Public Health and Community Nursing Commons^™

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. …

Reducing Annual Emergency Department Visits Through Improved Asthma Discharge Teaching, Alvin R. Walters

Master's Projects and Capstones

Asthma is the most common pediatric condition in the United States, and a child's home environment plays an impactful role in the triggering of asthma exacerbations (Harper et al., 2015). Current emergency department (ED) ideology focuses on symptoms management, with little time spent on education, and virtually no attention paid to the home environment. Evidence shows that programs which incorporate home environmental assessments into asthma patient education produce a reduction in annual ED visits, fewer missed school days, decreased use of rescue medications, and improvements in quality of life (Gruber K.J., et al, 2016, Hollenbach J.P. & Cloutier M.M., 2015, …

Strategic Community Healthcare Management, Stephanie Penrod

Master's Projects and Capstones

Federally Qualified Health Centers(FQHC) and Community Health Centers are growing with the Affordable Care Act. This paper introduces literature that supports the need for Community Health Centers and management of low income patients with chronic illnesses. This paper also reviews the fieldwork experience at a FQHC. It reviews the goals, project, methods and findings of the fieldwork. This paper also elaborates on the scope of the project and a quality improvement report for the FQHC in observation. It discusses the future potential implementation of the recommendations and the benefits for both employees and patients. This paper concludes with follow up …

Tuning "The System": An Evaluation Or Restorative Practices In San Lorenzo School District, Amber White

Master's Projects and Capstones

In 2013, The Director of Student Support Services for the San Lorenzo Unified School District (SLZUSD) implemented a Restorative Practices program in an effort to improve relationships on campus and decrease suspension and expulsion rates in SLZUSD. The Directors push for RP was fueled by the passing of Assembly Bill 1729 (AB-1729), when the California Education Code changed to allow for alternative disciplinary actions. States nationwide have passed bills similar to AB-1729 and allowed schools to use alternative punitive practices. Despite good natured intentions there were many faculty members who did not respond with enthusiasm and there has since been …

Implementing Change To Decrease The Emergency Department Visits For Pediatric Clients Referred To Mental Health Services, Diane Sandoval

Master's Projects and Capstones

The purpose of this clinical nurse leader (CNL) internship project is to implement an improvement intervention to decrease emergency department visits or psychiatric emergency services visit rates for pediatric clients receiving mental health services through the ambulatory clinic. The goal is to increase client safety by preventing harm to themselves or others and improving quality of care provided through timely nursing telephone triage. The project is taking place in a county run pediatric ambulatory clinic. We will participate in a shared leadership team to make recommendations for improvement at the microsystem level. Team members include the charge nurse, clinic manager, …

Intranasal Naloxone Adminstration Education, Natalie O. Levchenko

Master's Projects and Capstones

The Clinical Nurse Leader project focused on the provision of education on intranasal naloxone administration to healthcare providers in Lake County in order to educate patients, their families, peers, and members of their social network. Fatal opioid overdose rates from prescribed or illicit opioids are four times greater in Lake County than California. The setting is Lake County, California, with a population of 65, 000, a radius of 1,300 square miles, and an annual per capita income of $21,000, with 24.3 % living in poverty. The CNL project focused on the Clinical Nurse Leader elements: Systems Analyst/Risk Anticipator, Outcomes Manager, …

Issues In Patient Information Transmission: Standardizing Home Health Admission, Philippa Thomas

Master's Projects and Capstones

When 84 patients, current and former, complained about lack of information during the intake process within five months period, a uniform "Patient Screening Tool" (Appendix L) was developed to improve the admissions process to this home health agency. Intake staff is responsible for receiving accurate information from the referral sources, confirming qualifications to receive services, and initiating education about services to the patient. While the population served has a wide range in age, diagnoses, discharge settings and cultures, the majority are over 65, frail, homebound and are returning home after hospital, SNF or rehabilitation settings.

Data were collected through evidence …

Increasing The Awareness Of Trauma Informed Care In The School Setting: Giving Practitioners The Tools To Actively Participate In Trauma Related Care, Rebekah L. Sypniewski

Doctor of Nursing Practice (DNP) Projects

Of the approximately 15 million children and adolescents who have a mental health disorders that are interfering with their functioning, a mere 25% seek medical advice or treatment (Melnyk, Kelly, & Lusk, 2014). Furthermore, two thirds of youth report experience at least one traumatic event by age 16 (Suarez, Belcher, Briggs, & Titus, 2012). School health practitioners have regular contact with children and adolescents as they typically attend school five days a week, nine months out of the year. The consistent presence of the relationship between the practitioner and student creates an ideal environment for discussing the sensitive topics necessary …

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 …

Implementing Change To Decrease The Re-Admission Rate For Clients Of A Care Transition Program, Aileen Tran

Master's Projects and Capstones

The clinical nurse leader (CNL) internship project’s purpose is to implement a change to decrease readmission for clients in a care transition program, thereby improving quality of life. This care transition program aids with the transition from hospital to home for adults. The microsystem is composed of public health nurses, volunteers, student interns, supervisors, and an administrative assistant. The aim statement for this change project is to improve patient safety by decreasing readmission rates by implementing an initial follow-up phone call within one day of discharge in 75% of the care transition clients by April 30, 2016. This project was …

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 …

Staff Education: Nutrition Education In The Intellectually /Developmentally Disabled Community, Claire C. Bradley-Davalos Msn Rn

Master's Projects and Capstones

The objective of my project is to develop staff education regarding a nutrition initiative developed to address the 44% obesity rate among clients in our care. My target population is direct care staff working in the Intellectually/Developmentally Disabled (IDD) community, and high functioning clients who live independently in the community. The staff knowledge was tested pre- and post-education to demonstrate knowledge retained. Staff are required to get a score of 80 or better to pass. Test results are interpreted to see which content areas need further teaching or clarification. Initial results indicate that four areas of education need to be …

Improving Inpatient Influenza Compliance Rates With A Standing Orders Program, Marlee E. Gruber

Master's Projects and Capstones

Influenza vaccinations are recommended yearly as part of a primary care performance measure to prevent and control seasonal influenza. Rates of influenza are steadily increasing and can lead to severe negative impacts and even fatalities with patients. According to the Center for Disease Control (CDC)’s Morbidity and Mortality Weekly Report (MMWR), less than 40 percent of the U.S. population receives the flu vaccine yearly. It is suggested by the CDC that Annual vaccination is the most effective method for preventing influenza virus infection and its complications. The Department of Health and Human Services’ Healthy People 2020 includes a goal of …

Increasing Hpv Awareness And 3-Dose Series Compliance Among The Female Population (Ages 11-26) In A Community Health Clinic, Vanessa Orozco

Master's Projects and Capstones

Abstract

The overall goal of this project was to increase HPV 2nd and 3rd dose compliance rates by a combined 10% among the female adolescent population (ages 11-26). This was to be achieved by implementing EBP follow-up calls to not only schedule appointments but also to serve as a reminder for patients to come into previously scheduled appointments. This project was chosen as prior clinic and organization-wide meetings had delineated compliance rates at just 7%. There were various methods employed to implement this project including an initial microsystem assessment, which entailed a Root Cause Analysis, Process Mapping, SWOT analysis, Cost-Analysis, …

Reinventing The Medical Request Process In A Correctional Healthcare Setting, Leah Murphy

Master's Projects and Capstones

This project was developed as part of a Clinical Nurse Leader course of study with the goal of gathering and evaluating microsystem data, and the creation and implementation of a process improvement project. The project was conducted in a correctional setting which houses male and female detainees with a wide variety of medical needs. The project addressed long wait times for detainees who have submitted a request for services from the medical department. The goal of this project was to reduce wait times for medical requests, and provide service for a greater number of patients. This project is needed because …

Improving Hand Off Communication To Enhance Patient Outcomes And Staff Satisfaction, Karin Weinstock

Master's Projects and Capstones

Abstract

The specific aim statement is: Improving hand off communication to enhance patient outcomes and staff satisfaction 50% by August 6. Staff had 100% participation. Reduction in unnecessary appointments occurred and a structured standardized hand off form with situation, background, assessment, and recommendation (SBAR) was implemented at the start date. The clinic has 2 exam rooms, 1 lab, a reception area, and two small offices. The majority of the clients are Hispanic females ages 15-25. The non-profit clinic provides free medical services to the community. Evaluation methods yielded quantitative and qualitative results through chart audits and direct observations.

In-services, one-to-one …

Process Change At An All-Volunteer Run Clinic With Pcmh Level 1 Recognition, Erin Flynn

Master's Projects and Capstones

This project directly involves the Clinical Nurse Leader (CNL) essential Informatics and Healthcare Technologies, and the CNL role function will be to act as a Team Manager. (AACN, 2013). The global aim of this process improvement is to improve the clinic workflow to increase patient and provider satisfaction in a Patient-Centered Medical Home (PCMH). The need for this project was discovered during the process of applying for PCMH recognition (of which the clinic has now earned level 1), and successful implementation of this project will meet PCMH guidelines. While applying for PCMH recognition, a clinic workflow document had to be …

Patient Engagement In Transitional Care, Sheeree Dela Pena

Master's Projects and Capstones

The Clinical Nurse Leader Master’s project was conducted about a public health program called the Transitional Care Program that was working in partnership with a county hospital system, Santa Clara Valley Medical Center. The specific aim was to reduce hospital re-admissions of high-risk patients by supporting patient motivation and engagement in the Transitional Care Program by May 2015. Over a four-month period, data was collected through ten client visits, interviews with two public health nurses, information available about the program, and current research conducted on transitional care, hospital discharges, and patient engagement. Various aspects of the program were assessed, such …

Pre-Exposure Prophylaxis (Prep) Education Improvement Project, Reginald M. Hilarie

Master's Projects and Capstones

In 2012, the US Food and Drug Administration approved the pill Truvada for use as pre-exposure prophylaxis or PrEP. Its purpose is to help prevent HIV infection by taking one pill every day. This project aims to improve PrEP patient education provided by the multi-disciplinary team and to decrease new HIV infection and sexually transmitted infections (STIs) to zero. The focus of the study is patients on PrEP at the Infectious Disease and HIV Clinic in San Francisco Veterans Administration Medical Center. The Clinical Nurse Leader, in collaboration with the multidisciplinary team, incorporated Pender’s Health Promotion Model Theory in developing …

Mobile Nurse Practitioner: A Pilot Program To Address Service Gaps Experienced By Homeless Individuals, Joan Alviar Fraino

Nursing and Health Professions Student Research and Publications

An estimated 2.3 to 3.5 million individuals are homeless in the United States, many of whom have chronic medical and mental illnesses. Underserved individuals who are homeless experience gaps in services, resulting in poor health care outcomes and readmission to the hospital setting, often presenting in crisis through the emergency department. The financial state of hospitals is negatively impacted by the burden of patients returning to the hospital due to unresolved issues. The current article presents the role of a psychiatric-mental health nurse practitioner as part of a pilot program, Opportunity Village Mobile Health, that provides a comprehensive approach to …

Scaled-Up Mobile Phone Intervention For Hiv Care And Treatment: Protocol For A Facility Randomized Controlled Trial, Kelly L'Engle, K Green, S M. Succop, A Laar, S Wambugu

Nursing and Health Professions Faculty Research and Publications

Background: Adherence to prevention, care, and treatment recommendations among people living with HIV (PLHIV) is a critical challenge. Yet good clinical outcomes depend on consistent, high adherence to antiretroviral therapy (ART) regimens. Mobile phones offer a promising means to improve patient adherence and health outcomes. However, limited information exists on the impact that mobile phones for health (mHealth) programs have on ART adherence or the behavior change processes through which such interventions may improve patient health, particularly among ongoing clients enrolled in large public sector HIV service delivery programs and key populations such as men who have sex with men …

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 …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

Implementing An Evidence Based Foot Assessment Protocol For Use By Nurses Caring For Adult Diabetic Patients Seeking Care In The Thanh Nhan Hospital Endocrinology Department, Amy Ly

Doctor of Nursing Practice (DNP) Projects

The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam.

Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed.

The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Prevention Of Hiv Mother-To-Child-Transmission In Sub-Saharan Africa, Sidik Abdul-Mumuni

Master's Projects and Capstones

The transmission of HIV infection from an HIV-positive mother to her child during labor, pregnancy, breastfeeding or delivery is termed as mother-to-child HIV transmission (WHO, 2013 report on HIV). A range of 15-45% infection transmissions are possible when no intervention strategies are put into place. Globally, goals and initiatives have been set to combat this issue as well as speeding up the interventions and achieve possible transmission rates of levels less than 5% and total elimination of new infant HIV infections by 2015 (WHO, 2013 report on HIV). In 2011, 57% of pregnant women living with HIV in low and …

Clinical Nurse Leaders In The Community: Building An Academic Faculty Practice Partnership, Chenit Ong-Flaherty

Nursing and Health Professions Faculty Research and Publications

The Affordable Care Act (ACA) emphasis on preventive care and primary health has given community organizations and outpatient care environments renewed attention. Nursing has been offered the opportunity to lead healthcare into a new era. One of the two new nursing programs to be given life in this movement is the Clinical Nurse Leader (CNL). The CNL is a graduate level educated nurse who specializes in healthcare systems leadership, a facilitator of care in the complex healthcare environments of today. They are equipped to see the wider and broader perspective of things, assess needs, research the best interventions for problems …

Rn Transition To Practice Program In The Primary Care And School Settings: Development, Implementation, And Evaluation, Maria-Idalia O. Lens

Doctor of Nursing Practice (DNP) Projects

New graduate registered nurses (RN) are facing a difficult time finding jobs since the economy of the United States has declined. Since then the California Institute of Nursing and Health Care, along with funding from the Betty Moore Foundation, have developed RN transition programs. These programs were developed to increase skills, confidence, and experience among new RN graduates to promote their transition into the nursing workforce. The programs also were designed to retain newly licensed nurses in the nursing profession while engaging competencies that could be transferred to both acute and outpatient care settings. In addition, the programs are intended …

Report On Jesuit Grant Issued December 15, 2007 For "African Mothers Health Initiative: Future Usf Partnership Of Social Justice And Community Health?, Marcianna Nosek

Nursing and Health Professions Faculty Research and Publications

No abstract provided.