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How Implicit Bias Leads to Racial Disparities in Maternal Care and Experiences
Mia Yee
Background: Maternal mortality rates have decreased all over the world. However, in the United States, the maternal mortality rate has been steadily increasing. Women of color reportedly are forced to accept the burden of an unequal association between race and morbidity & mortality due to implicit discriminatory attitudes of healthcare professionals. Objective: To better understand the relationship between implicit bias and maternal care in the San Francisco Bay Area between non-Hispanic White & Black women and to explore racial disparities in their maternal narratives. A literature review was performed and a study is proposed. Future Directions: To Identify the differences in maternal care among women of color so that possible interventions can be researched and implemented to improve patient-centered maternal care to all women and to reduce discriminatory practice in the San Francisco Bay Area.
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Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-of-Life
Joanne Nguyen and Dana Bagis
Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care based training, with the overarching goal of promoting holistic patient care, especially for patients approaching the end of life. The literature review encompasses a threefold examination of spiritual care practice from diverse perspectives, including those of nurses, patients, and chaplains. The focus is on identifying barriers to spiritual care nursing practice, understanding the impacts of spiritual care on patients' well-being (or the lack thereof), exploring nurses' perceptions regarding their capacity to provide spiritual care, and evaluating the effectiveness of spiritual training sessions. Building upon these insights, a quasi-experimental study has been designed to assess the effects of spiritual care training on improving nurse competency and enhancing holistic patient care. The findings from this research have the potential to contribute to the development of targeted interventions and training programs that address the specific spiritual care needs of ICU nurses, ultimately enhancing the quality of care provided to patients, particularly those nearing the end of life.
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Improving the Psychosocial Effects of a Burn Injury
Leila Young
Burn injuries are an existing risk factor of social impairment. The main priority of care for a burn patient includes the focus on pain management and wound care. However, scarce research has been studied on how to improve the psychological adjustment of burn victims. There is limited availability of evidenced based practice that is related to promoting a healthy social life after a burn. Without interventions to help re-engage burn victims with society, they will turn to negative coping mechanisms such as avoidance, isolation and distancing. The goal of this study is to enhance the social interaction of burn survivors during their recovery. This mixed method study aims to improve social impairment of burn victims in the Bay Area with the use of journaling. A pre and post test will be given, using the tool PROMIS-29, to acknowledge the psychological state of the burn victims before and after the journaling intervention. The sample size will include 100 participants that have been recruited through burn centers, burn units, in-patient hospitals and support groups. Participants will write journal entries each day for six weeks. The journal entries will be examined for similar themes and the results of this study will demonstrate the psychological wellbeing of the participants. In evaluation, the post test and journal entries will show the impact of the intervention of psychosocial ramifications. The literature suggests that there is no reason to focus on the psychological dynamic of burn victims. This study will identify interventions that progress the development of psychological dynamics and ability to interact in society of burn victims in the Bay Area. This study will provide evidenced based practice that can be used to further the research of burn survivors.
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In-Person Vaccine Education and Parental Vaccine Acceptance
Sophia Zhao
Understanding the reasons behind parental vaccination hesitancy plays a critical role in community health, preventing vaccine preventable diseases, and increasing vaccination rates. It is crucial to determine how different vaccination promotion and education methods can be used to increase vaccine acceptance in parents as they play an integral role in their child's health and well-being. This research poster aims to determine the effects in-person vaccine education has in vaccine hesitant parents.
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Kangaroo Care Education for Low Socioeconomic Status Families in The Neonatal Care Unit
Joara Peterson
The early contact between mother and baby is known as skin-to-skin, also referred to as “kangaroo care” (KC). It involves placing the baby on the mother’s chest as soon as it is appropriate (Thompson, 1979). This interaction was primarily for bonding but many researchers have discovered additional benefits. There is significant correlation between kangaroo care and weight gain (especially for low birth weight infants), as well as body temperature and heart rate regulation, which reduces the risk of medical complications. It also decreases levels of stress in mothers and babies by lowering the release of cortisol hormone (Mohammadi et al. 2021). The purpose of this study is to investigate the disparities in access and utilization of KC for newborns. The study will also assess the impact of these disparities on maternal and infant outcomes such as weight gain, temperature regulation, neurocognitive enhancement, particularly among families of low-socioeconomic status. A literature review investigated research on topics such as benefits of kangaroo care, challenges and disparities for implementation of kangaroo care for families with low socioeconomic status, and prenatal teaching as an intervention. Pregnant women will be randomly assigned to either the control or experimental group receiving the intervention. We will use descriptive statistics to compare the means of the two groups of women. The inferential statistics will be used to determine the p-value and predict statistical significance . If the p-value is lower than 0.05 there will be a higher probability that the results are statistically significant and not by random chance that prenatal education will increase kangaroo care as an intervention, therefore we can reject the null hypothesis.
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Lived Experiences of People with Substance Use Disorder as Healthcare Education to Develop Empathy for this Population
Whitney Bynum
Stigmas that develop among healthcare workers regarding patients with substance use disorder include: "drug-seeking", "violent", and "unmotivated". These beliefs can decrease the quality of care provided and results in less people seeking out needed treatment. Healthy People's 2030 goals include reducing drug and alcohol addiction. In order to do this, healthcare workers need to show empathy and form trusting relationships with this patient population. Building a trusting relationship allows the patient to be more receptive to help and suggestions. Learning the life story of a patient can help healthcare workers develop empathy and reduce negative attitudes.
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Maternal Postnatal Depressive Symptoms and Its Effects on Infant Bonding
Tammy Nguyen
The objective of this thesis is to gain insight on precipitating factors that increase postpartum mother’s depressive symptoms, including stress and anxiety, and how attachment is influenced. Maternal-infant bonding is defined as the emotional relationship and interaction between mother and infant. Postnatal depressive symptoms typically are under-diagnosed due to a lack of education and the stigma of believing that the effects are “normal” consequences of motherhood. Those affected may not seek professional help. Unrealistic expectations about bonding with their infants can have a negative mental health impact on mothers and influence infants’ behaviors. High expectations of needing to be a perfect mother or not meeting certain goals for their child’s care can make mothers feel unaccomplished, increase stress and frustration, lead to parental burnout, and in severe cases, resentment towards their infant. Many factors impact maternal experiences in the postpartum phase, including economic stressors and marital differences, but most importantly infant behaviors. Mothers who struggle to meet their infant’s needs, such as feeding, diaper changes, or sleeping arrangements may encounter negative infant reactivity emotions, which only deepens their depression.
To investigate, primary research articles about mother-infant attachment and bonding and causes of ineffective attachment were examined. A plan for future study will include the Maternal Role Attainment Theory by Ramona Mercer. The study will use a prospective longitudinal mixed methods design. Two hundred pregnant women will be followed until one-year postpartum. Quantitative data collection will include surveys asking about mother’s anxiety on a rating scale. Qualitative data will be gathered on infants’ emotional reactivity when stressed and interventions used by mothers to console them. This research may offer insights that aids nurses in providing effective care for mothers with postpartum depression and their newborns.
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Medical Cannabis in Pediatric Patients with Chronic Pain and Diseases
Marissa Colombo
Pediatric chronic pain has seen a disturbing rise which ends up affecting the child’s routine and impacting their family’s lives. Medical cannabis has Food and Drug Administration-approved derivatives, yet the studies that focus on medical cannabis do not discuss targeting pain in pediatric patients. Children who experience chronic diseases and treatment-resistant pain are not normally offered medical cannabis as a treatment option which needs to change. The purpose of this paper is to explore the impact of medical cannabis within the pediatric population. If children experience pain that is similar to adults, withholding techniques that can help alleviate their pain should be avoided. The study will assess how pediatric patients adapt to medical cannabis. The proposed research design is a quantitative, test-retest study focused on pediatric patients who are 3-12 years old and have been diagnosed with a chronic disease, treatment-resistant pain, or both. There will be a collaboration with Bay Area pediatric outpatient offices. The study will use the Wong-Baker Faces Pain Rating Scale and Likert Scale. There are many ethical considerations surrounding this study since pediatric patients are a vulnerable population due to their varying mental capacities. Post-treatment, patients and parents will re-evaluate pain and daily living. Statistical analysis will help identify areas for further research regarding different demographics. The results are anticipated to provide valuable contributions to pediatric pain management.
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Nurse-Led Education for Postpartum Depression in Primiparous Asian-American Mothers
Colleen Peralta
The postpartum period is a critical point when women remain a vulnerable in the hospital setting. This stems from various physical, emotional and psychological changes that women face after childbirth, when patient support and attention is vital. For instance, the postpartum stage poses risk to women for complications, such as postpartum depression (PPD). When left untreated and misdiagnosed, PPD can lead to adverse maternal outcomes, such as: problems with mother-infant bonding, difficulty breastfeeding, and an increased risk for suicide (Mayo Clinic, 2022).
Asian-American mothers with postpartum depression face unique challenges, including the stigma surrounding mental health, which remains prevalent within the this community. This can make it challenging for mothers to open up and seek mental health care for postpartum depression. As a result, it is important to investigate the Asian-American population of mothers in order to provide quality maternal healthcare for all patients.
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Polypharmacy: Increasing Medication Adherence
James C. Kelly
Polypharmacy is a common problem among older adults where they take multiple medications concurrently, leading to negative health outcomes such as adverse drug reactions, drug-drug interactions, and non-adherence to medications. To address this issue, a randomized controlled trial (RCT) is proposed that will involve elderly patients (aged 65 years or older) who are taking five or more medications. Participants will be randomly assigned to either the intervention or control group, with the intervention group receiving nurse-led medication therapy management (MTM) and patient education to improve medication adherence. The Health Belief Model can be used to educate and empower older adults on the risks associated with polypharmacy and help them make informed decisions about their medication regimen. The proposed RCT has the potential to improve medication adherence and reduce negative health outcomes associated with polypharmacy, ultimately improving the overall health and well-being of the older adult population.
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Prevalence of Hypoglycemia Induced by Overtreatment in Elderly Type Two Diabetics Using Continuous Blood Glucose Monitors
Alyssa Mae T. Tubera
Background: The most common way of reading blood glucose (BG) levels in type II diabetics is by manually pricking one’s finger with a needle and measuring the glucose through a monitoring device. There has been an increased use in continuous glucose monitoring (CGM) that permits clients to wear a sensor on their arm that simultaneously records glucose levels throughout the day and reports the results to a smartphone or monitoring device. Depending on the result and whether the patient is using insulin, it will determine how much medication will be administered. There is little research on the impacts of using CGM devices in conjunction with antihyperglycemic drugs in type II diabetics who live independently and are over age 65.
Objective: To examine devices that monitor BG continuously compared to devices that monitor BG with periodic finger sticks. The question arises: Are elderly patients with type II Diabetes who live independently and use these devices, disproportionately affected by hypoglycemic episodes induced by over-treatment with anti-diabetic drugs?
Literature Review: Research highlighted benefits of using CGM devices versus self-monitoring BG such as recording glucose levels at night, increased self-care behavior, and decreased hemoglobin A1C. Other factors may contribute to hypoglycemia such as physical exercise, prolonged fasting, and use of ACE inhibitors. There remains a knowledge gap in the impact that CGM devices have on independent type II diabetics who live independently.
Proposal:
Purpose: To gather data on prevalence of hypoglycemia in independent, type II diabetics ≥65 years old while using CGM devices and antidiabetic medications
Population: type II diabetics ≥65 years who live independently, use CGM devices, and antihyperglycemic medications
Study Design: Prospective Longitudinal observational study
Study Method: Survey
Clinical Significance:
Study intends to bring awareness of possible complications of using CGM devices in type II diabetics ≥65 who live independently.
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Promoting Parental Comfort to Facilitate Conversations on Adolescent Sexual Health and Behaviors
Angelina Jolie Banes and Lauren Liddell
This thesis proposal will investigate the impact of a comprehensive digital sexual health education program on the comfort levels of parents and teens when discussing sensitive topics such as pregnancy and sexually transmitted infections (STIs). The research is guided by Orem’s Self-Care Deficit Nursing Theory, which emphasizes the need to assess and address individuals’ self-care deficits, including the ability to engage in safe and informed sexual behaviors. The research design is a quantitative, quasi-experimental study with a one-group pre and post-test design. The sample consists of 50 parents and 50 teens from Marin County, who will participate in an online intervention using the Media Aware Parent program. The outcomes will be measured by pre and post-intervention surveys and the Parent-Adolescent Communication Scale. The expected results are that the intervention will increase the knowledge, confidence, and comfort levels of parents and teens regarding sexual health issues, and improve the quality of communication between them. The findings could potentially contribute to the development of more effective sexual health education programs and communication strategies for families.
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Sex Education in Chinese American Adolescents
Onsheng Seto
Comprehensive sex education has shown improvements in lowering STIs and unplanned pregnancies among adolescents. Implementing a sex education course provides youths the tools to develop a safe and positive view of sexuality which encourages them to approach sex and sexual health wisely and confidently. The findings of this study aims to promote comprehensive sex education as well as bring awareness to the disparity in teen pregnancy and STIs among ethnic groups. This research proposal seeks to evaluate the efficacy of comprehensive sex education in Chinese American adolescents while taking cultural considerations to better understand their practices, beliefs, and attitudes on sex.
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Sexual Education In Adolescence: Contraception Education For Adolescents Leads To Improved Sexual Practices
Marie Poellinger and Erica Jade Fong
Adolescents of low socioeconomic status from 13-18 years of age face many challenges when it comes to maintaining safe sexual health practices, leading to unwanted pregnancies and exposure to sexually transmitted diseases (STI’s). Challenges include:
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economic barriers → limited access to health care or lack of health insurance
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lack of proper sex education and therefore limited knowledge around contraceptive
Addressing these challenges is crucial for better sexual health outcomes. The nurse’s role is essential in providing education about contraceptive options, access to local resources, and guidance pertaining to safe sexual health practices (Dixon, 2014)
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Supportive Interventions for Adults with Needle Phobia
Camille Alyssa Bustos
The focus on addressing needle phobia has primarily been limited to psychology clinics, leaving a gap in support for those receiving injections from health care professionals in the hospital or clinic setting. It is important for health care providers and mental health professionals to work together to address this gap and ensure that individuals with needle phobia have access to the care and treatment they need (Centers for Disease Control and Prevention [CDC], 2022).
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The Effect of Delivery Method on Breastfeeding Initiation and Duration
Mariana Carina Benitez
There is a plethora of research focusing on the physical effects of each delivery method on a mother’s ability to initiate and sustain breastfeeding, however, there may be more psychosocial factors that influence a mothers decision to start and continue breastfeeding once they deliver. It is very common to be educated about breastfeeding after the baby has already been delivered, but it is often missed that education before may improve breastfeeding rates and increase mothers' breastfeeding self-efficacy rates. The primary purpose of this project is to evaluate the effectiveness of breastfeeding support groups that provide information, guidance, and social support from other breastfeeding mothers prenatally and postpartum. The goal of this is study is to examine how support groups address psychosocial factors that influence a mothers decision to initiate and continue breastfeeding, such as self-efficacy. A single group, pretest/posttest design will be utilized for the study. Participants will include nulliparous pregnant women over the age of 18 from an outpatient obstetrics clinic in San Rafael. They will attend a support group led by other breastfeeding mothers twice, at 35 weeks and 37 weeks. The participants will complete a demographic survey before going into the support group as well as the Prenatal Breast-feeding Self-efficacy Scale. Two weeks after delivery, the mother will complete the Breastfeeding Self-Efficacy Scale Short-Form to evaluate their feelings toward breastfeeding postpartum. Statistical analysis will be completed on the tools utilized in the study. The results of this study will demonstrate that attending the support groups will have a positive effect on the self-efficacy of mothers while breastfeeding. Therefore, pregnant women will benefit from support groups led by other breastfeeding mothers as it will increase their individual self-efficacy.
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The Effect of Nursing Education on the Utilization of Kangaroo Mother Care and Weight Gain of Preterm and Low Birth Weight Infants
Jhenalynn Valete
Kangaroo Mother Care (KMC), often referred to as skin-to-skin contact, is an intervention for preterm and low birth weight infants, involving the practice of the mother or caregiver holding the newborn against their bare chest (Cleveland Clinic, 2023). This is a cost-effective and natural way to enhance health outcomes such as temperature regulation, weight gain, respiratory function, pain mitigation, and facilitation of breastfeeding for the neonate (Jefferies et al., 2012).
Nursing staff may have limited knowledge regarding KMC which creates challenges in effectively educating parents. This information prompts the following question: “Can Nurse Education about the Importance of Kangaroo Mother Care Increase its Utilization and Promote Weight gain in Low Birthweight and Preterm Infants?”
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The Effects of Breastfeeding Education on Working Moms of Low Socioeconomic Status
Grace Ngo and Suzanne Manseau
Breastfeeding plays an important role in promoting immunity due to the high concentration of antibodies (Tangsuksan et al., 2020). Immunity is important for the infant the first year of their lives. Women of low socioeconomic status (LSES) are less likely to breastfeed due to a lack of resources (Kebede & Seifu, 2021). In addition LSES women living in Marin often lack the proper resources and education for breastfeeding (Heck et al., 2006). The purpose of this thesis proposal is to investigate if educating pregnant women of low socioeconomic status will increase breastfeeding rates.
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The Effects of Exercise on the Body’s Tolerance to Breast Cancer Treatments
Lindsay C. Lim
Background: Breast cancer is known as one of the most common types of cancer. Treatments for this cancer include chemotherapy, radiation therapy, and surgery. These treatments, however, can cause negative side effects such as extra pain and fatigue. Exercise is a common intervention that is used in order to keep the body strong while these treatments are occurring.
