Digital Commons Network^™

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Tips Toolkit To Prevent Falls In Hospitalized Older Adults: A Rural Hospital Approach, Viridiana G. Gonzalez Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Falls remain the leading cause of injury-related deaths among hospitalized older adults, contributing to significant morbidity, extended hospital stays, and increased healthcare costs. Implementing effective fall prevention strategies is especially challenging in rural hospitals due to staffing shortages, limited funding, and variability in clinical practice.

Local Problem: A 30-bed Medical-Surgical Unit in a rural Southwest Texas hospital experienced a rise in patient falls among older adults aged 65 and older, including several incidents requiring advanced medical treatment and one resulting in serious injury. A gap analysis revealed inconsistent implementation of tailored fall prevention strategies.

Methods: A quality improvement (QI) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

A Comprehensive Exploration Of Stress And Depressive Symptoms In Farm Populations, Julie C. Derringer

Theses and Dissertations--Nursing

High rates of depression and suicide continue to be a concern, despite four decades of growing research into the mental health of farmers. Most farmers have an awareness of a need for improved mental health, but a lack of knowledge persists. As agricultural production demands increase and the number of family farms decreases, the stress placed upon farmers to support the food chain is higher than ever. Understanding the association between farm demands and resources among farmers is key for the development and implementation of programs to decrease occupational stress and depressive symptoms to improve mental health outcomes across farming …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

Recognizing And Responding To Moral Distress: Using Transformational Leadership To Increase Nurse Leader Thriving, Miriam Dowling-Schmitt

DNP Scholarly Projects

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High …

Critical Incident Debriefing: Impact On Oncology Nurses And The Infusion-Related Reaction Care Bundle, Megan A. Corbett

DNP Scholarly Projects

Background: A critical incident is a sudden, unexpected, emotionally distressing event commonly experienced by oncology nurses. Debriefing is an evidence-based best practice that facilitates communication, reflection, and learning to identify quality improvement opportunities to enhance clinical practice, patient safety, and quality of care. However, debriefing within oncology care settings is inconsistent despite the demonstrated benefit and availability of frameworks. Infusion-related reaction management follows an algorithm that directs care delivery, aligning with a care bundle approach. Care bundles, when consistently and reliably applied, help identify connections between the critical incident (i.e., infusion-related reaction) and opportunities for improvement to ensure clinicians follow …

Design And Implementation Of A Nursing Peer Practice Case Review Program In An Academic Surgical/Trauma Icu, Natalie Tredway

DNP Scholarly Projects

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on …

Promoting Rapid Identification Of Oncological Emergencies In The Emergency Department : A Quality Improvement Project, Christine Hart Brown

DNP Scholarly Projects

BACKGROUND: The American Cancer Society estimates 2,041.90 new cases of cancer in the U.S. (1 in 18 Americans) with a global projection of thirty-five million new cases annually by 2050. With this alarming increase, early recognition of oncological emergencies in the Emergency Departments is essential. Life-threatening conditions require rapid assessment, accurate diagnosis, and immediate interventions. Qualified emergency nurses must understand the effects that cancer and treatment have on the immune, metabolic, and hematologic systems. This quality improvement (QI) project focuses on assessing emergency nurses’ oncological knowledge of acute emergencies and providing a resource for rapid identification.

PROBLEM STATEMENT: …

College Health Provider Experiences With Inclusive And Affirming Care Of Sexual And Gender Minorities, Somatra Lynn Connolly

Open Access Dissertations

Increasing numbers of individuals in the U.S. are identifying as sexual and gender minorities (SGM). Approximately 17-21% of U.S. college students identify as SGM, comprising a sizable portion of minoritized groups on college campuses. College students who identify as SGM are at significant risk for physical and mental health issues, experiences of victimization, and poorer health outcomes. It is essential that colleges and universities ensure their campuses are meeting the needs of their entire student body, including SGM students. This study aims to: (1) obtain an in-depth understanding of college healthcare provider (HCP) experiences and their perceptions with inclusive and …

Diabetes Device Knowledge And Confidence Among School Nurses: A Mixed Methods Study, Cassandra F. Moffitt

Nursing Theses and Dissertations

Problem: Type 1 diabetes is one of the most common chronic medical conditions in childhood. While manageable, these children may spend half of their day in the school setting and often need assistance from a school nurse to manage their care.

Theory: Bandura’s Social Cognitive Theory (1977) served as the theoretical framework for this study.

Research Questions: The research questions explored knowledge, confidence, and additional predictors of confidence related to diabetes devices.

Design/Methods: An explanatory sequential mixed methods design was used. The Diabetes Device Confidence Scale (DDCS) was used to measure device confidence, while Subscale 10 of the KAT-1 instrument …

Mindfulness In Homeless Women Experiencing Anxiety, Ally Bennion, Amanda Ho, Elina Le, Elizabeth Tsamous, Jaeda Yamasaki, Madi Ourada, Sara Nemera

Nursing Leadership in Community Engagement Projects

Mindfulness in Homeless Women Experiencing Anxiety

Half of Washington's homeless population resides in Seattle, King County (Axios, 2024). In response, seven Seattle Pacific University nursing students conducted an assessment on homeless women in Seattle. Partnering with a women’s day center, we assessed their health needs and barriers as part of a nursing leadership project. Through activities like bingo, we aimed to build trust and surveyed the women and staff on health concerns. Our findings revealed chronic anxiety as a key issue, leading to underutilization of health resources. Such resources include a mobile emergent dental van that previous nursing students earned …

Enhancing Medication Storage Protocols For Safety Optimization In Cardiac Care Unit Inpatients, Baothu Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to enhance medication security in the cardiac care unit by implementing a standardized storage protocol to reduce unsecured medications by 20% by December 6, 2024, following a 93-day implementation period. Additionally, the project sought to achieve 100% staff competency in the protocol by September 30, 2024.

Background: Unsecured medications pose significant patient safety risks, including unauthorized access, incorrect administration, and treatment delays. This project aligned with the Patient-Centered Caritas Model and addressed compliance deficiencies identified by the Joint Commission and the hospital’s quality control team.

Methodology: A Plan-Do-Study-Act (PDSA) framework guided the project, integrating …

Improving Pituitary Lab Evaluation Following Radiation Therapy For Sinonasal/Nasopharyngeal Malignancies, Brandon M. Mcanulty, Msn, Aprn, Agacnp-Bc, Rnfa

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this QI project was to create a standardized order set aiming to increase consistency in lab work completion for improved monitoring of pituitary dysfunction in patients diagnosed with sinonasal and nasopharyngeal malignancies. Background: Radiation therapy is important in the treatment plan for this population. The hypothalamic-pituitary axis is frequently included within the radiation field, contributing to radiation induced pituitary dysfunction. There is no established order set for outpatient pituitary lab monitoring at the organization. Methods: Established order sets were modified to include pituitary labs to create a centralized ordering workflow among providers from all three departments …

Adapting The Minority Stress Model Among Middle-Aged And Older Adults With And Without Hiv: Understanding The Interplay Between Minority Stress, Mental Health, And Sexual Risk Behaviors, Alexis R Long Thompson

All ETDs from UAB

This dissertation aims to adapt Meyer’s Minority Stress Model to understand the interplay between minority stress, mental health, and sexual risk behaviors among middle-aged and older adults with and without HIV. The study utilizes data from the MACS WIHS Combined Cohort Study, focusing on adults aged 40 and older. It examines the relationships between perceived stress, psychosocial factors (depression, substance use, social support), and sexual risk behaviors, considering the impact of minority identities such as race, gender, sexual orientation, and HIV status. The findings highlight significant differences in perceived stress, depressive symptoms, substance use, and social support across different intersectional …

Racial Disparities In Adherence To Diabetes Management Guidelines: The Impact Of Immigration Status Among Asian Populations In The U.S., Aliya Kuerban Phd, Fnp-Bc, Ms, Ma, Rn, Yuging Zhang

Nursing: Faculty Presentations

Background/Purpose

Asian populations in the U.S. demonstrate lower adherence to diabetes management guidelines compared to other racial groups. The American Diabetes Association (ADA) recommends a minimum of two annual A1C tests to manage diabetes effectively. This study examines racial disparities in adherence to these guidelines, focusing on the impact of immigration-related factors and patient perceptions of provider communication. The findings aim to identify barriers and inform strategies to enhance diabetes management and improve patient-provider interactions in underserved communities.

Theoretical/Conceptual Framework

This study employs a modified patient-provider communication model as its theoretical framework, emphasizing how effective communication can influence adherence to …

Prospective Evaluation Of Plasma Proteins In Relation To Surgical Endometriosis Diagnosis In The Nurses’ Health Study Ii, Naoko Sasamoto, Long H. Ngo, Allison F. Vitonis, Simon T. Dillon, Maryam Aziz, Amy Shafrir, Stacey A. Missmer, Towia A. Libermann, Kathryn L Terry

Health Sciences Faculty Publications

No abstract provided.

Flipped Classroom Versus Lecture: A Quasi-Experimental Study Evaluating The Performance Of Dental Students.”, Manal Elhijazi, Ihsane Benyahya

Health Sciences

Background: The flipped classroom is an active pedagogical modality that improves learning, autonomy and critical thinking. This work aims to evaluate the impact of the flipped classroom on student performance compared to the lecture in a biomaterials course.

Material and methods:Second-year dental students were invited to participate voluntarily in this quasi-experimental study .Thus, they were divided into two groups: one group benefited́ from the flipped classroom while the control group attended the lecture. At the end of a formative evaluation for both groups, their average grades were compared using Student's test (significance threshold set at p

Results : …

Loma Linda Nurse - Vol. 33, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | The Strategic Pillars of LLUSN

6 | Building Campaign Update

8 | Scholarship Opportunities

10 | Andreia Lofthouse: Assistant Dean of Student & Alumni Relations

LLUSN HIGHLIGHTS

12-17 | ALUMNI NEWS

18-27 | ACADEMICS

28-32 | HOMECOMING

33-35 | FACULTY UPDATES

Iimproving Discharges Within The Monitored Pod Units Of A Regional Health Center In Bryan, Tx, Paul R. Russell Iii

Doctor of Nursing Practice Final Project Abstract

IMPROVING DISCHARGE RATES WITHIN THE MONITORED POD UNITS OF A REGIONAL HEALTH CENTER IN BRYAN, TX

Purpose

The purpose of this scholarly project was to improve discharges by 11:00 a.m. within the Monitored Pod Units located in a regional hospital in Bryan, Texas.

Background

The current discharge rate by 1100 for the monitored pod units at the regional health center was below the health system goal of 50%. The impacts of delayed discharges are broad and can be seen throughout the regional health center. Delayed discharges have a direct effect on staff satisfaction, patient satisfaction, and decreased revenue.

Methodology

This …

Reducing Hospital-Acquired Pressure Injuries: A Quality Improvement Project Implementing A Visual Reminder System In The Intensive Care Unit, Henry H. Remschel Iii

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to reduce hospital-acquired pressure injuries (HAPIs) by 10% in an intensive care unit through the implementation of a skin risk assessment form and a visual reminder system.

Background

Hospital-acquired pressure injuries negatively impact patient outcomes and can increase costs associated with a hospital stay. Studies have shown that visual reminders can improve nursing intervention compliance and correlate with improved patient outcomes.

Methodology

The project implemented a skin-risk assessment form to identify patients at risk for developing pressure injuries during their hospital stay. For high-risk patients, a “High Skin Risk” magnet was placed outside …

A Framework For Mixed Reality Within Healthcare Education, Benyamin Ebadinia

Theses

Understanding complex three-dimensional systems and spatial relationships is a recurring difficulty in healthcare education, where students are often expected to reason about internal structures and multi-system processes from 2D diagrams, textbook figures, and static mannequins. This thesis presents the design, implementation, and mixed-methods evaluation of Systems Simulation, a reusable mixed reality (MR) application intended to help undergraduate nursing students explore human anatomy and pathophysiology using immersive 3D visualization.

Built in C# with the StereoKit framework for Microsoft HoloLens 2, Systems Simulation organizes nine anatomical body systems within a shared application. Learners can select a system, anchor the model in their …

Investigating The Impact Of Game-Based Immersive Learning On Nursing Students' Communication Skills And Attitudes Toward Serving In Underserved Communities, Lin Zhong, Debra Penrod, Brandon Hirsch, Kelli Whittington

Journal of Educational Technology Development and Exchange (JETDE)

Many nursing education programs incorporated service learning, particularly community immersion, into the curriculum to improve students’ communication skills and foster favorable attitudes towards caring underserved populations who face health disparities delivery. However, the teaching modality in community immersion is still lecturing sessions. This traditional teaching modality could not fully address the learning preferences of the new generation of nursing students, who are enthusiastic consumers of technology and active participants in the digital world. There is a demand of innovative teaching strategies, such as game-based learning (GBL), to engage the new generation of nursing students. Unfortunately, empirical studies of exploring the …

Implementation Of The Novel Nurse Intuition Patient Deterioration Scale To Assess For A Correlation Among Nurse Intuition And Patients Returning To The Intensive Care Unit, Janie L. Walsh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Adult hospitalized medical and surgical patients at an academic medical center are being transferred out of the Intensive Care Unit (ICU) to the step-down floor and having rapid response calls in less than 48 hours after the transfer. Nurse intuition is not a consideration in the decision to transfer a patient. Physiological variables such as Modified Early Warning Scores (MEWS) and vital signs are relied on heavily as indicators for escalation or de-escalation of care. There is evidence supporting the use of acknowledging nurse intuition to better predict a patient’s readiness for transitions of care.

Purpose: To evaluate the …

An Evidence-Based Practice Initiative To Improve Blood Pressure Control, Teresa D. Hines

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: High blood pressure (HBP) is a significant public health concern. It affects millions of adults in the United States (US) and half of the adult population in the Appalachia regions. High blood pressure is a known risk factor for cardiovascular disease (CVD), which is the leading cause of morbidity and mortality Appalachia. Complications associated with high blood pressure result in substantial economic burdens for patients and their families, healthcare systems, and national economies. High blood pressure is a significant health issue in West Virginia (WV), with an estimated 602,000 people suffering from HBP.

Purpose: The purpose of this …

Implementing A Routine Patient Health Questionnaire-9 (Phq-9) Screening Bundle For Adults (18-65 Years) Scheduled For A Psychiatric Evaluation, Olivier Bertrand Djoumessi

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Depression affects 21 million American adults (8.4%), yet only 28% receive appropriate screening. In Texas, where 20.8% of adults experience depression, systematic screening remains inconsistent. This quality improvement project addressed a critical gap at an outpatient mental health clinic in the Dallas-Fort Worth metroplex, where Patient Health Questionnaire-9 (PHQ-9) screening occurred in only 40% of psychiatric evaluations, resulting in missed diagnoses and inconsistent treatment. Using the Plan-Do-Study-Act framework, the project implemented a comprehensive PHQ-9 screening bundle consisting of staff training, electronic health record integration, and a treatment algorithm based on severity thresholds. The intervention targeted adults, aged 18-65, scheduled for …

A Path Analysis Of Predictive Factors Affecting Kangaroo Mother Care Practice Among Mothers In Communities In Upper East Region, Ghana, Francis Anaba Agana

Chulalongkorn University Theses and Dissertations (Chula ETD)

This cross-sectional descriptive correlational study aimed to explore the level of KMC practice among the mothers in communities in Upper East Region, Ghana, and to explore the direct and indirect effects of socioeconomic status, social support, maternal autonomy, self -efficacy and sociocultural norms on the practice of KMC in communities in Upper East Region, Ghana. The sample were 300 mothers of preterm and/low birth weight babies recruited by using stratified random sampling technique. This study applied the Socio-Ecological Model as a theoretical framework. Data were collected using questionnaires including socioeconomic status, social support, maternal autonomy, self-efficacy, sociocultural norms and KMC …