Digital Commons Network^™

The Impact Of Implementing A Discharge Tool On Nurses’ Confidence And Press Ganey Patient Survey Scores In Discharge Planning, Cristan Ledbetter

Doctor of Nursing Practice Projects

A needs assessment at a rural hospital revealed an opportunity for improvement in discharge planning. The purpose and aim of this project was to improve nurses’ confidence in the discharge process and improve Press Ganey survey scores in communication about medicine domain and discharge information domain. Inadequate discharge planning leads to poor patient outcomes, concern for patient safety, increased healthcare costs, and inferior patient satisfaction. The quality improvement (QI) project utilized a one-group pretest/posttest QI design. An evidence-based, standardized discharge tool was implemented. The Susan Grundy confidence scale (C-Scale) was used to evaluate nurses’ confidence in the discharge process pre- …

Enhancing Healthcare Provider Confidence And Accuracy In Performing And Documenting The Abnormal Involuntary Movement Scale, Victoria Okoani-Nneji

Doctor of Nursing Practice Projects

Monitoring for medication-related movement disorders is essential for adults with schizophrenia receiving antipsychotic medications; however, inconsistent Abnormal Involuntary Movement Scale (AIMS) assessment and documentation can limit timely recognition of abnormal movements. This quality improvement project evaluated a six-week structured AIMS education program designed to improve provider confidence and documentation accuracy in an outpatient behavioral health setting in Central Ohio. Guided by Benner’s Novice-to-Expert Model and Kotter’s Eight-Step Change Model, the project used a one-group pretest-posttest design with 15 licensed behavioral health providers. Weekly sessions included instruction, demonstration, guided practice, case-based learning, scoring, interpretation, and electronic health record (EHR) documentation. Descriptive …

Integration Of The Kidney Failure Risk Equation To Guide Nephrology Referral In Adults With Chronic Hypertension, Shawn A. Siddiqi

Doctor of Nursing Practice Projects

Chronic hypertension is an established risk factor for chronic kidney disease (CKD). Baseline chart review at a Texas family practice clinic showed inconsistent renal risk documentation, and providers did not use a standardized renal risk-stratification tool to guide nephrology referral. The aim of this quality improvement project was to implement a standardized Kidney Failure Risk Equation (KFRE) workflow to improve renal risk documentation, nephrology referral decision-making, and provider self-efficacy for adults with chronic hypertension over eight weeks. Lewin's Change Theory guided practice change, the Donabedian model guided quality evaluation, and the Plan-Do-Study-Act (PDSA) cycle structured implementation. Three providers (one physician, …

Standardizing Discharge Communication In Urgent Care: A Teach-Back Quality Improvement Initiative, Pearlean Smith

Doctor of Nursing Practice Projects

Deficits in health literacy and inconsistent discharge education contribute to patient misunderstanding and avoidable return visits. This quality improvement project evaluated a standardized teach-back discharge education process at a community urgent care clinic. Lewin's Change Theory guided the change process, the Iowa Model guided implementation, and Donabedian's Structure-Process-Outcome Framework guided evaluation. A quantitative one-group pretest-posttest design included eight participants: three nurse practitioners, two licensed practical nurses, and three medical assistants. Participants completed a 30-minute teach-back educational session followed by a 12-week implementation period. Measures included the five-item Confidence Scale, discharge audits, and aggregate electronic medical record data on seven-day return …

Social And Psychological Well-Being Of Aps Clients With Elder Mistreatment And Self-Neglect, Thara Ayyar

Summer Research Program Abstracts

No abstract provided.

Quality Improvement Project: Implementing The 2025 Aha Hypertension Guidelines In Rural Primary Care, Johanna M. Alvarez

Doctor of Nursing Practice Projects

Hypertension contributes to cardiovascular morbidity and mortality, and delayed adoption of updated guidelines can increase therapeutic inertia in rural primary care. This Doctor of Nursing Practice quality improvement project addressed an evidence-to-practice gap at a rural Federally Qualified Health Center where clinicians used 2017 American Heart Association/American College of Cardiology hypertension protocols after release of the 2025 guideline. The purpose was to determine whether structured education and point-of-care visual decision aids improved provider knowledge, attitudes, self-reported practices, and selected clinical adherence metrics over 3 months. Guided by the Iowa Model, Lewin’s Change Management Model, and the Plan-Do-Study-Act framework, a quasi-experimental …

Determining Impact On Provider Adherence To Current Diabetes Guidelines: A Quality Improvement Project, Rashemia Suber

Doctor of Nursing Practice Projects

The delivery and documentation of evidence-based adult lifestyle counseling for patients with type 2 diabetes mellitus (T2DM) were found to be inconsistent in a clinic that serves an underserved population. This quality improvement (QI) project assessed whether a provider education program based on the 2025 American College of Lifestyle Medicine (ACLM) Diabetes Guidelines would improve provider confidence and documentation of lifestyle recommendations. A quasi-experimental, pretest-posttest design was guided by both Pender's Health Promotion Model as the theoretical framework and Lewin's Change Theory as the change theory. The Plan Do Study Act (PDSA) cycle guided this project as the implementation framework. …

The Impact Of Provider Medication Reconciliation Education On Hospital Readmissions In A Skilled Nursing Facility, Vivian Nwozu

Doctor of Nursing Practice Projects

Aging causes frailty and multiple comorbidities, necessitating polypharmacy. Complicated drug regimens predispose patients to adverse drug events and hospital readmissions. The practice problem was high rates of medication-related readmissions due to inadequate provider knowledge of medication reconciliation and the lack of a standardized tool. This project aimed at evaluating the impact of provider medication reconciliation education on hospital readmissions in a skilled nursing facility. A pretest-posttest study design was utilized. The Donabedian Model of Healthcare Quality guided the translation of evidence into practice, whereas Lewin’s Change Model and Plan-Do-Study-Act models guided implementation. Eight providers were educated on medication reconciliation using …

Staff Education On Early Cpi-Based De-Escalation Strategies And Unit-Based Resources, Doris Onyenji Lerama

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education evidence-based practice initiative implemented at a state-operated adult inpatient psychiatric facility in California. The practice gap was inconsistent nursing staff knowledge of early Crisis Prevention Intervention-based de-escalation strategies and available unit-based resources despite an established crisis-prevention framework. The practice-focused question asked whether a standardized staff education activity would increase staff knowledge, as measured by anonymous pre-education and immediate post-education scores. The purpose was to develop, implement, and evaluate the education using staff knowledge change as the sole measurable outcome. The Johns Hopkins Evidence-Based Practice Model guided appraisal and synthesis of 11 evidence sources …

Expression Of Follicle Stimulating And Luteinizing Hormone Receptors In Porcine Testes After Timing The First Vaccination For Immunocastration, Sayamon Srisuwatanasagul, Rungrueang Yodsheewan, Amornthep Archawakulathep, Suvaluk Seesupa, Kongkiat Srisuwatanasagul, Atthaporn Roongsitthichai, Siriluck Juntautsa

The Thai Journal of Veterinary Medicine

This study aimed to examine the expression of follicle stimulating hormone receptor (FSHR) and luteinizing hormone receptor (LHR) in the testes of male fattening pigs based on the timing of the first immunocastration dose. A total of 24 male pigs were randomly assigned to 3 groups: C (n=8) consisted of only intact pigs, T1 (n=8) contained those immunocastrated at 15 and 19 weeks of age, and T2 (n=8) was composed of those immunocastrated at 9 and 19 weeks of age. The expression of FSHR and LHR was evaluated using H-score from immunohistochemistry and protein band intensity from Western blotting. Immunohistochemistry …

When To Refer A Child With High Blood Pressure, Corinn Cross, Douglas Blowey

Pediatrics in Practice: A CME Podcast

Should my child with persistent high BP see a specialist? Douglas Blowey, MD, Director of the Hypertension Clinic at Children's Mercy - Pediatrics in Practice - CME, outlines practical referral triggers for pediatricians. He discusses persistent or stage‑2 hypertension, symptomatic or emergency presentations, age under six, evidence of kidney disease or protein/blood on urinalysis, and failure of lifestyle changes — plus the initial tests primary care should obtain before referral.

Click here to stream the podcast episode.

Staff Education To Improve 7-Day Post-Discharge Psychiatric Follow-Up, Michael Curtis Kwashie

Walden Dissertations and Doctoral Studies

Too many psychiatric patients leave the hospital without a follow-up appointment, a gap that may cost lives. Research has consistently shown that the days immediately after discharge from psychiatric inpatient or emergency care are among the most dangerous in a patient’s trajectory, marked by elevated suicide risk, relapse, and avoidable readmission. Yet, across behavioral health settings, completion of outpatient follow-up within 7 days of discharge remains inconsistent; typically, standardized processes are often missing. This doctoral project in staff education was created to fill that gap and examined whether implementing a standardized discharge transition protocol, supported by targeted, interdisciplinary staff education, …

Staff Education To Improve Sleep Hygiene Knowledge And Competency Among Nursing Staff On An Inpatient Behavioral Health Unit, Jennings Ubadi Mekoba

Walden Dissertations and Doctoral Studies

This staff education project addressed the gap in standardized knowledge and implementation of evidence-based sleep hygiene interventions among nursing staff on an inpatient behavioral health unit. Sleep disturbances affect 80%–90% of psychiatric patients and directly impact treatment outcomes and recovery. I developed the practice-focused question to consider whether an evidence-based sleep hygiene education program would enhance the awareness, knowledge, and practices of the nursing staff regarding sleep hygiene interventions. A thorough literature review of 23 high-quality sources formed the background for the development of a structured educational intervention that encompassed assessment methodologies, nonpharmacological interventions, environmental interventions, and patient education interventions. …

Implementation Of An Evidence-Based Multifactorial Fall-Prevention Staff Education Program In A Long-Term Care Facility., Peter Mufua Tumenta

Walden Dissertations and Doctoral Studies

Walden University College of Nursing This is to certify that the doctoral study by Peter Mufua Tumenta has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Melanie Braswell, Committee Chairperson, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2026 Executive Summary Falls are a significant patient safety concern among older adults in long-term care (LTC) facilities. This Doctor of Nursing Practice quality improvement project implemented and evaluated a standardized, evidence-based multifactorial fall-prevention staff education program to improve …

Sociodemographic And Geographic Factors Underlying Breast Cancer Survival Disparities Among Women In The United States, Colletta Brabham-Orr

Walden Dissertations and Doctoral Studies

Breast cancer-specific mortality in the United States remains higher among women in rural and socioeconomically disadvantaged areas, yet few population-based studies have been conducted to jointly scrutinize demographic and structural determinants of this disparity. Informed by the social determinants of health framework, this secondary data analysis, using records from the SEER Research Plus database, examined the association between age at diagnosis, race and ethnicity, rural/urban residence, county-level median household income, and breast cancer-specific mortality among U.S. women aged 18 and older diagnosed with malignant invasive breast cancer between 2010 and 2020 (N = 285,865). Bivariate chi-square tests and binary logistic …

Journal Ida 2023 102 4

Journal IDA

The Journal IDA is a peer-reviewed, scientific periodical owned and published by the Indiana Dental Association, a constituent of the American Dental Association.

Journal IDA concentrates on the clinical aspects of dentistry, including case studies and research; practice management and business aspects of dentistry, from start up to transition; and also includes special and regular feature articles.

Journal Ida 2023 102 3

Journal IDA

The Journal IDA is a peer-reviewed, scientific periodical owned and published by the Indiana Dental Association, a constituent of the American Dental Association.

Journal IDA concentrates on the clinical aspects of dentistry, including case studies and research; practice management and business aspects of dentistry, from start up to transition; and also includes special and regular feature articles.

Indian Standard For Safe Handling Of Biotherapeutic Products Used In Homoeopathy: Guidelines, Kumar Vivekanand, Indra Gaurav Saxena, Divya Taneja, Shailendra K. Saxena, Shrishti Dixit, Raj Kumar Manchanda

Indian Journal of Research in Homoeopathy

Biotherapeutic products used in Homoeopathy are derived from biological sources of human, animal, microbial and other origins and include pathological and non-pathological preparations such as nosodes and sarcodes. Owing to the biological nature of these materials, their safe handling, preparation, storage, testing and documentation require systematic controls to protect personnel, the public and the environment. The Indian Standard `IS 19901:2026, Safe Handling of Biotherapeutic Products Used in Homoeopathy — Guidelines', provides a comprehensive framework for risk assessment, biosafety classification, containment, determination of first safe dilution (FSD), safety and efficacy evaluation, quality assurance, formulation, dispensing and documentation. The standard also establishes …

Is My Child's Heart Murmur Dangerous?, Bob Underwood, Mahmoud Jaara, Pezad Doctor

Pediatrics in Practice: A CME Podcast

Is my child's heart murmur dangerous or just harmless? Heart murmurs and when they matter — Pezad Doctor, MD, Pediatric Cardiology at Children's Mercy - Pediatrics in Practice - CME, and Mahmoud Jaara, MD, pediatric cardiology fellow at Children's Mercy - Pediatrics in Practice - CME, explain how to tell innocent murmurs (soft, systolic, short, position‑dependent) from concerning ones, which symptoms and family history raise concern, and what to expect at a cardiology visit (exam, oxygen saturation, pulses).

Click here to stream the podcast episode.

Quality Improvement Project: Improving Nursing Knowledge And Confidence Of Dysglycemia In Pediatric Oncology Patients, Lindley Abrams

Doctor of Nursing Practice Projects

Treatment-induced dysglycemia is a frequently underrecognized complication of pediatric cancer therapy. Pediatric oncology nurses play a critical role in recognizing and managing dysglycemia; however, limited exposure to specialized dysglycemia education may contribute to gaps in knowledge and confidence. A site needs assessment found that 53% of nurses reported discomfort with glycemia-related concepts, supporting the need for targeted education. The purpose of the project was to evaluate changes in pediatric oncology nurses’ knowledge and confidence in recognizing and responding to treatment-induced dysglycemia. The project aimed to provide a structured educational intervention and measure pre- and post-intervention changes. Newman’s Health as Expanding …

Quality Improvement Project: Electronic Consent's Influence On Consent Error Rates, Alexis Fogle

Doctor of Nursing Practice Projects

Surgical consent errors increase the risk of inaccurate documentation, compromise patient safety, and disrupt procedure times. Evidence indicates that adopting electronic consent can optimize workflow, support accurate and complete documentation, improve readability, and enhance record reliability. This project evaluated whether initiating electronic consent, compared with handwriting surgical consent forms, reduced the number of improper surgical consent forms completed over six weeks. Roy’s Adaptation Model guided the change process, and the Theory of the Person as an Adaptation System provided the theoretical basis. The Plan-Do-Study-Act model supported evidence-based implementation of the electronic consent intervention. The quality improvement project was conducted on …

Implementing An Evidence-Based Practice Training Program To Impact Nursing Skills Competency And Self-Efficacy In A Long-Term Care Facility, Angela Mcknight

Doctor of Nursing Practice Projects

Long-term care facilities require nursing staff who can competently perform clinical skills; however, the project site relied primarily on written in-service education and attendance verification without direct validation of psychomotor performance. The purpose of this quality improvement project was to evaluate competency-based nursing education in a long-term care facility. The aim was to strengthen demonstrated urinary catheterization competency and evaluate changes in perceived professional nursing competence and general self-efficacy among licensed nurses. A quasi-experimental, one-group pretest-posttest design included 12 registered and licensed practical nurses. Plan-Do-Study-Act guided implementation, Lewin’s Change Theory guided organizational change, and Social Cognitive Theory supported the educational …

A Quality Improvement Project: Impacting Communication Perceptions Among Nursing Staff And Providers Regarding Perioperative Medication Management Impacting Anesthesia Care, Demetria Jefferson

Doctor of Nursing Practice Projects

Medication-related surgical cancellations disrupt patient care, increase healthcare costs, and contribute to inefficient use of perioperative resources. Evidence supports standardized education and communication to improve perioperative medication safety. This quality improvement project aimed to improve staff self-efficacy in communicating medication instructions and reduce surgical cancellations associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and phentermine. Bandura’s Social Cognitive Theory and Lewin’s Change Model guided the project. A quasi-experimental one-group pretest-posttest design included perioperative staff who provided medication instructions across two settings within an academic health sciences center. Using the Plan-Do-Study-Act framework, interventions included standardized staff education, patient …

Training Faculty For Skills Evaluation: A Quality Improvement Project, Shelley Leezer

Doctor of Nursing Practice Projects

There is an identified gap between nursing knowledge learned in academic settings and application of clinical skills in practice settings. Literature contributes this gap to poor knowledge retention, lack of constructive feedback, and inability to apply knowledge to clinical practice. The purpose of this project was to address skill mastery and retention in nursing students within a university. The project aim was to improve faculty feedback and evaluation to best support skill mastery in the skills laboratory. Lewin’s Change Management Model and Dr. Patricia Benner’s Novice-to-Expert Theory guided project design and progress. This pre- and post-intervention study followed a PDSA …

Impact Of Sexual Orientation On Syphilis Diagnosis Among African American Men In Colorado, Emmanuel Bhatti

Walden Dissertations and Doctoral Studies

Syphilis remains an ongoing public health concern among African American men. Elevated rates during the COVID-19 pandemic further underscored the need for focused attention on this population. The risk factors driving syphilis diagnosis among African American men during a pandemic like COVID-19 remain poorly understood. The purpose of this quantitative cross-sectional study was to examine the association between sexual orientation and syphilis diagnosis among African American men in Colorado. Social cognitive theory was applied to understand the interaction among sexual orientation, HIV status, age, and syphilis diagnosis. Sexual orientation categories include men who have sex with men (MSM), men who …

Early-Onset Progressive Encephalopathy With Brain Oedema And/Or Leukoencephalopathy 1: Report Of Three Siblings, Fatema Al-Amrani, Fathiya Al-Murshedi, Khalid Al-Thihli, Eiman Al-Ajmi, Buthaina Al-Musalhi, Asmaa Al Shehhi, Amna Al Futaisi

Sultan Qaboos University Medical Journal

NAXE encephalopathy, also known as early-onset progressive encephalopathy with brain oedema and/or leukoencephalopathy-1 (PEBEL-1), is a rare and often lethal autosomal recessive mitochondrial disorder. Typical presentation includes psychomotor regression, ataxia, respiratory insufficiency and seizures triggered by febrile illness. This report describes three siblings from a consanguineous family who presented to a tertiary care hospital in Muscat, Oman, in 2022 and were found to have a homozygous pathogenic variant in the NAXE: NM_144772.2:c.827del, p.(Pro276Hisfs*43). Beyond the classic neuroradiological and clinical features of PEBEL-1, these patients exhibited novel phenotypic manifestations, including axonal polyneuropathy, Bull's eye maculopathy and a late-onset presentation of …

A Phenomenological Hermeneutic Study Of The Lived Experiences Of Pre-Licensure Nursing Students’ First Semester Clinical Rotations Following Simulation Learning, Ogochukwu Vera Nnakwe

Doctoral Dissertations and Projects

This phenomenological hermeneutic study aims to understand the lived experiences of pre-licensure nursing students during their clinical rotation semester following simulation learning at Southeastern University. The guiding theory for this study is Kolb’s experiential learning theory (Kolb, 1984). Simulation learning in nursing education is a teaching approach that lets learners practice practical nursing skills in a safe environment without risking patient safety, thus bridging the gap between theory and practice (Mishra et al., 2023). It offers students opportunities to improve their knowledge of clinical skills and enhance their abilities (Koukourikos et al., 2021). The study involved a sample of 12 …

Barriers And Facilitators To Health Literacy Among Black Americans With Overweight And Obesity In South Carolina: A Mini-Ethnographic Study, Shelly Campbell-Timmons

Doctoral Dissertations and Projects

The purpose of this qualitative mini ethnography adapted from traditional ethnography with limited time and scope, was to explore and understand perceptions of barriers and facilitators to health literacy among Black Americans with overweight and obesity in three South Carolina counties. Population data showed that approximately 40.3% of U.S. adults are obese. Moreover, Non-Hispanic Black communities are disproportionately affected by overweight and obesity despite efforts to combat the weight-related health risk. Still, limited health literacy should be the focus of public health strategies like teach-back and plain language communication, to address overweight and obesity prevalence and disparities. The study was …

Re-Education On Chlorhexidine (Chg) Bathing Protocol Affects Patient Chg Bathing Compliance And Surgical Site Infection (Ssi) Rates, Mary Samantha Ross

Doctoral Dissertations and Projects

Surgical site infections (SSI) are considered a hospital-acquired infection, leading to increased hospital length of stay (LOS), readmission rates, increased cost, morbidity, mortality rates, and poor postoperative outcomes. The literature review demonstrated the benefits of preoperative Chlorhexidine (CHG) bathing, but called for standardized protocols, improved education, and patient compliance. Research and clinical experience supported the need for improved patient compliance with CHG bathing. Consistent SSI rates even after protocol changes called for re-education of nursing staff in addition to addressing patient compliance issues. Therefore, providing re-education on the updated protocol, which addresses patient compliance issues, can lead to a reduction …

Standardized Screening And Monitoring Of Bioidentical Hormone Replacement Therapy In Women Ages 35–50, Amanda Ellen Hampton

Walden Dissertations and Doctoral Studies

In this quality improvement project, I evaluated a pilot implementation of a standardized bioidentical hormone replacement therapy (BHRT) screening and monitoring tool embedded within the electronic health record (EHR) at an integrative medicine practice in the southeastern United States. Grounded in the Johns Hopkins evidence based practice (EBP) model, the project addressed a documented gap in consistent screening, initiation, and monitoring of hormone replacement therapy (HRT) for women ages 35 to 50 presenting with menopausal symptoms. The practice focused question examined whether a standardized, EHR embedded BHRT screening and monitoring tool could improve screening rate compliance, laboratory monitoring adherence, and …