Nursing Commons^™

Problems Experienced In The Second And Third Months After Discharge From A Heart Failure-Related Hospitalization, Joan S. Grant, Lucinda J. Graven

Journal of Patient-Centered Research and Reviews

The purpose of this study was to identify high-priority problems experienced by individuals during the second and third month after discharge from an acute care facility for heart failure. This descriptive, exploratory study, an extension of a previous analysis that examined high-priority problems in the first month, comprised 19 participants who were assigned to an intervention group that received a randomized, 12-week-pilot coping partnership (COPE-HF) intervention. A trained research nurse provided the intervention, and participants used a standard list to identify high-priority heart failure-related problems. Quantitative and content data analysis was conducted. While the highest-priority problem continued to be managing …

Exploring Men Who Have Sex With Men’S Hiv Pre-Exposure Prophylaxis Initiation Decision-Making Processes In The Southern United States, Portia Thomas

Doctorate of Nursing Science Dissertations

In 2012, the first pharmacological HIV preventative agent, pre-exposure prophylaxis (PrEP) was approved in the U.S. for individuals at high-risk of contracting HIV. Men who have sex with men (MSM) are at increased HIV risk, due to their engagement in anal intercourse (AI), which is the most common mode of HIV transmission and the riskiest type of sex. Although evidence indicates that most PrEP paients are MSM, a paucity of evidence exists on MSM’s PrEP initation decision-making process. The purpose of this study was to explore how HIV-negative MSM engaging in protected or unprotected AI decide to initiate PrEP based …

Napnap Position Statement On Immunizations, Lacey Eden, Cheryl Cairns, Karlen E. (Beth) Luthy, Mary Koslap-Petraco

Faculty Publications

The National Association of Pediatric Nurse Practitioners (NAPNAP) supports the timely and complete immunization of all infants, children, adolescents, and adults in an attempt to maximize the health and wellbeing of all people. Routine childhood immunizations prevent as many as 3 million deaths per year. In addition, 1.5 million deaths per year could be avoided if global vaccination efforts continue to improve (World Health Organization, 2017).

Utilizing Home Health Services To Reduce High-Risk Readmissions: A Quality Improvement Project, Courtney Robare

Nursing and Health Professions Faculty Research and Publications

The Centers for Medicare and Medicaid (CMS), the Joint Commission (TJC), Institute for Healthcare Improvement (IHI), and the Agency for Healthcare Research and Quality (AHRQ) have all highlighted readmissions as an issue in healthcare that needs to be addressed. Many of these organizations have piloted programs which aim to decrease readmissions.

The MAP (Medication Focus, Access Assistance, and Provider Collaboration) program seeks to decrease the readmission rate of high-risk patients. Readmissions are costly and often lead to negative patient outcomes. To decrease cost to the hospital and avoid penalties from the Centers for Medicare and Medicaid (CMS), the MAP program …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Utilizing The Stop-Bang Questionnaire As A Preoperative Assessment Tool In Patients Undergoing Endoscopic Procedures, Emily Randle

Doctoral Projects

In the world of anesthesia, obstructive sleep apnea (OSA) can cause a conglomeration of post-operative complications. One of the best ways to avoid these complications is to alter one’s anesthetic to accommodate the needs of a patient with OSA. The current issue with altering one’s anesthetic is that a majority of patients with OSA still remain undiagnosed. My project that will showcase just how many patients have undiagnosed OSA.

The goal of this project was to recognize how many patients were at moderate to high risk for OSA. I did this by providing an in-service on OSA and the STOP-Bang …

Loma Linda Nurse - Vol. 26, Loma Linda University School Of Nursing

Loma Linda Nurse

Contents

FEATURES

4 | Where Legacies Begin — Alyssa Vega

8 | A Promise to Go Where the Lord Calls

10 | What I Wish I Had Known Before I Started Nursing School

14 | Constructing New Opportunities for Nursing Graduates

LLUSN HIGHLIGHTS

16-21 | ALUMNI NEWS

22-25 | HOMECOMING

26-27 |COMMENCEMENT

28-37 | ACADEMICS

38-39 | FACULTY UPDATES

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Solicitude: Towards A Heideggerian Care Ethics-Of-Assistance, Babette Babich

Articles and Chapters in Academic Book Collections

No abstract provided.

Best Practice Policy: Utilizing A Standardized Handoff Tool Postoperatively In An Intensive Care Unit For Patients Undergoing Cardiac Surgery, Alexandra Bradley

Doctoral Projects

Communication is a key aspect of care in the health care setting. Handoff communication occurs between medical provider’s numerous times a day. Each patient handoff performed has the potential for ineffective communication, leading to poor patient outcomes. The Joint Commission has recognized handoff communication as one of the main causes of sentinel events, or unexpected events that results in patient harm or death, in the health care setting (Joint Commission on Accreditation of Health care Organizations [JCAHO], 2012). The Joint Commissions National Patient Safety Goal requires “a standardized approach” for provider handoffs. The introduction of a checklist or handoff tool …

Nicu Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Renea L. Beckstrand, Rebecca F. Isaacson, Janelle L. B. Macintosh, Karlen E. Luthy, Lacey Eden

Faculty Publications

Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles.

Objective: The objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs.

Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.

Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between …

A Malignant Hyperthermia Competency Training For Nurse Anesthesia Trainees: Development, Implementation, And Evaluation, Andrew Christ

Grace Peterson Nursing Research Colloquium

A Malignant Hyperthermia Competency Training for Nurse Anesthesia Trainees: Development, Implementation, and Evaluation

Andrew Christ, RN, BSN, DNP Candidate

Faculty: Karen Kapanke, CRNA, DNP

Background: Video simulation is an alternative method of teaching that can play an important role in nurse anesthesia education. Using video simulation for uncommon crisis could prove beneficial.

Objectives: The purpose of this study is to analyze the effects of an educational video simulation regarding malignant hyperthermia (MH) recognition and management on knowledge of nurse anesthesia trainees (NATs).

Methods: A single group pretest-posttest design was used to compare knowledge on recognition and management of malignant hyperthermia. …

Implementation And Compliance With A Goal-Directed Fluid Therapy (Gdft) Protocol For Total Hip Arthroplasties: A Two-Year Review, Michelle Pavlik

Grace Peterson Nursing Research Colloquium

Background: Historically, goal-directed fluid therapy (GDFT) has been shown to improve patient outcomes when used in the perioperative setting for specific cases (colorectal, etc). When anesthesia providers use GDFT protocols, intraoperative fluid therapy is” patient specific” via the use of dynamic patient-specific physiologic parameters.

Objectives: The aim of the study is to assess whether GDFT improved patient-specific fluid administration. A secondary aim was to assess adherence to the instated GDFT protocol.

Method: A retrospective chart review was conducted on 201 patients undergoing total hip arthroplasty (THA) procedures following implementation of a GDFT protocol at the University of Illinois at Chicago …

Attitudes And Beliefs Among Anesthesia Provides Regarding Smartphone Use For Intraoperative Anesthetic Management, Jasprit Dulat, Marjorie Reeves

Grace Peterson Nursing Research Colloquium

Background: Smartphone technology has evolved at the same accelerated pace as healthcare technological innovation. The literature shows that healthcare providers already utilize Smartphone technology to bridge gaps in knowledge and provide quality care to patients. Critics of these advancements are leery about Smartphone use in the operating room (OR) because it may be a source of distraction for anesthesia providers; however, supporters argue that their use is also recognized as a potential aid in learning. Objectives: This study was conducted to assess workplace attitudes and beliefs regarding the use of Smartphones in the operating room in order to establish policies …

Management Of Risk Factors To Decrease Peanut Allergy Occurrences In The Youth Population, Emily Vukovich

Grace Peterson Nursing Research Colloquium

Abstract

Background: Recent increases in prevalence of peanut allergy has become a significant public health concern. There are many risk factors that have been determined to cause development of peanut allergies. These risk factors include genetics, race, sex, primary, and secondary prevention. Previous guidelines have given no evidence that preventing an infant from allergenic foods stunts development of peanut allergy.

Objectives: The purpose of this integrative literature review was to identify if early exposure to peanut prevents occurrence of peanut allergy development.

Method: An integrative literature review was conducted undergoing extensive search for studies that have focused …

Management Of Risk Factors To Decrease Peanut Allergy Occurrences In The Youth Population, Emily Vukovich

Grace Peterson Nursing Research Colloquium

Abstract

Background: Recent increases in prevalence of peanut allergy has become a significant public health concern. There are many risk factors that have been determined to cause development of peanut allergies. These risk factors include genetics, race, sex, primary, and secondary prevention. Previous guidelines have given no evidence that preventing an infant from allergenic foods stunts development of peanut allergy.

Objectives: The purpose of this integrative literature review was to identify if early exposure to peanut prevents occurrence of peanut allergy development.

Method: An integrative literature review was conducted undergoing extensive search for studies that have focused …

The Benefits Of Complementary And Alternative Medicine For Treating Rheumatoid Arthritis: An Integrative Review Of Literature, Kali Polich

Grace Peterson Nursing Research Colloquium

Abstract

Background: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that is characterized by joint swelling, tenderness, synovial joint destruction all of which leads to disability as well as premature death. It is a disease that affects all bodily systems as well as daily living. The current methods of treatment are aggressive medications in various forms. Complementary and alternative methods (CAMs) of treatment can be useful in the treatment of Rheumatoid Arthritis as well as improving the quality of daily living.

Objectives: The purpose of a literature review was to explore the current treatment methods of Rheumatoid Arthritis as well …

Improving Communication: Huddling For Change, Harnoor Chahal

Master's Theses

The purpose of this communication improvement project is to incorporate huddles between interdisciplinary departments within a microsystem in order to improve customer satisfaction by decreasing the number of grievances. Based on the increasing number of grievances due to delayed hospital discharge, which results from a lack of communication between team members, there is an increased need for communication between the microsystem. By implementing weekly huddles between the Inpatient and Outpatient nurses, not only will there be increased care-coordination, but there will also be a decreased delay in discharge from the hospital caused by missed or no communication. Evidence-based practice indicates …

Improving Pediatric Oral-Systemic Health Through Motivational Interviewing: An Interprofessional Training Intervention, Oksana Prodan

Doctor of Nursing Practice (DNP) Projects

Introduction: In response to the prevalence of early childhood carries (ECC) in the United States, recommendations were established for pediatric primary care providers to routinely incorporate oral-systemic health promotion services into clinical practice. An interprofessional education project was developed between Advanced Practice Registered Nurses (APRNs) and dentistry students in San Francisco to assist trainees in the effective delivery of oral systemic health promotion services. Improving health promotion communication skills was identified as an area of need for both sets of learners. Therefore, the IPE activity was designed to incorporate Motivational Interviewing (MI) into the training along with pediatric oral …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Clinical Nurse Leader As Educator: Creating Standardized Orientation Materials For Patient Care Coordinators, Sylvia Su

Master's Projects and Capstones

The purpose of this quality improvement project is to create standardized orientation materials for patient care coordinators (PCC) in a medium-sized community hospital. The problem of not providing standardized orientation materials to newly-hired PCCs presents a risk of PCCs being unable to render the same level of quality of care to patients. Standardized orientation materials can help the newly-hired PCCs to access needed resources in a timely manner and provide patients with consistent quality of care. In order to create the orientation materials, a pre-intervention qualitative interview was conducted to determine the need for developing such tools. Through several PDSA …

Promoting Adherence To Best Practice Related To Urine Reflex To Culture Testing, Maykel Verdecia Alonso Ba,Rn-Cphn

Nursing and Health Professions Faculty Research and Publications

Over a two week period, the infection control nurse, from a trauma designated facility located in norther California, planned a practice improvement project in collaboration with the laboratory microsystem to educate referring physicians and increase adherence to the Centers for Disease Control (CDC) protocol, which delineates recommended best practices related to urine reflex to culture testing. Urinalysis (UA) is a test that triggers a reflex urine culture when pyuria is present. Frequent urine culturing without the presence of pyuria can cause unnecessary treatment with antimicrobials. From January 2017 to December 2017, 10% of UAs from 200 urine samples from asymptomatic …

The Interactive Patient Careboard: A Technological Innovation To Improve Patient Safety, Perla Q. Baldugo

Master's Projects and Capstones

Problem: An innovative method to communicate with the patient and between interdisciplinary team members is the use of the interactive patient careboard (IPC) which has declined since its implementation. Concurrently, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for the med surg unit need improvement. The low HCAHPS scores in communication suggested to nursing leadership that revitalizing use of the IPC could lead to improvements in the scores. The ideal shift handoff includes IPC as a focal point of communication. The RN is expected to display the careboard during handoff and identify for the patient the healthcare …

Decreasing Falls In A Medical Surgical Unit: A Quality Improvement Project, Ann Chetty

Master's Projects and Capstones

Abstract

The purpose of the project was to decrease the number of falls occurring in the 48-bed medical-surgical unit by building standard work for hourly rounding and communication. Falls are a patient safety issue and are preventable. Since the Institute of Medicine has published “To Err is Human” in 1999, there have been a multitude of studies on falls, yet falls continue to be prevalent in health care organizations. The increase in patient falls adversely impact the patient’s length of stay, discharges to nursing homes and the facility’s reputation for providing safe care. The staff in this microsystem used the …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Prospectus For Improving Measure Ii Scores Of Hospice Visits When Death Is Imminent In The Hospice Item Set, David Ainsworth

Master's Projects and Capstones

Abstract

Problem: Center for Medicare Services (CMS) created a new quality measure pair to collect data on hospice visit patterns by a registered nurse in the last three days of life (Measure I), and at least two visits by a social worker, home health aide, licensed vocational nurse or spiritual counselor in the last seven days of life (Measure II). A hospital-based hospice organization created a quality improvement project to address this problem and improve both parts of the measure pair, but special emphasis was placed on improving Measure II, as initial data revealed the …

Preventing Hospital Acquired Pneumonia: A Quality Improvement Project, Calyn Pascual

Master's Projects and Capstones

Abstract

Problem: From October 2016 to September 2017, the 5^th floor medical surgical telemetry unit has had 9 incidences of hospital-acquired pneumonia (HAP). Among the facility, this is the floor with the highest HAP incidences.

Context: HAP is associated with $40,000 to $65,000 to each patient care cost; an additional 7-9 days of stay in the hospital, increases the chances of discharging a patient to a skilled nursing facility instead of home, and has an attributable mortality rate (Quinn, et al., 2014).

Interventions: Daily oral brushing self-audits are given to patient care technicians (PCT) for both day and evening …

Reducing Workplace Injuries Among Advice Registered Nurses, Mey Saephanh

Master's Projects and Capstones

An area of concern for clinical nurse leaders (CNLs) is the increasing incidence of workplace injuries in integrated healthcare systems with call centers where repetitive stress injury (RSI) is among the leading causes of workplace injuries. Recurring pain and discomfort that call center Advice Registered Nurses (ARNs) experience hurts them and their teams, influences the operation of the call center, and decreases the quality of care provided to the healthcare system members. Due to high call volumes ARNs do not adequately use breaks or other measures to reduce physical strain. There is an opportunity to reduce RSIs through deployment of …

Implementation Of A Screening Protocol To Improve Provider Assessment Of Depression In Patients With Psoriasis, Marlee Bryant

Doctoral Dissertations and Scholarly Projects

Patients with psoriasis are at an increased risk for depression. Despite this risk, many dermatology care providers do not screen for depression in practice, including providers at the target practice for this project. This evidence-based practice pilot project was purposed to increase dermatology providers’ assessment of depression in patients with psoriasis. This project involved implementing a depression screening protocol at one private dermatology practice and educating providers on the use of the protocol including the embedded depression screening tool, the Patient Health Questionnaire-9. The project leader used a quasi-experimental design and collected data utilizing retrospective chart reviews completed pre- and …