Family Practice Nursing Commons^™

Educational Prevention Program Of Surgical Site Infections (Ssi) At A Metropolitan Pediatric, Daniel Chavez

Master's Theses

Surgical Site Infections are a common hospital acquired disease. The prevention of Surgical Site Infection at a metropolitan pediatric hospital was lacking thorough education on how to prevent Surgical Site Infections. Literature was used to support this educational program with evidence based practices. To further reduce Surgical Site Infections education played a key role. Most importantly the distribution of education is what this educational program aimed toward supporting. In order to optimize patient outcomes through the use of our educational program literacy requirements must be me. Using this information our team constructed educational pamphlets that would help empower patients so …

Improving Pediatric Oral-Systemic Health Through Motivational Interviewing: An Interprofessional Training Intervention, Oksana Prodan

Doctor of Nursing Practice (DNP) Projects

Introduction: In response to the prevalence of early childhood carries (ECC) in the United States, recommendations were established for pediatric primary care providers to routinely incorporate oral-systemic health promotion services into clinical practice. An interprofessional education project was developed between Advanced Practice Registered Nurses (APRNs) and dentistry students in San Francisco to assist trainees in the effective delivery of oral systemic health promotion services. Improving health promotion communication skills was identified as an area of need for both sets of learners. Therefore, the IPE activity was designed to incorporate Motivational Interviewing (MI) into the training along with pediatric oral …

Quiet At Night: A Quality Improvement Project, Maria Novales-Fiel

Master's Projects and Capstones

Abstract

Problem: Providing a quiet environment is essential in patient’s healing and recovery. Last year, the October 15 through May 17 survey period resulted at a 2 Star Rating for the hospital, which is below the top 25th percentile. This result along with the patient population, telemetry designation, and unit size prompted the selection of the inpatient telemetry unit in Northern California for the change strategy plan.

Context: The microsystem is a 24-bed adult inpatient telemetry unit in Northern California. Assessment of the unit shows that inconsistencies exist when it comes to bundling care at night. Doors are …

Reducing Delays In Follow-Up Care Through Process Optimization, Liam Malpass

Master's Projects and Capstones

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used …

Newborn Kangaroo Care Immediately After Cesarean Birth, Sarah Abdolcader

Master's Projects and Capstones

Newborn Kangaroo Care Immediately after Cesarean Birth

Sarah Abdolcader

Global Aim: Improve exclusive breastfeeding rates from 76% to 80% in the Perinatal Unit during the newborn’s hospital admission by February 2018.

Project Aim: Improve the percentage of mother/baby skin-to-skin (kangaroo holding) from a baseline of 55% to 65% by August 2017.

Setting: Perinatal Units

Participants: Newborns birthed via cesarean section

Evidence: According to the World Health Organization (2003), hospitals should have a goal of >80% exclusive breastfeeding rates for all newborns during their acute hospital stay and it begins with skin-to-skin contact (SSC), newborn’s bare chest placed on mom’s bare …

Standardization Of Shift Report By Implementing A Nursing Report Sheet And Addressing Patient Values To Meet Patient Needs, Roman A. Salas

Master's Projects and Capstones

Bedside shift report is a complex process, which involves the transition of care from one clinician to another. The Agency for Healthcare Research and Quality (AHRQ) (2013) reported that approximately 70% of patient adverse events are attributed to communication failures between healthcare providers. Nurses remain inconsistent with information sharing during bedside shift report leading to communication gaps. The object of the clinical nurse leader (CNL) internship project is to provide true patient-centered by standardizing bedside shift report by implementing a nursing report sheet and addressing patient needs. The project was conducted in a level-one trauma center in San Diego, CA …

Evidence-Based Verbal De-Escalation Techniques For The Family Nurse Practitioner: Education And Simulation, Rachael K. Misitano

Doctor of Nursing Practice (DNP) Projects

Background: Healthcare workers are 4 times more likely to be exposed to workplace violence than workers employed in private industry, with assault rates as high as 7.8 per 10,000 workers. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults, and or threats of assault, directed toward persons at work or on duty” (OSHA, 2015, p. 2). Verbal de-escalation techniques that assist with care of the agitated patient are not routinely taught to Family Nurse Practitioners (FNPs) throughout their years of advanced coursework, yet it is something they are likely to encounter …

Promotion Of Advance Care Planning For Individuals Experiencing Homelessness, Sarah A. Hubbell

Doctor of Nursing Practice (DNP) Projects

Vulnerable populations in the United States experience disparities in access to advance care planning and may have significant unmet healthcare needs at the end of life, including unrelieved suffering. People who are homeless have increased morbidity and mortality risks, yet lack opportunities to discuss end-of-life preferences. A Doctor of Nursing Practice project consisted of designing, implementing, and evaluating an educational intervention in two settings for nurse practitioners and other clinicians on advance care planning with individuals experiencing homelessness. The intervention was associated with increased knowledge and confidence in advance care planning ability. Participants expressed positive intention to change individual practice …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

The Development, Implementation, And Evaluation Of A Transgender Health Resource Bundle, Lovejeet Kaur

Doctor of Nursing Practice (DNP) Projects

Transgender populations experience disproportionate social and health disparities that can negatively impact quality of life. Healthcare barriers due to gender based discrimination and lack of medical insurance and culturally competent providers contribute to low levels of access to preventative health care screenings, resulting in sub-optimal health outcomes. The unique health circumstances of transgender individuals have been understudied in the literature. As a result clinicians are often under-informed of their specific health maintenance needs and screening guidelines. To help address this disparity, a Doctor of Nursing Practice (DNP) student at the University of San Francisco facilitated the collaborative assessment, development, implementation …

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 …

Kinder Ready: Exploring The Role Of Technology In Promoting School Readiness Among Low-Income Parents In A Clinic-Based Setting, Brenda Lu

Master's Projects and Capstones

The Stanford Pediatric Advocacy Program advocates to improve the health status of children in Silicon Valley and the surrounding community. This summer, I worked on a project called Kinder Ready, with the goal of evaluating the feasibility of technology use in promoting school readiness in children ages zero to five. We used a variety of qualitative research methods, including focus groups, one-on-one interviews, and surveys to collect feedback from the community on what their children need to transition into schools. Our local participatory research approach has paved the way for many new partnerships with local organizations, while strengthening existing ones. …

Development, Implementation And Evaluation Of A Screening Mammography Program, Christine Natan

Doctor of Nursing Practice (DNP) Projects

Breast cancer is a major public health concern in the United States and remains a priority for national women’s health centers, primary care practices and cancer control organizations such as the American Cancer Society (ACS). The cancer care continuum includes the spectrum of prevention/risk reduction, early detection, treatment, and living with the diagnosis. Currently there are no proven primary prevention options for women at average risk of developing breast cancer; therefore, secondary prevention interventions such as screening mammography and clinical breast examination (CBE) are required to reduce morbidity and mortality. This manuscript describes a Doctor of Nursing Practice (DNP) led …

A Quality Improvement Project On Diagnosis And Management Of Asthma In A Private Pediatric Setting., Sosamma Ashley

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Although national guidelines exist for the diagnosis and management of asthma, general practice differs significantly from recommendations. Quality improvement methodology when implemented can narrow quality gaps.

Objective: The objective of the project was to create and implement a plan of action to address identified gaps in key clinical activities of asthma care among pediatric population in a private pediatric setting in Northern California

Methods: The project was centered on the use of Education in Quality Improvement for Pediatric Practice (EQIPP), a program of the American Academy of the Pediatrics. Both the pediatrician and the DNP student took this …

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …

Fnp Led Mobile Health Services For The Homeless Population, Tenzin D. Lama

Doctor of Nursing Practice (DNP) Projects

A small percentage of the U.S. population uses the greatest portion of the healthcare services. Homeless people are often such a group of “super-utilizers” of the healthcare system. Due to multiple medical and psychosocial conditions, people experiencing homelessness face numerous barriers to accessing healthcare, thus leading increased utilization of hospitals and emergency departments (EDs) services. Many of these events are preventable through improved primary care interventions. The literature on Respite/Recuperative Care, Transitional Care, and Mobile Health interventions have shown effectiveness in providing safe and quality care to homeless individuals during the critical transitional period post hospital discharge while also reducing …

A Quality Improvement Project To Increase Diabetes Self-Efficacy In A Rural Primary Care Clinic Through Patient Utilization Of A Diabetic Logbook, Margo D. Sutton

Doctor of Nursing Practice (DNP) Projects

The prevalence of type 2 diabetes mellitus (T2DM) has increased substantially in the United States in recent years. Teaching self-management to diabetic patients is essential to help them control their chronic disease. Albert Bandura’s theory of self-efficacy is commonly used in chronic disease self-management programs and is the theoretical framework upon which this Doctor of Nursing Practice (DNP) pilot project was built.

This evidence-based change in practice project took place in a rural primary care clinic in the central valley of California, and involved the development of a diabetes logbook, which was a tool for patients to use to learn …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Improving Care Of Assisted Living Residents With Dementia Through A Competency-Based Behavioral Training Curriculum For Assisted Living Caregivers, Mary Ann Z. De Vera

Doctor of Nursing Practice (DNP) Projects

Behavioral and psychological symptoms of dementia (BPSD) are common among residents of assisted living facilities. Inadequately managed symptoms of BPSD can lead to problematic behaviors with significant consequences for patients and caregivers. Non-pharmacologic approaches to the management of problematic behaviors in individuals with dementia are the preferred management option. Caregiver training and education to enhance knowledge and skills in managing behavioral and psychological symptoms for assisted living caregivers is indicated to provide optimum care for patients with dementia. The purpose of this doctor of nursing practice (DNP) project was to develop and implement a caregiver-training workshop utilizing a competency-based behavioral …

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

SPECIFIC AIM: We aim to Improve the medication administration process and involve all staff within 6 months

In the microsystem consisting of 14 family practice and urgent care clinics, there is not a standard process based on evidence based practices for medication administration. With and estimated of 400-600 medications (immunizations included) being administered per day, without a standard of care protocol, the risk for medication errors is evident.

Objectives and changes anticipated based on implementation of the project is to engage staff in support for improving medication administration standard of care based …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Improving Women’S Health Services By Adding Long-Acting Reversible Contraceptive Methods Into Primary Care-Focused Student Health, Shu-Chen Jennie Cheng

Doctor of Nursing Practice (DNP) Projects

Often resulting from inconsistent contraceptive use, unintended pregnancy among young women between ages 18-24 continues to be an issue in the United States. Long-acting reversible contraceptives, including intrauterine contraceptives and the subdermal contraceptive implant, are safe, effective, long-acting, easily reversible, and non-user dependent contraceptive methods, yet currently are greatly underutilized. Most of the contraceptive methods are provided at our student health services except for the highly effective long-acting reversible contraceptive methods. As family nurse practitioners and health care providers, it is essential to integrate this service into primary care-focused college student health clinics by providing evidence-based information to clinical providers …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …