Nursing Commons^™

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

A Guide To Vaccine Policy Change At A National Level, Janelle Bird

Doctor of Nursing Practice Final Manuscripts

Abstract

Health policy is in a near constant state of improvement. In order to solidify those improvements, health policy requires assistance from the upcoming generations of healthcare workers to push for those changes. Due to the outdated vaccination policy in the American Nurses Association (ANA), many states continued to issue exemptions based upon unsupported religious preferences. This helped to worsen the outbreak of measles in 2018-2019. The Previous ANA Policy on Vaccinations as of July 21, 2015 stated the ANA supports immunization exemptions only for the following reasons: Medical contraindications and Religious beliefs. Educate and train future health care professionals …

Impact Of Psychotropic Medications On Electrical Cardiac Conduction In The Emergency Department: A Best Practice Review, Juliann Hatt

Doctor of Nursing Practice Final Manuscripts

Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency …

Introducing Trauma-And Resiliency-Informed Care In A Residential Treatment Setting, Connie Quach

Doctor of Nursing Practice Final Manuscripts

Background: The link between trauma exposure and substance use is well established. Seventy-five percent of individuals in substance use treatment report histories of abuse and trauma. Early traumatic experiences or repetitive trauma exposure disrupts a person’s ability to self-regulate which may demonstrate as disruptive behavior or present as physiological symptoms.

Purpose: The purpose of this project was to introduce and increase awareness of trauma and resiliency informed definitions, techniques, and provide resources for staff in a residential treatment setting.

Evidence-based Intervention and Methods: Participating nurses and resident assistants received a one hour presentation on trauma, resiliency, and its associated interventions. …

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …

Screening For Postmenopausal Osteoporosis In Women Between Age 30-64 In Primary Care: A Policy Perspective With Recommendations, Shenwan Wang

Doctor of Nursing Practice Final Manuscripts

Osteoporosis is a silent disease leading to osteoporotic fractures and even death. Postmenopausal women are extremely susceptible to osteoporosis because of estrogen deficiency. But less than 1 in 4 women with an osteoporotic fracture was screened or treated for osteoporosis. Postmenopausal women have been proven to benefit from early osteoporosis detection and treatment. However, there is no current national policy on screening for postmenopausal osteoporosis before age 65. Nurse practitioners can play an important role in screening for postmenopausal osteoporosis in primary care to prevent osteoporotic fractures and improve quality of life.

Optimizing Best Telehealth Practices Among Advanced Practice Registered Nurses, Karen Swafford

Doctor of Nursing Practice Final Manuscripts

Abstract

Optimizing best clinical telehealth practices among APRNs

Abstract Title: Optimizing best clinical telehealth practices among APRNs through a survey that gauges their preparedness in core competencies and their recommendations.

Background: In April 2020, about half of all Medicare primary care visits were done through telehealth due to the COVID-19 pandemic. Telehealth evoked a strong positive response among patients, which created a new niche in healthcare. To effectively leverage its value, one of its key goals is the promotion of best clinical practices (Agrawal, 2020). However, very little information was found about programs that address NP training in telehealth. …

"It's The Way You Sing It": Translating Music Therapy For Isolated Older Adults Affected By Covid-19 To The Television Screen, Eunice Wong

Expressive Therapies Capstone Theses

The current Covid-19 pandemic has increased the likelihood of loneliness and social isolation among older adults due to the restrictions on movement and visitations in care facilities. Loneliness and social isolation have consistently been identified as risk factors for poor mental and physical health in older people. Meanwhile, a growing number of older adults are utilizing technological resources to enhance their interpersonal relationships and overall quality of life. In the winter of 2020/2021, an innovative music therapy-informed television program was designed and produced for isolated older adults in need of mental and emotional support. This project, produced jointly by a …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet

Dissertations

Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a …

Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Forty percent of the US population ages 20-39 are categorized as obese,

their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults.

Aims of Service Change: This evidence-based project proposal aims to provide a toolkit …

Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James

Doctor of Nursing Practice Final Manuscripts

Background: Adolescent obesity is a serious health concern with increased worldwide prevalence. Excess weight gain can affect adolescent’s physical and emotional health. The adolescent with excess weight can involve acute and chronic long-term health complications that continue into adulthood.

Methods: Health care providers screened for overweight and obese adolescents during annual physicals and follow-up visits. Thirty adolescents at the 85th - 95th percentile and above on the growth chart received a pre and post clinical-screening questionnaire for eating behaviors and exercise. Individualized education with parent involvement and motivational interviewing (MI) was implemented with monthly follow-ups for 4 months.

