How Does The Frequency Of Visits Impact The Quality Of Life For Nursing Home Residents?, Sophie M. Carlton

Honors Undergraduate Theses

This integrative literature review examines the relationship between quantity of visitation and quality of life (QOL) of nursing home residents. The purpose of this review is to examine existing research to determine whether an optimal “dosage” of visitation exists that meaningfully enhances QOL for this vulnerable population. Establishing an evidence based- guideline may help reduce uncertainty for families and promote more consistent improvements in resident well-being. Nursing home residents are the focus of this work because their limited ability to leave the facility makes visitation one of their primary sources of non-occupational social interaction. The COVID19 pandemic further heightened the …

The Knowledge, Experiences, And Attitudes Of Nurses Regarding Trauma-Informed Care For Sexually Abused Intrapartum Patients, Kayleigh Mcgraw

Honors Undergraduate Theses

Labor and delivery nurses care for women from diverse backgrounds who are preparing for a life-changing event, often marked by fear, excitement, sadness, and joy. However, 1 in 5 women in the United States have experienced rape or attempted rape, and for these survivors, labor can become re-traumatizing. Many report flashbacks, dissociation, and a sense of “being back in the rape” during childbirth. Research further links prior sexual assault to unplanned cesareans, traumatic births, and childbirth-related PTSD. Trauma-informed care (TIC) provides a framework to reduce these risks by encouraging providers to understand trauma, recognize signs of distress, and act to …

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Reducing Re-Hospitalizations Among Adult Residents In Skilled Nursing Facilities: A Guideline Project, Nicole Crooks

Doctor of Nursing Practice (DNP) Scholarly Projects

Purpose: This project aimed to develop an evidence-based guideline to support early recognition of clinical deterioration and improve communication among SNF staff, with the goal of reducing avoidable rehospitalizations, and to evaluate stakeholder perceptions of the proposed recommendations. Methods: A literature review was completed to develop eight recommendations that were used to create a guideline and toolkit for the SNF setting. Six stakeholders evaluated the recommendations on a 4-point scale. Ratings were analyzed using descriptive statistics and the Friedmans test. Results: Stakeholder ratings were favorable, with means ranging from 3.50 to 3.83. Recommendations 3 and 6 had the highest means …

Microalbumin Screening In Hypertension: An Evidence Based Implementation, Nicole C. Votaw

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

Microalbuminuria is an early indicator of Chronic Kidney Disease (CKD). Hypertension (HTN) is one of the leading causes of CKD. Early treatment of CKD can delay and even prevent progression to End Stage Renal Disease (ESRD). Monitoring patients with HTN more frequently for microalbuminuria can identify CKD earlier than annual screening so that treatment can be initiated sooner to offer greater protection of the kidneys over time.

Background

In a small, rural clinic, it was determined that Urine Microalbumin (UMA) screening in office was not being done, but has been shown to be beneficial in identifying CKD.  Current practice …

Improving Hpv Vaccine Series Completion Rates Among Adolescents In A Primary Care Clinic, Emily K. Nettle

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

Human Papillomavirus (HPV) vaccination prevents HPV related cancers, yet completion rates remain below state (Texas) and national goals. At the selected primary care clinic, 42% of adolescents aged 15-18 years had completed the HPV vaccine series as of October 2025. This quality improvement project aimed to improve HPV vaccine initiation and follow-up dose scheduling through a culturally tailored, multilevel intervention.

Methods

Guided by the Plan-Do-Study-Act framework, an eight-week intervention included bilingual education for adolescents and caregivers, provider education, electronic health record (EHR) prompts, and digital reminders. Baseline data from an eight-week period in 2025 were compared with intervention data …

Hospital-Acquired Pressure Injury Reduction: A Quality Improvement Bundle Strategy, Vickey Thompson

Doctor of Nursing Practice (DNP) Scholarly Projects

Hospital-acquired pressure injuries (HAPIs) remain a national and global challenge, contributing to preventable harm and negatively affecting patient safety, quality of care, and clinical outcomes. Current evidence underscores opportunities to strengthen pressure injury prevention strategies. Purpose: This quality improvement project implemented an evidence-based pressure injury prevention (PIP) bundle to reduce HAPI rates by improving nursing knowledge and attitudes and increasing adherence to protective dressing application and repositioning practices. Methods: The PIP bundle consisted of targeted education, monitoring of prophylactic dressing application, and structured repositioning strategies focused on turn frequency and offloading angle. Data were collected via pre- and …

Improving Nurse–Patient Communication Through Evidence-Based Strategies, Tekhesia Phillips

Doctor of Nursing Practice (DNP) Scholarly Projects

Effective nurse–patient communication is essential to patient understanding, safety, and experience. This quality improvement project evaluated a structured communication bundle consisting of Teach-Back, intentional bedside nurse rounding, and nurse leader rounding on an adult intermediate care unit. A pre–post quality improvement design guided by the Plan–Do–Study–Act framework was used. The historical nurse communication composite baseline was 46.7%, and the project objective was to increase the composite by at least 10 percentage points while achieving at least 80% adherence to each process measure. During implementation period, nurse leader rounding was completed in 313 of 523 eligible opportunities (59.8%). Teach-Back was validated …

Interventional Pulmonary Reflex Biomarker Testing In Advanced-Stage Lung Cancer, Tonya Hooper

Doctor of Nursing Practice (DNP) Scholarly Projects

National Comprehensive Cancer Network guidelines recommend biomarker testing for patients with advanced-stage non-small cell lung cancer. Delays in ordering biomarker testing increase turnaround time (TAT) and delay initiation of targeted therapy. National benchmarks recommend biomarker result TATs of 10-14 days. Evidence suggests reflex biomarker testing at time of pathologic diagnosis reduces TAT and improves workflow efficiency. This quality improvement (QI) initiative implemented reflex biomarker testing for patients newly diagnosed with advanced-stage lung cancer to reduce biomarker testing TAT by 7–14 days within an interventional pulmonary service line. The QI used a pre-post design guided by the Plan-Do-Study-Act (PDSA) framework and …

Reducing Left Without Being Seen Rates Through Risk Identification And Rapid Provider Evaluation, Jeremiah W. Slatten

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Patients who leave the emergency department before evaluation may experience delayed care and contribute to quality and safety concerns. At the project site, the baseline left without being seen rate was 7%. This quality-improvement project evaluated whether a risk-identification tool linked to rapid provider evaluation could improve care for patients at increased risk of leaving before evaluation.

Methods: The project was implemented over eight weeks in a large urban community emergency department. Adults presenting as walk-in patients were screened using a left without being seen risk-identification tool. Patients with a risk score of 3 or greater were classified as …

Socioeconomic Influences On Doula Access And Perceived Care Quality Among Black Women Experiencing Severe Maternal Morbidity, Deborah Esene

2026 Spring Honors Capstones Projects

Black women experience disproportionately high rates of maternal morbidity and mortality, making it essential to examine access to and the perceived impact of doula support. This study examines whether socioeconomic status influences access to and the perceived benefits of doula support among Black women who experienced severe maternal morbidity (SMM). Researchers surveyed Black women ages 18-49 who had a live birth within the past two years and experienced SMM. Participants were recruited and completed an online survey in late 2020. Key variables included income, education, doula use, and perceived quality of prenatal, intrapartum, and postpartum care. Among 188 participants, 12.2% …

Promoting The Use Of Smoke Evacuation Systems In The Operating Room: A Quality Improvement Initiative, Andrea Leigh Drayer

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Surgical smoke produced during procedures poses serious health risks to operating

room (OR) staff and patients, yet many hospitals, including an academic medical center in

northern West Virginia, have underutilized smoke evacuation systems. The imminent

enforcement of West Virginia House Bill 4376, mandating smoke evacuation use, provided both

urgency and opportunity for an intervention.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project

was to increase timely compliance with the use of smoke evacuation systems during all smoke-

producing procedures, ensuring alignment with safety standards and legislative requirements.

Methods: A systematic evidence review of academic …

An Evidence-Based Practice Initiative To Promote Debriefing Within The Obstetrics Surgical Team, Rachel Lynn Runatz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Operating room debriefing is an evidence-based strategy shown to improve communication, efficiency, patient safety, and safety culture; however, debriefing is inconsistently performed in obstetric operating rooms due to workflow, cultural, and time-related barriers.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to increase the frequency of debriefings in the Birthing Center operating rooms at WVU Medicine Children’s Hospital through implementation of a nurse-driven, evidence-based debriefing initiative.

Intervention: A nurse-driven debriefing protocol was implemented using the Iowa Implementation for Sustainability Framework. Interventions included staff education, accessible laminated debriefing documents, identification of nurse champions, leadership support, and …

The Effects Of Music Therapy On Anxiety And Sedation Requirements For Total Knee Arthroplasty Patients Undergoing Regional Anesthesia: An Evidence-Based Practice Pilot Initiative, Kyra Marie Savrese

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Excessive noise in the operating room negatively impacts patient comfort and outcomes, particularly in patients undergoing spinal anesthesia who have the potential for awareness.

Background: Research demonstrates that music therapy is a low-cost, low-risk intervention that reduces perioperative anxiety and sedative requirements. Literature supports the use of music as an adjunct to anesthesia care, especially in orthopedic populations.

Purpose: At J.W. Ruby Memorial Hospital, orthopedic procedures with regional anesthesia expose patients to high noise levels, often leading to increased anxiety, sedation use, and longer recovery times. Addressing this problem aligns with institution goals for safe, patient-centered care.

Methods: Using …

Empowered Choices: A Quality Improvement Women’S Health Initiative In Faith-Based Nursing For Women Recovering From Substance Use Disorder, Jennifer Mewshaw

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Women with substance use disorder (SUD) face higher rates of unplanned pregnancy, reproductive infections, and delayed prenatal care. Faith community nurses (FCNs) often already serve within this community and have a long history of promoting public health interventions. However, they lack the knowledge and confidence in sexual and reproductive health (SRH) education.

Evidence Review: A literature review identified barriers to SRH care for women with SUD and the role of FCNs in community and public health interventions. Evidence supports providing FCNs with the knowledge and skills to deliver SRH education and support for women with SUD using trauma-informed and …

Implementation Of A Ventilator-Associated Pneumonia Bundle To Reduce The Incidence Of Ventilator-Associated-Pneumonia And Improve Patient Care, Taylor Ryan Rice

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Ventilator-associated pneumonia (VAP) is a concerning complication that can

develop from complications when a patient is placed on a mechanical ventilator. Endotracheal

intubation puts patients at risk for micro aspiration, which can lead to VAP.

Evidence Review: Nine articles were selected for review; after critical appraisal, seven were

kept for further review. Evidence in these articles shows that using evidence-based methods in a

VAP bundle can decrease the length of stay, mechanical ventilator days, and the incidence of

VAP.

Purpose: The purpose of this project was to improve oral care for intubated patients and keep

the incidence of VAP …

Improving Healthcare Professionals’ Comfort Level Screening For Intimate Partner Violence, Madison M. Mitzel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Pregnancy increases a woman’s risk of experiencing intimate partner violence (IPV). Although healthcare visits typically increase during pregnancy, IPV screening is often overlooked, and many women remain unaware of available domestic violence resources. 
Local problem: Globally, women are impacted by IPV, with those living in rural areas facing a higher risk. 
Methods: The Abuse Assessment Screen (AAS) was implemented in a rural women’s health facility to screen patients for IPV. Prior to implementation, healthcare professionals within the facility received education regarding the screening protocol and available resources for patients. 
Interventions: The comfort level of the healthcare professionals discussing IPV …

Improving Adolescent Sexual Health Education Through A Gamified Quality Improvement Initiative In Kenya: Game On For Safe Choices, Alyssa Kashia Lee, Isabel Diazdeleon, Ilyana Karkar

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Adolescent sexual health remains a significant public health concern in rural Kenya because of the limited access to comprehensive sexuality education; therefore, contributing to high rates of sexually transmitted infections (STIs), HIV, unintended pregnancy, and gender-based violence. This quality improvement project evaluated the implementation of the Game On for Safe Choices, a culturally responsive, game-based sexual health education intervention designed to improve adolescents' sexual health knowledge and confidence. The project was conducted at ByKay Hotel in Sega, Siaya County, Kenya, and included 25 adolescents aged 15–17 years. Guided by the Plan-Do-Study-Act framework, participants completed three interactive educational stations focused on …

Patient-Centered Education In Fall Risk And Prevention Decreases The Number Of Falls On The Orthopedic Unit, Kaitlyn Chan, Amparo Guzman Garcia, Tran Huynh

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Inpatient falls are a major patient safety concern, particularly in orthopedic units where mobility limitations, comorbidities, and postoperative factors elevate risk and contribute to preventable injury, longer hospital stays, and increased costs. At Sutter Medical Center Sacramento’s orthopedic unit, an annual rate of 16 falls and persistent gaps in patient and staff education highlight the need for a targeted quality improvement initiative despite use of an EPIC predictive fall-risk model. Guided by the Plan-Do-Study-Act framework, this project implements a comprehensive fall-prevention education program modeled on the Fall T.I.P.S. toolkit, including a standardized bedside brochure, visual cues (wristbands, door signage, bedside …

A Guideline To Address Barriers To Mental Health Treatment Experienced By Law Enforcement Officers, Jacqueline Estrella

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Law enforcement officers are exposed to repeated trauma on the job that may negatively affect their mental health. Officers may avoid seeking mental health treatment due to police culture, stigma, and other barriers which may increase risks for suicide, absenteeism, and maladaptive coping.

Objectives: Develop an evidenced-based guideline to address barriers law enforcement officers face in seeking mental health treatment.

Methods: The National Quality Measures Clearinghouse (NQMC) Domain Framework was used to guide a literature review to identify best practices suitable for a guideline. Articles were graded for strength based on the John Hopkins Nursing Evidence Based Practice (JHNEBP) …

Breast Milk Versus Formula Feeding In The Development Of Necrotizing Enterocolitis Among Nicu Infants: An Integrative Review, Mackenzie Jameson, Faye Li, Liudmila Ryzhova, Mia Smith

Master's Projects

Introduction/Question: NEC is a serious condition characterized by the death of intestinal tissue, primarily affecting premature infants or those with low birth weight. The incidence of NEC poses a significant concern in neonatal healthcare due to its substantial mortality risk, particularly among vulnerable populations. This condition can lead to various complications, including sepsis, nutritional deficiencies, delays in growth and development, and, in severe cases, death. NEC not only impacts the health of the infant but also affects the emotional well-being and bonding experiences of parents. Despite advancements in neonatal care, the rate of NEC has increased, highlighting the need …

Asthma Integrative Review: Effects Of Aerobic Exercise On Asthma Exacerbation, Abigail Williams, Dazya Crayton, Nicole Stasiak, Sabrina Stich

Master's Projects

Asthma is a chronic respiratory illness defined by airway inflammation and episodes of exacerbation. Pharmacological intervention remains the treatment of choice; however, there is growing evidence to support moderate intensity aerobic exercise as adjunct therapy to promote asthma control. The integrative review evaluates current evidence supporting the PICO question: In adults with mild to moderate asthma, what is the effect of prescribed aerobic exercise on reducing exacerbations? A systematic search of CINAHL, Health Source: Nursing, MEDLINE, and PubMed identified eligible studies. The inclusion criteria required peer-reviewed quantitative articles written in English and published within the past five years. In addition, …

The Effects Of Attending Prediabetes Prevention Workshops On Improving Students' Awareness, Knowledge, And Interest, Madelene Hamann

DNP Research Projects

Abstract

Objective:This DNP project evaluated the effectiveness of a five-week educational intervention on adolescents’ knowledge of prediabetes, awareness, and intentions to adopt healthy lifestyle behaviors. Method and Intervention:Youth aged 13 to 18 years participated in five 40-minute school-based workshops. Outcomes were measured using the Adolescent Diabetes Awareness Test (ADAT), Health Belief Model (HBM), and Centers for Disease Control and Prevention (CDC) workshop evaluation. Effect sizes and 95% confidence intervals (CIs) were used to determine clinical relevance. Results:The intervention had a large, clinically relevant effect on prediabetes knowledge and awareness measured by the ADAT (Hedges’ g = 1.10) …

Utilizing Youth Mental Health First Aid: A Community-Based Prevention Strategy To Increase Teh Confidence Levels Of Seventh-Day Adventist Adults In Assisting Youth With Mental Health Distress, Sarah Hillebert

DNP Research Projects

Abstract 

Objective: Youth Mental Health First Aid (YMHFA) is an initiative from the National Council for Mental Wellness that trains adults in identifying and responding to adolescents exhibiting mental health distress. This DNP project evaluated the effectiveness of YMHFA in increasing the mental health literacy and confidence scores of Seventh-day Adventist (SDA) adults. Method: quality improvement, pretest-posttest quasi-experimental design was used. Participants were SDA adults aged 22 to 74 who work with youth in school, church, or camp settings (n=19; Mean age = 48.5 years, SD = 10.5). The quantitative MHFA 2.1 measured mental health literacy and confidence to intervene, …

Updating Order Set Review Policy To Improve Adherence To Evidence-Based Practice In A Multi-Hospital System, Corynne Lurie

West Chester University Graduate Theses, Dissertations, and Final Projects

Ensuring that clinical order sets reflect current evidence-based practice is essential to delivering safe, high-quality, and consistent patient care across health systems. In multi-hospital organizations, maintaining alignment across facilities presents additional challenges, including variability in workflow, stakeholder involvement, and policy adherence. This quality improvement project evaluated the existing order set review process within a three-hospital health system to determine whether current policies effectively support system-wide needs and promote best practices. Guided by Lewin’s Change Theory, a qualitative descriptive design was used to assess current workflows and gather feedback from stakeholders involved in order set development and review. Survey data, with …

Implementing A Nurse Re-Education Program To Promote Timely Use Of The Jada® System In The Postpartum Hemorrhage Cascade: A Quality Improvement Project, Maegan E. Doody

Master's Theses and Capstones

Background: Postpartum hemorrhage (PPH), defined as blood loss greater than 1,000 mL after delivery, is a leading cause of maternal morbidity in the United States. Identification of risk factors and timely intervention are critical to improving maternal outcomes after delivery. First-line interventions include manual uterine massage, uterotonic medications, and antifibrinolytic medications; however, when bleeding is not well controlled, the Jada® System (Jada) is a newer vacuum-induced hemorrhage control device with a high efficacy and safety profile, particularly when implemented earlier in the hemorrhage cascade.

Local Problem: In 2025, the annual rate of PPH within the microsystem was 7.29%, …

Reducing Readmissions For Copd Through Improved Education: A Gap Analysis, Raphael Gaughan

Master's Theses and Capstones

No abstract provided.

Enhancing Patient Safety And Team Communication Via Standardized Unit Handoff Tools In Inpatient Rehabilitation, Julia Rae Before

Master's Theses and Capstones

Abstract

Background: Interdisciplinary safety huddles in healthcare are used to facilitate staff communication, voice patient safety concerns and identify high acuity patients, as well as identify current unit issues that need resolution. Using characteristics of safety huddles, revising patient report sheets to include pertinent safety information often shared during huddles may lead to an increase in staff perception of communication as well as awareness to patient safety concerns. Within an in-patient rehabilitation hospital, anonymous staff reports indicated dissatisfaction with interprofessional communication and microsystem data revealed increased events of adverse patient outcomes and safety concerns. Baseline data indicated inconsistent patient handoff …

A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Enhancing Safety And Efficiency In Cardiac Admission Handoffs Through Implementation Of An I-Pass Checklist: A Quality Improvement Project, Soraia D. Barros

Master's Theses and Capstones

Abstract

Background: Effective care handoff is a necessary step for maintaining patient safety during hospitalizations. The goal of this quality improvement project was to improve the completeness of information, particularly cardiac-related, provided by the ED staff to the CSSU nurses. The implementation involved the creation of a cardiac checklist and applying it to the pre-existing I-PASS forms used during asynchronous handoff.

Local Problem: The macrosystem implemented an updated system for handoffs between the ED and CSSU by substituting an over-the-phone report with a faxed I-PASS sheet. The result, as identified by the CSSU staff, is that reports contain undetailed patient …