Medicine and Health Sciences Commons^™

A Kid's Guide To Infectious Disease, Abby Carroll

Honors Theses

A Kid’s Guide to Infectious Disease is an educational illustrated book intended for young pediatric patients, ages three to five. This project was inspired by my personal interests, involvement at the University of Mississippi, and experience as a medical assistant. Over the past couple of years, I have had the opportunity to work as a medical assistant, interacting with many pediatric patients and their families at HealthPointe Primary Care. As a pre-physician assistant student studying biology, I was inspired to create a resource for these kids by both my classes at the University of Mississippi and my passion for pediatric …

Ni Reprimir, Ni Rezar, Ni Traducir: Latinos En Nueva York Piden Cuidados De Salud Mental Incluyentes, Laura Rojas Aponte

Capstones

In New York City, only three out of ten Latinos diagnosed with depression receive treatment, compared to over half of white adults with the same condition, according to the latest Department of Health report. Despite the clear need for mental health care, access remains limited, with a lack of culturally competent services further widening the gap.

While mental health has become a more open topic in recent years, many Latinos still face significant barriers to therapy, including high costs, limited insurance coverage, cultural stigma, and disconnects between patients and providers. However, there are ongoing efforts to address these challenges, ranging …

The Evidence Is In: Breast Implants Are Making People Sick Increasingly Women Find When They Have Their Implants Removed, Their Symptoms Improve—Or Disappear., Pamela J. Appea

Capstones

Over the years, breast implants have been associated with a wide range of health issues, including cancer and autoimmune diseases, but surprisingly these issues are not well known to the public. In 1992, health concerns led the FDA to halt the use of silicone gel breast implants for cosmetic surgeries, although implants containing saline remained available (it was during this period that the Oprah segment that Gmitro remembered ran on TV). In 2006, after more research, which some experts believe was insufficient, the FDA re-approved the use of silicone implants. In 2019, a novel “textured” breast implant manufactured …

Integrating The Bedside Mobility Assessment Tool (Bmat): Increasing Compliance With Assessments And Charting In Medical Surgical Units, Khaterah Sayed

Master's Projects and Capstones

Objective: Decreased patient mobilization is associated with poor patient recovery and increased hospital costs. Complications include decreased functional capacity, pressure injuries, deep vein thrombosis, and infections. Aim: The Bedside Mobility Assessment Tool (BMAT) is a mobility assessment tool designed to help healthcare providers safely mobilize patients (Boynton et al., 2020). In a 244-bed California hospital, preliminary data from three medical-surgical units indicate an average daily patient census of 23.7 of which only 31.3% were assessed using the BMAT. This quality improvement intervention aims to increase compliance with the BMAT by 10%. Interventions: Over a six-week period, staff received …

Patient-Centered Language During Peripartum Bedside Reports, Krystal H. Nguyen

Master's Projects and Capstones

Problem Using complex medical language that excludes the patient can result in lower patient satisfaction, increased miscommunication, and heightened anxiety for patients. Hospital A’s peripartum mesosystem currently does not have a training on the use of patient-centered language during labor and delivery (L&D) patient transfers to postpartum (PP). Context Hospital A is an urban tertiary care medical center located in the Bay Area, with its peripartum mesosystem consisting of 35 L&D and postpartum beds distributed across two floors. Intervention Through analysis of stakeholder engagement, an ongoing literature review and a mesosystem needs assessment, potential barriers to implement patient-centered language in …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Enhancing Communication And Reducing Near Misses Through Comprehensive Handoff Tools At A Residential Nursing Facility, Sabrina Guralnik, Sophia Nguyen, Gabriela Benelyahu, Giselle Peyus

Master's Projects and Capstones

Our quality improvement project at Regina House addresses communication gaps during patient handoffs, which have led to missed or delayed care. The research underscores the critical role of effective communication in patient safety, particularly for vulnerable populations in nursing homes. Current handoff practices at Regina House are inconsistent, especially among Certified Nursing Assistants, resulting in frequent reporting errors and communication disparities.

To enhance patient safety and care continuity, this project introduces a standardized handoff tool and an incident reporting system, aligning with Regina House’s goal of improving care quality. Over three months, CNAs will receive training on the tool, with …

Improving Documentation Compliance And Patient Mobility Using The Bedside Mobility Assessment Tool, Hayley M. Bernard

Master's Projects and Capstones

Objective: Patient immobility during hospitalization contributes to avoidable complications including increased length of stay, pressure injuries, thromboembolic events, reduced functional capacity, and increased rates of discharge to rehabilitation facilities. The Bedside Mobility Assessment Tool (BMAT) was developed to empower Registered Nurses to safely assess and mobilize patients without a physical therapy evaluation. Aim: This quality improvement projects aims to enhance nurse compliance with BMAT documentation by 10% in three medical-surgical units of a 244-bed Northern California Hospital. Preliminary findings indicate an average daily patient census of 23.7 of which only 31.3% are assessed using the BMAT. Methods: Across a six-week …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Implementing The Donna Wright Competency Model In Pediatric Perioperative Units For Nursing Professional Development, Benjamin Amezcua

Master's Projects and Capstones

Background Each year, preventable adverse events in hospitals lead to numerous deaths. Research consistently indicates a strong correlation between nurse competency and improved patient outcomes, emphasizing the importance of healthcare organizations prioritizing the continuous development of their staff's skills. Bay Area Children’s Hospital A is taking a proactive step by adopting the Donna Wright Competency Model (DWCM), changing from the traditional approach competencies to a collaborative, shared governance model that incorporates the input and perspectives of the nursing staff. Objectives The project aims to utilize the DWCM to enhance the competencies of 90 nurses in the pediatric perioperative units at …

Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

Baby-Friendly Hospital Initiative: Becoming Baby-Friendly Designated, Krystal Angelique Mora

Master's Projects and Capstones

Section I: Abstract

Problem Despite efforts to increase breastfeeding rates, the influence of formula companies has contributed to the decrease in rates, affecting the health outcomes of infants. In response, the Baby-Friendly Hospital Initiative (BFHI) introduced standardized education for nursing staff to support infant growth and development. Context Hospital A Birth Center is a 33-bed culturally diverse unit that provides care to mothers in Northern California, delivering approximately 7,400 babies each year and helping patients transition into motherhood. Aim The quality improvement project aims to enhance the retention of BFHI-aligned education provided during hospitalization by 26.2%, raising retention rates among …

Impact Of Supply Organizational Culture Within A Surgical Unit, Irene T. Peng

Master's Projects and Capstones

Objective: This quality improvement project aims to propose an intervention that helps anesthesia technicians improve communication efforts, reduce delays in care, and reduce medical waste. Aim: At least 80% of the anesthesia technicians are educated on properly stocking the pediatric anesthesia medical lockers utilizing the standardized checklist and handoff report tool to reduce waste and increase timely patient care after three months of implementation. Methods: Assessment surveys were used to identify the surgical unit’s current issues and Hospital A’s staff's opinions of pediatric medical anesthesia C-lockers. Resources such as the GANTT Chart, Fishbone Analysis, Budget Analysis, SWOT Analysis, and PDSA …

The Donna Wright Competency Model In Pediatric Perioperative Nursing Development, Nadia Hamid

Master's Projects and Capstones

Abstract

Background Preventable adverse patient events occur daily in hospitals across the United States which can be significantly decreased by effective nurse competency assessment. Bay Area Children’s Hospital X has adopted the Donna Wright Competency Model (DWCM) to support their institutional goal of Magnet status for excellent nursing care. With the goal of changing the traditional approach of competency achievements by engaging nurses through shared governance. Objective The project seeks to attain a higher level of performance for 90 nurses employed on the perioperative unit (PPU) to provide a safer environment to support patient centered care. Aim By December 1, …

Infant Mortality Data: Missing Pieces To Prevention In Lesotho, Jacinda Croissant

Master's Projects and Capstones

Lower-middle-income countries (LMICs) like Lesotho lack complete and quality infant mortality data. Without infant mortality data, it can be challenging to develop public health education, programming, and policies to address preventative infant deaths in specific populations (Rao et al., 2004). A literature review identified strategies to improve infant mortality data in LMICs. Through a community engagement model and digital storytelling, community members can gain awareness, begin an ongoing conversation about local public health issues, and participate in an improved data collection system. Infant mortality is often used as an indicator of health for a population; improved infant mortality data can …

Improving Health Equity: Integrating Mental Health Services Into Mobile Health Clinics For Unhoused And Low-Income Populations In The United States, Tiffany Lynn Wong

Master's Projects and Capstones

Mental health disparities among homeless and low-income populations in the United States highlight significant challenges in access and quality of care. This literature review explores the integration of mental health services into Mobile Health Clinics (MHCs) as a promising recommendation to address these disparities. I used various search engines, extracting 10 articles published from 2013 to 2023 focused on the U.S. MHCs show its effectiveness in improving healthcare access and quality of care, covering different services like mammography, reproductive health, COVID-19 testing, and diabetes care. Building on these successful models, this paper proposes extending MHCs to include mental health screenings, …

Reducing Heart Failure Readmissions Through Standardized Daily 1:1 Education, Neil R. Carlos

Master's Projects and Capstones

Problem: In 2023, a Northern California hospital's Cardiac Procedure Unit (CPU) admitted 100 heart failure patients, with 24 readmissions primarily due to inadequate self-management education. These admissions cost over $8.4 million, highlighting the urgent need for better patient education to reduce readmissions and healthcare expenses.

