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

DNP Qualifying Manuscripts

Background: Rural population accounts for 15% of the population in the United States of America. Rural residents have a higher risk of health disparities 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.

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. The Save the Children organization’s Community …

Addressing Culturally Congruent Care Amongst African Americans In Skilled Nursing Facility: A Systematic Review, Adekemi T. Adedipe

DNP Qualifying Manuscripts

Introduction: Healthcare disparities and mistrust of the healthcare system discourage African Americans from seeking mental health services. Healthcare providers face challenges delivering culturally appropriate care. Examining current cultural practices can inform the education needed for healthcare providers to understand cultural care and awareness. This review aimed to identify evidence available to understand the impact of a cultural training on healthcare providers in skilled nursing facilities.

Methods: APA PsycINFO, CINAHL, and PubMed, were searched for English-language studies published between January 2016 and January 2022. Healthcare cultural competency training

in any aspect of cultural care was considered. Outcomes of interest included changes …

Mental Health Screening After Trauma: A Concise Review, Christine Mcgahey

DNP Qualifying Manuscripts

OBJECTIVE: To gain a better understanding of the value of mental health screening for PTSD risk in hospitalized trauma survivors.

DATA SOURCES: Studies were pooled from a literature search performed on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION: Relevant studies published between 2015 and 2022 in English, excluding traumatic injuries incurred during combat.

DATA EXTRACTION: Ten articles were selected for inclusion in this review.

DATA SYNTHESIS: There is a significant and widespread mental health burden following traumatic injury. Early screening to quantify the risk for PTSD can …

Implementing A Courtesy Call System To Increase Patient Satisfaction, Tessa Garcia

Master's Projects and Capstones

Abstract

Problem: An assessment of a home health microsystem found a decrease of patient satisfaction using Home Health Consumer of Healthcare Providers and Systems (HHCAHPS) survey scoring. Low HHCAHPS scores equivalate to poor quality care, which has a negative impact on patients and the organization itself.

Context: The setting for this project was a home health department microsystem in Northern, California serving a 400-patient population. The project was implemented within the quality department of the home health organization.

Interventions: Evidence shows that implementation of a courtesy call check-in improves satisfaction and patient outcomes. A courtesy call check-in was implemented to …

Advancing Treatment For Opioid Use Disorder In A Rural Emergency Department, Jill M. Wabbel

Doctor of Nursing Practice (DNP) Projects

Background: The opioid epidemic escalated in the United States due to the availability of prescription opioids, heroin, and synthetic opioids like fentanyl. Unfortunately, access to treatment is not always accessible, especially in rural communities with limited resources.

Local Problem: Tehama County is a rural county in northern California with limited access to treatment for opioid use disorder. The local Emergency Department (ED) and primary care-based Medication-Assisted Treatment (MAT) clinic collaborated to increase access. However, services remain under-actualized due to limited understanding of MAT best practices, stigma related to substance use within the ED culture, and poor articulation between the ED …

Improving Donor Bank Milk Administration Workflow In The Neonatal Intensive Care Unit, Davelyn M. Moffit

Master's Projects and Capstones

_Abstract

Problem: Improvement in the donor bank milk (DBM) administration workflows is required to reduce documentation errors and discrepancies. Increased awareness of errors and their impact on quality, safety, and risk management is imperative to optimize clinical, operational, and financial outcomes, as well as a hospital’s reputation.

Context: Research shows human milk is beneficial to the growth of premature and medically-diagnosed term infants. Regulatory agencies recommend standards and guidelines to handle human milk and to monitor compliance and safety practices of healthcare organizations.

Intervention: An audit tool and process map were created to internally monitor the current process for DBM …

Teaching Time: Postoperative Urinary Catheter Care In The Preoperative Setting Before Surgery, Lynn Utecht

Master's Projects and Capstones

Abstract

Problem: Patients who have same day surgery often have little or no recall of the postoperative home care instructions when delivered in the aftercare area. The number of instructions that are required for home care, combined with medications given for pain and nausea as well as anesthesia, can make recall of these instructions difficult. The purpose of this quality improvement project was to provide the postoperative instructions for post prostatectomy patients discharged with an indwelling urinary catheter in the pre-operative area before the patient underwent surgery to decrease the length of time the patient spent in the recovery unit. …

Environmental And Occupational Health Risks: Educating Undergraduate Student Nurses For Best Practice, Dorinda A. Mercado

DNP Qualifying Manuscripts

The environments we inhabit, whether homes, schools, workplaces, or the communities that envelop them, are replete with ubiquitous health risks that we routinely ignore to avoid analysis paralysis from worries. Environmental risks are hidden in food, drink, household and personal care products, furniture, and building materials; chemical hazards and physical residues of modern living contaminate air, water, and soil. Occupational hazards are prevalent in workplaces as diverse as agriculture, highways, and hospitals. A recent study by the Centers for Disease Control and Prevention (2022) found that out of 2,310 urine samples taken from a group of Americans from the United …

Educating Providers Without Prescriptive Authority About Psychopharmacology Basics: Bridging The Interdisciplinary Work Among Psychotropic Prescribers And Psychologists, Olivia Ceja

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the fund of knowledge among psychologists, licensed clinical social workers, and talk therapists in outpatient psychiatric settings by educating clinicians about psychopharmacologic basics and the role and work of a psychiatric nurse practitioner during group supervision meetings. This can help bridge the gap of psychopharmacologic knowledge between mental health providers with and without prescriptive authority.

Problem: Evidence shows that psychologists with non-prescribing capabilities are not often trained or educated about the very medications that their clients are often taking. Currently, psychotropic medication education is not a standard aspect …

Improving Medication Side Effects Documentation And Clinician Understanding In Home Health, Katherine Bales

Master's Projects and Capstones

Abstract

Problem: In home healthcare services, care experience scores are increasingly the strategy for evaluating the continuity of care to patients who require post-hospital follow up and guidance on medication management. Clinician understanding of how to use the available medication education tools impacts how well patients are able to manage their own care.

Context: The organization’s Home Health clinicians have not done well providing medication education on side effects as evidenced by low survey scores. The focus of the project is improving the medication education provided to patients and documentation thereof. The project takes place in a home health microsystem …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Managing Congestive Heart Failure Through Standardized Symptom Assessment, Shanda M. Joy

Master's Projects and Capstones

Abstract

Problem: Transitional care programs have increased in popularity to focus on optimizing transitions of care from acute hospitalization to home based settings to reduce hospital readmissions. The transitional care model utilized at this urban, integrated health facility is mostly 100% telephonic, short term (30 days) case management. Approximately 30% of the patients referred to the program have a diagnosis of congestive heart failure.

Context: Hospital reimbursement has decreased due to high readmissions rates, especially among congestive heart failure (CHF) patients. This process improvement project was aimed at decreasing CHF related readmissions through educating patient/families on CHF watch symptoms and …

Preventing Hospital-Acquired Pressure Injury In High-Risk Patients, Sahara Thapa

Master's Projects and Capstones

Hospital-Acquired Pressure Injury (HAPI) can be costly for Skilled Nursing Facilities (SNFs) and painful for the patients. Most pressure injuries are considered preventable, but many patients die each year from complications from pressure injuries. Pressure injury treatment costs millions of dollars annually, which could be spent on other treatments. A quality improvement (QI) project was formulated to address pressure-related injuries and improve patient care outcomes in one skilled nursing facility in Northern California. Based on a review of current evidence, HAPI prevention education was implemented for all patient care staff. The education focused on skin assessment, risk factors, staging of …

Improving Outreach With Stroke Patients After Discharge, Marsha Belen

Master's Projects and Capstones

Problem: The 90-day mRS post discharge call project aimed to improve the outreach in stroke patients treated with thrombolytics alone or in combination with mechanical endovascular reperfusion (MER) therapy. An audit of calls was completed and revealed a gap that a number of patients were not reached or did not receive a call attempt. Having a higher outreach provides useful feedback on the patient’s progress within 90-days of being discharged in relation to the effectiveness of the stroke treatment received according to the mRS.

Context: The Neuro Coordinator was responsible for making the 90-day post discharge call and worked in …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Tepezza: Improving Delays In Treatment, Rebecca D. Page

Master's Projects and Capstones

Problem: There is gap in time from when a Tepezza (teprotumumab) order is placed until the time a patient receives their first infusion.

Context: Delays in the initiation of Tepezza infusions result in worsening symptoms and a decrease in quality of life for patients diagnosed with thyroid eye disease.

Interventions: Interventions included scheduling regular meetings with involved departments, following each patient who has been prescribed Tepezza through the initiation of therapy, and improving staff and patient education.

Measures: Outcome measures include decreasing days from order placement to first infusion from an average of 61 days to 30 days or less …

Utilization Of A Block Excellence Specialty Team Is B.E.S.T, Lauren E. Pittman

Master's Projects and Capstones

Perioperative registered nurses and anesthesiologists that rely on a process for placing regional anesthesia (R.A.) blocks on the correct side for surgical patients consistently provide high-quality, safe care. Infrequently anesthesiologists place the wrong side peripheral nerve blocks (P.N.B.). Due to the sensitive nature of sentinel events, the frequency of its occurrence at this quality improvement (Q.I.) project site is unavailable. Therefore, a report by Harris et al. (2021) was referenced for the incidence of wrong side blocks (W.S.B.), which were recorded in worldwide, national, and multihospital health care system cohorts as 3.63/10,000, 1.6/10,000, and 1.28/10,000 respectively. The PreOp/PACU nursing staff …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone

Master's Projects and Capstones

Abstract

Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.

Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.

Intervention: A …

A "Collaborative" Approach To Improving Nurse Turnover, Tiffany M. Nawabi

Master's Projects and Capstones

Problem: A cardiovascular unit is experiencing an increase in RN turnover and decreased NDNQI RN to RN interaction scores.

Context: Several recent studies demonstrate that a collaborative environment of well-being and enhanced RN communication can improve nurse retention rates (Alsufyani et al., 2021), as well as increase job satisfaction (Ylitörmänen et al., 2019).

Interventions: Nursing-led collaborative sessions were launched, consisting of the unit’s clinical nurses, the management team, and interprofessionals. The collaborative meetings provide a forum for the nurses to express their concerns, collaborate, and develop meaningful solutions.

Measures: The first measure is the Human Resource’s nursing retention report, with …

Optimization Of Postoperative Length Of Stay, Sadia Imran

Master's Projects and Capstones

Abstract

Problem: The increased patient postoperative length of stay (LOS) is impacting the throughput of the operating room and resulting in prolonged wait time for new post-anesthesia care unit (PACU) admissions from the operating room. The baseline data indicated that average LOS of laparoscopic cholecystectomy patients after surgery was 153 minutes, which is longer than the regional 90-minute standard.

Context: To deliver more efficient care, the healthcare team determined that improving LOS for laparoscopic cholecystectomy patients would increase patient care experience, improve department efficiency, and decrease healthcare cost (Health Catalyst, 2018).

Intervention: The microsystem adopted the continuous improvement methodology to …

Improving Compliance With The Sep-1 Sepsis Management Bundle, Allison Uppendahl Mrs.

Master's Projects and Capstones

Abstract

Problem: Providing high quality sepsis care is an organizational priority, however this medical center has only met the target compliance goal for the Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis management bundle 50% of the time over the past year. Root cause analysis has revealed that 40% of the fallouts have been attributed to non-compliance with the intravenous fluid bundle element.

Context: A microsystem analysis was completed on the quality department, a supporting microsystem to the larger mesosystem involved with providing acute sepsis care. A return-on-investment analysis demonstrated that efforts to improve sepsis care and reduce sepsis …

Improving Colorectal Cancer Screening In Primary Care, Bushra Iqbal

Doctor of Nursing Practice (DNP) Projects

Colorectal Cancer (CRC) is the second leading cause of cancer related deaths in the U.S., although it is preventable with adequate routine screening. Medically underserved minorities and immigrants require screening program awareness in their respective communities. The incidence of CRC remains markedly high despite the screening modalities among various populations. In the United States (U.S.), there were approximately 147,950 reported CRC diagnoses, 53,200 deaths, and over 35.2 cases per 100,000 in California alone reported in 2020 (Siegel et al., 2020). Healthcare providers can prevent colorectal cancer (CRC) through adequate routine screening. Various screening practices are widely implemented in primary cases …

Community Health Worker Program - Substance Use Disorder In Pregnancy, Alicia Claire Kletter Dnp

Doctor of Nursing Practice (DNP) Projects

Background Substance use disorder (SUD) in pregnancy is a concern for mother, baby and community. Healthcare policies are increasingly calling for diversification of the workforce to meet healthcare needs. Community health workers (CHWs) are understood from the literature to be effective at bridging the gap between patient and healthcare provider, especially for vulnerable populations. Local Problem California’s Central Valley is majority Latinx and faces challenges from poverty, lack of medical resources, unemployment and SUD at rates which are higher than other communities. Combine SUD with pregnancy and the need for robust social connections, psychological support, and physical healthcare become even …

Psychobiology Of Resilience, Rosarina A. J. Pelikan

DNP Qualifying Manuscripts

Nurse managers experience high levels of stress due to the complex bureaucratic and chaotic nature of the job, which can lead to burnout. In nurse managers, burnout negatively impacts the ability to meet the strategic goals of the quadruple aim: patient quality, patient satisfaction, cost savings, and employee well-being. Strategies to address burnout include minimizing or removing unnecessary causes of stress and provide the skills to protect against burnout. Resilience is a competency nurse leaders must have to withstand overwhelming job-related stress. Resilience-enhancing strategies have psychobiologic underpinnings and can be easily incorporated into nurse managers’ work schedules.

Implementing A Diabetic Foot Care Program In A Virtual Primary Care Clinic, Zahra Naderi Asiabar

Doctor of Nursing Practice (DNP) Projects

Abstract

Background

Healthcare professionals (HCPs) have a key responsibility in delivering preventative and early intervention diabetes foot management within primary care. Diabetic foot ulcers (DFUs) are a major complication of diabetes and can lead to amputations and other wound issues.

Comprehensive care and treatment of diabetes are most effective when patients can access a supportive connection with providers. Before the pandemic, there were many reasons to utilize a technology-based distance approach to health care. The coronavirus pandemic in 2019 prompted additional reasons for the transition to distant care.

Problem

The yearly screening of a virtual foot exam on patients with …

Implementing Nurse Extracorporeal Membrane Oxygenation Specialists To Maintain A Sustainable Program, David L. Boyd

DNP Qualifying Manuscripts

Extracorporeal membrane oxygenation (ECMO) offers hope for patients with acute respiratory distress syndrome when other treatment methods fail. However, ECMO requires continuous hourly management leading to extremely high operating costs. With the onset of the COVID-19 pandemic, the high number of patients on ECMO led to a significant increase in the costs when using perfusionists to manage ECMO. Switching to a nurse-driven model resulted in a 52% decrease in costs related to the hourly management. Changing to a nurse-driven program provided increased nursing support and sustainability, and with determination and support, other ECMO centers can change to nurse-driven programs too.