Medicine and Health Sciences Commons^™

Increasing Nursing Policy And Advocacy Engagement, Marketa Houskova

Doctor of Nursing Practice (DNP) Projects

At present, professional nursing does not benefit from strong policy development and advocacy influence in the United States. This project focused on CA nursing policy development and advocacy influence deficit among new members of a statewide professional nursing association. There are nearly 457,000 licensed registered nurses (RNs) in CA (BRN, 2019) and around 3.8 million RNs in the United States (AACN, 2019) making CA RNs twelve percent of the national nursing workforce. Yet only five percent of RNs serve on hospital boards, and legislative efforts to advance important nursing issues such as full practice authority for advanced practice RNs in …

Improving Chronic Hepatitis B Virus Screening At A Safety-Net Primary Care Clinic, Uwaezu J. Umeh

Doctor of Nursing Practice (DNP) Projects

Hepatitis B Virus (HBV) is a type of virus that affects the liver. Chronic hepatitis B is usually asymptomatic and many HBV carriers remain unaware of their viral status, thereby may unknowingly transmit the disease. If left untreated or undetected, it could lead to cirrhosis, hepatocellular carcinoma or mortality. Although this virus is endemic in some parts of the world such as Asia and Africa, it is important to note that HBV has become a global problem. The Centers for Disease Control and Prevention (CDC) in conjunction with the United States Preventive Services Task Force (USPSTF) estimates that about 700,000 …

Adopting Complex Case Management Competencies, Phyllis Stark

Doctor of Nursing Practice (DNP) Projects

Improving disposition management of complex hospitalized patients is crucial to the success of acute care facilities. Most hospital patients discharge in less than 5 days, but there is a cohort of complex patients whose length of stay far-exceeds the norm (Centers for Medicare and Medicaid Service Website, n.d.). Today’s case managers are focused on patients who are discharging today or tomorrow in order to keep hospital census cycling through. This phenomenon known as “throughput” drives daily operations and is a measure of success. When case managers are faced with complex patients whose length of stay measured in weeks, months, or …

A Quality Improvement Project To Implement Shared Medical Appointments For The Management Of Type 2 Diabetes In Latino Patients, Denisse Maldonado

Doctor of Nursing Practice (DNP) Projects

Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource …

Expanding Magnetic Resonance Imaging Access For Patients With Cardiovascular Implantable Electronic Devices, Rosalie Geronimo

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with non-conditional cardiovascular implantable electronic devices (CIEDs), which lack magnetic resonance imaging (MRI) components, are unable to undergo MRI.

Context. The Heart Rhythm Society guidelines for patient device management and Centers for Medicare and Medicaid Services requirements for persons with specific expertise in implanted permanent devices to manage CIEDs during MRI spurred policy, procedure and staffing changes.

Interventions. The evidence-based change-of-practice project comprised of workflow development, policy and procedure changes, implementation of required staffing support to manage the CIED during an MRI.

Measures: The outcome measure was to improve access to MRI for patients with CIEDs, measured …

Perceptions Of Nurses After The First Year Of Practice: Expectations And Reality, Susan R. Lesser

Dissertations & Theses (Open Access)

Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems.

Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and …

Nursing Practice Meets Theory, Debra J. Morton

Doctor of Nursing Practice (DNP) Projects

These are challenging times for nurse leaders. Over the last decade, debates on healthcare reform have focused on the cost of care in the United States. This discussion has placed increasing pressure on nurse leaders to operate organizations that are more efficient, while improving quality and patient outcomes.

The practice of commanding and directive leadership has never been effective long term. Nurses want leaders to make sense of a situation and explain the why. With the growing trend toward hospital reimbursement for performance measures that are nurse-driven and informed consumers with higher expectations than ever before, it is vital …

Strengthening The Advanced Practice Clinician Workforce Pipeline Through Preceptor Education And Support, Tarina Levitt-Trujillo

Doctor of Nursing Practice (DNP) Projects

Problem: The Advanced Practice Clinician (APC) workforce pipeline is dependent on clinical training opportunities. Clinician providers are encouraged to precept students but rarely are offered support tools to ensure a successful process. Lack of adequate support can result in a suboptimal outcome for the APC students.