Context: A quality improvement initiative was launched in the CPU that handles pre- and post-cardiac care, including for heart failure patients. The unit's focus on urgent care and other priorities resulted in insufficient patient education regarding heart failure.

Intervention: From January to June 2024, the initiative implemented daily personalized teach-back education sessions on self-management. These …

Beat The Clock: Improving First Case On-Time Starts (Fcots) In The Ambulatory Surgery Unit (Asu), Myrna M. Bernardo

Master's Projects and Capstones

Abstract

Problem: A local Bay Area hospital Ambulatory Surgery Unit (ASU) strives to maintain the first case on-time starts (FCOTS) at 90%. Optimal FCOTS compliance enhances operating room (OR) efficiency, resource utilization, and patient outcomes. Data from January 2022 to December 2023 shows that ASU’s FCOTS remains at a monthly average rate of 67%. This project focuses on closing the 23% gap by achieving 73% FCOTS compliance in the first quarter to progressively achieve the unit 90% goal or higher.

Context: The five ASU ORs handle a daily volume of 25-35 cases. An interdisciplinary team conducted a root cause analysis …

The Impact Of Adverse Childhood Experiences And Allostatic Load On Premature Birth Rates: A Literature Review, Roxane J. Scherek

Master's Projects and Capstones

This paper examines the relationship between Adverse Childhood Experiences (ACEs), allostatic load, and the likelihood of women giving birth prematurely in the United States and Canada. I searched multiple databases exploring this association, identifying nineteen articles published between 2004 and 2024. The literature highlights that racism and discrimination are a cause of chronic stress, and that this stress, and implicit bias, are both implicated in preterm birth. While ACEs scores have been found to be associated with preterm birth, the results for allostatic load are mixed. The results suggest that more attention should be paid to mitigating the stress associated …

Optimizing Fall Prevention: A Quality Improvement Initiative To Enhance Documentation And Intervention Accuracy Using The Hester Davis Scale In Medical-Surgical Units, Kiana Conn, Brooklin Hunter-Johnson, Jashan Kahlon, Adrian Paz

Master's Projects and Capstones

Falls among hospitalized patients remain a critical safety concern, particularly in medical-surgical units caring for geriatric and oncology patients. This quality improvement project aimed to evaluate and address gaps in adherence to fall prevention protocols by utilizing the Hester Davis Scale (HDS) in two medical-surgical units at a large metropolitan hospital in Southern California. The project focused on auditing current practices to identify inconsistencies in documentation and intervention implementation, emphasizing areas such as bed alarm activation, fall risk signage placement, and armband use. Weekly audits were conducted from October 3 to October 29, 2024, to establish baseline data and inform …

Improving Anesthesia Technician Workflow: Implementation Of A Standardized Checklist And Formal Handoff Communication Tool To Enhance Management Of The Pediatric Portable Anesthesia Lockers Recommendation, Megan Shayna Sosnick Msel, Rn

Master's Projects and Capstones

Objective: The surgical department of a well-known Bay Area medical center faces substantial challenges in supply management. These challenges include inconsistent stocking, disorganized storage, and an inefficient ordering process. These logistical issues impact patient care negatively, increase supply costs, and weaken team morale and communication. U.S. hospitals spend $83 billion annually on medical supplies, with $25.4 billion wasted on preventable material expenses (Balkhi et al., 2022). Aim and Methods: This quality improvement project aims to train 80% of anesthesia technicians in proper stocking procedures for portable pediatric anesthesia lockers within three months. Interventions include the implementation of a standardized …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In The Adult Oncology Population Through Improved Compliance With Oral Hygiene Protocols, Kenneth R. Brown

Master's Projects and Capstones

Objective

Oncology patients receiving chemotherapy are at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia, and aspiration pneumonia rates are higher than desired. Improved oral hygiene protocols and compliance in this population reduces the incidence of these complications.

Context and Background

The microsystem assessed includes six oncology units at Hospital A, a large California academic hospital. Aspiration pneumonia, commonly associated with MBI, is a life-threatening challenge that increases costs and complications in oncological treatment settings. An aspiration pneumonia task force focused on six oncology acute care units is committed to reducing the incidence of hospital acquired …

Transforming Care: Elevating Oral Hygiene Compliance To Combat Nosocomial Aspiration Pneumonia In Adult Oncology Patients, Karina Larrea

Master's Projects and Capstones

Objective Aspiration pneumonia is a preventable, yet common complication in oncology patients undergoing chemotherapy, steered by suboptimal compliance with oral hygiene protocols and elevated susceptibility due to mucosal barrier injuries. Despite its major impact on healthcare costs and morbidity, compliance with evidence-based practices remains inadequate. Aim This project aimed to decrease nosocomial aspiration pneumonia rates from 1.5% to 1.3% by enhancing oral hygiene compliance from 41% to 70% over a 12-week period. Methods Proposed interventions included implementing paired oral hygiene order sets into electronic medical records, once-per-shift cues, staggered patient education sessions, and staff education on standardized protocols. Pre-intervention data …

Implementation Of A Food Security Program To Reduce Hypertension At A Primary Care Clinic, Maribel Ballesteros

Master's Projects and Capstones

The food security program aims to reduce hypertension and food insecurity by increasing access to fresh fruits and vegetables. Although food insecurity is a growing public health issue, the food security program experienced significantly low enrollment compared to projected values. The quality improvement project was conducted in an adult medicine department in a primary care clinic in San Francisco serving the Latinx community. To address the issue of low program enrollment, a comprehensive educational food security program flyer was developed containing program information, including frequently asked questions. The flyer aimed to increase program enrollments by increasing program education. Fifty flyers …

Optimizing Peripartum Bedside Reports Through Patient-Centered Communication, Harpreet Kaur

Master's Projects and Capstones

Abstract

Background Effective patient-centered communication (PCC) during bedside shift reports (BSR) is crucial in peripartum care, where patients face physical recovery and emotional adjustment. However, communication gaps during transitions from labor and delivery (L&D) to postpartum (PP) units can lead to patient dissatisfaction and misinterpretation of care instructions. Hospital A, an urban tertiary care medical center in San Francisco, operates a peripartum mesosystem across two floors with 35 dedicated beds. Aim The project aims to increase patient satisfaction by implementing patient-centered language in bedside reports for peripartum units from 70% to 80% for a three-week period. Methods Stakeholder engagement, a …

Utilizing Pupper, A Social Robot Dog, To Increase Happiness And Improve Mood In Pediatric Patients Of A Cardiac Step-Down Unit, Angela Feng Wu

Master's Projects and Capstones

Objective The usage of social robots in pediatrics is an emerging field of study. Preliminary research shows that they are effective at improving the psychosocial well-being of pediatric patients. This quality improvement project focuses on Pupper, a newly developed quadruped social robot dog, and its ability in improving mood and happiness in pediatric patients of a cardiac step-down unit. Aim The aim of this project is to increase average mood scores of pediatric cardiac patients aged 3-25 years by 50% from their baseline of 3.75 to 5.63 on a six-point scale within a one-month time frame. Methods Before intervention and …

Implementing Donna Wright’S Competency Model For Enhancing Nursing Professional Development In Pediatric Perioperative Units, Justin C. Chu

Master's Projects and Capstones

Background Hundreds of thousands of deaths occur in hospitals annually due to preventable adverse events. As literature shows nurse competency is positively associated with improved patient outcomes, it is the mission of any healthcare organization to continually improve staff competency. Bay Area Children’s Hospital X is looking to adopt the Donna Wright Competency Model (DWCM) to change the way they approach this process, transitioning from traditional methods of manager-selected competencies to a collaborative, shared governance approach. Objectives Utilizing the DWCM, the project goal is to enhance competencies among 90 nurses in pediatric perioperative units. The ultimate goal is to create …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

The Abusive Effects Of Trauma On Leadership Styles And Performance, Robert Kraft

Doctor of Ministry Major Applied Project

This Doctor of Ministry (DMin) Major Applied Project (MAP) investigates the relationship between toxic leadership in the military and trauma, particular how trauma can have negative, abusive effects on leadership style and performance. Most research in this area addresses trauma in postvention. This MAP addresses trauma’s potential effect on leadership style and explores the use of a pre-emptive, preventative training. Leadership theory is explored as well as trauma in the form of mental disorders, such as PTSD and narcissism. The author’s experience as an ordained pastor of The Lutheran Church—Missouri Synod, serving as an Army Chaplain, revealed the value of …