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We Have Fifty-Eleven Problems, Of Course, Racism Is One: Exploring the Navigation of a PWI
Full text linkThis study explored the experiences of three Black women navigating dual roles as graduate students and instructors at a predominantly white institution (PWI). Their narratives revealed persistent challenges like implicit bias, racism, microaggressions, and limited opportunities, reflecting broader systemic issues that impact Black students in similar environments. Despite these adversities, the women demonstrated notable resilience. The findings emphasize the importance of creating policies and practices that foster inclusivity and support for marginalized communities within academic settings. By highlighting both personal and systemic barriers, this research contributes to understanding the complexities of Black women’s experiences at PWIs
Presence is Power: Restoring Compassionate Birth Through Volunteer Doulas
No full textThe Volunteer Doula Program at Hospital AB was implemented to address labor support, particularly during the COVID-19 pandemic, when many birthing individuals experienced increased emotional and physical isolation. Supported by existing literature on the benefits of doula care in improving birth outcomes and maternal satisfaction, this quality improvement project aimed to evaluate the effectiveness of integrating trained, non-clinical volunteer doulas into hospital-based maternity care. Using a mixed-methods approach, data was collected through patient satisfaction surveys, doula intervention logs, nurse feedback surveys, nulliparous, term, singleton, vertex (NTSV) cesarean section rate comparisons, and debriefing sessions with staff and volunteers. Survey ratings averaged between 5.3 and 10.5 out of 15 across emotional and physical support domains, and 89% of nurses reporting that volunteer doulas were valuable during the labor process. A trend toward lower cesarean rates among patients who received doula support was also observed. Qualitative results show the emotional, informational, continuous labor support by birthing people and volunteer doulas. To promote collaboration between volunteer doulas and labor and delivery nurses, aligning with patient-centered maternity care, which is this organization\u27s commitment. While some challenges were noted, such as early role clarification and documentation inconsistencies, these were addressed through targeted onboarding and communication strategies. The volunteer program demonstrates the value of integrating volunteer doulas into hospital systems and supports continued investment in training, education, and sustainable program development to further improve outcomes in maternal care.
Keywords: doula, volunteer doula, collaboration, labor and delivery, labor and delivery nurse
Enhancing Pediatric Perianesthesia Nursing Practice with the Donna Wright Competency Model
Full text linkBackground Pediatric perianesthesia nurses care for patients with a wide range of complex needs. While annual competency checks are required, traditional checklist approaches do not always reflect real-life clinical situations or give nurses a chance to fully engage in their learning. This can contribute to gaps in clinical knowledge and reduced engagement in continuous learning. Objective At a San Francisco Bay Area children’s hospital, only 65% of perianesthesia nurses rated themselves as confident in their competencies. As a result, the leadership team decided to implement the Donna Wright Competency Model (DWCM), which focuses on meaningful, staff-led skill development. Aim This quality improvement project aimed to increase nurse self-assessed competency ratings by 15% in a two month period. Methods Thirty nurses participated in skills day sessions designed around topics they felt least confident in. Training included simulations, hands-on practice, and didactic. Nurses completed pre- and post-surveys using a 4-point scale (1 = very comfortable, 4 = very uncomfortable). Results Average scores improved from 1.97–2.17 before the intervention to 1.33–1.47 after, showing a 32.09% increase in perceived competency. Conclusion The DWCM helped nurses feel more confident and supported in their roles. While the project was limited by a small sample size and self-reported data, the findings suggest a meaningful impact on nurse confidence and engagement
Thinking Long-Term: Nursing Education on Long-Acting Injectable Antipsychotics
Full text linkBackground Schizophrenia cases and their associated healthcare costs have drastically increased over time in the United States. Antipsychotic nonadherence is a primary contributor to the high rates of relapse and rehospitalization among adult patients with schizophrenia. The development of long-acting injectable antipsychotics (LAIs) has positively impacted medication adherence, however, this treatment modality is still underutilized in practice due to barriers, such as physician and patient negative attitudes toward LAIs and lack of education. Nurses hold a unique position to potentially change practice and address some of the barriers to LAI usage. Local Problem A Mental Health Rehabilitation Center in California continues to be plagued with high readmission rates mainly due to patient oral antipsychotic medication nonadherence post-discharge. Despite the high rates of medication nonadherence, LAI usage rates are considerably low. Methods A web-based education course on LAIs was developed and implemented to psychiatric nursing staff working at a Mental Health Rehabilitation Center in California. Interventions Pre-and post-surveys were given before starting the course and after completion. An additional survey was sent out to participants one month post education. Results Survey measures showcased an increase in knowledge, attitudes, and confidence levels of nurse participants upon course completion. Conclusions Nursing education on LAIs has the potential to improve nurses’ knowledge, confidence, and attitudes of the formulation. Future efforts to change current practice and subsequent patient outcomes should emphasize nursing education initiatives
More Than a Diagnosis: Elevating Person-Centered Care in the Surgical Intensive Care Unit Through Personalized Communication Boards
Full text linkObjective: Intensive care units are associated with complex care and high acuity interventions, however, there is a potential for dehumanization of patients. With the focus being placed on life-saving interventions, many patients and their family members feel that they are not being treated beyond their medical diagnosis. Aim: This quality improvement project aims to address these barriers in care by designing and implementing communication whiteboards in the surgical intensive care unit (SICU) at Hospital A to enhance patient and family-centered care, improve patient satisfaction, and enhance interdisciplinary communication. Post-implementation, the goal was to increase utilization of the standardized whiteboards from 0% to 75% by May 2025. Methods: Surveys were completed among staff members, patients, and their family members to determine the information that would be most beneficial to have on the whiteboards. Data from staff and patient surveys were analyzed to identify features with over 60% agreement for board implementation. These included favorite music, pronouns, hobbies, traditions, and family messages/photos. Results: Due to budget constraints, three communication whiteboards were created and piloted across the unit over a two-week period. Results from the pilot found that there was a 60% utilization rate of the new whiteboards highlighting the feasibility of broader implementation. Conclusion: The original aim of this project to achieve 75% utilization was not met, however given the limitations of this project, a 60% utilization rate and positive feedback from staff, patients, and their families prove a strong initial adoption
Balancing Burrowing Owl (Athene cunicularia hypugaea) Protections while Maintaining Renewable Energy Development within the San Joaquin Valley
Full text linkBalancing the needs of wildlife and people has long been a complex challenge. The San Joaquin Valley exemplifies this tension, as space for agriculture and urbanization compete for land use of native grasslands– often resulting in the conversion of grasslands for agriculture fields, commercialized areas, or energy development. With an increasing number of agricultural landscapes going fallow and the passing of SB-100 in 2018, solar farm development has emerged as an attractive option to offset financial losses from unproductive farmland. However, the same landscapes favored for solar development also provide suitable habitat for sensitive species such the western burrowing owl (Athene cunicularia hypugaea). As burrowing owl populations continue to decline and edge closer to being listed as endangered in the state of California, reconciling energy development with species protection has become increasingly urgent. Leading to the focus of this paper of how can we optimize protections for burrowing owl populations while meeting and maintaining energy development goals within the state? Through geospatial analysis and review of existing regulations and mitigation plans, this paper offers actionable recommendations for land developers and resource managers. The Geospatial Analysis revealed that only 3% of the San Joaquin Valley can support new solar site development while avoiding prime suitable burrowing owl habitat. The identified gaps in the mitigation measures and permit planning offer insights for updating burrowing owl regulations and reinforce the importance of prioritizing habitat protections throughout the planning process
Assessing Climate Change Resilience Strategies in the Central American Coffee Industry
Full text linkCoffee is one of the most valuable commodities on the planet, responsible for a global annual income of over $200 billion. The longevity of the coffee industry is directly threatened by the adverse effects of climate change. This report evaluates various climate change resilience strategies used in the Central American coffee industry, including agroforestry farming methods, crop hybridization, and coffee-sector specific climate action programs. The assessment was done through a literature review of two opposite coffee farming methods, a case study of a prominent F1 hybrid coffee breeds, and a program analysis of a coffee-specific climate action program in Costa Rica. The literature review on farming methods revealed that agroforestry (AF) systems tend to produce have reduced coffee yield totals when compared to direct-sun monoculture (DSM) systems but produce higher quality products and facilitate various beneficial ecosystem services. The case study of Centroamericano, a prominent, commercially available hybrid coffee breed, demonstrated the potential of hybrid coffee varieties to maintain high coffee yields amidst changing climatic conditions but also revealed the need for further research in the field of hybridization. The program analysis of Costa Rica’s NAMA Café and NAMA Support Program characterized the structure of successful government support programs that can serve as models for other Central American nations looking to implement similar frameworks in the pursuit of coffee-sector-specific climate action
Shifting US Strategies: Preventing China’s Continued Military Aggression Through Unrestricted Warfare Tactics Targeting Supply Chains
Full text linkStrategic competition between the United States and the People\u27s Republic of China (PRC) has developed into a complex multi-domain struggle encompassing military, economic, and trade aspects. This research demonstrated that the current U.S. deterrence strategy is mismatched in its ability to engage with the PRC and its use of asymmetric tactics. While the US continually depends on technological advantage through expensive platforms, the PRC is developing more subtle ways in which to subvert the US\u27 ability to respond to an expanding China. While the US response has focused on conventional means, the PRC has adopted Unrestricted Warfare as a counter doctrine to combat the US and assert dominance within the indo-pacific region. This thesis offers a series of changes that can be implemented in US strategy to begin to content with PRC through adoption of Unrestricted Warfare doctrine and focusing on asymmetric means of targeting the PRC while staying away from a conventional conflict. Specifically, this thesis exposes gaps in Chinese agricultural system and scarcity in critical environmental resources. By advocating to exploit these gaps through means of economic and trade warfare, the US is able to evolve its strategy to better counter the PRC\u27s current tactics and maintain its advantage in the region
Saving Lives: Naloxone Education and Training for Mental Health Re-Entry Program Providers
Full text linkBackground Opioid overdose fatalities are a major public health concern with significant cost implications. Naloxone effectively reverses opioid overdose symptoms and prevents fatalities, yet many healthcare professionals lack the confidence and knowledge to administer it. This knowledge gap delays efforts to combat opioid overdose. Local Problem Opioid-related fatalities are among the leading causes of preventable deaths. In a northern California county, opioid overdose deaths increased by 20% from 2018 to 2021, with 48 fatalities in 2021. A needs assessment revealed that healthcare providers at a reentry program in that county had limited knowledge and confidence in using naloxone. Methods A quality improvement (QI) project on naloxone education and training for healthcare professionals was planned, implemented, and evaluated. A 60-minute PowerPoint-based naloxone training session led by the DNP scholar was delivered to 18 staff at the reentry program. The naloxone education and training covered opioid overdose signs and symptoms, risk factors, responding effectively, and proper naloxone administration. Intervention Pre - and post-session surveys were utilized to obtain quantitative and qualitative data Results The survey assessments indicated that participants’ knowledge and confidence level about naloxone increased after the presentation. The knowledge outcomes assessments increased by an average of 11.45% post-presentation and the confidence outcomes assessment increased by 72% post-presentation. Conclusion This low-cost intervention successfully bridged the knowledge gap on opioid overdose response among reentry program staff. Recommendations for future naloxone education and training initiatives, project limitations, and policy adoption were also examined
eHealth for Older Adults: Building Digital Confidence for Better Health
Full text linkAbstract
Problem The healthcare field is becoming more technologically advanced than ever before, the older adults are often left behind due to decreased technology literacy. The quality improvement project revolves around enhancing the digital health literacy of older adults at Facility A a low income independent living facility in the greater San Francisco Bay Area. The technology workshops are imperative to improve the digital divide that older adults are experiencing. Aim The goal of the workshops is to improve the confidence of older adults through weekly workshops that were conducted over a six week period where they were instructed on how to utilize telehealth and manage their medications to improve their self management skills. Methods One hour weekly individualized workshops will be conducted weekly as the intervention which will be measured through surveys were conducted before and after the workshops to assess their confidence in managing their health. Results The participation rate was low at 10.3% there was an increase in confidence with managing their health with the digital tools. Conclusion Barriers were identified such as the low engagement and the workshops being voluntary but despite these limitations these interventions were successful in helping bridge the gap between older adults and technology. For the future expanded efforts are necessary to support the adoption of technology in managing older adults\u27 health