Maternal, Child Health and Neonatal Nursing Commons^™

Standardizing Gestational Diabetes Group Education In An Outpatient Maternal-Fetal Medicine Clinic: A Quality Improvement Project, Nina Prieto

Master's Projects and Capstones

Gestational diabetes mellitus (GDM) requires timely and consistent education to support effective self-management and reduce maternal and fetal complications. Baseline assessment of an outpatient maternal-fetal medicine clinic identified variation in educational materials, teaching approaches, referral processes, scheduling, and workflows across English- and Spanish-language GDM group visits. This quality improvement project aimed to standardize the group visit process and increase staff compliance with standardized materials and workflows from 0% to 50% over a 12-week period. Data were collected through direct observation of group and individual education sessions, stakeholder feedback, review of existing materials, referral and attendance patterns, and workflow analysis. These …

Creating Consistency: Standardizing Gestational Diabetes Group Visit Framework In High-Risk Obstetric Care, Danielle Pack

Master's Projects and Capstones

Objective: Gestational diabetes mellitus (GDM) requires timely and consistent education to promote effective self-management and improve maternal and fetal outcomes. Baseline observations at a Santa Clara County high-risk obstetric clinic identified variation in educational materials, educator delivery, referral processes, and workflows between English- and Spanish-language GDM group visits. A review of the literature supported standardized diabetes education and group prenatal care as strategies to improve consistency, efficiency, and patient access. Aim: This quality improvement project aimed to develop and implement a standardized GDM group visit framework for nurse practitioners, registered dietitians, and scheduling staff, with the goal of increasing compliance …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Standardizing Group Visits For Gestational Diabetes Education: A Quality Improvement Initiative In An Outpatient Maternal-Fetal Medicine Clinic, Nha Nguyen

Master's Projects and Capstones

Objective: At an outpatient maternal-fetal medicine clinic in Northern California, gestational diabetes mellitus (GDM) education is delivered inconsistently across nurse practitioners (NPs) and registered dietitians (RDs), with no standardized curriculum, referral criteria, or educational materials. Aim: By August 12, 2026, this project aimed to develop and implement a standardized GDM group visit framework for NPs, RDs, and scheduling staff in maternal-fetal medicine clinic, increasing compliance with standardized referral, enrollment, and educational processes from a baseline of 0% to 50%. Methods: Using baseline observations, workflow assessment, stakeholder input, and a literature review, the QI team developed standardized bilingual slide …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Reducing Primary Cesarean Births Among Nulliparous, Term, Singleton, Vertex (Ntsv) Patients Through Structured Multidisciplinary Communication, Toyin Ajani

Master's Projects and Capstones

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a …

Improving Peer Feedback Participation Through Psychological Safety Interventions In Labor & Delivery Nurses, Lindsey C. Hora

Master's Projects and Capstones

Abstract 

Background: Labor and Delivery (L&D) units require effective communication, speaking up, and team learning to support safe care. Psychological safety informed this quality improvement project as a contextual strategy to strengthen peer feedback engagement.  

Problem: Peer feedback participation among eligible L&D registered nurses at a large acute care hospital in Santa Clara, California, was 14.29% (N = 112) below the 30% project target and 80% organizational target. Low participation limited routine feedback for professional development, recognition, and team learning.

Interventions: Interventions included psychological safety education, peer feedback reinforcement, workflow integration, platform navigation support, dedicated completion time, and unit champions. …

Promoting Interprofessional Collaboration By Increasing Visibility Of Volunteer Doula Services, Ciera Rose Zelie

Master's Projects and Capstones

Objective: The 22-bed Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team developed a standardized doula awareness poster featuring each doula's name, photo, years of experience, and personal interests. Aim: Enhance visibility and promote the integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post-implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for four weeks, a post-survey assessed these same domains to determine …

Improving Doula Visibility And Integration In The Labor & Delivery Unit Through The Implementation Of Creative Standardized Visual Strategies, Ninna Alessandra Arcena Acebedo

Master's Projects and Capstones

Objective: The 22-bed, Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post- implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for four weeks, …

Improving Interdisciplinary Communication And Collaboration With The Standardization Of Doula Care Through An Informatics Tool, Shela Le

Master's Projects and Capstones

Objective: The 22-bed Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post-implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for a month, a post-survey assessed these …

Implementing A Standardized Doula Awareness Tool To Improve Team Collaboration And Patient Understanding, Stephanie Wong

Master's Projects and Capstones

Setting: 22-bed, Labor and Delivery (L&D) unit in the Bay Area serving diverse birthing patients. Problem & Context: The unit lacks a standardized model to introduce doulas, clarify their roles, or communicate their value. Evidence shows that doulas feel unseen by other hospital staff (Kett et al., 2022) and report that their role can be misunderstood, undervalued, or unrecognized, creating barriers to effective partnership (Louis-Jacques et al., 2024). Pre-survey: Only 19.2% of the participating volunteer doulas felt patients understood their role as a doula, and 11.5% felt patients were only slightly knowledgeable. In terms of collaboration, just 15.4% felt consistently …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Improving Effective Assistant Nurse Manager Communication In Obstetrics, Julie Marie Glover

Master's Projects and Capstones

Abstract

Problem: This quality improvement project addresses inconsistent leadership communication among Assistant Nurse Managers (ANMs) in the Obstetrics (OB) department of a hospital in Northern California. ANM and staff concerns around shift handoff, huddles, and leadership responsiveness have created confusion and hindered team coordination. The project aims to improve communication effectiveness scores among OB ANMs from 50% to 75% by July 11, 2025.

Context: The project was conducted in the Maternal-Child-Health (MCH) unit of a hospital in Northern California, specifically targeting communication practices among OB ANMs. Concerns around communication practices were voiced by both ANM leadership and frontline staff, signaling …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Enhancing Adherence To Oxytocin Administration Guidelines To Reduce Postpartum Hemorrhage Rates In A Labor And Delivery Unit, Maya Denny

Master's Projects and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) remains a critical challenge in maternal care. It shows a 13% PPH incidence rate in a high-risk labor and delivery unit in a northern California medical center, exceeding the national benchmark of 5%–10% based on 2021 ACOG data from 150 patient records.

Problem: There is inconsistent adherence to oxytocin administration guidelines, with only 60% of 100 audited charts documenting fetal and uterine activity, contributing to the elevated rate. The team is looking for a target rate of 90%.

Intervention: This involves implementing a checklist, providing training for 25 clinicians, and conducting two 30-minute simulation scenarios …

Intimate Partner Violence Prevention And Intervention At A Primary Care Clinic, Atticus Madrid

Master's Projects and Capstones

Abstract

Intimate partner violence (IPV) is a massive health concern in the Spanish-speaking community. There is a high rate IPV, worsening by factors such as language barriers, cultural stigma, and the constant fear of deportation. Resent data underscores the need for standardized IPV screening and trauma-informed care, thus supporting early recognition and intervention. The aim of this Quality Improvement (QI) project is to increase IPV detection rate by 25% from March 10, 2025, to April 15, 2025, in an San Francisco community clinic using an electronic tool called a HITS (Hurt, Insult, Threaten, Scream) and by trauma-informed staff training. Methods …

Strengthening The Birthing Bridge: Educating Labor And Delivery Nurses On Scope And Impact Of Volunteer Doulas, Catherine H. De La Torre

Master's Projects and Capstones

The objective of this quality improvement project was to address the lack of collaboration between the Labor and Delivery (L&D) nurses and the volunteer doulas on a L&D unit at a Bay Area hospital. There were reports of not understanding the role of the volunteer doula, which may have led to a lack of collaboration between both teams. The aim of this project was to improve the L&D nursing staff's understanding of the scope of practice of the volunteer doula to increase positive perception and collaboration between both professions by 25%, from 63% to 88%, following an educational intervention at …

Journey To Baby-Friendly: Standardizing Patient Breastfeeding Education In The Postpartum Microsystem, Emily Korwin

Master's Projects and Capstones

Problem Low breastfeeding rates remain a global challenge and a cause of adverse infant health outcomes despite the benefits of exclusive breastfeeding. In response, UNICEF and the WHO developed the Baby-Friendly Hospital Initiative (BFHI) to promote, protect, and support breastfeeding for infant growth and development. Context Hospital A is a mid-size hospital in Northern California. It has 24 labor, 13 antepartum, and 33 postpartum beds and serves a diverse population of patients. Intervention After a literature review, microsystem assessment, stakeholder survey, and root cause analysis, a standardized infant feeding nurse patient education checklist was developed and aligned with Baby-Friendly teaching …

Journey To Baby-Friendly Designation: Standardizing Infant Feeding Education, Jasmine Geronimo Ibay

Master's Projects and Capstones

Problem The influence of formula companies in hospitals has caused a decrease in national breastfeeding rates, increasing risks of adverse health outcomes among infants. In response, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 to support breastfeeding practices for infant development and eliminate commercial interests of formula companies from hospitals. Context The quality improvement (QI) project was conducted at Hospital A’s Birth Center, serving a diverse population of patients in the greater East Bay of Northern California. The microsystem has 24 labor beds, 13 antepartum beds, and 33 …

Patient-Centered Language During Peripartum Bedside Reports, Krystal H. Nguyen

Master's Projects and Capstones

Problem Using complex medical language that excludes the patient can result in lower patient satisfaction, increased miscommunication, and heightened anxiety for patients. Hospital A’s peripartum mesosystem currently does not have a training on the use of patient-centered language during labor and delivery (L&D) patient transfers to postpartum (PP). Context Hospital A is an urban tertiary care medical center located in the Bay Area, with its peripartum mesosystem consisting of 35 L&D and postpartum beds distributed across two floors. Intervention Through analysis of stakeholder engagement, an ongoing literature review and a mesosystem needs assessment, potential barriers to implement patient-centered language in …

Baby-Friendly Hospital Initiative: Becoming Baby-Friendly Designated, Krystal Angelique Mora

Master's Projects and Capstones

Section I: Abstract

Problem Despite efforts to increase breastfeeding rates, the influence of formula companies has contributed to the decrease in rates, affecting the health outcomes of infants. In response, the Baby-Friendly Hospital Initiative (BFHI) introduced standardized education for nursing staff to support infant growth and development. Context Hospital A Birth Center is a 33-bed culturally diverse unit that provides care to mothers in Northern California, delivering approximately 7,400 babies each year and helping patients transition into motherhood. Aim The quality improvement project aims to enhance the retention of BFHI-aligned education provided during hospitalization by 26.2%, raising retention rates among …

Optimizing Peripartum Bedside Reports Through Patient-Centered Communication, Harpreet Kaur

Master's Projects and Capstones

Abstract

Background Effective patient-centered communication (PCC) during bedside shift reports (BSR) is crucial in peripartum care, where patients face physical recovery and emotional adjustment. However, communication gaps during transitions from labor and delivery (L&D) to postpartum (PP) units can lead to patient dissatisfaction and misinterpretation of care instructions. Hospital A, an urban tertiary care medical center in San Francisco, operates a peripartum mesosystem across two floors with 35 dedicated beds. Aim The project aims to increase patient satisfaction by implementing patient-centered language in bedside reports for peripartum units from 70% to 80% for a three-week period. Methods Stakeholder engagement, a …

Improving The Diagnosis And Treatment Of Obstetric Sepsis, Edwije Joseph

Master's Projects and Capstones

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries.

Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Standardizing Nurse Knowledge Exchange In The Peripartum Mesosystem, Gabrielle Ann Romena

Master's Projects and Capstones

Problem Handoff report is a significant source of medical error, as reported by the Joint Commission. As it stands, Hospital A’s peripartum mesosystem has no standardized policy regarding the Nurse Knowledge Exchange (NKE) process. Context Hospital A is an urban tertiary care medical center in San Francisco, with its peripartum mesosystem divided into two floors with a total of 35 dedicated beds. Intervention Stakeholder engagement, literature review, and mesosystem analysis identified potential barriers to bedside NKE. To address the identified causes, the project implemented a standardized handoff guide and staff education. Measures The outcome measured was comprehensiveness of NKE as …

Raising The Bar: Optimizing Peripartum Handoff Through Standardized Nurse Knowledge Exchange (Nke), Kimberly Martinez Rn

Master's Projects and Capstones

Problem Hospital X’s peripartum microsystem has no policy guiding the Nurse Knowledge Exchange (NKE) process. Variability in handoffs during patient transfers could lead to medical errors and adverse events. This quality improvement (QI) project aims to pilot a standardized handoff guide to improve nurse communication and avoid adverse patient outcomes following patient transfers. Context The setting for this QI project was a peripartum mesosystem at an urban hospital located in Northern California with 21 postpartum rooms and nine labor rooms. Intervention The project employed a systematic approach that involved engaging stakeholders, analyzing microsystems, reviewing literature, and analyzing data to identify …

Unlocking The Potential Of Peripartum Handoff: Standardizing Nurse Knowledge Exchange (Nke), Kiana Killian

Master's Projects and Capstones

Problem The absence of a structured and standardized handoff during patient transfers may result in the unintentional omission of patient information, medical errors and adverse events. No standardized bedside handoff process, referred to as Nurse Knowledge Exchange (NKE), was observed in Hospital A’s peripartum mesosystem during patient transfers from the Labor and Delivery (L&D) unit to the Postpartum unit. Context Hospital A is a medium-sized urban hospital located in Northern California. The peripartum mesosystem includes 21 postpartum rooms and nine laboring rooms. Intervention Through the recruitment of stakeholder engagement, review of literature supporting evidence-based practices, and a mesosystem assessment, a …

Improving Preeclampsia Education And Assessment Frequency Among Nurses And Patients With Non-Severe Features In A Postpartum Unit, Monica Heredia

Master's Projects and Capstones

Problem: This Quality Improvement project aimed to improve preeclampsia education among Registered Nurses (RNs) and simplify the preeclampsia assessment frequency for patients with non-severe features in the Mother-Baby Postpartum Unit at Hospital Y.

Context: The Quality Improvement project occurred in a 25-bed Mother-Baby Postpartum unit at Hospital Y. The nurse educators at Hospital Y requested that University of San Francisco (USF) nursing students focus on increasing preeclampsia education among nurses and reducing the nursing assessment frequency.

Interventions: Collect quantitative data through observation and hand anonymous questionnaires to the registered nurses and clinical nurse leaders (CNLs) to determine …

Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn

Master's Projects and Capstones

This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …

Improving Education On Preeclampsia With Non-Severe Features And Frequency Of Assessment Among Nurses In The Maternal-Child Postpartum Unit, Alyssa J. Willsher

Master's Projects and Capstones

Problem: This Quality Improvement (QI) project aims to improve preeclampsia education among nurses and reduce the frequency of preeclampsia assessments among patients(without severe features) (SF) in the Mother-Baby postpartum unit at Hospital A. Nurses often stated that patients are unable to have uninterrupted rest periods with frequent assessments, which research shows is necessary for reducing patient blood pressure.

Context: The QI project is implemented in a 25-bed postpartum unit that cares for women and their newborns in the postpartum period. The unit’s nurse educator and nurse manager requested that the visiting University of San Francisco research group focus on simplifying …