8224 research outputs found
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Cool & Connected OC: A Quality Improvement Initiative to Increase Cooling Center Utilization and Decrease Heat-Related ER Visits Among Seniors in Orange County
No full textCool & Connected OC (Abstract )
Laura Germano, Valentin Huerta, Thaomi Pham, & Manar Sahalam
University of San Francisco | School of Nursing and Health Professions
NURS 660 B: Practicum Part II- Quality Improvement & Outcomes Management
Professor Schwartz
November 30, 2025 Abstract
Objective: Climate change has increased the frequency and severity of extreme heat events, placing older adults, particularly those in small board-and-care homes in inland Orange County, at elevated risk of heat-related illnesses and emergency department (ED) visits. Many of these facilities lack structured emergency protocols, adequate cooling infrastructure, and culturally appropriate education, all of which contribute to preventable hospitalizations. Problem: Data indicate that approximately 4% of heat-related ED visits among older adults originate from residents of these board and care facilities, particularly in “heat island” zones such as Santa Ana, Anaheim, and Garden Grove, areas characterized by high population density, limited access to cooling centers, and socioeconomic vulnerability. Methods/Interventions: The Cool & Connected OC quality improvement initiative aimed to reduce heat-related ED visits by 25% by September 30, 2026, through a multi-component intervention guided by Kotter’s 8-Step Change Model and the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) framework. Implementation could be carried out in collaboration with public health stakeholders and agencies and includes the distribution of culturally tailored cooling kits, multilingual caregiver education, GIS mapping to identify high-risk heat zones, deployment of mobile cooling centers, and coordinated transportation services. Results: Early outcomes demonstrated increased caregiver knowledge, stronger facility-level preparedness, and greater utilization of cooling resources among vulnerable seniors. Conclusions: These preliminary findings suggest that nurse-led, community-based interventions can play a critical role in reducing climate-related health risks and promoting system-wide resilience. Ongoing evaluation through summer 2026 will assess the program\u27s sustainability and impact on reducing preventable ED visits among at-risk older adults
Enhancing Palliative Care Knowledge and Empathetic Communication in Assisted Living: An Educational Quality Improvement Initiative
No full textObjective: Palliative care education in assisted living facilities remains underdeveloped despite its essential role in promoting patient-centered, compassionate end-of-life care. This project sought to address gaps in knowledge and confidence surrounding palliative care among staff and residents (Sisters) by building on existing evidence that early education and communication improve end-of-life outcomes. Aim: This quality improvement initiative aimed to enhance understanding of palliative care principles and increase comfort discussing end-of-life needs among residents and staff at a faith-based assisted-living community. Methods: Education was delivered through tailored powerpoint video presentations, in-person sessions, and printed handouts, followed by pre- and post-intervention surveys measuring changes in knowledge and self-reported confidence. Results: Post-intervention findings demonstrated a 28.6% increase in understanding of palliative care concepts and 16.5% improved comfort discussing end-of-life needs amongst residents, with staff results inconclusive. Conclusions: These results underscore the value of incorporating palliative care education into long-term care settings, where improving communication, symptom awareness, and end-of-life preparedness can foster more empathetic, patient-centered care while promoting dignity and comfort for residents nearing the end of life
Integration of Post-Fall Huddles to Promote Fall Prevention in a Skilled Nursing Facility
No full textA quality improvement initiative was implemented in a San Francisco Bay Area, skilled nursing facility serving primarily older residents in need of chronic disease management. The facility displayed a high fall-risk burden, in which an extensive microsystem assessment was conducted to determine possible contributors. Information gathered through observation, as well as staff and stakeholder interviews displayed insufficient education, poor interdisciplinary communication and collaboration, limited staff adherence, and inconsistencies in post-fall protocol completion to be among the most imperative areas for improvement. A thorough analysis of literature was conducted to determine potential evidence-based interventions to address barriers and achieve the project\u27s goal of reducing falls, recurrent falls, and associated injuries within the microsystem. The implementation strategy of integrating structured post-fall huddles was determined to be an effective approach in promoting fall prevention by enhancing education, communication, and collaboration. This project aimed at reducing fall rates by 25% over a five-week period. A comprehensive binder with educational materials and post-fall huddle guide was developed and placed at the nursing station. In-service trainings and informational presentations were conducted to educate staff on the implementation project, and tip sheets were posted within the unit to continuously reinforce these efforts. Although predicted fall metric outcomes were not achieved, survey results regarding knowledge and perceptions displayed a positive increase. Great emphasis was placed on promoting education, collaboration, and structure within the facility, yet adherence to post-fall huddles remained limited. Thus, allowing recommendations to be made regarding continued leadership support, on-going staff education, and strengthened workplace culture to achieve sustainability
Promoting Interprofessional Collaboration by Increasing Visibility of Volunteer Doula Services
No full textObjective: 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\u27s 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 changes in visibility, role clarity, and team integration. Results: Post-intervention responses from the doulas showed increased feelings of visibility, improved perception that patients and staff understood their role, and strengthened a sense of integration within the L&D team. After intervention, the percentage of doulas who felt consistently supported doubled from 15.4% to 30%. Rarely feeling supported dropped to 0%. Conclusion: The implementation of a doula awareness poster improved visibility, role clarity, and integration of volunteer doulas within the L&D microsystem. Ongoing updates to the poster and continued staff education are recommended to sustain and further enhance doula-staff collaboration
From Fear to Familiar: Reducing Technology-Induced Anxiety in Seniors
No full textAbstract
This quality improvement project focuses on reducing the average technology-induced anxiety score among senior community members through 1:1 mentorship sessions. Aim During an eight-week period from September 10, 2025, to November 5, 2025, this project will reduce the severity of technology-induced anxiety by 25% from the established baseline. Methods: A 5P Microsystem assessment was conducted alongside an initial questionnaire to gauge the residents’ interests and concerns regarding technology use. From the results, focused mentorship sessions were conducted once a week and pertained to the chief complaint the resident had for eight weeks. The mentorship sessions were one-to-one and individualised to support the resident with their immediate needs, rather than a generalizable lecture. A Fishbone analysis and SWOT analysis were conducted to identify organisational and personal barriers that prevented project success. Positive results were determined by the difference between pre- and post-survey scores on a weekly basis, indicating growth or regression. The data was then inserted into a database that tracked the weekly entries over the course of the mentorship initiative. A PDSA cycle was also created to document the course of the project. Results By the end of the eight-week period, a 28.6% reduction in technology anxiety was observed in 22 participants. Conclusion The mentorship program at Facility X was successful, as the result of a 28.6% reduction exceeded the planned 25% stated in the AIM statement. It should be noted that some limitations of the project included consistent resident participation and a small sample size in relation to the community size
Improving Knowledge to Improve Care: Strengthening Nurse Expertise in the Emergency Management of Diabetic Ketoacidosis
No full textAbstract
Setting: A high acuity emergency department within a large hospital system. Problem: Nurses in the emergency department reported inconsistent understanding and utilization of the existing Diabetic Ketoacidosis (DKA) protocol. Pre-intervention survey results showed that 84% of nurses identified the DKA order set as confusing, and only 15% reported feeling “very comfortable” with the protocol. These knowledge gaps contributed to delays in glucose monitoring, inconsistent insulin administration, uncertainty about order-set responsibilities, and variable adherence to evidence-based management. Context: DKA is a time-sensitive, high-risk emergency that requires precise, protocol-driven actions to prevent complications such as electrolyte imbalance, cerebral edema, prolonged hospitalization, and increased healthcare costs. Standardized, streamlined interventions and staff education are essential for reducing variation and improving safety and workflow efficiency in the ED. Intervention: A targeted education intervention was delivered during pre-shift huddles across day and night shifts. Education clarified the correct DKA order set, roles and responsibilities, insulin and electrolyte management, required hourly glucose checks, equipment access (glucometers, i-STAT), and admission workflow. A pre- and post-survey was used to evaluate changes in staff comfort and perceived barriers. Results: Pre/post comparisons demonstrated improvements in staff familiarity with the protocol, reductions in reported confusion with the order set, and increased comfort in applying the DKA workflow. Staff also reported better clarity regarding insulin ordering, glucose monitoring expectation, and the correct sequence of steps in the DKA management process. Conclusion: A brief, structured educational intervention delivered during the ED pre-shift huddles improved nurses’ comfort and clarity with the DKA protocol. These findings support ongoing reinforcement of DKA education and continued use of standardized protocols to enhance performance and patient safety in the ED
From Fear to Familiar: Reducing Technology Anxiety Among Older Adults in a Senior Community
No full textAbstract The population of low-income older adults residing in senior housing is often limited to healthcare access, online services, and social support services due to the technology-related anxiety they experience. Aim: This project aimed to reduce the mean modified technology- anxiety score among residents aged ≥65 at a low-income residential community in the East Bay Area, CA, by at least 25% from baseline by November 5, 2025, through implementation of a weekly, 1:1 technology mentorship program delivered over eight weeks. Methods: A 5P microsystem assessment and pre- and post-survey were conducted during the intervention and mentorship sessions. Random residents participated in one-on-one weekly mentorship sessions during the 8-week period. A Fishbone and SWOT analysis were completed to help identify the positive and negative areas of growth in confidence with the decrease in technological anxiety among participants. An implementation of a PDSA was completed to reveal any changes throughout the mentorship. Results: There was a reduction in technology anxiety after the one- on-one mentorship program took place by 28.6%, above the 25% initial goal. Conclusion: A convenient sample of 22 residents participated, and a reduction of 28.6% was accomplished in participants’ technology anxiety. The residents’ baseline anxiety score averaged at 7.36, which decreased by 2.13 points to 5.23, representing a 28.6% reduction from baseline
Exploring Specters of Feminism in the Work of Joyce Carol Oates
Get PDFThis collection originates from the international conference “Specters of Feminism in the Work of Joyce Carol Oates,” held at Aix-Marseille Université in March 2024 as part of the broader project “Women and the F-Word: Thinking about Women’s Resistance to Feminism.” The introduction situates Oates’s vast and varied oeuvre within evolving feminist discourses, highlighting her ambivalent personal stance toward feminism and the critical consensus that her work engages deeply with feminist themes, especially sexual violence, trauma, and the complexities of gendered power. The essays gathered here explore how Oates’s stylistic experimentation, intertextuality, and representations of female agency and victimhood simultaneously reflect, resist, and redefine feminist heritage. By examining Oates’s engagement with canonical texts, her nuanced portrayals of gendered experience, and her recent public advocacy, this collection invites further investigation into the protean specters of feminism in her work, urging a reconsideration of how feminist discourses are transmitted, transformed, and sometimes haunted in contemporary literature
Youth Fiction and Trans Representation
Get PDFTom Sandercock begins Youth Fiction and Trans Representation asserting that this is the first book to catalog and trace transgender and gender variant representation across various forms of media (Sandercock, p. i). Sandercock presents a compelling collection of transgender representation case studies, with an intended audience of transgender studies scholars, LGBTQ+ and allied educators seeking to add meaningful gender-explorative literature to their curriculum, and transgender people interested in a gender retrospective view of their childhood or adolescent media. Examining not only mere representation of young transgender and gender variant people, Sandercock explores the intersections of gender and various vertices of social power and inequity including racism, policing and carceral culture, and ableism. While some analyses may feel reaching at times, Youth Fiction and Trans Representation does well in presenting the nuances and complexities of representation and challenging hegemonic heteronormativity to support transgender visibility
The Community University of Social Work: The Creation of an Alternative Educational Space in Kenya
Get PDFColonization has scarred African social work, especially in Nairobi, Kenya, where neoliberal politics has turned a profession dedicated to advancing social justice into an arm of the state. State education for social work is highly restrictive; new social workers do not learn about the impact of racism and capitalism on mental health. Instead, they are trained to serve the government’ s interests. Thus, I conceived an alternative fugitive higher education community to educate and train social workers through an antiracist and decolonized curriculum. Grounded in African education theory, this community-based collaboration of future social workers is a revolutionary act of disengagement from state education. This track follows the planning, creation, and implementation of the pilot program of the Community University of Social Work and provides a path for others to develop and realize this intervention within their local contexts