Medicine and Health Sciences Commons^™

Decreasing Maternal Breastfeeding Dissatisfaction During The Night Shift Related To Lactation Support, Robyn Caston

Master's Projects and Capstones

Abstract

Problem

This paper will discuss the Clinical Nurse Leader (CNL) project's specific aim: to decrease maternal dissatisfaction during the night shift related to lactation support in a high-risk maternal department.

Context

Research has shown that adding lactation support improves the decision to exclusively breastfeed and increases the duration. Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization, UNICEF, and the American Academy of Pediatrics. Many studies about lactation support have demonstrated the health benefits to mothers and their infants.

Interventions

A baseline survey will …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Employee Engagement And Increasing Patient Satisfaction In The Pediatric Outpatient Setting, Carol Liang

Master's Projects and Capstones

Problem: An ambulatory pediatric surgical center in the San Francisco Bay Area has an organizational goal of reaching the 85th percentile in NRC patient satisfaction scores. The annual compliance report states the current score is at 80.7 as of September 2021. These NRC findings indicate several areas for improvement including: (1) trust providers with care, (2) care providers listened, (3) was told when could leave, (4) got help as soon as wanted, (5) care provider explain things, (6) NPS: facility would recommend, and (7) procedure began on time.

Context: Priorities include implementing strategies to increase employee engagement and patient satisfaction. …

Diabetic Education In An Uninsured Patient Population, Amanda Whistler

Doctor of Nursing Practice Projects

Abstract

Patient education is an important factor in the management of Type 2 Diabetes. Successful outcomes can be causally related to proper patient education. Many times, patients are left with more questions than answers about their newly diagnosed condition. Some groups of patients are affected by prediabetes and diabetes more than other groups. Differences in health status or access to health care among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. This is a major concern in the United States for health care providers.

A spreadsheet was used to record the blood glucose levels of each …

Increasing Low-Dose Ct Screening In Primary Care, Bethany Huelskoetter

Doctor of Nursing Practice Projects

Abstract

Lung cancer was ranked as the second most common cancer diagnosed in 2020 and had the highest death rate compared to all other cancers, excluding nonmelanoma skin cancers (ACS). Early detection is key in decreasing the mortality of lung cancer. A low dose CT (LDCT) is a yearly screening tool developed to detect lung cancer early in high-risk patients yet is much underutilized in primary care. The purpose of this project is to increase the number of LDCT orders placed for qualified patients to decrease the lung cancer mortality rate. There were two main methods for this project: education …

Mindfulness And Meditation To Reduce Test And Evaluation Anxiety In Doctoral Nurse Anesthesia Students, Jenna L. Tebbenkamp

Doctor of Nursing Practice Projects

Abstract

Mindfulness and Meditation to Reduce Test and Evaluation Anxiety in Doctoral Nurse Anesthesia Students

Background/Information

A significant number of university students report experiencing test anxiety. Extreme anxiety has been reported as a cause of withdrawal from university studies. Certified Registered Nurse Anesthetists are required to complete an intense curriculum with tests and evaluations prior to passing a national board certifying exam, which is anxiety provoking.

Purpose

The primary objective of this project was to provide mindfulness intervention information to be utilized by the DNP students and assess desires of having a mindfulness meditation practice to alleviate academic anxiety.

Methods …

Inpatient Observation Safety Assistant Practices, Jennifer Knight

Doctor of Nursing Practice Projects

Abstract

Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.

Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this …

Implementation Of A Risk Assessment Tool To Increase Screening For Extragenital Gonorrhea And Chlamydia In Men Who Have Sex With Men, Andrew P. Tharp

Doctor of Nursing Practice Projects

INTRODUCTION: Gonorrhea and chlamydia account for the majority of sexually transmitted infections (STIs) in the United States and are often thought to infect only the urogenital tract. Infections can also be harbored at extragenital sites (rectum and oropharynx), and these infections can increase susceptibility to HIV. Extragenital screening recommendations exist for populations deemed high risk, including men who have sex with men (MSM); yet, routine screening is not consistently completed.

PURPOSE: To improve screening rates for extragenital gonorrhea and chlamydia in MSM within a primary care setting by using an STI risk assessment tool.

