Digital Commons Network^™

Inconsistent Post-Fall Follow-Up And Documentation In A Skilled Nursing Facility, Brooke Beier

Celebrating Scholarship and Creativity Day (2018-)

Falls remain a significant safety concern in skilled nursing facilities and are associated with increased morbidity, hospitalization, and loss of independence among older adults. While fall prevention strategies are widely implemented, inconsistent post-fall follow up and incomplete documentation can negatively impact residents and the facility. At a moderate-sized skilled nursing facility in central Minnesota, a review of recent fall reports identified inconsistencies in post-fall follow-up documentation, as well as gaps in staff education and the absence of a clearly defined post-fall documentation policy. The facility experienced 44 resident falls in the month of January alone, highlighting the urgency of addressing …

Effect Of Music Therapy And Music Focused Interventions On Fall Rates In A Memory Care Unit, Emily Spanier, Cassie Howe, Hannah Reiter, Paige Mauer

Celebrating Scholarship and Creativity Day (2018-)

This quality improvement project examined the effect of music therapy and activity-focused interventions on fall rates in a memory care unit at a long-term care facility. The project was developed after staff identified falls as a major safety concern, with the memory care unit accounting for a disproportionate number of facility-wide falls. Through audits and observations, the team found that boredom, wandering, restlessness, and lack of meaningful engagement were common contributing factors to falls among residents with dementia. To address this issue, the team implemented low-cost, person-centered interventions including playing familiar music through Alexa, encouraging participation in simple arts and …

Implementation Of Positive Reinforcement To Promote Staff Adherence To Bowel And Bladder Plans At A Long-Term Care Facility, Alfonso Segura Sanchez

Celebrating Scholarship and Creativity Day (2018-)

Background: Bowel and bladder plans (BBPs), also known as toileting programs, are individualized restorative nursing programs that have strategies to promote continence in residents and reduce the negative consequences of incontinence (Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual Version 1.20.1, 2025). Purpose: Senior nursing students implemented positive reinforcement in a quality improvement (QI) project to reduce rates of incontinence and inconsistent adherence to BBPs at Elim Wellspring, a skilled nursing facility for long-term care in Princeton, MN. According to the Minnesota Department of Human Services and Minnesota Department of Health, the most recent report on quality indicators for …

Optimizing The Charge Nurse Role To Improve Workflow And Communication In A Community Living Center, Ndidi Kalu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of optimizing the charge nurse role on workflow efficiency and communication within a Community Living Center. Identified practice gaps included role ambiguity, inconsistent delegation, and communication breakdowns, which contributed to delays in care and decreased staff satisfaction. An evidence-based approach was used to standardize charge nurse responsibilities, strengthen leadership practices, and introduce structured communication processes. The project demonstrated that improving role clarity and leadership consistency supports more effective delegation, enhances team communication, and improves care coordination. Outcome included increased staff engagement, improved workflow efficiency, and enhanced patient safety. This initiative …

Telehealth Workflow Optimization, Taku Ajongakoh Stella

Walden Dissertations and Doctoral Studies

This evidence-based quality improvement (EBQI) project addresses the 36% telehealth no-show rate at an outpatient behavioral health clinic in Maryland. High attrition rates currently compromise continuity of care and result in a projected annual revenue loss of $124,000. The present project proposed a standardized workflow redesign in the current Integrated Care Approach (ICA) notes Electronic Health Record (EHR) system to address the manual outreach inconsistency. Significant interventions involved the activation of automated multimodal reminders at 72-hour, 24-hour, and 1-hour intervals, and the obligatory 24-hour technical pre-verification connection. Moreover, the project introduced a systematic 48-hour follow-up procedure of missed visits to …

The Effect Of A Mass Casualty Incident Adult Hyper-Realistic Simulation On Nurse Confidence Levels And Satisfaction Of Nurses: A Quasi-Experimental Study, Melodie Ann Nutter

Doctoral Dissertations and Projects

The purpose of this quantitative quasi-experimental study was to examine registered nurses (RNs) satisfaction and confidence levels after experiencing hyper-realistic simulations using a mass casualty incident (MCI) simulation method. With the world seeing a rise in MCI events, nurses often become one of the first professional medical providers to interact with the affected individuals. To fill this gap in education, the introduction of intensive hyper-realistic simulation training plays a vital role and provides an advanced perspective on the ever-increasing MCIs in today’s healthcare environment. This quasi-experimental study, using the Wilcoxon rank test and paired, assessed the satisfaction and confidence levels …

Evaluating The Screening And Referral Process For The Use Of Phq-9 Screening Tool In Middle-School Aged Students: A Scoping Review, Kaythi Soe, Msn, Pmhnp-Bc, Fnp-Bc, Margaret Harvey Phd, Acnp-Bc, Fhrs, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

No abstract provided.

