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Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett

Dissertations

Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study …

Remind: Raising Awareness Of Nurse Burnout Using An Educational Intervention, Emily Louise Missimer

Doctoral Dissertations and Projects

Burnout is an international occupational phenomenon that can negatively impact one’s physical, emotional, and psychological well-being. Although burnout affects all occupations, professionals working in the healthcare field are known to be at high risk for occupational burnout secondary to factors such as high-stress environments, critically ill patients, increased patient care requirements, frequent exposure to mortality, and shiftwork with long hours, among other factors. Of the subgroup of healthcare providers, it is also widely known that nurses who have a high exposure to death, such as hospice nurses, are at an even higher risk for occupational burnout. At a hospice care …

Prearrival Phone Call Initiative To Decrease Procedural Cancellations And Delays, Fazali Nkoloma

Walden Dissertations and Doctoral Studies

This doctor of nursing practice project evaluation of an organizational quality improvement initiative focused on evaluating the effectiveness of implementing a prearrival phone call process for interventional radiology patients scheduled for procedures requiring moderate sedation or anesthesia. Adherence to NPO guidelines is crucial for patient safety before moderate sedation and anesthesia. The practice problem identified was the number of procedures that were canceled or delayed because of patient nonadherence with NPO guidelines. The practice-focused question that guided this project was, Can the implementation of prearrival phone calls in the preprocedural radiology surgical services help improve patient adherence with NPO protocol …

The Implementation Of A Blended Learning Course To Enhance Leadership And Management Capabilities In Liberian Student Nurse Anesthetists, Donnell Carter

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Leadership plays a crucial role in the functioning of a health system, particularly in resource-constrained settings like Liberia. Effective leadership is essential for identifying solutions and leading teams towards achieving important objectives. Improving leadership competencies among emerging Liberian nurse anesthetists is key to enhancing anesthesiaoutcomes in Liberia. The delivery of high-quality, safe anesthesia in Liberia is contingent on this.

METHODS: This quality improvement project (QI) implemented a transnational blended learning leadership andmanagement course to increase the knowledge, skills, and confidence of Liberian student nurse anesthetists. We used quantitative methods to organize and describe selected outcomes. We also used qualitative …

Knowledge, Skills, And Barriers To Palliative Care Referrals By Oncology Providers, Audra Meador, Bailey Waldron

Doctor of Nursing Practice Projects: College of Nursing

Palliative Care is an evidence based and integrative aspect of cancer care that has demonstrated improved quality of life and diminished symptomology, however, barriers to referrals exist. With the growing interest in and demand for specialized healthcare services, more research on integration and referral practices surrounding palliative care is necessary. This study aimed to explore the knowledge, attitudes, perceptions, and barriers to referring cancer patients to outpatient palliative care at a teaching and research hospital. In one cancer center, 50 physicians, Advance Practice Providers, and nurse case managers responded to an electronic survey regarding interest and support for palliative care …

Reducing Medical Supplies Waste By Managing Healthcare Resources In A Clinical Setting In The United States: Lessons Learned From The Covid-19 Pandemic, Chiatuogu Anna Ukaga

Walden Dissertations and Doctoral Studies

The gap in practice identified for my DNP capstone project is reducing medical supplies waste by managing healthcare resources in a clinic setting in the United States of America. The Organizational Change Process (OCP) Evaluation project assessed a tracking and exchange system to track the inventory of supplies used in different worksite clinics and their expiration dates. Knowledge of the expiration dates enabled exchange or shift to high-utilization areas before the supplies expired, thereby reducing waste, costs, and environmental pollution. The healthcare organization was a mix of ambulatory clinics and hospitals of varying scopes and sizes. The small clinics served …

Implementation Of A Standardized Pain Assessment Tool To Drive Opioid Management In End-Of-Life Patients In A Medical Intensive Care Unit, Sonia Carrizales

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement project implemented a standardized pain assessment tool, the Multidimensional Observational Pain Assessment Tool (MOPAT), to drive opioid administration for end-of-life (EOL) patients. This project intended to increase opioid administration to EOL patients through increased confidence levels noted in bedside staff with the use of a standardized pain assessment tool.

Background

The project was implemented in a thirty-two-bed adult medical intensive care unit in Round Rock, Texas. The patients focused on in this project were those transitioned to EOL care.

Methodology

A pre-and post-survey was sent to bedside staff to gauge confidence levels. The MOPAT was then …

Stress And Burnout Among Icu Nurses, Jaspreet Kaur

2025 Spring Honors Capstone Projects - Archive

Burnout is a significant occupational hazard for Intensive Care Unit (ICU) nurses. High patient acuity, staffing shortages, and long shift hours increase stress and diminish well-being among nurses, affecting patient care outcomes. This study examined the prevalence of stress and burnout among ICU nurses to identify contributing factors and potential interventions. An anonymous online survey was conducted among 110 ICU nurses, utilizing the Maslach Burnout Inventory (MBI) and the Perceived Stress Scale(PSS). Findings revealed that 42.5% of nurses reported high emotional exhaustion, while 37.5% felt they had little to no control at work. The most frequently cited workplace stressors were …

The Lived Experience Of New Graduate Nurses Implementing Evidence-Based Practice In A Clinical Setting, Kimberly A. Mcfarland

Electronic Theses and Dissertations

The purpose of this qualitative interpretive phenomenological analysis study was to explore the perceptions and lived experiences of new graduate nurses (NGNs) as they implemented evidence-based practice (EBP) in clinical settings. This study addressed the problem that NGNs often lack the skills and confidence to effectively apply EBP, despite its critical role in improving patient outcomes. The research aimed to provide insight into the challenges, support systems, and strategies that influence EBP integration during the transition from student to practicing nurse. The study utilized the interpretive phenomenological analysis methodology to analyze data collected through semistructured interviews conducted via the Teams …

Implementation Of Houdini Guidelines Nurse-Driven Protocol To Lower Catheter-Associated Urinary Tract Infections And Foley Utilization Days, Tammie N. Collins

Electronic Theses and Dissertations

Catheter-associated urinary tract infections are a common issue in healthcare settings. These issues contribute to hospital-acquired infections and can lead to complications and increased healthcare costs. The quality project evaluated the impact of the HOUDINI guidelines nursedriven protocol to reduce infection rates and Foley utilization days. A structured guideline for Foley catheter safe removal was implemented using a quantitative method. Catheter-associated urinary tract infection rates and Foley utilization days pre- and postintervention were tracked. Data were collected using the electronic health records, infection control data sheets, and the HOUDINI checklists. A baseline assessment of catheter-associated urinary tract infections rates was …

Quality Improvement Project Enhancing Patient Care In Nurse Practitioner Private Practices: A Train-The-Trainer Approach To Implementing Evidence-Based Chronic Mental Disease Management Interventions, Chioma Waters

Doctor of Nursing Practice Projects

Chronic mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD) are frequently treated by nurse practitioners (NPs) in outpatient private practices. Despite the evidence supporting Cognitive Behavioral Therapy (CBT) as a first-line intervention, its utilization remains limited in NP settings, often due to lack of training and confidence. The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate whether a structured train-the-trainer program could improve NP confidence in applying CBT in practice. Guided by the Iowa Model and Kotter’s 8-Step Change Model, this quality improvement project utilized a quasi-experimental, pre-post survey design to assess …

Improving Access To Mental Health Care Using Telehealth, Lavern Palmer

Doctor of Nursing Practice Projects

More than half of adults with mental illness in the United States live in mental health deserts—geographic areas with limited access to mental health services and persistent barriers to care. This study investigates the impact of telehealth implementation on patient no-show rates at a rural community clinic in Georgia. The aim was to determine whether the use of telehealth for psychiatric care would decrease the no-show rate of mental health appointments. A retrospective analysis was conducted using patient attendance logs collected 12 weeks before and after the implementation of telehealth services. Quantitative data were analyzed using a Pearson correlation to …

Quality Improvement Project Staff Development For Fall Prevention In Community Living Center, Morayo Olatunbosun

Doctor of Nursing Practice Projects

Falls among elderly residents in the community living center continue to be a serious public health concern, increasing mortality, morbidity, and healthcare costs. Despite existing prevention measures, fall-related incidence remains high. The purpose of this quality improvement project is to reduce fall rate in a community living center by implementing structured staff training. A facility needs assessment revealed gaps in fall prevention knowledge, inconsistent protocol use, and limited staff confidence in managing fall risks. In the methodology used to answer the PICOT question, the Donabedian Model guided structure, process, and outcome evaluation, while Kotter’s Change Model informed implementation strategies. The …

Quality Improvement Project Provider Burnout Related To Patient Satisfaction, Sherita Lee

Doctor of Nursing Practice Projects

Provider burnout is a critical issue in healthcare, often intensified by increasing demands to meet patient satisfaction benchmarks. This quality improvement project aimed to examine whether a structured stress reduction program could reduce provider burnout and positively influence patient satisfaction scores in a small outpatient clinic. Guided by the PICOT question—In the clinic setting (P), does the implementation of a stress reduction program for providers (I), compared to no intervention (C), lead to improved patient satisfaction scores (O) over a six-week period (T)? —the project used a pre- and post-intervention design. The intervention included mandatory provider breaks, communication training, and …

Improving Access To Mental Health Care Using Telehealth, Lavern Palmer

Doctor of Nursing Practice Projects

More than half of adults with mental illness in the United States live in mental health deserts—geographic areas with limited access to mental health services and persistent barriers to care. This study investigates the impact of telehealth implementation on patient no-show rates at a rural community clinic in Georgia. The aim was to determine whether the use of telehealth for psychiatric care would decrease the no-show rate of mental health appointments. A retrospective analysis was conducted using patient attendance logs collected 12 weeks before and after the implementation of telehealth services. Quantitative data were analyzed using a Pearson correlation to …

Organization Change Process Initiative Recurrent Emergency Room Visits By Mental Health And Substance Use Patients, Julie Marie Tucker

Walden Dissertations and Doctoral Studies

The rising rates of patients diagnosed with mental health and substance use disorders (MHSUD) signify a critical national crisis, worsened by the COVID-19 pandemic, as reported by the United States Department of Health and Human Services. This increase has reduced access to essential resources and treatment options, resulting in overcrowded emergency rooms (ER) and extended wait times. Addressing these issues is vital for nursing practice, as they significantly influence patient care and health outcomes, especially for vulnerable populations. This doctoral project explores whether an organizational change designed to raise awareness of updated community resources impacts MHSUD patient visits to the …

Nursing Education On The Health Benefits Of Animal Assisted Therapy, Sara C. Barker, Allie P. Dunlap, Daniel T. Do, Charde Willis

SPARK Symposium Presentations

Background: Does nurse education for pediatric oncology families teaching daily animal-assisted therapy (AAT) health benefits reduce anxiety from 35% to 18% compared to current practice?

Methods: A literature search was conducted using CINAHL (356 articles), PubMed (412 articles), and Google Scholar (289 articles) with keywords including animal-assisted interaction, pediatric cancer, pet therapy, psychological support, caregivers, and psychosocial outcomes. Filters applied included peer-reviewed articles, English language, full text, publication within the last five years, randomized controlled or quasi-experimental study design, and relevance to nursing practice. 4 articles were chosen due to being directly relevant to education related to AAT and psychosocial …

Facilitating The Use Of Sbar By Nursing Staff For Handoff Communication, Amarillis L. Tompkins

Student Scholarly Projects

Practice Problem: Clear communication during shift handoffs is crucial to minimize errors and ensure patient safety in intensive care. The current SBAR framework used in the MICU is constrained by limited documentation space, which led to communication inefficiencies and heightened risks for patient care.

PICOT: The PICOT question that guided this project was: In the NFSG VA MICU, will staff nurses (P) using a revised SBAR communication tool with a checklist (I), compared to the current outdated SBAR tool without a checklist (C), improve the accuracy and completeness of patient handoff communication (O) over eight weeks (T)?

Evidence: The project …

The Green Room: Creating An Environment To Combat Burnout In The Emergency Department, Vitaliy Kovdiy

Theses and Graduate Projects

BACKGROUND: In 2020 a pandemic created dangerous workloads leading to many nurses quitting their careers due to chronic stress. This project will create the green room, which is the name of this recharge room, where staff can go to experience a moment of peace to decrease their stress levels. This room had a spa aesthetic with comfortable seating and green plants. METHODS: This quality improvement project follows the plan-do-study-act model. When participants arrived, they filled out a questionnaire before using the room. They were then shown all the things they could do to utilize the room. After they were done …

Addressing Organizational Factors Contributing To The Underreporting Of Workplace Violence In Nursing, Jason K. Blomquist

Doctor of Nursing Practice Projects

Background: Nurses routinely face threats, verbal abuse, and physical violence, yet widespread underreporting obscures the full scale of the problem, hindering efforts to address workplace culture and protect nurses.

Aim: Through leadership engagement and targeted staff education, this quality improvement project sought to increase workplace violence reporting rates on a 35-bed medical/surgical unit.

Methods: Over eight weeks, a three-phase intervention was implemented. Phase one equipped charge nurses with uniquely designed training (DIVER framework) to strengthen leadership support. In phase two, staff received micro-education through established communication channels. Phase three reinforced learning via interactive staff meetings. Pre- and post-intervention surveys assessed …

Empowering Staff Wellbeing: A Team-Based Qi Initiative, Rebecca Lauren Smith, Elizabeth Morse, David Phillippi

SPARK Symposium Presentations

Project Title: Empowering Staff Wellbeing: A Team-Based QI Initiative

Keywords: Burnout, wellbeing, DNP, primary care, QI methodology

Background and Rationale: The consequences of burnout in healthcare are alarming: worse patient outcomes, lack of continuity of care, higher turnover, and increased cost to employers. Many studies of burnout and wellbeing of clinicians focus on larger institutions such as hospitals and Federally Qualified Health Centers. Over the past several years, burnout has been discussed among our small, eight-person clinician team working in a small, non-profit primary care clinic. Yet, there has been no formal assessment of the level of burnout among …

Provider Burnout Related To Patient Satisfaction, Sherita A. Lee

Doctor of Nursing Practice Projects

Provider burnout is a critical issue in healthcare, often intensified by increasing demands to meet patient satisfaction benchmarks. This quality improvement project aimed to examine whether a structured stress reduction program could reduce provider burnout and positively influence patient satisfaction scores in a small outpatient clinic. Guided by the PICOT question—In the clinic setting (P), does the implementation of a stress reduction program for providers (I), compared to no intervention (C), lead to improved patient satisfaction scores (O) over a six-week period (T)? —the project used a pre- and post-intervention design. The intervention included mandatory provider breaks, communication training, and …

Preeclampsia: Implementation Of The American College Of Obstetricians And Gynecologists Standardized Protocol, Sheila Ann Harwell

Electronic Theses and Dissertations

Preeclampsia is a significant medical condition that affects the perinatal population, posing risks to both the mother and fetus. Complications associated with preeclampsia include stroke, seizure, placental abruption (premature separation of the placenta from the uterus), fetal growth restriction (impaired growth due to reduced blood flow through the placenta), premature birth, and low-birth-weight infants with associated developmental issues. Because there is no cure for preeclampsia, the current management involves the timely administration of intravenous antihypertensives to reduce the risk of stroke and seizure. The gap in practice identified was the obstetrical department’s lacking a standardized protocol, compared to adopting the …

Management Of Aggressive And Disruptive Behavior In The Emergency Department Using De-Escalation Techniques And Simulation: A Quality Improvement Project To Improve The Knowledge And Confidence Of Emergency Department Nurses And Clinical Staff, Ernestine Darby-Littlejohn

Electronic Theses and Dissertations

Abstract

Approximately 40% of all healthcare workers have reported episodes of violence by patients over the last 2 years. This Veteran’s Health Agency reported 824 disruptive events reported in the last 5 years, of which 56 occurred in the emergency department. Research shows that interventions are not always timely, resulting in the clinical staff requesting the Veteran’s Health Agency Police to intervene when a veteran’s level of stress is escalating. The gap in practice is shown to be related to a lack of knowledge in the clinical staff in managing high stress levels exhibited by some veterans, limited knowledge of …

The Clinical Impact Of A Standardized Pathway For Chest Pain Evaluation In The Urgent Care Setting, Tysheena L. Jones

Doctoral Dissertations and Projects

This study aimed to evaluate the deficiencies in the current chest pain evaluation practices compared to standard of practice at urgent care centers and to develop an evidence-based clinical workflow prioritizing the reduction of the door-to-EKG times utilizing the Marburg heart score assessment tool. Conducted in three urgent care centers within a larger not-for-profit healthcare system, the retrospective pretest-posttest design involved 44 patients presenting with chest pain. Utilizing t-tests, the study found a significant reduction in door-to-EKG times from 39 minutes pre-intervention to 14 minutes post-intervention (p < 0.05). The pre implementation chart reviews revealed that 7 (32%) of the charts had the required risk assessment tool used, and score documented in the EMR. The post implementation chart reviews revealed that 6 (27%) of the charts had the required risk assessment tool used and score for chest pain documented in the EMR. The Marburg Heart Score facilitated timely identification of high-risk patients while minimizing unnecessary EKGs for low-risk individuals, though protocol adherence and external workflow disruptions were noted limitations. The findings underscore the importance of standardized workflows in enhancing care efficiency and patient outcomes, suggesting that future research explore long-term sustainability and broader implementation in urgent care settings.

Building Capacity For Trauma-Informed Care: Enhancing Knowledge, Attitudes, And Practice Of Trauma-Informed Care Among Nurses, Kim G. Cudjoe

Doctoral Dissertations and Projects

Exposure to trauma is a global and pervasive phenomenon that is known to have negative consequences on the health, health outcomes, and well-being of individuals and at-risk populations to include Veterans. The implementation of trauma-informed care concepts and principles in the delivery of healthcare services among all staff and across the span of healthcare allows healthcare professionals to realize the impact of trauma on individuals, to recognize the signs and symptoms of trauma, to respond to trauma through improved practices, procedures, and policies; and to prevent re-traumatization while receiving care. The purpose of this evidence-based project is to develop and …

The Impact Of Standardized Leadership Rounding On Nursing Satisfaction, Amber N. Vaughn

Regis University Student Publications (comprehensive collection)

This quality improvement project aimed to address the lack of standardized communication between staff and management within the behavioral health service line, as this contributed to a negative culture. This project explored if implementing standardized leadership rounds would increase nursing staff satisfaction compared non-standardized rounds. This project utilized a pre- and post- intervention survey design, with a survey consisting of 15 questions. Eleven (N=11) nurses participated in the study, completing both the pre- and post- intervention surveys. There was an eight-week period of intervention between the pre- and post- intervention surveys. The pre-intervention survey mean score was 6.4848, while the …

Case Management For End-Stage Renal Disease Patients, Jamie L. Andrews

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Social determinants of health (SDOH) and health literacy directly impact adults with end-stage renal disease (ESRD) on hemodialysis (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2022; Ulrich, 2020). Adults with ESRD account for 1.5 million hospital admissions and 500,000 re-admissions within 30 days annually (NIDDK, 2022). Case management is essential in reducing re-admissions for adult ESRD patients, requiring abilities to identify factors affecting adult ESRD patients appropriately.

Methods: Therefore, an evidence-based practice (EBP) project using the IOWA Model framework was implemented to increase the knowledge base in identifying care and resources for ESRD patients for telephonic …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.