Digital Commons Network^™

Quality Improvement Project: Improving Pneumococcal Vaccination Rates Through Provider Education In Primary Care, Leikasha Allen

Doctor of Nursing Practice Projects

Pneumococcal disease remains a major cause of illness and mortality among adults aged 65 years and older, leading to severe pneumonia, bacteremia, and meningitis, particularly in vulnerable populations. Although effective vaccines and clear Centers for Disease Control (CDC) and Advisory Committee Immunization Practice (ACIP) guidelines, vaccination in this age group remains inadequate. This Doctor of Nursing Practice (DNP) quality improvement project aimed to determine the impact of pneumococcal vaccination compliance through evaluating provider knowledge, confidence, and adherence to evidence-based guidelines through targeted education. Guided by Rogers’ Diffusion of Innovation Theory and the Health Belief Model, a 20-minute evidence‑based educational session …

Improving Diabetes Care: Staff Training On Updated Ada Guidelines, Jeffrey Wilson

Doctor of Nursing Practice Projects

The incidence of diabetes is rising, requiring clinical staff to stay current with the American Diabetes Association (ADA) Standards of Care. A lack of knowledge and outdated practices were revealed during the needs assessment at the project site. This quality improvement (QI) project sought to determine whether ADA‑centered educational training could impact staff members' knowledge of diabetes. Orem’s Self‑Care Deficit Nursing Theory and Lewin’s Change Theory served as the theoretical frameworks to promote provider competence and adherence to evidence‑based diabetes treatment. Quasi‑experimental pre–post design was used with a convenience sample of four clinical staff at a rural outpatient clinic. Study …

Standardizing Patient-Centered And Trauma-Informed Communication Practices Among Staff In A Behavioral Health Setting, Jayla Brown

Doctor of Nursing Practice Projects

The purpose of this quality improvement project was to evaluate the effect of an evidence-based educational intervention on staff attitudes toward trauma-informed and patient-centered communication in an outpatient behavioral health clinic. Guided by Lewin’s Change Theory and Jean Watson’s Theory of Human Caring, the project aimed to improve staff knowledge, attitudes, and confidence in applying trauma-informed communication strategies across all clinic roles. An eight-week educational intervention based on the SAMHSA Trauma-Informed Care Toolkit was implemented for clinical and administrative staff. A quantitative pretest–posttest quasi-experimental design was used, with outcomes measured using an adapted Attitudes Related to Trauma-Informed Care scale. All …

Staff Education To Improve Psychiatric Nurses’ Use Of Evidence-Based Strategies For Supporting Medication Adherence In Outpatient Settings, Lilian Ndifon

Walden Dissertations and Doctoral Studies

Psychiatric medication nonadherence remains a persistent barrier to effective outpatient mental health care and contributes to relapse, rehospitalization, and disrupted continuity of care. In outpatient psychiatric settings, nurses are often responsible for patient education and follow-up, yet many lack formal training in evidence-based strategies to support medication adherence. This staff education project was implemented at an outpatient psychiatric facility to address this practice gap. The practice-focused question asked whether a structured staff education intervention would improve outpatient psychiatric nurses’ knowledge of evidence-based medication adherence strategies. Twelve outpatient psychiatric nurses participated in a one-hour educational session focused on motivational interviewing, psychoeducation, …

Quality Improvement Project: Empowering Nurses And Medical Assistants To Improve Medication Adherence: A Screening-Based Quality Improvement Initiative, Maria Garcia

Doctor of Nursing Practice Projects

Medication nonadherence is a persistent challenge in clinical settings that negatively influences patient outcomes and is often driven by cost, access, and patient-related barriers, as widely documented in the literature. Nurses and medical assistants play a critical role in identifying these barriers; however, inconsistent screening and limited staff confidence may hinder intervention. The purpose of this quality improvement project was to evaluate the impact of implementing the Brief Medication Questionnaire (BMQ) on staff confidence in addressing medication adherence and to assess clinic-wide utilization of the tool. The project was guided by the Iowa Model of Evidence-Based Practice and Lewin’s Change …

Staff Education To Reduce Compassion Fatigue In Acute Care Staff Nurses, Kamala C. Mcgee

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF), burnout, and moral distress are common in high-acuity nursing environments, yet nurses are rarely taught how to recognize or manage these challenges. The guiding question for this staff education project was about whether education focused on CF and mindfulness-based coping strategies would improve nurses’ knowledge and attitudes in an acute care VA medical center. Posteducation results (n = 20) showed meaningful, statistically significant improvements. Familiarity with CF increased from baseline (M = 2.35; SD = 1.04) to post implementation (M = 3.75; SD = .91), t(19) = −5.085, p < .001. Confidence in recognizing CF in oneself improved from baseline (M = 2.6; SD = .875) to post implementation (M = 3.60; SD = .821), p = .004. Confidence in recognizing CF in colleagues increased from baseline (M = 2.40; SD = .821) to postimplementation (M = 3.15; SD = .671), p = .012. Agreement that seeking help is a sign of weakness decreased from baseline (M = 2.00; SD = .503) to postimplementation (M = 1.40; SD = .951), p = .024. Although perceptions of organizational support did not change, nurses reported greater use of mindfulness, peer support, and boundary setting, supporting nurse wellbeing and psychological safety. Several recommendations emerge from this project. CF education should be integrated into routine staff development, annual competencies, and onboarding for new nurses. By reducing stigma around seeking help and promoting peer awareness, this work supports fostering a workplace culture where all nurses feel safe, supported, and valued, a positive social change.

Optimizing Patient Adherence Through Improved Technology-Based Communication By Enhancing Staff Efficiency At An Opiate Treatment Program Clinic, Jennifer Parsons

Doctor of Nursing Practice Projects

High rates of missed appointments and unreliable follow-up remain a problem in outpatient opioid treatment clinics. This project improved the communication workflow at a methadone maintenance clinic by strengthening reminder systems and staff coordination. A needs assessment found several problems: appointment reminders were inconsistent, tracking was unreliable, and staff communication often relied on manual handoffs. The project was to test a technology-based workflow designed to improve staff communication and reduce missed appointments. The Technology Acceptance Model and Lewin’s Change Theory guided the change. The clinic implemented automated reminders, secure messaging, and clearer documentation to support daily communication. A pre-post evaluation …

Quality Improvement Project: Leveling Pharmacology: A Faculty Development Initiative, Allison Berg

Doctor of Nursing Practice Projects

The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to address limited faculty self-efficacy in developing higher-level, competency-based pharmacology questions for clinical quizzes within an Associate Degree in Nursing (ADN) program. A faculty needs assessment identified an overreliance on recall-based pharmacology assessments, contributing to gaps in students’ clinical reasoning and medication competency. Guided by Bandura’s Theory of Self-Efficacy and Lewin’s Change Theory, a structured faculty development session was implemented to improve faculty confidence and skills in writing application-based pharmacology questions. A pre- post intervention design was used with ADN faculty participants (N = 5) at a …

Improving Lunch Break To Enhance Nurse Happiness And Job Satisfaction, Evelyn O. Dumkwu

Doctor of Nursing Practice Projects

Nurses frequently forgo scheduled lunch breaks due to high workload demands, inadequate staffing, and organizational cultures. Consistently skipping breaks has been associated with reduced happiness and lower job satisfaction, which may ultimately compromise the quality of patient care. This quality improvement (QI) project examined whether the structured observance of scheduled lunch breaks enhances nurses’ subjective happiness and job satisfaction. Guided by Lewin’s Change Theory and the Donabedian Theoretical Framework and implemented using the Plan–Do–Study–Act (PDSA) framework, the project employed a quasi-experimental pre–post design during a six-week implementation period. Ten full-time nurses participated in the project. Investigator-designed Subjective Happiness and Job …

Quality Improvement Project: Effectiveness Of Staff Education On Fall Prevention, Theresa Oahre Okoyomo

Doctor of Nursing Practice Projects

Falls increase injury and mortality rates and decrease patients' quality of life. Hospital falls also incur enormous financial burdens on hospitals. In 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for fall-related injuries. The problem addressed in this quality improvement project was staff confidence in fall prevention and hospital fall rates. The purpose is to improve staff confidence and reduce fall rates by 95 % within six weeks. The 2025 CDC/STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention was the program of choice because it aligns with the hospital's fall-prevention policy. This project design is …

Quality Improvement Project: Reducing Medication Errors To Improve Patient Safety, Paulina Irish

Doctor of Nursing Practice Projects

Medication administration errors remain a persistent threat to patient safety in emergency department settings, where high acuity, rapid throughput, and workflow interruptions increase vulnerability to preventable adverse events. The purpose of this Doctor of Nursing Practice quality improvement project was to increase medication-safety knowledge scores by at least 10% and reduce medication administration error rates by 20% within eight weeks among registered nurses in a freestanding emergency department in South Texas. The project was grounded in Lewin’s Change Theory as the theoretical framework and implemented using the Plan–Do–Study–Act quality improvement model. A quasi-experimental, single-group pretest–posttest design was used with a …

Quality Improvement Project: Reducing Test Anxiety: Faculty Training For Supporting Students, Chichi Markham

Doctor of Nursing Practice Projects

Test anxiety significantly affects nursing students’ academic performance and well-being. Emotional Freedom Techniques (EFT) offer a non-pharmacological method for alleviating anxiety; however, research on faculty-centered approaches in nursing education is limited. The purpose of this quality improvement project is to evaluate the impact of EFT training on nursing faculty’s knowledge, attitudes, and confidence regarding test anxiety, as well as on student exam performance. Guided by Lewin’s Change Theory, Stetler’s Model, and the Plan-Do-Study-Act (PDSA) cycle, the initiative aimed to enhance faculty capacity to identify and address test anxiety within a prelicensure nursing program. A pre-post quality improvement design involved faculty …

Staff Education On Evidence-Based Interventions To Improve Patient Engagement In An Outpatient Mental Health Clinic, Gloria Egeh

Walden Dissertations and Doctoral Studies

In this project, I implemented a staff education initiative at an outpatient psychiatric facility in Michigan to address gaps in clinicians’ and office managers’ knowledge of evidence-based patient engagement strategies. Limited understanding had hindered patient participation in treatment planning, symptom self-management, and shared decision-making, key components of recovery-oriented care. The education initiative was aimed at enhancing staff competencies to strengthen therapeutic alliances, improve treatment adherence, and support positive mental health outcomes. Guided by a practice-focused question, in the project I examined whether an evidence-based staff education program would improve patient engagement among adults receiving outpatient mental health services. A pre-/postintervention …

Staff Education To Prevent Falls Among Older Adults In Primary Care, Chioma Nwosu

Walden Dissertations and Doctoral Studies

Falls are a significant health concern for the elderly population and a major cause of injury and functional decline among older adults, yet fall prevention practices are inconsistently applied in primary care. The purpose of this project is to evaluate the impact of staff education on fall risk screening and prevention for adults aged 65 years and older using the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) framework. This project employs a pre–post quality improvement design in a primary care clinic. Clinical staff received education on STEADI-based fall risk assessment, documentation, and evidence-based interventions. Data were collected through chart …

A Nurse-Led Staff Education Program To Prevent And Detect Elder Abuse By Caregivers In The Home, Nicola Violet Brown-Walters

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a nurse-led, evidence-based staff education initiative designed to improve the prevention and detection of elder abuse in the home by caregivers within an outpatient primary care setting. Elder abuse places older adults at risk for physical harm, neglect, medication mismanagement, and violations of autonomy and patient rights. Elder abuse remains a pervasive and underrecognized problem in nursing practice, often resulting from limited staff education, inconsistent screening practices, and uncertainty regarding mandatory reporting requirements. The practice-focused question examined whether implementing a nurse-led targeted education program guided by the ADDIE instructional design model and …

Staff Education To Improve Knowledge Of Nurse-Led Telemonitoring For Suicide Prevention, Finny Ngozi Rogers

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was a staff education initiative addressing a critical practice gap: clinical staff at a mental health facility lacked the practical knowledge to implement evidence-based telemonitoring protocols for suicide prevention, despite strong supporting research. High rates of suicide attempts and readmissions underscored the urgency for this intervention. The practice-focused question was: “Will a staff education program designed to educate healthcare providers on nurse-led telemonitoring protocols increase staff knowledge?” The purpose of this project was to develop, implement, and evaluate an educational program for providers to increase their knowledge on how a telemonitoring protocol can reduce …

Staff Education Project Staff Education On Medication Adherence, Blessing Nwoke

Walden Dissertations and Doctoral Studies

Medication adherence is a critical component of effective psychiatric treatment, yet staff understanding and consistent reinforcement of adherence strategies are often limited in outpatient behavioral health settings. This Doctor of Nursing Practice (DNP) project implemented a staff education initiative to improve knowledge and awareness of medication adherence using the ESPACOMP Medication Adherence Reporting Guideline (EMERGE) as the foundational framework. The program was conducted in an outpatient psychiatric facility and aimed to align staff knowledge with evidence-based standards for monitoring and supporting adherence. Educational sessions were delivered to clinical staff, incorporating key components of EMERGE to clarify terminology, enhance consistency in …

Quality Improvement Project: The Impact Of Hypertension Management Education In Primary Care, Toyin K. Aliu

Doctor of Nursing Practice Projects

Hypertension (HTN) is one of the leading causes of clinic visits and prescription medication use in primary care settings. Despite the availability of evidence-based guidelines to improve HTN management, adherence in clinical practice is often lacking. At the project site, 30% of patients have uncontrolled HTN. This is attributed to providers’ inadequate knowledge of the JNC-8 HTN management guidelines and inconsistent adherence to them. This project aimed to improve hypertension management in a primary care setting by educating providers on the JNC-8 guidelines to enhance adherence to evidence-based practices over six weeks. The purpose was to align medical providers with …

Quality Improvement Project: The Influence Of Education On Provider Self-Efficacy And Utilization Of The Columbia Suicide Severity Rating Scale (C-Ssrs), Doreen Nwaogwugwu

Doctor of Nursing Practice Projects

Suicide remains one of the leading causes of death worldwide, underscoring the critical need for consistent, evidence-based suicide risk screening in mental health facilities. Despite being a validated, evidence-based tool, the use of the Columbia Suicide Severity Rating Scale (C-SSRS) is often hindered by inadequate provider training. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the impact of provider education on self-efficacy and utilization of the C-SSRS in an outpatient mental health clinic. This quality improvement project used a quasi-experimental, one-group pretest-posttest design guided by the Health Belief Model, Lewin’s Change Theory, and the …

Quality Improvement Project: Enhancing Nurse Communication, Courtesy, And Respect At The Bedside, Rachel Kemp

Doctor of Nursing Practice Projects

Effective communication is key to the nurse-to-patient relationship, patient outcomes, and patient satisfaction. The literature widely shows that barriers such as increased workplace violence and fear and biases within patient interactions hinder communication. This quality improvement project aimed to enhance nurse-to-patient communication, using an evidence-based tool, and leveraged Foli’s Theory of Nurses’ Psychological Trauma to explain and predict barriers. Success is measured by improvement of patient experience in the three nursing domains; courtesy and respect, listen to you, and explain in a way you understand. Lewin’s Change Theory and the plan, do, study, act (PDSA) framework was used to promote …

Quality Improvement Project: Building Competence And Confidence: Updating Nursing Faculty Knowledge Of The Flipped Classroom Model, Jamie Newman

Doctor of Nursing Practice Projects

The increasing complexity of healthcare requires undergraduate nursing education to move beyond traditional lecture-based instruction toward teaching strategies that promote clinical judgment. Although the flipped classroom model is shown to support these outcomes, faculty at the project site reported uncertainty and inconsistency in flipped classroom implementation. The purpose of this quality improvement project was to evaluate the impact of a structured, evidence-based faculty development intervention on undergraduate nursing faculty confidence, readiness, and competence to implement the flipped classroom model. Guided by Lewin’s Change Theory and the Stetler Model of Evidence-Based Practice, this quality improvement project used a quantitative, pre-experimental one-group …

Quality Improvement Project: Impact Of Evidence-Based Self-Care Practice On Burnout In Nursing Faculty, Lori Boyd

Doctor of Nursing Practice Projects

Nursing faculty burnout is a national concern supported by literature, which compromises faculty well-being, creativity, retention, and sustainability of nursing programs. Burnout is characterized by the subscales of emotional exhaustion, depersonalization, and feelings of reduced personal accomplishment. At the project site, leaders reported that faculty often left their roles due to increased workload and being overwhelmed by the rigorous expectations of the role, underscoring the need for a process to support nursing faculty burnout. This quality improvement (QI) project aimed to evaluate the impact of evidence-based self-care practices on nursing faculty burnout using Maslach's Burnout Inventory Toolkit, a valid and …

Clinical Practice Guideline For Universal Anxiety Screening For Advanced Practice Providers, Kelechi Blanton

Walden Dissertations and Doctoral Studies

This project was a clinical practice guideline (CPG) focused on anxiety screening in a primary care setting using the Generalized Anxiety Disorder (GAD-7) screening tool. The practice problem addressed general anxiety disorder and the need for standardized assessments for risk, as recently been recommended by the U.S. Prevention Service Task Force (USPSTF). Anxiety disorder is common but frequently untreated, due in part to low rates of screening. Lack of an evidence-based guideline for anxiety screening may contribute to delayed diagnosis and inconsistencies. The practice-focused question was, Does the evidence support development of an evidence-based CPG for universal anxiety screening in …

Staff Education Using A Workplace Violence Reduction Bundle, Julla Panneh

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) quality improvement project addressed the ongoing issue of workplace violence (WPV) among medical-surgical nurses in an acute care setting. WPV poses significant risks to staff safety, psychological well-being, and the overall care environment. Guided by current evidence and professional guidelines, the project implemented a structured educational intervention focused on the Workplace Violence Reduction Bundle, incorporating the Broset Violence Checklist (BVC) and evidence-based de-escalation strategies. Medical-surgical nursing staff participated in tailored educational sessions; knowledge was assessed through pre- and post-intervention surveys, and program acceptability was evaluated through staff feedback. Data analysis revealed modest improvements in …

Staff Education To Nurses To Lmprove Routine Foot Examinations For Diabetic Patients, Sarah Abrefi

Walden Dissertations and Doctoral Studies

Diabetes-related foot complications remain a significant cause of morbidity, hospitalization, and lower-extremity amputation, despite strong evidence supporting routine preventive assessments. In many outpatient settings, variability in nursing knowledge, skill, and documentation practices contributes to inconsistent implementation of comprehensive diabetic foot examinations. The purpose of this practice-focused quality improvement project was to evaluate the effectiveness of a structured staff education program designed to improve nurses’ knowledge and competency in performing comprehensive diabetic foot assessments in an outpatient diabetes clinic.A pretest–posttest evaluative design was used to measure changes in knowledge following the educational intervention. Ten registered nurses participated in a structured educational …

Staff Education On Preventing Benzodiazepines Related Falls In Older Adults, Dafnee Gilles

Walden Dissertations and Doctoral Studies

In geriatric psychiatric setting, falls rates are higher than general wards and could reach up to 13-25 falls per 1000 hospital days. High use of benzodiazepines in older adults is a major cause of increased falls despite recommendations to avoid its prescription to the population. This DNP staff education project focused on training nurses working in an 80 bed capacity geriatric psychiatric facility on best evidence based practice of preventing falls associated with use of BZDs. The identified practice issue was knowledge deficit on evidence based best practices to prevent falls in older adults under BZDs medications. The project aims …

Staff Education To Improve Knowledge On Early Recognition Of Staff Burnout In Nurses Working In Long-Term Care, Geraldine Ndeng Akonwah

Walden Dissertations and Doctoral Studies

This doctoral project was a practice-based staff education project aimed at educating nurses concerning early burnout recognition. The educational intervention was chosen to promote awareness and knowledge related to the concept of burnout and self-care among nurses employed in a long-term care facility. The practice problem addressed was the high prevalence of nurse burnout and the limited ability of nurses to recognize early signs of burnout. The problem is significant in nursing practice as burnout is detrimental to the clinical judgment, patient safety, job satisfaction and staff retention. The guiding question of the project was as follows: Does a staff …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Immediate Skin-To-Skin Contact At Very Preterm Birth And Effect On Infant Socio-Emotional Stress Response And Mother–Infant Cortisol Co-Regulation: Secondary Outcomes From The Randomised Clinical Immediate Parent-Infant Skin-To-Skin Study (Ipistoss), Karoline Lode-Kolz, Siri Lillieskold, Hanne Brit Hetland, Eleonora Mascheroni, Stina Klemming, Hanne Pike, Agnes Linner, Nils J. Bergman, Bjorn Westrup, Ulrika Ådén, Evalotte Morelius, Rosario Montirosso, Wibke Jonas, Siren Rettedal

Research outputs 2022 to 2026

Objective To explore the effects of immediate parent–infant skin-to-skin contact (iSSC) at very preterm birth on maternal–infant behavioural responses and hypothalamic–pituitary–adrenal (HPA) axis reactivity to age-appropriate socio-emotional stress at 4months corrected age. Design Two secondary outcomes from a multicentre randomised controlled trial with two non-blinded parallel groups. Setting Three Scandinavian neonatal intensive care units, level 2 and level 3. Participants 91 infants born at gestational age 28+0to 32+6 from April 2018 to June 2021. Singletons and twins with a second caregiver present were included, regardless of mode of birth. Higher-order births, infants with congenital infections and major malformations were excluded. …

Prevalence Of Premenstrual Syndrome, Premenstrual Dysphoric Disorder, And Dysmenorrhea In Nursing Students: A Systematic Review, Meta-Analysis, And Evidence-Based Recommendations, Sabyasachi Maity, Bharathi Gadad, Hansapani Rodrigo, Seham Noorani, Ayesha Usman, Chloe Lark, Mona Attarpour, Ivy Mageto, Lucas Schwartz, Nikhilesh Anand

School of Medicine Publications

Introduction: Menstrual disorders—including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea—are highly prevalent among women of reproductive age and are associated with impaired academic performance, psychological distress, and reduced social functioning. Nursing students are particularly vulnerable due to the combined demands of intensive academic schedules and clinical training, yet prevalence estimates and institutional responses remain inconsistent.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251109363). PubMed, Scopus, Web of Science, CINAHL Ultimate, and APA PsycINFO were searched for studies published between 2016 and 2025. Eligible studies reported prevalence or …