Medication Safety: A Policy Journey To Reduce Medication Errors, Elia M. Campos, Kathleen Klimpel, Joseph Burkhard

Doctor of Nursing Practice Final Manuscripts

Abstract

Medication Safety: A Policy Journey to Reduce Medication Errors

Background: Medication errors have long been a significant concern. Unsafe medication practices and errors can pose serious risks of injury and preventable harm within healthcare systems.

These errors can lead to severe consequences and have the potential to result in injury, disability, or even death. The World Health Organization highlights that in the United States, an estimated 1.3 million people experience medication-related harm, with 7,000-9,000 people dying due to a medication error each year (WHO, 2023). On average, one adverse drug effect (ADE) adds more than $2,000 to the cost …

Perceptions, Benefits, And Challenges Of Using Travel Nurses: Perspective From Nurse Leaders, Fang-Yu Chou, Kim Failla, Melissa Skorka, Evangeline Fangonil-Gagalang

School of Nursing and Health Science: Faculty Scholarship

No abstract provided.

Integrating An Sms Text Reminder Program For Smi Patients To Combat Provider Appointment No-Shows, Philip Spreter Bsn

Doctor of Nursing Practice Final Manuscripts

Abstract

We are in the digital age in all avenues of life, especially healthcare. The standard of care is no longer just a paper reminder card and a call from the office to confirm the patient is going to make it in the week of their appointment. Cards get lost and more people are screening their phones due to a rise in robocalls and scams, which is leading to more people corresponding via text. This is why text-based reminders are now the new, preferred standard for reminding patients of their appt. With that said, there appears to be a deficit …

Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett

Dissertations

Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study …

Parent’S Health Literacy And Stress Level In The Inpatient Pediatric Setting, Tina C. Smith

Dissertations

Purpose: This study examined the relationship between parent health literacy and stress levels during their child’s inpatient hospitalization.

Background: In 2019, over five million pediatric hospitalizations occurred in the United States. Parents are central to their child’s care, but stress and sociodemographic factors may hinder their ability to understand and apply health information. This study explored how stress and other variables impact parent health literacy during hospitalization.

Methods: A cross-sectional design included a demographic survey, the Perceived Stress Scale (PSS-10), and the Newest Vital Sign (NVS). Bivariate analyses (Chi-square, t-tests) and logistic regression were used to assess …

Improving Equity In Women's Stroke Outcomes, Lindsay M. Warner

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project is to review research-based evidence evaluating the inequities in women’s stroke research and treatments and how this effects women’s stroke outcomes. This paper sought to identify current recommendations for improving sex equity for women’s stroke research and identify further areas of policy change to ensure that women’s health outcomes are prioritized in this historically underrepresented population.

Background: An area of critical importance to society is the significant cause of gender-based inequity in healthcare and research. Historically medical research has primarily involved males and the findings have been …

Life In The Fast Lane: Improving Patient Intermittent Fasting Compliance, William C. Moreo

Doctor of Nursing Practice Final Manuscripts

Background: In the United States, 2 in 5 adults are obese. The U.S. spends approximately $147 billion annually on healthcare related to obesity. Intermittent Fasting (IF) has emerged as an evidence-based, safe, and cost-effective approach to weight loss. When instructed correctly, it has been shown to improve patient BMI and total weight over a short-term duration.

Purpose of the Project: The purpose of this study was to determine the effectiveness of a standardized time-restricted eating (TRE) intermittent fasting education protocol for primary care providers (PCP) and its impact on their confidence levels in managing patients. This project aims to enhance …

Why Throughput Is Group-Put, Edward Sales

Doctor of Nursing Practice Final Manuscripts

Introduction: University of California San Francisco (UCSF) Saint Mary’s Health, has two hundred forty licensed beds to utilize for patient care, ninety one that can be used for inpatient medical surgical patients. Throughput is a challenging issue, especially at Unit seven west which houses thirty beds. Post op surgical orthopedic patients, medical surgical patients from the emergency department (ED), intensive care unit (ICU), and telemetry downgrades are waiting for inpatient beds, which causes delays in care and increases length of stay.