METHODS: Clinicians completed a baseline knowledge …

Short Term Medical Mission Antibiotic Protocol, Greg Jennings

Doctor of Nursing Practice Projects

Background/Introduction: Short term medical mission trips are growing in popularity and with this growth the level of care provided must remain evidenced based. Mission groups traveling to developing countries consist primarily of volunteers. And while many of those serving on mission trips are medically trained, some have minimal healthcare knowledge. Pharmacists are not always available to dispense medications on mission trips and therefore it is common for registered nurses in the pharmacy to dispense the medications prescribed by the providers. Because the medications available on mission trips are limited, often times substitutions must be made, especially when it comes …

Improving Access To Reproductive Life Planning Following Implementation Of One Key Question® In Practice, Ashley Wittler

Doctor of Nursing Practice Projects

Abstract

Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use …

Viloxazine In The Treatment Of Attention Deficit Hyperactivity Disorder, Amber N. Edinoff, Haseeb A. Akuly, John H. Wagner, Megan A. Boudreaux, Leah A. Kaplan, Shadman Yusuf, Elisa E. Neuchat, Elyse M. Cornett, Andrea G. Boyer, Adam M. Kaye, Alan David Kaye

School of Pharmacy Faculty Articles

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children. Over the past twenty years, research on the disease and its characteristics and treatment options has grown exponentially. The first-line pharmacologic treatment of ADHD is stimulants, which have a response rate of ~70%. With the support of four phase 3 studies involving more than 1,000 pediatric patients 6–17 years old, the FDA has approved the non-stimulant, serotonin-norepinephrine modulating agent (SNMA) viloxazine in an extended-release capsule (viloxazine ER) for treatment of ADHD in children aged 6–17. Viloxazine modulates serotonergic activity as a selective 5-HT22B receptor antagonist and 5-HT2C …

It’S Hapi Hour: An Action Plan On Preventing Hospital-Acquired Pressure Injuries, Emira Maureen A. Romero

Master's Projects and Capstones

Hospital-Acquired Pressure Injuries (HAPIs) are detrimental to both the hospital and the patient as they are costly, painful, and can lead to further infection and an increased length of stay. Although this problem is seen across the country, this action plan focuses on a microsystem (i.e. medical-surgical telemetry unit) in Hospital A in the San Francisco Bay Area. The target population includes medical-surgical telemetry patients at high risk for HAPIs (i.e. Braden score <18, moisture/mobility scores <2, patients with devices at risk for device-related pressure injuries). The proposed intervention is an evidence-based HAPI prevention bundle that includes utilization of wound care champions and turn teams, increasing attendance of daily huddles, implementing a standardized algorithm for escalation and documentation, and reinforcement of evidence-based HAPI prevention measures. Effectiveness of this bundle will be measured through chart audits, nursing questionnaires, and staff interviews. These measures will be conducted 12 months post-implementation and findings will be compared to the baseline data in order to investigate whether there is a reduction in HAPI incidence. Since this project is currently in the Study phase of the proposed Plan, Do, Study, Act (PDSA) cycle, this action plan concludes with recommendations of how the team can continue to move forward in addressing the project’s specific aim.

Hapi Prevention Bundle: An Initiative To Prevent Hospital-Acquired Pressure Injuries, Karla D. Penilla Lozano

Master's Projects and Capstones

Problem: Hospital-Acquired Pressure Injuries (HAPI) are a serious health problem as they increase patient morbidity and mortality. They are detrimental to patients, families, and healthcare systems. Context: Research supports HAPI prevention bundles are a way to standardize care processes and reduce the incidence of pressure injuries. This evidence-based practice intervention was initiated to develop a HAPI prevention bundle in an adult Medical-Surgical Telemetry unit. A literature review was conducted to identify the best HAPI prevention practices. Intervention: The evidence-based pressure injury preventive bundle includes interventions consistent with proper skin assessments and documentation, patient risk identification, development of Wound Care Champions, …

The Relationship Between Surgical Site Infections And Hand Hygiene Discharge Teaching, Eishlee Renel A. Jasa

Master's Projects and Capstones

Problem: In the span of a nine-month period, the incidence of surgical site infections (SSIs) in a singular perioperative unit reached 13. SSIs have been linked with negative consequences for both the patient and healthcare system, decreasing quality of life and increasing costs.

