Nursing Commons^™

Development Of An Ehealth Harm Reduction Resource To Address Opioid Use Among Youth In Rural Northern California, Carolyn Perrotti Lake

Doctor of Nursing Practice (DNP) Projects

Problem: Opioid use and misuse is a leading cause of injury and death among adolescents and young adults in the United States, with a three-fold increase in opioid overdoses since 2000 (Carney et al., 2018; Hudgins et al., 2019). Opioid misuse correlates with misuse of other substances, which exponentially increases health risks over time. The most effective treatment for opioid use disorder (OUD) among adolescence is through effective prevention interventions that either prevent the development of the OUD or enable timely diagnosis and treatment in order to prevent poor health outcomes.

Context: The use of eHealth technology, which has …

Prevention Of Abusive Head Trauma Using An Educational Program For Parents/Caregivers, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The National Center on Shaken Baby Syndrome reports that 1,300 abusive head trauma (AHT) cases occur in the USA each year, a quarter of which are fatal. Injuries are caused by impact, shaking, or both and result in intracranial and spinal damage, retinal hemorrhages, fractures of the ribs and other bones. AHT case rates in the community involved in this project had a 22% increase of AHT from 2018 to 2019.

Context: A practice improvement project involved the implementation of an AHT educational program targeted at parents/caregiversreceiving care services at a children’s hospital pediatric well-child clinic located in …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Developing A Culturally Relevant Mental Health Assessment For Persons Of African Descent, Roberta Iyamu

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Persons of African descent have lower access to mental health care, are less likely to receive needed care, and are more likely to be misdiagnosed, experience severe disease, and to receive mental health care through primary care than non-Hispanic Whites. Context: Cultural norms related to mental health as well as the lack of culturally congruent health care delivery contribute to lower mental health care access and uptake among persons of African descent. Interventions: Campinha-Bacote’s cultural competence model and the BATHE technique provided the theoretical framework for the development and implementation of a nurse practitioner (NP) (n = 4) …

The Nurse Will See You Now: Improving Nurse-Led Chemotherapy Teaching, Laura Oka

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: According to The International Agency for Research on Cancer (IARC) 2020 World Cancer Report, cancer has contributed to 9.6 million deaths in 2018 and is now globally considered the second most common cause of death (IARC, 2020).

Context: As a cancer patient moves beyond diagnosis, there becomes a need to introduce the plan of care and education related to evidence-based treatments with an intent to cure. As the delivery of these treatments continues to move toward outpatient care, herein lies the challenge of sharing important information with the patient to improve health outcomes.

Intervention: This DNP change of …

Optimizing Pediatric Preoperative Experiences In The Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one …

Standardized Outreach: Increasing Vaccine Uptake In The Latinx Community Through A Standardized Phone Call Process, Vanesa Vazquez

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in several minority communities since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines (Increased risk, 2020). The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake, particularly in the Latinx community. Patients at a community clinic in Oakland, California have made apparent their distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. Most of these patients are Latinx-identifying and are considered more at risk for development of COVID-19 in …

Optimizing Mri Experience For Children Living With Autism Spectrum Disorder, Lyn Tran

Master's Theses

Magnetic Resonance Imaging (MRI) in pediatric patients living with Autism Spectrum Disorder (ASD) is often complicated by challenges. The child perceives the MRI environment as abnormal and uncertain of the implications of the procedure. The child may exhibit distress becoming anxious and frightened, reluctant to enter the scanner, and unable to remain still throughout the duration of the procedure. The issue lies within the child’s mental and behavioral challenges to understand and follow the task demands to ensure safety and accurate acquisition of image artifacts. After reviewing literature, observing MRI protocol for pediatric patients, and conducting multiple nursing staff surveys …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Vanessa M. Arteaga

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latinx and Black community since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines. The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake. Patients at a community clinic in Oakland have expressed hesitance of the COVID-19 vaccine. They also exhibited increased frustration with the staff who are contacting them to schedule vaccine appointments and provide information. This resulted in refusal of the vaccine and less than desirable number of vaccine appointments. The objective of this …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Stephanie Ramirez

Master's Projects and Capstones

In the United States, Latinx communities have experienced a disproportionately high burden of COVID-19 infections and hospitalizations throughout the pandemic. The focus of this quality improvement project is to standardize the patient outreach process and education to increase COVID-19 vaccine uptake. The ambulatory community clinic in the city of Oakland, California serves a majority of underserved Latinx patients that have demonstrated distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. The high burden of COVID-19 infections among the Latinx community has led to misinformation and fear. In order to overcome this issue, Clinical …

Preventing Central Line Associated Bloodstream Infections In An Adult Intensive Care Unit, Monica Shaw

Master's Projects and Capstones

Central line associated blood stream infections (CLABSI) are considered preventable healthcare acquired infections, and are associated with significantly increased morbidity, mortality, and length of hospital stay. The CLABSI rate in an inpatient unit is a meaningful metric in relation to the safety and quality of care in that microsystem. This quality improvement project examines the efficacy of a CLABSI prevention bundle in reducing CLABSI events and improving adherence to central line care policy within a medical surgical adult intensive care unit. The target areas the bundle aimed to improve were unit processes, awareness of CLABSI and central line policies, and …

Improving Patient Experience And Staff Workflow During Ed To Inpatient Interfacility Transfers, Jonathan Nakagawa

Master's Projects and Capstones

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

Code Blue: Do You Know What To Do? Increasing Nurse Confidence And Readiness Through In-Situ Mock Code Simulation, Katelyn Nusser

Master's Projects and Capstones

An underprepared nurse is the most dangerous threat to patient survival in the intense and frightening environment of a code blue situation. With basic life support certification required on merely a biannual basis, it cannot be expected that nurses maintain the skills and knowledge without routine application. This quality improvement project proposed the following PICOT question: for medical-surgical nurses, how does in-situ mock code blue training between BLS recertification periods affect nurse readiness and confidence in a code blue situation? Mock code simulations were conducted over a three-week period with an emphasis on hands-on practice as well as teamwork and …

Implementing In-Situ Mini Mock Code Trainings For Medical-Surgical Nurses To Improve Nurse Readiness And Self-Confidence During A Code Blue, Allison Haley Jeong

Master's Projects and Capstones

Immediate, high-quality cardiopulmonary resuscitation (CPR) and early defibrillation are important in increasing survival rates during a cardiac arrest. At the Medical Center, which is part of an integrated healthcare system in a metropolitan area of the San Francisco Bay Area, a quality improvement project was implemented to increase readiness and self-confidence of medical-surgical nurses during a code blue situation. Nurse participants completed a pre- and post-intervention survey containing questions about their self-confidence in performing different skills relevant to a code blue, scored on a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). The intervention included an in-service …

Standardizing And Documenting Decision-To-Incision Intervals For Unscheduled Cesarean-Section Deliveries, Molly Bloom

Master's Projects and Capstones

The term decision-to-incision interval (DII) refers to the interval between when a laboring patient and their healthcare provider agree to an unscheduled surgical cesarean section (C/S) delivery and when the first incision is made in the operating room. The ideal length for this interval varies with the urgency of each case, and there is no international consensus regarding the timing. In an urban labor and delivery unit in a private hospital, examination of this interval revealed inconsistent documentation of the decision, as well as unclear guidelines on the DII for two of the three unscheduled C/S urgency levels. This quality …

Educating Providers To Screen For Post-Traumatic Stress Disorder, Alyssa Fraino

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the knowledge base of psychiatric providers in outpatient psychiatric settings, by educating clinicians regarding the significance of implementing a post-traumatic stress disorder (PTSD) screening tool during the initial evaluation of patients. This can help to identify patients with PTSD that may not have been identified on initial visit, and may otherwise go unrecognized or untreated for PTSD, without the inclusion of a PTSD screening tool.

