Nursing Student Work-Study Internship: Partnering To Bridge The Education-To-Practice Gap, Jonalyn M. Wallace

Doctor of Nursing Practice (DNP) Projects

Abstract

Discussed for decades, the need for transitional experiences bridging educational and practice settings gained momentum in the mid-1970s with the release of Kramer’s groundbreaking book Reality Shock: Why Nurses Leave Nursing. Nursing student internship programs were developed in the 1970s as one effort to address this issue. The Northern California Region of Kaiser Permanente partners with five universities to conduct the Nursing Student Work-Study Internship Program (WSP). The program provides senior level nursing students with a paid internship in clinical practice settings, working under the supervision of RN preceptors. The aim of the program is to improve the …

Development Of A Toolkit To Enhance Nursing Education Of Veteran Health Concerns, Carlee Y.S. Balzaretti

Doctor of Nursing Practice (DNP) Projects

Abstract

U.S. Veterans are a vulnerable patient population, more prone to health disparities as compared to the general population. There are 21.8 million Veterans currently in the United States, with the majority receiving their healthcare outside of the Veteran Health Administration. Veterans form a culture that is steeped in military tradition and it is essential that healthcare providers have knowledge regarding this vulnerable population to provide care that is culturally appropriate. In response to the Veteran healthcare crisis, the Department of Veteran Affairs initiated the Veteran Affairs Nursing Academy Partnership (VANAP), a joint venture between VHA medical centers and schools …

Optimizing Engagement In The Acute Care Setting: A Nurse Driven Staffing Model, Denise D. Fall

Doctor of Nursing Practice (DNP) Projects

Health care is on the threshold of major reform. Central to this reform will be the ability to maximize patient outcomes and resource allocation. The delivery of nursing care is essential to these concepts. Nursing care delivery impacts both patient outcomes and labor costs. Every aspect of care delivery has changed over time: length of stay, acuity, payment methodologies, documentation, technology, and regulatory requirements. Yet the model by which we allocate resources to the bedside is based on an archaic notion and forecasting model around one variable. The development of effective nurse staffing strategies will ensure those delivering care are …

Transforming Self And Systems Through Implementation Of A Caring Coach Leader Program, Priscilla Javed

Doctor of Nursing Practice (DNP) Projects

Assistant nurse managers and nurse managers, often referred to as middle managers, have a direct impact on daily hospital operations, clinical work environments, delivery of high quality safe patient care, and patient outcomes. The stressful demands of this role have caused turnover rates to soar above the national average on some of the inpatient hospital units. Instability of nursing management oversight negatively effects staff job satisfaction and delivery of high quality safe patient care. In reviewing the organizations initial orientation program for transitioning middle managers into their new role, it was missing the supportive guidance of a coach. A Caring …

The Use Of Electroacupuncture For Cervical Ripening In Pregnant Women, Becky A. Nauta

Theses & Dissertations

The purpose of this study was to compare cervical ripening outcomes, based on Bishop scoring methodology, of pregnant women receiving usual care treatment (UC) with those receiving electroacupuncture plus UC. A sample of 36 pregnant women completing their 39^th week of gestation was randomized into one of the two groups. The women in the UC group continued to meet with their provider on a weekly basis until delivery. The women in the electroacupuncture plus usual care group met with their provider on a weekly basis and also received electroacupuncture treatments: three in the 39th gestational week and two in …

The Effects Of A Preceptor Coaching Intervention On Use Of Clinical Judgment By New Graduate Nurses, Sue A. Schuelke

Theses & Dissertations

This work attempts to evaluate a preceptor intervention on the development of critical thinking/clinical judgment from the new graduate’s point of view as well as from the preceptor’s point of view. Manuscript 1 is a systematic review of the literature related to preceptor’s interventions and its effect on clinical judgment. Manuscript 2 describes the results of focus group interviews of preceptors and the viewpoint on clinical judgment and related concepts. Results of a pilot study: The effects of a preceptors coaching on new graduates clinical judgement, is reported in Manuscript 3. Each section includes an overview of each manuscript, a …

Using Multi-Modal Education In A Public Health System To Increase Rates Of Cervical Cancer Screening, Christina Nardi