Background: Unit seven west is a surgical ortho floor with a high admission census consisting of three to ten …

Improving Social Drivers Of Health Screening In An Inpatient Setting For Sdoh Data, John P. Lussier

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose

Title of the Project: Improving Social Drivers of Health Screening in an Inpatient Setting for SDoH Data

Purpose: This evidence-based practice project aimed to increase social drivers of health (SDoH) screening compliance by redesigning the workflow to distribute responsibility between nursing and case management, ultimately improving identification and referral of patients with supportive service needs.

Background: Screening for SDoH needs facilitates the provision of appropriate supportive services. The existing workflow required nurses to conduct initial screening in five domains (Housing Stability, Utility Difficulties, Food Insecurity, Interpersonal Safety, and Transportation Needs), with positive responses triggering additional investigative questions. These …

Crisis Without Cops: Trauma-Informed Mental Health Care For Bipoc Communities, Amanda Carson

Doctor of Nursing Practice Final Manuscripts

This policy paper advocates for a structural transformation in mental health crisis response, moving beyond police-led interventions toward trauma-informed, community-rooted models grounded in public health and equity. Drawing on Critical Race Theory (CRT), neuroscience, and program evaluations of models like CAHOOTS, 988, Denver’s STAR, and Durham’s HEART, it examines how systemic racism, institutional mistrust, and implicit bias contribute to disproportionate harm for BIPOC individuals. The paper highlights the effectiveness of peer-led, culturally responsive alternatives that reduce force, hospitalization, and disengagement from care. Using Kingdon’s Multiple Streams Framework, it proposes actionable, scalable policy strategies supported by recent federal momentum, including the …

Optimizing Psychiatric Care Through Pharmacogenomics: An Evidence-Based Program To Increase Multi-Gene Pharmacogenomic Testing And Provider Competence In Mental Health Settings, Marc Boulanger

Doctor of Nursing Practice Final Manuscripts

Objective: This scholarly project aimed to enhance psychiatric providers' competency, confidence, and knowledge in the PHASER pharmacogenomic (PGx) testing program at the VA San Diego Healthcare System.

Background: PGx testing enhances psychiatric care by enabling precise medication management tailored to a patient’s genetic profile, improving treatment effectiveness and reducing adverse drug reactions. Despite demonstrated clinical utility, adoption of PGx remains limited due to provider knowledge gaps. This project addresses these gaps through targeted education.

Methods: Two educational modules, developed with input from the PHASER site-lead, aimed to enhance provider knowledge and confidence in PGx. Module one introduced the PHASER program …

Implementation Of A Tracheostomy Discharge Education Class For Nicu Nurses, Todd N. Chamoy

Doctor of Nursing Practice Final Manuscripts

Infants who are ventilator-dependent or have anatomic anomalies of their airway frequently require tracheostomy placement prior to discharge from the hospital in order to be cared for safely at home. At this large quaternary children’s hospital in Southern California, preparing these infants for discharge after tracheostomy placement has not been the role of the NICU nurse. There was no system in place on how to train caregivers, and the NICU staff felt unprepared. Evidence supports use of intensive educational programs to improve nurse knowledge and skills of tracheostomy care, allowing NICU nurses to provide improved care and pre-discharge teaching.

A …

Suprathel Burn Dressing Versus Standard Care: Impact On Hospitalization Duration And Post- Discharge Outpatient Visits, Isaac Awolola

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project is to determine the effectiveness of Suprathel a synthetic, one-time application, wound dressing that acts as a temporary skin substitute, particularly effective for partial-thickness burns and deep dermal burns vs, the standard of either Polysporin or Santyl, Xeroform, gauze on the frequency of outpatient (OP) visits after a patient’s discharge. A secondary aim of this project was to investigate whether Suprathel burn dressing significantly decreases the length of stay (LOS) for patients with second-degree burns involving < 20% total body surface area (TBSA). The results showed that the use of Suprathel dressings resulted in a shorter hospital stay 7.05 vs 9.35 days with a higher number of outpatient visits 5.47 vs 2.69 visits, compared to conventional dressings. The use of Suprathel dressings as a standard practice reduces inpatient hospitalization but increases outpatient visits and resource utilization. The use of Suprathel dressings shortens the length of hospitalization and may augment patient comfort, and decrease overall healthcare costs associated with hospitalization. Due to the reduction in need for painful daily dressing changes, Suprathel dressings constitute a potentially preferred option in burn care and could thereby influence treatment protocols and enhance patient outcomes.

Keywords: Wound care, Suprathel dressing, total body surface area, Outpatient Visits, Second-degree Burn, Length of stay, Gauze

Electronic Medical Record Clinical Decision Support Across The Ob Continuum Of Care: Enhancing Doula Education And Usage, Jonese D. Randall

Doctor of Nursing Practice Final Manuscripts

Background: The United States is seeing an uptick in maternal deaths by 159% since 2019, with maternal mortality higher with cesarean procedures (Hoyert, 2020; Riches et al., 2024[LC1] ). UC San Diego Health NTSV C-Section rates between September 2024 – October 2024 ranged between 22-54%, well above the benchmark of 23.4% in California (Slone, n.d.). Doulas are trained to care for the mother before, during, and after birth by being an advocate, providing physical and emotional support, and being a continuous support person (Dekker, 2017). Doulas have been shown to improve birthing outcomes by providing these support mechanisms, particularly …

Implementation Of One Key Question® Screening Tool To Increase Reproductive Life Planning At A Community Health Clinic, Laura D. Adams

Doctor of Nursing Practice Final Manuscripts

Introduction: This evidence-based practice project implemented and evaluated the One Key Question® (OKQ) screening tool to improve pregnancy intention screening and reproductive health counseling in primary care. The goal was to better identify reproductive health needs among women of reproductive age and enhance provider engagement in preconception and contraceptive counseling.

Background: Nearly half of all pregnancies in the U.S. are unintended, and many women do not receive timely reproductive health counseling. Despite national recommendations, pregnancy intention screening is often missed in primary care. Early identification of reproductive goals supports better outcomes through tailored education, contraception, or preconception care. OKQ is …

Increase Knowledge And Competency Of Point Of Care Ultrasound (Pocus) Among Emergency Nurse Practitioner Students Incorporating Web-Based Videos And Clinical Benchmarks., Andrew N. Walsh

Doctor of Nursing Practice Final Manuscripts

Background: Point of care ultrasound (POCUS) is a critical skill in Emergency Medicine (EM), and Emergency Nurse Practitioner (ENP) students are increasingly expected to demonstrate proficiency. ENP students often face limited opportunities for hands-on practice compared to EM residents. Research suggests that the didactic component of POCUS training delivered through e-learning is as effective as in-person instruction. The American College of Emergency Physicians (ACEP) supports the flipped classroom model, which maximizes simulation time and focuses on psychomotor skills and clinical application, allowing didactic portions to be delivered online. Additionally, ACEP recommends a benchmark of at least 25 POCUS examinations to …

Utilizing A Clinical Resource Hub To Improve Access And Workflow For Retinopathy Screenings In The Veteran Population, Erin Kelly Pope

Doctor of Nursing Practice Final Manuscripts

Abstract

Utilizing a Clinical Resource Hub to Improve Access and Workflow for Retinal Screenings in the Veteran Population

Erin K. Pope, MSN, RN, AGCNS-BC, AMB-BC

Scot Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, SCRN, FCNS

Background: Diabetic retinopathy (DR), a progressive complication of diabetes mellitus (DM), is the leading cause of blindness among working-age adults. As DR can remain asymptomatic until advanced stages, annual screenings are critical for early detection and management. Teleretinal imaging is an evidence-based method for DR screening, offering cost efficiency and reduced demand on ophthalmology clinics. At the Veterans Administration’s (VA) Loma Linda Healthcare System …

Implementing The Fib-4 Tool For Liver Fibrosis Screening In Diabetic Patients In Primary Care, Robert I. Montillano

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-non-alcoholic fatty liver disease (NAFLD), affects over 1 in 3 adults with type 2 diabetes mellitus (T2DM) and is a leading cause of advanced liver fibrosis. Despite guideline support from the American Diabetes Association (ADA) and American Association for the Study of Liver Diseases (AASLD), screening practices remain inconsistent in primary care. The Fibrosis-4 (FIB-4) index is a validated, low-cost, noninvasive tool for fibrosis risk stratification, yet it remains underutilized despite its availability in many electronic health record (EHR) systems.