Findings: Data …

Utilizing Post Graduate Residency Program In New Graduate Nurse Practitioners To Improve Clinical Outcomes, Lashaunda Jethro

Doctor of Nursing Practice Final Manuscripts

Utilizing Post Graduate Residency Program in New Graduate Nurse Practitioners to Improve Clinical Outcomes.

by LaShaunda R Jethro

The Advanced Practice Registered Nurse (APRN) role across the continuum of patient care continues to evolve, and the APRN continues to play a significant part in sustaining the current healthcare system and controlling the rising incidence of mortality and medical cost. While a substantial amount of evidence demonstrates that Nurse Practitioners (NPs) are expert healthcare providers, some studies also report that many new NPs fail to be confident in their capability to undertake the NP role and attend to increasing patient loads. …

A Systematic Review: The Impacts Of Non-Pharmacological Therapy Interventions, Such As Exercise, On Postpartum Depressive Symptoms In Postpartum Women?, Jennifer Rafala, Amanda Kozlowski, Kristin Simons, Madison Rhoad, Courtney Greene

Symposium of Student Scholars

Abstract

Title: A Systematic Review: The impacts of non-pharmacological therapy interventions, such as exercise, on postpartum depressive symptoms in postpartum women?

Background: Postpartum depression is a psychological condition most often seen within six weeks after birth. Often confused with short-term “baby blues”, postpartum depression can be debilitating including excessive crying, insomnia, fatigue, feelings of hopelessness and worthlessness, and other disruptive symptoms that can impede the new mother’s ability to care for herself and her baby. Postpartum depression often goes unrecognized by new mothers; however, when diagnosed, treatment regimens frequently include pharmacological interventions.

Objectives: This systematic review aimed to determine the …

How Various Exercise Modalities Impact Quality Of Life, Physical Activity, And Program Adherence In Patients With Copd, Hannah Brookshire, Sarah Barnes, Natalie Cagle, Nancy Starnes, Elia Schaefer

Symposium of Student Scholars

How Various Exercise Modalities Impact Quality of Life, Physical Activity, and Program Adherence in Patients with COPD

Background: Chronic obstructive pulmonary disease (COPD) is a group of diseases that causes breathing difficulty due to airway obstruction. Adherence to physical activity recommendations for those with COPD is often problematic and leads to worsening dyspnea and quality of life. Due to the prevalence of COPD, it is important to understand how different exercise modalities impact quality of life and adherence to physical activity.

Objective: The purpose of this systematic review was to determine if patients with COPD have a better quality of …

A Systematic Review: The Impact Of Social Support Programs On Caregiver Burnout For Caregivers Of Children With Cancer, Vanessa Otamendi, Jalaya Graves, Autumn Whitley, Joanna Juarez, Helena Walker

Symposium of Student Scholars

Title: A Systematic Review: The Impact of Social Support Programs on Caregiver Burnout for Caregivers of Children with Cancer

Background: In addition to children diagnosed with cancer, their caregivers may also experience hardship. While caregivers handle their own personal responsibilities, they also provide emotional, physical, and financial support to their children. In addition to the likely stress that occurs from caring for a child with a long-term illness, lack of social support, educational resources, or support programs may lead to caregiver burnout.

Objective: The purpose of the systematic review was to review published research focused on caregiver burnout for caregivers …

A Systematic Review: The Effect Of Social Support On Emotional Burden Of Alzheimer’S Caregivers, Jessica Monahan, Julia Samuel, Guadalupe Perez, Cristiana Seixas, Adanech Jones

Symposium of Student Scholars

Background: Alzheimer’s disease is a degenerative form of dementia that affects not only patients but also their caregivers. Various social support interventions have been shown to benefit caregivers by decreasing stress, depression, anxiety, and other physical and psychological issues.

Objective: The purpose of the systematic review was to determine the effect of social support on emotional burden for caregivers of patients with Alzheimer’s disease.

Methods: Research was conducted using the databases PubMed and CINAHL to identify eligible studies. Specific inclusion and exclusion criteria were used when screening studies. After evaluation and assessment of the studies, a total of eight …

Development Of An Ehealth Harm Reduction Resource To Address Opioid Use Among Youth In Rural Northern California, Carolyn Perrotti Lake

Doctor of Nursing Practice (DNP) Projects

Problem: Opioid use and misuse is a leading cause of injury and death among adolescents and young adults in the United States, with a three-fold increase in opioid overdoses since 2000 (Carney et al., 2018; Hudgins et al., 2019). Opioid misuse correlates with misuse of other substances, which exponentially increases health risks over time. The most effective treatment for opioid use disorder (OUD) among adolescence is through effective prevention interventions that either prevent the development of the OUD or enable timely diagnosis and treatment in order to prevent poor health outcomes.