Problem: Evidence suggests that PTSD is underreported and overlooked in most populations. However, there is no standardized practice surrounding the routine use of …

Utilizing Tracer Methodology To Evaluate The Effectiveness Of A Hospital Antimicrobial Stewardship Program, Christine Smyth

Doctor of Nursing Practice (DNP) Projects

Antimicrobial resistant organisms are a growing threat in the United States and globally. It has become the expectation that healthcare institutions, including hospitals, contribute resources to create and maintain antimicrobial stewardship programs to decrease antimicrobial resistance, improve patient outcomes, and decrease the spread of multi-drug resistant organisms. The methods utilized to evaluate antimicrobial stewardship at hospitals often only evaluate outcome measures and fail to capture knowledge of the hospital antimicrobial stewardship program among prescribers, clinical pharmacists, and nurses, as well potential barriers to antimicrobial stewardship among healthcare providers. The purpose of this Doctor of Nursing project is to implement and …

Improving Surface Cleaning And Hand Hygiene Using Fluorescent Markers, Taryn Whitman

Master's Projects and Capstones

Problem: Compared to inpatient units, ambulatory care clinics have differences in staffing available and frequency to perform room turnover (RTO). Pre-intervention data revealed poor Hand hygiene (HH) and high-touch surface cleaning (HTSC) knowledge and low RTO compliance reliability. Currently, there is no process for objectively monitoring RTO compliance and staff self-evaluation of HH, HTSC, and RTO performance is incongruent with observations.

Context: HH and HTSC are a crucial component of preventing healthcare-associated infections (HAIs). Estimated loss of revenue for one northern California tertiary university hospital system (HCO) campus was nearly $1.8 million dollars in Medicare penalties for 2018.

Intervention: …

Optimizing Pediatric Experiences In Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one hour staff inservice …

Utilizing A Stress And Coping Model Into A Preventive Abusive Head Trauma Parent/Caregiver Educational Program, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abusive head trauma (AHT) is a serious form of child maltreatment that is the primary cause of fatal head injuries in children younger than 24 months and is the cause for over 50% of severe or fatal traumatic brain injury incidences. These injuries can be caused by impact, shaking, or the combination of shaking and impact. These multi-factorial injuries can cause intracranial and spinal damage, retinal hemorrhages, and fractures of ribs and other bones. The age and severity of injuries will be used to assess the diagnosis of AHT. When AHT occurs, it is often tied to the behavior from …

You Are What You Think: The Impacts Of Body Weight Perception In Young Adolescent Women, Olivia Ceja

DNP Qualifying Manuscripts

While research suggests a multifactorial array of contributors to adolescent obesity including lack of physical activity, dietary behaviors, psychosocial factors including the perception of being overweight and body dissatisfaction have been more recently associated with unhealthy weights, unhealthy behaviors and amplified risk of obesity. At an all girl’s private college preparatory middle and high school in Los Angeles, amid a competitive and rigorous academic environment, students face additional pressure to succeed and strive for perfection. Although body weight perception can be used to identify students who are at risk for eating disorders at the middle and high school levels, the …

Effects Of Naloxone Prescription Programs On Opioid Overdoses In Three Months, Patricia Tinglin

DNP Qualifying Manuscripts

Background: Fatal opioid overdose is a growing concern in the United States (U.S.). The medical community was assured by pharmaceutical companies that opioid pain relievers were not addictive. As a result, providers prescribed them at a significantly higher rate, which led to more extensive use of authorized and unauthorized opioids before it was realized that they can be highly habit-forming (The U.S. Department of Health and Human Services [HHS], 2019). A growing body of evidence supports Naloxone Prescription Programs (NPP) for the prevention of fatal overdoses (Enteen et al., 2010). Objective: To describe evidence found to answer the following …

Increasing Chlamydia Screening In The High-Risk Population Using Electronic Notification And Targeted Education: A Primary Care Approach, Michael Barnett

Doctor of Nursing Practice (DNP) Projects

The primary care office is an ideal setting and the front gate for screening young adults for chlamydia infection. Chlamydia is the most common sexually transmitted infection in the US and sexually active women aged 24 and younger are at the highest risk for having it (Centers for Disease Control and Prevention [CDC], 2016). Screening is simple and effective and can be completed through a urine test. Treatment is straightforward and involves a one-time dose of antibiotic medicine. Untreated infections in women can lead to pelvic inflammatory disease (PID), chronic pelvic pain, infertility, and life-threatening ectopic pregnancies (Papp, Schachter, Gaydos, …

Identification And Mitigation Of Environmental Hazards In Psychiatric Patient Suicide Prevention: A Review, Alan Le

DNP Qualifying Manuscripts

Background: Environmental hazards are a factor in the bulk of inpatient suicide cases, which disproportionately impact psychiatric patients. Current measures to minimize suicide risk include process-oriented solutions and environmental safeguards such as breakaway structures.