Purpose: This Doctor of Nursing Practice (DNP) evidence-based practice (EBP) project …

Improving Patients' Confidence In Self-Care Management And Preventing Hospital Readmission Within 30 Days Of Discharge In The Heart Failure Population, Kelly Carroll

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Heart failure (HF) is a chronic, progressive condition and a leading cause of hospital admissions nationwide. The 30-day readmission rate for HF patients is approximately 23.4%, contributing to increased morbidity, mortality, and significant healthcare costs. Each HF-related readmission is estimated to result in a financial loss of $15,789 per patient due to reduced reimbursement from both private and public insurers. This underscores the critical need for timely follow-up care, particularly within the first 30 days post-discharge.Without adequate follow-up and patient education, many individuals lack the confidence and knowledge necessary for safe and effective self-management in the outpatient setting, …

Policy Proposal For Integrating Pediatric Mental Health Into Nursing Practice In Uganda, Giselle S. Perez

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Mental health disorders affect over 1 in 7 individuals aged 10 to 19 globally. In low- and middle-income countries like Uganda, limited access to mental health specialists and pervasive stigma exacerbate the gap in care. Nurses, often the first point of contact, typically lack adequate pediatric mental health training. The proposal aims to address this gap by equipping nurses with the knowledge and competencies to identify, intervene, and support children with mental health disorders. Purpose: This proposal advocates for implementing targeted, continuing education in pediatric mental health for Ugandan nurses. The goal is to enhance the quality of …

Beyond The Bmi: An Educational, Family-Centered Approach To Identifying Risk For Childhood Obesity, Michelle J. Mak

Doctor of Nursing Practice Final Manuscripts

Background: In the United States, the increasing prevalence of obesity has caused public health concerns. From 2017 to 2020, 14.7 million children ages 2 to 19 were considered obese. The main parameter for diagnosis is a body mass index (BMI) at or above the 95th percentile on the growth chart. Additionally, overweight is defined as a BMI between the 85th and 95th percentiles. At a pediatric primary care clinic in San Diego, CA, over a third of patients are considered overweight or obese. Obesity comorbidities can include type 2 diabetes, hypertension, and hyperlipidemia. Overweight adolescents have a 70% likelihood of …

From Fee For Service To Outcome Based Care: A Policy Proposal To Reduce Provider Burnout In Assertive Community Treatment, Amanda M. Thompson

Doctor of Nursing Practice Final Manuscripts

Purpose: This project examines the impact of the fee-for-service (FFS) reimbursement models on provider burnout within Assertive Community Treatment (ACT) programs and proposes a hybrid reimbursement framework that integrates case-rate and outcome-based payment structures. The goal is to enhance care quality, improve provider retention and optimize patient outcomes by addressing financial and administrative inefficiencies inherent in the current model.

Background: Mental illness affects over 59 million U.S. adults with serious mental illness (SMI) presenting significant challenges in healthcare delivery. ACT is an evidence-based, multidisciplinary approach designed to provide intensive, community-based psychiatric care to individuals with serious mental illness (SMI). However, …

Increasing Advance Directive Completion: A Future Initiative For All, Hilda A. Lince

Doctor of Nursing Practice Final Manuscripts

Abstract

Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.

Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE …

Optimizing Warfarin Management In Cardiovascular Care, Tessa A. Martinez

Doctor of Nursing Practice Final Manuscripts

Background: Maintaining a therapeutic International Normalized Ratio (INR) is essential to reduce bleeding and thromboembolic risks in patients on warfarin therapy. In a rural outpatient cardiac clinic serving a predominantly underserved population, many patients face financial and access barriers that preclude the use of newer non-vitamin K antagonist oral anticoagulants (NOACs). Patients with atrial fibrillation (AF) or mechanical valve replacements who rely on warfarin require consistent monitoring and management, which can be challenging in settings with limited resources and staffing.

Purpose: The purpose of this evidence-based pilot project was to improve therapeutic INR outcomes through the implementation of a standardized …

Implementing A Provider Education Program For Opioid Medication Management, Mitra A. Taylor

Doctor of Nursing Practice Final Manuscripts

Implementing a Provider Education Program for Opioid Medication Management

Mitra Akhavan Taylor, BSN, RN

Joseph F. Burkard, DNSc, CRNA, EBP-C, AACN Health Policy Fellow

Introduction: Continuing health provider education is an important intervention supported by health policy to counter the opioid epidemic. The purpose of this evidence-based project was to create and implement an opioid prescribing program in line with California and Federal regulations in response to the opioid epidemic. The purpose of this project was to evaluate the effect of the program and EMR template and guidelines on opioid prescribing practices. The motivation behind this evidence-based practice (EBP) project …

The Use Of Systemic Inflammatory Response Syndrome (Sirs) Criteria By Nurses In The Nursing Home Setting To Identify Sepsis, Edwin Tobbee Y. Arceo Jr

Doctor of Nursing Practice Final Manuscripts

Background: Sepsis is a life-threatening organ dysfunction caused by an infection. In the United States, treating sepsis costs approximately $23 billion annually, making it the most expensive condition treated in hospitals. Severe infections in nursing homes are estimated to occur in one to three million cases annually. Infections in nursing homes are on the rise, and the cost of hospitalization due to sepsis is increasing dramatically. Diagnosing sepsis is often delayed in nursing homes.

Purpose of the Project: This project aims to train nursing home nurses to use the SIRS screening tool to identify potential sepsis cases early and administer …

Decreasing Dermal Filler Adverse Events Using Qsen And Benner Theoretical Frameworks To Assess Competency, Stacey D. Stephens Ross

Doctor of Nursing Practice Final Manuscripts

Background: Aesthetic nursing is a new branch of nursing practice. Formal nursing education and standards are lacking, making it challenging to assess competency of an aesthetic nurse. Adverse events (AEs) range from minor (bruising) to severe (vascular compromise and blindness) and can be associated with poor technique or lack of knowledge. Standardized practice using evidence-based (EB) protocols is necessary to provide safe, high-quality care. The Institute of Medicine (IOM) and the Joint Commission support the use of the Quality and Safety in Nursing (QSEN) programs to improve outcomes and promote safety. Due to varied training, “experienced” aesthetic nurses may or …

Strategic Policy Development To Reduce Same-Day Cancellations: A Nurse-Led Preoperative Approach, Amanda Kuelz

Doctor of Nursing Practice Final Manuscripts

Background: Same-day surgical cancellations are a persistent and costly issue within outpatient surgery centers, accounting for approximately 5% of elective cases. These disruptions result in inefficient utilization of operating room (OR) time, increased staffing burdens, lost reimbursement, and diminished patient satisfaction. Unanticipated cancellations undermine scheduling reliability and workflow efficiency, contributing to care fragmentation and increased financial strain on health systems. A growing body of evidence suggests that nurse-led, structured preoperative screening has the potential to mitigate these challenges by identifying risk factors in advance and facilitating timely interventions. Nurses' clinical acumen and communication expertise uniquely position them to lead such …

Guidelines For The Use Of Artificial Intelligence In Manuscript Preparation And Review: Aenj’S Current Perspective On Artificial Intelligence, K. Sue Hoyt, Donna Agan

School of Nursing and Health Science: Faculty Scholarship

No abstract provided.

From Classroom To Practice: Boosting Enp Proficiency With Online Pocus Training, Andrew Walsh, Pedro A. Colio, Sukhdeep Singh

School of Nursing and Health Science: Faculty Scholarship

No abstract provided.