Digital Commons Network^™

Predictors Of Complications Among Adult Patients Diagnosed With Type 2 Diabetis Mellitus At Thika Level Five Hospital, Kenya, Bernard Wambua Mbithi

MSc in Advanced Practice Nursing

Introduction: Despite advances in the management of Type 2 diabetes mellitus (T2DM), anecdotal reports from Thika Level Five Hospital indicate that patients still present with diabetes mellitus-associated complications. Therefore, this research aimed to determine the predictors of complications among adult patients diagnosed with T2DM in the hospital.

Methodology: Analytical cross-sectional design was utilized in this research. To select the respondents, purposive sampling was used to recruit six nurse managers and their deputies (making a total of 12 nurses), while 294 patients in the clinic were recruited using systematic sampling. Purposive sampling was also used to recruit 15 patients …

Bridging Disability Studies And Nursing Education: A Curricular Intervention, Serena Karim

2025 Fall Honors Capstones Projects - Archive

Although one in four Americans experience disability in their lifetimes, the majority of nurses and other healthcare professionals feel ill-prepared to care for patients with disabilities (PWD). Factors such as inaccessible healthcare facilities, insufficient clinical knowledge, and biases about the quality of life of PWD contribute to mounting health inequities between PWD and non-disabled people. To further understand how education can impact nursing students’ comfortability and confidence toward caring for PWD, a 30-minute disability studies lesson was implemented for junior-level nursing students. 51 students who attended the lecture provided anonymous pre- and post-lecture surveys, which contained Likert scale and free …

Improving Patient Access To Providers By Optimizing Message Center Workflow, Serena Valino

Walden Dissertations and Doctoral Studies

This project was an evaluation of a quality improvement initiative that addressed the practice problem of having large volumes of unanswered messages within the patient portal. To increase patient access to the healthcare provider, a literature search was conducted using the practice-focused question: Can standardization of patient portals improve the message turnaround time? In January 2024, a scoping review of nursing message center pools determined 79 pools lacked standardized names and established workflows for 37 ambulatory clinics. Pool names were identified for each clinic and listed using an Excel spreadsheet. Clinic pool members were isolated, and it was determined by …

A Change In Practice: Improving Uti Management In A Long-Term Care Facility By Implementing Rapid Urinary Culture Collection Protocols To Enhance Timely Treatment And Reduce Hospitalizations, Tania Ojeda

Doctor of Nursing Practice

ABSTRACT

Background: Urinary tract infections (UTIs) remain a leading cause of morbidity among elderly residents in long-term care facilities, where diagnosis is frequently delayed due to atypical presentation, cognitive impairment, and inconsistent urine specimen handling. Purpose: This quality improvement (QI) project aimed to improve the timeliness and accuracy of UTI management in a memory care facility through standardized evidence-based protocols. Objectives: The project sought to ensure that: (a) 100% of staff would be educated on the protocol; (b) 100% of residents with suspected UTIs would have urine sent for urinalysis and culture within 8 hours of symptom onset; (c) 100% …

Implementation Of The Modified Severity Assessment Scale (Msas) For Alcohol Withdrawal In An Inpatient Psychiatric Unit, Grace R. Lindsey

Doctor of Nursing Practice

Background: Alcohol withdrawal is a potentially life-threatening condition frequently seen in psychiatric inpatient settings, especially among individuals with co-occurring alcohol use disorder and mental illness. The Clinical Institute Withdrawal Assessment for Alcohol Scale-revised, while widely used, depends on patient self-report, making it less effective for individuals with altered mental status or psychosis.

Purpose: This quality improvement project implemented the Modified Severity Assessment Scale, an objective, observation-based alcohol withdrawal protocol, in an inpatient psychiatric setting to improve safety, treatment accuracy, and care standardization.

Objectives: The project focused on ensuring full staff adoption of the protocol, reducing intensive care unit transfers …

Examining And Addressing Increased Hospital Inpatient Falls Rates At An Urban Community Hospital, Juan Lira

Doctor of Nursing Practice

Abstract

Background: Falls are the leading cause of reported injuries within the hospital setting. Injuries from falls occur in about20-45% of the time and is the leading cause of injury and injury death among the adult population. Inpatient falls are associated with an additional $14,0000 per occurrence and a prolonged hospitalization by 6.3 days. Increased falls rates affect hospitals rating, accreditation and reimbursements. This hospital is experiencing inpatient falls that exceed national average and corporate goals.

Purpose: The purpose of this project is to reduce the hospital falls rate by 10% within 90 days of initiating evidence-based evaluation and facility-wide …

Implementation Of An Information Sheet For Pediatric Patients With Autism Spectrum Disorder In An Inpatient Setting To De-Escalate Aggressive Behaviors And Reduce Seclusion Rates, Megan R. Castro

Doctor of Nursing Practice

Introduction: Research shows that most seclusion events in pediatric psychiatric settings involve pediatric patients with neurodevelopmental disorders, particularly autism spectrum disorder (ASD). A lack of provider expertise contributes to elevated seclusion rates, highlighting the need for evidence-based, ASD-informed care.
Purpose: To reduce seclusion events within a pediatric psychiatric facility in South Texas, by implementing an evidence-based intervention upon admission that could decrease aggressive behaviors and the likelihood of requiring seclusion. Evidence summary: Literature and guidelines underscore the importance of identifying sensory triggers and calming strategies at admission. Collaborative care and personalized interventions, such as a patient information sheet that identifies …

Implementing A Cardiac Catheterization Pre-Procedure Protocol To Decrease Avoidable Same-Day Cancellations, Christina C. Perry

Doctor of Nursing Practice

Background and significance of the problem: Pediatric congenital heart defect patients are amongst the sickest hospital population. These patients require planned palliation in the cardiac catheterization lab (cath lab), which has a limited number of providers and appointments available. In the cath lab, the percentage of avoidable same-day cancellations for interventional procedures was found to be greater than 30%, representing significant resource utilization opportunities.

Purpose: The purpose of this project was to develop and implement a standardized, evidence-based pre-procedure protocol to decrease avoidable same-day cath lab cancellations.

Goals and objectives: The goals of this project were a 10% decrease in …

Well-Being And Quality Of Life Of Kenyan Nurses, Midwives And Community Health Volunteers: Measurement Properties And Correlates Of The Bbq And Who-5, Paul Mwangi, Sabina Odero, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Healthcare workers’ quality of life (QoL) and well-being is directly linked to the quality of services they deliver. However, there is a shortage of validated measures to assess QoL, well-being and their predictors among healthcare workers in Kenya, as in other LMICs. This study aimed to assess the reliability and validity of the Brunnsviken Brief Quality of Life Scale (BBQ) and WHO-5 well-being index (WHO-5) among nurses, midwives and community health volunteers (CHVs) in Kenya. The BBQ and WHO-5 were selected due to their established psychometric strengths, brevity, and prior use in healthcare settings. Additionally, the sociodemographic, psychological, and health …

Evaluating The Impact Of Evidence-Based Guidelines On Corticosteroid Prescribing For Acute Upper Respiratory Infections In Outpatient Primary Care, Cody Allen Boyd Hyatt

Doctoral Projects

Inappropriate corticosteroid prescribing for acute upper respiratory tract infections (AURTIs) remains a prevalent issue in outpatient primary care despite limited evidence supporting their use in otherwise healthy adults. This Doctor of Nursing Practice (DNP) project aimed to reduce inappropriate corticosteroid prescribing for AURTIs by implementing an evidence-based clinical practice guideline over an eight-week period in a rural primary care setting.

The doctoral project employed pre- and post-intervention design. Providers were introduced to the corticosteroid guideline derived from the 5-Minute Clinical Consult, emphasizing appropriate use criteria for corticosteroids in AURTI cases (Unbound Medicine Inc., 2025). Educational outreach and clinical reminders …

Code Crimson Ob: A Lifeline For Maternal Health, Colleen Cowie, Elizabeth Barrera, Leah Williams-Jones, Mercy R. Banaszak, Leonor Ruiz, Arvinder Singh

Nursing & Health Sciences Research Journal

Introduction: Postpartum hemorrhage (PH) accounts for 12% of maternal deaths in the U.S. and affects approximately 5% of obstetric individuals. Despite available treatments, delays in recognition and response can lead to severe complications or death. The purpose of this evidence-based practice project was to improve maternal outcomes by implementing Code Crimson OB, a specialized obstetric rapid response team (RRT) for managing maternal hemorrhage.

Methods: An unannounced maternal hemorrhage drill revealed critical delays in mobilizing appropriate personnel. In response, the RRT protocol was revised to include Code Crimson OB, ensuring rapid, coordinated intervention. Hospital-wide education was conducted, and the protocol officially …

Implementation Of A Pharmacist-Driven Monitoring Protocol For Individuals Receiving Multiple Qt-Prolonging Medications In Acommunity Hospital, Maria A. Ruiz, Maura Falli, Kristina Lee, Mario Pascual, Radhan B. Gopalani

Nursing & Health Sciences Research Journal

Background: Torsades de pointes is a life-threatening polymorphic ventricular tachycardia, associated with QT interval lengthening on an electrocardiogram. Hospitalized individuals are routinely administered multiple medications with the potential to prolong the QTc interval. This quality improvement project sought to implement a pharmacist-driven protocol to identify and monitor individuals on multiple QT-prolonging medications using pharmacovigilance software, VigiLanz®, and the Tisdale risk score, aiming to reduce adverse drug reactions (ADRs) in a community hospital.

Methods: This was a single-center prospective quality improvement project of individuals admitted to the hospital from February through March 2024. Individuals with two or more scheduled QT-prolonging medications …

A Case Of Monocular Diplopia In The Setting Of High-Grade Urothelial Bladder Carcinoma Treated With Pembrolizumab, Leanne Dumeny, Joana Nuraj, Roshni Bisoondial, Nicole Moscoso, Arvinder Singh, Lorena Bonilla Md

Nursing & Health Sciences Research Journal

Case Presentation: We present the case of a 70-year-old male with a history of highgrade urothelial carcinoma who had been treated with multiple cycles of immune checkpoint treatment, pembrolizumab, presenting to the emergency department with worsening bone pain, abdominal discomfort, and hematuria.

Clinical Course: He reported blurry vision and monocular diplopia in the right eye for the past month. Physical examination revealed an inability to fully track with the right eye along with fatigue-induced diplopia, raising concerns for metastatic or immunotherapy-related ocular involvement. Imaging primarily revealed metastatic disease in the right orbital apex involving the rectus muscles, intraconal fat, and …

Quality Improvement Project: Enhancing Learning Through Structured Debriefing In Simulation, Catherine Jones

Doctor of Nursing Practice Projects

This quality improvement (QI) project examined the impact of structured debriefing training on nursing faculty perceptions of confidence, competence, and skill in simulation-based education (SBE) at a northeast Texas community college. The problem addressed was the lack of a standardized debriefing process, leading to inconsistent faculty practices and variable student learning outcomes. The QI project, guided by the National League for Nursing (NLN) Jeffries Simulation Theory and Lewin’s Change Theory, used a one-group pretest–posttest design to evaluate faculty outcomes following training in Debriefing for Meaningful Learning (DML) and guided self-evaluation using the Debriefing Assessment for Simulation in Healthcare (DASH) Instructor …

Shared Decision Making In Women's Health: A Quality Improvement Project, Brittney Butler

Doctor of Nursing Practice Projects

Shared decision-making (SDM) is the best practice in contraceptive counseling, yet it remains underutilized in primary care, particularly within underserved communities. Limited SDM use reduces patient autonomy, weakens satisfaction, and contributes to inconsistent documentation. This quality improvement (QI) project aimed to evaluate whether an educational intervention on SDM for contraceptive counseling improved provider self-efficacy and the electronic medical record (EMR) documentation of SDM practices. Guided by Bandura’s Social Cognitive Theory and Lewin’s Change Management Model, the project sought to enhance provider confidence and foster sustainable behavioral change. A quasi-experimental, one-group pretest–posttest design was implemented at a rural Federally Qualified Health …

Integrating Sbirt Training Into The Family Nurse Practitioner Curriculum: A Pilot Dnp Project, Fiji Simmons

Doctor of Nursing Practice (DNP) Projects

Background: Substance Use Disorder (SUD) and Alcohol Use Disorder (AUD) are major public health concerns, particularly in underserved populations. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is evidence-based models that promote early detection and care. Integrating SBIRT into Family Nurse Practitioner (FNP) curricula prepares future providers to address substance use in primary care. Local Problem: Despite the effectiveness of SBIRT, its use in primary care remains inconsistent. Barriers, including limited training, low confidence, and unfamiliarity with referral resources, hinder implementation. Structured education and protocols are needed to support provider readiness. Methods: SBIRT was integrated into the FNP curriculum of …

Impact Of Multimodal Analgesia In Comparison To Conventional Analgesia In Coronary Artery Bypass Graft Patient With Implementation Of An Enhanced Recovery After Surgery Order-Set, Rhoda Musyoka, Radhan Gopalani, Maura Falli, Maria Ruiz, Cathleen Charles, Yanija Zhang, Esty Trimino, Laura Dominguez Vasquez, Tom Nguyen

Nursing & Health Sciences Research Journal

Background: An Enhanced Recovery After Surgery (ERAS) pilot program was implemented for coronary artery bypass graft (CABG) procedures under a single cardiothoracic surgeon in May 2024 across two community hospitals. We assessed the impact of multimodal analgesia facilitated through the ERAS CABG order-set compared to the non-ERAS (conventional) CABG order-set.

Methods: This study was an Institutional Review Board-approved, multi-site, retrospective chart review of participants admitted to two community hospitals for a CABG procedure from June 2024 to January 2025. Participants who utilized the preand post-ERAS or the pre- and post-conventional CABG order-sets were included. The primary outcome was the opioid …

Addressing Nursing Student Burnout Through Mindfulness And Zen Den At University Of The Pacific, Jeremy Seaton, Tanairi Ingram, Natalia Zelayandia

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background:

Burnout among nursing students is a critical issue that negatively impacts academic performance, mental well-being, and long-term professional retention. Entry-Level Master of Science in Nursing students at University of the Pacific experience heightened stress due to rigorous coursework, clinical demands, and underdeveloped institutional mental health support.

Aim:

This Quality Improvement project aimed to reduce stress and strengthen emotional resilience among nursing students through Mindfulness-Based Stress Reduction education and the creation of a peer-supported wellness space, the “Zen Den.”

Methods:

A pre- and post-intervention design was implemented, utilizing surveys to measure mindfulness knowledge, attitudes toward self-care, and stress awareness. Zen …

Enhancing Pediatric Sun Safety: A Parent-Focused Intervention In El Dorado County, Ashley Riley, Calvin Nauer, Alaina Godwin

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background:

Childhood ultraviolet (UV) exposure is the most significant modifiable risk factor for skin cancer, yet proper sun protection remains inconsistently practiced by parents. In El Dorado County, California, where high altitude and intense sun exposure amplify UV risk, knowledge gaps and misinformation persist despite resource availability. This quality improvement (QI) project aimed to strengthen parental knowledge, confidence, and modeling of sun-safe behaviors for their children through an evidence-based community education program.

Aim:
The goal of this QI initiative was to improve parental attitudes, self-efficacy, and photoprotective behaviors by implementing a three-part, nursing-led educational intervention focused on UV risk awareness, …

The Fascia Iliaca Regional Nerve Block Using Ultrasound And Landmark Technique: An Objective Structured Clinical Examination For Nurse Anesthetists, Braxton T. Beech, Parker F. Rigby

Doctoral Projects

The fascia iliaca block (FIB) is an effective regional anesthesia technique used in various clinical settings, including operating rooms, emergency departments, and pain management clinics. Despite its advantages in reducing postoperative complications and minimizing opioid use, FIB remains underutilized among Certified Registered Nurse Anesthetists (CRNAs), primarily due to limited exposure and training. This doctoral project examines the implementation of an Objective Structured Clinical Examination (OSCE) as an educational intervention to enhance CRNA proficiency in performing FIB using both ultrasound-guided and landmark techniques.

A pre- and post-test study design was conducted with 18 CRNA participants attending a continuing education workshop. Demographic …

Breastfeeding Safety Following Maternal Anesthesia: A Guideline Development, Megan Honea, Mary Johnson

Doctoral Projects

Recommendations regarding breastfeeding following maternal anesthesia are inconsistent and often not up to date with current best practice guidelines. Previous recommendations have led to mothers unnecessarily “pumping and dumping” breast milk has benefits for both mother and baby. These benefits include (a) increasing the infant’s access to colostrum, (b) encouraging mother-baby bonding, (c) improving the mother’s breastfeeding experience, (d) and providing significant health benefits to the infant. The purpose of this scholarly project was to develop a set of evidence-based recommendations that focus on mothers who desire to breastfeed following general anesthesia. These recommendations will highlight maternal- fetal transfer of …

The Effect Of Exercise On The Development Of Gestational Diabetes Mellitus In Pregnancy: A Systematic Review Of Literature, Abigail Reiche

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review is to synthesize literature examining the relationship between using exercise as a preventative method for gestational diabetes development during pregnancy, and the effect it may have on lowering glycemic levels. Health Source: CINAHL and PubMed were systematically searched for peer-reviewed journal articles that studied pregnant women (P), and the relationship of consistent exercise (I), compared to no physical exercise (C), on lowering glycemic levels resulting in positive pregnancy outcomes (O), throughout gestation (T). Twenty articles were retrieved in accordance with the PICOT objectives. Additional criteria included only articles from 2019-2024 and articles that were …

Bridging The Language Gap: The Impact Of In-Person Versus Remote Interpreter Services On Medication Adherence And Patient Safety In Adult Spanish-Speaking Patients, Ashley E. Alarcon Martinez, Jocelyn N. Lopez Maradiaga

Nursing | Student Research Posters

Background: Significant health inequities are caused by language barriers between patients and health care staff, resulting in miscommunication among adult Hispanic patients with low English proficiency, reducing medication adherence, impairing patient safety, and raising the possibility of medical errors. To address this issue, interpreter services, both in-person and remote translation, have been introduced in healthcare settings to enhance communication. Objective: The purpose of this study is to investigate the differences in patient safety and medication adherence between in-person and remote translation services for adult Hispanic individuals with limited English proficiency in healthcare settings. Methods: The proposed research involves five local …

Prevention Of Burnout Among Critical Care Nurses, Jenelle Balaoing, Junela Bautista

Nursing | Student Research Posters

Background: Nursing burnout is a state of mental and physical exhaustion caused by excessive stress among nurses. Critical care nurses face challenges with direct patient care that contribute to emotional and psychological strain that are greatly influenced by workplace adversity and emotional management. Purpose: This research examines the prevalence of burnout among pediatric and adult intensive care unit (ICU) nurses, highlighting particularly high rates of burnout among those with extended years of service. Method: ICU nurses will participate in a qualitative interview that involves open ended questions relevant among burnout and resilience during shifts. Aspects specifically years of critical experience …

Improving Pharmacovigilance Via Systematic Gass Screening And Interdisciplinary Collaboration In The Outpatient Setting, Dustin Bower

Doctor of Nursing Practice Projects

The goal of this Doctor of Nursing Practice (DNP) quality improvement project was to enhance pharmacovigilance practices among non-medical mental health providers (NMMHPs) in an outpatient psychiatric setting. The project addressed the issue of limited recognition and reporting of adverse drug reactions (ADRs) by NMMHPs, which can lead to delays in clinical intervention and compromise patient safety. To tackle this problem, a quasi-experimental, pre–post intervention design was employed. Two evidence-based strategies were implemented: (a) eight weekly collaborative training sessions that focused on identifying, documenting, and communicating ADRs, and (b) the integration of the Glasgow Antipsychotic Side-Effect Scale (GASS) into the …

Enhancing Provider Knowledge And Compliance With Diabetic Retinopathy Screening Through Education: A 4-Week Plan, Maureen Odemena

Doctor of Nursing Practice Projects

Diabetic retinopathy (DR) is a leading cause of vision impairment that can be prevented if found and treated early. Inadequate provider knowledge and adherence to guidelines, and low referral rates for screening at the project site, highlighted the need for targeted training. Studies show that evidence-based education plans improve engagement in DR screening. This quality improvement (QI) project aimed to impact knowledge, self-efficacy, and compliance among healthcare providers (HCPs—nurse practitioners and physicians) and increase screening rates by implementing an American Diabetes Association (ADA) guideline-based education plan over 4 weeks. Based on the health belief model and Kurt Lewin’s change theory, …

Quality Improvement Project: Empowering Nurse Educators: Implementing A Mentoring Program For Professional Growth, Sarah Sugg

Doctor of Nursing Practice Projects

With the ongoing nursing shortage, nursing education plays a vital role in shaping the future of healthcare through the preparation of competent and skilled nurses. Literature supports that a persistent challenge within nursing academia is the lack of structured mentoring programs to support novice nursing faculty transitioning into academic roles. This quality improvement project addressed this gap through the implementation of a structured, evidence-based mentoring program compared to informal mentoring. The purpose of the project was to empower novice nursing faculty with less than three years of teaching experience by enhancing teaching competence, confidence, job satisfaction, and retention. Guided by …

Quality Improvement Project: Increasing Breast Cancer Screening Rates Among Women Ages 40-74 At A Federally Qualified Health Center By Implementing A Provider Alert Tool, Tiny Stephens

Doctor of Nursing Practice Projects

Breast cancer maintains its position as the leading cause of cancer-related death for women worldwide and remains the second deadliest cancer among female patients in the United States (Centers for Disease Control, 2024). The screening rates at Federally Qualified Health Centers (FQHCs), which serve medically underserved communities, remain lower than national benchmarks, thus putting their patients at risk for receiving late-stage cancer diagnoses. This quality improvement project implemented an evidence-based electronic medical record (EMR) provider alert tool at a Northeast Georgia FQHC to address a baseline mammogram order compliance rate falling below national standards at 45%. The project aimed to …

Quality Improvement Project Nursing Student Retention Strategies: A Focus On Peer Mentoring, Anh Vittoria

Doctor of Nursing Practice Projects

The nursing shortage remains a concern in healthcare. Increasing the number of students who complete nursing programs and enter the profession can help with the demand for nurses in the workforce. Nursing programs face challenges with student retention, which limits the number of nurses entering the profession. The quality improvement project aimed to examine the effects of a peer mentorship program on first-year associate degree nursing students’ perception of support and course completion rates. The purpose is to impact student retention and sense of support in an Associate Degree Nursing Program (ADN) through peer mentorship. The project was guided by …

Quality Improvement Project Enhancing Documentation Practices In Community Mental Health Clinics, Carol Parker

Doctor of Nursing Practice Projects

Accurate and timely documentation are essential for safe, high-quality care in community mental health settings. This quality improvement (QI) project addressed inconsistent documentation practices among licensed, unlicensed, and Qualified Mental Health Specialist (QMHS) staff at an outpatient clinic. The purpose of the QI project was to implement and assess a structured in-service training program using the Accountable Health Communities–Health-Related Social Needs (AHC-HRSN) screening and documentation tool to improve staff knowledge, enhance documentation accuracy, and facilitate care coordination. Guided by the Iowa Model of Evidence-Based Practice and Lewin’s Change Management Model, a pre- and post-intervention design was used. Fifteen staff members …