Aims: To perform a review of the literature that identifies environmental suicide hazards and interventions implemented to abate hazards and reduce suicide risk.

Methods: Electronic databases were searched using relevant keywords. Inclusion criteria consisted of articles published 2009-2020 that identified environmental suicide hazards or examined efficacy of interventions implemented to abate hazards. The Johns Hopkins Research and Non-Research Evidence Appraisal Tools were used for critical appraisal. …

Scholarly Manuscript: Deficiencies In Memory And Effective Education Of De-Escalation Techniques In Mental Health Settings, Balraj Bajwa

DNP Qualifying Manuscripts

Objective: To appraise and evaluate evidence recognizing the lack of effective staff education on de-escalation techniques, the impact that this creates on nursing practice, and staff perceptions on de-escalation methods and techniques in acute care inpatient and/or outpatient mental health settings.

Methods: Three databases were searched (CINAHL, PubMed, and PsycINFO) to identify articles/reviews which focused on de-escalation techniques and training. Additionally, five journals were also reviewed to help with the search process. Specific inclusion criteria were used to streamline the search process and to help identify articles/reviews which were primarily focused on the desired objective. Five different articles …

Streamlining Care For Children With Autism Spectrum Disorder, Siavash Rostami Jafarabad

DNP Qualifying Manuscripts

Background: Autism spectrum disorder (ASD) is a chronic and developmental disorder that affects about one out of every 65 children in California, and one in 59 children in the United States. Children with ASD have difficulty communicating and interacting with others, and experience oversensitivity to new stimuli and environments.

Problem: In healthcare settings, children with ASD experience numerous challenges related to lack of adequate knowledge and education of staff regarding ASD, and lack of appropriate environmental and sensory resources which reduce quality of care provided to this population.

Objective: To analyze and evaluate the evidence regarding effective staff education and …

Rural Young Adult Health: Drivers And Barriers To Accessing Care, Maggie Thompson

DNP Qualifying Manuscripts

Adolescents and young adults are developmentally inclined to seek autonomy and take risks. This propensity for risk and challenging boundaries is essential for personal identity formation and belief systems development. During the transition to adulthood, adolescents and young adults often place a high value on peer group acceptance and adhering to perceived social norms. As a result, adolescents and young adults are more likely to engage in pleasure-seeking behaviors despite the associated risks.

The potential for harm often grows in young adulthood, as newfound freedoms present more significant opportunities to engage in risk-taking behaviors. Despite some enduring controversy, age-specific, preventative …

The Use Of Simulation With The School Of Nursing And Health Professions (Sonhp) Prelicensure Students To Support The Practice Toward The Transgender Communities, Genevieve Charbonneau

Nursing and Health Professions Faculty Research and Publications

The purpose of this paper is to examine the different disparities in student disciplines and provide critical review of current literature on how microaggressions against transgender communities and more specifically against transgender patients are lacking in many of the prelicensure nursing programs at the School of Nursing and Health Professions Simulation Center (SONHP) in the San Francisco Bay Area. The goal of the research would be to enhance nurse faculty readiness for student diversity in the classroom and clinical setting and provide experiential learning in nursing education as well as promote knowledge, skills and attitudes (KSAs) to have a more …

Standardizing Thoracic Aortic Aneurysm Education, Marjorie Anne Gisslow

Master's Projects and Capstones

Problem: Patients receive information about a new thoracic aortic aneurysm (TAA) diagnosis from their primary care providers (PCPs). As TAA is a relatively rare conditions, many PCPs have rudimentary knowledge of TAA, and need information and support from cardiac specialists to address their patients’ concerns and guide their care.

Context: In the Regional TAA Surveillance Program the TAA nurses offer educational content for patients through the information they provide to the PCPs. Currently the educational material available to PCPs is not comprehensive or easily accessible.

Intervention: Uniform, comprehensive educational content provided through recommendations in the patient’s electronic medical record at …