University of San Francisco

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    PROCESS IMPROVEMENT TO REDUCE THE INCIDENCE OF DELIRIUM IN AN OVERFLOW UNIT

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    Abstract Problem: This quality improvement project aims to reduce the incidence of hospital-acquired delirium in an overflow unit, which serves a diverse patient population from medical-surgical and telemetry microsystems. The unit averages 96 delirium episodes annually, costing approximately 3,456,000.Thegoalistoreducedeliriumincidenceby25Context:Deliriumisaprevalentandsevereneuropsychiatricsyndromethatsignificantlyaffectsolderhospitalizedpatients,characterizedbyacutedisturbancesinattention,awareness,andcognition.Interventions:Theprojectintroducedabundleoffourinterventionsoverfourmonthstopreventdeliriuminoverflowunits:staffeducationusingtheConfusionAssessmentMethod(CAM)tool;environmentalmodifications,suchasplacingclocksonbedsidetables;patientengagementstrategies,includingincreaseddaytimemobilization;proactivemonitoringprotocols,withmonthlyauditstoassessdeliriumincidence.Measures:Outcomemeasuresincludedtheincidenceofdelirium.Processmeasuresincludedpreโˆ’andpostโˆ’interventionstaffsurveystoassessbaselineandcomparativeknowledge(n=30).Weeklydeliriumauditswereconductedandanalyzedoverfourmonths.Results:Interimresultsindicateincreasedstaffknowledgeinidentifyingandpreventingdelirium(n=30),withareductionintheincidenceofdeliriumin2patients,resultinginsavingsof3,456,000. The goal is to reduce delirium incidence by 25%, decreasing monthly cases from 8 to 6 by October 31, 2024, and annual cases to 72 by April 2026. Context: Delirium is a prevalent and severe neuropsychiatric syndrome that significantly affects older hospitalized patients, characterized by acute disturbances in attention, awareness, and cognition. Interventions: The project introduced a bundle of four interventions over four months to prevent delirium in overflow units: staff education using the Confusion Assessment Method (CAM) tool; environmental modifications, such as placing clocks on bedside tables; patient engagement strategies, including increased daytime mobilization; proactive monitoring protocols, with monthly audits to assess delirium incidence. Measures: Outcome measures included the incidence of delirium. Process measures included pre- and post-intervention staff surveys to assess baseline and comparative knowledge (n=30). Weekly delirium audits were conducted and analyzed over four months. Results: Interim results indicate increased staff knowledge in identifying and preventing delirium (n=30), with a reduction in the incidence of delirium in 2 patients, resulting in savings of 72,000. RN surveys (n=117) post-implementation indicated 100% satisfaction. Conclusions: The project demonstrated the necessity of nursing assessment and delirium prevention interventions. Clinical Nurse Leaders (CNLs) need to continuously advocate for evidence-based projects to prevent delirium and its high costs, particularly in heterogeneous units like overflow units

    The Cypher: โ€œWe\u27ve Been Inside These Systemsโ€

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    In this track, Black Educology Mixtape Producers Ant, Dre, and Eghosa sit around a virtual roundtable to discuss what has brought us to create a second volume of BE. Our conversation moves and meanders as we refrain and chorus each other\u27s thoughts and experiences. We talk about systems. A lot. The systems of thought, systems of oppression, the systems of education that have led us to seek others to join in an ongoing and creative discussion that centerers Black experiences in formal and informal educational settings. In editing our cypher, we have done our best to preserve our spoken language as much as possible and suggest that your read the text ourloud

    Understanding Mental Health Provider\u27s Experiences of Burnout, Vicarious Trauma, and Vicarious Resilience from the provider perspective

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    The physical and psychological impacts on mental health providers as a result of burnout, vicarious trauma, and vicarious resilience have not been researched extensively. This study examined burnout and vicarious trauma among mental health providers in New Mexico given the high need population and low access to resources. This qualitative study, employed individual interviews, examined the lived experiences of seven mental health providers who are currently employed in the state of New Mexico in order to better understand the impact of burnout, vicarious trauma, and vicarious resilience. Inclusion criteria for participants included providing mental health services to children and families in the state of New Mexico, being employed with an organization affiliated with the state of New Mexico, and being employed for a minimum of six months. A thematic analysis framework (Braun & Clarke, 2008) was used to examine the themes that emerged from the data, which included: (1) burnout, (2) mental health career trajectory, (3) occupational preparedness, (4) support, (5) vicarious trauma, (6) vicarious resilience, (7) job satisfaction, (8) employment challenges, (9) spirituality/ faith, (10) impacts of COVID-19. The findings of this study demonstrated high rates of burnout, vicarious trauma, and vicarious resilience. Investigating the experiences of mental health providers may, in turn, help future organizations implement interventions to reduce the negative outcomes of burnout and vicarious trauma while helping support vicarious resilience

    Female Biology

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    Over twenty years ago I developed a course for the upper- level biology major at the University of San Francisco called Female Biology. This was from what I perceived as a gap in the undergraduate biology curriculum- students were not learning about the evolutionary aspects of being female and studying the specific health-related issues unique to women. The information in the most widely used general biology textbooks written from a male perspective, focuses on research gained from male models by work conducted in male-led laboratories. There still exists a problem with a lack of adequate representation of women in biomedical research. The focus of the course is the unique biological aspects of the female sex. There is also an emphasis on the inequities experienced by female scientists. Topics covered include evolution and genetics of sex, gender identity, sexuality, reproduction, anatomy, and physiology. Additionally, an effort is made in this course to recognize disparities in healthcare across marginalized female and transgender populations. Book available for free download in PDF and epub format - compatible with most eReaders. Female Biology Copyright ยฉ 2023 by Jennifer A. Dever is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives CC BY-NC-ND 4.0 International License, except where otherwise noted.https://repository.usfca.edu/faculty_books_all/1102/thumbnail.jp

    Cultivating an Environment of Black J.O.Y. in Educational Settings

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    Jubilantly creating Opportunities and possibilities to be Youโ€ฆauthentically and unapologetically. This track focuses on creating and facilitating an environment of Black Joy within educational environmentsโ€”particularly those environments that have not always been welcoming, affirming, or equitable. The track will first seek to explore current research and literature about Black Joy in schools, and then share strategies and curriculum ideas that promote authentic experiences with learning inside and outside of the classroom. The track closes with 29 tips that promote the uplifting and amplification of Black voices and the Black experience within education

    Improving Firefighter Health Through Education in Sleep Science

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    Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefightersโ€™ sleep have been recommended. This quality improvement project implemented a four-week educational program on sleep science in Firehouse X from May to July 2024. Members were provided with educational materials in various formats weekly. A station sleep champion kept members engaged in the program. Environmental changes were supported. Members were surveyed before and after implementation using the Pittsburg Sleep Quality Index (PSQI). The aim of this project was to improve sleep quality by 25% over four weeks and have 90% participation. 17 of the eligible 18 members participated in the first survey, but an additional two were unavailable for the 4-week follow-up. Thus, participation fell from 94% to 83%. Results demonstrated that all but one member improved their sleep scores, with three members improving by over 25%. However, the average percent improvement was 15%, falling short of the 25% goal. These results demonstrate the effectiveness of educating firefighters in sleep science. This program can be expanded to other firehouses in XFD

    Enhancing Opioid Pain Management Documentation From Assessment to Reassessment

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    Abstract Problem Effective pain management with opioids when ensuring proper documentation presents a major challenge in medical-surgical settings. Poor documentation threatens patient safety and compliance standards of care. Context An urban community hospitalโ€™s medical-surgical Unit A and B hosted this quality improvement (QI) project, which was conducted from January to April of 2024. The need for various focused interventions to improve compliance and patient outcomes was demonstrated by the continuously low pain assessment and reassessment documentation rates below the 90% hospital standard. Interventions The project included strategies for staff engagement through observations, systems tutorials of the electronic health record (EHR), chart audits and pre- and post-surveys. Stakeholders from management, information technology (IT) specialists, and nursing worked together to guarantee complete implementation. MeasuresQuarterly data to monitor rates for pain assessment and reassessment compliance were utilized to track if the hospital was reaching the 90% goal. Results Preliminary data indicated gains for Unit B as it reached 74.2% for assessment and 88.1% for reassessment, respectively, and Unit A achieved compliance rates of 66.2% for assessment and 87.5% for reassessment. Both units were below the 90% goal, even with the improvements. Conclusion This QI project emphasizes that organized interventions can greatly improve opioid pain management and documentation procedures that are necessary for patient safety and efficient pain treatment. The differences between units highlight the requirement of customizing plans to the dynamics of each unit. To promote a culture of constant development and high-quality treatment, future efforts should implement ongoing education, thorough data collection, specifically prioritizing technology. Keywords: Pain management, Quality Improvement, Assessment and Reassessment, Medical-Surgica

    Evaluating the Impact of Wildfires on Mixed Conifer Forest Regeneration and the Effectiveness of USFS Management Strategies on Restoring Ecosystem Services

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    Wildfires are increasing in frequency, duration, and severity across Western North America. 20,438,720 acres (20.1%) of California has burned at least once since 2010. Projections suggest a statewide increase in burned area between 36% and 74% by 2085, with some forested areas in Northern California exceeding 100% in all modeled scenarios. Fire regimes have deviated far from their historical norm, significantly increasing the risk of type conversion from forest to other ecosystems. Californians rely on the myriad of ecosystem services produced by these forests to meet their basic needs. Access to these fundamental services will be severely reduced if appropriate action is not taken to ensure the regeneration of these ecosystems. This paper explores the impact of wildfire on ecosystem services and the programs and processes executed by the United States Forest Service (USFS) in response. A geospatial analysis of the North Complex fire (2020) tracks regeneration over three years and quantifies the loss of sediment retention services due to severe wildfire. The USFS invested significant resources in developing decision support tools, devising long-term reforestation strategies, and conducting assessments of post-fire conditions. However, findings reveal the stark loss of land cover to non-forest vegetation in the absence of reforestation treatments applied by the USFS. Over the last decade, only 6% of the post-wildfire reforestation activities identified by the USFS were implemented. Three years post-fire, sediment delivery to the stream networks within the boundaries of the fire perimeter increased by 15%. The USFS has considerable grounds to make up to achieve the REPLANT Actโ€™s mandated reforestation goals. Established programs and processes are sufficiently thorough, but this research uncovered lagging execution of reforestation activities in affected areas. Consolidating existing decision support tools, commitments to long-term monitoring, and adopting new geospatial technologies are paramount to the agencyโ€™s ability to scale its reforestation program

    Implementation of Lymphedema Education Toolkit for Nurse Coordinators

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    Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patientโ€™s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education. Context: This quality improvement project was conducted at Hospital S Womenโ€™s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment. Interventions: An evidence-based lymphedema education toolkit was created for nurse coordinators at Hospital S Womenโ€™s Cancer Center to utilize and refer to when educating patients on lymphedema, standardizing the quantity and quality of education patients receive. Measures: An identical pre- and post- survey was administered to nursing staff prior to and following implementation of our lymphedema education toolkit. This survey assessed nurse coordinatorsโ€™ current knowledge of lymphedema, aiming to see if there was an increase in knowledge following implementation. Results: Implementation of the lymphedema education toolkit showed an average 12% improvement of lymphedema knowledge amongst the 40% of nurse coordinators on staff in our microsystem who participated in both the pre- and post- assessment surveys (n=6). This data indicates an enhanced understanding and ability to educate patients with lymphedema on their diagnosis, risk factors, prevention, and treatment options compared to the current practice. Conclusion: This quality improvement project has positive implications in improving early interventions for patients with lymphedema

    Crafting Community Solar Programs to Alleviate Energy Burdens and Empower Communities in Virginia

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    Low to moderate-income (LMI) groups usually suffer from high energy burdens and community solar is a renewable energy strategy that can save LMI groups on their monthly electricity bills. This research explores the intersection of renewable energy and energy justice, specifically the potential for community solar, energy efficiency, and home weatherization to alleviate Virginia\u27s energy burdens. Included is an analysis of incentives, programs, and Greenhouse gas emission goals for the state, investigations on how low-income groups are receiving aid and what is available to them from programs and utilities, suitable sites for solar based on groups in need, and comparisons are made between active community solar programs in other states to what Virginia offers. These analyses reveal that Virginia has solar incentives and programs however not enough for LMI groups to benefit. This confirms that there is not enough funding to tackle the everyday needs of all burdened people to benefit from renewably sourced electricity. Recommendations for the state to improve Community Solar for disadvantaged groups include 1) empowering and providing funding for smaller communities to facilitate community solar, electric bill assistance, and weatherization relief, 2) Optimizing the location of community solar and new infrastructure with low-income communities in mind, 3) improving education towards the availability of energy assistance and the benefits renewable energy provides for smaller communities, 4) emphasize the importance of collaboration between utilities, governments, non-profits, and communities to create a cohesive and well run community solar program. These recommendations stress that small LMI communities need to gain more support and financial benefits to be included in the renewable energy revolution

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