Context: Clinician preceptors in a large healthcare organization looking to build a robust APC pipeline to support future patient populations.

Interventions: Preceptor materials were developed and delivered to clinical preceptors to help them successfully precept advanced practice clinician students during their clinical rotations. This material consisted of 20 microlearning modules to help clinicians …

Nurse Manager Succession Planning: Building A Leadership Pipeline For The Future, Katie Stephens

Doctor of Nursing Practice (DNP) Projects

Problem. This academic medical center was increasing bed-capacity and needed to hire 12 additional nurse managers (NM) to meet these new requirements. Promoting assistant nurse managers (ANM) to the NM role saves time and money, supports leadership and cultural continuity, and demonstrates a strong organizational commitment to internal human capital.

Context. Formal nurse manager succession planning (NMSP) programs have been shown to increase nurse manager competency and retention rates, while also helping to identify and develop new generations of nurse leaders. To mitigate the recent loss of ANMs and strengthen the remaining leadership bench strength, the organization is developing, implementing, …

Dnp Project: Development Of A Nurse-Led Pop-Up Clinic Model In San Diego, Jennifer King

Doctor of Nursing Practice (DNP) Projects

Baccalaureate nursing programs across California (CA) are required by the state board of nursing to provide theory of public health and applied clinical learning to meet the requirements of the state’s public health nurse (PHN) certification. Students in Bachelor of Science in Nursing (BSN) programs are expected to enter the workforce prepared to address population health needs that synthesize community-based assessment and understand epidemiologic approaches to strategize interventions in diverse populations at the local, state and national levels. To adequately prepare nurses for true population health practice, clinical experiences need to be in appropriate settings where they can apply theory …

Coaching Nurse Leaders In Conflict Management And Team Building To Improve Retention, Jeanette Black

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Retention of assistant nurse managers (ANMs) was identified as a concern from interviews with executive leadership and ANMs employed at a large hospital within a Northern California integrated health system. The nurse leader orientation training was reviewed, with gaps identified in conflict management and team building.

Context: The attrition rate of U.S. nurse managers in 2010 was 8.3%, higher than executive nurse leaders, with replacement costs equal to 75% - 125% of a nurse manager’s salary (Loveridge, 2017). Employee turnover and dissatisfaction due to conflict can have detrimental effects on retention, productivity, morale, and quality of patient care. …

Mindfulness-Based Stress Reduction Activities Via Smartphone In Advanced Practice Providers: A Pilot Quality Improvement Project To Reduce Perceived Stress, Burnout, And Intent To Leave, Cynthia L. Larsen-Bednarchik

Doctor of Nursing Practice Projects

Abstract

Burnout, attrition, and decreased work engagement among Advanced Practice Providers (APPs) are growing concerns and can have a negative influence on health care provider wellbeing. Chronic workplace stress is linked to various physical health problems, such as fatigue, insomnia, heart disease, depression, anxiety, and obesity. Chronic provider burnout is costly and extends to organizations and hospitals due to higher attrition, increased absenteeism, and decreased work engagement. Mindfulness-based stress reduction (MBSR) programs focus on the intent of practicing mindfulness to cultivate a state of being that is nonjudgmental, openhearted, friendly, curious, accepting, and compassionate. MBSR programs afford clinicians a way …

Improving Discharge Medication Education On A Sepsis Unit: A Quality Improvement Project, Maria Noguez

Master's Projects and Capstones

Ineffective discharge education plays a role in increased readmission rates, adverse drug events, and worsened patient outcomes post-hospitalization. When combined, the resulting financial burden on America’s healthcare system is exorbitant, as is the physical and mental toll on unsuspecting patients. To close the current gaps in discharge teaching, this project is incorporating the teach-back method and utilizing updated medication handouts.

