Digital Commons Network^™

Quality Improvement Initative To Reduce Falls Among Geriatric Patients In The Inpatient Mental Health Setting, Regina Johnson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are widely recognized as a leading cause of injury and hospitalization among older adults, with geriatric psychiatric patients at particularly high risk due to polypharmacy, cognitive impairment, and mobility challenges. At the project site, baseline audits revealed inconsistent use of structured fall risk tools, limited nurse-driven medication review, and gaps in post-fall documentation. The absence of an embedded electronic health record feature for medication review highlighted a significant practice gap requiring intervention.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce fall risk in a geriatric psychiatric hospital through structured post-fall medication …

Implementing A Standardized Ssri Tapering Protocol In The Outpatient Setting, Chelsea Sopo-Ngwa

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Selective serotonin reuptake inhibitors (SSRIs) are one of the most prescribed antidepressant medications in the outpatient psychiatric setting. Abrupt discontinuation or improper tapering of these medications may result in SSRI withdrawal symptoms. Adverse effects may lead to poor patient outcomes and increase healthcare utilization. A baseline chart review and provider readiness survey within the outpatient psychiatric practice revealed inconsistency in provider documentation related to SSRI tapering plans, patient education, and follow-up planning. The gap in practice highlighted the lack of a standardized SSRI tapering protocol to guide evidence-based medication tapering practices and promote patient safety.

Aim: The …

Determinants Of Uptake Of Breast Cancer Screening Among Women Of Reproductive Age In Makueni County, Lola Ndirangu

MSc in Advanced Practice Nursing

Background: Breast cancer is the most diagnosed cancer in all women worldwide, with women in low and middle-income countries dying of the disease in disproportionate numbers because of late diagnosis and access to screening services. Sub-Saharan Africa is an under-researched area, and the level of screening uptake in Kenya, especially in rural and semi-arid areas, including Makueni County, is low. This research assessed the factors that determine the reproductive age women's screening uptake of breast cancer in Makueni County.

Methodology: The cross-sectional design was analytical and was conducted in Makueni County Referral Hospital, where 301 randomly chosen women …

Examining Racial And Ethnic Disparities In Nurse Burnout, Intent To Leave, And Student Debt Burden: A Cross-Sectional Study, Jacqueline Christianson, Kyla Aiyeku, Abiola O. Keller

College of Nursing Faculty Research and Publications

Background:

A racially and ethnically diverse nursing workforce can only enhance the profession's ability to serve the widely diverse U.S. population. Embracing differences allows nurses to develop a broader understanding of each other and of their patients. Yet many nurses of color face unique challenges that can adversely impact their well-being and their longevity in this profession.

Purpose:

The purpose of this descriptive cross-sectional study was to examine levels of burnout, intent to leave the profession, and student debt burden among nurses who self-identified as Asian, Black or African American, or Hispanic, and compare these to the levels reported by …

Supporting Discharge Preparation For Children With Medical Complexity: A Scoping Review, Emily Moore, Mia Waldron, Darlene Acorda, Cara Gallegos, Barbie Giambra, Stacee M. Lerret, Christine R. Platt, Danielle A. Sarik, Zara Sajwani-Merchant, Nesibe Sumeyye Kutahyalioglu, Pamela Gampetro, Susan Groshong, Marianne Weiss, Teri L. Hernandez, Sandra Staveski

College of Nursing Faculty Research and Publications

Background

The transition from hospital to home is a critical period for children with medical complexity (CMC) and their caregivers, often associated with increased risks and stress. Both registered nurses and advanced practice nurses play a pivotal role in facilitating this transition through discharge preparation, including planning, coordination, and teaching. However, best practices for optimizing discharge processes for CMC remain unclear. The need for a comprehensive understanding of hospital discharge during this crucial time is apparent as adverse events following discharge are common and are often attributed to insufficient preparation and communication. This scoping review aims to identify key nursing …

Exploring Barriers To Patient Care In A South Carolina Free Clinic, Jonathan G. Green

Doctor of Nursing Practice Scholarly Projects

Access to healthcare remains a persistent challenge for medically underserved populations who rely on free medical clinics for primary care services, particularly in non-Medicaid expansion states such as South Carolina. Free clinics serve as critical safety-net providers, yet patients frequently encounter barriers that limit access, continuity, and quality of care. The purpose of this Doctor of Nursing Practice (DNP) project was to explore and identify the structural, social, and interprofessional barriers to patient care within a South Carolina free medical clinic to inform targeted, evidence-based interventions. A mixed-methods needs assessment design was used, combining a retrospective chart review of forty …

Combating Obesity: Creating A Comprehensive Wellness Plan For Uninsured & Low-Income Populations, Kayla C. Berrios

Doctor of Nursing Practice Scholarly Projects

Aim: The aim of this project was to research the specific barriers encountered by obese patients that are low-income and uninsured. The goal of this data collection was to inform the stakeholders involved in creating a comprehensive wellness plan for obese patients.

