Nursing Commons^™

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Kori Fitzgerald Bsn, Rn, Phn, Fnp/Dnp Student

Doctor of Nursing Practice Final Manuscripts

Title: Utilization of Telehealth for Palliative Care Follow-up Visits

Background: A vital part of cancer management is the implementation and integration of palliative care, to prevent and relieve suffering and to improve quality of life for patients with serious chronic illness. However, access to palliative care services continues to be inadequate. There is a nationwide shortage of skilled palliative providers and the supply is insufficient to meet the growing demand.

Purpose of Project: Implementing telehealth visits with palliative care patients with advanced cancer at the UCSD Moores Cancer Center has the potential to maintain patient satisfaction with …

Reducing Ed Re-Admissions In Post-Op Neuro Patients Utilizing A Np Telephone Follow-Up Protocol, Katherine Curran

Doctor of Nursing Practice Final Manuscripts

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to …

Reducing Hospital Readmission Rates Via Np- Initiated Post Discharge Telephone Calls In Dialysis Dependent End Stage Renal Disease Patients, Fabiola Carapia

Doctor of Nursing Practice Final Manuscripts

Purpose/Aim:To determine whether a nurse practitioner-initiated phone call, in addition to the standard transition-of-care (TOC) protocol, will reduce 30-day hospital re-admissions by 50% in patients with end-stage renal disease (ESRD) after an inpatient index hospitalization.

Background: $27 billion is spent annually by Medicare for hospital readmissions. Approximately $17 billion of this amount can be attributed to avoidable causes (Kauffman, 2016). Hospitals have been penalized for excessive readmission rates under the Hospital Readmissions Reduction Program beginning in 2012 (HRRP; Centers for Medicare & Medicaid Services [CMS], n.d.). Index hospitalization refers to the first time, in a series of hospitalizations, that …

The Safety And Efficacy In Reversal Of Neuromuscular Blockades With Sugammadex Versus Neostigmine, Nicole L. Landen

Nursing Capstones

No abstract provided.

Spreading The News About Peanuts: Implementing An Infant Allergy Risk Assessment, Kelly E. Kotula

Doctor of Nursing Practice Final Manuscripts

Peanut allergies are the leading cause of death from food anaphylaxis. In 2017, the National Association of Allergy and Infectious Disease (NIAID) issued a guideline for use by primary care providers to identify infants who would benefit from early peanut consumption. Many providers have not yet implemented these guidelines in clinical practice. The purpose of this project was to implement a practice change to improve assessment of risk factors for peanut allergies utilizing the NIAID guideline in infants at their six-month well-child examination at a pediatric primary care practice. Risk factors assessed included: a history of eczema and/or egg allergy …

Implementation Of A Critical Incident Stress Management Program For Nurse Anesthetists., Peter C. Slivinski, Joanne V. Hickey

Journal of Nursing & Interprofessional Leadership in Quality & Safety

BACKGROUND: Healthcare is a stressful profession where in addition to routine stressors, there are critical incident (CI) events which are occurrences capable of overwhelming an individual’s normal coping mechanisms. The purpose of this quality improvement project was to improve the process by which certified registered nurse anesthetists (CRNAs) exposed to critical incident events are provided post-critical incident support thus mitigating the potential for CI stress

METHODS: We created a CI stress management pilot program for nurse anesthetists employed by an academic hospital located in the Southeastern United States. The program was based upon concepts introduced by Medically Induced Trauma Support …

Gabapentin As An Adjunct To Decrease Opioid Consumption, Bethany L. Myhre

Nursing Capstones

No abstract provided.

Nurse Anesthesia Program Administrator's Decision-Making In Determining Interventions For A Student Exhibiting Unsatisfactory Clinical Performance, Laura S. Bonanno

LSU New Orleans Theses and Dissertations

The purpose of this grounded theory study is to define the process that nurse anesthesia program administrators use to determine if a student nurse anesthetist’s unsatisfactory clinical performance warrants intervention by the program. There is little room for error in anesthesia practice as mishaps typically result in significant injury and death. Students who exhibit unsatisfactory clinical performance may pose an immediate risk to patient safety as well as a future risk if allowed to progress in the program. The lack of guidance in the form of clearly articulated expectations and processes contribute to the emotional strain nurse anesthesia faculty and …

Lipid Emulsion And The Management Of Local Anesthetic Systemic Toxicity, Randall Hagemeister

Nursing Capstones

No abstract provided.

