Nursing Commons^™

Reducing Heart Failure Readmissions Through Standardized Daily 1:1 Education, Neil R. Carlos

Master's Projects and Capstones

Problem: In 2023, a Northern California hospital's Cardiac Procedure Unit (CPU) admitted 100 heart failure patients, with 24 readmissions primarily due to inadequate self-management education. These admissions cost over $8.4 million, highlighting the urgent need for better patient education to reduce readmissions and healthcare expenses.

Context: A quality improvement initiative was launched in the CPU that handles pre- and post-cardiac care, including for heart failure patients. The unit's focus on urgent care and other priorities resulted in insufficient patient education regarding heart failure.

Intervention: From January to June 2024, the initiative implemented daily personalized teach-back education sessions on self-management. These …

Reducing Healthcare-Acquired Pneumonia In A Geriatric Long-Term Care Facility, Jacob R. Magsalin

Master's Projects and Capstones

Problem: Healthcare-acquired pneumonia (HAP) is a nosocomial infection that poses a serious threat in geriatric long-term care facilities due to its high morbidity and mortality.

Context: This evidence-based quality improvement project seeks to reduce the incidence of HAP in a geriatric long-term care facility in the San Francisco Bay Area by utilizing findings

from existing literature.

Interventions: Key interventions include improving and standardizing oral care techniques and promoting education on HAP prevention to allow patients and their families to be more proactive in preventing this complication.

Measures: Outcome measures include HAP diagnosis rates after implementation, any costs saved for the …

Enhancing Communication And Reducing Near Misses Through Comprehensive Handoff Tools At A Residential Nursing Facility, Sabrina Guralnik, Sophia Nguyen, Gabriela Benelyahu, Giselle Peyus

Master's Projects and Capstones

Our quality improvement project at Regina House addresses communication gaps during patient handoffs, which have led to missed or delayed care. The research underscores the critical role of effective communication in patient safety, particularly for vulnerable populations in nursing homes. Current handoff practices at Regina House are inconsistent, especially among Certified Nursing Assistants, resulting in frequent reporting errors and communication disparities.

To enhance patient safety and care continuity, this project introduces a standardized handoff tool and an incident reporting system, aligning with Regina House’s goal of improving care quality. Over three months, CNAs will receive training on the tool, with …

Improving Documentation Compliance And Patient Mobility Using The Bedside Mobility Assessment Tool, Hayley M. Bernard

Master's Projects and Capstones

Objective: Patient immobility during hospitalization contributes to avoidable complications including increased length of stay, pressure injuries, thromboembolic events, reduced functional capacity, and increased rates of discharge to rehabilitation facilities. The Bedside Mobility Assessment Tool (BMAT) was developed to empower Registered Nurses to safely assess and mobilize patients without a physical therapy evaluation. Aim: This quality improvement projects aims to enhance nurse compliance with BMAT documentation by 10% in three medical-surgical units of a 244-bed Northern California Hospital. Preliminary findings indicate an average daily patient census of 23.7 of which only 31.3% are assessed using the BMAT. Methods: Across a six-week …

Optimizing Peripartum Bedside Reports Through Patient-Centered Communication, Harpreet Kaur

Master's Projects and Capstones

Abstract

Background Effective patient-centered communication (PCC) during bedside shift reports (BSR) is crucial in peripartum care, where patients face physical recovery and emotional adjustment. However, communication gaps during transitions from labor and delivery (L&D) to postpartum (PP) units can lead to patient dissatisfaction and misinterpretation of care instructions. Hospital A, an urban tertiary care medical center in San Francisco, operates a peripartum mesosystem across two floors with 35 dedicated beds. Aim The project aims to increase patient satisfaction by implementing patient-centered language in bedside reports for peripartum units from 70% to 80% for a three-week period. Methods Stakeholder engagement, a …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Implementing The Donna Wright Competency Model In Pediatric Perioperative Units For Nursing Professional Development, Benjamin Amezcua

Master's Projects and Capstones

Background Each year, preventable adverse events in hospitals lead to numerous deaths. Research consistently indicates a strong correlation between nurse competency and improved patient outcomes, emphasizing the importance of healthcare organizations prioritizing the continuous development of their staff's skills. Bay Area Children’s Hospital A is taking a proactive step by adopting the Donna Wright Competency Model (DWCM), changing from the traditional approach competencies to a collaborative, shared governance model that incorporates the input and perspectives of the nursing staff. Objectives The project aims to utilize the DWCM to enhance the competencies of 90 nurses in the pediatric perioperative units at …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In The Adult Oncology Population Through Improved Compliance With Oral Hygiene Protocols, Kenneth R. Brown

Master's Projects and Capstones

Objective

Oncology patients receiving chemotherapy are at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia, and aspiration pneumonia rates are higher than desired. Improved oral hygiene protocols and compliance in this population reduces the incidence of these complications.

Context and Background

The microsystem assessed includes six oncology units at Hospital A, a large California academic hospital. Aspiration pneumonia, commonly associated with MBI, is a life-threatening challenge that increases costs and complications in oncological treatment settings. An aspiration pneumonia task force focused on six oncology acute care units is committed to reducing the incidence of hospital acquired …

Utilizing Pupper, A Social Robot Dog, To Increase Happiness And Improve Mood In Pediatric Patients Of A Cardiac Step-Down Unit, Angela Feng Wu

Master's Projects and Capstones

Objective The usage of social robots in pediatrics is an emerging field of study. Preliminary research shows that they are effective at improving the psychosocial well-being of pediatric patients. This quality improvement project focuses on Pupper, a newly developed quadruped social robot dog, and its ability in improving mood and happiness in pediatric patients of a cardiac step-down unit. Aim The aim of this project is to increase average mood scores of pediatric cardiac patients aged 3-25 years by 50% from their baseline of 3.75 to 5.63 on a six-point scale within a one-month time frame. Methods Before intervention and …

Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

Baby-Friendly Hospital Initiative: Becoming Baby-Friendly Designated, Krystal Angelique Mora

Master's Projects and Capstones

Section I: Abstract

Problem Despite efforts to increase breastfeeding rates, the influence of formula companies has contributed to the decrease in rates, affecting the health outcomes of infants. In response, the Baby-Friendly Hospital Initiative (BFHI) introduced standardized education for nursing staff to support infant growth and development. Context Hospital A Birth Center is a 33-bed culturally diverse unit that provides care to mothers in Northern California, delivering approximately 7,400 babies each year and helping patients transition into motherhood. Aim The quality improvement project aims to enhance the retention of BFHI-aligned education provided during hospitalization by 26.2%, raising retention rates among …

Optimizing Fall Prevention: A Quality Improvement Initiative To Enhance Documentation And Intervention Accuracy Using The Hester Davis Scale In Medical-Surgical Units, Kiana Conn, Brooklin Hunter-Johnson, Jashan Kahlon, Adrian Paz

Master's Projects and Capstones

Falls among hospitalized patients remain a critical safety concern, particularly in medical-surgical units caring for geriatric and oncology patients. This quality improvement project aimed to evaluate and address gaps in adherence to fall prevention protocols by utilizing the Hester Davis Scale (HDS) in two medical-surgical units at a large metropolitan hospital in Southern California. The project focused on auditing current practices to identify inconsistencies in documentation and intervention implementation, emphasizing areas such as bed alarm activation, fall risk signage placement, and armband use. Weekly audits were conducted from October 3 to October 29, 2024, to establish baseline data and inform …

Impact Of Supply Organizational Culture Within A Surgical Unit, Irene T. Peng

Master's Projects and Capstones

Objective: This quality improvement project aims to propose an intervention that helps anesthesia technicians improve communication efforts, reduce delays in care, and reduce medical waste. Aim: At least 80% of the anesthesia technicians are educated on properly stocking the pediatric anesthesia medical lockers utilizing the standardized checklist and handoff report tool to reduce waste and increase timely patient care after three months of implementation. Methods: Assessment surveys were used to identify the surgical unit’s current issues and Hospital A’s staff's opinions of pediatric medical anesthesia C-lockers. Resources such as the GANTT Chart, Fishbone Analysis, Budget Analysis, SWOT Analysis, and PDSA …

The Donna Wright Competency Model In Pediatric Perioperative Nursing Development, Nadia Hamid

Master's Projects and Capstones

Abstract

Background Preventable adverse patient events occur daily in hospitals across the United States which can be significantly decreased by effective nurse competency assessment. Bay Area Children’s Hospital X has adopted the Donna Wright Competency Model (DWCM) to support their institutional goal of Magnet status for excellent nursing care. With the goal of changing the traditional approach of competency achievements by engaging nurses through shared governance. Objective The project seeks to attain a higher level of performance for 90 nurses employed on the perioperative unit (PPU) to provide a safer environment to support patient centered care. Aim By December 1, …

Developing A Trauma-Informed Family-Centered Care Toolkit For Neonatal Intensive Care Unit Nurses, Sonja A. Alli-Casella

DNP Qualifying Manuscripts

Background: The neonatal intensive care unit (NICU) may be a stressful, traumatizing, or re-traumatizing experience for parents of critically ill newborns and infants.

Problem: NICU nurses and other healthcare providers may not realize their impact on parental stress responses as neonatal care providers may not have adequate training to support adults experiencing acute emotional distress.

Methods: Strong evidence supports using family-centered care (FCC) in the NICU to promote bonding and parental involvement in caring for their infants. This manuscript aims to review current research and literature on trauma-informed care training and its impact on nurse confidence in managing dysregulated adults, …

Enhancing Disaster Response Competencies In Nursing Education Through Simulation-Based Training: An Integrated Literature Review, Paul Dreater

DNP Qualifying Manuscripts

Objectives: This integrated literature review aimed to identify and prioritize disaster management education content to equip undergraduate and graduate nursing students with the necessary knowledge and skills for competent disaster response.

Data sources and review method: A literature search was conducted across multiple databases, including Cochrane, CINAHL, PsycINFO, PubMed, Google Scholar, Fusion, and Scopus, using keywords such as disaster nursing, disaster preparedness, simulation, education, and mass casualty incidents. Filters restricted results to English-language studies from the past ten years within nursing education. Selected articles were reviewed and summarized to address the research question: What are the essential disaster …

Enhancing Disaster Preparedness In Nursing Education: A Quality Improvement Approach Using Simulation And Training, Paul Dreater

Doctor of Nursing Practice (DNP) Projects

Background: Natural or artificial disasters threaten safety and continuity in educational settings. The University of San Francisco School of Nursing and Health Professions (USF SONHP) identified a critical gap in its disaster preparedness, underscored by the absence of a comprehensive disaster plan. This shortfall highlights the need for an educational strategy encompassing disaster readiness and response, particularly given the potential for such events to cause substantial harm and disruption.

Local Problem: A gap analysis conducted at the USF SONHP revealed the lack of a structured disaster plan, underlining the urgent need for an initiative to develop and implement a comprehensive …

Composting For Cleaner Air, Simi Benisty, Katie Bui, Narmin Solman, David Woo

Master's Projects and Capstones

The aim of this project was to address food waste at Mary's Kitchen by implementing a composting initiative to divert organic waste from landfills. The project took place in a nonprofit organization that serves food to the homeless, where the target population includes staff, volunteers, and clients of the kitchen. Key interventions involved creating educational materials on composting, recycling, and waste management, including flyers in both English and Spanish, as well as a QR code for easy access. Additionally, smaller, color-coded buckets were introduced to replace the 33-gallon bins, making waste sorting more manageable. Measures included staff and volunteer compliance …

An Integrated Review: Faith Community Nurse Transitional Care Model Health Ministry, Youn Kyeong Cummings

DNP Qualifying Manuscripts

The hospital readmission rate is highest among underserved communities, and providing a continuum of care to these populations can yield a greater reduction in the readmission rate. Church and faith-based clinics often help underserved communities, and equipping them with the transitional care model (TCM) and an Advanced Practice Registered Nurse (APRN) with specialized training as a Faith Community Nurse (FCN) can implement whole-person care, improve the health of the community, and reduce hospital readmission.

California has a 14.5% readmission rate. There is uncertainty surrounding the presence of transitional care departments in California's community hospitals, with some of these facilities offering …

Trauma-Informed Care: A Therapeutic Approach In Communication, Nicole A. Leonce

DNP Qualifying Manuscripts

As medical providers, it is crucial to use therapeutic communication when building relationships with patients. Bias, stigma, and judgment often manifest through a provider’s body language and choice of words, exacerbating patient trauma and leading to health disparities. Trauma-informed care (TIC) addresses these issues by emphasizing respect, compassion, and empathy. TIC has been extensively studied in high-income regions such as Australia, Europe and the United States, but its application in low- and middle-income countries (LMIC) such as Kenya, is less understood. The aim of this study was to assess the knowledge, attitudes, and skills of nurses working in a rural …

Impact Of Mindfulness-Based Interventions On Nursing Burnout: An Integrative, Lily Myo

DNP Qualifying Manuscripts

Burnout in the nursing profession is prevalent and can be a significant burden for not only the individual nurse but to patients and the healthcare system at large. Burnout is considered by the World Health Organization as an occupational phenomena specifically resulting from chronic workplace stress that has not been successfully managed, and is not related to other life events. Given the need for support among registered nurses in reducing consequences of burnout and the emerging data about mindfulness based practices as a tool to enhance resilience, this integrated review seeks to understand if education on mindfulness based interventions can …

Thinking Long-Term: Nursing Education On Long-Acting Injectable Antipsychotics, Arslan Rashid

DNP Qualifying Manuscripts

Schizophrenia cases and their associated healthcare costs have drastically increased over time in the U.S. Antipsychotic non-adherence is a primary contributor to the high rates of relapse and rehospitalization among the schizophrenic adult population. The development of long-acting injectable antipsychotics (LAIs) has positively impacted medication adherence, however, this treatment modality is still underemployed in practice due to barriers, such as physician and patient negative attitudes toward LAIs and lack of education. Nurses are in a great position to address these barriers as they serve as mediators between providers and patients. This literature review aims to discover evidence that LAI education …

Reducing Compassion Fatigue On A Cardiac Telemetry Unit, Nicole Rocio Garzon

Master's Projects and Capstones

Abstract

Background: Compassion fatigue (CF) among nurses is a significant concern affecting both individual well-being and patient care outcomes. Findings from a 2020 national survey found two-thirds of nurses (62%) struggle with CF and even a high rate for those nurses under the age of 25 years. Through a review of current literature and case studies, the effectiveness of these interventions in reducing stress, enhancing resilience, and improving overall job satisfaction among healthcare professional is examined. Practical implications for implementing these interventions in healthcare organizations are discussed, emphasizing the potential for creating supportive environments that foster emotional and mental well-being …

Education And Training On Naloxone Administration For Healthcare Professionals: An Integrative Literature Review, Remigus C. Nwaokoro

DNP Qualifying Manuscripts

Abstract

Background: Healthcare professionals’ lack of knowledge and confidence in administering naloxone affects their willingness to inform at-risk patients about its use in the event of an overdose. The lack of understanding and confidence in using naloxone delays efforts to inform at-risk patients about this life-saving treatment for opioid overdose. This integrative literature review aimed to answer the following question: Do increased education and training enhance healthcare professionals' knowledge and confidence in administering naloxone and decrease the rate of opioid overdose fatalities?

Methodology: A comprehensive search of the literature (2019 and 2024) was conducted to identify studies of education …

Prospectus For Expected Discharge Date Accuracy (Edd) – Prepare To Go, Mary Jane D. Esmilla Msn, Bsn, Rn

Master's Projects and Capstones

Problem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.

Context: A team analysis improved EDD accuracy, patient satisfaction, …

Implementing The "Baby Drop Bundle", Natalie Aguirre

Master's Projects and Capstones

Problem: Falls are a preventable type of trauma that may lead to serious injury, prolonged hospital stays, and non-reimbursable costs to the organization. While there are established fall prevention policies for ambulatory patients, infants dropped by their caregivers are largely excluded.

Context: This quality improvement project aims to decrease newborn drops by implementing the “Baby Drop Bundle”. The bundle allows caregivers and bedside providers to partner in creating a safe environment for the patient.

Interventions: The Clinical Nurse Leader (CNL) will provide a brief in-service during the morning safety huddle to introduce the bundle to staff. The bundle includes educational …

Improving Firefighter Health Through Education In Sleep Science, Elisabeth J. Filiss

Master's Projects and Capstones

Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefighters’ sleep have been recommended.

This quality improvement project implemented …

Decreasing Inappropriate Wound Consults, Arpita Hinton

Master's Projects and Capstones

Abstract

Background: This project was centered around the wound nurses and their workload. It also highlighted the opportunity for education for frontline staff. The wound nurses at this northern California hospital are a group of five nurses that support the whole hospital. Usually there are two staffed per day to support a facility that continues to have three to four overflow areas open to accommodate its high census.

Problem: My project focused on decreasing inappropriate wound consults. There are many consults places that do not need the intervention of a skilled wound nurse. These consults lead to time that is …

Reducing Same-Day Case Cancellation By Implementing 72 Hours Preop Phone Calls, Debbie Sharon Centeno

Master's Projects and Capstones

Problem: The increased frequency of same-day surgical cancellations affects patient care quality, causes loss of expenses for patients and facilities, and causes non-compliance with block utilization against regional standards.

Context: A collaborative effort was undertaken to reduce same-day case cancellations in the Ambulatory Surgery Unit (ASU). Patients received preoperative instructions 24 hours before surgery through email or phone call. Data collection revealed that the common causes of same-day cancellations were avoidable reasons (not NPO, patient ill, request for another schedule, no ride), indicating the need for improvement in delivering preoperative phone calls.

Interventions: This included educating preoperative nurses, creating a …

Enhancing Teamwork With Cliftonstrengths, Lauren A. Lelaidier

Master's Projects and Capstones

Abstract

Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging.

Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved.

Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one …