Digital Commons Network^™

Telepsychiatry Follow-Up To Reduce Emergency Department Visits In Adults With Bipolar Disorder, Obianuju Tobechukwu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project involved the development of a clinical practice guideline (CPG) for implementing structured telepsychiatry follow-up visits to reduce relapse rates and emergency department (ED) use among adults with bipolar disorder. The project addressed the growing need for accessible, evidence-based psychiatric follow-up care, particularly for patients facing barriers to consistent in-person visits. The practice-focused question guiding this project was: In adults with bipolar disorder, how do structured telepsychiatry follow-up visits, compared with in-person visits, affect relapse rates and Ed utilization? A systematic review and critical appraisal of current evidence were conducted using the Johns Hopkins …

Quality Improvement Project: Enhancing Nurse Communication, Courtesy, And Respect At The Bedside, Rachel Kemp

Doctor of Nursing Practice Projects

Effective communication is key to the nurse-to-patient relationship, patient outcomes, and patient satisfaction. The literature widely shows that barriers such as increased workplace violence and fear and biases within patient interactions hinder communication. This quality improvement project aimed to enhance nurse-to-patient communication, using an evidence-based tool, and leveraged Foli’s Theory of Nurses’ Psychological Trauma to explain and predict barriers. Success is measured by improvement of patient experience in the three nursing domains; courtesy and respect, listen to you, and explain in a way you understand. Lewin’s Change Theory and the plan, do, study, act (PDSA) framework was used to promote …

Quality Improvement Project: Building Competence And Confidence: Updating Nursing Faculty Knowledge Of The Flipped Classroom Model, Jamie Newman

Doctor of Nursing Practice Projects

The increasing complexity of healthcare requires undergraduate nursing education to move beyond traditional lecture-based instruction toward teaching strategies that promote clinical judgment. Although the flipped classroom model is shown to support these outcomes, faculty at the project site reported uncertainty and inconsistency in flipped classroom implementation. The purpose of this quality improvement project was to evaluate the impact of a structured, evidence-based faculty development intervention on undergraduate nursing faculty confidence, readiness, and competence to implement the flipped classroom model. Guided by Lewin’s Change Theory and the Stetler Model of Evidence-Based Practice, this quality improvement project used a quantitative, pre-experimental one-group …

Quality Improvement Project: Implementation Of The Surgical Safety Checklist To Improve Adherence To Time-Out At In-Office Procedure, Funke Osaremwinda

Doctor of Nursing Practice Projects

Surgical errors in ambulatory and in-office procedural settings continue to rise despite well-established safety standards, such as the time-out (TO) protocol. Literature consistently links non-adherence to the TO protocol to preventable events such as wrong patient, wrong site, or wrong surgery. At the cardiovascular ambulatory clinic where the quality improvement (QI) project was implemented, the baseline needs assessment indicated inconsistent TO practices and the absence of a standardized tool to support TO. The purpose of this project was to improve adherence to the TO safety protocol through staff education and implementation of the evidence-based World Health Organization (WHO) Surgical Safety …

Quality Improvement Project: The Impact Of Hypertension Management Education In Primary Care, Toyin K. Aliu

Doctor of Nursing Practice Projects

Hypertension (HTN) is one of the leading causes of clinic visits and prescription medication use in primary care settings. Despite the availability of evidence-based guidelines to improve HTN management, adherence in clinical practice is often lacking. At the project site, 30% of patients have uncontrolled HTN. This is attributed to providers’ inadequate knowledge of the JNC-8 HTN management guidelines and inconsistent adherence to them. This project aimed to improve hypertension management in a primary care setting by educating providers on the JNC-8 guidelines to enhance adherence to evidence-based practices over six weeks. The purpose was to align medical providers with …

Improving Benzodiazepine Refill Workflow And Communication Via Telehealth Using A Standardized Sbar Protocol, Hendricks Agwu

Doctor of Nursing Practice Projects

The development in telehealth operations in outpatient mental health care has enhanced access to care at the expense of creating challenges in communication and workflow, especially when it comes to dealing with high-risk substances like benzodiazepines. The role ambiguity, inaccurate refill timeline, documentation lapses and high chances of medication errors are caused by inconsistent communication during the process of telehealth refills. This quality improvement project was aimed at assessing the effects of applying a standardized Situation, Background, Assessment, Recommendation (SBAR) communication and documentation protocol to workflow efficiency, interprofessional communication, and medication safety when making benzodiazepine refills in a telehealth outpatient …

Quality Improvement Project: The Influence Of Education On Provider Self-Efficacy And Utilization Of The Columbia Suicide Severity Rating Scale (C-Ssrs), Doreen Nwaogwugwu

Doctor of Nursing Practice Projects

Suicide remains one of the leading causes of death worldwide, underscoring the critical need for consistent, evidence-based suicide risk screening in mental health facilities. Despite being a validated, evidence-based tool, the use of the Columbia Suicide Severity Rating Scale (C-SSRS) is often hindered by inadequate provider training. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the impact of provider education on self-efficacy and utilization of the C-SSRS in an outpatient mental health clinic. This quality improvement project used a quasi-experimental, one-group pretest-posttest design guided by the Health Belief Model, Lewin’s Change Theory, and the …

Quality Improvement Project: Impact Of Evidence-Based Self-Care Practice On Burnout In Nursing Faculty, Lori Boyd

Doctor of Nursing Practice Projects

Nursing faculty burnout is a national concern supported by literature, which compromises faculty well-being, creativity, retention, and sustainability of nursing programs. Burnout is characterized by the subscales of emotional exhaustion, depersonalization, and feelings of reduced personal accomplishment. At the project site, leaders reported that faculty often left their roles due to increased workload and being overwhelmed by the rigorous expectations of the role, underscoring the need for a process to support nursing faculty burnout. This quality improvement (QI) project aimed to evaluate the impact of evidence-based self-care practices on nursing faculty burnout using Maslach's Burnout Inventory Toolkit, a valid and …

Clinical Practice Guideline For Universal Anxiety Screening For Advanced Practice Providers, Kelechi Blanton

Walden Dissertations and Doctoral Studies

This project was a clinical practice guideline (CPG) focused on anxiety screening in a primary care setting using the Generalized Anxiety Disorder (GAD-7) screening tool. The practice problem addressed general anxiety disorder and the need for standardized assessments for risk, as recently been recommended by the U.S. Prevention Service Task Force (USPSTF). Anxiety disorder is common but frequently untreated, due in part to low rates of screening. Lack of an evidence-based guideline for anxiety screening may contribute to delayed diagnosis and inconsistencies. The practice-focused question was, Does the evidence support development of an evidence-based CPG for universal anxiety screening in …

Improving Blood Pressure Control In Home Care Patients Through Implementation Of Acc/Aha Hypertension Guidelines And Structured Blood Pressure Monitoring, Farrah Lynn Yuille

Walden Dissertations and Doctoral Studies

This clinical practice guideline addressed the practice problem of the lack of standardized and consistent hypertension management in the home setting. Addressing this practice problem is important within nursing practice, as uncontrolled blood pressure increased the risk of hospitalizations, emergency department visits, and long-term cardiovascular complications. The practice question focused on translating evidence-based hypertension guidelines into clinical practice and evaluating their impact on patient outcomes in the home care setting. The purpose of the project was to engage three voluntary participants in evaluating the clinical practice guideline per the American College of Cardiology and American Heart Association hypertension guidelines within …

Staff Education Using A Workplace Violence Reduction Bundle, Julla Panneh

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) quality improvement project addressed the ongoing issue of workplace violence (WPV) among medical-surgical nurses in an acute care setting. WPV poses significant risks to staff safety, psychological well-being, and the overall care environment. Guided by current evidence and professional guidelines, the project implemented a structured educational intervention focused on the Workplace Violence Reduction Bundle, incorporating the Broset Violence Checklist (BVC) and evidence-based de-escalation strategies. Medical-surgical nursing staff participated in tailored educational sessions; knowledge was assessed through pre- and post-intervention surveys, and program acceptability was evaluated through staff feedback. Data analysis revealed modest improvements in …

Psychiatric Nursing Staff Promoting The Use Of Long-Acting Injectables Antipsychotics, Yetunde Oloto

Walden Dissertations and Doctoral Studies

This project is a staff education aimed at improving psychiatric staff knowledge regarding the use of long-acting injectable (LAI) antipsychotics among patients with schizophrenia. The practice problem addressed was the limited use of LAIs among psychiatric nurses when treating schizophrenia patients, which contributes to medication non-adherence and subsequent relapse, hospitalization, increased healthcare costs, and diminished quality of life. In nursing practice, this problem is important because nurses are frontline practitioners who administer medications, provide education, and monitor patient adherence. The problem-focused question developed was “Among psychiatric nurses, does staff education on the use of long-acting injectable antipsychotics compared to oral …

Staff Education To Decrease Polypharmacy And Improve Medication Adherence In Older Adults In Primary Healthcare Settings, Nadine Pean Noel

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education initiative to address polypharmacy and increase medication adherence among older adults in a primary care setting. Polypharmacy is a prevalent and significant safety concern in older adults, increasing the risk for adverse drug events, medication nonadherence, hospitalizations, and decreased quality of life. The purpose of the project was to implement and evaluate a structured staff education focused on evidence-based strategies for medication review, deprescribing, and the integration of smartphone-based adherence tools. The practice-focused question guiding this project was as follows: Will an evidence-based staff education program focused on polypharmacy …

Staff Education To Nurses To Lmprove Routine Foot Examinations For Diabetic Patients, Sarah Abrefi

Walden Dissertations and Doctoral Studies

Diabetes-related foot complications remain a significant cause of morbidity, hospitalization, and lower-extremity amputation, despite strong evidence supporting routine preventive assessments. In many outpatient settings, variability in nursing knowledge, skill, and documentation practices contributes to inconsistent implementation of comprehensive diabetic foot examinations. The purpose of this practice-focused quality improvement project was to evaluate the effectiveness of a structured staff education program designed to improve nurses’ knowledge and competency in performing comprehensive diabetic foot assessments in an outpatient diabetes clinic.A pretest–posttest evaluative design was used to measure changes in knowledge following the educational intervention. Ten registered nurses participated in a structured educational …

Prevalence And Factors Associated With Delayed Surgery Among Children With Wilms Tumor At Mulago Hospital: A Mixed-Method Study, Lule Daniel, Shamim Nabidda, Abraham Muhwezi, Ronald Naitala, Anne Akullo, Enid Kawala Kagoya, Ruth Namazzi, Nasser Kakembo, Joan N. Kalyango

School of Nursing & Midwifery, East Africa

Introduction:  Wilms tumor (WT) is a highly treatable form of childhood cancer, with five-year survival rates greater than 90% in high-income countries. In low- and middle-income countries, survival is still low. Delayed surgery is one of the leading factors for poor survival, as it leads to tumor complications, making subsequent treatment more complex. However, there is a paucity of information in Uganda on the prevalence and factors associated with delayed surgery. This study aimed to determine the prevalence and factors associated with delayed surgery, and to explore the barriers and facilitators of timely surgery among children with WT at …

Staff Education To Improve Rn Accountability In Interdisciplinary Rounds Using Qr Code Tracking, Jennifer L. Zimmerman

Walden Dissertations and Doctoral Studies

Interdisciplinary rounding is essential for effective communication, coordinated care, and patient‑centered decision‑making; however, baseline observational audits on pediatric inpatient units at a large northeastern hospital revealed that nurses were present for only 54% of rounding opportunities, with no formal accountability process. This Doctor of Nursing Practice project aimed to improve registered nurse (RN) engagement and accountability in interdisciplinary rounds through a structured staff education intervention paired with a QR code–based tracking process. The practice‑focused question examined whether educating nursing staff on a QR code rounding system would increase nurses’ knowledge of rounding expectations and positively influence accountability behaviors. Fourteen RNs …

Staff Education On Preventing Benzodiazepines Related Falls In Older Adults, Dafnee Gilles

Walden Dissertations and Doctoral Studies

In geriatric psychiatric setting, falls rates are higher than general wards and could reach up to 13-25 falls per 1000 hospital days. High use of benzodiazepines in older adults is a major cause of increased falls despite recommendations to avoid its prescription to the population. This DNP staff education project focused on training nurses working in an 80 bed capacity geriatric psychiatric facility on best evidence based practice of preventing falls associated with use of BZDs. The identified practice issue was knowledge deficit on evidence based best practices to prevent falls in older adults under BZDs medications. The project aims …

Staff Education Project Staff Education To Integrate Nutrition Into Mental Health Care In An Acute Medical Setting, Yolene Auguste

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education initiative designed to support the implementation of a protocol that integrates nutrition and mental health screening in an acute medical setting. The practice problem addressed inconsistent identification of nutrition-related needs and mental health concerns, along with variable follow-through on referral pathways, limiting holistic care and contributing to unmet needs during and after hospitalization. Nutrition and mental health are bidirectionally related, with dietary quality and lifestyle factors influencing mental health outcomes and overall well-being (Dubois & Giroux, 2025). The practice-focused question guiding this project was: In adult patients receiving care …

Immediate Skin-To-Skin Contact At Very Preterm Birth And Effect On Infant Socio-Emotional Stress Response And Mother–Infant Cortisol Co-Regulation: Secondary Outcomes From The Randomised Clinical Immediate Parent-Infant Skin-To-Skin Study (Ipistoss), Karoline Lode-Kolz, Siri Lillieskold, Hanne Brit Hetland, Eleonora Mascheroni, Stina Klemming, Hanne Pike, Agnes Linner, Nils J. Bergman, Bjorn Westrup, Ulrika Ådén, Evalotte Morelius, Rosario Montirosso, Wibke Jonas, Siren Rettedal

Research outputs 2022 to 2026

Objective To explore the effects of immediate parent–infant skin-to-skin contact (iSSC) at very preterm birth on maternal–infant behavioural responses and hypothalamic–pituitary–adrenal (HPA) axis reactivity to age-appropriate socio-emotional stress at 4months corrected age. Design Two secondary outcomes from a multicentre randomised controlled trial with two non-blinded parallel groups. Setting Three Scandinavian neonatal intensive care units, level 2 and level 3. Participants 91 infants born at gestational age 28+0to 32+6 from April 2018 to June 2021. Singletons and twins with a second caregiver present were included, regardless of mode of birth. Higher-order births, infants with congenital infections and major malformations were excluded. …

Staff Education To Improve Knowledge On Early Recognition Of Staff Burnout In Nurses Working In Long-Term Care, Geraldine Ndeng Akonwah

Walden Dissertations and Doctoral Studies

This doctoral project was a practice-based staff education project aimed at educating nurses concerning early burnout recognition. The educational intervention was chosen to promote awareness and knowledge related to the concept of burnout and self-care among nurses employed in a long-term care facility. The practice problem addressed was the high prevalence of nurse burnout and the limited ability of nurses to recognize early signs of burnout. The problem is significant in nursing practice as burnout is detrimental to the clinical judgment, patient safety, job satisfaction and staff retention. The guiding question of the project was as follows: Does a staff …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Sexual And Gender Minority Nurses’ Minority Stress In The Workplace: A Scoping Review, Justin Chavis, Robin Dawson Phd, Rn, Cpnp-Pc, Faan, Liam C. Hein

Faculty Publications

Background

Purpose

Methods

Prevalence Of Premenstrual Syndrome, Premenstrual Dysphoric Disorder, And Dysmenorrhea In Nursing Students: A Systematic Review, Meta-Analysis, And Evidence-Based Recommendations, Sabyasachi Maity, Bharathi Gadad, Hansapani Rodrigo, Seham Noorani, Ayesha Usman, Chloe Lark, Mona Attarpour, Ivy Mageto, Lucas Schwartz, Nikhilesh Anand

School of Medicine Publications

Introduction: Menstrual disorders—including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea—are highly prevalent among women of reproductive age and are associated with impaired academic performance, psychological distress, and reduced social functioning. Nursing students are particularly vulnerable due to the combined demands of intensive academic schedules and clinical training, yet prevalence estimates and institutional responses remain inconsistent.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251109363). PubMed, Scopus, Web of Science, CINAHL Ultimate, and APA PsycINFO were searched for studies published between 2016 and 2025. Eligible studies reported prevalence or …

Nurse-Led Telehealth Quality Improvement Initiative For Chronic Disease Management In Rural North Dakota, Alona J. Jarmin

Walden Dissertations and Doctoral Studies

In this quality improvement project, I assessed a telehealth-enhanced care coordination model in a rural primary care clinic to improve chronic disease management for adults with limited access to in-person services. The issues addressed included delayed follow-up, inconsistent self-management support, and limited continuity of care, which significantly affect rural populations and health equity. The purpose of this doctoral project was to evaluate whether a structured telehealth follow-up protocol improved key care coordination outcomes, appointment adherence, follow-up timeliness, and documentation completeness for rural adults receiving chronic disease management services. In this project, I employed a pre-/postimplementation evaluation design using de-identified electronic …

Program Proposal For A Nurse Led Pre-Procedure Readiness Program, Walter Magramo

Walden Dissertations and Doctoral Studies

Same-day outpatient procedural cancellations represent a persistent challenge for healthcare organizations, negatively affecting patient safety, access, operational efficiency, and financial performance. This Doctor of Nursing Practice (DNP) executive leadership project proposes the implementation of a nurse-led, artificial intelligence (AI)–enhanced preprocedural readiness program within an outpatient procedural department. The initiative integrates standardized nurse-led readiness checklists, AI-supported clinical decision support embedded in the electronic health record, structured nurse-led outreach, and standardized patient and staff education to proactively identify and address preventable barriers to procedural readiness. Internal organizational data identified a sustained same-day cancellation rate of approximately 22%, with most cancellations attributable to …

Mitigating Throughput Delays, Sherry Cabebe-Jacolbia

Walden Dissertations and Doctoral Studies

Throughput widely affects all healthcare organizations. The patient care quality gap centers on throughput because poor flow and boarding causes overcrowding, leading to adverse outcomes and mortality. The practice-focused question was: How can the hospital throughput be improved to help prevent adverse effects when boarding in the emergency room (ER) for a long period of time? This process improvement project was implemented by multidisciplinary teams who addressed barriers in patient flow in real-time. The implementation stage showed boarding time in August of 2025 of 4,275 minutes to October 2025 of 2,545 minutes. The throughput performance trending scorecard of the metrics …

Staff Education On Motivational Interviewing And Culturally Responsive Education To Reduce No-Shows And Appointment Cancellations, Aisha Adigun

Walden Dissertations and Doctoral Studies

No-show and late appointment cancellations remain significant challenges in outpatient psychiatry clinics, negatively impacting continuity of care, clinic efficiency, and patient outcomes. Motivational interviewing (MI) and culturally responsive communication are evidence-based approaches that support patient engagement and understanding, yet they are not consistently incorporated into staff education related to appointment adherence. This project evaluates whether staff education on MI and culturally responsive communication increases staff knowledge and skills in educating patients about no-show and appointment cancellation policies and whether this education contributes to improved appointment attendance. A pre–post intervention design will be used in an outpatient psychiatry clinic. Clinical and …

Multimodal Interventions To Assist In Reducing No Show Rates In An Outpatient Primary Care Setting, Amelia Barber

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) incorporated a Clinical Practice Guideline (CPG) approach to address a practice issue of increased no show rates of patients scheduled for follow-up appointments in an adult outpatient primary care setting. Missed appointments symbolize a long-standing practice problem in ambulatory care, exacerbating challenges like healthcare expenses, fragmented care, inefficient resource utilization, and delayed treatment often resulting in negative patient outcomes. The project’s purpose was to develop an evidence-based CPG with integrated multimodal patient outreach strategies, including patient portal, text messaging, transportation support, and live reminder calls within Electronic Health Record (EHR) system to prevent and/or …

The Importance Of Timely Documentation Of Updates On Patients’ Records In Improving Documentation Accuracy And Reducing Clinical Errors At The Home Health Agency, Sandra Aigbekaen

Walden Dissertations and Doctoral Studies

Timely and accurate documentation is essential to patient safety, care coordination, and risk reduction in home health care. In this Doctor of Nursing Practice project, I implemented an evidence-based educational intervention to improve documentation practices among clinicians at a pediatric home health agency in the southwest United States. Guided by the analyze, design, develop, implement, and evaluate (ADDIE) instructional design model, I conducted the project to evaluate whether focused education would improve documentation accuracy, consistency, and timeliness. A targeted literature review on electronic health record (EHR) best practices, structured documentation, and patient safety informed the development of five training modules …

Developing A Comprehensive Program Plan For Postpartum Mental Health Assessment And Follow-Up Care, Kimberly Osborne

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an executive leadership proposal to develop an evidence-based program plan for standardized postpartum mental health screening and structured referral processes within an obstetric clinic. The practice problem was inconsistent postpartum mental health screening and follow up. Internal organizational data demonstrated elevated no-show and cancellation rates among obstetric patients referred for mental health services, reflecting gaps in care coordination, particularly for rural and underserved populations. The purpose of this project was to develop a comprehensive program plan guided by the following practice-focused question: Will a standardized postpartum mental health screening and structured referral program …