Doctor of Nursing Practice (DNP) Projects

While Papanicolaou (Pap) screening has been implemented since the 1950’s, and is linked to decreased rates of cervical cancer, national screening rates are still below the national target screening rate. In Contra Costa County (CCC), the current cervical cancer screening rate is 50.92% (Contra Costa Health Services [CCHS], 2016a). This is far below the national goal of 93% and the first benchmark of 54.33% needed in order to receive state funding under the California Department of Health Care Services (DHCS) Medi-Cal 2020 waiver. The Medi-Cal 2020 waiver has a 5-year Public Health Incentives and Redesign in Medi-Cal (PRIME) program requiring …

Promoting An Increase In Preceptors For Nurse Practitioner Students By Providing The Necessary Tools For Preceptorship, Sonja K. Albright, Sonja Albright

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to confirm the difficulties and barriers to precepting nurse practitioner students found in the literature by conducting a focus group with nurse practitioners who were currently precepting and some who were not. Participants were volunteers at a 4-State APN Conference in Joplin, Missouri. The group did confirm the barriers to precepting noted in the research. The most common theme noted during the group was that nurse practitioners felt ill-prepared to precept nurse practitioner students, a concept also noted in the literature. A Voiceover PowerPoint presentation was created based on the research and concepts discussed …

A Paradigm Shift In The Diagnosis And Treatment Of Polycystic Ovarian Syndrome: A Practice Change In Primary Care, Patricia L. Sullivan

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Patricia Lynn Sullivan

The purpose of this Doctor of Nursing Practice (DNP) Scholarly Project was to determine whether participants’ knowledge of the updated guidelines on the diagnosis and treatment of the obese patient with polycystic ovarian syndrome (PCOS) is increased following a continuing education presentation. The increase in the knowledge of PCOS guidelines for an obese patient is documented using a pretest/ posttest method following the continuing education program which utilizes a PowerPoint presentation. PCOS is the most common endocrine disorder in women. This DNP capstone project was designed to provide a literature …

Impact Of Nurse Fatigue And Nursing Handoffs On Patient And Nurse Safety, Melody A. Seitz

Nursing Theses and Dissertations

In healthcare today, patient safety continues to be a major concern. Nurse fatigue from long work shifts and inadequate patient handoffs may lead to errors and near errors that harm patients and nurses. The intent of this study was to fill a gap in understanding the effect shift length has on patient safety and maternal newborn nurses’ personal safety. A cross sectional survey design was administered via Qualtrics, a web-based online software program. Participants included two groups of maternal newborn nurses. One group worked 8-hour shifts (N = 70) and the other group worked 12-hour shifts (N = 151). Statistical …

Exploration Of Factors Affecting Nurse Faculty Use Or Resistance To Online Education, Lisa M. Harless

Nursing Theses and Dissertations

The substantial increase in online nursing program enrollment demands that nurse educators be adept in the delivery of online education; however, a significant challenge exists in how to deliver practice-based nursing education in the online environment. Teaching online requires a change in the traditional role of the educator accompanied by the effective use of online learning technologies. Some studies suggest that faculties remain pessimistic to online delivery of education and do not participate, yet few objectively examine variables that influence resistance or use. Included in this dissertation are two manuscripts. The first manuscript defines resistance and addresses prominent concerns associated …

Breast Cancer-Related Lymphedema In Hispanic Women: A Phenomenological Study, Juanita C. Acebedo

Nursing Theses and Dissertations

Objective: This study explored the lived experience of Hispanic/Latino women dealing with BCRL.

Participants: A convenience and purposive sampling of 13 Hispanic women, 42-80 years old with diagnosed breast cancer-related lymphedema for over one year, were recruited December 2015 – April 2016.

