Digital Commons Network^™

Increasing Efficiency And Flow In Primary Care Clinics Using Triage Protocols Based On The Donabedian Model, Verneita Mun

Doctor of Nursing Practice Projects

Purpose

This project evaluated the effectiveness of triage protocols based on the Donabedian model in increasing efficiency and flow in primary care clinics. Patients experienced extended wait times in primary care clinics, resulting in aggravated outcomes and dissatisfaction with care delivery. Healthcare providers also experienced stress and burnout due to workload and operational inadequacies. These inefficiencies mandated a quality improvement approach that addressed patient satisfaction, workflow optimization, and resource management.

Methods

This project used structured triage protocol based on the Donabedian model, which addressed the dimensions of structure, process, and outcomes. The proposed solution was disseminated through a quality improvement …

Supporting Nurse Practitioner Autonomy: A Policy Proposal To Advance Hospice Np Scope, Lauren Hochart

Doctor of Nursing Practice Final Manuscripts

The Nurse Practitioner (NP) profession has achieved many advancements in its autonomy and scope of practice in the last 61 years since becoming a recognized advanced practice registered nursing role. However, some areas of healthcare still limit the NPs ability to practice autonomously even though it is within their scope of practice. This is notable in the subspecialty of hospice care with regards to certifying a terminal diagnosis as part of eligibility determination for a Medicare beneficiary to be able to receive covered hospice services. This health policy paper reviews current hospice regulations and provides evidence to support the benefits …

Exercise Prescription For Adults With Prediabetes In The Primary Care Clinic, Katherine W. Hall

Doctor of Nursing Practice Final Manuscripts

Prediabetes affects approximately one in three adults in the United States, with an estimated 10% progressing to Type 2 Diabetes Mellitus (T2DM) annually. Despite strong evidence supporting exercise as a first-line intervention to prevent disease progression, most patients in primary care settings do not receive structured physical activity counseling. This evidence-based project (EBP) aims to address this gap by implementing a standardized protocol to assess baseline physical activity levels and deliver individualized exercise prescriptions to adults with prediabetes in the primary care clinic.

Eligible participants, defined by HbA1c values between 5.70% and 6.49%, were identified during routine primary care visits …

Enhancing Emergency Department Preparedness For Amniotic Fluid Embolism Through Evidence-Based Simulation Training, Olivia M. Smoak

Doctor of Nursing Practice Final Manuscripts

Maternal mortality in the United States remains a significant and worsening public health concern, with increasing reliance on emergency departments (EDs) as access points for maternal care. Emergency clinicians are therefore more likely to encounter high-acuity obstetric emergencies, including maternal cardiac arrest and amniotic fluid embolism (AFE), yet often receive limited formal training in these conditions. Simulation-based education, interdisciplinary training, and cognitive aids have been identified as effective strategies to improve performance in high-risk, low-frequency events.

The purpose of the evidence-based practice project was to evaluate whether an interdisciplinary simulation with obstetric-led debrief and introduction of the AFE checklist improves …

Innovating Adhd Care: A Doctoral Capstone On A Pilot Adult Adhd Diagnostic Clinic Implementation, Fozia Aman

Doctor of Nursing Practice Final Manuscripts

Objective: To evaluate whether an APRN-led pilot Adult ADHD Diagnostic Clinic within a large academic healthcare system in the San Diego area improves timely access to diagnostic evaluation and optimizes care disposition for adults with suspected ADHD.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by inattention and/or hyperactivity-impulsivity that interferes with functioning in daily life. It often emerges in childhood and persists into adulthood, affecting approximately 360 million adults globally. Despite its prevalence and associated functional and psychiatric burden, adult ADHD remains underdiagnosed and undertreated due to limited primary care training, stigma, and reduced access to psychiatric services, resulting in delayed …

Improving Transition To Adult Care: Assessing Health Insurance Literacy In Adolescent Patients With Congenital Heart Disease, Kaitlyn V. Mudge

Doctor of Nursing Practice Final Manuscripts

Background: With advances in surgery and medical management, 95% of children with congenital heart disease (CHD) survive into adulthood. Transition to adult care is an intricate process. Up to 60% of adolescents fail to follow through with cardiology care, facing three times the risk of needing emergency services. Only 25% of young adults with CHD knew of the need to change their care to an adult provider and to acquire health insurance as an adult. One barrier to successful transition is a lack of insurance coverage and limited insurance health literacy. Higher insurance literacy is associated with increased utilization …

Strength In Numbers: Six Nursing Faculty Embark On A Shared Journey To Doctorate Success, Melissa P. Arthur, Leigh Moore

Inquiry: The Journal of the Virginia Community Colleges

Pursuing a Doctor of Nursing Practice (DNP) is a demanding and transformative experience, one that can be both daunting and profoundly rewarding. This article chronicles the journey of six dedicated nursing faculty and administrators from Southside Virginia Community College (SVCC) who undertook this challenge together, turning an academic endeavor into a shared mission of growth, resilience, and collaboration. Originating from a spontaneous suggestion, this collective pursuit of doctoral education evolved into a powerful example of professional solidarity.

As seasoned educators and leaders, the group had previously collaborated on pivotal institutional milestones such as ACEN accreditation, Board of Nursing improvement initiatives, …

Culturally Competent Nurse-Led Education To Reduce Delayed Diagnosis And Increase Awareness Of Polycystic Ovary Syndrome In Reproductive-Aged South Asian Women, Madeeha Syeda

Honors College Theses

Polycystic ovary syndrome (PCOS) is a common condition that affects hormones in women, especially in their 20s and 30s. Symptoms of PCOS include irregular periods, abnormal hair growth, acne, obesity, hyperpigmentation of the skin, cysts, skin tags, thinning hair, and infertility (Newin, 2023). While the exact cause of PCOS is unknown, it is linked to insulin resistance, higher levels of androgens, and low-grade inflammation (Newin, 2023). In regards to complications, PCOS can increase risk for gestational diabetes, preeclampsia, preterm term, and C-section deliveries. In terms of treatment, there is no cure but early diagnosis is key to reducing symptoms (Newin, …

Improving Antihypertensive Medication Adherence Through Education And Follow- Up Phone Calls In A Primary Care Setting, Sarah Peterson

Doctor of Nursing Practice Final Manuscripts

Hypertension affects nearly half of adults and significantly increases the risk of stroke and cardiovascular disease; however, poor medication adherence remains a primary barrier to effective blood pressure management. The purpose of this evidence-based practice (EBP) project was to improve antihypertensive medication adherence among adult patients in a primary care setting. Guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care, the project utilized a pre-test/post-test design at a private practice clinic. The sample included adults with a hypertensive diagnosis and active prescriptions. Medication adherence was defined as the Morisky Medication Adherence Scale (MMAS-8) scores, measured before and …

Closing The Gap: Integrating A Standardized Depression Screening In Primary Care, Cyndy Marie Oreas

Doctor of Nursing Practice Final Manuscripts

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Text Message Delivery Of Pre-Procedural Recommendations Prior To Lip Augmentation With Hyaluronic Acid Filler: An Evidence-Based Pilot Project, Jenna De Jonge

Doctor of Nursing Practice Final Manuscripts

Patients seeking lip augmentation procedures commonly experience self-resolving soft-tissue complications such as swelling and bruising. There are many widely accepted pre-procedural recommendations available to help patients minimize the risk of these undesirable outcomes. At a Medical Aesthetics practice in Southern California, lip augmentation patients often arrived to their appointment non-adherent to pre-procedural recommendations that were available on the practice website. Text message delivery systems have been used to improve patient adherence to healthcare instructions across a variety of healthcare settings. To address this gap, I implemented text message delivery of pre-procedural recommendations to lip augmentation patients prior to their appointment. …

Optimizing Lactation Support: Enhancing Patient-Centered Care And Breastfeeding Self Efficacy Through Data-Driven Survey Analysis, Jessica L. Doshay

Doctor of Nursing Practice Final Manuscripts

Objective: The objective of this project was to implement evaluation of an integrated lactation support model within a multi‑site pediatric primary care organization to assess patient experience and breastfeeding confidence associated with a lactation consultation.

Background: Optimizing the patient experience is an indicator of healthcare quality. Improving breastfeeding outcomes remains a national priority. Structured lactation support delivered by International Board-Certified Lactation Consultants (IBCLCs) enhances breastfeeding outcomes, the impact of this is often undocumented in primary care settings.

Methods: This quality improvement project was conducted within the lactation department of a multicenter pediatric clinic in Southern California. Pediatric clinicians who were …

Implementation Of Comprehensive Checklist For Opioid Use Disorder Treatment In Primary Care, Sophia R. Madden

Doctor of Nursing Practice Final Manuscripts

Background: The escalating opioid crisis demands a comprehensive approach to Opioid Use Disorder (OUD) management. Patients often face comorbid mental illnesses, infectious diseases, concurrent substance use, and social determinants of health (SDOH)—all of which increase the risk of treatment attrition. Standardizing care through evidence-based clinical practice guidelines and tools is essential for improving treatment quality and consistency.

Purpose: This project aimed to increase comorbidity screenings and improve resource access for OUD patients at a San Diego Internal Medicine primary care office by implementing a comprehensive care checklist based on the American Society of Addiction Medicine (ASAM) guideline.

Methods: The ASAM …

Increasing Access To Medications For Opioid Use Disorder For All Justice-Associated Populations, Edgar Rodriguez

Doctor of Nursing Practice Final Manuscripts

The purpose of this paper is to support a federal mandate requiring universal access to medication of opioid use disorder for all the justice-involved populations. The policy proposal aims to standardize evidence-based treatment across correctional systems, improve treatment initiation during incarceration, strengthen continuity of care after release, reduce overdose mortality, and address disparities in access for racial and economic groups and rural communities. This policy paper calls for the increase of access to medications of opioid use disorder across the United States for all justice-involved population. The opioid crisis has created a public health problem in the United States by …

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Poor Compliance With Private Nursing And Midwifery Practice Guidelines In Urban Settings In Uganda, Dan Muramuzi, Edson Atwine, Barbara Okiror, Mercy Muwema, Christine Nimwesiga, Laban Muteebwa

School of Nursing & Midwifery, East Africa

Background: Optimal compliance with private practice guidelines is one of the core components of quality improvement in nursing and midwifery professions. Private nursing and midwifery practice guidelines in Uganda were introduced in 2019. However, little has been documented about compliance with these guidelines, despite playing a crucial role in ensuring safe nursing and midwifery practice and maintenance of professional standards.  We assessed the compliance with private nursing and midwifery practice guidelines of Uganda (2019) and explored barriers to optimal compliance with these guidelines in private health facilities licensed by the Uganda Nursing and Midwifery Council (UNMC) in Kampala Metropolitan …

Descriptive Qualitative Study Of Nursing Students' Perceptions And Behaviors During Student-Led Class Sessions In Uganda, Proscovia Nakaye, Veronica Nakkonde, Mercy Muwema, Grace Nakate

School of Nursing & Midwifery, East Africa

Introduction: Student-led class sessions are a pedagogical approach where students actively engage in the learning process, influencing content, activities, and pace. This method fosters independent learning, communication skills, and teamwork. While some studies have shown the effectiveness of student-led sessions, nursing students often exhibit challenges, such as inattention and negative attitudes, affecting the quality of learning and patient care. Understanding nursing students' perceptions and behaviors in this context is essential for improving nursing education.

Methods: This descriptive qualitative study aimed to explore nursing students' perceptions and behaviors during student-led class sessions at Uganda Christian University. Sixteen direct-entry nursing students …

Prevalence Of Teenage Pregnancy And Associated Factors Among Adolescent Girls In Bobi Subcounty, Northern Uganda., Grace Auma, Margaret Alioru, Geoffrey Kaujju, Grace Nakate

School of Nursing & Midwifery, East Africa

Methodology: A Cross-sectional study design. A survey was conducted among 4893 married girls aged 15-19 years using quantitative methods. Quantitative data was collected through the structured questionnaire, which was administered, data was collected and entered in EPI-INFO 2020 software, and was cleaned and analyzed using STATA version 15.0. Binary logistic regression was done to examine the factors independently associated with teenage pregnancy. A multistage sampling technique was used.

Results: Our study showed that the prevalence of teenage pregnancy in Bobi Sub-County, Omoro District, is high at 27.5%. Significant Factors contributing to the likelihood of teenage pregnancy included those …

Structures And Processes Of Critical Care Nursing Practice: Insights From Four Ugandan Intensive Care Units, Dominic Ogwal Savio, Edrisa Ssemwanga, Winter Patrick, Lameck Ssemogerere, Cliff Aliga

School of Nursing & Midwifery, East Africa

No abstract provided.

Extending The Global Impact Of Dnp Education: Integrating Scholarly Dissemination And International Practice Projects, Cynthia Plonien, Pricilla Muisyo, Deborah Behan, Kristine Cope, Cathy Brown

Nursing Faculty Publications & Presentations

The Doctor of Nursing Practice (DNP) Program at the University of Texas at Arlington initiated a global outreach effort in 2024 through two complementary strategies: expansion of a digital repository to support dissemination of DNP scholarly work and implementation of pilot DNP projects in Kenya. Together, these initiatives represent an integrated model for global engagement that combines knowledge dissemination with application of practice-based scholarship. The repository has facilitated international access to DNP projects, demonstrating significant global reach across multiple countries. Concurrently, a pilot project in Kenya was established through a strategic in-country professional partnership, enabling culturally relevant and sustainable implementation …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Promoting Foot Care Health In Individuals Recovering From Addiction: A Collaborative And Community-Based Nursing Intervention, Erika Frahm, Kayla Goodrow, Zoe Hofmaister, Jaycie Inouye, Shuma Katori, Caleb James Maza, Fauzia Tomno

Nursing Leadership in Community Engagement Projects

As housing instability and homelessness increase in King County, many basic needs, including foot care, are often unmet. According to a study on foot health among vulnerable populations, individuals may be unable to perform proper foot care due to prioritization of basic daily needs over preventative care (Razmus, 2023). Research indicates that foot-related complications are highly prevalent among vulnerable populations and may worsen without timely intervention (Haughton et al., 2026). Barriers such as fear of stigmatization and untreated mental health conditions can also limit access to healthcare services (Kimball et al., 2023). These statistics inspired the purpose of this community …

Parent-Focused Resource And Staff Crisis Tool For Addressing Teen Suicidal Ideation, Maya Ewing, Jasmine Crisan, Delaney Fewel, Brandon Fung, Kaylee Cornejo, Alyssa Arthur, Christine Elayda

Nursing Leadership in Community Engagement Projects

The team of seven Seattle Pacific University nursing students partnered with an agency that functions as a family resource center. The agency provides emergency shelter, mobile outreach, and basic needs to families in King County. The team created an evidence-based solution focused on education for suicide prevention. Additionally, the team identified a gap in available staff clinical resources during emergencies.

Implementation Of A Provider-Focused Multimodal Educational Initiative To Address Polypharmacy And High-Risk Medication Use In A Home And Community Medicare Advantage Setting, Jennifer Butler-Rickard, Kellie Olsen, Eileen Stuart-Shor, Craig Drew

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Community-dwelling adults are at risk for adverse drug events such as falls, hospitalizations, cognitive decline, drug-to-drug interactions, and mortality related to high-risk medication use and polypharmacy, often defined as concurrent use of five or more different medications. Lack of provider knowledge of polypharmacy and high-risk medication use as well as suboptimal communication with primary care providers can lead to gaps in medication management in this vulnerable population.

LOCAL PROBLEM: Patients seen by the Comprehensive Annual Health Assessment Program advanced practice clinicians (APCs) at the project Medicare Advantage insurer organization often experience polypharmacy. Given the lack of provider knowledge of …

Staff Education To Improve Treatment Adherence Among Young Adults With Mental Health And Substance Use Disorders In An Outpatient Behavioral Health Clinic, Nkechinyere Eririma Nwachukwu

Walden Dissertations and Doctoral Studies

No abstract provided.

Improving Antihypertensive Medication Adherence Through Patient-Centered Assessment In Rural Primary Care, Tiesha Keoni Mathis

Walden Dissertations and Doctoral Studies

No abstract provided.

An Emotional Intelligence Staff Education Program For Patient-Aligned Care Team (Pact) Members, Linda Rogers

Walden Dissertations and Doctoral Studies

No abstract provided.

Staff Education To Improve Fall Prevention Knowledge In A Transitional Care Unit, David M. Ogato

Walden Dissertations and Doctoral Studies

No abstract provided.