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Understanding Adult Patients’ Experiences Of Trauma-Informed Care In Outpatient Healthcare, Jayme Aguero

Dissertations (1934 -)

Trauma is recognized as a universal human experience. Well-established evidence demonstrates the negative impact of trauma on health outcomes. In 2014, following a recommendation from SAMHSA, trauma-informed care (TIC) was implemented across human service sectors, including healthcare. While TIC has been in use for the past decade, adults’ experiences of receiving TIC in outpatient healthcare remain largely unknown. The purposes of this study were (a) to explore and describe how adults’ healthcare experiences aligned with the principles of TIC being implemented in outpatient healthcare settings and (b) to understand the perceived usefulness and meaning of TIC for adult patients. A …

Quality Improvement Project: Improving Provider Workflow And Documentation For Routine Mental Health Screening In An Outpatient Psychiatric Clinic, Sharon Uchechi Joshua

Doctor of Nursing Practice Projects

Depression and anxiety are leading causes of disability and are frequently underdiagnosed in outpatient psychiatric settings due to inconsistent screening and documentation practices. Evidence supports the use of standardized tools, such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), to improve early detection and clinical outcomes. This quality improvement (QI) project evaluated whether implementing standardized electronic health record (EHR) templates and provider education would improve documentation of PHQ-9 and GAD-7 screenings. The aim was to increase the consistency of screening and documentation among psychiatric providers. The project was guided by the Plan-Do-Study-Act (PDSA) framework and Lewin’s Change …

Embedding Social Determinants Of Health Into Maternal Simulation Scenarios: Enhancing Nursing Staff Awareness Of Equity-Based Education, Sherina Evans

Doctor of Nursing Practice Projects

Despite growing evidence emphasizing the importance in addressing disparities in maternal health outcomes, maternal health simulations often lack integration of social determinants of health (SDOH) and cultural considerations. The purpose of this Doctor of Nursing Practice quality improvement project was to enhance nursing faculty cultural awareness through simulation scenarios that incorporate SDOH and culturally responsive elements. This project was guided by Lewin’s Change Theory and the Jeffries Simulation Framework. The aim was to strengthen faculty awareness and skills to support the development of culturally inclusive simulation experiences. Descriptive statistics were utilized to analyze results which was a limitation. Nursing faculty …

Improving Monitoring And Documentation Of Long-Acting Injectable Antipsychotic Adherence In Patients With Schizophrenia Through Staff Education And Refill History Review, Stacy Ann Bruce

Doctor of Nursing Practice Projects

Schizophrenia is a chronic psychiatric disorder associated with relapse, hospitalization, and poor outcomes when medication adherence is suboptimal. Nonadherence increases morbidity and healthcare utilization (World Health Organization, 2022; Zhao et al., 2025). Long-acting injectable (LAI) antipsychotics improve adherence and reduce hospitalization, but inconsistent monitoring and documentation in outpatient settings hinder early identification of missed doses (Lieslehto et al., 2022). This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate whether staff education and structured refill-monitoring processes improve identification and documentation of nonadherence to LAI antipsychotics. Using Kotter’s Change Management Model and the Plan-Do-Study-Act framework, the project focused on …

From Novice To Effective: Strengthening Clinical Education In Nursing, Stephanie Campbell

Doctor of Nursing Practice Projects

The professional transition from clinician to educator is often complicated by a lack of formal training and professional development. This gap in training and support compromises the delivery of nursing education and leads to feelings of inadequacy, diminished confidence, and higher rates of attrition. This quality improvement (QI) project seeks to improve the quality of clinical education by evaluating the impact of a structured onboarding process on a novice nurse educator’s self-efficacy and perceived support. Guided by Lewin’s Change Theory and Bandura’s Social Cognitive Theory, the project aims to enhance the onboarding process for novice nurse educators. The Find, Organize, …

Quality Improvement Project: Reimplementation Of Bedside Reporting, Veronicah Banga

Doctor of Nursing Practice Projects

Communication breakdown during nursing shift handoffs is a major patient safety challenge in healthcare today. At the project site, 85% of handovers occurred at the central nursing station, and most staff nurses expressed dissatisfaction with the quality of the bedside reporting. In psychiatric nursing, unique barriers exist that make bedside reporting challenging, including patient confidentiality and an individual's diagnosis. Such barriers eroded bedside reporting (BSR) over time, leading to measurable safety risks and nursing dissatisfaction. The purpose of this quality improvement project was to reintroduce bedside handoffs using the Situation, Background, Assessment, and Recommendation (SBAR) framework and to maintain BSR …

Quality Improvement Project: Improving The Clinical Teaching Experience Through Clinical Adjunct Orientation, Elissa Saunders

Doctor of Nursing Practice Projects

Clinical adjunct nursing faculty often transition into academic roles without formal preparation, leading to role insecurity and high turnover rates that negatively impact student clinical experiences. The purpose of this quality improvement (QI) project was to implement a structured orientation checklist to improve perceived clinical teaching competency among novice clinical adjunct faculty. The project aimed to standardize onboarding and support the transition from clinical practice to academia. A quantitative pre-post intervention design was used with a convenience sample of clinical adjunct faculty employed for less than one year at a rural university nursing program. The project was guided by Kotter’s …

Strengthening Evaluation For Student Success, Hollan Scrivner

Doctor of Nursing Practice Projects

Student evaluation is an important factor in guiding students to develop self-confidence and gain competency in nursing skills. For evaluation to be effective, it must be consistent. The purpose of this quality improvement project is to implement a training program to improve consistency and interrater reliability among faculty conducting skill evaluations. The impact of the training program will be measured by a pre- and post-grading exercise using a skills rubric. Data will be extracted from the rubrics and entered into a codebook for data analysis. The project was guided by the theoretical framework of Stephens’ Star Model of Knowledge Transformation …

Quality Improvement Project: The Impact Of The Clinical Judgment Measurement Model In Nursing Faculty, Lamia Zeidan

Doctor of Nursing Practice Projects

Clinical judgment is essential for nursing practice and can be taught using the Clinical Judgment Measurement Model (CJMM). A needs assessment conducted at the project site revealed that students had limited clinical judgment skills, there was no emphasis on clinical judgment in nursing skills courses, and the faculty had a limited understanding of the CJMM. In response to the findings of the needs assessment, the quality improvement (QI) project was developed using a quasi-experimental design. Guided by Lewin’s Change Theory and Benner’s Novice to Expert Educator theoretical framework, the project aimed to provide faculty with education on the CJMM and …

Building Connections For Care: A Practical Guide For Novice Nursing Professional Development Practitioners, Debra Hunt

Student Dissertations

Building Connections for Care is a practical textbook designed to support novice Nursing Professional Development Practitioners (NPDPs) as they transition from expert bedside clinicians to educational leaders within complex healthcare systems. Grounded in the Association for Nursing Professional Development (ANPD) practice model, the book integrates ethical foundations, communication strategies, leadership frameworks, and inquiry methods to build confidence and competence in the NPDP role. Chapters trace a developmental pathway from role transition and Benner’s novice-to-expert model through ethics and just culture, incivility and workplace culture, and communication skills including feedback, SMART goals, SBAR, and professional digital conduct. Subsequent chapters expand NPDP …

New Graduate Nurse Retention Strategies Toolkit For Managers And Leadership, Taryn Ryan

Student Scholarly Projects

Practice Problem:

Nurse retention has been a persistent issue for over a decade, with increasing turnover among new graduate nurses. Many new nurses leave the profession due to inadequate preparation for clinical roles and responsibilities.

PICOT:

The PICOT question that guided this project was: For nurse managers and leaders supporting new graduate nurses (P), how does the development of a best-practice retention toolkit (I), compared to existing retention practices (C), guide evidence-based strategies to improve nurse retention (O)?

Evidence:

Evidence indicates that new graduate nurses often feel insufficiently prepared for patient care responsibilities, compromising patient safety (Haddad et al., 2023; …

Nurse Driven Intervention To Address Cesarean Section Rates, Cavetta Tulloch-Lewis

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Abstract

Cesarean sections (C-sections) account for approximately one-third of births in the United States and remain the most common inpatient surgical procedure. Primary cesarean sections are a major contributor to rising rates, often leading to repeat cesareans in subsequent pregnancies. While medically necessary C-sections are lifesaving, their overuse in low-risk pregnancies is associated with increased maternal morbidity. Labor dystocia is one of the leading indications for primary cesarean delivery and may be mitigated through evidence-based, nurse-driven interventions such as maternal positioning and peanut ball utilization. Registered nurses are uniquely positioned to influence labor progression and promote vaginal birth through continuous …

Reducing Social Isolation In Elderly Hospice Patients Through Structured Social Interventions, Ashley Babayan

Walden Dissertations and Doctoral Studies

This doctoral project was conducted as a quality improvement organizational change initiative aimed at reducing social isolation among elderly hospice patients through structured social interventions. Social isolation is a significant psychosocial concern in hospice populations and is associated with increased emotional distress, depression, and decreased quality of life. Despite hospice care’s holistic philosophy, structured and standardized social engagement interventions are inconsistently implemented across settings, creating a gap in practice. The practice-focused question guiding this project was: In elderly hospice patients experiencing social isolation, how do structured social interventions (regular visits, group activities, and emotional support systems), compared to standard hospice …

Utilizing Proactive Rounding With Nursing Leadership To Improve Patient Satisfaction Scores In An Adult Medical-Surgical Unit, Lily A. Bogyah

Student Scholarly Projects

Practice Problem: Patient satisfaction is a key quality indicator that reflects patients’ perceptions of care and the healthcare system’s performance. Patient satisfaction scores at the project site were significantly lower than the national benchmark, particularly on the adult medical-surgical unit.

PICOT: The PICOT question that guided this project was: In patients on an adult medical-surgical unit (P), how does the use of proactive patient rounding conducted by nurse leaders (I) versus current practices alone without such rounding (C) affect patient satisfaction scores over an eight-week period (T)?

Evidence: A literature review of multiple studies found that implementing daily nurse leader …

Implementation Of A Standardized Suicide Risk Screening Protocol Using The Columbia-Suicide Severity Rating Scale (C-Ssrs) In An Outpatient Mental Health Clinic, Kemisola Ebietomiye

Doctor of Nursing Practice Projects

The outpatient mental health clinics across the United States lack consistent suicide risk assessment methods. This project developed standardized procedures which used Columbia-Suicide Severity Rating Scale (C-SSRS) assessment together with provider education and electronic health record systems to evaluate how these elements impacted provider self-efficacy and their ability to record screening results. The project used a pre-post design to examine (n=24) psychiatric providers at an urban outpatient clinic through the combined methods of Lewin's Change Theory and the Plan-Do-Study-Act framework. The General Self-Efficacy Scale measured provider self-efficacy, and structured EHR audits tracked documentation rates pre- and post-implementation over six weeks. …

Quality Improvement Project Standardizing Simulation In Nursing Education: A Faculty Training Initiative, Andrea Reyes

Doctor of Nursing Practice Projects

Simulation-based education is essential in nursing programs as clinical placement opportunities decline. However, inconsistent faculty preparation can compromise the quality of simulation delivery. The purpose of this quality improvement project was to implement and evaluate a standardized simulation faculty training initiative to determine its impact on nursing faculty's confidence in simulation facilitation. Guided by the Jeffries Simulation Framework and Lewin’s Change Theory, a quasi-experimental pre-post design was used to examine changes in faculty confidence following participation in a training program aligned with national standards and guidelines. Faculty confidence was measured using the Simulation Educator Needs Assessment Tool (SENAT) administered pre- …

Standardizing Patient-Centered And Trauma-Informed Communication Practices Among Staff In A Behavioral Health Setting, Jayla Brown

Doctor of Nursing Practice Projects

The purpose of this quality improvement project was to evaluate the effect of an evidence-based educational intervention on staff attitudes toward trauma-informed and patient-centered communication in an outpatient behavioral health clinic. Guided by Lewin’s Change Theory and Jean Watson’s Theory of Human Caring, the project aimed to improve staff knowledge, attitudes, and confidence in applying trauma-informed communication strategies across all clinic roles. An eight-week educational intervention based on the SAMHSA Trauma-Informed Care Toolkit was implemented for clinical and administrative staff. A quantitative pretest–posttest quasi-experimental design was used, with outcomes measured using an adapted Attitudes Related to Trauma-Informed Care scale. All …

Quality Improvement Project: Impact Of Mindfulness-Based Stress Reduction On Nurse Burnout In Skilled Nursing Facilities, Chinenye Okafor

Doctor of Nursing Practice Projects

Burnout is a persistent and critical problem in skilled nursing facilities, contributing to reduced job satisfaction, increased turnover, and compromised quality of care. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the impact of a Mindfulness-Based Stress Reduction program on burnout among registered nurses in a skilled nursing facility. Guided by the Job Demands–Resources framework and Lewin’s Change Theory, a quantitative pretest–posttest design was implemented using the Plan–Do–Study–Act. Ten nurses consented to participate in an eight-week intervention, and four completed both pre- and post-intervention measures. Burnout was measured using the Maslach Burnout Inventory–Human Services …

Addressing Faculty Gaps In The Psychiatric Mental Health Nurse Practitioner Program, Shea Brock

Doctor of Nursing Practice Projects

Graduate nursing programs increasingly rely on adjunct faculty to sustain enrollment growth; however, inconsistent onboarding processes may contribute to variability in faculty preparedness and job satisfaction. The purpose of this quality improvement project was to implement a standardized adjunct faculty education program and evaluate its impact on adjunct faculty knowledge and job satisfaction within an online Psychiatric–Mental Health Nurse Practitioner (PMHNP) program. A quantitative, quasi-experimental one-group pre–post design was utilized. Six adjunct faculty members (n = 6) completed a 10-item EXXAT Knowledge Survey and a 10-item Faculty Satisfaction Survey before and after participation in a structured one-hour education session focused …

Quality Improvement Project: Effectiveness Of Staff Education On Fall Prevention, Theresa Oahre Okoyomo

Doctor of Nursing Practice Projects

Falls increase injury and mortality rates and decrease patients' quality of life. Hospital falls also incur enormous financial burdens on hospitals. In 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for fall-related injuries. The problem addressed in this quality improvement project was staff confidence in fall prevention and hospital fall rates. The purpose is to improve staff confidence and reduce fall rates by 95 % within six weeks. The 2025 CDC/STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention was the program of choice because it aligns with the hospital's fall-prevention policy. This project design is …

Quality Improvement Project: Reducing Medication Errors To Improve Patient Safety, Paulina Irish

Doctor of Nursing Practice Projects

Medication administration errors remain a persistent threat to patient safety in emergency department settings, where high acuity, rapid throughput, and workflow interruptions increase vulnerability to preventable adverse events. The purpose of this Doctor of Nursing Practice quality improvement project was to increase medication-safety knowledge scores by at least 10% and reduce medication administration error rates by 20% within eight weeks among registered nurses in a freestanding emergency department in South Texas. The project was grounded in Lewin’s Change Theory as the theoretical framework and implemented using the Plan–Do–Study–Act quality improvement model. A quasi-experimental, single-group pretest–posttest design was used with a …

Improving Benzodiazepine Refill Workflow And Communication Via Telehealth Using A Standardized Sbar Protocol, Hendricks Agwu

Doctor of Nursing Practice Projects

The development in telehealth operations in outpatient mental health care has enhanced access to care at the expense of creating challenges in communication and workflow, especially when it comes to dealing with high-risk substances like benzodiazepines. The role ambiguity, inaccurate refill timeline, documentation lapses and high chances of medication errors are caused by inconsistent communication during the process of telehealth refills. This quality improvement project was aimed at assessing the effects of applying a standardized Situation, Background, Assessment, Recommendation (SBAR) communication and documentation protocol to workflow efficiency, interprofessional communication, and medication safety when making benzodiazepine refills in a telehealth outpatient …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Staff Education To Enhance Self-Care Support For Nurses, Charisma Olive

Walden Dissertations and Doctoral Studies

Background: High stress and burnout among maternity unit nurses negatively impact both nurse well-being and patient care quality. Research indicates that nurse burnout is associated with impaired cognitive function, reduced emotional connection with patients, and suboptimal job performance, all of which directly impact patient safety. Purpose: The purpose of this quality improvement project was to implement a comprehensive staff education program teaching evidence-based self-care strategies while assessing organizational support systems for nurse wellness. Methods: This three-phase quality improvement project utilized Lewin’s change management model combined with the ADDIE instructional design framework. Phase I (baseline assessment) involved 17 participating maternity nurses …

Staff Education To Enhance Phq-9 Depression Screening In A Mental Health Clinic, Constance Gawum Chingo

Walden Dissertations and Doctoral Studies

Doctor of Nursing Practice Project Summary Lack of standardization in the implementation and documentation of the Patient Health Questionnaire-9 (PHQ-9) was noted in this outpatient mental health clinic, impeding reproducible depression screening and evidence-based monitoring. The purpose of this Doctor of Nursing Practice (DNP) project was to examine whether staff education, enhanced by clinical workflow aids, could foster uniform PHQ-9 documentation in applicable patient encounters. Strategies employed included a systematic staff education session, a quick reference guide, an electronic health record (EHR) guide, and provision of prompt guidance and support during adoption. A pre- and post-quality improvement assessment was conducted …

Resilience Education To Increase Staff Knowledge Regarding Stress Management, Patricia Ngozi Egwu

Walden Dissertations and Doctoral Studies

This doctoral project implemented a staff education program to promote nursing knowledge of resilience training and stress management at an outpatient mental health clinic. Workplace stress contributes to medication errors and to poor Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Nurse Communication scores, both of which undermine patient safety. The practice-based question was: Does resilience education enhance stress management strategy knowledge from pre- to post-education? The purpose was to evaluate whether structured resilience education improved nursing knowledge of stress management, guided by the analysis, design, development, implementation, and evaluation (ADDIE) model. Using the Johns Hopkins evidence-based practice (JHEBP) …

Staff Education To Reduce The Incidence Of Bias In Managing Patients With Opioid Use Disorder In A Rehabilitation Center, Almarie Alison Mclaren

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed stigma and implicit bias toward individuals with opioid use disorder (OUD) within a rehabilitation subacute care setting. OUD remains a significant public health concern and at the project site, inconsistent staff education was identified as a practice gap requiring intervention. The purpose of this practice-focused DNP project was to evaluate the impact of a structured staff education intervention on healthcare staff knowledge, attitudes, and confidence in caring for patients with OUD. The project was guided by a thorough evidence search. The project was implemented using brief, unit-based educational sessions delivered to interdisciplinary …

Quality Improvement Project: Improving Transitional Care Management (Tcm) Follow-Up Through Medical Assistant Education, Oben Assick

Doctor of Nursing Practice Projects

The underutilization of Transitional Care Management (TCM) services in primary care significantly contributes to preventable hospital readmissions and revenue loss. Despite established Centers for Medicare & Medicaid Services (CMS) guidelines, execution often fails due to knowledge gaps among frontline staff. This quality improvement project addressed low TCM task completion rates by implementing a structured educational intervention for medical assistants (MAs). The purpose was to evaluate whether targeted training improves timely patient follow-up, visit scheduling, and billing accuracy. The project utilized Kotter’s 8-Step Change Model to guide organizational change and the Health Belief Model to address behavioral barriers. A quantitative, quasi-experimental …

Leader Rounding For Outcomes To Improve Employee Retention, Laura R. Escobar

Electronic Theses and Dissertations

Intention to leave a nursing staff position, if not addressed, may lead to an increased rate of nursing turnover. High turnover rates can negatively affect staffing patterns, increase organizational costs, and disrupt the continuity of patient care. A quantitative quasi-experimental pre-/posttest design was used to evaluate the impact of the High Reliability Organization Leader Rounding for Outcomes tool to reduce the intent-to-leave scores, as measured by the Turnover Intention Scale (TIS-6), compared to current practice over 12 weeks. Implementation of the tool provided a structured leader rounding process designed to strengthen communication, recognize staff contributions, and proactively identify workplace concerns. …

Development Of An Educational Intervention To Enhance Nurses’ Knowledge And Intent To Implement Evidence-Based Diabetes Self-Management In Clinical Practice, Anne Marie Sieyou Ngouane

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was purposed with closing critical gaps in staff knowledge and adherence to diabetes self-management protocols in a busy primary care clinic. Rising readmission rates and uneven use of American Diabetes Association (ADA) standards signaled an urgent need for a structured approach to staff education. To address this, a one-hour interactive training session was created that blended teaching, evidence-based handouts, and a practical diabetes care checklist. Staff learning was measured through pretest and posttest, confidence and adherence used a 5-point Likert-scale survey, and 21day readmission data tracked patient outcomes. The project question asked if …