Objective: The objective of this thesis is to find a correlation between exercise and how it can decrease negative side effects in patients with breast cancer. This thesis includes a literature review which talks about what types of exercise are best, if a structured program is better, and if there is a positive correlation with a decrease in fatigue.
Methods: This study will be a longitudinal mixed method design utilizing surveys and observations. 90 participants who are either going through chemotherapy, radiation therapy, or surgery will be taken from an oncology infusion center and an operating room. Participants will be randomly placed into two groups, group A who will be going through treatment normally and group B who will be participating in a 6 month weekly exercise program. The participants will then be asked to answer the brief pain inventory to assess their pain and the revised piper fatigue scale to assess their fatigue. Participants will complete the survey again in 6 months to evaluate the continued outcome of the exercise.
Results: Results have not yet been collected but exercise is expected to help decrease symptoms of pain and fatigue in breast cancer patients. Group B will state that they are experiencing less symptoms and more relief.
Conclusion: The literature and previous studies have shown that exercise does help to decrease negative symptoms. This project is hoping to prove that exercise will help to relieve symptoms of fatigue and pain in breast cancer patients.
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The Effects of Hospital-Mandated Nurse to Patient Ratios on Patient Care
Vince Latorre
Background Nurse to patient ratios or nurse staffing is a controversial topic that is often discussed and argued in the medical field for its pros and cons. Nonetheless, the nurse to patient ratio plays a vital role on how nurses’ deliver quality care and provide safety to patients in a hospital setting. In 1999, California’s legislation passed a mandated nurse to patient ratio (AB 394) that requires all hospitals in California to have a set amount of patients a nurse can have depending on the unit the nurse works for. In 2023, California is still the only state that has passed legislation on nurse to patient ratio. Objective The primary objective of this study is to examine the correlation between nurse-to-patient ratios and patient care in a hospital setting. This thesis will evaluate whether lower nurse-to-patient ratios improves quality and safety patient care or decrease patient mortality. Also, this study will compare California’s mandated nurse to patient ratio with other states that do not have an implemented nurse to patient ratio. Method (convenience sample)
This observational research study will consist of 30 med surg patients at Kaiser Terra Linda in Marin City. The med surg patients will be observed over a 30 day time period from the admission date. Patient mortality rates, negative safety factors (falls, HAI’s, pressure ulcers due to lack of positioning), and quality of care will all be measured and collected by reviewing the patient’s chart. The statistics collected from the observation will then be compared with previous statistics at Kaiser Terra Linda and other hospitals in California. Results
The results have not yet been collected for the study, but it is expected that overall quality care will be improved and that patient mortality rates will be decreased due to the nurse to patient ratio. Conclusion The literature review discussed later in this paper concluded that the nurse to patient ratio correlates with improved quality care and decreased mortality rates. The study presented in this thesis will hopefully enhance the primary purpose that nurse to patient ratios have.
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The Effects of Loud NICU Environments on Premature Infants and Interventions to Help Minimize Noise
Elsy Gramajo
Noise in the Neonatal Intensive Care Unit (NICU) often exceeds recommended safe noise levels and has been found to have negative effects on premature infants and their health. Some of these effects can be changes in their heart rate, respiratory rate, and sleep patterns. In addition, negative effects, such as hearing loss, can cause permanent damage that impact children's long-term development. A preterm infant is an infant born before 37 weeks’ gestation. Being born prematurely comes with its own problems and many risks. Attempting to survive in an environment that causes more stress is not healing. Understanding the effects of noise on preterm infants’ physiological state and examining interventions to minimize NICU noise is essential. A review of the research literature was performed. Six primary studies exploring the effects of NICU noise on premature infants and interventions were found. The studies were divided into two categories: "Effects of noise exposure" and "Interventions." The studies highlight the effects seen in preterm infants when exposed to noise and show unique interventions that can help minimize these effects. Some interventions that have been found to help minimize noise include implementing quiet times on the units and the use of earmuffs over preterm infants' ears. Sound levels weren’t measured in the studies that implemented quiet times, so further research is needed to assess the effectiveness of the intervention. A quasi-experimental study is proposed, framed by Florence Nightingale's theory that a healthy environment is needed for patients' healing. With parents' consent, eligible NICU infants will be divided into an experimental group, receiving daily quiet time, and a control group, receiving care in the usual environment. The independent variable is sound level, and the outcome variable is infants' vital signs. This investigation may help nurses understand the effect of noise on premature infants' physiological status.
A collection of research posters authored by students from the Department of Nursing at Dominican University of California.
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