Context: The 20-bed post-anesthesia care unit (PACU) primarily serves adult patients in the East Bay Area, where a variety of surgeries including elective and emergent procedures are performed. This facility specializes in general surgeries, where laparoscopic excisions and hernia repairs were the most commonly observed.

Intervention: The Standardized 3-Step Hand Hygiene Discharge Teaching is aimed to improve …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Improving Patient Hand-Off Communication By Utilizing The Situation-Background-Assessment-Recommendation (Sbar) Tool Between The Perioperative Services Departments, Maureen Mijares

Master's Projects and Capstones

Problem: The Situation-Background-Assessment-Recommendation (SBAR) patient handoff communication is required when the patient is transferred from one department/unit to the next phase of care. There is no standard SBAR utilized within the perioperative services departments.

Context: There are three types of patient handoff communication utilized in the perioperative services departments; Electronic Health Record (EHR), paper form, and verbal via phone.

Intervention: A standardized SBAR patient handoff communication tool to provide a framework to improve patient handoff communication between nurses within the perioperative services departments.

Measures: The outcome measure for this process improvement project is defined as the number of patient handoff …

Aidet And Commit To Sit Implementation In The Outpatient Surgical Setting, Olivia V. Meehan

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET and commit to sit to improve communication and increase the patient satisfaction of an outpatient surgery microsystem. The microsystem’s patient satisfaction is assessed, and it is currently scoring below the reach goal of 85^th percentile. The detractors from their overall score mainly stem from the patient not feeling listened to, informed, or updated on the timeline. AIDET and commit to sit are ideal tools for addressing those deficits.

Context: The microsystem being addressed is an outpatient surgery unit that specialized in general surgery for the pediatric population. The pediatric population that the …

Increase Access To Community-Based Health Care For Underserved Individuals: A Quality Improvement Project, Piper Oneal

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background: Health care access disproportionately affects certain populations. Health care opportunities for uninsured adult members of a rural community can be limited. Suwannee County is a rural community with a population of 43,814 of which 40.8 % live below the 200% poverty income level (WellFlorida Council, 2020). Problem: In 2016, 23.8% of adults in Suwannee County were unable to see a doctor in the past year due to the inability to pay and lack of insurance (Florida Department of Health, 2020). Community-based health care initiatives can address such issues by targeting underserved individuals, reducing barriers, and making health services …

Steroid Receptor-Coregulator Transcriptional Complexes: New Insights From Cryoem, Ping Yi, Xinzhe Yu, Zhao Wang, Bert W O'Malley

Faculty, Staff and Students Publications

Steroid receptors activate gene transcription through recruitment of a number of coregulators to facilitate histone modification, chromatin remodeling, and general transcription machinery stabilization. Understanding the structures of full-length steroid receptor and coregulatory complexes has been difficult due to their large molecular sizes and dynamic structural conformations. Recent developments in cryo-electron microscopy (cryoEM) technology and proteomics have advanced the structural studies of steroid receptor complexes. Here, we will review the insights we learned from cryoEM studies of the estrogen and androgen receptor transcriptional complexes. Despite similar domain organizations, the two receptors have different coregulator interaction modes. The cryoEM structures now have …

Utility Of S100a12 As An Early Biomarker In Patients With St-Segment Elevation Myocardial Infarction, Xiaolin Zhang, Minghui Cheng, Naijing Gao, Yi Li, Chenghui Yan, Xiaoxiang Tian, Dan Liu, Miaohan Qiu, Xiaozeng Wang, Bo Luan, Jie Deng, Shouli Wang, Hongyan Tian, Geng Wang, Xin-Liang Ma, Gregg W Stone, Yaling Han

Department of Emergency Medicine Faculty Papers

Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.

Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.

Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral …

Code Blue Readiness: Improving Nurse Confidence And Performance, Michelle Zia Sultani

Master's Projects and Capstones

In the event of a code blue, otherwise known as a cardiac arrest, in a hospital setting, the nurse is usually the first to respond. A nurse must be confident in themselves and their skills to provide quality compressions and other BLS skills. Many nurses on medical surgical floors do not experience a code blue. This quality improvement project aims to improve the confidence, and quality of Code Blue readiness in nurses working on Medical Surgical units. The process begins with nurses answering a pre-survey about their current confidence in handling a code. The process ends with nurses answering a …

Chosen Family: One Woman’S Fight To Become Her Best Friend’S Next Of Kin, Yessenia M. Moreno

Capstones

Nearly 70,000 people have died of COVID-19 in the state of New York. For the queer community, this time of death and mourning has highlighted how complicated things can get at the end of someone’s life.

This audio documentary, “Chosen Family, ”is the story of one woman’s fight to overcome the legal system and become her best friend’s health care proxy in the final battle of his life .

Link to capstone project: https://medium.com/@yessimoreno/7b3d96691b9f

Targeting Nstemi Readmissions: Education To Protect The Hearts Of Our Patients, Gisha Gireesan

Master's Projects and Capstones

Section I: Abstract

Problem: January and February 2021 data showed a rise in readmissions for the NSTEMI population. This is significant as 2020 had a readmission rate of 5.6% and 7.3% in 2019. This sudden increase in readmissions within the first two months of the year is a cause for concern and immediate action is needed.

Context: 2020 had a reduction in cardiac catheterizations due to the multiple canceled cases during the COVID 19 pandemic. As the cases were being rescheduled along with new cases in 2021, the institution experienced an uptake in readmissions.

Interventions: The staff of department 220 …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Specialty Palliative Care: A Quality Improvement Project, Leticia Ries

Master's Projects and Capstones

Abstract

Problem: Patients identified on the regional database as specialty palliative care (SPC) patients with congestive heart failure (CHF) have not been consulted annually, as expected by evidence-based practice.

Context: Twenty-three percent of patients with a life-limiting illness on the SPC registry were seen year to date. Patients with CHF are vulnerable populations who benefit from an SPC consult to address quality of life, frequent admissions, and suffering.

Interventions: A rapid experiment of two interventions was evaluated for a solution approach. An electronic report identifying hospitalized registry patients and a standardized triage process were the critically assessed interventions to mitigate …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Increasing Organizational Chemotherapy Competencies, Ruth Manuel Monsalud

Master's Projects and Capstones

Problem: Despite its 21 facilities in Northern California, the organization has limited capability to administer chemotherapy infusion, resulting in both provider and patient inconveniences due to lack of qualified chemotherapy-certified nurses.

Context: The cost of interfacility transfers for 1 year were over $1.7 million, not including decreased provider and patient satisfaction.

Interventions: 12 staff nurses on 6S unit will complete a two-phase individualized training program and earn an Oncology Nursing Society Fundamentals of Chemotherapy Immunotherapy Administration provider card to ensure adequate coverage for patients requiring chemotherapy administration during their hospital stay.

Measures: Training existing nurses in chemotherapy was encouraged. Another …

Improving An Electrocardiogram Competency Assessment Tool For Registered Nurses, Laurel K. Ng

Master's Projects and Capstones

Abstract

Problem: Rapid and accurate interpretation of an EKG rhythm is an advanced-level competency required for all acute care nurses working in a cardiac monitored/telemetry unit. Observational data collected over a 4-month period by the facility clinical nurse educators identified that less than half of the nurses required to take the EKG exam passed on the first attempt.

Context: The education department at the facility onboards approximately 550-600 nurses annually for the 241-bed community hospital in the San Francisco Bay Area of Northern California, part of a larger healthcare organization.

Interventions: A total of 19 nurses from various …

Enhanced Recovery After Surgery: Effectiveness Of Real Time Data Tracking Tools, Alatia S. Jentons

Master's Projects and Capstones

Enhanced Recovery after Surgery (ERAS) has been proven by evidence to lower both recovery time and postoperative complication rates while also being cost-effective. It is a new recovery process that consists of several bundles in order to meet adherence. The hospital site where this project was conducted was at a Northern California Medical Center which provides care for in-patient postoperative, urgent and non-urgent cases. On our assigned units, we identified the potential for improvement after observing a lack of standardization of real-time charting for ERAS. This resulted in retro data, which is not an effective way to collect data when …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …