Perinatal Anxiety And Depression During The Covid 19 Pandemic, Helen Xumin Chen, Nancy Selix, Marcianna Nosek

DNP Qualifying Manuscripts

Abstract

The novel coronavirus disease 2019 (COVID-19) outbreak places perinatal women at higher risk of developing anxiety and depression. Uncertainty, fear, and confusion in medical, social, economic, occupational and political aspects of life in the US add to existing stressors that perinatal women experience. To optimize the quality of perinatal care during the pandemic, appropriate mental health interventions must be implemented to prevent and alleviate perinatal anxiety and depression and improve maternal and infant outcomes. Measures include increased screening, non-pharmacologic and/or pharmacologic interventions and the use of telehealth for care delivery.

Keywords: perinatal anxiety, perinatal depression, COVID-19, SARS CoV-2, maternal …

Catheter-Associated Urinary Tract Infection (Cauti) Prevention In Spinal Cord Injury Unit, Golda Nebre

Master's Projects and Capstones

PROBLEM: Hospital-acquired infections (HAI) continuous to be a safety challenge in today’s healthcare systems. Applying a lens to the most common HAIs such as Catheter-associated urinary tract infection (CAUTI) in a Spinal Cord Unit calls for evidenced-based solutions and process improvement. CAUTIs are not only costly and prolongs the patient’s hospitalization, it’s a preventable harm that significantly affects the quality of life of spinal cord injury patients.

CONTEXT: Spinal Cord Injury Unit (SCIU) in VA Palo Alto is a 19-bed capacity inpatient unit where CAUTI rates have been increasing in the recent years. There is a high risk for CAUTIs …

Healthcare Provider Education: Adult Jamaicans With Type 2 Diabetes, Patricia Anderson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Worldwide prevalence of type 2 diabetes mellitus (T2DM) among the Jamaican population is 11.9% (WHO, 2016). Jamaican patients and their families have experienced first-hand the debilitating complications of this deadly disease.

Context: Jamaicans with diabetes who live in the US experience these same complications. Approximately 300,000 Jamaicans live in Florida (Peart, 2020). This change of practice project was conducted with healthcare providers employed in a family medicine clinic in Florida that treat Jamaicans with T2DM.

Intervention: This change of practice project used an online evidence-based educational training (i.e., Jamaican culture, diet, and health beliefs and how to use …

The Use Of Online Applications To Improve Chronic Wound Care In Primary Care; A Literature Review, Zahra Naderi Asiabar

DNP Qualifying Manuscripts

Abstract

Background: Chronic wounds are a major burden on patients, health care professionals, and the healthcare system. Primary care professionals need to be prepared with the information and skills that will help them perform high-quality wound care.

Objective: The purpose of this manuscript is to assess the use of mobile applications to support health care providers in primary care who care for patients with chronic wounds.

Data Sources: A review of the evidence was performed using CINAHL, Cochrane/ DARE, PubMed, Ovid, and Evidence-Based Journals to explore the consequences of using online wound care applications by primary care practitioners.

Conclusions: The …

Ultrasound-Guided Peripheral Intravenous Catheter Insertion For Nurse Practitioners, Alvin Joseph Abad

Doctor of Nursing Practice (DNP) Projects

Problem

Intravenous (IV) catheter insertion is a necessary skill in the emergency department (ED) for indications such as medications, fluids, and blood transfusions. Occasionally, patients present with difficult IV access (DIVA), requiring multiple insertion attempts and central venous catheter (CVC) placements. Due to the invasive nature of these procedures, patients can experience a great deal of pain and discomfort. Furthermore, although CVCs are necessary in critically ill patients that require hemodynamic monitoring or vasopressor infusions, they can cause several problems. For instance, central-line associated blood stream infections are some of the most common complications and result in increased costs and …

Optimizing Screening Mammography: Educating Underserved Individuals With Limited English Proficiency, Yao Luo

Doctor of Nursing Practice (DNP) Projects

Problems: Culture and language may create huge barriers to the delivery of high-quality care for patients with Limited English Proficiency (LEP) who are seeking breast cancer care, especially in a population that consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 45 years of age.

Context: LEP patients’ inability to effectively communicate and inadequate knowledge about screening mammography have put them at great risk of receiving additional images during the exam, as well as brought a huge burden to technologists regarding breast positioning.

