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Optimizing Efficiency In Joint Injections In An Outpatient Orthopedic Oncology Clinic Using Lean Six Sigma, William Alexander Byrd

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Prolonged in-room wait time in an outpatient orthopedic oncology clinic was identified as an important driver of dissatisfaction and operational inefficiency. Baseline in-room times in this setting were reported as M=96.2 minutes for patients receiving injections and M=92.9 minutes for those not receiving injections. This quality improvement project used Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, Control) framework to streamline clinic workflow for the joint injection process. Over an eight-week period, four key interventions were introduced: a standardized order set for medications, pre-bundled supplies and portable supply toolbox, telephone pre-consenting of patients, and optimized scheduling of …

Comparing The Evolution Of The Advanced Practice Nurse Role: Insights From Switzerland And Kenya, Carole Mackavey, Sara Kohler, Eunice Ndirangu, Rachel Kimani, Constance Shumba, Bernard Mutwiri, Colette Henderson, Anna Jones

School of Nursing & Midwifery, East Africa

The article explores the evolution of Advanced Practice Nurse (APN) roles in Switzerland and Kenya, highlighting their development, challenges, and influence on healthcare delivery. Despite notable differences in income levels and healthcare infrastructure, both countries are committed to strengthening primary care through the deployment of APNs. Switzerland uses APNs to address provider shortages and improve chronic disease management, whereas Kenya uses them to increase access in underserved areas. A comparative analysis explores how regulatory frameworks, educational models, scope of practice, and health system priorities influence the adoption of advanced practice nursing (APN). Switzerland’s established healthcare system supports the integration of …

Music Interventions For Critically Ill Patients: Evaluating Effects Of Music On Psychoemotional Symptoms In Critically Ill Patients Receiving Respiratory Support, Allyson Crighton

Honors Undergraduate Theses

Critically ill adults receiving respiratory support in intensive care units (ICUs) frequently experience psychoemotional disturbances such as agitation, anxiety, and delirium, which contribute to prolonged ventilation, increased sedative use, and adverse patient outcomes. While pharmacologic management remains standard practice, associated risks including oversedation and delirium highlight the need for safe, complementary interventions. Emerging evidence suggests that music-based interventions may offer a non-invasive, cost-effective strategy to reduce psychological or emotional distress in this vulnerable population. This integrative literature review examined the effects of music interventions, including passive music listening and structured music therapy, on agitation and related psychoemotional outcomes in critically …

Parenting Stress And Its Association With Parental Technoference: An Integrative Literature Review, Emily S. Machuca

Honors Undergraduate Theses

Introduction: Today, digital devices are a part of daily life, but can serve as a distraction that interrupts important relationships, a process referred to as technoference. In the context of parenting, device use during child interactions may reduce parental attentiveness and engagement, with potential implications for child development and behavior. Parenting stress may influence how and why parents engage with digital devices in the presence of their children. However, the association between parenting stress and parental technoference remains unclear in the current literature. This integrative literature review aimed to synthesize existing evidence examining the relationship between parenting stress and parental …

Examining The Effectiveness Of Icu Diaries In Reducing Post–Intensive Care Syndrome (Pics) Psychological Symptoms: A Rapid Review Of United States–Based Studies, Lananh Tran

Honors Undergraduate Theses

Background: The growing recognition of Post-Intensive Care Syndrome (PICS) has prompted investigation into interventions, such as ICU diaries, to mitigate the long-term psychological effects of PICS. Intensive care unit (ICU) diaries – journals written by clinicians and loved ones during an ICU admission – are a tool that can help patients reconstruct the events of their critical care experience. Entries in the diary may include clinical updates, explanation of treatments, and encouraging words from loved ones or staff. Previous research in European countries found ICU diaries may be effective in reducing psychological effects post ICU admission.

Research question: The aim …

Implementing A Change Process To Support Respectful Communication In Newborn Units In Kenya: A Qualitative Study, Mwanamvua Boga, Peris Musitia, Dorothy Oluoch, Dyuti Sen, Hiza Dayo, Ane Haaland, Lisa Hinton, Jacinta Nzinga, Mike English, Sassy Molyneux

Institute for Human Development, East Africa

Background: In contexts of high workloads, resource shortages, and environmental inadequacies, neonatal nurses in many low- and middle-income countries face high levels of stress and burnout, as well as significant communication challenges. Advancing care in these ‘on the edge’ emotionally fraught contexts requires a multi-layered systems approac:, including context-sensitive courses that support respectful communication.

Methods: We share our learning from the implementation of a communication and emotional competence training process in two public hospital newborn units in Kenya. We adapted an existing course in collaboration with newborn unit nurse managers, with the aim of enhancing relationships among staff and …

Atypical Antipsychotic-Induced Weight Gain Preventive Bundle: A Quality Improvement Project, Jocelyn Urbano

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Antipsychotic-induced weight gain (AIWG) is a common, clinically significant adverse effect associated with second-generation antipsychotic medications and contributes to increased cardiometabolic risk among individuals with serious mental illness (SMI; Carolan et al., 2025; Hegde et al., 2024). Individuals experiencing homelessness or social instability often encounter additional barriers to maintaining healthy lifestyle behaviors and consistent engagement in healthcare, further increasing metabolic risks and treatment issues (Hamel et al., 2024; Kelly et al., 2025). This preventive care bundle, designed to reduce the risk of AIWG, was implemented in an outpatient behavioral health clinic serving an underserved urban Texas population.

As metformin may …

Burnout And Workforce Outcomes Among Registered Nurses, Madeline Willcoxen

Theses, Dissertations and Capstones

Purpose: The purpose of this study was to examine the relationship between staffing and organizational support interventions and workforce outcomes among registered nurses providing direct patient care in hospital settings. The study focused on three measurable outcomes: emotional exhaustion, absenteeism, and annual nurse turnover. The population included hospital-based registered nurses, and the comparison involved standard staffing and support conditions.

Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Studies published between 2015 and 2026 were identified using PubMed, CINAHL, Scopus, and PsycINFO databases. Inclusion criteria required quantitative studies examining staffing or organizational support interventions among registered nurses in …

Bridging The Gap: Human Trafficking Education Improves Nursing Students’ Knowledge And Confidence, Stephanie P. Arceneaux, Sharon Boudreaux

LHC Group • Myers School of Nursing

Background: Human trafficking (HT) is a global, national, and local public health concern, yet victims often go unidentified due to limited provider education and a lack of screening protocols. This quality improvement project implemented an asynchronous online HT education module for senior nursing students to enhance knowledge and confidence in identifying victims through recognition of red flags and use of screening questions. Method: The module addressed HT indicators, screening tools, screening questions, and available resources. Pre- and posttests using the PROTECT instrument assessed perceived knowledge, actual knowledge, and confidence. Results: Postintervention scores showed statistically significant improvement (p < .001) in knowledge and confidence. Only 10.67% of participants had prior HT training, and 52% preferred online, asynchronous learning. Conclusion: HT education …

Caught In The Midwife’S Hands: A Black Feminist Exploration Of Reproductive Health And Justice In Massachusetts, Nina Bakum

Gender, Sexuality, and Intersectionality Studies Honors Papers

No abstract provided.

Exploring Dominican University Nursing Students’ Perceptions Of Economic Barriers To Accessing Essential Women’S Health Products, Annabelle E. Burke

Nursing | Senior Theses

Period poverty is defined as inconsistent or inadequate access to feminine hygiene products, and it has been shown to negatively impact physical and mental health, academic performance, and dignity across diverse populations. Existing research highlights financial strain, social stigma, and insufficient support as key barriers to menstrual equity among individuals experiencing homelessness, adolescents living in low-resource environments, low-income women, and general undergraduate students (Brinkley & Niebuhr, 2023; Dave et al., 2022; Gruer et al., 2021; Lahme et al., 2018; Parkinson et al., 2024; Gilchrist et al., 2024). However, no studies have examined these issues amongst Dominican University nursing students who …

Paternal Involvement And Bonding In Neonatal Intensive Care Unit: Evaluating Daily Caregiving, Emotional Well-Being, And Father-Infant Connection, Ava G. Kinyon

Nursing | Senior Theses

Background: Premature birth and serious neonatal conditions frequently require infants to obtain care in the NICU, producing psychological and emotional obstacles for families. Despite the fact that skin-to-skin contact has been extensively researched for its strengths in encouraging stability and bonding, there persists restricted importance and understanding on paternal participation in routine caregiving tasks such as feeding, diapering, temperature checks, and swaddling. Purpose: This study aims to evaluate paternal participation in daily NICU caregiving tasks to address gaps in comprehending how these experiences impact bonding and emotional well-being among fathers of hospitalized infants. Methods: This study will employ a quasi-experimental …

The Impact Of Home Birth Integration On Maternal-Neonatal Outcomes And Patient Satisfaction: An Integrative Review, Mary E. Hillaker, Jennifer K. Jacobitz

All Electronic Theses and Dissertations

Introduction: Home birth is a safe option for low-risk populations. As awareness of home birth increases, so do the families choosing home birth. Governing bodies recommend well integrated maternal health systems, yet the impact of level of integration on perinatal outcomes and patient satisfaction has not been specifically examined. The purpose of this integrative review is to identify the impact home birth integration has on maternal and neonatal outcomes, patient satisfaction, and how communities can improve their integration level.
Methods: A keyword search of current literature was conducted using CINAHL, PubMed, and Scopus databases. An additional hand search of 2 …

Dosage Considerations For Aspirin Therapy To Prevent Preeclampsia In Pregnancy, Melissa S. Haraway

All Electronic Theses and Dissertations

Introduction: Preeclampsia remains the leading cause of maternal and neonatal mortality worldwide despite extensive and ongoing research on the subject. The use of aspirin therapy to reduce preeclampsia in pregnancy is widely researched and accepted into practice, however, optimal dosing is still debated. The purpose of this review is to identify which dosage of aspirin therapy offers the most effective reduction in preeclampsia without increasing the risk of postpartum hemorrhage.
Methods: The following databases were searched using the framework methodology by Whittemore and Knafl: CINAHL, PubMed, ScienceDirect, Scopus, ProQuest, and Citations. The search criteria limited articles to five years old …

Advancing Safe Medication Administration During Pediatric Emergency Care Through Nurse Education: A Quality Improvement Project, Ciera Hunter

Master's Theses and Capstones

Background: Due to the increased complexities of pediatric medication administration, preventable errors occur at a higher rate than in general adult populations. Rural emergency departments (EDs) often see fewer pediatric patients and have less specialized support available on-site. Nurse continuing education is an evidence-based intervention to reduce medication administration errors making it vital to supporting patient safety and maintaining pediatric readiness.

Local Problem: The microsystem is a rural, critical access hospital in northern New England. In 2021, the microsystem scored 66/81 on the National Pediatric Readiness Project’s (NPRP’s) ED Assessment. In 2026, the score dropped 11 points to 55/81. Contributing …

Addressing Perception Of Nurse Burnout Through Educational Interventions On An Inpatient Hematology And Oncology Unit: A Quality Improvement Project, Kendra Flint

Master's Theses and Capstones

Introduction Nurse burnout is a growing concern in healthcare due to its negative effects on nurse well-being, staff retention, patient safety and quality of care. This quality improvement project evaluated whether a brief educational intervention could improve nurses’ confidence in recognizing and managing early signs of burnout within an inpatient hematology and oncology unit.

Methods This QI project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation and evaluation. Registered nurses completed anonymous pre- and post- intervention electronic surveys and descriptive statistics were used to compare change in self-reported confidence and burnout perception.

Intervention Participants were directed through a brief electronic …

Improving Early Ambulation After Cardiac Surgery Using Nurse Education And Workflow Cues: A Quality Improvement Project, Nathan Seeley

Master's Theses and Capstones

Background: Early ambulation following cardiac surgery is an evidence-based practice that promotes postoperative recovery, reduces complications, and supports earlier discharge (Cook et al., 2024; Engelman et al., 2019; Kanejima et al., 2020). Despite its recognized benefits, consistent implementation remains challenging in busy inpatient settings due to workflow demands, competing priorities, and patient-related barriers.

Local Problem: Inconsistent early ambulation practices were identified on the Cardiac Surgical Step-Down Unit, creating an opportunity to improve adherence to evidence-based postoperative mobility practices.

Methods: This quality improvement project used the Plan-Do-Study-Act (PDSA) model to evaluate the impact of a brief nurse-focused educational intervention on early …

Improving Effective Completion Of Catheter Care Using A Reminder System To Minimize Incidence Of Catheter-Associated Urinary Tract Infections: A Quality Improvement Project, Morgan K. Leonard

Master's Theses and Capstones

BACKGROUND: CAUTI rates can be decreased by implementing a care cluster for RNs for CAUTI care into morning assessments and medication administration to ensure it is being done regularly with reminders through cards at the computers in patient rooms. LOCAL PROBLEM: The local problem in the microsystem were the catheter-associated urinary tract infection (CAUTI) rates at 1.199, while the national benchmark is 1.000 (Medicare, n.d.).

METHODS: Reminder cards were placed in patient rooms on the computers which are highly utilized by staY while providing patient care to serve as a reminder to complete catheter care in a high task burden …

Improving Efficiency In The Intensive Care Unit Through Reduction Of Nurse Burnout: A Quality Improvement Initiative, Johanna Grace Koroma

Master's Theses and Capstones

Abstract

Background: Intensive care unit (ICU) nursing is prone to high levels of burnout, which poses concern for staff wellbeing, patient safety, and microsystem strain (Kerlin et al., 2020). Educational interventions may serve as a means of increasing awareness on the issue and reducing the effects of burnout, through promotion of evidence-based management strategies.

Local Problem: One ICU microsystem identified several key contributing factors to nurse burnout, including staffing shortages, limited resources, competing responsibilities within the macrosystem, and insufficient organizational support (Zhang et al., 2025). Baseline survey data of the population observed a prevalence of 50% “high” burnout profiles among …

A Descriptive Study Of Cancer Care Experiences And Burden Of Rural South Dakotans, Sarah Mollman, Teddi Dowling, Patricia Woolridge, Jamie Hillmer, James Odom, Marie Bakitas, Hossein Moradi Rekabdarkolaee, Brandon Varilek

Journal Articles: College of Nursing

BACKGROUND: American Indian (AI) persons with advanced cancer (PwAC) in South Dakota have seen increased rates of cancer incidence and mortality compared to national rates. These inequities are driven by social determinants of health. Providing early palliative care is highly important for rural PwAC but is sparsely available in rural South Dakota.

OBJECTIVE: To explore cancer care experiences and patient symptoms and caregiver burden among AI and rural PwAC, and their family caregivers (FCGs), to understand the barriers and opportunities for adapting an early palliative care intervention.

DESIGN: Descriptive study design reporting on the qualitative and quantitative data collected.

METHODS: …

The Association Of Social Determinants Of Health On Mortality Among Adults With End-Stage Kidney Disease: A Systematic Review And Meta-Analysis, Prince Agyapong, Lauren Longacre, Patti Brooks, Hossein Moradi Rekabdarkolaee, Surachat Ngorsuraches, Aine O'Connor, Semhar Michael, Brandon Varilek

Journal Articles: College of Nursing

RATIONALE/OBJECTIVE:: Synthesize evidence from published studies on end-stage kidney disease (ESKD) mortality and determine associations between social determinants of health (SDOH) and ESKD mortality.

STUDY DESIGN:: This PRISMA-guided study examined all published research across four electronic databases.

STUDY POPULATIONS:: Adults with ESKD living in the United States.

SELECTION CRITERIA FOR STUDIES:: Clinical trials, observational, cross-sectional, and prospective/retrospective cohort studies were considered if one or more of the five domains of SDOH were present in the analysis.

EXTRACTION/ANALYSIS:: Extraction was performed independently by two reviewers using a standardized form that captured study purpose and design, outcomes, SDOH domain, setting, participant characteristics, …

Trauma And The Brain: Foundations To Trauma-Informed Care In Nursing, David Wolff

OER Materials

The goal of this presentation was to educated nursing students about what traumatic events are and how they impact a patient, thus informing their approach to nursing care that is trauma-informed.

Chronic Dislocations And Pain In A College Athlete, Rachel Joseph, Trina Walker, University Of Wisconsin - Madison, Rebecca Kronk, Karen J. Whitt, Deborah O. Himes

Faculty Publications and Presentations

This diagnostic case study describes an 18-year-old woman and competitive gymnast who presents with recurrent joint dislocations, chronic musculoskeletal pain, and dermatologic findings suggestive of a heritable connective tissue disorder. Early recognition of connective tissue disorders is essential for accurate diagnosis, genetic evaluation, injury prevention, and long-term management planning.

Treatment Manual For Nonsequential Format Two Part Program For Symptom Self-Management (12 Session Course & Support Group For Booster Dose Of Course), Robin Kay Buccheri, Louise Nigh Trygstad, Martha D. Buffum

Nursing and Health Professions Faculty Research and Publications

This is the Treatment Manual and 5 Appendices for NonSequential Format.  Two-Part Program for Symptom Self-Management of Auditory Hallucinations: 12 Session Course & Support Group for Booster Dose of Course

An Introduction For Nursing Research: An Open Educational Resource For The Undergraduate Nursing Student, Ellen Benjamin

OER Textbooks

The purpose of this text is not to prepare you to independently conduct research, but to help you become an informed and critical consumer of research. The ability to systematically evaluate the strengths, limitations, and applicability of research findings is known as critical appraisal. Critical appraisal is an expected competency of baccalaureate-prepared nurses [5] and requires a foundational understanding of research principles and methods. This book will introduce the research process, including common research methodologies, data collection and analysis approaches, ethical considerations, and strategies for translating research evidence into nursing practice.

Optimizing Tbi Care: Brain Oxygen Monitoring In Nursing - An Evidence-Based Practice, Alyssa Grisham

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims

This DNP project aims to enhance the care of patients with traumatic brain injury (TBI) by improving nurses’ knowledge, clinical decision-making, and early intervention strategies through the integration of brain oxygenation data into routine neurocritical care assessments. This project seeks to promote personalized patient care, reduce secondary brain injury, and improve neurological outcomes for critically ill adults with TBI by implementing an educational protocol designed to deepen understanding of brain oxygen monitoring.

Background of Problem & Description of Current Practice

TBI remains a leading cause of death and disability worldwide and continues to pose a significant public health burden. …

Changes In Telehealth Usage Among Medicaid Beneficiaries With Mental Illnesses In A Rural State: An Analysis Of Kentucky Medicaid Dataset Over 5 Years (2018–2022), Chizimuzo T.C. Okoli, Tianyi Wang, Bassema Abufarsakh, Sarret Seng, Zainab Almogheer, Jarrah Al-Kayed, Pooja Bhattarai, Holly Stith, Andrew Makowski

Nursing Faculty Publications

Introduction: Accessing mental health care remains challenging for Medicaid beneficiaries with mental illnesses (MI) in rural settings. The COVID-19 pandemic prompted telehealth service expansion through temporary policy changes and shifts in health care delivery. Despite the increased availability of telehealth as a modality to address disparities in health care access, telehealth adoption and associated use are inadequately explored among Medicaid beneficiaries with MI in Kentucky.

Objective: To examine trends and factors associated with telehealth use by residence status among Kentucky Medicaid beneficiaries with MI.

Design: A retrospective analysis of Kentucky Medicaid claims data obtained from 174,354 beneficiaries aged 18 years …

Preparation Of Australian Nurses For Contemporary Disability Care: A Desktop Review, Lesley Andrew, Martina Costello

Research outputs 2022 to 2026

Approximately 18% of Australians experience disability, with significant health inequities documented in this population. Despite nursing’s crucial role in addressing these inequities, questions remain about nurses’ preparedness to work effectively with people with disability. The review assessed Australian nursing education’s approach to prepare its graduate nurses for disability care in today’s Australia. Using a rigorous desktop analysis methodology, the review evaluated the publicly available undergraduate nursing degree curricula materials from all 32 Australian public universities that offered a preregistration nursing degree in 2024. The review found 50% of nursing degree curricula course materials omitted to mention disability in their publicly …

Nurses' Experiences Of Pain Management For Patients With Diagnosed Mental Health Conditions: A Systematic Review, Aaron Lapuz Alejandro, Middlewick, Seng Giap Marcus Ang, Rosemary Saunders, Irene Ngune

Research outputs 2022 to 2026

Aim: To synthesise the available evidence related to nurses' pain assessment and management practices for patients with diagnosed mental health conditions. Design: Mixed-methods systematic review. Data Sources: Medline, CINAHL, PsycINFO, SPORTDiscus and Psychology and Behavioural Sciences Collection. Methods: Databases search was conducted in March 2024 and updated in June 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Results: Of the 1318 eligible studies identified, 12 met the inclusion criteria. The included studies were methodologically robust overall but frequently neglected nonresponse bias and were predominantly conducted …

It's The Most Diverse Job I’Ve Ever Had: What Do Registered Nurses Working In Australian Schools Do?, Anita Moyes

Research outputs 2022 to 2026

Although nurses have been working in Australian schools for many decades, research has focused primarily on narrow aspects of clinical practice or service delivery in specific regions. The aim of this study was to identify the domains of practice registered nurses report in a typical working day in Australian schools, using interview data from a national sample. Forty-five nurses working in government and nongovernment schools in every state and territory of Australia participated. Interviews were analyzed using inductive content analysis ( Elo & Kyngas, 2008). Six distinct domains of practice characterized nursing work in Australian schools: (i) responding to diverse …