Digital Commons Network^™

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

Doctor of Nursing Practice (DNP) Manuscripts

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

Implementing Updated Npo Guidelines For Inpatient Procedures, Yasamin Ghanivand

Doctor of Nursing Practice (DNP) Projects

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recommends clear liquids up to 2 hours before non-emergent procedures, although many facilities still implement the outdated practice of ordering NPO after midnight.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

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

Methods: A …

Fueling Tiny Hearts: Optimizing Enteral Mct Oil Utilization In Patients With Congenital Heart Disease, Paige Baxter, Bailey Beard, Ashton Mudd, Isabelle Stallings

2025

No abstract provided.

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Staff Education To Increase Knowledge And Awareness Of Sexually Transmitted Diseases, Alie Sholola Sahid

Walden Dissertations and Doctoral Studies

Background STIs or sexually transmitted diseases (STDs) are consequential public health emergencies that affect millions of people globally and have long-term health implications (Garcia et al., 2024). STIs are infections that are passed from one person to another through sexual contact with the most common types of STIs include chlamydia, trichomoniasis, general herpes, and human papillomavirus (HPV). It is estimated that each year, more than 20% of the U.S. population has had an STI, with around 26.2 million cases per year (Centers for Disease Control and Prevention [CDC], 2024a). The common types of STIs include chlamydia, trichomoniasis, general herpes, and …

Tracking Towards Zero: Implementing A Picc Team Tracker To Prevent Clabsis, Carolina Maria Gerodias Cayetano

Master's Projects and Capstones

Background: Central line-associated bloodstream infections (CLABSIs) remain among the most serious and costly healthcare-associated infections in acute care settings, with each event associated with significant excess mortality, prolonged hospital stays, and avoidable healthcare costs. At Hospital A, a 239-bed acute care facility, two of six total CLABSI events over a 12-month period were associated with peripherally inserted central catheters (PICCs), representing 33% of all facility CLABSIs and exposing a critical gap in standardized PICC line surveillance and maintenance bundle monitoring.

Problem: The PICC team lacked a systematic, real-time tracking mechanism to monitor central line maintenance bundle adherence across seven adult …

Understanding Factors Influencing Multiple Tobacco Product Use Among Adolescents In Thailand: A Structural Equation Modeling Approach, Chaowalit Srisoem

Graduate Doctoral Dissertations

Tobacco use among Thai adolescents is shaped by personal, environmental, and product-related factors. However, the pathways linking these influences to actual behavior remain unclear. This study examined how personal, environmental, and product-related factors, along with intentions to use, relate to tobacco use among Thai adolescents. A cross-sectional secondary analysis was conducted using data from the 2022 Thailand Global Youth Tobacco Survey of 6,235 students aged 13–15 years. Survey weights methods were applied to produce nationally representative estimates. Confirmatory factor analysis and structural equation modeling assessed latent constructs, and multinomial logistic regression examined predictors of single, dual, and multiple product use. …

The Experience Of Wellness And Self-Care For Graduating Bsn Students, Jenny Pappas, Terri A. Clark, Tasha Ruffin, Deborah Ellison, Adrienne Wilk, Debra Rose Wilson

Journal of Social, Behavioral, and Health Sciences

The aim of this study was to explore how graduating prelicensure bachelor of science in nursing (BSN) students experience self-care and wellness, with the goal of informing future curriculum development. Nursing students face significant academic, emotional, and sociocultural pressures that heighten vulnerability to burnout. Despite widespread agreement that self-care is a professional expectation, little is known about the students’ experience within demanding programs. Guided by Orem et al.’s (2001) self-care deficit theory, a qualitative study using interpretive hermeneutic phenomenology was used to examine lived experiences of self-care and wellness. Sixteen graduating BSN students participated in in-depth, semistructured interviews. Interviews were …

Clinical Practice Guideline For Sepsis In Skilled Nursing Facility, Chinyere Okoroh

Walden Dissertations and Doctoral Studies

Sepsis is a life-threatening condition that can rapidly lead to organ dysfunction, septic shock, and death if not recognized and treated early. Older adults in skilled nursing facilities (SNFs) are especially vulnerable because of age-related physiological changes, chronic conditions, weakened immunity, and increased exposure to infections. Consequently, sepsis remains a major cause of hospital readmissions, mortality, and healthcare utilization among SNF residents. The SNF serving as the site for this Doctor of Nursing Practice (DNP) project experienced increased hospital readmissions associated with recurrent sepsis, highlighting the need for a standardized, evidence-based approach to sepsis recognition and management. The practice-focused question …

Implementation Of Staff Education To Reduce Or Prevent Pressure Injury, Beverley A. Moses

Doctoral Dissertations and Projects

Pressure injuries (PIs) present a significant clinical challenge in healthcare settings, particularly among patients with limited mobility, comorbidities, and complex musculoskeletal injuries. These injuries lead to adverse patient outcomes, such as increased morbidity, prolonged hospital stays, and an increase in healthcare costs. Despite advancements in clinical practice, PI prevention remains a critical area for quality improvement, necessitating a standardized, patient-centered approach to care. This Doctor of Nursing Practice (DNP) project aimed to improve patient outcomes by implementing a standardized educational initiative for nursing staff in a bone and joint unit at a private hospital in Upstate New York. The project …

Implementing A Structured Lifestyle Counseling Program To Improve Weight Management In Obese Adults Ages 18–65 Within The Private Primary Care Setting, Ntoge Sone Penda

Walden Dissertations and Doctoral Studies

Obesity is a major public health concern that affects millions of adults. As a chronic, progressive disease, obesity increases the risk of developing several medical conditions. Although evidence-based clinical practice guidelines recommend comprehensive lifestyle modification as a first-line treatment, implementation of structured lifestyle counseling in primary care remains inconsistent. The practice-focused question guiding this Doctor of Nursing Practice (DNP) quality improvement project was: Among obese adults aged 18–65 years in a private primary care setting, does implementing a structured lifestyle counseling program improve body weight and body mass index (BMI) outcomes over an 11-week period? An organizational change process guided …

Frailty And Activities Of Daily Living In Older Adults In Primary Care: A Cross-Sectional Study, Öznur Adadıoğlu, Ahmet Seven, Esin Danç

Makara Journal of Health Research

Background: This study aimed to examine frailty status and activities of daily living among older adults.

Methods: This descriptive and cross-sectional study was conducted with 306 voluntary participants aged 65 years and older who were registered at a primary healthcare center in a city in Türkiye. Data were collected using the Participant Information Form, the FRAIL Scale, and the Katz Index of Activities of Daily Living.

Results: Among the participants, 36.9% were non-frail, 42.2% were pre-frail, and 20.9% were frail. The mean Katz Index score was 5.42 ± 1.35. The mean scores of activities of daily living …

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …

Staff Education To Improve Nursing Knowledge On Pressure Injury Prevention, Kheeda Kimberly Gopaul

Walden Dissertations and Doctoral Studies

Staff education in this project was focused on improving nursing staff’s knowledge on pressure injury prevention, inspired by the persistent care quality gap. The gap in practice as of 2024 related to hospital-acquired pressure injury (HAPI) at the host health organization was reported to be approximately 0.2 per 1,000 discharges. It was apparent that education could benefit the nursing staff to improve their knowledge in pressure injury prevention. The education in service focused on continuous nursing skin assessments, to ensure over prolonged hospitalization, patients’ skin does not deteriorate with the development of pressure injuries or advancing of pre-existing pressure ulcers. …

Improving Pressure Injury Prevention Through Braden Scale Compliance And Education In The Emergency Department, Joycelyn Lee, Kira Simone Faerstain, Alyssa Kristine Ortiz, Ashley Briseida Cruz

Master's Projects and Capstones

Pressure injuries are a major burden in healthcare, particularly in the Emergency Department (ED). Patients can be sedentary for prolonged periods of time and don't always get their skin checked promptly. Patients visiting the ED often have comorbidities and patient-specific medical needs, such as seniors with fragile skin, malnourishment, immobility, etc. At a Southern Los Angeles Hospital, leadership found that there was a need for improvement in this area. Implementing standardized risk assessment methods can help to improve the consistent use of the Braden Scale as a predictive and preventive tool for identifying patients' risk for pressure injuries and promoting …

Improving Nursing Adherence To Chg Bathing And Pivc Maintenance Practices To Reduce Hospital-Onset Bacteremia In An Adult Medical-Surgical Unit, Mohabat Barikzai, Dinazar Altamirano, Edward Rivas, Sarah Trilles

Master's Projects and Capstones

Preventing hospital-onset bacteremia (HOB) is a healthcare priority given its association with increased morbidity, mortality, prolonged hospitalization, and healthcare costs. Literature identifies inconsistent adherence to evidence-based practices for chlorhexidine gluconate (CHG) bathing and peripheral intravenous catheter (PIVC) maintenance as a modifiable risk factor for HOB. This quality improvement (QI) project evaluated whether implementing standardized nurse education, routine compliance audits, and performance feedback would improve adherence to evidence-based CHG bathing and PIVC maintenance practices. The project aimed to achieve at least 90% nursing compliance with HOB prevention practices over an intended 8-week implementation period. A pre-post quality improvement design was implemented …

Food For Thought: Building Confidence In Healthy Food Choices Among Seniors In A Residential Facility Through Nutrition Education, Amy Rodríguez

Master's Projects and Capstones

This quality improvement project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence among independently living older adults residing in a low-income senior housing community. Aim By August 10, 2026, this project aimed to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthy meals by 20% among senior housing facility residents. Methods A microsystem assessment, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide project development and implementation. Weekly nutrition education workshops were conducted over a 10-week period and included presentations, group discussions, …

Breaking The Silence: Standardizing Routine Intimate Partner Violence Screening At A Community Clinic Serving The Latinx Community, Victoria M. Hall

Master's Projects and Capstones

Intimate partner violence (IPV) affects the Latinx population disproportionately due to socioeconomic status, cultural stigma, and language barriers. However, routine screening remains inconsistent and unstandardized at a local community clinic in San Francisco’s Mission District, despite evidence-based practices recommending it. The gap in IPV screenings across the Adult, Teens, and Women’s clinics resulted in only 1.6% of patients being screened in July 2025 and 4.1% in June 2026. This quality improvement project aimed to address low screening rates by standardizing IPV screening through a printed bilingual screener, a 60-minute staff in-service on IPV and the new screening protocol, and by …

Standardizing Gestational Diabetes Group Education In An Outpatient Maternal-Fetal Medicine Clinic: A Quality Improvement Project, Nina Prieto

Master's Projects and Capstones

Gestational diabetes mellitus (GDM) requires timely and consistent education to support effective self-management and reduce maternal and fetal complications. Baseline assessment of an outpatient maternal-fetal medicine clinic identified variation in educational materials, teaching approaches, referral processes, scheduling, and workflows across English- and Spanish-language GDM group visits. This quality improvement project aimed to standardize the group visit process and increase staff compliance with standardized materials and workflows from 0% to 50% over a 12-week period. Data were collected through direct observation of group and individual education sessions, stakeholder feedback, review of existing materials, referral and attendance patterns, and workflow analysis. These …

Addressing Food Insecurities Through Staff Education In The Rural Health Setting, Angela Dawn Suttle

Walden Dissertations and Doctoral Studies

Rural America, including Arkansans, face a number of social determinants of health (SDOH) including food insecurities (FIs) and the inability to access nutritious food. FIs contribute to poor outcomes and increases healthcare utilization. Inconsistent screenings for FIs in adults living in the rural health clinic (RHC) setting, lack of standardized workflows, and failure to provide community resources when FI is identified represents a significant gap in practice. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to increase utilization of screening tools for FI, implement a standardized workflow, and provide patients with resources to improve …

Staff Education To Improve Diabetic Care In A Primary Care Setting, Sally Uyen Nguyen

Walden Dissertations and Doctoral Studies

Inadequate patient education, inconsistent screening, missed referrals, and follow up with diabetes patients are challenges primary care managers and staff must overcome. Patients may experience negative effects that lead to poor health outcomes, delayed diagnosis, and undertreatment when provider and staff members are not educated about diabetes. The practice-focused question guiding the Doctor of Nursing Practice (DNP) staff education project involved exploring whether a staff education intervention on standardized diabetes care and screening protocols could improve physicians, managers, and medical assistants’ (MAs) knowledge of diabetes care in primary care clinics. The purpose of this project was to enhance staff knowledge …

Creating Consistency: Standardizing Gestational Diabetes Group Visit Framework In High-Risk Obstetric Care, Danielle Pack

Master's Projects and Capstones

Objective: Gestational diabetes mellitus (GDM) requires timely and consistent education to promote effective self-management and improve maternal and fetal outcomes. Baseline observations at a Santa Clara County high-risk obstetric clinic identified variation in educational materials, educator delivery, referral processes, and workflows between English- and Spanish-language GDM group visits. A review of the literature supported standardized diabetes education and group prenatal care as strategies to improve consistency, efficiency, and patient access. Aim: This quality improvement project aimed to develop and implement a standardized GDM group visit framework for nurse practitioners, registered dietitians, and scheduling staff, with the goal of increasing compliance …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Standardizing Group Visits For Gestational Diabetes Education: A Quality Improvement Initiative In An Outpatient Maternal-Fetal Medicine Clinic, Nha Nguyen

Master's Projects and Capstones

Objective: At an outpatient maternal-fetal medicine clinic in Northern California, gestational diabetes mellitus (GDM) education is delivered inconsistently across nurse practitioners (NPs) and registered dietitians (RDs), with no standardized curriculum, referral criteria, or educational materials. Aim: By August 12, 2026, this project aimed to develop and implement a standardized GDM group visit framework for NPs, RDs, and scheduling staff in maternal-fetal medicine clinic, increasing compliance with standardized referral, enrollment, and educational processes from a baseline of 0% to 50%. Methods: Using baseline observations, workflow assessment, stakeholder input, and a literature review, the QI team developed standardized bilingual slide …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Improving Adherence To Remote Patient Monitoring (Rpm) For Patients With Hypertension, Chioma Udegbune

Student Scholarly Projects

Practice Problem: Hypertension is a leading contributor to cardiovascular disease, and suboptimal adherence to remote patient monitoring (RPM) limits opportunities for timely intervention and effective blood pressure management in outpatient primary care.

PICOT: The PICOT question that guided this project was: Among outpatient clinic nursing staff responsible for remote patient monitoring (RPM) in adults with hypertension (P), how does implementation of a structured nurse-led education and reminder protocol (I), compared to standard RPM practices consisting of routine onboarding and passive reminder processes (C), influence patient adherence to RPM protocols (O) over a 10-week period (T)?

Evidence: Evidence supports nurse-led education, …

Best-Practice Patient Education On Glp-1, Low-Glycemic Diet, Intermittent Fasting, And Exercise For Weight Loss In Obese Nondiabetics, Clara Green

Walden Dissertations and Doctoral Studies

Executive Summary: Clinical Practice Guideline Best-Practice Patient Education on GLP-1, Low-Glycemic Diet, Intermittent Fasting, and Exercise for Weight Loss in Obese Nondiabetics by Clara Green MS, Walden University, 2020 BS, University of Texas at El Paso, 2014 Executive Summary Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2026

A Program Proposal For An Evidence-Based Dietary Program To Support Spanish Speaking Diabetic Patients, Shaquetta Ann Mccloud-Petion

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) executive leadership system improvement project addresses provider-identified gaps in dietary education for Spanish-speaking patients with diabetes, which may contribute to suboptimal glycemic control and diabetes self-management. A comprehensive review of evidence from CINAHL Complete, PubMed/MEDLINE, and Cochrane supports the use of culturally tailored, evidence-based dietary education to improve diabetes knowledge, self-management behaviors, and health outcomes. The project proposes the development and implementation of a standardized dietary education program using culturally appropriate dietary exchange tools within an outpatient clinic. The initiative aims to improve staff confidence, adoption, and consistency in delivering culturally responsive diabetes education …

Improving Documentation Of Skin Assessment In The Med-Surg Overflow Microsystem, Min Kim, Mikeal A. Swift

Master's Projects and Capstones

Abstract

Problem

Hospital-acquired pressure injuries (HAPIs) remain a costly patient safety concern with increased morbidity and prolonged hospitalization. Inconsistent admission skin assessment documentation in a 24-bed overflow medical–surgical microsystem led to delayed wound identification and misclassification.

Context

A baseline needs assessment (n = 15) identified key barriers, including low nurse confidence utilizing Rover (mobile software application) and linking photos to the LDA (lines-drains-airway) in the electronic health record.

Intervention

A bundle of 6 components was tested over 12 weeks: standardization of the two-RN skin assessments within 8 hours of admission or transfer; optimization of Rover photo capture and LDA linkage; …

Staff Education To Reduce Stress In Assisted Living Nursing Staff, Cherechi Onyenso

Walden Dissertations and Doctoral Studies

In this staff education doctor of nursing practice (DNP) project, I addressed a practice gap associated with inadequate staff knowledge of workplace stress-management strategies in an assisted living facility. Workplace stress in nursing practice is a contributing factor to burnout, reduced job satisfaction, poor teamwork, and a decline in the quality of resident care. The practice-focused question for this project was about whether staff knowledge would be enhanced over an 8-week period in comparison to baseline knowledge as a result of their participation in a structured staff education program on workplace stress management. The purpose of the project was to …