Interventions: A Doctor of Nursing Practice project was implemented to …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

Dnr No Polst Project, Reanda Scherson

Master's Projects and Capstones

Problem: The DNR No POLST project aims to increase the number of physician orders for life-sustaining treatment (POLST) forms completed on hospitalized patients who are designated DNR status. Currently, there is no process for ensuring completion of advanced care planning (ACP) materials, including the POLST form, on designated DNR patients throughout the hospital. Ensuring patients receive a complete and accurate POLST prior to discharge decreases the chance of unwanted overtreatment.

Context: This quality improvement project utilizes regionally trained life care plan (LCP) facilitators to initiate and assist patients and families in the completion of the POLST form. Approximately 70% of …

Improving Care Experience Of Total Joint Home Recovery Patients Through Nursing Education, Earvin Ledi

Master's Projects and Capstones

Problem: At a Northern California hospital (NCH), there is a current effort to ensure the perioperative patients are satisfied with their care. These patients receive the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey after surgery. The scores regarding discharge process and patient knowledge over the last five quarters have fluctuated between the 10th percentile and the 36th percentile. NCH relies on patient satisfaction scores to better serve their members.

Context: NCH understands the higher the scores, the more members they will retain and the higher the overall income. Based on the low OAS …

A Preoperative Hand Hygiene Campaign: " No One Left Behand.", Keri Mccoy

Master's Projects and Capstones

Abstract

Problem: Surgical site infections (SSIs) account for 20% of all hospital-acquired infections (HAIs). Performance of consistent, accurate hand hygiene practices by healthcare workers is the most effective means of preventing infection, yet the average compliance rates remain low. The preoperative (PREOP) unit carries tremendous responsibility for decreasing each patient's risk for SSI by adequately following the World Health Organization (WHO) guidelines for hand hygiene. The PREOP remains at a low average hand hygiene compliance rate of 69%, with decreased consistency, frequency, and knowledge deficit of hygiene practices. The aim of the quality improvement (QI) hand hygiene campaign is to …

Improving Medication Communication Of Nurses To Patients In The Cardiac Procedure Unit, Jose Abrogar

Master's Projects and Capstones

Abstract

Problem: Effective communication about medications and their potential side effects is a significant indicator of safe patient care and improved health outcomes. The Cardiac Procedure Unit (CPU) of a large medical center in California recently received a low HCAHPS (CMS, 2019) score of one star (out of five) in the area of medication communication.

Context: The CPU is a microsystem that provides pre and post cardiac procedure care for patients of diverse backgrounds. It has a highly competent staff administering patient care. Current patient medication education faces challenges that hinder patient receptivity and thus understanding.

Intervention: The proposed project …

Tele Critical Care Implementation And Education Project, Jeffrey Dover

Master's Projects and Capstones

Abstract

Problem: The intensive care unit has the highest rate of mortality and patient care costs in the hospital. There are significant challenges in improving care and controlling costs. One solution adopted by many healthcare organizations is intensive care telemedicine. Commonly known as eICUs or Tele Critical Care (TCC). These specialty units provide access to intensivists and nurses 24-hours a day and has shown success in reducing mortality and length of stay while providing cost savings.

Challenges exist in introducing telemedicine to a new setting. Barriers identified are high initial cost of equipment, competing priorities for resources, and nurse acceptance. …

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …

Keeping Patients Vertical In The Intensive Care Unit, Melanie Smith

Master's Projects and Capstones

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem’s current …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

The Significance Of Bridging The Health Literacy Gap, Ella Bermudez

DNP Qualifying Manuscripts

Objective: In the veteran population, almost one in every five patients has inadequate or marginal health literacy (Haun, Patel, French, Campbell, & Lapcevic, 2015). Having low health literacy predisposes patients to high emergency room (ER) utilization and hospital readmission (Mitchell, Sadikova, Jack, & Paasche-Orlow, 2012) and low treatment adherence (Miller, 2016). This manuscript aims to review the literature about health literacy and to encourage effective, standardized health education delivery to increase health literacy.

Method: An integrated review of the literature from Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases showed the importance of bridging the health literacy gap. …

Increasing Access To Medicare Annual Wellness Visits In Primary Care; Utilizing Registered Nurses As Part Of An Interdisciplinary Team Based Approach, Iyo Kubota

Doctor of Nursing Practice (DNP) Projects

Background: In order to provide evidence-based preventive care to the aging population, Medicare began providing free annual wellness visits (AWVs) to its beneficiaries in 2011. The AWVs are a great opportunity for primary care providers to develop personalized preventive care as well as health promotion. However, many primary care practices especially those with limited resources struggle to incorporate AWVs into their busy primary care practice. Centers for Medicare and Medicaid Services allows other providers than physicians, NPs and PAs to perform those visits including registered nurses, health educators, and registered dietitians.

Methods: A pilot project was conducted with 12 patients …

Care After Burn Trauma: A Burn Toolkit For Providers, Whitney Weyhing

DNP Qualifying Manuscripts

Problem: A burn injury can occur in a matter of seconds. Despite advances in medical innovations and scientific progress, accidental burns continue to represent a devastating major public health burden today. Burn traumas represent a great expense to the healthcare system, affect every age and demographic, and continue to possess significant morbidity and mortality.

Context: Due to the current knowledge deficit of basic burn treatment, this Toolkit will provide current best-practice guidelines with evidence-based wound care instruction.

Interventions: An interactive educational instruction, including a pre-test and post-test of overall comprehension, from initial assessment to management of burns. Included will be …

The Expansion And Evaluation Of Medication Assisted Treatment Services For An Underserved Rural Northern California Community, Carolyn Perrotti

DNP Qualifying Manuscripts

Problem: Widespread opioid misuse has led to the opioid epidemic that claims 130 deaths per day due to an opioid overdose (CDC, 2018). The opioid epidemic has plagued the United States for three decades and has been considered a public health emergency since 2017 (HHS, 2017). Rural communities are disproportionately affected by this problem and in 2014, the rate of opioid overdose deaths was 45% higher in rural communities (SAMHSA, 2018).

Context: Medication-assisted treatment (MAT) is considered the most effective treatment for opioid dependence because it incorporates medication management and biopsychosocial supports (Jones et al., 2018). Retention in a MAT …

Recruiting And Retaining Np Preceptors, Angelica Renteria

DNP Qualifying Manuscripts

It is estimated that by 2020, the shortage of primary care providers will reach over 20,000. This has led to a surge of nurse practitioner (NP) programs across the nation. Recruiting and retaining preceptors is of paramount importance. Barriers and incentives to precepting must be identified in order to maximize teaching capacity. More effective ways of training NP students (NPs) need to be explored to capitalize on the time preceptors invest with students. The adoption of the OMP teaching model may facilitate training for the preceptor and improve the learning of NPs due to its simplicity and efficiency.

Reducing The Second Victim Phenomenon: Promoting Healing With Caritas Coaching, Shanda N. Whittle

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The second victim phenomenon is one in which healthcare providers use dysfunctional mechanisms, such as anger, projection of blame, or drugs and/or alcohol to cope with serious mistakes in the absence of a healthier means for healing (Wu, 2000). This phenomenon can be caused by adverse events or other personal/professional crises and can lead to healthcare professional absenteeism, leaving the job or leaving the profession altogether (Burlison et al., 2018; Hirschinger et al., 2015).

Context: The second victim phenomenon was identified as a problem within this DNP student’s organization and support was obtained for conducting the project. A …

Wound Care Education For Primary Care Providers At A Regional Medical Center, Zaira Torres

Doctor of Nursing Practice (DNP) Projects

Problem. Due to the aging population and the high prevalence of chronic diseases such as diabetes and cardiovascular disease, in the US, millions of people suffer from chronic wounds secondary to these chronic conditions. Wound care treatment is very expensive, costing the US health care system approximately $10 billion annually. San Mateo Medical Center treats many patients with wounds. However, the treatment is suboptimal as most primary care providers (PCPs) are not trained to perform wound care according to best practice. This creates several problems such as a large number of referrals to the Vascular Clinic, visits to the emergency …

Evidence-Based Suicide Assessment And Prevention Training For Licensed Nursing Staff, Rose Waithira Zhang Dnp(C), Msn-Fnp-Bc, Bsn, Rn

Doctor of Nursing Practice (DNP) Projects

Section I: Abstract

Problem: Suicide is a major public health concern that kills over 45,000 people in the U.S every year. At a psychiatric hospital in Northern California, several suicide attempts occur every year.

Context: The aim of this DNP project was to train licensed nursing staff at a large safety net psychiatric hospital in Northern California on interventions and best practices in suicide prevention to improve suicide screening, assessment, and detection for an at-risk population.

Intervention: Interventions consisted of training on the appropriate use of (a) the organization’s Evidence-based Suicide Screening and Prevention Protocol and (b) an evidence-based suicide …

Reducing Frustration With Wait Times Utilizing Technology And Education: A Patient Satisfaction Improvement Model, Tiffany Brown

Doctor of Nursing Practice (DNP) Projects

Problem: Patients spend considerable amounts of valuable time waiting to be seen by physicians in outpatient clinical settings. Many consider waiting as wasted time, inactive time, or as a lost opportunity which can cause frustration. Research suggests that long clinic wait times have a major impact on patients with cancer causing a significant amount emotional distress. Context: At the hospital and thoracic oncology clinic implementation site which is located in northern California, the target time for a New Patient Visit (NPV) is less than or equal to 90 minutes, and less than or equal to 60 minutes for a Return …

Initiating Prep In Primary Care: Addressing The Adolescent And Young Adult High Risk Populations, Igor G. Mocorro

Doctor of Nursing Practice (DNP) Projects

Problem: Adolescents and young adults (AYA) ages 13 to 24 comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive therapies such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but it is evident that many clinicians are still reluctant to initiate PrEP in AYA patients based on perceived threats and barriers.

Context: Primary care clinics, including school-based clinics, have an opportunity to offer HIV prevention services including PrEP. This project, the Adolescent and Young Adult …

Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable

Master's Projects and Capstones

The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …

Competency-Based Practicum Evaluation Tools For Family Nurse Practitioner Programs, Angelica Renteria

Doctor of Nursing Practice (DNP) Projects

Problem: Training family nurse practitioners (FNPs) was identified as a concern within a university MSN FNP program. A major gap identified was that student practicum evaluation tools needed to be competency-based.

Context: The paradigm shift from content-focused curriculum to competency-based curriculum has led to a refinement in program accreditation and increased national certification requirements.

Interventions: Revision (aligned with NONPF core competencies and AACN Master’s essentials), adoption, implementation, and evaluation of competency-based FNP practicum evaluation tools and training of faculty and preceptors to use the revised tools and one-minute preceptor model were the interventions in this project.

Measures: …

Unaddressed Challenges For The “Most Honest And Ethical Profession:” A Pilot Study Of Web-Based Learning Strategies To Prevent Moral Distress, Kelly Straight

Doctor of Nursing Practice (DNP) Projects

Background: Nurses and nurse practitioners (NPs) face greater responsibility to address the ethical challenges that present during the course of patient care, due to advances in medical technology and pharmaceutical innovation, and because of widening disparities within the U.S. healthcare system. These ethical questions, which arise during the course of routine patient care, are increasing in both number and complexity in nearly every patient care setting. Even with codified ethical standards, unresolved and/or ongoing ethical questions and dilemmas pose further issues such as the development of moral distress. This pilot project was designed to help NPs and other healthcare workers …

Moral Distress: Unaddressed Challenges For The “Most Honest And Ethical Profession”, Kelly Straight

DNP Qualifying Manuscripts

Nurses and nurse practitioners (NPs) face greater responsibility to address the ethical challenges that present during the course of patient care, due to advances in medical technology and pharmaceutical innovation, and despite widening disparities within the U.S. healthcare system. These ethical questions, which arise during the course of routine patient care, are increasing in both number and complexity in nearly every patient care setting. Unresolved and/or ongoing ethical questions and conflicts encountered in patient care pose further issues such as the development of moral distress. The literature demonstrates that moral distress contributes to dissatisfaction, disengagement, and burnout which negatively affects …

Review Of Evidence Paper Practice And Patient Outcome Improvements Of Prescribing First-Line Antibiotics For Acute Uncomplicated Cystitis, Ira Amayun

DNP Qualifying Manuscripts

Abstract

Background: In 2017, the Centers for Disease Control and Prevention (CDC) published guidelines for treating acute uncomplicated cystitis (AUC) with nitrofurantoin (NTF), sulfamethoxazole-trimethoprim (SMX-TMP), or fosfomycin (FM) as appropriate first-line agents.

Objective: This paper aims to evaluate whether provider adherence to prescribing NTF, SMX-TMP, or FM has improved since the 2017 CDC guidelines were released, and to examine outcomes relative to use of prescribing guidelines in the treatment of AUC in non-pregnant women.

Methods: A literature review was conducted. The Cochrane Risk of Bias Tool was used to assess publication bias. The John Hopkins Research Evidence Appraisal Tool was …