to participate in this study. This research study offers an examination of past and present research regarding the history of African American nursing students, health disparity, social justice and diversity within the …

Examining Employee Knowledge Of The Jennie Edmundson Hospital Active Shooter Policy, Mallory W. Darais

Theses & Dissertations

Nationally, there has been a large increase in the number of active shooter events within healthcare facilities such as hospitals. Due to this increase, government organizations have recently released documents to guide healthcare facilities on implementing active shooter policies and updating emergency operation plans. Currently, recommendations from government entities such as the Federal Bureau of Investigation and the Department of Homeland Security suggest the “Run, Hide, Fight” approach during an active shooter incident. Jennie Edmundson Hospital, located in Council Bluffs, Iowa, and affiliated with the Methodist Health System, currently has an active shooter policy in place. Data was collected from …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Association Between Recipient’S Preexisting Antibodies And Allograft Vasculopathy And Mortality In Heart Transplant Patients, Hoang Tran, Lorena Baccaglini, Jane L. Meza, Brian D. Lowes

Theses & Dissertations

Objectives: To evaluate the role of preexisting Angiotensin II receptor type I antibodies (AT1RAb) and anti-HLA antibodies in predicting mortality and cardiac allograft vasculopathy (CAV) among heart transplant patients.

Methods: In this retrospective cohort study, we included 114 adults who received heart transplant from January 1^st, 2007 to December 31, 2014 and were followed up at Nebraska Medicine. 48 hours pre-transplant sera sample were used to detect antibodies. A cutoff of 10UL/ml was used for AT1RAb positive and mean fluorescence intensity of 3,000 and 1,500 were used for anti HLA class I and class II, respectively. Patients were …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …