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 …

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 …

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 …

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 …

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 …

Simulation Based Post-Partum Hemorrhage Training In Nigeria: A Pilot Project, Nneka Chukwu

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is one of the leading causes of mortality and morbidity among childbearing women globally (Ononge, Mirembe, Wandabwa, & Campbell, 2016). Although this outcome is preventable, it remains a significant cause of death among women, especially in underdeveloped countries. This paper examines an educational project that was aimed to increase the knowledge of student midwives and registered midwives in a rural academic setting in Nigeria.

Methods: A one-day educational pilot training which consisted of a didactic component and a case-based simulation training focused on identifying risk factors, assessment techniques, and management protocols for the PPH patient. There were …

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 …

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 …

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 …

Mentor-Based Orientation Program, Sheryl Pinugu Bano

Master's Projects and Capstones

The intention of this quality improvement project is to improve the process of staff development in a 16-bed, acute rehabilitation unit by implementing a mentor-based orientation program. Rehabilitation nursing is a specialty that requires knowledge of the rehab philosophy and milieu. The lack of a rehab-specific educational component of the orientation process causes the new nurses anxiety and dissatisfaction which negatively impacts nurse retention. The project aims to improve the confidence and competence of new nurses, decrease nurse turnover rate, and increase nurse retention by providing a rehab-specific, orientation class. The MiRehab booklet and a PowerPoint presentation were …

Assessment Of Falls On A Medical-Telemetry Unit, Sahar Taravati

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical-Telemetry unit.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a fall occurs. As a hospital organization, it is important to ensure funds are going to the appropriate places. Currently the metropolitan hospital had …

Improving Nurses' Proficiency And Confidence In The Use Of Aromatherapy For Patients In The Hospice Setting, Erika Bigwood-Keaton

Master's Projects and Capstones

The Institute of Medicine noted patient centered care as one of the six priority areas of improvement for the U.S. healthcare system. Recognizing that patients in hospice require specialized care to address the physical, emotional and spiritual needs that are associated with a terminal illness, the focus of this project is to improve the hospice nurses’ knowledge of and confidence in the use of aromatherapy for symptom management. There is recognition within the field of healthcare that patients are interested in having options for treatment. With little to no side effects, aromatherapy has been shown to be an effective alternative …

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 …

No More Baby Steps: Preventing Unintended Pregnancies Of Los Angles Minorities And Adolescents, Rachel Bass

Master's Projects and Capstones

Previous studies have identified pregnancy intention to correlate with both maternal and fetal health. Though unintended pregnancy rates are dropping in America, they remain high among minority and young women. Contraceptive usage, a leading protective factor for unintended pregnancies, has been found to vary greatly by age and ethnicity. These two projects aimed to decrease unintended pregnancy rates through increasing patient knowledge of contraceptive options and correct usage. The first project focused on creating a comprehensive, oral contraceptive pill instructional handout for research participants of the birth control pill study. This handout was created through the analysis of compliance errors …

Assessment Of Falls Protocol Use On Medical-Telemetry Units, Fanny Ku

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to identify a root cause analysis for an increase in falls at a large, metropolitan hospital and implement interventions designed to reduce the incidence of falls on the medical-telemetry unit.

Background: Falls, regardless of severity, may inflict irreparable consequences on patients, families, and hospitals. Approximately 20-30% of falls result in physical or emotional harm, including minor bruises, emotional trauma, and fractures (“Falls,” 2004). When falls occur, hospitals are generally responsible for all costs incurred from the sentinel event, and do not receive re-imbursement from insurances for services provided. In the large, …

A Multi-Prong Fall Awareness Program To Reduce The Occurrence Of Falls In A Skilled Nursing Unit, Cheri Labrador

Master's Projects and Capstones

Abstract

A multi-prong falls awareness program to reduce the occurrence of falls in a skilled nursing unit

Keywords: Fall awareness program, skilled nursing unit, fall rate

The project goal was to reduce the patient fall rate by 20% by implementing a fall awareness program for clinical staff. The program had two prongs and began with a pre-survey to determine current fall prevention knowledge. The staff was encouraged to participate in the training by providing risk factors that contribute to falls and simple strategies to prevent falls based on their knowledge of the patients (Boushon et al, 2012). A post-survey was …

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 …

Improving Early Sepsis Identification On Inpatient Units, Monica Schurle

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. In order to reduce the number of patients who decline to sepsis in hospital, an efficient sepsis protocol needs to be implemented. Nursing practices, knowledge, and early recognition of systemic inflammatory response syndrome (SIRS) were assessed and measured in order to implement effective interventions. A root cause analysis was conducted to identify any discrepancies with compliance performing the sepsis screening in a timely manner, identify …

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 …

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 …

Implementation Of A Fruit And Vegetable Voucher Program In San Francisco, Alexandra Kambur

Master's Projects and Capstones

Chronic disease has emerged as the predominant public health challenge of the 21st century. Chronic diseases like cardiovascular disease, cancer, type 2 diabetes and obesity have maintained their top positions as the leading causes of poor health, disability, death, and high health-care expenditures for over a decade. Health and hunger go hand-in-hand. Today over 15 million households in the United States struggle with food insecurity, meaning they do not have sufficient access to food that meets their dietary needs for an active and healthy life. The issue of food insecurity in cities like San Francisco, California is exacerbated by the …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno

Master's Projects and Capstones

With mentorship being a key to addressing several issues at a large community medical center, the leadership of the institution engaged with students of a Clinical Nurse Leader (CNL) Program to conduct a thorough assessment. This paper addresses the charge for a standardized and formalized evidence-based approach to a nurse mentorship program to address key areas that enhance not only the work environment but also the quality of care. These key areas include the 1) promotion of professional development and engagement via 2) acquisition of skills necessary to achieve nursing competence, 3) address lateral violence, 4) increase in staff retention …

Assessment Of Falls On A Medical-Telemetry Unit, Andie Reed

Master's Projects and Capstones

The purpose of this quality improvement project aimed at reducing falls on a medical-telemetry unit in a large metropolitan Magnet hospital. It was important for the MSN/CNL students to focus on falls because it is not just a concern for this institution, it is a national dilemma that needs to be addressed. Due to the complexities and intricate details of the IRB process, the MSN/CNL students were unable to collect data or further advance their project into the microsystem. Instead, information was attained from the University of San Francisco database to allow the MSN/CNL students to continue with the steps …

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 …

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 …

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 …

The Clinical Nurse Leader: Improving Early Sepsis Identification On Inpatient Units, Denise G. Lopez

Master's Projects and Capstones

CNL students were invited to a large metropolitan hospital in an effort to create a quality improvement project related to sepsis in order to decrease cost, the length of stay, and improve patient outcomes. CNL students shadowed nurses in order to better un derstand the nursing culture and assess the microsystem. Chart audits were reviewed to determine whether nurses at the assigned units were completing sepsis screenings on time and used the appropriate vital signs and labs. Nurses’ questionnaires were provi ded to assess sepsis knowledge and their understanding of sepsis. Results showed a lack in compliance in completing sepsis …

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 …

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 …