Medicine and Health Sciences Commons^™

An Online Self-Directed Learning Module For Regional Stroke Survey Success, Winchell Rodriguez Kuttner

Doctor of Nursing Practice (DNP) Projects

The lack of a standardized education for stroke coordinators focusing on The Joint Commission (TJC) standards and requirements in preparation for the stroke program disease-specific care (DSC) certification survey every two years has led to undue added stress prior to survey. The development of tools and resources has been identified to address the current educational gap in stroke coordinator orientation. This project addressed the gap by creating an online, self-directed learning module to assist the stroke coordinators in knowledge acquisition of the stroke standards and requirements.

A stroke coordinator plays a critical role in stroke care delivery. An educational module …

An Education Program For Novice Nurses To Increase Case Management Knowledge, Emily Trefethen

Doctor of Nursing Practice (DNP) Projects

Problem: Heart failure (HF) is a chronic disease where the heart cannot deliver an adequate amount of blood that the body requires. HF is one of the costliest cardiovascular diseases plaguing public health in the United States (Go et al., 2014). HF is the main reason for hospitalizations in adults and a leading contributor to the rise in healthcare costs. Approximately 25% of Medicare patients are readmitted within 30-days of discharge (Go et al., 2013). To address excessive hospital readmissions, the Centers for Medicare and Medicaid Services (2019) initiated the Hospital Readmissions Reduction Program in October 2012 to reduce Medicare …

A Performance Improvement Nursing Fellowship To Enhance Timely Access To Care, Cheryl Reinking

Doctor of Nursing Practice (DNP) Projects

This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient …

Identification Of Victims Of Human Trafficking: Leading Change Through A Global Pandemic, Connie Clemmons-Brown

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was …

Chief Nurse Executive Work Engagement: System Leadership Through A Natural Disaster, Strike, And Pandemic, Ryan Fuller

Doctor of Nursing Practice (DNP) Projects

Problem. In a 21-hospital region of a 39-hospital integrated health system, CNE turnover peaked at 63% (12 CNEs) in 2015. Interviews were conducted in 2019 with 12 CNEs across the region to understand potential issues related to CNE job satisfaction. Responses revealed concerns regarding empowerment, alignment, work-life balance, information transparency/sharing, and recognition. While identifying a solution to address CNE concerns, the organization experienced successive crisis events during a 12-month period that included a record-setting wildfire, multiple labor union strikes, and a novel pandemic. The regional leadership team (RLT) required new approaches to facilitate effective communication during a crisis between the …

Implementation Of Artificial Intelligence Initiated Rapid Responses To Reduce In-Hospital Cardiac Arrest, Alicia Potolsky

Doctor of Nursing Practice (DNP) Projects

Hospitals with strong and consistently activated rapid response teams (RRTs) have significantly fewer cardiac arrests. Early recognition of clinical deterioration supports the timely activation of RRTs, which increases earlier assessment and intervention. Current early warning tools are not sufficient and reliable for recognizing patient deterioration, and they are evolving, incorporating artificial intelligence (AI) to identify clinical decline much earlier. The project organization had previously implemented the medical early warning score tool into the RRT nurses’ practice to prioritize patient assessments, but this was not sustained due to its unreliability in identifying patients at risk.

Aiming to reduce the number of …

Creating A Thriving Informatics Culture, Nicholas Webb

Doctor of Nursing Practice (DNP) Projects

Nurses thrive best when they are empowered to make decisions that can positively impact healthcare delivery. Knowledge and application of nursing informatics principles can influence clinical, quality, operational, and financial outcomes in ways that were not available in previous professional nursing generations.

If nursing informatics is the solution, what is the problem? A survey regarding use and attitudes about nursing informatics was taken of chief nurse executives (CNEs) at an integrated, not for profit healthcare system in the Northern California region, where the author oversees the electronic health record (EHR). The results were surprising. Half said they did not know …

Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish

Doctor of Nursing Practice (DNP) Projects

Continuous Glucose Monitoring and Diabetes Management During Pregnancy

Abstract

According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …

Valley Fever: Education For Primary Care Providers And Allied Health Care Professionals, Michelle Elizabeth Bergen

Doctor of Nursing Practice (DNP) Projects

Valley Fever: Educating Primary Care Providers and Allied Healthcare Professionals

Abstract

Problem: Coccidioidomycosis (cocci), informally Valley Fever (VF), infects the lungs with the fungal spore coccidioides. It is prevalent in areas where soil disturbance occurs. Currently, there are no related educational or standardized guidelines exist for primary care providers (PCPs) in California’s Central Valley, where VF is highly endemic (Centers for Disease Control and Prevention, 2018).

Context: A Doctor of Nursing Practice project educational program for PCPs and allied healthcare workers (AHWs) at the Adventist Health Central Valley Network (AHCVN) clinics. The project aimed to educate PCPs to …

Pre-Conception Screening Tool, Nnenna Abaeze

Doctor of Nursing Practice (DNP) Projects

Problem: Sexually active women between the ages of 14 and 44 are at risk of pregnancy. This risk puts these women at high rate of unintended pregnancies.

Purpose: Currently, there is a nationwide initiative, Healthy People 2030, to reduce the rate of unintended pregnancies. Pre-conception screening is a method of mitigating this concern. Women typically receive pre-conception screening from an obstetrician, whom they visit during their annual well woman visit. The primary care setting is unique because women typically visit a primary care provider more frequently than their obstetricians. Every visit to a primary care provider is an …

Preceptor As Frontline Leader Utilizing Emotional Intelligence, Dwanette Judkins

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem - This paper describes a DNP project implemented in an acute care hospital in 2020. The hospital implemented a nurse residency program, with an evidence-based preceptor role development (PRD) component, which proved to be beneficial in growing the nursing workforce and building infrastructure; however, nurse turnover increased.

Context – Preceptors expressed feeling unsupported and not valued. The nurse executive team recommended the recognition committee expand its efforts to develop strategies to develop frontline leaders by building preceptor resiliency and increase retention. Preceptor development could positively impact the nursing workforce.

Intervention - The DNP student, was the executive sponsor …

Preconception Screening For Family Planning, Nnenna Abaeze

Doctor of Nursing Practice (DNP) Projects

Purpose/Objectives: The purpose of this literature review is to evaluate the effects of preconception screening tools on non-pregnant women between 13 and 44 years old in the primary care setting. The primary care setting is unique because non-pregnant women often visit a primary care provider more frequently than they visit their obstetrician/gynecologists when not pregnant. Every visit to a primary care provider is an opportunity to discuss family planning and evaluate potential health risk factors.

Data Sources: A literature search of peer-reviewed articles from 2010 to 2020 was conducted. The databases searched included: Cumulative Index to Nursing and …

Impact Of Cd82 Expression On Acute Myeloid Leukemia Chemosensitivity And Quiescence, Muskan Floren

Biomedical Sciences ETDs

Acute Myeloid Leukemia (AML) patients respond favorably to induction chemotherapy, however, long-term outcomes remain poor due to a high rate of chemoresistance and bone marrow minimal residual disease. To improve long-term patient outcomes, it’s critical to identify regulators of chemotherapy resistance in AML and develop therapies that are directed towards bone marrow resident AML cells. In Chapter 2, we uncover the impact of CD82 expression in AML response to chemotherapeutic treatment and the contribution of Protein Kinase C α (PKCα) and β1 integrin signaling in promoting p38 MAPK activation to support CD82-mediated AML cell survival. In Chapter 3, we …

Earlier Palliative Care Referrals For Nephrology Patients, Jerold Cohen

Doctor of Nursing Practice (DNP) Projects

Palliative care prevents and relieves suffering through the early identification and treatment of pain and other symptoms, which can be physical, psychosocial, or spiritual (World Health Organization, 2018). It is usually considered a service provided to oncology patients and has positively impacted their treatment. However, it is not as common for many other diseases where the patient would benefit from palliative care involvement. Presently, if palliative care is offered to nephrology patients, it is after they have started dialysis and are having second thoughts whether to continue this treatment plan as it has either become less effective or is interfering …

#Leadershipaccelerated: A Coach Mindset Focused Leadership Development Program, Diane Rindlisbacher

Doctor of Nursing Practice (DNP) Projects

Problem: Developing leaders to lead in environments that are dynamic, complex, and ambiguous is an area of focus for healthcare leaders. How leaders lead and how organizations develop leaders is tied to the outcomes they achieve (Development Dimensions International [DDI], 2019; Moldoveanu & Narayandas, 2019; Till, Dutta, & McKimm, 2016). To create a climate of trust and safety where teams succeed requires leaders to embed key attributes and competencies into their day-to-day work.

Context: A leader’s ability to create a climate of trust and safety and to adopt and apply a coach mindset to their work is intended to help …

Illicit Substance Use In Acute Care Hospitals: Creating A Safe Environment, Christina Sanford

Doctor of Nursing Practice (DNP) Projects

Problem: In January 2019, a medium-sized acute care hospital in Northern California reported new safety concerns related to patients using illicit substances in the hospital.

Context: Leaving the hospital AMA is an increasing problem in acute care hospitals among patients who use illicit substances, with a rate of 25% to 30% (Ti & Ti, 2015). Grewal et al. (2015) conducted a study of over 1,000 illicit substance users who had experienced a hospitalization, where 43.9% reported use of illicit substances while in the hospital.

Intervention: The project was the creation, implementation, testing, and evaluation of multiple interventions to improve …

Application Of Sustainability Framework For Quality Improvement In An Integrated Health System, Cristine Lacerna

Doctor of Nursing Practice (DNP) Projects

Problem: Sustaining improvement in quality and patient safety is a critical challenge confronting healthcare today (Lennox, Maher & Reed, 2018). Failure to sustain the gains achieved with the improvement and results in harmful patient outcomes, wasted resources, and impact future improvement work (Lennox et al., 2018). Context: To address this challenge, the organization for this DNP project was a large, integrated healthcare system with 21 medical centers in Northern California with a redesigned a regional quality program to focus primarily on supporting the sustainability of patient safety initiatives that have been successfully implemented and spread. Interventions: Two frameworks from the …

Implementing Virtual Sitters To Reduce Falls And Sitter Costs, Asia Quovadis Williams Plahar

Doctor of Nursing Practice (DNP) Projects

The setting for this DNP project was a 326-bed, suburban hospital in Northern California that was facing challenges with preventing falls with injury and rising sitter costs. Between May 2018 and June 2019, there were four sentinel events related to falls with significant injuries. This hospital was financially impacted by the growing cost of the expanding sitter program caused by the rising elderly patient population, with demographics requiring one-to-one, in-person sitters to observe them visually. There is ample research demonstrating the utility of video monitoring systems to improve patient safety by reducing falls, enhancing staff safety by reducing workplace injuries …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

Using Simulation For Oncology Nursing Competency Evaluation In Hospitals, Dana Littlepge

Doctor of Nursing Practice (DNP) Projects

Problem Oncologic patients requiring acute nursing care are usually admitted to the designated oncologic medical surgical nursing unit, these care settings often have low admission volumes of oncologic patients that require chemotherapy and or post-therapy care (Muehlbauer, Parr, & Perkins, 2013). Nurses in these environments have reported decreased professional confidence and not feeling safe enough to administer chemotherapy, monitor, and care for cancer patients (Muehlbauer, Parr, & Perkins, 2013).

Context: The current education structure for many hospitals in an integrated healthcare system, does not consistently provide all the components needed for an onsite oncologic nursing competency validation program. Developing a …

Creating An Educational Intervention To Combat Nursing Incivility Benchmark Study, Kathleen P. Melancon

MSN Capstone Projects

When most people reflect on the nursing as a profession, the term compassionate typically comes to mind. The association with compassion is no surprise as nursing is considered to be the most compassionate profession in the world. Nurses, by trade and in all areas of practice, have an ethical and professional responsibility to create and uphold an environment of mutual respect and civility. However, the notion of “nurses eat their young” and the behaviors that stem from this mindset are causing detrimental effects not only to those organizations employing nurses but to patients and the nurses themselves.

Over the last …

Workplace Wellness For Educators Of High-Risk Youth, Charissa Endow, Susan Macdermott, Becki Cohill, Karen Park

Fall 2020 Virtual OTD Capstone Symposium

Teaching is well-documented as a high-stress career and teachers who work with high-risk youth are exposed to additional stressors exacerbating this problem (Bottiani et al., 2019).

An in-depth needs assessment was conducted using an online survey, observations, interviews, and the Maslach Burnout Inventory-Educator Survey. The needs assessment revealed demand to increase communication and positive acknowledgment, promote a healthier lifestyle, and provide more wellness resources.

A program was developed and proposed to address high psychological stress and burnout which can result in teachers experiencing dissatisfaction, absenteeism, and high turnover. The program is designed to help enhance workplace wellness for teachers and …

Life After Death: An Occupational Therapy Perspective On Supporting Hospice Caregivers In The Transition Out Of The Caregiver Role, Shreya Patel, Susan Macdermott, Becki Cohill, Karen Park

Fall 2020 Virtual OTD Capstone Symposium

A phenomenological study was conducted to evaluate the occupational impact of transitioning out of the hospice family caregiver role in order to define and advocate for occupational therapy’s role in hospice and bereavement care, during and after hospice services. This study was conducted using qualitative in-depth interviews of former hospice family caregivers recruited from Facebook groups, online caregiver forums, and snowball sampling. Interviews were transcribed verbatim, coded using the software Dedoose, and analyzed thematically. The results of the thematic analysis suggested that the occupational impact of losing the caregiver role is correlated to (1) the quality of support systems, (2) …

Exploring Accessibility And Social Inclusion For Deaf And Hard Of Hearing Children In Residential Camps Through The Occupational Therapy Lens, Tiffany Coles, Susan Macdermott, Becki Cohill

Fall 2020 Virtual OTD Capstone Symposium

Children engage in various play, leisure, and social participation activities to enhance the development of life skills, independence, and social skills. Residential camps provide an opportunity to engage in leisure activities while learning to become independent and self-confident while socializing and making new friends. However, having a disability such as deafness and hearing loss may impact the camper’s experience.

This digital guidebook offers videos, pop-in information, and links to valuable resources for working with and understanding the Deaf and Hard of Hearing culture. The guidebook incorporates inclusionary strategies to help the campers and the staff develop inclusive mindsets and social …

Increasing Engagement In The Occupation Of Camping For Older Adults, Brittney Grant, Susan Macdermott, Becki Cohill, Karen Park

Fall 2020 Virtual OTD Capstone Symposium

Older adults report they disengage from adventurous leisure activities as they age, such as camping, because it becomes more physically difficult to complete and it is challenging to find peers willing to participate. A study was developed to determine strengths and challenges (if any) older adults (65+) experience while participating in the occupation of camping. Mixed methods virtual surveys (n=64) and semi structured interviews (n=19) were implemented to develop qualitative and quantitative data. The results were categorized into five themes: barriers and challenges affecting participation in camping, camping for socialization, upgrade in accommodation for increased “creature comforts”, camping as a …

Creating A Sustainable Occupational Therapy International Collaboration Through The Development Of A Cross-Cultural Pediatric Experience, Melissa Valencia, Becki Cohill, Beverly Hoffman, Susan Macdermott, Karen Park

Fall 2020 Virtual OTD Capstone Symposium

The multicultural population is expected to rise to 56% by the year 2060 (U.S. Census Bureau, 2017). Despite the ongoing increase in cultural diversity of the U.S. population, there still continues to be limited diversity in the field of occupational therapy (Crowe et al., 2016). In academia, it is recognized that there is a need for a necessary to focus on culture and occupational therapy. However, it is questioned to what extent this is actually implemented into the academic curriculum as what constitutes cultural competency in entry level practitioners varies (Humbert et al., 2012). Society is becoming less mono-cultural, indicating …

The Role Of Occupational Therapy In School Disciplinary Practices, Trisha Irwin, Angela Blackwell, Anne H. Watson, Steven M. Gerardi

Fall 2020 Virtual OTD Capstone Symposium

The capstone project discusses disproportionate rates of disciplinary practices utilized in public education and examines the negative impact current disciplinary practices have on adolescent well-being, school climate, student engagement, and student outcomes. Public schools across the United States are utilizing exclusionary disciplinary practices wherein the consequence often is more extreme than necessary, influencing continued student misconduct, failing to address trauma and deficits in social-emotional skills, and limiting academic performance and participation for all students.

The purpose of this project is to inform occupational therapy practitioners of their potential roles in addressing school disciplinary practices to better support students in promoting …

Occupational Therapist Role In Post-Secondary Education Transition Program: Emphasis On Self-Advocacy Skills, Nikki Voorhees, Becki Cohill, Susan Macdermott

Fall 2020 Virtual OTD Capstone Symposium

It is becoming increasingly important for individuals to obtain post-secondary education in order to gain employment (Alverson et al., 2019; Chandroo et al., 2018). This increased importance to attend post-secondary education makes it imperative for students who are graduating from high school to be fully prepared for the transition to post-secondary education (Rothman et al., 2008). The transition from high school to post-secondary education is difficult for any individual. However, it is even more difficult for students with learning differences, as they tend to have problems in the areas of social skills, communication, problem solving, self-advocacy, and executive functioning (Alverson …

Improving Frequency Of Hand Hygiene Education From Providers To Patients, Christopher Sutton, Nancy Moran, Vanessa Hernandez

Master's Projects and Capstones

Hand hygiene compliance is one of the most simplest forms of preventing infection. This paper focuses on improving the frequency and standardizing hand hygiene education to patients delivered by health care professionals from a primary care clinic. The ambulatory suburban community clinic in Oakland primarily serves the underserved population. The target population are the following providers: Physicians, Physician Assistants, Nurse Practitioners, Registered Nurse, Licensed Practical Nurse, and Medical Assistants. A survey was adapted from evidence-based studies, WHO, and CDC to collect data on current hand hygiene education provided to patients from healthcare professionals. An additional survey was given to patients …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …