Nursing Commons^™

Prospectus For Decreasing Lab Specimen Errors, Sabrina Scruton

Master's Projects and Capstones

Abstract

It has been estimated that >160,000 adverse patient events occur each year in the United States because of patient or specimen identification errors involving the laboratory (Sandhu, et. al 2017). The overall effect of specimen labeling errors often leads to patient safety issues related to medication errors, misdiagnosis, and delays in care (Sandhu, et. al 2017). The Women’s Clinic (WC) an outpatient clinic located within a larger northern California acute care facility had noted a significant increase in the number of lab years in the last year. This clinic sees on average four hundred patients and collects hundreds of …

Prospectus For Creating A Nurse Suggestive Acuity-Based Staffing Model In Ambulatory Infusion Settings To Improve Patient Safety And Quality Of Care, Yongli Qiu

Master's Projects and Capstones

Due to the lack of reliable and valid infusion nurse suggestive acuity-based staffing model, ambulatory infusion settings are burden with potentially compromised patient safety, poor quality of patient care with over-scheduling of unexpected complex patients, limited resources related to nurses and infusion chairs, the dissatisfaction of patients and family members, and infusion nurses’ burn out. This project seeks to determine the appropriate nurse to patient acuity-based point ratio in staffing and scheduling factors that influence nurse staffing model, and established nurse staffing strategies. This three-month project was conducted with the infusion nurses, a nurse manager, a nurse supervisor, an assistant …

Defining Young Adulthood, Elena Higley

DNP Qualifying Manuscripts

Young adulthood is a unique developmental period that occurs between the ages of 18 and 25 years, during which there are key developmental tasks that allow the young adult to participate in self-exploration and identity formation. Currently, among various organizations there are differing definitions and age range inclusions for young adulthood, which cause confusion during program development, healthcare service delivery, and research. Young adulthood should be categorized separately from adolescence and adulthood, because young adults have lower rates of healthcare utilization and worse health outcomes related to preventable causes of morbidity and mortality than the surrounding age groups. Young adults …

School-Based Mental Health Screening: Improving Outcomes Through Interprofessional Communication And Collaboration, Tiffany Gishizky

Doctor of Nursing Practice (DNP) Projects

For the adolescent population, the immediate impact a mental health disorder has on academics,relationships, and even suicide risk cannot be understated. Access to mental health care in low socioeconomic communities for adolescents is fraught with barriers. These include lack of transportation, lack of insurance coverage, fear of stigma, and a fundamental lack of knowledge regarding available resources. It is therefore a two-fold problem that exists for those in the care and observation of these adolescents; underutilization of appropriate routine screening and navigation to access care. This project aimed to remediate both of these issues at a high school located in …

Increasing Long Acting Reversible Contraception Use In Primary Care: Removing The Barriers, Jessamyn Phillips

Doctor of Nursing Practice (DNP) Projects

Problem: Unintended pregnancy is a serious public health concern. About half of all pregnancies in the United States are unintended (Guttmacher Institute, 2016). This project lead by a Doctor of Nursing Practice (DNP) student at the University of San Francisco, will showcase the development, implementation, and evaluation of a LARC training program aimed at improving confidence in counseling, competence in insertion, and evaluation increased rates of LARC usage in primary care, directed at reducing unintended pregnancy rates. This program expands upon the Healthy People 2020 goals dedicated to family planning and emphasis on increased utilization of the most effective forms …

Improving Access To Youth-Friendly Health Services In A Rural California Community, Elena Higley

Doctor of Nursing Practice (DNP) Projects

Adolescents and young adults experience relatively high rates of preventable morbidity and mortality due to injuries, mental health disorders, suicide, substance use, and reproductive health issues. It is paramount for healthcare providers to address risky behaviors early to thwart future adverse outcomes. Rural communities especially struggle with meeting the healthcare needs of their youth because there are fewer resources specifically dedicated to serving adolescents and young adults. This issue is evident in Grass Valley, California, a rural community in Nevada County, an area located in the foothills of the Sierra Nevada mountains. In response to limited access to youth-friendly healthcare …

Adolescent Sexual Reproductive Health Course: A Mixed Media Intervention And Quality Improvement Project In A School-Based Setting, Stephanie Calabrese

Doctor of Nursing Practice (DNP) Projects

Section I: Abstract

Problem: California’s adolescents carry a significant burden of newly acquired sexually transmitted infections (STIs) and gaps in adolescent sexual and reproductive health (SRH) knowledge have led to poor adolescent health outcomes. (CDE, 2019). Context: The California Healthy Youth Act (AB 329) was enacted on January 1, 2016, calling all school districts to ensure that all pupils receive comprehensive sexual health education, and HIV prevention education (CDE, 2019). In a proactive motion, parents from a northern California middle school approached a university to provide a Doctor of Nursing Practice (DNP) student to instruct its sixth grade’s …

A Toolkit For Administration Of Antipsychotic Medications In Nursing Homes, Nino Dantes Flores

Doctor of Nursing Practice (DNP) Projects

Psychotropic medications should be used with extreme caution in older adults residing in long- term care facilities. Delirium and altered mental status are associated with multiple complex underlying medical conditions and can be difficult to recognize, particularly among the elderly residing in long-term care facilities. The use of the California Department of Public Health (CDPH) Skilled Nursing Facility (SNF) Antipsychotic Toolkit allows for ethical and evidence- based care of the elderly within the regulations and best practice for use of antipsychotics. This Doctor of Nursing Practice quality improvement project is designed to provide a toolkit for practitioners of behavioral modification …

Enhancing Nutrition Education For School Aged Children; A Preventive Health Measure And Quality Improvement Project, Fanny M. Powell

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of the DNP project was to improve nutritional knowledge of the adolescents at Kings Canyon Unified School District while also improving their perceived ability to choose healthy food. This project was enveloped in a larger community outreach mission utilizing a free school-based clinic for the purposes of providing sports physicals to students and health screening and physicals to the community. Additionally, nurse practitioner students engaged in a cultural immersion experience through clinical rotations in Central Valley.

Methods: Adolescent students who registered for the clinic watched a nine-minute nutrition video, created by the DNP student, while waiting …

Enhancing Health Literacy Using Teach Back Method To Increase Patient Adherence To, Tram Mendoza

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy is a complicated and perplexing topic for those not trained in the medical field. Patients possess pieces of health literacy to some degree, while some have none at all. Limited health literacy can pose a very threatening risk on a patient’s well-being, interfering with their self-care and health maintenance, possibly creating more obstacles for the patient if health instructions and education are not clearly understood. This can lead to increased health expenditures due to treating the effects of poor health maintenance in addition to emergency room visits that may have not been necessary had the patient understood …

Standardizing Mammogram Screening In Primary Care: Integrating An Evidence Based Approach, Lacrisha Go

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Mammogram screening for surveillance and detection of breast cancer has long been recognized as a preventative health measure for women. However, easily recognizing when to screen individual women, based on age and risk factors, lacks clear guidance and often ends in fragmented and inconsistent practices among providers.

Methods: By developing and implementing the Screening Mammogram Initiation Protocol (SMIP), the desired goals of this project were to: a) align breast cancer screening recommendations to better meet individualized patient needs in primary care utilizing best practice guidelines, b) increase the rate of breast cancer screening across various demographics, and c) …

Improving Emergency Department Staff Compliance To The Sepsis Core Measure: A Quality Improvement Project, Maryoll Llanera

Master's Projects and Capstones

The Centers for Medicare & Medicaid Services (CMS) has reported the percentage of patients who received appropriate care for severe sepsis and septic shock for each Joint Commission-accredited hospital during its latest data collection period from 04/01/2017 - 03/31/2018. This has prompted many healthcare organizations in the United States to make compliance to the CMS mandated sepsis core measure a priority and explore different improvement strategies and techniques. A small community-based hospital in northern California is among these organizations and has focused specifically on its emergency department (ED). An internal audit was performed to identify areas of deficiency, and an …

The Fall Free Zone, Brendalyn Malimban

Master's Projects and Capstones

The fall prevention project is designed to decrease fall rates in the medical-surgical units by promoting accuracy in identifying fall risk patients and engaging patients in participating with their own safety. The project will follow Kotter’s change model to address the urgent need for reducing fall rates (Webster & Webster, 2018). A falls taskforce committee is already in place pursuing the goal mentioned. Engaging the staff members and leaders will be accomplished through reeducation of policies and procedures, admission process and the accurate use of the SCHMID Assessment Tool. These will take place during staff meetings, huddles and roving learning …

Improving Nurse-Physician Collaboration: Building An Infrastructure Of Support, Marshall Blue

Doctor of Nursing Practice (DNP) Projects

Abstract

Healthcare organizations have come to realize the 21st century brings many challenges. First and foremost is the challenge of improving patient satisfaction with their health care and their associated experience accessing this complex system. Other challenges are incorporating the patient perceptions of delivering high quality, safe, equitable care to the surrounding community while demonstrating cohesive teamwork. Healthcare professionals and organizations must find an effective and efficient pathway to provide excellent care to the patient within an extremely competitive market. Current research demonstrates a patient perceives they are receiving exceptional care when interdisciplinary conversations are noticed between the nurse and …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …

Advance Care Planning Interventions For Racially And Ethnically Diverse Populations: A Literature Review, Haley Kirkpatrick

DNP Qualifying Manuscripts

Background and purpose: Diverse populations are less likely to engage in end-of-life-care-planning. This literature review examined research on end-of-life planning interventions for diverse patient populations.

Methods: This systematic search included Academic Search Complete, Cochrane, CINAHL, and PubMed databases. Results were limited to peer-reviewed articles published in English between 2015 to 2019.

Conclusions: Each intervention was effective at increasing advance care planning (ACP) engagement. Community-based programs are costlier. PREPARE used less resources. If diverse populations are specifically targeted, ACP engagement increases.

Implications for practice: Healthcare institutions and practitioners should employ targeted interventions for ACP engagement of diverse groups.

Keywords: end-of-life-care planning, …

A Literature Review On Improving Nurse-Patient Communication Manuscript, Irene Gabbedon

DNP Qualifying Manuscripts

Effective communication happens when the sender of the message sends it, and it is conveyed and understood by the receiver (Gilbert & Hayes, 2009). Medical errors are the third leading cause of death in the United States alone (McMains, 2016). The Joint Commission (TJC) (2019) implemented National Patient Safety Goals (NPSG) in 2002, and improving communication among caregivers has been a goal that has been frequently revised. Due to ineffective communication, life-threatening errors are created among healthcare workers. Nurses play an important role in the communication channel and barriers can be created when there is a lack of health literacy. …

Childhood Obesity: Getting Back To The Basics, Fanny Powell

DNP Qualifying Manuscripts

Childhood obesity is an epidemic that affects the nation. The Centers for Disease Control and Prevention (CDC) (2015) states that over the past thirty years, the prevalence of childhood obesity has more than doubled in younger children and quadrupled in adolescents (CDC, 2015). Although obesity is a multifactorial health issue that is affected by genetics, metabolic factors, socioeconomic factors, and lifestyle choices (Stanford, 2018), a majority of pediatric obesity is as a result of consuming more energy than the body utilizes. There are both immediate and long-term consequences of obesity that negatively affect a child’s health which may carry over …

Hepatitis C Treatment In High Risk Patients: Implementation Of A Successful Community Focused Program, Annie Pedlar, Jodie Sandhu Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Projects

Background: The city of San Francisco boasts a high rate of hepatitis C infection (HCV) among IV drug users indicating the need for a hepatitis C treatment program. It is estimated that over two-thirds of people who are actively infected with HCV are IV drug users (EndHepCSF, 2017), and in 2017 the San Francisco Department of Public Health (SFDPH) estimated that there are 22,500 active people who inject drugs (PWID) in SF (SFDPH, 2017). With the presence of a wide population of IV drug users in SF there is an identified need for intervention to treat this high-risk patient …

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

DNP Qualifying Manuscripts

Background: The second victim phenomenon is one in which nurses and other 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 lead to healthcare professional absenteeism, leaving the job or leaving the profession altogether (Burlison, Quillivan, Scott, Johnson, & Hoffman, 2018). Following the release of an editorial by Dr. Wu (2000), organizational peer support programs have been developed to reduce this phenomenon. These types of peer support programs have been found to counter absenteeism and …

Enhancing Patient Medication Knowledge: Utilizing An Educational Tool To Improve Patient Satisfaction Scores, Elizabeth Orgon

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has recognized the need for medication education with communication about medication as a patient satisfaction indicator. Literature shows a medication guide or tool that is readily accessible and easy to understand for the patient can help provide nurses with a teach back method to help increase patient knowledge about common medications. Continued use of this tool will then positively affect communication between patients and providers thereby increasing medication communication related HCAHPS survey scores. Review of current Stanford Health Care HCAHPS survey data shows that all nursing units are continually …

Operationalizing A Theoretical Framework To Improve Patient Perception Of Care, Debra J. Morton

DNP Qualifying Manuscripts

The Centers for Medicaid and Medicare Services publicly report information that allows comparisons to be made across all hospitals to support consumer choice. A hospital’s reputation, coupled with the financial impact, depends on patient satisfaction, which must be taken seriously. Care experience scores are primarily nurse-driven, and nurse leaders have a large responsibility to produce results. The practice of commanding and directive leadership has never been effective long term. Nurses want leaders to make sense of a situation and explain the why. The need to inspire and create alternative ways to help nurses connect purpose to practice is imperative …

Burnout, Depression And Suicide Prevention For Nurses In High-Intensity Settings, April Ritchie

Doctor of Nursing Practice (DNP) Projects

Problem: Burnout in healthcare has been reported as high as 35% for hospital nurses in acute care and occurs at higher rates in high-intensity settings. Burnout can lead to depressive symptoms, which can lead to suicidal ideation in affected healthcare providers and warrants further attention.

Context: Studies indicate that identification and interventions can help improve burnout; therefore, nurses in the emergency department (ED), intensive care unit (ICU), labor and delivery (L&D), and neonatal intensive care unit (NICU) completed education, surveys, and tools to identify and treat the problem.

Interventions: Nurse education on burnout, depression, and suicide was completed, and …

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound …

Nursing Engagement In Policy Development And Advocacy, Marketa Houskova

DNP Qualifying Manuscripts

At present, professional nursing does not benefit from strong policy development and advocacy influence in the United States. There are 425,000 licensed registered nurses in California, which is nearly twelve percent of the national nursing workforce. Yet only five percent of nurses serve on hospital boards, and legislative efforts to advance full practice authority for advanced practice RNs fail year after year in California and other states. Although nursing ranked most trusted and ethical profession for the past 16 years (Gallup 2017) and enjoys much respect in society, its collective voice is not being heard by decision-makers and legislators. This …

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the …

Implementing Ihi Joy In Work Framework To Decrease Turnover Among Unit Leaders, Allison Reid

Doctor of Nursing Practice (DNP) Projects

Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016).

Context: According to Loveridge, the turnover rates of …

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person learning …