Digital Commons Network^™

Fall 2021

Scientia

A Decade of Progress and Success; Speech Language Pathology Program; COVID-19 Long-Hauler Study; Peer Mentors Initiative; Faculty Update; Expert Engagement: Three CSH initiatives further education and scholarship while supporting communities in need; Strategic Command: Business consultant and med tech expert Stephen Sichak helps others face pandemic challenges; Taking Care: A School of Nursing research team plumbs the pandemic experiences of nurses nationwide

Exploring The Relationships Between Emotional Intelligence, Perceived Organizational Support, Job Satisfaction, And Intent To Stay Among Minnesota School Nurses, Kristin K. Coudron

Dissertations, Theses, and Projects

School nurses face escalating job demands driven by increasing student health complexity, chronic condition management, and expanding public health responsibilities. Often serving as the sole healthcare professional within a school or district, they work in settings characterized by high autonomy, variable organizational support, and growing concerns about job satisfaction and retention. Limited empirical research has examined how personal and organizational resources jointly relate to school nurses’ intent to remain in practice. Guided by the Job Demands–Resources (JD–R) theory and the National Association of School Nurses School Nursing Practice Framework, this quantitative, correlational, cross-sectional study explored relationships among emotional intelligence, …

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Impact Of Implementing Standard Wound Care Guidelines For Patients In The Home Care Setting On Patient Outcomes, Raymond Anthony Flores Jr

Doctor of Nursing Practice (DNP) Projects

Wound care is among the most significant public health concerns, affecting millions of people worldwide. Most individuals with wounds end up self-managing their condition from their homes due to being discharged early from the hospital, owing to various reasons, and the costs associated with health care. Although home wound management offers convenience and lower costs for patients, it is also associated with substantial challenges, including limited access to and use of appropriate care protocols, wound management tools, and sufficient education on the topic, as well as limited professional advice. These limitations contribute to poor outcomes, including slow healing rates, infections, …

Improvements Upon Reprocessing Of Orthopedic Single-Use Instruments, Alyssa P. Nguyen

Master's Projects and Capstones

Internal Medline data for Hospital A, a level I academic trauma center, identified a quality gap due to improper segregation and underutilization of orthopedic single-use device reprocessing bins. The baseline reprocessing rate of 4% for orthopedic products results in missed sustainability opportunities, financial strain, and increased regulated waste. A proposed quality improvement intervention implemented updated communication strategies, visual management tools, and education modules to reinforce current reprocessing workflows and close knowledge gaps. Outcome measures include the percentage of SUDs collected for reprocessing, survey results on reprocessing awareness, and potential financial savings in Appendix I. Early data showed a 10% year-to-year …

Analysis Of U.S. Army Body Composition Policies: Implementation Effectiveness And Recommendations For Policy Enhancement At Brooke Army Medical Center, Michael L. Rizzo

Doctor of Nursing Practice (DNP) Manuscripts

US Army body composition policies (AR 600-9 and recent directives) are essential for military readiness, injury prevention, and force health protection, yet implementation gaps persist, particularly with the 2026 Department of Defense (DoD)-mandated waist-to-height ratio (WHtR < 0.55) transition. This DNP project evaluated policy implementation effectiveness at Brooke Army Medical Center using the W.K. Kellogg Foundation Logic Model and CFIR 2.0 framework. Analysis of 2022–2025 de-identified administrative data and 16 stakeholder questionnaires identified ≥10 implementation gaps, including low awareness of new standards and workload impacts. The project developed 8 evidence-based recommendations and an implementation roadmap to improve compliance, optimize resources, reduce administrative burden, and strengthen military readiness.

Implementing Updated Npo Guidelines For Inpatient Procedures, Yasamin Ghanivand

Doctor of Nursing Practice (DNP) Projects

Background: Nil per os (NPO) guidelines are utilized for patient safety during procedures to reduce the risk of pulmonary aspiration. The American Society of Anesthesiologists (ASA) recommends clear liquids up to 2 hours before non-emergent procedures, although many facilities still implement the outdated practice of ordering NPO after midnight. This practice can lead to prolonged fasting, which may cause increased hunger, thirst, hypotension, nausea, and dizziness, ultimately resulting in patient dissatisfaction and discomfort.

Purpose: To review and assess current ASA NPO guidelines that describe best practice to enhance the patient experience without increasing perioperative risk of pulmonary aspiration.

Methods: A …

The Impact Of Virtual Reality Simulation On Developing Competence And Confidence In Non-Technical Skills In Nursing. A Scoping Review, Katie Janz, Karen Clark-Burg, Khaya Morris-Binelli, Brennen Mills, Amanda Graf

Research outputs 2022 to 2026

Background: Medical errors are a global concern and can compromise patient safety, with up to 80% of these errors directly linked to non-technical skills (NTS) failures. Traditional simulation using mannikins is resource-intensive, and virtual reality simulation (VR) has the potential to offer comparable outcomes with enhanced consistency and lowered resource requirements, but the effectiveness of VR to teach and enhance NTS has been underexplored.

Aim: This scoping review explores the existing literature on VR simulation as a method for teaching NTS in nursing to evaluate whether VR simulation yields positive learning outcomes, particularly in comparison to traditional training methods such …

Impact Of A Head-To-Toe Assessment Simulation On The Self-Efficacy Of First Semester Nursing Students, Martin Dole

Nursing Faculty Publications

The transition into clinical practice presents significant challenges for first-semester nursing students, particularly related to self-efficacy and the ability to perform comprehensive patient assessments. Low self-efficacy may negatively influence clinical judgment, skill performance, and patient safety. The purpose of this Doctor of Nursing Practice project was to examine whether participation in a head-to-toe assessment simulation impacted general self-efficacy among first-semester nursing students. Guided by Bandura’s theory of self-efficacy, a quantitative, quasi-experimental, one-group pretest–posttest design was used to evaluate changes in self-efficacy following a high-fidelity simulation experience. A convenience sample of 42 first-semester Bachelor of Science in Nursing students participated in …

Beyond Screening In Amyotrophic Lateral Sclerosis: A Domain-Standardized, Measure-Flexible Framework For Comprehensive Neuropsychological Assessment, Etiane Navarro

Archives of Assessment Psychology

Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder in which cognitive, behavioral, language, and social-cognitive changes may occur across clinical phenotypes, including the ALS-frontotemporal spectrum. Neuropsychological assessment is important for characterizing nonmotor manifestations and identifying changes relevant to autonomy, everyday functioning, and clinical management. This systematic review examined literature identified through APA PsycINFO, PubMed, Google Scholar, and supplementary searching to characterize neuropsychological domains, measures, phenotype-related findings, and disease-specific limitations relevant to comprehensive assessment. Two hundred records underwent title and abstract screening, 150 reports were reviewed in full text, and 61 resources were retained for synthesis. ALS-specific screening instruments, including …

Implementation Of A Standardized Social Determinants Of Health Screening And Documentation Workflow In Primary Care, Callistus Eze Okereh

Walden Dissertations and Doctoral Studies

The completed quality-improvement project addressed inconsistent screening and incomplete electronic health record (EHR) documentation of low-income, limited family support, and transportation barriers in a primary care clinic. The nursing practice problem can disrupt access, adherence, chronic disease management, and continuity of care. The practice-focused question examined whether an ADDIE-based education program would improve social determinants of health (SDOH) screening, EHR documentation, staff knowledge and confidence, and referral or follow-up documentation during a 6- to 8-week period. The project purpose was to develop, implement, and evaluate a role-based education program and standardized workflow for clinic staff. Evidence sources were drawn from …

Implementation Of A Standardized Protocol To Improve Provider Documentation And Initiation Of Guideline-Concordant Hypertension Follow-Up Within 14 Days In Primary Care, Stella Williams

Doctor of Nursing Practice Projects

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality, yet timely follow-up after elevated blood pressure (BP) readings is not consistently documented in primary care. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a standardized hypertension screening follow-up protocol improved provider initiation or documentation of guideline-concordant follow-up within 14 days. The faculty-approved PICOT population was primary care providers in a primary care clinic; we used eligible electronic health record (EHR) encounters as the analytic records to observe provider performance. We used a quantitative pre/post design and retrospectively reviewed 30 eligible EHR encounters: 15 pre-implementation …

Effectiveness Of An Integrated Activity-Based And Tele-Monitoring Intervention On Mental Health Literacy And Resilience Among Urban Older Adults In Thailand: A Quasi-Experimental Study, Khunatpakorn Makkabphalanon, Pramote Thangkratok, Jutamast Wongjan, Natchaya Palacheewa

Journal of Health Research

Background: Mental health problems among older adults are a growing public health concern, particularly in urban areas. Mental health literacy can enhance problem recognition, self-help, and help-seeking. This study examined changes in mental health literacy and resilience among urban older adults following an integrated activity-based and tele-monitoring intervention.

Methods: A one-group quasi-experimental repeated-measures study was conducted among 30 adults aged 60 years and older in urban communities in Thailand. Participants received a structured 3-hour activity-based mental health literacy intervention followed by 1 month of tele-monitoring support. Data were collected at baseline, immediately after the intervention, and at 1-month follow-up. Changes …

Improving Provider Confidence In Suicide-Risk Screening Through Training On A Safe-T-Guided Pathway At Intake, Shukairo Mack Baker

Doctor of Nursing Practice Projects

Evidence supports structured suicide-prevention education, but inconsistent pathway use at outpatient intake prompted this quality improvement project to evaluate provider confidence. The aim was increased confidence after training on a Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) guided pathway. Donabedian's structure, process, and outcome model and the Awareness, Desire, Knowledge, Ability, and Reinforcement change model guided implementation through one Plan, Do, Study, Act cycle. A single-group pre-test and post-test design involved seven clinicians at one hybrid outpatient behavioral health clinic. All available eligible staff (100%) completed a 2.5-hour training and both surveys. The Suicide Risk Assessment Confidence Scale was administered …

Quality Improvement Project: Improving Nurse Confidence In Managing Patient Aggression Using The Brøset Violence Checklist And Team-Based Strategies, Grace Amakulor

Doctor of Nursing Practice Projects

Workplace violence remains a concern in psychiatric nursing, particularly when changes in patient behavior are not recognized early or communicated consistently. This quality improvement (QI) project was conducted at a psychiatric recovery center in Central Ohio after identifying a practice gap in aggression risk assessment and response. The purpose was to implement and evaluate a multicomponent aggression-management approach using the Brøset Violence Checklist (BVC), structured team huddles, and individualized aggression care plans. The aim was to improve nurse confidence (primary outcome) and reduce aggressive behavioral incidents (secondary outcome) over four weeks. Bandura’s Social Cognitive Theory and Lewin’s Change Theory guided …

Quality Improvement Project: Telehealth Follow-Up After Psychiatric Hospital Discharge, Ikemi Echeng

Doctor of Nursing Practice Projects

The period following psychiatric hospitalization is a high-risk transition during which inconsistent communication, delayed follow-up, and poorly coordinated referrals can create gaps in continuity of care. This quality improvement project addressed inconsistent post-discharge follow-up processes in a community outpatient mental health clinic. The purpose was to implement staff education and a structured workflow incorporating the Agency for Healthcare Research and Quality Discharge Phone Call Tool to improve staff confidence, telehealth follow-up, and referral coordination over eight weeks. A quantitative, quasi-experimental, one-group pre- and post-intervention design was used. Staff confidence was measured with Grundy’s C-Scale, and telehealth follow-up and referral activities …

Quality Improvement Project: The Impact Of Provider Education On Antipsychotic Medication Side Effects, Anthony Emego

Doctor of Nursing Practice Projects

Weight gain is a frequent and clinically relevant side effect of antipsychotic medication. A needs assessment at the project site found that roughly 55% of patients on an antipsychotic treatment had clinically significant weight gain, and providers had no formal training on how to prevent and manage this. The purpose of this quality improvement project was to determine if a provider-focused educational intervention is effective in increasing provider confidence and decreasing antipsychotic-induced weight gain in adult psychiatric patients. This quantitative, one-group pre-post design utilized Lewin's Change Theory and Bandura's Social Cognitive Theory. It was conducted at an outpatient psychiatric clinic …

Quality Improvement Project: Improving Psychiatric Provider Confidence In Prescribing Long-Acting Injectable (Lai) Antipsychotics Through A Structured Education Program, Emile Bihnyuy

Doctor of Nursing Practice Projects

Schizophrenia is a disorder that affects about 24 million people globally and needs regular antipsychotic drug management to prevent relapse. Although long-acting injectable (LAI) antipsychotics are associated with better adherence to and fewer relapses than oral antipsychotics, their use is underutilized in outpatient psychiatric care. This quality improvement project aimed to increase psychiatric providers' confidence in the prescribing of LAIs by implementing a structured 12-week education program in an outpatient psychiatric clinic in Texas. The implementation was guided by the Iowa Model of Evidence-Based Practice and the change process informed by Lewin's Change Model. Four psychiatric providers completed the modified …

Quality Improvement Project: The Impact Of Proper Utilization Of Suicidal Ideation Screening Tools, Anuoluwapo Bode-Oloye

Doctor of Nursing Practice Projects

Suicide remains a significant public health concern, emphasizing the importance of consistent and evidence-based suicide risk assessment in outpatient mental health settings. The purpose of this Doctor of Nursing Practice quality improvement project was to determine how the provider’s implementation of the Columbia Suicide Severity Rating Scales (CSSRS) according to the recommendations of the Substance Abuse and Mental Health Services Administration would impact the confidence and the rate of completion of suicidal screening tools (Columbia Suicide Severity Rating Scales) compared to current clinic policy in an outpatient mental health clinic for over twelve weeks. This project used Lewin’s change model …

Quality Improvement Project: Improve Patient Show Rate For Appointments At The Outpatient Diabetic Clinic, Smitha Mathew

Doctor of Nursing Practice Projects

Missed appointments disrupt diabetes management, delay treatment, and waste healthcare resources. This quality improvement project evaluated whether patient-centered scheduling, staff education, and multimodal communication reduced no-show rates among adults with diabetes. The Plan-Do-Study-Act model provided the theoretical and implementation framework, while Kotter’s Eight-Step Change Model guided practice change. The uncontrolled preintervention-postintervention project occurred from January through July 2026 in a hospital-based outpatient diabetes clinic. The evidence-based intervention included 45-minute staff education, scheduling based on patients’ preferred days and times, verifying contact information and communication preferences, sending telephone and text reminders, and re-engaging patients the same day after missed appointments. Appointment …

The Impact Of Provider Education On Medication Adherence In An Outpatient Psychiatric Clinic: A Quality Improvement Project, Tina Ezeh

Doctor of Nursing Practice Projects

Medication adherence is important in psychiatric care, as nonadherence can contribute to poor health outcomes and increased use of healthcare services. A needs assessment at an outpatient psychiatric clinic identified inconsistent medication adherence education, with only 30% of providers routinely providing education and 20% using a structured approach. The purpose of this quality improvement project was to evaluate structured provider education, with the aim of assessing changes in provider confidence and the frequency of medication adherence education over eight weeks. Kotter’s 8-Step Change Model guided project implementation, while the Donabedian Model was used for project evaluation. A quantitative, one-group pretest-posttest …

Quality Improvement Project: Evaluating The Impact Of An Emotional Support Program For Nurses In A Rural Outpatient Clinic, Tosheta Brown Greenfield

Doctor of Nursing Practice Projects

Nurse burnout is a persistent, well-documented threat to workforce sustainability and patient safety, with rural nurses at heightened risk due to chronic understaffing, geographic isolation, and limited access to organizational support. The purpose of this quality improvement project was to implement and evaluate an eight-week Emotional Well-Being Support Program (EWSP), with the aim of reducing burnout and perceived stress among nurses working in a small rural primary care clinic. Guided by Lewin's Change Model and the Iowa Model of Evidence-Based Practice, the project used a quasi-experimental pre-test/post-test single-group design with four participating nurses. Burnout was measured using the Maslach Burnout …

Quality Improvement Project: Providing Evidence-Based Practice Education On Administering The Edinburgh Postnatal Depression Screening During Visits Once Per Trimester And Postpartum, Megan Keeney

Doctor of Nursing Practice Projects

Perinatal depression (PND) is prevalent worldwide and frequently remains undetected and untreated due to inconsistent screening. At the project site, the Edinburgh Postnatal Depression Scale (EPDS) was administered postpartum only, without standardization. This quality improvement project implemented evidence-based provider education and a revised EPDS protocol, screening once per trimester and postpartum, to increase PND identification, provider self-confidence, self-efficacy, and behavioral health referral rates. This project was guided by Lewin’s Change Theory and the Donabedian framework. A quantitative pre-post design was used with nine providers in an outpatient women’s health clinic, alongside a retrospective and post-implementation electronic health record (EHR) review. …

Quality Improvement Project: Enhancing Suicide Recognition Protocols With The Use Of Columbia-Suicide Severity Rating Scale In An Outpatient Mental Health Practice, Pamela Oxley

Doctor of Nursing Practice Projects

Suicide prevention in outpatient mental health settings requires prompt recognition of and an appropriate response to suicide-related concerns, including those initially communicated to administrative staff. Frontline administrative phone staff may first encounter patients expressing suicidal thoughts; however, evidence supports education and standardized processes to facilitate effective recognition and response. At the project site, a practice gap existed in administrative staff preparation and confidence in responding to suicide-related concerns. The quality improvement project addressed this gap through structured, standardized Columbia-Suicide Severity Rating Scale (C-SSRS) education paired with a standardized suicide-risk stratification and escalation protocol. The project aimed to improve administrative staff …

Quality Improvement Project: Assessing Healthcare Providers’ Confidence, Familiarity, And Implementation Of The Audit-C Screening Tool For Alcohol Use Disorder In Adults With Depression In Primary Care, Babatunde Thanni Shittu

Doctor of Nursing Practice Projects

In depressed adults, alcohol use disorder (AUD) is a clinically meaningful comorbidity whose existence may go unnoticed unless a systematically introduced practice of conducting standardized alcohol-use screening is implemented. The current quality improvement (QI) project evaluated the use of the Alcohol Use Disorders Identification Test-Consumption (AUDI-C) in order to improve the capacity of healthcare providers to diagnose co-occurring AUD and integrate standardized screening into healthcare. Guided by the Knowledge-to-Action (KTA) framework and Kotter’s Change Model, the project aimed to improve provider familiarity, confidence, self-efficacy, screening, documentation, and referral practices. A pretest–posttest design was implemented with 13 licensed healthcare providers in …

Quality Improvement Project: Early Screening For Kidney Disease In Primary Care Clinics, Binsy Easow

Doctor of Nursing Practice Projects

Chronic kidney disease (CKD) is a common complication of diabetes. Evidence-based guidelines recommend urine albumin-to-creatinine ratio (UACR) screening for early identification of albuminuria in patients with diabetes; however, screening was inconsistently completed in an outpatient primary care clinic. This quality improvement project evaluated the impact of a standardized, provider-focused intervention on UACR screening completion and therapy intensification in patients with microalbuminuria. The Iowa Model served as the evidence-based practice framework, Lewin’s Change Theory provided the theoretical framework for practice change, and the Plan-Do-Study-Act cycle guided implementation and evaluation. A quasi-experimental pre- and post-intervention design was used. The intervention was delivered …

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 …

Quality Improvement Project: Determining Impact Of Mental Health Screening Provider Training, Sherri Bennett

Doctor of Nursing Practice Projects

Obesity is frequently associated with mental health concerns, yet these conditions may remain under identified when mental health screening is not consistently incorporated into medical weight-loss care. At the project site, fewer than 2% of patients who are overweight or obese were identified as needing mental health services, demonstrating a practice gap in screening and referral. The purpose of this quality improvement project was to evaluate whether targeted mental health screening education improved provider confidence. The aim was to increase confidence in conducting mental health screening among nurse practitioners in a medical weight-loss program. The Stetler Model provided the theoretical …

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 …