Antimicrobial Stewardship: Staff Nurse Knowledge And Attitudes, Katreena Collette Merrill, Sandra Forsyth Hanson, Sharon Sumner, Todd Vento, John Veillette, Brandono Webb

Faculty Publications

Background: Registered nurses are uniquely qualified to augment antimicrobial stewardship (AS) processes. However, the role of nursing in AS needs further development. More information is needed regarding gaps in registered nurse knowledge, attitudes toward AS, and how infection preventionists can help.

Methods: An online descriptive survey was deployed to a convenience sample of approximately 2,000 nurses at the bedside. The survey included 15 questions addressing: (1) overall knowledge of AS; (2) antimicrobial delivery; (3) knowledge and attitudes regarding antimicrobial use; (4) antimicrobial resistance; and (5) antimicrobial resources and education.

Results: Three hundred sixteen staff nurses from 3 hospitals (15.8%) responded …

Effect Of Intraoperative Dexmedetomidine Infusion On Perioperative Opioid Use, Lindsey Holter

Nursing Capstones

No abstract provided.

Intraoperative Lidocaine Infusions For Postoperative Pain Management, Sarah Solberg

Nursing Capstones

No abstract provided.

Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr

Doctor of Nursing Practice Final Manuscripts

Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification …

Exploring Help-Seeking Intentions Of Homeless Veterans Attending A Stand Down Event, Tara Vaughn

Nursing Theses and Dissertations

Lack of help-seeking behavior among homeless veterans results in higher burden of disease and lower quality of life. No studies have been conducted involving help- seeking intentions of homeless veterans within the veteran stand down population. Pender’s Revised Health Promotion Model was used to guide this descriptive correlational study with the aim of exploring the extent selected personal characteristics and experiences and behavior-specific factors affect help-seeking intentions among homeless veterans attending a stand down event.

A convenience sample of 86 homeless veterans (mean age 56) was recruited from a 3-day veteran stand down event in Northern California. Each participant was …

Anesthetic Implications For Patients With Friedreich’S Ataxia, Clara Hoss

Nursing Capstones

No abstract provided.

Malignant Hyperthermia Precautions In The Pediatric Patient, Amanda Versteeg

Nursing Capstones

No abstract provided.

Adductor Canal Block Verus Femoral Nerve Block In Total Knee Arthroplasty, Alexander D. Olson

Nursing Capstones

No abstract provided.

Music Therapy Assisted Childbirth In The United States: A Critical Literature Review, Sydney Mohr

Expressive Therapies Capstone Theses

Music therapy assisted childbirth is an approach of music therapy in which a licensed and credentialed professional utilizes music therapy interventions to address a variety of goals during childbirth. There is a lack of literature and missing knowledge on the topic, associated with an increased rate in traumatic birth cases, mothers with post-traumatic stress disorder, and postpartum anxiety and depression. The literature review provides a summary of the historical context of feminist theory and feminism, as well as brief descriptions of music therapy, guided imagery and music, and familiar music interventions. One of the primary goals of this type of …

Are They Ready? Participants’ Perceptions Following A Cert Training And Disaster Simulation, Ronda Christman

Adventist Human-Subject Researchers Association

The frequency of disasters is increasing and it is important that students and community members are trained to safely respond. Academy and University students along with community members experienced CERT training and disaster simulation. Learn how participants perceptions changed following a CERT training and disaster simulation.

Participants’ Perceptions Following Disaster Response, James C. Ingersoll, Ronda Christman, Stephanie Sanders

Adventist Human-Subject Researchers Association

Academy and University students responded and provided disaster relief following hurricanes Florence and Michael. Students gave of their time, energy, and talents to provide food, water, and debris removal to hurricane victims. Learn how participants perceptions changed following hurricane disaster relief efforts.

Implementation Of Change Of Shift Huddles In An Urban Medical Center, Benson Kahiu

Seton Hall University DNP Final Projects

Since 1999 when the Institute of Medicine (IOM) highlighted medical errors in hospitals, healthcare leaders continue to pursue relevant and sustainable patient safety initiatives. Some of these initiatives include projects that increase accountability while encouraging enhanced teamwork and communication between team members. The lack of consistent communication results in decreased patient outcomes and patient dissatisfaction. Decreased camaraderie in organizations, results in fiscal waste associated with employee tardiness and call-outs. This paper reviews the process and impact of implementing change of shift huddles in an urban medical center. Literature reviews concluded that positive outcomes were associated with implementation of huddles during …

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 …