Implementation Of Implicit Bias Training In A Doctor Of Nurse Practitioner Program, Macdana Selecon

Doctor of Nursing Practice (DNP) Projects

Background: Implicit bias in healthcare delivery refers to the unconscious mental associations healthcare providers make about patients from various social groups. Numerous studies suggest implicit bias contributes to health disparities primarily amongst marginalized groups. Furthermore, patients report a lower quality of communication from healthcare providers with higher implicit racial bias. In 2021, Assembly Bill 1407 (Nurses: Implicit Bias Courses Act) was passed to address the negative impact of bias on patient outcomes and requires California nursing schools to provide implicit bias training for nursing students.

Problem: All graduate nursing programs do not provide implicit bias (IB) training. As a result, …

Community Health Worker Certification Program - Motivational Interview, Advocacy, Communication And Conflict Resolution, Stella Antony

Doctor of Nursing Practice (DNP) Projects

Background: Rural residents have health disparities more than urban populations. The significant health inequities in the underprivileged population include a higher incidence of chronic diseases, lack of access to healthy foods, health care, health insurance, unhealthy eating habits, poor socioeconomic status, cultural and language barriers, and lack of health literacy. As locals, Community health workers (CHWs) meet these populations and can improve healthy lifestyle changes and advocate for their community.

Local Problem: The population in Fresno and Tulare County in Central Valley, California, is underprivileged, lacks access to proper health care, and has higher rates of health disparities, including chronic …

Depression Screening Tool For Hysterectomy Patients, Dede C. Mihedji

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The prevalence of hysterectomies in the United States ranges from

5.1 to 5.8 per 1000 women (Harnod et al., 2018). A standardized screening tool for assessing

depression preoperatively could mitigate the worsening of postoperative depressive symptoms in patients scheduled for a hysterectomy.

Local Problem: Currently, there is no standard of practice to routinely screen for depression in preoperative patients scheduled for hysterectomy surgeries. However, as with any surgical intervention, there are risks of long-term complications. Studies have identified that a hysterectomy may increase the risk of cardiovascular events, menopause, depression, and other outcomes (Madueke-Laveaux et al., 2022). …

Implementing An African American Cultural Awareness Program For Skilled Nursing Facility Staff, Adekemi T. Adedipe

Doctor of Nursing Practice (DNP) Projects

Background: Patient care is most effective when patients and providers establish a therapeutic connection in a cultural context. Nurses’ lack of awareness of a cultural context for patient care impairs establishing a therapeutic provider/patient relationship, with care of lesser quality and poorer health outcomes as consequences.

Local Problem: Staff at a Northern Californian skilled nursing facility (SNF) caring for African American patients with mental illness lacked self-awareness of the cultural context of care. Staff did not consider cultural constructs of care in treating patients and developing care plans.

Methods: Educational intervention to increase the cultural competence of a skilled …

A Quality Improvement Project On Anxiety Management Before Ketamine-Assisted Psychotherapy, Kiera Paulo

Doctor of Nursing Practice (DNP) Projects

Background: This Quality Improvement project sought to determine if a brief progressive muscle relaxation (PMR) session could decrease patient anxiety before receiving intramuscular (IM) injections for ketamine-assisted therapy. Problem: The Kerstin Helgason, NP clinic does ketamine-assisted therapy, and many patients express anxiety beforehand, either due to a fear of needles or nerves surrounding the medication treatment. Intervention: This project implemented a brief progressive muscle relaxation therapy for patients with anxiety before receiving their IM injection. Measures: The patient’s anxiety levels were measured before and after the PMR therapy using a five-point Likert scale ranging from none to very severe. Results: …

Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik

Doctor of Nursing Practice (DNP) Projects

Developing and Implementing an Infection Prevention Practice Fellowship Program

Abstract

Background: The COVID-19 pandemic placed huge demands on infection prevention programs (Blanchard et al., 2022), seriously taxing a profession already mired with progressively increasing workload and responsibilities (Bryant et al., 2016).

Local Problem: In a rapidly changing environment, infection preventionists (IPs) contend with pandemic surges, emerging infections, and supply chain disruptions. The NCAL Region of an integrated health system experienced IP turnover, and in the absence of a formal training program, newly hired IPs experienced variable to no opportunities to develop their competencies.

Methods: A literature review on infection prevention …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Improving Triage Accuracy In The Emergency Department, Vince Harrington

Master's Projects and Capstones

Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Oscar J. Castillo

Master's Projects and Capstones

Problem: The Quality Improvement (QI) Project focused on improving early sepsis management and sepsis bundle adherence among Emergency Department (ED) nurses to decrease sepsis mortality rates and avoidable length of hospital stays (LOS).

Context: A group of Clinical Nurse Leaders (CNL) students evaluated sepsis protocol compliance at Hospital A's ED, which provides critical care for patients with various medical conditions. The CNL students concentrated on patients identified with sepsis for the QI Project.

Interventions: Limitations and time did not allow for the implementation of interventions. Recommendations offered to management included increasing sepsis training biannually and intravenous placement skills, offering sepsis …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Nancy Zhu

Master's Projects and Capstones

Problem: Sepsis is a life threatening disease that has caused over a million deaths annually in the nation. Early recognition of sepsis is highly crucial for health care professionals to know to prevent an increase of mortality and morbidity rates. This quality improvement project aimed to increase sepsis bundle checklist awareness to the staff and compliance in the Intensive Care Unit to improve the sepsis cases.

Context: Clinical Nurse Leader students completed a microsystem assessment of the Intensive Care Unit at Hospital X in San Mateo County. This unit cares for patients with sepsis, septic shock, severe sepsis, organ failure, …

Data Quality: Integral To Cauti Surveillance And Improvement In Non-Critical Care Units, Mary Grace Daria

Master's Projects and Capstones

Background: Urinary tract infections (UTIs) are the most common type of healthcare-acquired infection (HAI), with 75% approximately associated with urinary catheter use. The key to preventing UTIs is to avoid the use of indwelling urinary catheters (IUCs). This study explores denominator data extract logic modifications to increase IUC data capture and accuracy. It is set in a 249-bed acute care, teaching hospital in the Diablo Service Area in Northern California.

Problem: The electronic system used to extract the CAUTI denominator data is inconsistently capturing the IUC device days from the electronic medical record (EMR). This has regulatory reporting ramifications and …

Improving Preeclampsia Education And Assessment Frequency Among Nurses And Patients With Non-Severe Features In A Postpartum Unit, Monica Heredia

Master's Projects and Capstones

Problem: This Quality Improvement project aimed to improve preeclampsia education among Registered Nurses (RNs) and simplify the preeclampsia assessment frequency for patients with non-severe features in the Mother-Baby Postpartum Unit at Hospital Y.

Context: The Quality Improvement project occurred in a 25-bed Mother-Baby Postpartum unit at Hospital Y. The nurse educators at Hospital Y requested that University of San Francisco (USF) nursing students focus on increasing preeclampsia education among nurses and reducing the nursing assessment frequency.

Interventions: Collect quantitative data through observation and hand anonymous questionnaires to the registered nurses and clinical nurse leaders (CNLs) to determine …

Reducing Hospital-Acquired Pressure Injury In An Inpatient Medical-Surgical Telemetry Adult Unit By Educating And Encouraging Basic Wound Care Prior To Wound Care Consult, See Wai (Amy) Kong

Master's Projects and Capstones

Problem: A medical center in the Diablo Service Area had one of the highest rates in hospital-acquired pressure injury (HAPI), benchmarking with other facilities, with the project unit one of the top offenders. The patients and the medical center both suffered from the harm. Barriers to HAPI prevention included lack of patient turnings, skin assessment, and early standard wound care treatment.

Context: This project focused on the primary care team standardizing early wound care treatment to avoid wound progression.

Interventions: Interventions included re-educating the primary care team on early basic wound care using a standard wound care guideline created by …

Mentoring Nurses After Specialty Training Or Orientation In Labor And Delivery, Benjamin Jlopleh Worji

Master's Projects and Capstones

Mentoring Nurses After Specialty Training or Orientation in Labor and Delivery

Abstract

Background: The setting for this project was a northern California hospital-based healthcare system referred to as “Hospital KV.” Hospital KV is a non-profit, integrated hospital that operates to improve the community’s health. Hospital KV’s maternal child health (MCH) department comprises a labor and delivery(L&D) unit, a mother and baby unit (MBU), also referred to as a postpartum unit, and an intermediate nursery (IMN).

Problem: The hospital KV MCH department faced the challenge of a nursing shortage. The nursing shortage was associated with substantial challenges to Hospital KV, its …

Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn

Master's Projects and Capstones

This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …

Improving Education On Preeclampsia With Non-Severe Features And Frequency Of Assessment Among Nurses In The Maternal-Child Postpartum Unit, Alyssa J. Willsher

Master's Projects and Capstones

Problem: This Quality Improvement (QI) project aims to improve preeclampsia education among nurses and reduce the frequency of preeclampsia assessments among patients(without severe features) (SF) in the Mother-Baby postpartum unit at Hospital A. Nurses often stated that patients are unable to have uninterrupted rest periods with frequent assessments, which research shows is necessary for reducing patient blood pressure.

Context: The QI project is implemented in a 25-bed postpartum unit that cares for women and their newborns in the postpartum period. The unit’s nurse educator and nurse manager requested that the visiting University of San Francisco research group focus on simplifying …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno

Master's Projects and Capstones

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths as well as hospital length of stays.

Context: A microsystem assessment, in the emergency department (ED) unit, was performed in Hospital A located in the Greater San Francisco Bay area by Clinical Nurse Leader (CNL) students. This ED unit cares for a variety of critical care patients ranging from urgent to life-threatening conditions.

Intervention: An intervention was not implemented in the ED unit due to time constraints and limitations; however, CNL students provided recommendations …

Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada

Master's Projects and Capstones

Problem: In September 2023, it was found that only 25% of nurses were familiar with an inpatient handoff sepsis bundle checklist (IHSBC) on a Medical-Surgical Unit in Hospital A. This evidence-based project aimed to improve resocialization of the IHSBC such that compliance to the bundle continues to be maintained well above the benchmark of 75%. Context: Clinical Nurse Leader (CNL) students at the University of San Francisco conducted a microsystem assessment of the Medical-Surgical Unit at Hospital A. This hospital aimed to maintain high rates of compliance with the IHSBC. Interventions: Resocialization of the IHSBC was completed in October, and …

Give Love With Lovenox: Reducing Pulmonary Embolism Risk In The Postpartum Unit Through Lovenox Prophylaxis Nursing Education, Guadalupe Sierra Arroyo

Master's Projects and Capstones

Problem: This quality improvement project aims to improve nurse education on Lovenox prophylaxis to reduce pulmonary embolism occurrence post-discharge amongst high-risk postpartum women who underwent vaginal/cesarean deliveries and to increase patient medication compliance in the Family Baby Unit (FBU) at Hospital X.

Context: The quality improvement project occurred on the Family Baby Unit (FBU) at Hospital X. This 25-bed unit has recently had an increased rate of pulmonary embolisms post-discharge due to poor Lovenox medication adherence amongst patients and lack of education among nurses.

Intervention: Data was collected in the microsystem. This data was collected through questionnaires to assess nurses' …

Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan

Master's Projects and Capstones

The purpose of this quality improvement project was to use evidence-based practices to determine if personalized education on disease self-management would lead to improved treatment adherence in a residential facility. The target population consisted of four elderly female patients who had been diagnosed with congestive heart failure (CHF) and were struggling with the self-management of their disease. Contributing barriers to effective CHF self-management were determined using a root cause analysis, and included a lack of educational templates, declining cognitive ability of the residents, and no electronic health record (EHR). Using the Self-Determination theory, the interventions were implemented. Phase one was …

Dodge The Fall: A Newborn Fall Prevention Initiative, Lenora Thompson

Master's Projects and Capstones

Problem: This newborn fall prevention initiative was developed in response to an increase in the number of newborn falls at a Bay Area hospital on the postpartum unit. This hospital had gone six years without a newborn fall but by September of 2023 had three falls on the postpartum unit.

Context: The setting for this newborn fall prevention initiative is an urban, NICU level III Bay Area hospital that provides high-risk obstetric care. This Bay Area hospital has 247 licensed patient beds; 10 beds make up the postpartum unit and 11 beds make up the antepartum unit which serve as …

Lovenox Prophylaxis: Improving Lovenox Nurse Education In A Postpartum Unit, Amy T. Nguyen

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase nurse education about Lovenox

prophylaxis within the postpartum unit to reduce risks of pulmonary embolism among high-risk postpartum women in the postpartum unit. Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the postpartum unit at Hospital X located in the southern Bay Area. This unit accommodates 25 beds and provides care for postpartum mothers after both cesarean section and vaginal births. Intervention: An anonymous pre-intervention survey was distributed to the registered nurses on the unit. Educational handouts were created and distributed to the nurses on the unit. …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Elizabeth Rose Maykel

Master's Projects and Capstones

Problem: In order to lower sepsis morbidity and mortality rates through early recognition and treatment, this quality improvement project sought to raise sepsis awareness and bundle compliance within the Intensive Care Unit.

Context: Clinical Nurse Leader (CNL) students completed a microsystem assessment of the Intensive Care Unit at Hospital X in Northern California. This unit cares for patients with sepsis, organ failure, respiratory failure, different types of shock, acute kidney injury, and traumatic brain injury.

Interventions: The implemented intervention included a refresher huddle on sepsis bundle awareness. Though the intervention was ineffective, the students did offer recommendations …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Efrain Perez Trujillo

Master's Projects and Capstones

Problem: This quality improvement (QI) project aims to optimize early sepsis management and sepsis bundle compliance among Emergency Department (ED) registered nurses in order to reduce the risk of sepsis-related deaths and associated hospital length of stay.

Context: Clinical Nurse Leader (CNL) students conducted a microsystem assessment on the ED at Hospital A, located within the greater San Francisco Bay Area. This microsystem, equipped with 115 nurses and 44 rooms, consists of an acuity of care for urgent to life-threatening medical conditions, including sepsis.

Intervention: Following time constraints, and limitations, implementation of an intervention was not feasible; however, CNL students …

Reducing Care Companion Utilization In Medical-Surgical And Telemetry Units, Mary Jane B. Sagabaen

Master's Projects and Capstones

Abstract

Problem: The facility highly utilized sitters or care companions, negatively impacting the staffing plan, budget, and productivity. An average of 56 hours of care companions were used daily. This greatly exceeded the budget of 33 hours a day. Reassigning Patient Care Technicians (PCT) as care companions resulted in inadequate nurse support for patient care and increased cost for additional staffing needs. Despite this, the fall rate remained higher than the target.

Context: The patient population is mainly 65 years old and above, sometimes with confusion, dementia, delirium, and at high risk for falls and elopement. The culture included promptly …

Dodge The Fall: A Newborn Fall Prevention Initiative, Shirley B. Varela

Master's Projects and Capstones

Problem: There has been a rise in In-hospital newborn falls following evidence-based practices such as breastfeeding and rooming that promote mother and baby bonding (Karlsson et al., (2021). U.S. hospitals have approximately 600 to 1,600 newborn falls annually (The Joint Commission [TJC], 2018).

Context: A San Francisco Bay hospital with a postpartum unit experienced three newborn falls as of 2023. The level III neonatal intensive care unit is a high-risk obstetric facility with more than 3,000 births annually. It comprises 21 hospital beds: 10 on the postpartum and 11 on the antepartum floors.

Intervention: Developing and implementing the “Pledge Form …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Camila Sanchez

Master's Projects and Capstones

Problem: The purpose of this quality improvement (QI) project revolves around increasing overall staff nurse compliance, enhancing their sepsis education resources, and usage of their provided education and bundle. This goal was created to produce more positive patient outcomes at Hospital X, along with its improved management of sepsis. Hospital X is an acute care facility located in the San Francisco Bay Area.

Context: The unit that was studied during this QI project was the emergency department of Hospital X. This unit provides level I trauma services in addition to other types of emergency care and contains 44 beds. Not …

Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy

Master's Projects and Capstones

Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.

Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.

Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …

Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso

Master's Projects and Capstones

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.

Context: The endocrinology clinic serves a patient population, …