Context: The use of eHealth technology, which has …

Prevention Of Abusive Head Trauma Using An Educational Program For Parents/Caregivers, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The National Center on Shaken Baby Syndrome reports that 1,300 abusive head trauma (AHT) cases occur in the USA each year, a quarter of which are fatal. Injuries are caused by impact, shaking, or both and result in intracranial and spinal damage, retinal hemorrhages, fractures of the ribs and other bones. AHT case rates in the community involved in this project had a 22% increase of AHT from 2018 to 2019.

Context: A practice improvement project involved the implementation of an AHT educational program targeted at parents/caregiversreceiving care services at a children’s hospital pediatric well-child clinic located in …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Developing A Culturally Relevant Mental Health Assessment For Persons Of African Descent, Roberta Iyamu

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Persons of African descent have lower access to mental health care, are less likely to receive needed care, and are more likely to be misdiagnosed, experience severe disease, and to receive mental health care through primary care than non-Hispanic Whites. Context: Cultural norms related to mental health as well as the lack of culturally congruent health care delivery contribute to lower mental health care access and uptake among persons of African descent. Interventions: Campinha-Bacote’s cultural competence model and the BATHE technique provided the theoretical framework for the development and implementation of a nurse practitioner (NP) (n = 4) …

The Nurse Will See You Now: Improving Nurse-Led Chemotherapy Teaching, Laura Oka

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: According to The International Agency for Research on Cancer (IARC) 2020 World Cancer Report, cancer has contributed to 9.6 million deaths in 2018 and is now globally considered the second most common cause of death (IARC, 2020).

Context: As a cancer patient moves beyond diagnosis, there becomes a need to introduce the plan of care and education related to evidence-based treatments with an intent to cure. As the delivery of these treatments continues to move toward outpatient care, herein lies the challenge of sharing important information with the patient to improve health outcomes.

Intervention: This DNP change of …

Optimizing Pediatric Preoperative Experiences In The Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one …

Standardized Outreach: Increasing Vaccine Uptake In The Latinx Community Through A Standardized Phone Call Process, Vanesa Vazquez

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in several minority communities since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines (Increased risk, 2020). The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake, particularly in the Latinx community. Patients at a community clinic in Oakland, California have made apparent their distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. Most of these patients are Latinx-identifying and are considered more at risk for development of COVID-19 in …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Vanessa M. Arteaga

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latinx and Black community since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines. The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake. Patients at a community clinic in Oakland have expressed hesitance of the COVID-19 vaccine. They also exhibited increased frustration with the staff who are contacting them to schedule vaccine appointments and provide information. This resulted in refusal of the vaccine and less than desirable number of vaccine appointments. The objective of this …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Stephanie Ramirez

Master's Projects and Capstones

In the United States, Latinx communities have experienced a disproportionately high burden of COVID-19 infections and hospitalizations throughout the pandemic. The focus of this quality improvement project is to standardize the patient outreach process and education to increase COVID-19 vaccine uptake. The ambulatory community clinic in the city of Oakland, California serves a majority of underserved Latinx patients that have demonstrated distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. The high burden of COVID-19 infections among the Latinx community has led to misinformation and fear. In order to overcome this issue, Clinical …

Preventing Central Line Associated Bloodstream Infections In An Adult Intensive Care Unit, Monica Shaw

Master's Projects and Capstones

Central line associated blood stream infections (CLABSI) are considered preventable healthcare acquired infections, and are associated with significantly increased morbidity, mortality, and length of hospital stay. The CLABSI rate in an inpatient unit is a meaningful metric in relation to the safety and quality of care in that microsystem. This quality improvement project examines the efficacy of a CLABSI prevention bundle in reducing CLABSI events and improving adherence to central line care policy within a medical surgical adult intensive care unit. The target areas the bundle aimed to improve were unit processes, awareness of CLABSI and central line policies, and …

Improving Patient Experience And Staff Workflow During Ed To Inpatient Interfacility Transfers, Jonathan Nakagawa

Master's Projects and Capstones

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …