Digital Commons Network^™

Fall 2021

Scientia

A Decade of Progress and Success; Speech Language Pathology Program; COVID-19 Long-Hauler Study; Peer Mentors Initiative; Faculty Update; Expert Engagement: Three CSH initiatives further education and scholarship while supporting communities in need; Strategic Command: Business consultant and med tech expert Stephen Sichak helps others face pandemic challenges; Taking Care: A School of Nursing research team plumbs the pandemic experiences of nurses nationwide

Exploring The Relationships Between Emotional Intelligence, Perceived Organizational Support, Job Satisfaction, And Intent To Stay Among Minnesota School Nurses, Kristin K. Coudron

Dissertations, Theses, and Projects

School nurses face escalating job demands driven by increasing student health complexity, chronic condition management, and expanding public health responsibilities. Often serving as the sole healthcare professional within a school or district, they work in settings characterized by high autonomy, variable organizational support, and growing concerns about job satisfaction and retention. Limited empirical research has examined how personal and organizational resources jointly relate to school nurses’ intent to remain in practice. Guided by the Job Demands–Resources (JD–R) theory and the National Association of School Nurses School Nursing Practice Framework, this quantitative, correlational, cross-sectional study explored relationships among emotional intelligence, …

Diagnostic Delays In Endometriosis Among Reproductive-Aged Women: An Evidence-Based Primary Care Policy Proposal, Francis P. Ronayne

Capstones

No abstract provided.

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Impact Of Implementing Standard Wound Care Guidelines For Patients In The Home Care Setting On Patient Outcomes, Raymond Anthony Flores Jr

Doctor of Nursing Practice (DNP) Projects

Wound care is among the most significant public health concerns, affecting millions of people worldwide. Most individuals with wounds end up self-managing their condition from their homes due to being discharged early from the hospital, owing to various reasons, and the costs associated with health care. Although home wound management offers convenience and lower costs for patients, it is also associated with substantial challenges, including limited access to and use of appropriate care protocols, wound management tools, and sufficient education on the topic, as well as limited professional advice. These limitations contribute to poor outcomes, including slow healing rates, infections, …

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

Doctor of Nursing Practice (DNP) Manuscripts

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

Implementing Updated Npo Guidelines For Inpatient Procedures, Yasamin Ghanivand

Doctor of Nursing Practice (DNP) Projects

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

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

Methods: A …

In Adults Older Than 18 Years With Obesity Living In Massachusetts, Can Engaging In A Weight Loss Program Help Them Lose Weight After Insurance Stops Covering Their Weight Loss Medications?, Angel Nagawa

Capstones

Executive summary

The Problem

Obesity rates continue to rise sharply across the United States. Weight loss medications have high compliance but face major insurance restrictions. Strict clinical criteria leave many patients without accessible treatment options.

The Proposed Solution

Launch structured, lifestyle-focused clinical weight loss programs. Provide an effective, accessible alternative to restricted pharmaceutical therapies.

Supporting Evidence

Evaluated data from three distinct randomized controlled trials. Findings confirm successful long-term weight management for program participants. Results prove effective control over serious obesity-related comorbidities.

Policy recommendation

Implement structured lifestyle programs as a primary, frontline intervention modality. Improve broad-scale patient health outcomes across clinical …

Anaemia In Pregnancy In Rural New South Wales: A Retrospective Study Of Prevalence, Risk Factors, And Guideline Adherence, Yuanwei Zhang, Esther Adama, Uchechukwu Levi Osuagwu

Research outputs 2022 to 2026

Aim: To determine the prevalence of anaemia in pregnancy in rural New South Wales (NSW) and assess the alignment of screening and treatment practices with the 2020 Australian Pregnancy Care Guidelines (APCG).

Methods: A retrospective cohort study at the Regional Hospital using records from 301 women who gave birth between 1st January and 4th September 2024. Data were sourced from eMaternity and PowerChart systems, focusing on haemoglobin and ferritin levels, demographic factors, iron deficiency risk factors, and birth outcomes.

Results: Iron deficiency was identified in 61.8% of women, with 6.0% diagnosed with iron deficiency anaemia (IDA). These rates were lower …

The Impact Of Virtual Reality Simulation On Developing Competence And Confidence In Non-Technical Skills In Nursing. A Scoping Review, Katie Janz, Karen Clark-Burg, Khaya Morris-Binelli, Brennen Mills, Amanda Graf

Research outputs 2022 to 2026

Background: Medical errors are a global concern and can compromise patient safety, with up to 80% of these errors directly linked to non-technical skills (NTS) failures. Traditional simulation using mannikins is resource-intensive, and virtual reality simulation (VR) has the potential to offer comparable outcomes with enhanced consistency and lowered resource requirements, but the effectiveness of VR to teach and enhance NTS has been underexplored.

Aim: This scoping review explores the existing literature on VR simulation as a method for teaching NTS in nursing to evaluate whether VR simulation yields positive learning outcomes, particularly in comparison to traditional training methods such …

Co-Design And Feasibility Testing Of A Midwife-Led Birth Debrief: An Implementation Science Project, Kate Buchanan, Phoebe Backhouse, Leanne Graham, Amy O’Meagher, Sara Bayes

Research outputs 2022 to 2026

Background: The period spanning pregnancy, birth and postpartum is characterised by psychosocial as well as physiological changes: many women experience new or worsening mental ill-health during the perinatal period. Midwives play a critical role in supporting and promoting psychosocial health by providing mental health education, counselling and screening. Often this includes a post-birth conversation, guided reflection, or debrief. Information about the effectiveness and experiences of specific and structured midwife-led birth debrief is scant. Aim: Our study aimed to assess the perceived effectiveness, experiences and implementability of a midwife-led birth debriefing intervention in one Australian maternity unit. Methods: A Type II …

The Benefits And Barriers To Expanding Crna Programs In Michigan, Grace Van Zweden

Honors Theses

The demand for Certified Registered Nurse Anesthetists (CRNAs) and their delivery of safe, high-quality anesthesia care has increased significantly due to nationwide anesthesia provider shortages and the growing reliance on CRNAs to meet healthcare system needs. This demand underscores the importance of expanding nurse anesthesia programs in Michigan and across the United States to support nurses pursuing advanced education and to improve patient access to essential care within their communities. The CRNA profession has evolved over time to meet the changing needs of the healthcare system, and current CRNA programs require applicants to satisfy rigorous and highly specific admission criteria. …

The Unacknowledged Challenge Of Moral Distress For Nurse Academics, Adam Burston, Glenna Mae Guiriba, Meena Gupta, Sara Bayes

Research outputs 2022 to 2026

The pluralistic nature of healthcare presents nurses with situations challenging their moral values which nurses must navigate. Challenges to moral values can result in the experience of moral distress, a problem that is common within the clinical nursing context. Moral distress is a known and well-researched phenomenon within nursing and has long contributed to detrimental effects such as frustration, anger, anxiety, decreased job satisfaction, burnout and ultimately attrition. However, despite extensive research in clinical environments, minimal research exists detailing this concept within the context of nursing academics and educators. Nurses can experience moral distress if they are in or exposed …

The Value Of Pilot And Feasibility Studies In Nursing Education Research: A Worked Example, Dhanya Anand Anil Kumar, Natasya Raja Azlan, Hugh Davies, Chandra P. Salgado Kent, Debbie Massey, Karen Strickland

Research outputs 2022 to 2026

Background: Feasibility studies play a critical role in determining whether clinical or educational interventions can be implemented as intended before progressing to large-scale trials. In nursing education, many innovative teaching strategies, particularly complex interventions such as simulation-based learning, are often advanced directly to full trials without first establishing feasibility. This premature progression creates recruitment, acceptability, fidelity, and protocol adherence challenges, which may compromise study quality and valuable resources. This paper addresses this gap by clarifying the purpose and value of feasibility studies in nursing education research and outlining key considerations for designing an early-stage feasibility study that aligns with contemporary …

Trust But Verify: Testing A Framework For Ai Interrogation In Nursing Education, Michael Chamberlain

AI in the Classroom: A Virtual Summit

Generative AI produces fluent, confident output that is sometimes fabricated. Nursing students increasingly submit work built on sources that do not exist, or that exist and do not support the claims drawn from them. This session reports two semesters of classroom observation testing whether prompt design can address that problem.   The hypothesis was that structuring student prompts to require the AI to validate its own sources would improve detection of hallucinated citations. It did not. Across two sections, students who used the structured format caught fabricated citations at the same rate as students given an open prompt. Structure did change …

Pre-Procedural State Anxiety In Patients Scheduled For Colonoscopy, Zahraa Kareem Mansoor Al-Saady, Mohammed Hakim Shamran Al-Hchaim

Maaen Journal for Medical Sciences

Background: Anxiety is a common issue among patients undergoing invasive medical procedures such as colonoscopy because of concerns regarding the procedure itself and its possible results. High levels of anxiety can negatively affect patient readiness and cooperation during the examination, thereby influencing the quality and outcome of the procedure.

Study objective: To assess the prevalence and severity of pre-procedural anxiety among patients scheduled for colonoscopy and examine the association between socio-demographic and clinical characteristics and anxiety levels.

Methodology: A descriptive cross-sectional study design was employed to collect data from patients undergoing colonoscopy. A validated and comprehensive questionnaire tailored for individuals …

Impact Of A Head-To-Toe Assessment Simulation On The Self-Efficacy Of First Semester Nursing Students, Martin Dole

Nursing Faculty Publications

The transition into clinical practice presents significant challenges for first-semester nursing students, particularly related to self-efficacy and the ability to perform comprehensive patient assessments. Low self-efficacy may negatively influence clinical judgment, skill performance, and patient safety. The purpose of this Doctor of Nursing Practice project was to examine whether participation in a head-to-toe assessment simulation impacted general self-efficacy among first-semester nursing students. Guided by Bandura’s theory of self-efficacy, a quantitative, quasi-experimental, one-group pretest–posttest design was used to evaluate changes in self-efficacy following a high-fidelity simulation experience. A convenience sample of 42 first-semester Bachelor of Science in Nursing students participated in …

Implementation Of A Standardized Protocol To Improve Provider Documentation And Initiation Of Guideline-Concordant Hypertension Follow-Up Within 14 Days In Primary Care, Stella Williams

Doctor of Nursing Practice Projects

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality, yet timely follow-up after elevated blood pressure (BP) readings is not consistently documented in primary care. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a standardized hypertension screening follow-up protocol improved provider initiation or documentation of guideline-concordant follow-up within 14 days. The faculty-approved PICOT population was primary care providers in a primary care clinic; we used eligible electronic health record (EHR) encounters as the analytic records to observe provider performance. We used a quantitative pre/post design and retrospectively reviewed 30 eligible EHR encounters: 15 pre-implementation …

Midwifery Student Attrition In Australia: A Scoping Review, Terri Downer, Tanya Capper, Olav Muurlink

Research outputs 2022 to 2026

Problem: Global literature suggests that attrition rates from entry-to-practice midwifery programs are increasing. However, little is known about student attrition in the Australian context.

Background: Australia faces a growing midwifery shortage, prompting calls to increase program enrolments. Evidence from the United Kingdom shows high and rising attrition in entry-to-practice programs. In Australia, the scale of midwifery student attrition and the factors influencing it remain largely underexplored.

Aim: To identify and synthesise existing Australian literature on factors influencing midwifery student attrition.

Methods: A search of PubMed, Medline, CINAHL Ultimate, Embase, MIDIRS, EBSCO, and Google Scholar databases was conducted with key data …

Effectiveness Of An Integrated Activity-Based And Tele-Monitoring Intervention On Mental Health Literacy And Resilience Among Urban Older Adults In Thailand: A Quasi-Experimental Study, Khunatpakorn Makkabphalanon, Pramote Thangkratok, Jutamast Wongjan, Natchaya Palacheewa

Journal of Health Research

Background: Mental health problems among older adults are a growing public health concern, particularly in urban areas. Mental health literacy can enhance problem recognition, self-help, and help-seeking. This study examined changes in mental health literacy and resilience among urban older adults following an integrated activity-based and tele-monitoring intervention.

Methods: A one-group quasi-experimental repeated-measures study was conducted among 30 adults aged 60 years and older in urban communities in Thailand. Participants received a structured 3-hour activity-based mental health literacy intervention followed by 1 month of tele-monitoring support. Data were collected at baseline, immediately after the intervention, and at 1-month follow-up. Changes …

Quality Improvement Project: Enhancing Suicide Recognition Protocols With The Use Of Columbia-Suicide Severity Rating Scale In An Outpatient Mental Health Practice, Pamela Oxley

Doctor of Nursing Practice Projects

Suicide prevention in outpatient mental health settings requires prompt recognition of and an appropriate response to suicide-related concerns, including those initially communicated to administrative staff. Frontline administrative phone staff may first encounter patients expressing suicidal thoughts; however, evidence supports education and standardized processes to facilitate effective recognition and response. At the project site, a practice gap existed in administrative staff preparation and confidence in responding to suicide-related concerns. The quality improvement project addressed this gap through structured, standardized Columbia-Suicide Severity Rating Scale (C-SSRS) education paired with a standardized suicide-risk stratification and escalation protocol. The project aimed to improve administrative staff …

Impact Of Cannabis Use Screening And Early Intervention In Outpatient Psychiatric Settings, Theresa Chibuoke

Doctor of Nursing Practice Projects

Cannabis use can complicate psychiatric assessment, treatment planning, and clinical outcomes, yet standardized cannabis-use screening remains inconsistently implemented in behavioral health practice. This quality improvement (QI) project addressed inconsistent cannabis screening and referral practices in an outpatient psychiatric clinic by implementing a standardized workflow to improve screening documentation to at least 80% and timely referral completion to at least 75%. A quantitative, quasi-experimental pretest-posttest design included 10 outpatient psychiatric providers over six weeks. Lewin’s Unfreeze-Change-Refreeze model guided change, the Plan-Do-Study-Act framework supported implementation, and Donabedian’s Structure-Process-Outcome model guided the project. The evidence-based intervention incorporated provider education, the valid and reliable …

Quality Improvement Project: The Impact Of Proper Utilization Of Suicidal Ideation Screening Tools, Anuoluwapo Bode-Oloye

Doctor of Nursing Practice Projects

Suicide remains a significant public health concern, emphasizing the importance of consistent and evidence-based suicide risk assessment in outpatient mental health settings. The purpose of this Doctor of Nursing Practice quality improvement project was to determine how the provider’s implementation of the Columbia Suicide Severity Rating Scales (CSSRS) according to the recommendations of the Substance Abuse and Mental Health Services Administration would impact the confidence and the rate of completion of suicidal screening tools (Columbia Suicide Severity Rating Scales) compared to current clinic policy in an outpatient mental health clinic for over twelve weeks. This project used Lewin’s change model …

Quality Improvement Project: Providing Evidence-Based Practice Education On Administering The Edinburgh Postnatal Depression Screening During Visits Once Per Trimester And Postpartum, Megan Keeney

Doctor of Nursing Practice Projects

Perinatal depression (PND) is prevalent worldwide and frequently remains undetected and untreated due to inconsistent screening. At the project site, the Edinburgh Postnatal Depression Scale (EPDS) was administered postpartum only, without standardization. This quality improvement project implemented evidence-based provider education and a revised EPDS protocol, screening once per trimester and postpartum, to increase PND identification, provider self-confidence, self-efficacy, and behavioral health referral rates. This project was guided by Lewin’s Change Theory and the Donabedian framework. A quantitative pre-post design was used with nine providers in an outpatient women’s health clinic, alongside a retrospective and post-implementation electronic health record (EHR) review. …

Quality Improvement Project: Improving Nurse Discharge Competency Through Standardized Education And Discharge Tools In An Inpatient Behavioral Health Hospital, Valina Williams

Doctor of Nursing Practice Projects

Inconsistent discharge education and variable use of structured discharge tools can affect the consistency of transitions from inpatient behavioral health care. The purpose of this Doctor of Nursing Practice quality improvement project was to improve nurse discharge competency by implementing standardized discharge education and reinforcing use of a structured discharge tool in a rural inpatient behavioral health hospital. A quantitative, quasi-experimental one-group pretest-posttest design was used over 12 weeks with 16 eligible registered and licensed practical nurses. Organizational readiness was assessed at baseline, and nurse self-efficacy was measured before and after implementation. Discharge-tool adherence and 30-day readmissions were also evaluated. …

Determining Impact On Provider Adherence To Current Diabetes Guidelines: A Quality Improvement Project, Rashemia Suber

Doctor of Nursing Practice Projects

The delivery and documentation of evidence-based adult lifestyle counseling for patients with type 2 diabetes mellitus (T2DM) were found to be inconsistent in a clinic that serves an underserved population. This quality improvement (QI) project assessed whether a provider education program based on the 2025 American College of Lifestyle Medicine (ACLM) Diabetes Guidelines would improve provider confidence and documentation of lifestyle recommendations. A quasi-experimental, pretest-posttest design was guided by both Pender's Health Promotion Model as the theoretical framework and Lewin's Change Theory as the change theory. The Plan Do Study Act (PDSA) cycle guided this project as the implementation framework. …

The Impact Of Provider Medication Reconciliation Education On Hospital Readmissions In A Skilled Nursing Facility, Vivian Nwozu

Doctor of Nursing Practice Projects

Aging causes frailty and multiple comorbidities, necessitating polypharmacy. Complicated drug regimens predispose patients to adverse drug events and hospital readmissions. The practice problem was high rates of medication-related readmissions due to inadequate provider knowledge of medication reconciliation and the lack of a standardized tool. This project aimed at evaluating the impact of provider medication reconciliation education on hospital readmissions in a skilled nursing facility. A pretest-posttest study design was utilized. The Donabedian Model of Healthcare Quality guided the translation of evidence into practice, whereas Lewin’s Change Model and Plan-Do-Study-Act models guided implementation. Eight providers were educated on medication reconciliation using …

Staff Education On Early Cpi-Based De-Escalation Strategies And Unit-Based Resources, Doris Onyenji Lerama

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education evidence-based practice initiative implemented at a state-operated adult inpatient psychiatric facility in California. The practice gap was inconsistent nursing staff knowledge of early Crisis Prevention Intervention-based de-escalation strategies and available unit-based resources despite an established crisis-prevention framework. The practice-focused question asked whether a standardized staff education activity would increase staff knowledge, as measured by anonymous pre-education and immediate post-education scores. The purpose was to develop, implement, and evaluate the education using staff knowledge change as the sole measurable outcome. The Johns Hopkins Evidence-Based Practice Model guided appraisal and synthesis of 11 evidence sources …

Quality Improvement Project: The Impact Of Self-Assessed Quality Of Sleep On Illness Experience And Job Satisfaction Among Night Shift Nurses, Eunice Ikpekpe

Doctor of Nursing Practice Projects

Compromised sleep quality, illness experience, and job satisfaction are important concerns among registered nurses working night shifts. The purpose of this quality-improvement project was to evaluate changes in self-assessed sleep quality, illness experience, and job satisfaction following participation in the six-week Sleep Hygiene and Recovery Program (SHRP) among night-shift registered nurses at a large, urban, Level I trauma academic teaching medical center. The project used a quantitative, quasi-experimental, single-group pretest–posttest design guided by the Plan-Do-Study-Act framework and Lewin’s Change Management Theory, with the Neuman Systems Model and Pender’s Health Promotion Model providing the theoretical foundation. SHRP was a structured, evidence-informed …

Staff Education To Improve 7-Day Post-Discharge Psychiatric Follow-Up, Michael Curtis Kwashie

Walden Dissertations and Doctoral Studies

Too many psychiatric patients leave the hospital without a follow-up appointment, a gap that may cost lives. Research has consistently shown that the days immediately after discharge from psychiatric inpatient or emergency care are among the most dangerous in a patient’s trajectory, marked by elevated suicide risk, relapse, and avoidable readmission. Yet, across behavioral health settings, completion of outpatient follow-up within 7 days of discharge remains inconsistent; typically, standardized processes are often missing. This doctoral project in staff education was created to fill that gap and examined whether implementing a standardized discharge transition protocol, supported by targeted, interdisciplinary staff education, …