Starting on the sepsis unit of a large, local medical center – the Clinical Nurse Leader (CNL) interns employed assessment tools to identify areas for improvement. The data revealed rushed, incomprehensive discharge medication education and reflected in low HCAHPS scores …

Optimizing The Implementation And Dissemination Of The Recovery Model Approach, Lani Schofield

Master's Projects and Capstones

For a period of nine months spanning 2018 and 2019, monthly patient satisfaction survey scores in a 22-bed sub-acute inpatient psychiatry unit at a safety-net hospital in California decreased significantly, which revealed that patients felt they were not receiving satisfactory care and which warranted calls for innovative approaches to improve care delivery. The patient experience of care affects recovery and length of stay. Because prolonged hospital stays result in increased costs and increased use of healthcare resources in hospital units, including sub-acute psychiatric microsystems, it benefits hospitals to improve the quality of patient care. In an effort to improve quality …

Improving Identification Of Ssi In Snf, Jennifer Teng Yuan Yu

Master's Projects and Capstones

Educational deficit in basic wound assessment can lead to failure to recognize early signs of infection or wound deterioration. Despite many challenges towards wound care, there are potential opportunities to reduce patient injury and clinical outcomes through continuing education. The purpose of this paper is to review literature on current wound care knowledge in nurses and assess existing wound care knowledge in nurses at a skilled nursing facility. A 10-question pre-test wound assessment quiz based on the Bates-Jensen Wound Assessment Tool (BWAT) selected by the Wound Care Coordinator (WCC)/Wound Care Specialist (WCS) was given to 22 nurses: 5 Registered Nurses …

Reducing Vascular Access Complications Through Precise Cannulation Plan Implementation, Rosemarie Quicho

Master's Projects and Capstones

Abstract

Aneurysm, which is the dilatation of the arteriovenous fistula (AVF), and pseudo-aneurysm, which is caused by leaking of blood outside the arteriovenous graft (AVG), pose a threat to the vascular access (VA) and the patient (Mudoni et al., 2015). Uneven vein penetration by dialysis needles and subsequent skin scarring lead to the development of inflammatory changes in the VA area. Scab formation masks the signs of ongoing inflammation. Damage to and tearing of the scab can then lead to lethal exsanguination from the VA (Handlos, Marecová, Smatanová, Dvořáček, & Dobiáš, 2018). Dialysis staff members are trained to use the …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Amanda Dailor, Macy Therese G. Andrada, Julie C. Barragan, Samantha T. Gerber, Mercedes S. Greenberg, Tatyana Grib

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause-Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures performed …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Use Of A Prevention Bundle To Reduce Colon Surgical Site Infections, Stephanie Kimberly Leong

Master's Projects and Capstones

Site Infections (SSIs) are the second highest amongst healthcare-associated infections (HAIs). SSI rates are disproportionally higher among colon surgeries, resulting in significant complications with adverse clinical and economic impacts (Keenan et al., 2014). The overall upward trend in SSI rates, including the increase colon SSI rates in 2018 called for immediate action in a 120-bed community medical center. A multidisciplinary team was assembled to implement an improvement initiative using evidence-based guidelines. An evidence-based care bundle was designed and implemented to prevent and reduce colon SSI rates. There are seven process measures: the use of chlorhexidine wipes preoperatively, hair clipping outside …

Implementation Of A Mentor Program To Support Nurse Retention: A Pilot Project, Lucy Camarena

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Primary factors affecting nurses’ decisions to stay at an organization include nurse self-concept, job satisfaction, and professional growth. A high turnover rate of nurses poses a risk to patients’ safety and healthcare outcomes. The implementation of mentor programs in institutions that employ new nurses has been shown to reduce turnover rates, increase the quality of patient care, and empower nurses in professional development. The existing literature supports the use of mentor programs and encourages their implementation in healthcare institutions.

Interventions: The DNP project’s goal was to identify effective methods of promoting positive nurse self-concept and increasing job satisfaction …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Transitions Of Care: Raising Awareness And Improving Identification Of The Social Determinants Of Health, Stephanie Le

Master's Projects and Capstones

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care.

Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease …

Implementing The Fast Track Improvement Bundle: A Total Joint Replacement Quality Improvement Project, Kathleen Cho, Grace Ryu, Laura Palmer, Crystal Eng, Shannon Danneman

Master's Projects and Capstones

The Fast Track program is a patient-centered and evidence-based intervention for post-surgical patients. It is widely used in many hospitals today because it has proven to promote early recovery, reduce postoperative complications, and decrease both length of stay and medical costs. Within a non-profit, Magnet community based hospital, the Fast Track program was implemented in April 2019. Currently, the success rate of the program is at 74%, which has warranted the initiation of a Quality Improvement (QI) project.

This project began with a microsystem assessment, root cause analysis (RCA), and strengths, weaknesses, opportunities, threats (SWOT) analysis. Four main barriers were …

Improving Discharge Medication Education On A Sepsis Unit: A Quality Improvement Project, Kayla Melton, Maria Noguez, Fabiola Lopez, Jillian Eisenberg, Deanna Lee

Master's Projects and Capstones

Ineffective discharge education plays a role in increased readmission rates, adverse drug events, and worsened patient outcomes post-hospitalization. When combined, the resulting financial burden on America’s healthcare system is exorbitant, as is the physical and mental toll on unsuspecting patients. To close the current gaps in discharge teaching, this project is incorporating the teach-back method and utilizing updated medication handouts.

Starting on the sepsis unit of a large, local medical center – the Clinical Nurse Leader (CNL) interns employed assessment tools to identify areas for improvement. The data revealed rushed, incomprehensive discharge medication education and reflected in low HCAHPS scores …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Julie Barragan, Macy Andrada, Mercedes Greenberg, Tatiana Grib, Samantha Gerber, Amanda Dailor

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause-Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures performed …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Tatyana Grib, Macy Therese G. Andrada, Julie C. Barragan, Amanda K. Dailor, Samantha T. Gerber, Mercedes S. Greenberg

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause- Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures …

An Approach To Increase Education In The Flu Vaccination Clinic Process, Koki Guangxi Inlow, Lucy Dale, Devante Lindsey, Nancy Tran Manalo, Elena Teresa Cleary

Master's Projects and Capstones

The Health Ministries Program, located in Orange County, is supported by a large faith-based community hospital and provides community resources such as flu vaccinations that are overseen by the Faith Community Nurse (FCN). In collaboration with the program, University of San Francisco (USF) nursing students researched and developed an implementation of a multi-purpose educational flyer to increase education and better streamline the process at flu vaccination clinics throughout Orange County faith-based organizations. Research shows that many individuals still do not get vaccinated due to misconceptions, misinformation, and lack of knowledge on the importance of flu vaccinations. The cost of flu-related …

Improving The Rate Of Hand Hygiene Immediately Before And After Wound Care In The Street Nurse Microsystem, Amanda Ramos Sandoval

Master's Projects and Capstones

The street nurse team of Sacramento, CA provides many services to patients who are experiencing homelessness, including a substantial amount of wound care. While the street nurses were performing hand hygiene (HH) prior to and after wound care, they would often not be performing it immediately prior and post-wound care. Because the nurses hike to their patients (who are living on the streets or in out of the way camps) the street nurses would often perform hand hygiene while at their cars prior to going to the patient and again when they returned to their cars after performing wound care. …

"Rise And Shine" Early Ambulation In Surgical Patients, Bhapinder Thiara

Master's Projects and Capstones

Abstract

An assessment done in a hospital unit established low rates of early ambulation for patients in postoperative care. At the same time, early ambulation after surgery has been shown to improve clinical outcomes and patient satisfaction. Some of the factors for the low rates of early ambulation include inadequate nurse staffing, poor teamwork, and the inability to utilize technology effectively. Consequently, a project was designed to empower nursing staff, promote interprofessional collaboration, and obtain technologies for ambulation. It is expected that the project will improve rates of early ambulation and lower hospital length of stay.

The Nurse’S Role In Prognosis-Related Communication In Pediatric Oncology Nursing Practice, Amy Rose Newman, Lauri Linder, Kristin Haglund

College of Nursing Faculty Research and Publications

The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses’ operational definition of PRC, (2) nurses’ roles in PRC, and (3) nurses’ preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished …