Digital Commons Network^™

Closing The Loop: Strengthening Cauti Prevention With Urinary Catheter Management, Erika N. Braun

Master's Projects and Capstones

Objective: Catheter-associated urinary tract infections (CAUTIs) are among the most common preventable healthcare-associated infections and are associated with significant patient harm and increased healthcare costs. Baseline assessment across five adult cardiovascular and critical care units within a community-based acute care hospital identified four CAUTI events during the first half of 2026 and revealed important nursing knowledge deficits related to bladder scanning protocols and urinary catheter management practices. Aim: This Quality Improvement (QI) Project aimed to improve nursing knowledge of evidence-based bladder scanning protocols and urinary catheter management practices through targeted educational interventions implemented over a 10-week period, with …

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 …

You Haven’T Been Forgotten: Driving Improvements In Trust, Transparency, And Accountability Through A Patient-Centered Communication Initiative In The Emergency Department, Ellie Mead

Master's Projects and Capstones

Objective: In Spring 2026, the Emergency Department (ED) at Hospital X identified difficulties securing high levels of patient satisfaction. Over one third of patients did not feel adequately “informed about delays,” and observation of nurse-patient interactions in front-end care areas confirmed these communication gaps: in 87% of interactions, nurses did not explain next steps to the patient, and in none of the 51 interactions observed did nurses proactively inform patients about possible delays. Aim: This quality improvement initiative sought to improve the patient experience in the ED and drive a 10% increase in Press Ganey patient satisfaction survey results relating …

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 …

Draining The Risk, Holding The Line: A Nurse-Driven Approach To Catheter-Associated Urinary Tract Infection Prevention, Thy Nguyen

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most common preventable healthcare-associated infections, with CMS eliminating reimbursement for hospital-acquired cases since 2008. Within a five-unit, high-acuity microsystem at an urban acute care hospital, four CAUTIs were documented between January and July 2026 despite established prevention protocols. Adherence gaps were identified in catheter necessity assessment, maintenance practices, and nurse-driven removal protocol use. This quality improvement project was guided by the Johns Hopkins Evidence-Based Practice framework and Lewin's Change Theory. A targeted nursing education intervention addressing bladder scanning, dependent loop identification, and catheter care bundle adherence was implemented across the microsystem over …

Confidence Versus Competence: Addressing Nursing Knowledge Gaps In Catheter Care To Reduce Catheter-Associated Urinary Tract Infections, Leslie Anne Villanueva Bautista

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most prevalent and preventable healthcare-associated infections (HAIs), contributing substantially to patient morbidity, mortality, prolonged hospitalization, and healthcare expenditures. Most hospital-acquired UTIs are related to urinary catheters, and this burden costs the United States alone an estimated $340 to $450 million annually (Yang et al., 2022). CAUTIs are UTIs that occur in patients with indwelling urinary catheters. This quality improvement project aimed to increase adherence to existing bladder scanning protocols and strengthen urinary catheter care to prevent CAUTI. Baseline staff nurse knowledge was obtained, and reinterpretation of the facility’s existing protocols and bundles …

Implementation Of A Structured Safety Planning Intervention In An Outpatient Psychiatric Setting, Ellen Riccio

Walden Dissertations and Doctoral Studies

This organization change process evaluation addressed continued reliance on outdated no-suicide and no-harm contracts in an outpatient psychiatric setting, despite evidence that such contracts do not reduce suicide risk and may create a false sense of security. Adult outpatients with mood or psychotic disorders who express safety concerns represent a population for whom structured, collaborative safety planning is the accepted standard of care. Addressing this gap is central to patient safety and quality nursing care. The practice-focused question asked whether replacing no-suicide contracts with a structured, six-step Safety Planning Intervention would influence safety events, self-harm behaviors, and psychiatric hospitalizations among …

Staff Education To Improve Staff Knowledge, Confidence, And Intent To Consistently Implement Medication-Assisted Treatment, Matilda Boachie

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice staff education project addressed inconsistent medication-assisted treatment (MAT) implementation in a masked crisis stabilization unit. MAT was available, but staff education was informal and inconsistent, contributing to variation in knowledge, confidence, patient education, documentation, and discharge planning. The practice-focused question that was answered through this project was whether structured staff education would improve knowledge, confidence, and intent to consistently implement MAT. The purpose was to develop, implement, and evaluate structured education for interdisciplinary staff. De-identified pre- and post-education surveys were analyzed with descriptive statistics, and aggregate averages were compared because individual surveys were not matched. …

Implementation Of An Evidence-Based, Standardized Hypertension Follow-Up Protocol To Improve Quality And Outcomes Among African American Females In A Primary Care Setting, Fausat Oluremi Ojo

Walden Dissertations and Doctoral Studies

Hypertension is a major modifiable risk factor for cardiovascular disease, stroke, kidney disease, and premature mortality. African American women experience a disproportionate burden of hypertension and hypertension-related complications, making timely follow-up and treatment intensification essential quality and equity priorities. This evidence-based practice project implemented a standardized hypertension follow-up protocol in a primary care setting to improve blood pressure (BP) control and follow-up reliability among African American females ages 18 to 65 with a hypertension diagnosis. The project population included 67 patients, numbered 1 to 67. Baseline BP report data showed that 47 patients had BP less than 140/90 mm Hg, …

An Interprofessional Organization Change Process To Reduce Catheter-Associated Urinary Tract Infections, Bolatito Owolabi

Walden Dissertations and Doctoral Studies

This organization change process initiative addressed a critical safety practice gap regarding catheter-associated urinary tract infection (CAUTI) prevention in a 450-bed acute care facility. This gap was recognized based on evidence that the facility’s CAUTI Standardized Infection Ratio (SIR) was above the national benchmark—and daily necessity assessment compliance of only approximately 50%. This gap was attributed to an organizational interprofessional culture, which hindered timely device removal. Prolonged catheter dwell times increase patient morbidity, extend hospital stays, and expose the organization to severe financial penalties. The project aimed to safely reduce device dwell times by structurally empowering bedside nurses. I used …

Implementation Of A Nightshift Sleep Promotion Bundle To Support Delirium Prevention In A Neurosurgical Intensive Care Unit, Pamella Simpson

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) quality improvement project aimed to identify the need for a consistent sleep-promotion protocol in an adult neurosurgical intensive care unit (NSICU). Disrupted sleep is a frequent problem for patients who are seriously ill and can lead to delirium, longer hospital stays, higher health care expenses, diminished cognitive function, and death. While there was evidence supporting nonpharmacological sleep-promotion and delirium-risk-reduction interventions, they were not consistently implemented at the project site, creating a gap between evidence and clinical practice. The purpose of this project was to implement and evaluate an evidence-based night-shift sleep-promotion bundle. The practice-focused …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

Impacting Competency In C-Ssrs Suicide Risk Screening On An Inpatient Psychiatric Unit, Fidelis Sangye

Doctor of Nursing Practice Projects

Suicide remains a leading public health concern, and inconsistent application of the Columbia-Suicide Severity Rating Scale (C-SSRS) may contribute to variability in suicide risk assessment and delayed intervention within inpatient psychiatric settings. The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a standardized C-SSRS-guided educational intervention on staff competency in suicide risk screening. Guided by Lewin’s Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, this quantitative pretest-posttest QI project was conducted on an adult inpatient psychiatric unit. The intervention consisted of a 25-minute instructor-led PowerPoint presentation on standardized C-SSRS administration and evidence-based suicide risk …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

The Impact Of A Structured Education Program On Artificial Intelligence Use For Nursing Faculty On Teaching Practices, Katy White

Doctor of Nursing Practice Projects

Artificial intelligence (AI) is increasingly integrated into nursing education; however, nursing faculty report inconsistent preparedness, including gaps in AI knowledge and self-efficacy for responsible AI integration. This quality improvement project addressed inconsistent faculty preparedness through an asynchronous AI educational program. The purpose was to address gaps in AI knowledge and self-efficacy, and the aim was to evaluate changes in AI self-efficacy and AI knowledge while supporting AI integration into nursing education. Rogers' Diffusion of Innovations Theory served as the change theory, the Technology Acceptance Model served as the theoretical framework, and the Plan-Do-Study-Act framework guided implementation. A quantitative one-group pretest-posttest …

Reducing No-Show Rates In An Outpatient Behavioral Health Clinic Through A Multimodal Patient Engagement Intervention, Gwendoline Osong

Walden Dissertations and Doctoral Studies

Reducing No-Show Rates in an Outpatient Behavioral Health Clinic Through a Multimodal Patient Engagement Intervention

Implementation Of A Standardized Columbia-Suicide Severity Rating Scale Screening Process In An Outpatient Psychiatric Practice, Dela Mensah Frimpong

Walden Dissertations and Doctoral Studies

This doctoral project was an organizational change initiative designed to implement a standardized suicide risk screening process in an outpatient psychiatric practice. The identified practice problem was inconsistent staff use and documentation of suicide risk screening, which could result in missed warning signs, delayed provider notification, incomplete documentation, and inconsistent follow-up care. Suicide risk identification is an essential nursing responsibility and a key component of patient safety (The Joint Commission, 2024; Zero Suicide, n.d.). The practice-focused question examined whether staff education and implementation of a standardized Columbia-Suicide Severity Rating Scale (C-SSRS) workflow would improve staff compliance, documentation completion, and knowledge …

Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu

Walden Dissertations and Doctoral Studies

Quality Improvement Initiative Implementation of an Electronic GAD-7 Screening Tool to Improve Anxiety Screening Completion and Documentation

Reducing Urinary Tract Infections In Long-Term Care Residents, Felicity Antwi

Walden Dissertations and Doctoral Studies

This quality improvement (QI) project addressed delays in diagnosing urinary tract infections (UTIs) at a skilled nursing facility (SNF), where reliance on urine culture testing and patient monitoring resulted in an average diagnostic period of 72 hours. A high UTI incidence and UTI-involved hospitalization rate are both nurse-sensitive indicators that are important to address in the nursing practice context because they portend negatively for nursing quality and safety. This quality improvement (QI) project addressed the practice-focused question: among long term care (LTC) residents with suspected UTIs in a nursing home (NH), how does reducing the diagnostic period from 72 hours …

Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton

Walden Dissertations and Doctoral Studies

Burnout is a recurrent problem for healthcare workers and is associated with staff turnover, a decline in the quality of care, emotional fatigue, and risks to patient safety. This Doctor of Nursing Practice (DNP) staff education initiative created a mindfulness-based training program to expand the knowledge of registered nurses, nurse practitioners, and medical assistants on mindfulness practices in a behavioral health setting. Baseline assessment data identified a need for support to address emotional fatigue, absenteeism, and staff disengagement, with a mean pre‑education knowledge score of 66%. A structured, in‑person educational program addressing burnout awareness, stress reactivity, and helpful mindfulness methods …

Standardized Metabolic Monitoring Protocol For Adult Outpatients Who Are Prescribed Antipsychotic Medications, Abel Bueno Gonzalez

Walden Dissertations and Doctoral Studies

This doctoral project was an organization change process evaluation of a quality improvement initiative in a masked outpatient mental health clinic. The practice challenge was poor metabolic monitoring and documentation among adult outpatients taking antipsychotics that were not in line with guidelines. This problem is relevant to nursing practice because use of antipsychotic medications raises risk for weight gain, dyslipidemia, hypertension, and glucose abnormalities, and not monitoring risks may delay referral or management. The practice-focused question was: According to evidence, among adult patients who are prescribed antipsychotic medications in an outpatient mental health clinic, what is the impact of implementing …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Improving Exam Scores: Alternative Next Generation Questions In Curriculum, April Morgan

Doctor of Nursing Practice Projects

Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Dnp Final Report: Improving Diabetes Self-Efficacy Through Nutrition Education: A Quality Improvement Project, Lakimberely S. Wooten

DNP Final Reports

Diabetes affects 12.7% of residents in Northeast Texas and is the 7th leading cause of death. Internal evidence indicates low health literacy and a heavy disease burden in the service area, underscoring the need for a standardized, low-cost, and feasible approach to nutrition education. This quality improvement project evaluated the feasibility of implementing an instructor-led nutrition education session. Guided by the Johns Hopkins Evidence-Based Practice Framework and the ADKAR behavioral change model, adult participants with Type 2 diabetes received instruction on the Plate Method. Participants enrolled in a 4-week, instructor-led diabetes education class completed a 1-hour, nutrition education session using …

The Tension Of Retention And Retirement: A Narrative Study Of Full-Time Nursing Faculty Within Five Years Of Retirement At Public, Four-Year Institutions In Texas, Shelley Hunt

Electronic Theses and Dissertations

This narrative inquiry, qualitative study explored the retirement decision-making process of nursing faculty at public, four-year institutions who were within five years of retirement. Through purposive sampling, 11 participants across eight institutions consented to participate and were interviewed via Zoom. Due to the nursing faculty shortage, the researcher hypothesized that nursing faculty nearing retirement may be retiring not only as a natural progression of their career but also because of factors that lead other early and mid-career faculty members to leave academia. Through thematic analysis, four themes emerged: Finding Meaning and Fulfillment in the Nurse Faculty Role, Institutional Factors Shaping …

Nurse-Led Quality Improvement Asthma Self-Management In Primary Care, Jolene Steinert-Abderhalden

DNP Projects

Background:
Poorly controlled asthma contributes to preventable morbidity, yet many adults lack consistent self-management support. Local Problem: Baseline assessment at a rural Midwestern clinic revealed limited asthma knowledge, inconsistent action-plan use, and low confidence among adults with Asthma Control Test (ACT) scores below 20.

Methods:
This quality improvement project used a pre- and post-intervention design guided by Lean methodology and the Plan-Do-Study-Act (PDSA) framework. Interventions: Registered nurses delivered standardized asthma education, inhaler-technique review, and action plan reinforcement with monthly structured follow-up for 16 weeks.

Results:
Among four enrolled participants, three completed follow-up. Mean ACT scores improved from 17.5 at baseline …

Educating School Nurses On Trauma-Informed Care, Na-Keisha Allene White

Walden Dissertations and Doctoral Studies

Trauma-informed care is a critical component of supporting students' overall wellness, and school nurses are central to this work. They are often the first professionals to recognize when a student is exhibiting a trauma response or experiencing a mental health concern during the school day. Although evidence-based school health organizations have advanced efforts to ensure that academic environments are prepared to support students’ mental health needs, school nurses are too often left out of these strategic planning processes. Their exclusion not only overlooks their clinical expertise but also weakens the school’s ability to respond effectively and holistically to student needs. …