The Use Of Life-Like Robotic Animals In The Acute Care Setting To Assist In The Care Of Patients With Dementia, Abby Denby

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The purpose of this pilot project was to describe the effect of life-like robotic animals on the nurses’ ability to provide care, patients’ level of agitation, use of antipsychotic medications, restraint and sitter use for patients with dementia in an acute care setting. Nurses report challenges and feelings of helplessness while caring for patients with dementia. Dementia may cause depression, agitation, aggression (physical or verbal) and a decrease quality of life. Animal Assisted Therapy (ATT) is a growing therapy in many healthcare settings but there is a lack of literature specifically related to the use of AAT in the acute …

Older Women’S Experiences Of Intimate Partner Violence: A Phenomenological Study, Lourdes Irene

Doctoral Dissertations

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. Despite the growing number of women over age 60 in Puerto Rico, knowledge is lacking about culturally specific IPV in women of this age group. This lack of knowledge is problematic because women experiencing abuse often do not report it, health professionals are not educated to identify cases of abuse in older women, and researchers often includes IPV with other types of abuse, such as negligence by families. Therefore, the purpose of this study was to explore and describe the experiences and …

Investigating The Relationship Between Unavoidable, Hospital Acquired Pressure Injury And Mortality: Is Unavoidable, Hospital Acquired Pressure Injury A Signal Of Increased One-Year Mortality Risk?, Eileen Jimenez

Theses & Dissertations

The purpose of this dissertation was to explore the strength of the relationship between unavoidable Hospital Acquired Pressure Injury (HAPI) and increased risk of one-year mortality for patients age 55 and older who were admitted to a hospital from 2015 to 2018. A quantitative, retrospective case-control study was designed to compare demographics, comorbid conditions, pressure injury risk, and living situation of those patients that developed unavoidable HAPI and hospitalized adults with similar physiological burdens that remained injury-free. The one-year mortality for the HAPI group was 27 of 48 (56%), and 26 of 47 patients (55%) for the Control group. The …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Aiming For Zero: Creating A Culture Of Safety And Improving Cauti Outcomes In The Microsystem, Shiela Escobar

Master's Projects and Capstones

Abstract

Problem: Catheter-associated urinary tract infection (CAUTI) remains the leading cause of hospital-acquired infection (HAI) despite being preventable. CAUTI increases the length of stay, morbidity, mortality, readmissions, and costs. There is also increasing antimicrobial resistance in pathogens causing CAUTI. Thus, reducing HAIs such as CAUTI should be a priority for every institution.

Context: The microsystem for this CAUTI quality improvement project is a 24-bed adult medical-telemetry unit in an acute care teaching hospital with excessive CAUTI. This project aims to improve the unit’s CAUTI standardized infection ratio (SIR) from a baseline of 2.54 to 1.75 by October 2020. A SIR …

Prospectus For Mitigating Loneliness During Quarantine For Older Adults In Long Term Care Facilities, Emily Gines

Master's Projects and Capstones

In 2020 as the COVID-19 pandemic resulted in quarantine safety measures and facility closures, facilities that cared for older adults in particular were hit the hardest. Long term care facilities (LTCFs), specifically those that care for older adults with memory care problems, must find ways to provide high-quality, standard care, despite many regulations and changes. Although infection control is an important aspect of care among this population, we must also consider how we can maintain quality of life and social connection. Loneliness is defined as the subjective feeling of being alone or perceived isolation. It can also relate to the …

Decreasing The Fall Rate On A Medical Surgical Unit With An Enhanced Fall Algorithm In The Electronic Medical Record, Natali Sokolovski

Master's Projects and Capstones

This paper summarizes the quality improvement falls prevention project on a Medical-Surgical unit with an Enhanced Fall Algorithm incorporated in the Electronic Medical Record conducted by two Clinical Nurse Leader students of the University of San Francisco.

This project addresses the patient falls events in a San Francisco-Bay Area Hospital on a Medical-Surgical unit. The aim is to decrease the rate of falls on a Medical-Surgical microsystem unit by 50% with an Enhanced Fall Algorithm incorporated into the Electronic Medical Record by June 2021. The patient population consists of general medical surgical patients where many of the patients have an …

Fall Risk Factors Among Hospitalized Older Adults With Alzheimer’S Disease And Related Dementias, Jean Bettencourtt Sconza

Doctoral Dissertations

Falls are a common and devastating complication of hospital admission for older adults. Falls are especially significant for those with Alzheimer’s Disease and related dementias (ADRD) as they are at high risk to fall and to suffer injuries from falling. Despite the large body of research on falls in hospitals, less is known about fall risk factors among patients with ADRD. The purpose of this retrospective case-control study was to determine which risk factors are predictors of falls among hospitalized older adults with Alzheimer’s disease and related dementias (ADRD) by comparing those who fell with those who did not fall. …

Nurses' Attitudes Toward Physician-Assisted Suicide, Cheyenne Star Lowrey-Lagrone

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Physician-assisted suicide, or PAS, is end-of-life option in which patients self-administer physician-prescribed lethal medication to end their life. Nurses' own interpretations and understandings of the legalities, ethical dilemmas, and factors that influence their attitudes can be analyzed to determine the nurses’ role in the support or opposition of the practice. Although nurses do not have an active role in PAS, they play a pivotal role in patient advocacy and education. This paper analyzes the factors that contribute to nurses’ attitudes toward the practice, along with the benefits of education of this topic going forth.

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

Exploring The Effects Of The Cycling Without Age Program On Older Adults Living In Long-Term Care, Victoria Cotnam

Electronic Thesis and Dissertation Repository

The Cycling Without Age program, offered in long-term care homes around the world, allows residents to experience the feeling of a bike ride in the trishaw as a volunteer pedals the electrical bike. The purpose of this pragmatic observational study was to measure the effects of an existing program in a Canadian long-term care home on residents’ happiness, quality of life, pain and functional status (using Resident-Assessment Instrument Minimum Data Set 2.0). A convenience sample of 39 residents participated in two groups, a biking group (n=23) and a strolls group (n=16) over the period of 12 weeks. Findings show that …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

The Use Of Tailored Interventions To Prevent Falls: A Quality Improvement Project In The Telemetry Unit, Roda Galang

Student Scholarly Projects

Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion.

Practice problem: The objectives of the fall initiative …

The Effect Of Medication Reconciliation Timeout On Patient Safety: An Evidence-Based Project, Renante Dizon

Student Scholarly Projects

Practice Problem:There was a report of a high rate of medication errors from inaccurate medication reconciliation during admission to a local hospital in South Texas. The medication error rate was 14.88% on 20 reviewed charts, and 85% of all evaluated charts contained at least one medication discrepancy.

PICOT: This evidence-based, system-change project was guided by the following PICOT question: For nurses administering medication in a long-term acute care hospital, does the implementation of Medication Reconciliation Timeout Process (MRTP) decrease the medication errors, compared to the usual medication practice, in one month?

Evidence: Thirteen pertinent studies recommended the use of …

A Policy Change To Reduce Hospital-Acquired Clostridium Difficile Infection Rates: A Quality Improvement Project, Nia Hidalgo

Student Scholarly Projects

Practice Problem: At a small community facility in Los Angeles County, there was a reporting rate of hospital-acquired Clostridium difficile cases that was higher than both state and national benchmarks.

PICOT: The PICOT question that guided this project was: In acute care patients aged 18-90, does not retesting for CDI for at least seven days compared to retesting in less than seven days reduce the incidence of false positive CDI tests during the first seven days of the hospital stay?

Evidence: The evidence demonstrates that if patients are tested initially for Clostridium difficile and then retested seven days after, the …

Catheter-Associated Urinary Tract Infection (Cauti) Prevention In Spinal Cord Injury Unit, Golda Nebre

Master's Projects and Capstones

PROBLEM: Hospital-acquired infections (HAI) continuous to be a safety challenge in today’s healthcare systems. Applying a lens to the most common HAIs such as Catheter-associated urinary tract infection (CAUTI) in a Spinal Cord Unit calls for evidenced-based solutions and process improvement. CAUTIs are not only costly and prolongs the patient’s hospitalization, it’s a preventable harm that significantly affects the quality of life of spinal cord injury patients.

CONTEXT: Spinal Cord Injury Unit (SCIU) in VA Palo Alto is a 19-bed capacity inpatient unit where CAUTI rates have been increasing in the recent years. There is a high risk for CAUTIs …

Dnr No Polst Project, Reanda Scherson

Master's Projects and Capstones

Problem: The DNR No POLST project aims to increase the number of physician orders for life-sustaining treatment (POLST) forms completed on hospitalized patients who are designated DNR status. Currently, there is no process for ensuring completion of advanced care planning (ACP) materials, including the POLST form, on designated DNR patients throughout the hospital. Ensuring patients receive a complete and accurate POLST prior to discharge decreases the chance of unwanted overtreatment.

Context: This quality improvement project utilizes regionally trained life care plan (LCP) facilitators to initiate and assist patients and families in the completion of the POLST form. Approximately 70% of …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

An Assessment Of The Utilization Of Geriatric Depression Screenings In Primary Care Providers, Ashleigh Flora, Devi Moon, Tiffine Prisock, Shelby Reeves, Rachel Romero

MSN Research Projects

The purpose of this study was to determine the practices of primary care providers in relation to screening and treating geriatric depression. According to the Geriatric Mental Health Foundation (GMHF), depression and suicide are significant public health issues for older adults, noting that depression is one of the most common mental disorders experienced by elders. Research indicates the issue of geriatric depression is poorly approached by providers and patients do not receive appropriate care. Depression cannot be measured with lab or diagnostic tests; the only way to assess depression is to screen patients by asking questions. When screening for depression, …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Increasing Access To Medicare Annual Wellness Visits In Primary Care; Utilizing Registered Nurses As Part Of An Interdisciplinary Team Based Approach, Iyo Kubota

Doctor of Nursing Practice (DNP) Projects

Background: In order to provide evidence-based preventive care to the aging population, Medicare began providing free annual wellness visits (AWVs) to its beneficiaries in 2011. The AWVs are a great opportunity for primary care providers to develop personalized preventive care as well as health promotion. However, many primary care practices especially those with limited resources struggle to incorporate AWVs into their busy primary care practice. Centers for Medicare and Medicaid Services allows other providers than physicians, NPs and PAs to perform those visits including registered nurses, health educators, and registered dietitians.

Methods: A pilot project was conducted with 12 patients …

Implementation Of Post Falls Huddles In Skilled Nursing Facility, Princess Lomax

Evidence-Based Practice Project Reports

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this …