Methods: Using interpretive phenomenology, Hispanic women with BCRL were individually interviewed using open-ended questions to explore common themes experienced by this particular ethnic group. Sampling continued until data saturation was met. Recruiting took place through four health care practices in south Texas. Data consisted of field notes, researcher journaling, recorded audio interviews, and the respective transcriptions. Data analysis …

Quality Of Death People With Terminal Illnesses Are Turning To An Age-Old Method To End It All: Self-Starvation, Kazi E. Awal, Alyssa Pagano

Capstones

Voluntarily stopping eating and drinking (VSED) is getting more attention in the medical community. Though physician assisted dying legislation passed in two more states in 2016--there are now 7 states where it is legal--the practice, where doctors prescribe a lethal dose of sedatives so that terminally ill patients can end their own lives, is inaccessible to many. But fasting to death is a way for patients suffering from terminal illnesses or other debilitating diseases to end their lives on their own terms that is legal everywhere. As extreme as it sounds, research shows the process can be made comfortable with …

Educational Needs Of Nurses For Wound Care, Stephanie Adee

Doctor of Nursing Practice Scholarly Project

The purpose of this study was to conduct a needs assessment of registered nurses’ knowledge base and attitudes toward wound care and to be able to customize a wound assessment tool to meet those needs. The visual assessment is an essential part of wound care and performing accurate assessments can lead to making the correct diagnosis, starting appropriate treatment timely, and discharging patients sooner. There are over five million patients suffering from chronic wounds and more cases are added yearly. The nurses need a tool to assist them in their daily assessments. This study utilized an anonymous survey of 23 …

Development And Presentation Of An Employer Sponsored Health Center Proposal, Johnna Costello

Doctor of Nursing Practice Scholarly Project

Employer managed health centers were investigated in order to develop a business proposal to present to a Midwestern city for implementation. Benefits to the employer and employee were investigated and included in the proposal. Companies of varying size have implemented successful onsite health centers and help to increase employee productivity while decreasing the overall cost of health care and health care insurance. Self-insured companies with at least 1000 employees are recommended and will provide the earliest return of investment. Lost productivity is a significant cost to the company, on average a company will spend more on lost productivity than on …

Building Allas: Creation Of An Asthma And Allergies App, Benjamin J. Cochran

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to determine the potential need for an app to allow patients to self-manage their asthma and allergies. Through a substantial literature review, the need for an app as well as a desire for this population to manage their disease was demonstrated. Determination was made to have three separate components to create an all-inclusive app, an education component, an asthma tracker, and a personalized allergy profile. The app was storyboarded before being sent to providers and small focus group for proof of concept and functionality of components. The app, ALLAS, was constructed and housed on …

Improving Provider Knowledge In The Evaluation, Diagnosis, And Treatment Of Adhd, Amanda L. Swink

Doctor of Nursing Practice Scholarly Project

Pediatric diagnosis of attention deficit hyperactivity disorder (ADHD) is on the rise with an increasing financial burden to the healthcare system and the patient (Center for Disease Control, 2015). This study sought to determine if an educational intervention would increase the knowledge of primary care providers in respect to ADHD clinical practice guidelines and the diagnosis and treatment of pediatric patients. An initial online survey was administered to primary care nurse practitioners in an attempt to determine their knowledge level, provider feelings and current practices in regards to pediatric ADHD in this region. Approximately four weeks after the online survey, …

Diabetes Self-Management Education: A Rural Health Development, Ashleigh A. Heter

Doctor of Nursing Practice Scholarly Project

The purpose of this Scholarly Project was to explore the need for a Diabetes Self-Management Education (DSME) Program in a rural health community in Southeast, Kansas (SEK). Statistics in Crawford County reveal that 10% of the population has been diagnosed with type 2 Diabetes Mellitus (T2DM) and a rising number of patients that are classified as obese. Without serious interventions many of these patients will develop T2DM. DSME programs provide essential skills and resources for patients to maintain glycemic control and reduce risks associated with this life-long disease. This study utilized data from fifty T2DM patients in the SEK area. …

Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones

Master's Projects and Capstones

When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.

The purpose of this project was to gain a comprehensive understanding of the current handover process of …

Approach To Safety Improvement: Focusing On Better Care (Fall Prevention In Medical Surgical/Intermediate Care Unit), Jose Fox Caballes Jr

Master's Projects and Capstones

Patient safety is one of the major concern of any healthcare provider during their patient’s hospital stay. This project addressed the steady trend of fall incidences compared to last fiscal years’ data of an average of 4 falls per month. This trend created urgency to envisioned a plan for solutions to prevent this circumstance from happening. This Clinical Nurse Leader led a project in creating a process in identifying all patients that are high risk to fall (HRTF) prior to their admittance or transfer to Medical Surgical/Intermediate Care Unit and throughout their hospital stay until they are discharged. In addition, …

Ihss: Repackaging Consumer Information, Deloras N. Puran

Master's Projects and Capstones

Currently, qualified Californians with disabilities and aging individuals can receive consumer-directed care through the IHSS program. Despite the strong demand for the program, new consumers are still struggling to begin their service after enrollment.

This study assisted San Francisco In Home Supportive Services Public Authority to understand how new consumers can navigate the IHSS program services after enrollment. Focus group and semi-structured in-depth interviews were conducted to gather feedback from consumers regarding what type of information would they need after enrollment, and how would they want to receive the information. Based on the feedback, written and virtual deliverables were designed …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Nonpharmacological Approaches In Dementia Care, Gay Lynn Warren

Master's Projects and Capstones

The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to …

Lactation Clinic: Improving Patient Lactation Support, Iana Johnson

Master's Projects and Capstones

Despite the numerous health benefits and recommendations that breastfeeding is the optimal method for nourishing infants, many still choose other ways to feed their babies during the first year of life. This project considers the initiation and future implementation of a Lactation Clinic as an additional patient support service provided in the inpatient and outpatient settings. A Failure Modes and Effects Analysis (FMEA) was conducted in an effort to evaluate and eliminate “what could go wrong” before such an establishment becomes operational. The Risk Priority Numbers (RPNs) from the analysis reveal the lack of use (RPN 50) and streamlining (RPN …

Chlorhexidine Gluconate Bathing In Hospitalized Patients: Reducing Barriers And Increasing Compliance Rate, Maria R. Dominguez

Master's Projects and Capstones

The organization-wide implementation of Chlorhexidine Gluconate (CHG) bathing protocol is one of many measures used to help reduce hospital-acquired infections (HAI) at the 30-bed, Medical-Surgical Specialties and Palliative Care Unit. CHG bathing compliance rate for the unit for the week of August 14-20 was 82.9%, with a 40.4% refusal rate. This is below the 90% desired performance rate. The purpose of this project is to identify the barriers to CHG compliance and to implement interventions that will aid in reducing these barriers and increase CHG compliance rate. Patient declining was identified as one of the main barriers to CHG bathing. …

Minimizing The Inappropriate Use Of Physical Restraint, Shiela Marie C. Telmo

Master's Projects and Capstones

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Increasing Patient Satisfaction And Decreasing Hospital Readmission Due To Deep Venous Thrombosis By Providing Anticoagulation Education For Orthopedic Patients, Margaret Gniewosz

Master's Projects and Capstones

Abstract

Improving Process on Oral Anticoagulant Education for Orthopedic Patients

The aim of this project is to improve anticoagulation education for orthopedic patients to increase patient satisfaction. The microsystem for this project is a medical-surgical (MS), 50-bed unit in a medium size hospital. Because orthopedic patients are at high risk to develop DVT postoperatively, proper anticoagulants and anticoagulation education is an important aspect of patient care. By implementing a well-designed and easy-to-read patient handout on anticoagulants with instructional script for nurses will empower patients to achieve higher level of anticoagulant knowledge and in result, increase patient satisfaction. A preliminary round …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Standardization Of Body Imaging Huddle In Radiology, Margaret M. Browne Mcmanus

Master's Projects and Capstones

Mag Browne McManus

Clinical Nurse Leader Abstract

University of San Francisco

Abstract

Communication amongst healthcare providers is critical to reducing errors, and in procedural areas, the huddle can be used to standardized communication amongst the team before the beginning of interventional procedures (Goldenhar, Brady, Sutcliffe, Muething, & Anderson, 2013). Prior to the implementation of the revised huddle, a staff survey indicated none of the staff were satisfied with the current process. The objectives of the standardization of the body imaging huddle in the department of radiology were to increase staff satisfaction by 15% and reduce the time from patient arrival …