Associate Degree Program Administrator Perceptions Of Clinical Dishonesty, Cynthia Moore Swineford

Doctoral Dissertations and Projects

The purpose of this hermeneutic phenomenological study was to explore the perceptions of associate degree nursing program administrators regarding faculty reporting of dishonest clinical behaviors by pre-licensure nursing students. Aristotle’s theory of virtue ethics guided this examination of how administrators interpret ethical responsibility, leadership influence, and professional accountability related to clinical dishonesty. The central research question asked, “What are the perceptions of associate degree program administrators regarding faculty reporting of dishonest student behaviors in clinical settings?” The sample included 11 associate degree nursing program administrators from programmatically accredited nursing programs in three mid-Atlantic states. Data were collected through semi-structured interviews, …

Establishing A Standardized Suicide Risk Screening Policy For Psychiatric Providers: Closing Gaps In Provider Accountability And Clinical Documentation, Fadekemi Olude

Doctor of Nursing Practice Projects

Psychiatric providers in outpatient settings often experience inconsistent confidence and incomplete documentation when conducting suicide risk screening, contributing to missed opportunities for early identification of at-risk patients. This quality improvement project addressed the need for standardized suicide risk screening at an urban outpatient psychiatric clinic. The purpose was to evaluate documentation using the Columbia-Suicide Severity Rating Scale (C-SSRS). Using a pre-post intervention design guided by Lewin's Change Theory and the Donabedian Model of Quality Improvement, a 60-minute training session was delivered to 31 psychiatric providers. Participants completed pre- and post-intervention General Self-Efficacy Scale (GSES) surveys. Chart audits (N = 1,970) …

New Nurse Faculty Mentorship: A Quality Improvement Project, Kimberly B. Porter

Doctor of Nursing Practice Projects

The ongoing nursing faculty shortage limits program capacity and makes it harder to retain novice nurse educators transitioning from clinical practice to academia. The literature highlights issues such as insufficient mentorship, role confusion, and a lack of structured support as key factors contributing to early faculty attrition. This quality improvement (QI) project aimed to implement and evaluate an evidence-based mentorship program to improve perceptions of mentorship effectiveness among new-to-academia nurse faculty in a School of Nursing in Arkansas. The purpose was to implement and evaluate a mentorship program designed to improve perceptions of mentorship among new-to-academia nurse faculty. The project …

Impact Of Provider Confidence And Psychiatric Referrals Through Education And Implementation Of The Gad-7 Anxiety Screening Tool In An Outpatient Family Clinic, Maceline E. Check

Doctor of Nursing Practice Projects

Gaps in provider and nurse confidence in identifying and managing anxiety disorders in outpatient family clinic settings contribute to underdiagnosis, delayed intervention, and reduced psychiatric referrals. This quality improvement project evaluated the impact of provider education and implementation of the Generalized Anxiety Disorder-7 (GAD-7) screening tool on provider and nurse confidence and appropriate psychiatric referral rates, with the goal of improving clinical decision-making and standardizing anxiety screening practices. The project was guided by Lewin’s Change Theory and the Iowa Model of Evidence-Based Practice. Using a quasi-experimental pre- and post-intervention design, providers and nurses in an outpatient family clinic received structured, …

Quality Improvement Project: Impacting Staff Confidence In Recognizing Hiv Medication Adherence, Joy Nwansi-Iro

Doctor of Nursing Practice Projects

Medication adherence to antiretroviral therapy is essential for viral suppression and improved outcomes among individuals living with human immunodeficiency virus (HIV). Despite advances in treatment, healthcare providers lack confidence in recognizing medication adherence challenges and implementing appropriate interventions. Evidence suggests that provider education using standardized adherence assessment tools improves adherence monitoring and clinical decision-making. The purpose of this quality improvement project is to evaluate whether an educational intervention and a standardized workflow using the CASE Adherence Index would impact healthcare staff confidence in recognizing HIV medication adherence. Lewin’s Change Theory guided the project through the stages of unfreezing, change, and …

How Does Cognitive Behavioral Therapy (Cbt) And Antipsychotics Compare To Antipsychotics Alone Impact Inpatient Length Of Stay: A Scoping Review, Morgan E. Johnson, Hailey M. Wade, Y'Esha V. Williams-Click, Rocquell Duncan, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Background

Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on …

Executive Summary: Executive Leadership System Improvement Improving Depression Screening And Follow Up Processes, Rebecca Geneiveve Hidalgo Salomon

Walden Dissertations and Doctoral Studies

Depression remains a significant public health burden in the United States, contributing to disability, healthcare utilization, and economic cost. Internal 2024 audits at the project site identified variability in Patient Health Questionnaire 9 PHQ 9 screening and follow up processes, with 68% of screenings completed, 55% of follow ups timely, and disparities among patients with limited English proficiency. These findings indicate a systems level reliability and equity gap. This executive leadership system improvement project focused on developing a standardized, nurse led, electronic health record supported workflow to improve PHQ 9 completion and timely follow up. The practice focused question asked …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Quality Improvement Project: Improving Adn Faculty Professional Development Through Simulation Training, Sharon Haley Peace

Doctor of Nursing Practice Projects

Lack of structured simulation training for nursing faculty, which has been identified as a gap in the literature, can negatively impact the quality of simulation-based education and student learning outcomes. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to develop, implement, and evaluate an evidence-based training intervention aimed at improving faculty self-efficacy and competence in simulation facilitation. The project was guided by Lewin’s Change Theory and Kolb’s Experiential Learning Theory to support faculty development. A quantitative, quasi-experimental pre-post design was used with a convenience sample of nine associate degree nursing faculty at a rural community …

Recovery Instruction Improvement Project, Jonathan Eyestone, Katy Germundson

Publications 2026-present

No abstract provided.

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

Improving Cultural Competence Among Healthcare Professionals Through A Targeted Staff Training Program, Oyindamola Akinkugbe

Doctor of Nursing Practice Projects

Limited culturally competent care for Hispanic patients worsens existing health disparities, creates misunderstandings, leads to poor health outcomes, and reduces satisfaction with the quality of care. In an outpatient clinic, more than 70% of patients are Hispanic, yet healthcare providers reported a lack of confidence in caring for culturally diverse patients. Extensive literature supports staff training to improve provider cultural competence, but implementation remains inconsistent across healthcare settings. This quality improvement project addressed this gap by implementing a targeted staff training program grounded in the Culturally and Linguistically Appropriate Services (CLAS) in Nursing framework. The purpose of this project was …

Enhancing Shared Decision-Making In Mental Health Care: A Quality Improvement Initiative, Joanna L. Hysler

Doctor of Nursing Practice Projects

Shared decision-making (SDM) is an evidence-based approach that enhances patient engagement, treatment adherence, and clinical outcomes in psychiatric care. Despite strong support in the literature, SDM remains inconsistently implemented in mental health settings due to limited provider training, time constraints, and organizational barriers. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate an educational intervention designed to improve SDM utilization and provider confidence within a private outpatient psychiatric practice. The project was guided primarily by the Plan-Do-Study-Act framework to support structured practice change, with Lewin’s Change Theory providing additional conceptual support. The intervention …

Staff Education To Improve Knowledge Of Evidence-Based Engagement Strategies To Reduce No-Show Rates, Jerrica Luster

Walden Dissertations and Doctoral Studies

High no-show rates in outpatient mental health settings remain a persistent barrier to effective care delivery, negatively affecting continuity of care, patient outcomes, and access to services. In the identified practice setting, inconsistent use of evidence-based engagement strategies beyond standard reminder practices contributed to missed appointments. The purpose of this Doctor of Nursing Practice project was to evaluate whether a structured staff education intervention on evidence-based engagement strategies would improve staff knowledge as a foundation for enhancing appointment adherence. A quantitative pre- and posttest design was used to evaluate knowledge change following the intervention. Participants included outpatient mental health clinic …

Community-Based A1c Screening Initiative To Improve Diabetes Risk Identification Among People Experiencing Homelessness, Rebecca Drake, Deedee Long, Mariita Carter

Student Works

Abstract

Purpose: People experiencing homelessness (PEH) experience high rates of undiagnosed diabetes yet face significant barriers to preventive screening. This quality improvement project aimed to improve access to diabetes screening for PEH through on-site hemoglobin A1C (A1C) testing in a trusted community setting.

Methods: On-site A1C screening was implemented at the Utah County Food and Care Coalition (F&CC) using a low-barrier, community-based approach. Screening was conducted during routine service hours and integrated into existing workflows. Process, outcome, and balancing measures were used to evaluate feasibility, reach, and unintended effects.

Results: The intervention primarily supported identification of diabetes risk and referral …

Nurse Education On Nonpharmacological Management Of Knee Osteoarthritis, Toyin Mary Ajayi

Walden Dissertations and Doctoral Studies

The Doctor of Nursing Practice (DNP) project aims to fill the gaps in the management of knee osteoarthritis (OA) in adults aged 40 to 75 years in a primary care practice. Knee OA is a common chronic disease that significantly impacts pain, mobility, and quality of life. Although there is empirical evidence that nonpharmacological interventions, including exercise, weight control, and self-management education, are effective, these methods are not consistently used in clinical practice, and pharmacologic treatment continues to be used. The project was designed to inform healthcare personnel about evidence-based nonpharmacological strategies to improve patient outcomes and reduce reliance on …

Staff Education On Early Sepsis Recognition For Medical-Surgical Nurses In The Acute Care Setting, Nadine Nzenga Udom

Walden Dissertations and Doctoral Studies

In this staff education project, I targeted early sepsis recognition and response among medical-surgical nurses. The practice gap at the site was nurses’ limited knowledge of sepsis indicators and screening tools, which contributed to delayed escalation of care. The practice-focused question guiding the project was “Does educating medical-surgical nurses on early sepsis recognition and response improve knowledge of early sepsis recognition and response?” I applied the analysis, design, development, implementation, and evaluation (ADDIE) and Johns Hopkins Evidence-Based Practice (JHEBP) models to design a structured sepsis education program for nursing staff. I searched for peer-reviewed literature via databases accessed through the …

Evaluating Mental Health Providers’ Knowledge And Attitudes Towards Stigma Among Teenagers Aged 13 To 19 Years With Mental Illness, Fredrica Murray Johnson

Wisdom & Compassion: The LUSON Journal

Limited knowledge and poor attitudes among mental health providers contribute to stigma towards individuals with mental illness, adversely affecting treatment experience and outcomes. This study evaluated the effectiveness of an educational intervention in improving mental health providers’ knowledge and attitudes toward stigma-based practices. The clinical question stated: Among mental health providers, does an educational intervention, compared to standard practice, improve knowledge and attitudes of stigma and promote evidence-based care delivery to adolescents aged 13 to 19 with mental illness within six weeks? The Iowa Model of Evidence-Based Practice (EBP) was the framework used to implement the quasi-experimental study. The two …

Non-Alcoholic Fatty Liver Disease, Diet And Contributing Factors: A Narrative Literature Review, Rachel Joseph, Ashley Tharpe, Sherri Ann Walker

Wisdom & Compassion: The LUSON Journal

Objectives: The purpose of this narrative literature review is to explore the relationship between Non-alcoholic fatty liver disease (NAFLD) and dietary habits, and identify factors that contribute to the development, progression, and potential management of NAFLD.

Methods: Search terms such as non-alcoholic fatty liver disease (NAFLD), diet, and nutrition, including plant-based and vegetarian diets, were used to identify 45 peer-reviewed publications published within the last five years.

Results: Dietary factors, biological, environmental, obesity, mental health, and genetic factors can contribute to the development of NAFLD. This multisystem problem can have economic, social, and psychological consequences that affect a person’s quality …

Resilience In Nursing Education: A Literature Review Examining The Experiences Of Ukrainian Nursing Students In The United States, Katherine Ferrell, Rachel Joseph

Wisdom & Compassion: The LUSON Journal

The purpose of this literature review is to examine the experiences of international students who originate from war-torn areas, who live in the United States (US). Drawing from peer-reviewed sources, the review examines the academic, psychological, and social challenges these students face, including trauma, cultural adjustment, and gaps in institutional support. It highlights the resilience and coping strategies employed by students, as well as the role of universities in fostering inclusive environments. The review also identifies critical gaps in current research, particularly regarding long-term mental health outcomes and culturally responsive support services. This paper aims to synthesize existing literature on …

Navigating Life And Death: A Moral Critique Of Euthanasia Practices Worldwide, Brooke Fuzie, Rachel Joseph

Wisdom & Compassion: The LUSON Journal

Euthanasia and physician-assisted death remain deeply debated ethical issues shaped by history, law, and cultural values. This narrative review explores how diverse ethical frameworks, shifting global legislation, and cultural perspectives inform current discourse, with special attention to the role of nurses guided by the American Nurses Association (ANA) Code of Ethics. Drawing on peer-reviewed studies, legal documents, and recent case analyses published between 2013 and 2025, the review identifies three key insights. Ethical frameworks influence whether society accepts or opposes euthanasia; robust legal safeguards are needed to protect autonomy and prevent misuse; and palliative care and advance care planning, including …

Perceived Knowledge, Attitude, Practice, And Barriers Of Jordanian Nursing Faculty To Integrate Genomic Concepts In The Curriculum: A Cross-Sectional Descriptive Study, Rachel Joseph

Wisdom & Compassion: The LUSON Journal

Background: Rapid advances in genomics knowledge and the expansion of precision medicine have amplified expectations for nurses to integrate genomic concepts into education and clinical practice. Evidence regarding genomic knowledge, attitudes, practices, and barriers among nursing faculty in the Middle East is limited. To equip practicing and emerging nurses, faculty must be equipped. Faculty preparedness is critical to successful curriculum integration and to preparing future nurses for genomic-informed care.

Purpose: This study examined the perceived knowledge, attitudes, practices, and barriers related to integrating genomic concepts in the nursing curriculum among nursing faculty in Jordan.

Methods: A cross-sectional descriptive design was …

More Than Machines: Our Identity In Christ, Jerrod A. Boggs

Wisdom & Compassion: The LUSON Journal

No abstract provided.