Nursing Commons^™

The Eat Sleep Console Approach: An Evaluation Of Impact, Outcomes And Continuation Of Care, Stefanie Disilvio

Doctor of Nursing Practice (DNP) Manuscripts

Neonatal Opioid Withdrawal Syndrome (NOWS), a subgroup of Neonatal Abstinence Syndrome (NAS), is a constellation of postnatal symptoms that occurs due to the abrupt cessation of intrauterine opioid exposure. Historically, these infants have been evaluated and treated by the Finnegan Neonatal Abstinence Scoring Tool (FNAST) (Appendix A). Recent evidence supports the use of the Eat Sleep Console Approach (ESC) (Appendix B) as an alternative to the FNAST. The ESC model focuses on the comfort and care of these infants by maximizing nonpharmacologic methods and increasing family involvement in the treatment of their infant. The purpose of this project was to …

Improving Measurements And Self-Management Skills Of Cardiovascular Disease By Incorporating A Healthy Lifestyle In Hispanic Adults: A Promotoras Led Program, Kelly Llewellyn

Doctor of Nursing Practice (DNP) Manuscripts

Hispanic community members face unique challenges related to language barriers, culture, access to care, and trust in healthcare providers. Hispanic community members have a higher incidence of cardiovascular diseases and diabetes than their non-Hispanic counterparts. Hispanic males were most likely to die of cardiovascular disease in 2017 (CDC, n.d.a), and for females, death from cardiovascular disease was only second to cancer (CDC, n.d.b.). Hispanics are 70% more likely to be diagnosed with diabetes than non-Hispanics (Office of Minority Health, nd.) Promotoras are trusted members of the Hispanic community who can assist healthcare providers in providing disease prevention education and self-management …

Enhancing Elementary School Educators And Staffs Behavioral Classroom Management Strategies To Support Children Affected By Trauma Through Utilization Of Trauma-Informed Care (Tic) And Social-Emotional Learning (Sel) Modalities: A Quality Improvement Project, Kerstin Burt

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background: The fundamental ACE study asked more than 17,000 adults about their childhood trauma exposure and how it has impacted their health as an adult. The study found a link between ACE exposure and a higher likelihood of experiencing adverse emotional and physical outcomes (Felitti et al., 1998).

Problem: Educators and staff encounter children affected by trauma and are untrained in trauma-informed care approaches, known as the “Four R’s” (SAMHSA, 2014b).

Purpose: This quality improvement (Q.I.) project aimed to respond to the trauma-informed care (TIC) and social-emotional learning (SEL) gaps among educators and staff at a private elementary school …

Program Evaluation Of A New Initiative In An Interdisciplinary Pediatric Concussion Clinic: Active Rehabilitation Following Sports Concussion, Kelly Gettig

Doctor of Nursing Practice (DNP) Manuscripts

Mild traumatic brain injury (mTBI) or concussion is a growing public health concern in adolescents, and early interventions should target persistent symptoms that can impact learning, behavior, and emotions. The past decade has brought increased awareness, identification, and reporting of concussion and an accompanying explosion of quality research on the management of concussion. The overwhelming theme that has emerged is active rehabilitation which challenges the long-standing recommendation of rest and restriction.

This comprehensive program evaluation has focused on a new initiative in a pediatric interdisciplinary brain injury clinic, including an analysis of the impact of active rehabilitation on athlete concussion …

Cultural Care Needs Of Spanish Speaking Parents With Limited English Proficiency Whose Children Are Hospitalized: An Ethnonursing Study, Jennifer Stephen

Electronic Theses and Dissertations

Purpose: Parents’ inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and understand nurses’ role in providing culturally congruent care.

Design and Methods: Leininger’s qualitative, ethnonursing method was used for this study. The Theory …

Exploring Cultural Values, Beliefs, And Perceptions Of Human Papillomavirus Vaccine Acceptance In African American Men, Rashida Henderson

Electronic Theses and Dissertations

Introduction: African American (AA) /Black men have a higher rate of anal and rectal HPV-associated cancer, which the HPV vaccine can prevent. Purpose: This study aimed to understand the cultural values, perceptions, and beliefs of the HPV vaccine in African American/Black Men. Method: Through a focused ethnography, a semi-structured guide was utilized to interview 24 AA men. Inclusion criteria included identifying as AA/Black, aged 18-30 years, born and living in the United States, identify and born as male, and able to understand, read, and write English. Results: Through Leininger’s Four Phases of Analysis, three themes emerged: 1) lack of knowledge …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Is Trauma Informed Care Practiced In Public Std Clinics In New York State, Antonia Brewer

Electronic Theses and Dissertations

Introduction: Sexually transmitted diseases (STDs) are increasing in the United States and often result in long-term adverse health outcomes. New York State (NYS) local health departments (LHDs) provide public STD clinics for high risk populations also found to have high rates of violence. This study examined if/how trauma informed care (TIC) is implemented in these settings. The study sample were LHD STD Program Directors in NYS.

Method: A convergent parallel mixed methods study design was used which included an online survey and follow up interviews. Survey data were analyzed using univariate statistics and conventional content analysis was used to analyze …

Hospital Nursing Factors Associated With Decreased Odds Of Mortality In Older Adult Medicare Surgical Patients With Depression, Aparna Kumar, Douglas Sloane, Linda Aiken, Matthew Mchugh

College of Nursing Faculty Papers & Presentations

Background: Depression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources, 30-day mortality; and the impact of depression on this relationship.

Methods: This was a retrospective cohort study employing a national nurse survey, hospital data, and Medicare claims data from 2006-2007. The sample included: 296,561 older adult patients, aged 65-90, who had general, orthopedic, or vascular surgery in acute care general hospitals …

Implementing A Clinical Decision Algorithm To Improve Fluid Resuscitation In Sepsis, Teresa Wavra

2022 Southern California Nursing Research Conference

Stabilizing hemodynamics using intravenous fluid and vasopressor support are essential therapies used to restore tissue perfusion in patients with sepsis. The project site noted poor compliance with the Surviving Sepsis Campaign recommendations for fluid resuscitation and vasopressor support in patients with refractory hypotension. The purpose of this quality improvement project was to determine if or to what degree the implementation of Douglas et al.’s clinical decision algorithm to guide fluid resuscitation impacted the number of patients who required mechanical ventilation when compared to current practice among adult patients with sepsis hypotension and shock in a community hospital in urban California …

An Ebp Approach To Managing Post Cardiac Arrest Interdisciplinary Care, Mary Kay Bader, Teresa Wavra, Tauseef Qureshi, Jon Cline, Marne Andersen

2022 Southern California Nursing Research Conference

The Joint Commission (TJC) published new performance standards on Post Cardiac Arrest (PCA) care that went into effect on Jan 1, 2022. The new standards encourage hospitals to review and synthesize current scientific literature on Post Cardiac Arrest Syndrome (PCAS) and analyze current hospital practice. Following a review of the evidence, hospitals are guided to create a multidisciplinary protocol and education that facilitates training of personnel, implementation of the evidence into clinical practice, data collection, and case review processes. The intent of the standard is to bring hospital based clinical practice in line with the established standards to improve patient …

The Impact Of Therapeutic Neonatal Positioning In The Nicu, Amanda Blaise

2022 Southern California Nursing Research Conference

Also presented at the National Association of Neonatal Nurses (NANN) Conference in September 2023

Health Promoting Self-Care: Evaluating The Impact Of Food And Fitness Challenge On The Physical And Psychological Health Of Healthcare Workers, Giancarlo Lyle-Edrosolo, Gena Oppenheim, Emily Enos, Marlon G Saria

2022 Southern California Nursing Research Conference

Background: The unprecedented rates of burnout, stress, and turnover amongst healthcare workers following the COVID-19 pandemic highlighted the importance of prioritizing caregiver physical and mental health. Despite a direct correlation between nurses with multiple health problems and turnover intention, literature searched over the last two decades yielded minimal results using terms such as, nurses and diet, fitness or exercise therapy. A recent study, which focused on female nurses, found an improvement in psychological health by addressing diet, while another found a decrease in occupational stress with an aerobics program. There is even less data to support the use of a …

The Mindfulness Minute Ebp Project, Veronica Silva

2022 Southern California Nursing Research Conference

No abstract provided.

Improving Nurse Leaders' Transformational Leadership Skills In The Online Environment, Tanya Haight

2022 Southern California Nursing Research Conference

Leadership is critical to the success of most organizations, and the achievement of an organization's goals is largely dependent on the leaders' ability to engage, motivate, and influence their teams—often referred to as Transformational Leadership. This is especially true for healthcare organizations wherein the morbidity and mortality of patients may be affected by the quality of leadership. At the start of the COVID-19 pandemic, in-person meetings transitioned to the online format without nurse leaders' formal training. Leaders cited this lack of orientation as impeding their ability to sustain an online-virtual transformational leadership presence with their teams. They reported varying degrees …

Evidence Based Practice Confidence In Nurse Residents, Cari Shaver, Stefanie Anderson, Emy-Lee Marie Anglo Ricafrente, Sandy Martir

2022 Southern California Nursing Research Conference

No abstract provided.

Exploring The Lived Experiences Of New Graduate Nurses During The Covid-19 Pandemic, Julie Youn

2022 Southern California Nursing Research Conference

Background

New graduate nurses (NGNs) in acute care settings are particularly vulnerable to the stressors inherent in nursing, due to the immense amount of experiential learning required at the bedside during the first year of practice. The high amount of stress experienced by NGNs is reflected in high turnover rates. Nurses with less than two years of experience accounted for almost half (47.5%) of all nurse turnovers in 2019. Furthermore, the COVID-19 pandemic has caused much physical and emotional turmoil in the nursing profession due to the increased workload and emotional distress. However, there are limited studies exploring the experiences …

Educating Providers Without Prescriptive Authority About Psychopharmacology Basics: Bridging The Interdisciplinary Work Among Psychotropic Prescribers And Psychologists, Olivia Ceja

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this evidence-based change in practice is to increase the fund of knowledge among psychologists, licensed clinical social workers, and talk therapists in outpatient psychiatric settings by educating clinicians about psychopharmacologic basics and the role and work of a psychiatric nurse practitioner during group supervision meetings. This can help bridge the gap of psychopharmacologic knowledge between mental health providers with and without prescriptive authority.

Problem: Evidence shows that psychologists with non-prescribing capabilities are not often trained or educated about the very medications that their clients are often taking. Currently, psychotropic medication education is not a standard aspect …

Improving Medication Side Effects Documentation And Clinician Understanding In Home Health, Katherine Bales

Master's Projects and Capstones

Abstract

Problem: In home healthcare services, care experience scores are increasingly the strategy for evaluating the continuity of care to patients who require post-hospital follow up and guidance on medication management. Clinician understanding of how to use the available medication education tools impacts how well patients are able to manage their own care.

Context: The organization’s Home Health clinicians have not done well providing medication education on side effects as evidenced by low survey scores. The focus of the project is improving the medication education provided to patients and documentation thereof. The project takes place in a home health microsystem …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Managing Congestive Heart Failure Through Standardized Symptom Assessment, Shanda M. Joy

Master's Projects and Capstones

Abstract

Problem: Transitional care programs have increased in popularity to focus on optimizing transitions of care from acute hospitalization to home based settings to reduce hospital readmissions. The transitional care model utilized at this urban, integrated health facility is mostly 100% telephonic, short term (30 days) case management. Approximately 30% of the patients referred to the program have a diagnosis of congestive heart failure.

Context: Hospital reimbursement has decreased due to high readmissions rates, especially among congestive heart failure (CHF) patients. This process improvement project was aimed at decreasing CHF related readmissions through educating patient/families on CHF watch symptoms and …

Preventing Hospital-Acquired Pressure Injury In High-Risk Patients, Sahara Thapa

Master's Projects and Capstones

Hospital-Acquired Pressure Injury (HAPI) can be costly for Skilled Nursing Facilities (SNFs) and painful for the patients. Most pressure injuries are considered preventable, but many patients die each year from complications from pressure injuries. Pressure injury treatment costs millions of dollars annually, which could be spent on other treatments. A quality improvement (QI) project was formulated to address pressure-related injuries and improve patient care outcomes in one skilled nursing facility in Northern California. Based on a review of current evidence, HAPI prevention education was implemented for all patient care staff. The education focused on skin assessment, risk factors, staging of …

Improving Outreach With Stroke Patients After Discharge, Marsha Belen

Master's Projects and Capstones

Problem: The 90-day mRS post discharge call project aimed to improve the outreach in stroke patients treated with thrombolytics alone or in combination with mechanical endovascular reperfusion (MER) therapy. An audit of calls was completed and revealed a gap that a number of patients were not reached or did not receive a call attempt. Having a higher outreach provides useful feedback on the patient’s progress within 90-days of being discharged in relation to the effectiveness of the stroke treatment received according to the mRS.

Context: The Neuro Coordinator was responsible for making the 90-day post discharge call and worked in …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Tepezza: Improving Delays In Treatment, Rebecca D. Page

Master's Projects and Capstones

Problem: There is gap in time from when a Tepezza (teprotumumab) order is placed until the time a patient receives their first infusion.

Context: Delays in the initiation of Tepezza infusions result in worsening symptoms and a decrease in quality of life for patients diagnosed with thyroid eye disease.

Interventions: Interventions included scheduling regular meetings with involved departments, following each patient who has been prescribed Tepezza through the initiation of therapy, and improving staff and patient education.

Measures: Outcome measures include decreasing days from order placement to first infusion from an average of 61 days to 30 days or less …

Why Is Blood Glucose Control Important To Self-Care Of Pregnant Women With Gestational Diabetes Mellitus?, Mi-Joon Lee, Bum Jeun Seo, Yeon Sook Kim

Nursing Faculty Publications

This study aimed to investigate the change in self-care, self-efficacy, and health status of pregnant women with gestational diabetes mellitus (GDM), and to identify whether blood glucose control influences pregnancy outcomes. This study is experimental research using a one-group pretest-posttest design. The study subjects were 40 pregnant women diagnosed with GDM, and the data were collected in their 24th and 40th week of gestation and analyzed using SPSS 27.0. Paired samples t-test was used to compare the health status, self-care, and self-efficacy of subjects between antepartum and postpartum, and t-test and non-parametric test were used to evaluate the changes in …

Heart Failure, Molly Davis

Nursing Student Class Projects (Formerly MSN)

Heart Failure is defined as the pathophysiologic condition in which the heart is unable to generate an adequate cardiac output such that perfusion of tissues or increased diastolic filling pressure of the left ventricle, or both occurs (Huether & McCance, 2019).