Digital Commons Network^™

Illuminating Leadership Excellence: An Evidence-Based Qi Intervention Reigniting Nurse Leaders From Burnout To Brilliance Using Caring Science And Reflective Practice, Matthew S. Elliott

Master's Projects and Capstones

Abstract

Problem: A 2024 assessment at a 250‑bed Northern California medical center revealed that 76% of 16 inpatient nurse leaders met "high‑burnout" criteria on the Maslach Burnout Inventory, and leader turnover had climbed to 25%, more than triple national benchmarks, threatening patient care quality, financial stability, and alignment with Magnet® and employee engagement goals.

Context: Root causes included pandemic‑era promotions without development support, a task‑oriented leadership culture, and eroding psychological safety (Press Ganey engagement ≈ 30%). An integrative logic model positioned Watson's Caring Science as the theoretical base, Schön's Reflective Model for adaptive learning, and the Prosci ADKAR change framework …

Enhancing Client Intake Efficiency In The Removal Defense Program: A Nursing-Led Quality Improvement Initiative, Johnny Linares, Julia Tran Ngo, Daniel Orea, Atheana Yadira Lopez

Master's Projects and Capstones

This quality improvement project focuses on optimizing the intake process for the Removal Defense Program at a nonprofit immigration legal office serving asylum-seeking clients. The existing intake relied on unstructured, phone-call-based intake interviews that gathered incomplete information, leading to inconsistent documentation, reduced efficiency, and significant client processing delays. A structured, multilingual, and multiplatform new-client admission protocol coupled with the implementation of a client-facing resource guide for waitlist clients were co-developed and implemented using the Lippitt Change Theory framework. Utilizing a mixed methods approach, the study involved staff interviews and observational assessments with staff members from the program. Baseline intake process …

Preventing Nurse Burnout Through Self-Care Strategies, Doris Iwuh

Walden Dissertations and Doctoral Studies

Executive Summary: Staff Education Project Preventing Nurse Burnout through Self-Care Strategies by Doris Iwuh MS, Walden University, 2022 BSN, Grand Canyon University, 2020 ADN, Radiance College, 2016 Executive Summary Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2025 Summary An outpatient mental health clinic identified a rise in burnout among psychiatric nurse practitioners, licensed therapists, and social workers. A gap in practice revealed that staff lacked knowledge of self-care strategies to manage burnout, leading to the project question: Does implementing an educational program for nurses and mental health specialists on …

Improving Intraoperative Antibiotic Stewardship To Reduce Surgical Site Infections: A Quality Improvement, Allyson Nichelle Heard

Doctor of Nursing Practice (DNP) Manuscripts

Purpose: Surgical site infections (SSIs) have been associated with poor pre-surgical incision antibiotic and intraoperative redosing practices and are the leading cause of postoperative readmissions and healthcare-acquired infections. A Quality Improvement (QI) project was developed to evaluate SSIs rates and pre-surgical incision antibiotic dosing and intraoperative redosing practices of anesthesia providers at a Level 1 trauma center in the Midwest. Methods: A pre- and post-intervention knowledge, attitudes, and practices (KAP) survey addressing intraoperative antibiotic stewardship was administered to 138 anesthesia providers. Interventions included education, a reference sheet, and a clinical pathway. Data analysis for surgical procedures involving anesthesia services, …

Enhancing Care Coordination And Expedited Appointment Scheduling By Structured Workflow Process In Oncology Clinics: A Quality Improvement Initiative, Jasmine Lassiter

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: Delays in oncology appointment scheduling can negatively impact timely cancer treatment, care coordination, and patient outcomes. Inefficiencies often stem from inconsistent workflows, communication breakdowns, and limited visibility into provider availability, contributing to scheduling inaccuracies, and treatment delays (Fletcher et al., 2023; Johnson et al., 2020). Purpose: This quality improvement project aimed to implement and evaluate a structured workflow for expedited oncology appointment scheduling in an outpatient setting to improve scheduling accuracy, care coordination, and healthcare team vitality. Intervention and Implementation Plan: Guided by the Institute for Healthcare Improvement (IHI) Model for Improvement and the Johns Hopkins Evidence-Based …

The Implementation Of A Pilot Program On Puberty And Menstruation Education For Adolescent Females And Youth Development Specialists For A Gender-Specific Community Organization: A Quality Improvement Project, Cassandra Tavares

Doctor of Nursing Practice (DNP) Manuscripts

Background & Significance: Adolescent girls in the United States (U.S.) often lack adequate education and support regarding puberty and menstruation, despite the importance of this knowledge for healthy development (Schmitt et al., 2022). Only 21% of school systems serving ages 8–12 provide puberty education, and many educators feel unprepared to teach it (Schmitt et al., 2022). Purpose: This quality improvement project aimed to equip youth development specialists (YDS) at a community organization with a structured curriculum and educational tools to confidently educate adolescent females (ages 8–13) on the physical, emotional, and social aspects of puberty and menstruation. Intervention: A four-day …

Quality Improvement Project Impact Of Impostor Phenomenon On Medical Personnel, Elizabeth L'Heureux

Doctor of Nursing Practice Projects

The DNP project examined medical healthcare personnel who displayed an impostor phenomenon (IP), as reflected in the Perceived Stress Scale (PSS-10) surveys, identifying a lack of structured support for reducing stress. The aim of the quality improvement project (QI) is to evaluate the impact of a four-week structured mentorship and resilience training intervention on perceived stress levels among medical healthcare personnel experiencing symptoms of the impostor phenomenon. The QI project utilized the Cognitive-Affective framework to shape what needed to change, the origins of IP stress, while Lewin’s Change Theory guided how to implement and sustain those changes. A quasi-experimental study …

The Effects Of A Breastfeeding Educational Program On Nurses’ Self-Efficacy And Knowledge, Amanda Quinn

Doctor of Nursing Practice Projects

Breastfeeding, a cornerstone of maternal and infant health, faces barriers due to inadequate healthcare provider education, contributing to low exclusive breastfeeding rates. The purpose of this quality improvement project was to evaluate the impact of a four-week educational program on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. This project evaluated a four-week educational program’s effect on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. Using a quasi-experimental pre-post design, nine licensed/certified staff (medical assistants, licensed practical nurses, registered nurses, advanced practice registered nurses) …

Quality Improvement Project Evaluating The Impact Of A Structured Training Program On Cultural Competency Among Mental Health Providers In A Local Outpatient Clinic, Adedamola Adefioye

Doctor of Nursing Practice Projects

Culturally responsive care is critical in addressing mental health disparities, but many mental health providers express feeling unprepared to engage with culturally diverse patients. Low cultural competence is associated with communication failures, lack of patient trust, and the possibility of poorer treatment outcomes. This quality improvement project evaluated the impact of a structured cultural competency training program at an outpatient behavioral health clinic. A quasi-experimental, one-group pre-test/post-test design was used with the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R). Eight licensed mental health providers participated in four weekly one-hour interactive training sessions using …

Staff Education Project Building Proficiency In Debriefing And Empowering Healthcare Professionals With Confidence And Knowledge, Kristie Lynn Van Waus

Walden Dissertations and Doctoral Studies

Debriefing is a critical reflective practice in healthcare that facilitates team learning, promotes psychological safety, and supports quality improvement following clinical events. Despite its recognized value, healthcare professionals report limited training and a lack of confidence in participating in debriefing. I conducted this staff education project to increase staff knowledge and confidence related to effective debriefing practices by delivering targeted in-person education and measuring outcomes using a pre- and post-intervention knowledge and confidence assessment. The education focused on the essential elements of effective debriefing and use of a standardized data collection form. Participants completed a preintervention assessment measuring their knowledge …

Improving Effective Assistant Nurse Manager Communication In Obstetrics, Julie Marie Glover

Master's Projects and Capstones

Abstract

Problem: This quality improvement project addresses inconsistent leadership communication among Assistant Nurse Managers (ANMs) in the Obstetrics (OB) department of a hospital in Northern California. ANM and staff concerns around shift handoff, huddles, and leadership responsiveness have created confusion and hindered team coordination. The project aims to improve communication effectiveness scores among OB ANMs from 50% to 75% by July 11, 2025.

Context: The project was conducted in the Maternal-Child-Health (MCH) unit of a hospital in Northern California, specifically targeting communication practices among OB ANMs. Concerns around communication practices were voiced by both ANM leadership and frontline staff, signaling …

Education Plan On Colonoscopy Preparation And Communication To Improve Colonoscopy Prep And Ensure Better Outcomes, Maryam Pourjalil

Walden Dissertations and Doctoral Studies

This Doctor of Nursing practice (DNP) staff education project introduced a formalized staff education program to refine colonoscopy preparation quality at a community gastroenterology clinic. Suboptimal bowel preparation in 20%–30% of colonoscopies resulted in missed lesions, higher costs, and decreased satisfaction of the provided quality of care, which highlighted the need for enhanced staff education in nursing practice. The project question was: Does the education of staff on colonoscopy preparation procedures bridge the existing knowledge gap regarding modern colonoscopy techniques? My goal was to increase staff knowledge regarding standardize prep instructions. The project was designed using best practice evidence and …

Exploration Of The Cultural Beliefs, Values, And Practices Of African American/Black Women Or Birthing Persons Regarding Postpartum Depression: A Focused Ethnography, Stephanie Jacobs

Electronic Theses and Dissertations

Introduction: Postpartum depression (PPD) is the most prevalent perinatal mental health illness in women, affecting approximately 10% to 20% of all women in the United States, and a disproportionately higher number of African American women. The aim of this study was to explore the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression.

Research Question: What are the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression?

Methodology: A focused ethnography was chosen for this study and consisted of semi-structured interviews. Data was transcribed and analyzed …

Quality Improvement Project Increasing Job Satisfaction Among Nurses, Sarah Hines

Doctor of Nursing Practice Projects

Ineffective nurse leadership has been attributed to low nurse satisfaction, a decrease in morale, and can increase nurse turnover rates. Patient care and safety can be affected when nurses are dissatisfied with their workplace. The purpose of this quality improvement project was to increase nurses’ satisfaction rates on three behavioral health units by providing leadership classes for nursing leaders to attend to help combat nurse dissatisfaction rates. The methods utilized a quantitative design with pre- and post-intervention measurements. Pre- and post-intervention Likert-scale questionnaire data collected from direct-patient care registered nurses who met inclusion criteria on three behavioral health units by …

Implementation Of Cognitive Therapy Online Modules To Impact Advanced Practice Leader Burnout: A Quality Improvement Project, Courtney Cambell

Doctor of Nursing Practice Projects

Advanced Practice Provider (APP) leaders face unique stressors due to their dual roles as clinicians and administrators, which places them at an elevated risk for burnout. This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate the impact of self-paced cognitive behavioral therapy (CBT) programs, specifically Learn to Live and Lyra, on burnout among APP leaders at a medical center affiliated with a university and a children's hospital. Theproject spanned over six weeks, during which participants completed the Mini-Z Worklife Questionnaire for Leaders, assessing the effectiveness of the CBT programs. Although the original statistical analysis plan included a …

Quality Improvement Project Nursing Lab Instructors’ Experiences Using A Structured Prebriefing Tool In Simulation Education, Avion Smith-Samms

Doctor of Nursing Practice Projects

The International Nursing Association for Clinical Simulation and Learning (INACSL) endorses the inclusion of prebriefing as a Standard of Best Practice to enhance psychological safety, clarity, and engagement in simulation; without a structured approach, nursing students often experience anxiety, reduced confidence, and a lack of preparedness. At the project site, a university’s simulation learning lab, nursing lab instructors reported inconsistent prebriefing practices, leading to suboptimal simulation experiences. This Quality Improvement (QI) project aimed to evaluate the impact of implementing the INACSL prebriefing tool on nursing lab instructors’ perceptions of preparedness, confidence, and student performance. A quasi-experimental design was used over …

Does The Addition Of Digital Care Along With Standard Chemotherapy Teaching That Is Provided At City Of Hope Increase Patient Satisfaction And Confidence?, Sheridan Wendy Lomeli, Brooklin Mize, Tatyana Franco, Daniela Naemi

Master's Projects and Capstones

Chemotherapy education is critical when it comes to improving patient confidence, reducing anxiety, and enhancing symptom management. However, there is still a variety of patients who begin their infusion therapy with a limited understanding of what to expect. This quality improvement project was conducted at an outpatient infusion center, exploring whether combining traditional nurse-led chemotherapy education calls with a digital care platform would enhance patient satisfaction and confidence compared to standard care alone. A total of forty-one adult oncology patients participated in an educational survey at the end of each follow-up phone call, which was completed three days after their …

A Toolkit For Treating Obesity In Children With Metabolic Syndrome, Karen Mayers-Scott

Walden Dissertations and Doctoral Studies

This doctoral project seeks to bridge the existing knowledge gap in using Metformin to manage childhood obesity in patients with metabolic syndrome. The primary goal was to develop a complete toolkit to educate healthcare providers on utilizing Metformin in obese children with metabolic syndrome. Metabolic syndrome, characterized by higher triglycerides, decreased high-density lipoprotein cholesterol, increased blood pressure, elevated fasting plasma glucose, and increased waist circumference, offers considerable health hazards for children. The practice-focused question is, Is the toolkit deemed useful to providers for treating obesity in children with metabolic syndrome using metformin?” The project employed the theory of planned behavior, …

Staff Education To Improve Knowledge Of Phq-9 Use, Grace Eluma

Walden Dissertations and Doctoral Studies

The DNP project revolved around educating healthcare staff on using a depression screening tool known as the Patient Health Questionnaire (PHQ-9). Undiagnosed depression can affect people’s quality of life, their functional condition, and general health outcomes, making it a significant problem that needs to be addressed. The U.S Preventive Services Task Force (USPSTF) recommends using evidence-based screening tools such as the PHQ-9 to assess, diagnose, and monitor the condition’s severity. However, a few nurses use this tool despite being aware of it or misusing it, resulting in under-utilization, inappropriate assessment, and increased events. The project aimed to implement a staff …

Kid Power: Mastering Asthma Management To Keep Hospitals Away!, Kriste L. Moret

Master's Projects and Capstones

Problem: Pediatric asthma remains a leading cause of preventable hospitalizations, particularly in California’s Central Valley, where environmental and health disparities worsen symptoms. Many children are discharged without understanding their Asthma Action Plan (AAP) or feeling confident in symptom management.

Context: On a unit in a community hospital in this high-risk region, asthma-related admissions persisted. Gaps in discharge education highlighted the need for a structured intervention. The Institute for Healthcare Improvement (IHI) Model for Improvement (MFI) guided this effort.

Intervention: A nurse-led, developmentally appropriate asthma education bundle was implemented. Teaching began on admission and was reinforced using teach-back, color-coded AAPs, culturally …

Best Practices To Prevent Nurse Burnout And Reduce Turnover In The Hospital, Bernice Marie Yale

Master's Projects and Capstones

Abstract

Problem Nursing is facing a crisis in workforce well-being, and trends indicate signs and symptoms of burnout. Increasing turnover rates, emotional exhaustion, staff depersonalization, and team disengagement have resulted in a perceived toxic environment in a hospital-based microsystem.

Context A 4-month project was initiated to improve morale and communication. Several assessment tools were utilized to foster a high-performing team and reinforce principles of Watson’s theory of caring.

Interventions Optimization of required daily leader rounds to encourage patient participation, and monthly 1:1 “direct report” rounds (n=65) were conducted to assess well-being, workplace stressors, and promote job satisfaction.

Measures To improve …

Staff Education To Address Medication Noncompliance In Outpatient Behavioral Health Settings, Elmase Nicolas Toussaint

Walden Dissertations and Doctoral Studies

This quality improvement project is a staff education initiative designed to address psychotropic medication noncompliance in an outpatient behavioral health clinic setting. The project arose from the identification of a significant gap in staff knowledge and confidence related to medication adherence strategies. Medication noncompliance in psychiatric care is associated with symptom exacerbation, increased hospitalization, and poorer patient outcomes, making it a critical issue in nursing practice. The practice-focused question guiding the project was: In an outpatient behavioral health clinic setting, does implementing a structured staff education program improve staff knowledge and confidence in addressing medication noncompliance? Analytical strategies included a …

Implementation Of A Triage System For The Residents At A Residential Facility To Improve Triage Assessment Skills Of The Staff As Well As Improve The Level And Timeliness Of Care, Andrew J. Choi Rn, Neha Gopal Rn, Andres N. Padilla Rn, Dana Son

Master's Projects and Capstones

Triage is an integral part of the clinical process which involves assessing patients and determining their level of care in order to get them appropriate, timely treatment. Several countries utilize a standardized triage system with established criteria to aid staff in their decision-making during assessments (Peta et al., 2023). The Nursing and Residential Triage (NaRT) tool, from the Manchester Triage System (MTS), was shown to enhance staff clinical assessment skills and help avoid inappropriate ED transfers during a study among older adults in a residential facility (Markey et al., 2024). For this project, the main issue identified at the residential …

Enhancing Patient Safety: Fall Prevention Through Video Education, Fithawit T. Zere

Master's Projects and Capstones

Abstract

Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.

Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.

Interventions: A …

Mental Health Provider Education On The Benefits Of Telepsychiatry To Increase Knowledge And Promote Adoption To Improve Organizational Efficiency, Standards Of Care, And Revenue Generation., Jada Eugene

Doctoral Dissertations and Projects

The study implemented an educational intervention on the benefits of telehealth among mental health providers to improve their level of knowledge and promote technology adoption to improve organizational efficiency, revenue generation, and standards of care. The clinical question was: Among mental health providers, does an educational intervention on the benefits of telehealth, compared to no education, enhance knowledge of telepsychiatry consultations and promote adoption to improve organizational efficiency, standards of care, and revenue generation? Utilizing the Iowa Model of EBP, the researcher implemented a pilot study using the quasi-experimental design. Knowledge, telehealth usability, revenue generation, and standards of care were …

Enhancing Nurse Well-Being Through Mandatory Rest Breaks At A Hospital, Elise Njang

Doctor of Nursing Practice Projects

Nurses are essential to the healthcare system, yet their demanding 12-hour shifts in hospital settings often leave little opportunity for adequate rest. The absence of structured rest breaks not only endangers nurses' well-being but may also compromise the quality of patient care. This quality improvement (QI) project aimed to evaluate the effects of implementing structured, mandatory 15-minute rest breaks on nurse burnout and job satisfaction. The initiative addressed a critical gap at the project site, where nurses typically received only one 30-minute lunch break per shift, despite evidence supporting the benefits of more frequent rest breaks. A quasi-experimental pre- and …

Yo Soy Minnesota: Bridging Health Equity Gaps With Culturally And Linguistically Inclusive Resources For Hispanics In Central Minnesota, Liz Damaris Vincente Berrios

DNP Projects

Health disparities are preventable yet persist due to systemic inequities in social, economic, and healthcare structures. Rooted in historical injustices and social determinants of health, these disparities disproportionately impact minority communities, including Hispanics in Central Minnesota. Barriers such as limited English proficiency (LEP), provider biases, and inadequate health literacy further exacerbate inequitable health outcomes. Culturally and Linguistically Appropriate Services (CLAS) offer a modifiable solution to mitigate these disparities by ensuring healthcare resources align with diverse beliefs, practices, and linguistic needs. This project focuses on CLAS as a modifiable factor affecting Hispanics in Central Minnesota and explores the impact of "Yo …

Quality Improvement Project Fall Prevention Among Skilled Nursing Facility Residents Through Staff Education, Reena Mathew

Doctor of Nursing Practice Projects

Falls among older adults in Skilled Nursing Facilities (SNFs) remain a leading cause of injury, hospitalization, and decreased quality of life. Preventing these falls requires awareness and effective staff engagement. This Quality Improvement (QI) initiative is targeted to decrease fall rates in a 90-bed SNF by educating caregivers on the significance and practice of purposeful hourly rounding. The project helped to improve staff knowledge, consistency, and accountability in implementing hourly rounding as a preventive measure. A pre- and post-intervention design was utilized. Staff members received structured educational sessions based on evidence-based guidelines, including interactive modules and printed resources. Twenty staff …

Quality Improvement Project: Faculty Education On Clinical Evaluation Tool Utilization For Outcome-Based Assessment And Readiness In Clinical Competency Evaluation, Catherine Odom

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice (DNP) quality improvement initiative addressed the lack of consistency and subjectivity in clinical evaluations of nursing faculty at a community college in the southern United States. The intervention was a structured faculty development program spanning eight weeks, focusing on Objective Structured Clinical Examinations (OSCEs) and performance rubrics. The project was guided by the IOWA Model of Evidence-Based Practice and the Kotter Change Management Framework, aiming to boost faculty confidence and inter-rater reliability in clinical assessment. The PICOT question was whether a structured educational intervention would enhance self-reported faculty confidence in clinical assessments relative to no …

Quality Improvement Project Data At Risk: The Implications Of Inconsistent Nursing Documentation On Patient Care Interventions, Amber Jones

Doctor of Nursing Practice Projects

Accurate nursing documentation plays a vital role in ensuring high-quality patient care, yet inconsistencies remain a common challenge, particularly with preventive screenings like pediatric tobacco use. Research shows that when documentation is incomplete or incorrect, opportunities to identify and intervene with at-risk adolescents are often missed. This quality improvement project was developed to address a specific gap in documentation practices at a community health clinic, where staff often failed to consistently complete the pediatric tobacco screening tool. The goal of the project was to determine whether evidence-based education, combined with chart audits and feedback, could improve the consistency in which …