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Congratulations to the DNP Class of 2017!

Angelica Kaisa Ahonen -- Implementation of an Electronic Handoff Report: A Quality Improvement Project

Demetra Bastas-Bratkic -- Assessing Clinicians' Endorsement of Patient Activation in Health Management

Nancy Jo Bush -- Distress Screening in the Patient with Cancer

Chinyelu Uchenna Chukwurah -- Clinical Guidelines for Entry Level Nurse Practitioners

Sharmeline K Curameng -- Building Capacity for Nursing Research and Enculturation of EBP in Non-Magnet Hospitals

Joseph Marc Abay de Veyra -- Utilization of Lanyard Badge in Emergency Department for Care Coordination of SNF Patients

Alexandra Interiano -- Assessing Parental Knowledge on Obesity Determinants in Hispanic Children with a Culturally Modified Screening Tool

Paulo Narvaez Jusay -- Improving First Case Start Efficiency in Interventional Radiology: A Quality Improvement Project

Monette Leynes Lalimar -- Process Evaluation of a Group Medicare Annual Wellness Visit

Wan Ching Rachel Law -- Identification of Depressed Adolescents: Depression Screening Education for School Nurses\

Lisa Matheson -- Factors in Medication Errors Associated with Severity of Harm

Rosalinda Cifra Moran -- Medication Adherence in Hispanic Rheumatoid Arthritis Patients

Vi Huyen Nguyen -- Impact of a Seven-Day Reminder on Appointment Non-Attendance

Ngocdiep Pham -- Improving Elective Surgery Cancellations: A Quality Improving Project

Jutara Srivali Teal -- Supportive Care Nursing Clinical Protocol for a Public Acute Care Hospital

Mini Thomas -- A Tobacco Cessation Education Program for Acute Care RNs

Daniel J Weiss -- Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-Management


Ahonen_Angelica Angelica Kaisa Ahonen, DNP, RN, CMSRN, NE-BC

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: University of Phoenix
BS in Nursing: University of Ottawa

DNP Project Paper: Implementation of an Electronic Handoff Report: A Quality Improvement ProjectPDF File Opens in new window

Abstract: Critical information such as a patient’s vital signs, neurological status, and level of care is exchanged between registered nurses during a patient handoff report. It is imperative that the communication between registered nurses (RN) is accurate, specific, relevant, and timely. When the care of a patient is transferred from one healthcare provider to another, the patient may experience potential risk because of communication failure. The purpose of this doctoral project was to evaluate patient and nursing satisfaction with patient handoffs between the Emergency Department (ED) and Medical Telemetry unit. The aim of the proposed process was to have a concise communication tool. The use of this electronic handoff tool promotes relevant and timely communication. The project product is an electronic handoff tool that is consistent, safe, and efficient.

The project was framed in the Iowa Model of evidence-based practice. An inter-professional team was created consisting of frontline nurses, educators, administrators, and technicians. The team met to identify practice issues surrounding the current handoff process. The focus group met over a four month period. During these meetings, the ED to floor handoff report was developed

The handoff report is part of the Electronic Health Records (EHR) operating system of Sunrise, Allscripts Corp., Chicago, Illinois (Vawdrey et al., 2013). This EHR system is used at the University California Irvine (UCI). Conducted by the medical telemetry nurse manager and the emergency department nurse supervisor, in-service education was administered to all ED RNs and Medical Telemetry RNs on the new electronic handoff process.

A three-month pilot took place. Data collection began once the electronic handoff report pilot was implemented. The parameters analyzed were: (1) Nursing Satisfaction Survey; (2) Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Satisfaction-Overall Recommend and Nursing Communication mean scores; (3) Emergency Department pre and post pilot Diversion times.

Statistically significant changes in nursing satisfaction survey scores were observed for both the efficiency of handoffs and overall satisfaction, p < .001. Approximately 3/4 of the participants rated the Electronic Handoff Trial positively (Excellent, Very Good, or Good) while 1/4 of the participants rated it negatively (Fair to Poor). Patient satisfaction HCAHPS survey results observed at post-test demonstrate statistically significant improvements in ratings of both nurses overall and likelihood to recommend, p < .05.  A 10% increase in patient satisfaction was achieved after the implementation of the report.

As a result of positive feedback from the use of the ED to floor handoff report, the handoff process was expanded to all units within the hospital. More data will need to be collected by nursing leaders to determine if the ED to floor handoff report will demonstrate an improvement in patient safety, ambulance diversion times, and emergency department throughput.

Committee:
Chair: Angela Hudson, PhD, RN, FNP
Member: Gail Washington, DNS, RN

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Bastas-Bratkic_Demetra

Demetra Bastas-Bratkic, DNP, MPH, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Long Beach Campus
MS in Nursing: Johns Hopkins
MPH: University of California, Los Angeles
BS in Nursing: Johns Hopkins
BS in Biological Sciences: University of California, Irvine

DNP Project Paper: Assessing Clinicians' Endorsement of Patient Activation in Health ManagementPDF File Opens in new window

Abstract: The management of chronic conditions in the U.S. requires new strategies to more efficiently mobilize patients to be active partners in their health. The concept of empowering patients to have ownership in the management of their health and diseases is not new, yet the challenge continues with ways to actually enhance patient activation. One such strategy is use of the Patient Activation Measure (PAM™), which assesses patient knowledge, skill, and confidence for self-management (Hibbard, Stockard, Mahoney, & Tusler, 2004). The PAM™ has demonstrated positive predictive properties for behavior change in patients (Hibbard et al., 2004). This is a valuable tool for clinicians, as a patient’s score can serve as a guide for tailoring disease specific messaging and interventions. Also useful is a relatively new and reliable measure to assess and differentiate between clinicians, the Clinician Support for Patient Activation Measure (CS-PAM™) (Hibbard, Collins, Mahoney, & Baker, 2009).

Prior studies have demonstrated that departures from traditional patient-clinician roles are positively correlated with higher patient activation, but the success of this dynamic relies on clinician motivation for patient engagement. Continuing education training often does not incorporate strategies for partnering with patients. Few studies have examined the impact of training on clinician beliefs on their role in enhancing patient self-management and the degree clinician beliefs in supporting patient activation have on patient health outcomes. This project determined the impact of a tailored primary care provider (PCP) training on patient activation through participants’ adoption of taught strategies following training. Expert reviewers and pilot PCPs assessed the face validity of the educational training and post-training survey. The multi-method training was then delivered to PCPs after they completed the CS-PAM™. Prior to training, 61% of participants endorsed patient activation, the importance of patient knowledge, and patient involvement in care. In contrast, one month following training, over 85% of clinicians agreed they were confident in recognizing the value of patient activation and recognized its characteristics, and 71 % reported modifying their practice to increase patient activation. Higher scoring CS-PAM™ clinicians were more likely to be early adopters of training strategies. A need for additional patient activation training was reported by 34% of participants. Clinician focused multi-method trainings on patient activation offers an effective way to improve the PCP’s ability to impact patient activation and the engagement of patients in their own healthcare.

Committee:
Chair: Penny Weismuller, DrPH, RN
Member: Margaret Brady, PhD, RN, CPNP-PC

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Bush_NancyJo

Nancy Jo Bush, DNP, RN, AOCN, FAAN

DNP: Southern California CSU DNP Consortium, Long Beach Campus
MS in Nursing: University of California, Los Angeles
MA in Clinical Psychology:  Pepperdine University
BS in Nursing: University of Massachusetts, Amherst

DNP Project Paper: Distress Screening in the Patient with CancerPDF File Opens in new window

Abstract: The Institute for Medicine identifies distress screening as an essential aspect of comprehensive cancer care. Unfortunately, because of limited resources, not all community cancer sites consistently screen for distress. This quality improvement project implemented distress screening in a community based cancer support setting. Applying the Plan-Do-Study-Act (PDSA) framework, 21 participants of a Cancer Support Community (CSC) affiliate were screened with the CancerSupportSource® (CSS) during an intake interview. The CSS® is a validated 15-item distress screening instrument in an innovative touch-screen tablet format introduced by the CSC in 2014. The distress screening was valuable in opening sensitive communication between author and participants. The author found that screening led to an opportunity to discuss emotional topics that may have been overlooked without such screening. Approximately 62% of participants (13 of 21) screened positive for depression and two were found seriously depressed; this provided evidence that screening for distress is important. Screening facilitated referral to appropriate support groups, supportive activities within the community, and individual therapy. The PDSA provided a useful framework for guiding this successful community based quality improvement project. Nurses are valuable in bringing distress screening to community settings in order to meet the psychosocial needs of cancer survivors.

Committee:
Chair: Joy Goebel, PhD, RN, FPCN
Member: Kholoud Khalil, PhD, RN

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Chukwurah_Chinyelu

Chinyelu Uchenna Chukwurah, DNP, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: California State University, Long Beach
BS in Nursing: Grand View University

DNP Project Paper: Clinical Guidelines for Entry Level Nurse Practitioners
(under embargo, contact department for information)

Abstract: In western society, cosmetic treatments have evolved into a mainstream phenomenon. Botulinum Toxin Type A (BTX) and facial fillers (FF) are proven cost effective alternatives for millions of Americans in search for a youthful appearance without the expensive cost of surgery, complication, and downtime associated with invasive surgical procedures. The steady increase of consumer demand and the numbers of minimally invasive procedures being performed within the past few years indicates a foreseen increase in numbers of complications. Currently in the U.S., there is no standardized accreditation process to regulate the practice of aesthetic medicine practitioners. The development of a clinical practice guideline (CPG) for non-invasive cosmetic treatments was developed for entry-level nurse practitioners to facilitate appropriate technique, and accurate formulation and dosage for optimal therapeutic outcomes. Three experienced experts in the field of cosmetic injectables independently evaluated the potential impact of the new evidence based CPG to assess potential patient outcomes, provider satisfaction, efficiency, and potential patient safety impact. Their scores were used to compute scale context validity index (S-CVI) to predict relevance of this project through expert assessment. For the Facial Rejuvenation Tool (FRT) assessment tool, 6 out of 7 items were evaluated as strongly or agreeable recommendations by three experts (S-CVI = 0.85). For the CPGs, 7 out of 7 items were evaluated as strongly or agreeable recommendations by three experts (S-CVI = 1.00). These results support implementation of the new CPG into practice. 

Committee:
Chair: Gail Washington, DNS, RN
Member: Angela Hudson, PhD, RN, FNP

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Curameng_Sharmeline Sharmeline K Curameng, DNP, RN, FNP-C

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: University of Phoenix
BS in Nursing: University of Phoenix

DNP Project Paper: Building Capacity for Nursing Research and Enculturation of EBP in Non-Magnet HospitalsPDF File Opens in new window

Abstract: Magnet accreditation serves as a hallmark of excellence for nursing practice. Magnet vision solidifies high quality patient care, nursing excellence, and innovative nursing practices that are embedded in the five Forces of Magnetism. Magnet-recognized organizations demonstrate lower hospital mortality rates, improved patient care outcomes, and professional nursing excellence. However, many organizations struggle to obtain Magnet accreditation. Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructure that support the translation of research and EBP into clinical practice.

A systematic review of the literature was conducted to evaluate relevant data to support the successful implementation of the Magnet principle of New Knowledge, Innovations, and Improvements. As a result, several recommendations are made. Hospitals can use a variety of resources to support and build nursing research capacity, engage in evidence-based nursing care, and develop nursing innovations. There are several innovative ways that can be implemented by non-academic hospitals to close the research-practice gap and to integrate nursing research into clinical practice. Organizations must ensure strong leadership support to empower front-line nurses to reach their full professional potential to conduct research and to disseminate nursing research and EBP into clinical practice. 

Committee:
Chair: Ayman Tailakh, PhD, RN
Member: Elizabeth Winokur, PhD, RN

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DeVeyra_Joseph Joseph Marc Abay De Veyra

DNP: Southern California CSU DNP Consortium, Long Beach Campus
MS in Nursing: California State University, Dominguez Hills
BS in Commerce: De La Salle University, Philippines

DNP Project Paper: Utilization of Lanyard Badge in Emergency Department for Care Coordination of SNF PatientsPDF File Opens in new window

Abstract: Skilled Nursing Facility (SNF) residents account for more than 2.2 million hospital emergency department (ED) visits in the United States each year. Compared with other ED patients, SNF residents (i.e., patients) have higher medical acuity and complexity (Wang et al., 2011). The ED, therefore, serves a vital role in the treatment and care coordination of SNF patients, including delivering necessary and immediate care for a deteriorating medical condition or injury and offering a channel for hospital admission. Approximately 74% of SNF patients arrive at the ED without vital documentation such as vital signs, baseline cognitive function, code status, and pertinent disease information, which results in poor care coordination between the two settings (Gaddis, 2005; Terrell et al., 2005). From a healthcare delivery system perspective, the lack of transfer information accessible to ED clinicians results in unnecessary hospital utilization (e.g., duplication of tests/procedures, hospitalization, and readmissions) among SNF patients (Kessler et al., 2013). Given the potential patient risks and economic repercussions of a hospitalization, a communication tool was needed to improve care coordination between SNFs and EDs.

The specific aims of the project were to develop a business plan to expand the implementation of a lanyard badge as a tool to improve care coordination and to propose an evaluation plan to analyze its potential impact on preventable admission, 30-day readmission rates, and bed days in a Central Valley SNF. To ensure feasibility, the lanyard badge and business plan were sent to an expert panel consisting of qualified SNF and ED representatives. Experts included an administrator, medical director, quality improvement nurse, and director of nursing on the SNF side; and a former ED medical director, ED director, charge nurse, and registered nurse on the ED side. The ED Lanyard Badge Project requires a SNF to make it their policy to place a badge with a detachable lanyard containing essential patient clinical data as well as the SNF capabilities list on patients before sending them to EDs. The tool supplies critical clinical information and SNF capabilities which help ED clinicians make informed clinical decisions as to appropriateness of returning patients to SNFs after initial treatment rather than admit them to the hospital.

Projected cost analyses suggest that the tool can produce a cost savings of $12,366.58 after three-months. A plan for evaluating the full effect of ED Lanyard Badge was delineated. ED Lanyard Badge use should improve communication between the SNF and ED, which could reduce hospitalizations and bed days. Future researchers can use the delineated plan to examine its impact on both hospital admissions and readmissions.

Committee:
Chair: Ahlam Jadalla, PhD, RN
Member: Margaret Brady, PhD, RN, CPNP-PC

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Castaneda_Mira Alexandra Interiano, DNP, RN, FNP-C

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: Azusa Pacific University
BS in Nursing: California State University, Los Angeles

DNP Project Paper: Assessing Parental Knowledge on Obesity Determinants in Hispanic Children Implementing a Culturally Modified Screening ToolPDF File Opens in new window

Abstract: Introduction: Current trends indicate a decrease in obesity prevalence. However, obesity in Hispanic children continues to rise. Influences such as socioeconomic status and lifestyle behaviors are inevitably intertwined with cultural dynamics such as psychosocial factors, genetic, and metabolic etiologies.

Purpose: The purpose of this Doctor of Nursing Practice project was to adapt a well-established general nutritional screening tool and modify it to address specific needs for Hispanic family units.

Methods: Addressing perceptions, attitudes and knowledge deficits within the Hispanic family unit, a culturally modified tool was used in a clinical practice setting with 13 children and their parents. This tool assessed obesity determinants through tailored questions; it also provides targeted educational interventions based on identified knowledge deficits. Baseline anthropometric measurements were recorded, in addition to a three-month telephonic check-in to determine success/barriers, and allow for educational reinforcement. After 6 months, body mass index (BMI) in these children and adolescents will be obtained to determine if there was a 3-5% decrease from their baseline measurement.

Results: At baseline, 93% of respondents did not know what the term BMI meant. In addition, 77% of participant parents believed that their children were overweight, but many believed that children who are larger in size are in good health. Overall the participating children were consuming above-average levels of fast food (3.23 servings/week), sugary beverages (4.38 servings/day), and spent at least 3 hours on screen time, all of which were higher than recommendations set by the practice guidelines.

Discussion: It is evident from this small study that the Hispanic family unit may lack basic obesity conceptualization knowledge. Therefore, this suggests the need need to assess parental attitudes, perceptions, and knowledge deficits, address cultural nuances, and develop culturally competent interventions in order to initiate meaningful obesity change and reduce the prevalence of obesity.

Committee:
Chair: Darlene Finocchiaro, PhD, RN
Member: Kathy Hinoki, PhD, RN

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Jusay_Paulo

Paulo Narvaez Jusay, DNP, RN, ACNP-BC, AOCNP

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: California State University, Los Angeles
BS in Nursing: California State University, Los Angeles

DNP Project Paper: Improving First Case Start Efficiency in Interventional Radiology: A Quality Improvement ProjectPDF File Opens in new window

Abstract: In Interventional Radiology (IR), on-time First Case Start (FCS) is significant because a delay in the first case causes a ripple effect of subsequent delays to the remaining scheduled cases for the day. Delays in the first case lead to prolonged patient wait times, case cancelation, staff frustration, increased staff workload, and decreased patient satisfaction. The purpose of this quality improvement project was to improve FCS in IR. Methods included evaluating FCS before and after implementation of checklist and team briefing for all scheduled cases. Metrics consisted of time reports that included outpatient arrival check-in to radiology reception, patient time-in the IR suite, and actual start time when FCS is delayed, as well as the reasons for delays. During a 3-month postintervention period, implementation for the IR checklist and team briefing resulted in a decrease of total case delays from 94% preintervention to 87% postintervention. On-time FCS increased from 14.3% preintervention to 52.4% postintervention. During this project, many delays with FCS were found to be due to communication errors and lack of process standardization. Interdisciplinary team-based approach and implementation of improvement initiatives is an effective way to standardize the IR pre-procedural process thereby reducing delays. Replication of this project could improve the pre-procedural process and take the first step towards improving the IR workflow.

Committee:
Chair: Elizabeth Winokur, PhD, RN
Member: Jean O’Neil, DNP, RN, FNP-BC

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Lallimar_Monette Monette Leynes Lalimar, DNP, RN, ACNP-BC

DNP: Southern California CSU DNP Consortium, Fullerton Campus
MS in Nursing: University of California, Los Angeles
BS in Nursing: University of Santo Tomas, Philippines

DNP Project Paper: Process Evaluation of a Group Medicare Annual Wellness VisitPDF File Opens in new window

Abstract: The purpose of this DNP project was to perform a process evaluation of a quality improvement project, nurse practitioner-led group Medicare Annual Wellness Visit (AWV), using the PRECEDE-PROCEED Model. The Affordable Care Act (ACA) became a law in the United States in 2011. Under the ACA, Center for Medicaid and Medicare Services (CMS) ceased payment for annual physical examinations. Instead, CMS will reimburse for Annual Wellness Visits (AWV) with personalized preventive plan services (PPPS) without cost sharing to patients effective January 1, 2012. Health plans foresaw an increased demand for AWV with PPPS by large numbers of new insurance enrollees. A large health maintenance organization anticipated access problems and proactively determined that group Medicare AWV might avert access problems. Senior (65+) Kaiser Permanente (KP) Health Plan members covered by Medicare Part B were the target population for group visits. Group AWVs were implemented in the ambulatory care clinic at KP Medical Center in Panorama City, California. This center serves a moderately diverse patient population with a large percentage of Latinos and Filipinos.

The PRECEED-PROCEDE MODEL was used in the evaluation of the planning, implementation, and outcomes of these nurse practitioner-led group visits. Findings indicate that although the steps of the PRECEDE-PROCEED model had been followed, patient input and involvement was not solicited in the initial phase. Three screening tests (i.e., Timed Up and Go Test, Patient Health Questionnaire-9, and Clock Drawing Test) were chosen at the regional level as quality indicators for the AWVs. Since 2013, completion rates of these screening tests have been higher in patients seen in group AWVs versus individual AWVs; Panorama City typically had higher completion rates of these indicators, as compared to 12 other medical centers within the region, attributable to the group AWVs. During this period, documented patient evaluation for group AWVs showed high patient satisfaction with anecdotes of improved patient care experiences. Cost calculations indicate that cost savings occur when groups have at least six patients. Other cost savings estimated come from potential prevention of fall injuries among high risk patients referred to physical therapy for gait, balance, and muscle strength training.

Committee:
Chair: Dana Rutledge, PhD, RN
Member: Penny Weismuller, DrPH, RN

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Law_Rachel Wan Ching Rachel Law, DNP, MSHCM, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Fullerton Campus
MS in Nursing: California State University, Dominguez Hills
MS in Healthcare Management: California State University, Los Angeles
BS in Nursing: University of Wisconsin, Madison

DNP Project Paper: Identification of Depressed Adolescents: Depression Screening Education for School NursesPDF File Opens in new window

Abstract: One third of American teenagers suffer from depression. However, less than half of them receive necessary antidepression treatment. Untreated depression is often associated with absenteeism, poor academic performance, and behavioral and social problems. It can also increase risk of violence, alcohol or drug abuse, and even suicide. The American Academy of Pediatrics and the U.S. Preventive Service Task Force both recommend routine screening of adolescents for depression. However, screening rates in ambulatory settings are very low. School nurses, often the first health care professionals to encounter these young people, are well-positioned to recognize depression and make referrals to medical and mental health providers for proper diagnosis, referral, and treatment. Despite their access to teens, many school nurses do not feel confident addressing depression and are not comfortable in using a standardized screening tool. Using the PRECEDE framework for health program planning, barriers preventing school nurses from depression screening were identified. To remove some of these barriers, an education module was developed to provide training for school nurses on adolescent depression and screening. This education module is easily accessible online. It consists of a video presentation on adolescent depression, the PHQ-9 screening tool, and a case study. It also provides links to online resources and the PHQ-9 screening and referral forms. It is anticipated that after completion of the training, school nurses will have increased knowledge and confidence in identification and referral of the students at risk.

Committee:
Chair: Rachel McClanahan, DNP, RN, NCSN
Member: Penny Weismuller, DrPH, RN

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Matheson_Lisa

Lisa Matheson, DNP, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Long Beach Campus
MS in Nursing: California State University, Long Beach
BS in Nursing: University of Toronto

DNP Project Paper: Factors in Medication Errors Associated with Severity of HarmPDF File Opens in new window

Abstract: Patient safety is a widely-accepted concept throughout health care and society. Preventable medication errors impact patient safety, which affect patient clinical outcomes, patient satisfaction, and healthcare economics. Databases have been created to document adverse patient events and are used to collect, analyze, and trend data associated with medication errors. Data analytics involve a systematic analysis to glean lessons learned and minimize errors from recurring. In the United States, adverse event data are collected by healthcare facilities and voluntarily submitted to Patient Safety Organizations (PSO). Analyzing big datasets provides an opportunity to conduct data mining and develop predictive modeling to identify variables contributing to the causation and severity of harm associated with medication errors. This project explored the impact of facility type, patient demographics, and anonymity of reporting on severity of harm associated with medication errors. A retrospectives analysis was completed of a PSO database of over 340,000 events involving medication errors. Findings showed that medication errors were reported more frequently for both pediatric and adult patients at general acute care hospitals compared to academic healthcare facilities. Within the facilities, the volume of these errors occurred varied among pediatric and adult units. Higher severity of injury occurred with errors in critical care settings. Patient age impacted the severity of harm. Most importantly, this project identified the need to identify other key variables that could potentially minimize medication errors and the severity of harm resulting from adverse medication error events.

Committee:
Co-Chair: Beth Keely, PhD, RN
Co-Chair: Nik Gorman, EdD, MPH
Member: Margaret Brady, PhD, RN, CPNP-PC

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Moran_Rosalinda Rosalinda Cifra Moran, DNP, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Los Angeles Campus
MS in Nursing: University of California, Los Angeles
BS in Nursing: California State University, Dominguez Hills

DNP Project Paper: Medication Adherence in Hispanic Rheumatoid Arthritis PatientsPDF File Opens in new window

Abstract: Chronic and incurable, Rheumatoid Arthritis (RA) is an autoimmune inflammatory joint disease of unknown etiology that affects not only joints but also other organ systems in the body. Uncontrolled RA can lead to irreversible joint damage, significant functional disability, poor quality of life, enhanced comorbidities, and significant morbidity and mortality. However, symptoms can be effectively and durably controlled with medications. When patients adhere to treatment regimens, disability can be prevented. When RA patients are treated early, they maintain functional ability (Heimans et al., 2015). As Radner, Smolen, & Aletaha (2014) point out, achieving clinical remission is the goal to prevent joint destruction and possible disability. Patients’ decisions to take medication is typically based on knowledge and beliefs about their illness and treatment regimen (van den Bemt, Zwikker, & van den Ende, 2012).

Poor treatment adherence is a major contributor to disease progression, which can lead to disability. Among Hispanics, adherence rates as low as 49% were found (White, 2014). Patient knowledge, beliefs, and attitudes contribute to adherence. In this project, barriers to medication adherence among Hispanics with RA were identified in order to develop an education pamphlet designed to increase medication adherence. The project aim was to address combine information about education and non-adherence and to increase knowledge about disease progression of RA among Hispanics thereby increasing RA medication adherence.

Baseline information was gathered prior to development and implementation of the educational pamphlet. The present project found that 64% of study participants were non-adherent to their RA medications. Individuals with higher education were more likely to adhere to their medication regimen. The PKQ results showed that the majority of the participants had low knowledge regarding their RA. The self-administered postquestionnaire will be distributed after implementation of the education pamphlet to determine if there was a change in knowledge, beliefs, and medication adherence.

Committee:
Chair: Ayman Tailakh, PhD, RN
Member: Jean O’Neil, DNP, RN, FNP-BC

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Nguyen_Vi Vi Huyen Nguyen, DNP, RN, FNP-C

DNP: Southern California CSU DNP Consortium, Long Beach Campus
MS in Nursing: California State University, Long Beach
BS in Nursing: California State University, Long Beach
BS in Biological Sciences: University of California, Irvine

DNP Project Paper: Impact of a Seven-Day Reminder on Appointment Non-AttendancePDF File Opens in new window

Abstract: Appointment non-attendance, a patient’s failure to show up for an appointment or failure to cancel 24 hours in advance, has a negative impact on medical office revenue. Late cancellations also make it difficult to fill in vacant time slots. The aim of this project was to reduce non-attendance rates at an endocrine clinic in southern California using a 7-day automated appointment reminder system. The Plan-Do-Study-Act model provided the framework used to examine the change in the non-attendance rate over two distinct timeframes. A pre-post evaluation design was used: pre-intervention, data gathered from the 2-day reminder system, and post-intervention data gathered from the 7-day reminder system.\

Overall, the 7-day system resulted in a 2.3% reduction in non-attendance, a 0.6% increase in appointment attendance, and a 1.2% reduction of scheduled patients who chronically missed three to five scheduled appointments. The same result did not occur among the Vietnamese-speaking patients. Improvements in appointment attendance resulted in an estimated gain of six to nine thousand dollars in revenue. Post-intervention data suggested language used for the automated reminder might be an important factor to consider. Three recommendations were proposed: 1) review McLean et al. (2016) strategies to optimize a reminder system, 2) flag individuals who chronically miss appointments, and 3) select an automated appointment-reminder system that includes the Vietnamese language.

Committee:
Chair: Beth Keely, PhD, RN
Member: Joy Goebel, PhD, RN, FPCN
Member: Margaret Brady, PhD, RN, CPNP-PC

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Pham_Ngocdiep Ngocdiep Pham, DNP, MBA, RN, FNP-BC

DNP: Southern California CSU DNP Consortium, Long Beach Campus
FNP: University of California, Irvine
MS in Nursing: University of Phoenix
MBA: University of Phoenix
BS in Nursing: University of Phoenix

DNP Project Paper: Improving Elective Surgery Cancellations: A Quality Improving ProjectPDF File Opens in new window

Abstract: The purpose of the doctoral project was to identify factors associated with elective surgery cancellations (ESCs) on the day of surgery in a multispecialty orthopedic practice and develop recommendations to mitigate these factors.  Currently, ESCs increase the cost of health care delivery and contribute to patient and family dissatisfaction.  The rate of ESCs varies from 1% to 26% across settings.  Organizational (perioperative processes) and patient factors (knowledge deficits, communication issues, etc.) contribute to preventable surgical cancellations.

A quality improvement (QI) project was conducted in the orthopedic practice in a Southern California facility. A retrospective chart review of the orthopedic ESC cases was performed from January 1, 2015 to December 31, 2015.  Overall, 4,633 ES cases were reviewed.  Preventable and unpreventable ESC cases were identified based upon patient and organizational factors.  A report of recommendations to address ESCs was created for stakeholders. 

The data showed 3,264 out of 4,633 (70%) cases were cancelled and rescheduled more than once. No organizational factors were found to contribute to ESCs on the day of surgery.  However, 1.2% of ESCs were attributed to patient related factors.  The low ESC rate suggests the effectiveness of the orthopedic department’s perioperative care processes; nonetheless, a considerable amount of perioperative resources was expended during the cancellation and rescheduling process. 

This project revealed the need for further examination of ESCs to identify factors associated with multiple cancellations and rescheduling. The institution will need to develop a protocol to decrease any preventable patient or organizational factors that prevent an ES from occurring as scheduled.  Decreasing preventable ESCs may improve organization profitability and patient/family satisfaction.

Committee:
Chair: Joy Goebel, PhD, RN, FPCN
Member: Margaret Brady, PhD, RN, CPNP-PC

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SrivaliTeal_Jutara Jutara Srivali Teal, DNP, MTOM, RN, LAc

DNP: Southern California CSU DNP Consortium, Fullerton Campus
MS in Nursing: California State University, Dominguez Hills
MTOM: Emperor’s College of Traditional Oriental Medicine
BA in Psychology: University of California, Los Angeles

DNP Project Paper: Palliative Care Nursing Clinical Protocol for a Public Acute Care HospitalPDF File Opens in new window

Abstract: Seriously ill patients may require palliative nursing care that may be offered independently or in collaboration with palliative medical care. World-wide, approximately 40 million people require palliative care but only about 14% of those individuals receive it (World Health Organization, 2015). In a public 670-bed acute care hospital, palliative care consultation requires a physician's order and thus may arrive late in an illness trajectory. Acute care nurses may not be confident or proficient in providing palliative care. A palliative care knowledge survey in the local setting confirmed nurses’ knowledge deficit. 

A Supportive Care Nursing Clinical Protocol (SCNCP) was developed as a knowledge tool to meet the needs of acute care nurses providing care for seriously ill patients. The term “supportive care” is used instead of palliative care to avoid the stigma of palliative care and its potential tie with end-of-life (Cherny, 2009). The SCNCP is based upon national guidelines and scientific evidence. The SCNCP guides nurses to assess physiological, psychosocial, and spiritual factors commonly experienced by patients living with serious illness. Evidence-based nursing interventions in the SCNCP include using select complementary interventions including a thirst bundle, hand-held fan for dyspnea, and the use of mobile phone applications (apps) are suggested for mindfulness, relaxation, distraction, and coping. Approvals for the protocol have been made by the Nursing Protocol Committee, Professional Practice Committee, and the Nursing Executive Council. Implementation of the SCNCP is projected for Spring 2017.

Committee:
Chair: Dana Rutledge, PhD, RN
Member: Sue Robertson, PhD, RN

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Thomas_Mini Mini Thomas, DNP, RN, CCRN

DNP: Southern California CSU DNP Consortium, Fullerton Campus
MS in Nursing: Tamil Nadu Medical University, India
BS in Nursing: University of Madras, India

DNP Project Paper: A Tobacco Cessation Education Program for Acute Care RNsPDF File Opens in new window

Abstract: Tobacco use continues to be the foremost preventable cause of death in the United States. The emergence of newer tobacco products such as electronic cigarettes and hookah are a threat to the current progress in tobacco cessation interventions. Use of newer tobacco products is increasing at a rapid rate among adolescents and young adults. In addition to the known dangers of nicotine, newer tobacco products also bring hazards such as poisoning and explosions. Existing tobacco surveillance and cessation interventions primarily focus on cigarette smoking. A comprehensive tobacco screening method along with specific cessation interventions for each tobacco product must be implemented to address the changing landscape of tobacco use.

Hospital settings are excellent locations where nurses can play a major role in initiating tobacco cessation interventions. Hospitalized patients are in a temporary stage of abstinence from tobacco and have access to counseling services and pharmacotherapy. Nurses can capitalize on this teachable moment while patients are more receptive for initiating tobacco cessation. Nurses would require training to improve their confidence and participation on effective tobacco cessation approaches such as the 5A algorithm (ask, advice, assess, assist, and arrange) as well as interventions based on Stages of Change. An educational program for nurses on tobacco cessation interventions was developed to help in continuing the momentum in the decline of tobacco use.

Committee:
Chair: Asma Taha, PhD, RN
Member: Cynthia Greenberg, DNSc, RN, PNP-BC, FAAN

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Weiss_Daniel

Daniel J Weiss, DNP, RN, CHPN

DNP: Southern California CSU DNP Consortium, Fullerton Campus
MS in Nursing: Pace University, Pleasantville, NY
BA in Urban Studies: University of Minnesota, Twin Cities

DNP Project Paper: Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-ManagementPDF File Opens in new window

Abstract:  Background: Heart failure (HF) affects 6.5 million Americans, resulting in 1 million hospitalizations (with a 21.9% readmission rate) and over $30 billion in healthcare costs. Self-care support tools with color-coded zones (green = stable; yellow = caution; red = take action) can help patients recognize and respond to HF symptoms and reduce readmissions and costs. Studies are lacking on zone tools' impact on HF self-care and quality of life.

Purpose: The purpose of this evidence-based practice project was to test the effect of a low-literacy zone tool for heart failure self-management on self-care and quality of life.

Methods: The author led an inter-disciplinary palliative care (PC) team in adapting an existing green-yellow-red zone tool for HF self-management. Participants were randomly assigned to a control group receiving usual care or an intervention group receiving the zone tool plus usual care. At baseline and at 30 and 60 days, HF self-care and HF-related quality of life were measured respectively with the Self-Care of Heart Failure Index (SCHFI) and the Kansas City Cardiomyopathy Questionnaire (KCCQ-12).

Results: Due to the limited sample size, the findings of this pilot project were inconclusive regarding the effect of the HF zone tool on the outcomes of interest.

Implications for Practice: This EBP pilot project demonstrated the feasibility of developing and implementing a zone tool for HF self-management for patients with advanced HF in a home-based palliative care (PC) program. Further research is needed with larger samples to assess zone tools' effect on self-care and quality of life

Committee:
Co-Chair: Sue Robertson, PhD, RN
Co-Chair: Nik Gorman, EdD, MPH
Member: Joy Goebel, PhD, RN

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