Background: The staff at Good Neighbor Clinic have struggled to support their support their obese patients with weight reduction. Many of the ailments that patients seek care for correlate to their obesity. Health promotion in this community clinic needs a more comprehensive program to support patients during their weight loss experience, providing support and resources to allow for …

Empowering Mothers: A Digital Intervention For Perinatal Mental Wellness, Morgan Edmunds

Doctor of Nursing Practice Scholarly Projects

Aim: The aim of this project was to develop a smartphone application prototype for peripartum mental health. The goal of this application was to enhance access to education and quality mental health care.

Background: Currently, in the United States, peripartum mental health conditions are the leading cause of maternal morbidity and mortality (The Joint Commission, 2023). There is a gap in education, screening, and treatment for peripartum mental health due to distrust and a lack of resources, including a lack of mental health providers (Dossette et al., 2024; Feldman & Perret, 2023). Therefore, there is a significant number of women …

The Impact Workplace Violence Has On Nurse Burnout, Olivia Merryman Rn

Nurse Residency

In nurses working in the healthcare field, how does increased exposure to workplace violence, in comparison to an environment with effective violence prevention affect the rates of nurse burnout and retention of staff?

Loma Linda Nurse - Vol. 34, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | Jordan Robison Profile

6 | LLUSN Mission Service— A Living Legacy

10 | Steps to a New School

12 | Entry Level Master’s at Murietta

LLUSN HIGHLIGHTS

14-21 | ALUMNI NEWS

22-27 | ACADEMICS

28-33 | HOMECOMING

34-37 | FACULTY UPDATES

Fall Reduction Utilizing Fall Tailored Intervention For Patient Safety In Acute Care, Lauren Poindexter

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospitalized patient falls cause physical, psychological, and financial harm and persist despite prevention bundles. A Midwest Ohio acute medical unit experienced higher-than-benchmark fall rates (1.53–7.58 falls/1,000 patient days; unit rate 113% of the national median), with a rising trend in FY25. Reliance on the Schmid tool and existing interventions lacked structured patient/family engagement, as well as comprehensive medication assessment, leading to under-recognition of risk and limited nurse-driven prevention.

Aim of the Project: The aim of the project was to reduce inpatient fall rates and fall-related injuries on a medical unit by implementing the Agency for Healthcare Research and Quality …

Staff Education And Implementation Of Phq-9 And Gad-7 In An Adult Psychiatric Private Practice, Exta Oppong Tweneboa

Walden Dissertations and Doctoral Studies

The PHQ-9 and the GAD-7 are short screening instruments used for the detection of depression and anxiety symptoms in various settings, including general and mental health care settings (Pranckeviciene, et al., 2022). The purpose of this Doctor of Nursing Practice (DNP) project was to educate staff on the implementation of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) into an adult psychiatric private practice to standardize screening, improve diagnostic accuracy, and support measurement-based care for depression and anxiety. A structured staff education program was conducted with five nurse practitioners, one psychiatrist, two therapists, and two front-end administrative staff. …

Quality Improvement Project Improve Staff Knowledge On Spravato For Treatment Resistant Depression, Cynthia Barraza Guerra

Doctor of Nursing Practice Projects

Treatment-resistant depression (TRD), defined as major depressive disorder unresponsive to at least two adequate antidepressant trials, is linked to higher morbidity, diminished quality of life, and increased healthcare utilization. Spravato (intranasal esketamine), approved by the U.S. Food and Drug Administration, provides a novel mechanism of action through N-methyl-D-aspartate (NMDA) receptor modulation but requires strict safety oversight due to risks including dissociation and hypertension. This Doctor of Nursing Practice (DNP) quality improvement (QI) project evaluated whether a targeted educational intervention improved staff knowledge and confidence in Spravato safety protocols. Guided by Lewin’s Change Theory, Bandura’s Social Learning Theory, and implemented with …

Quality Improvement Project High-Quality Simulation Training For High-Quality Nurse Educators, Cherrelle Hawkins

Doctor of Nursing Practice Projects

The Associate of Applied Science in Nursing (AASN) faculty use simulation as a teaching modality to assist nursing students in preparing for their clinical experiences by transitioning knowledge into practice. To successfully facilitate simulations, faculty must possess knowledge and competence in facilitating simulation sessions. Faculty at the practice site lacked these characteristics due to the nonexistence of a simulation training program. This quasi-experimental quality improvement project aimed to implement formal simulation training for faculty to influence self-perceived knowledge and competence in facilitation constructed by the Adult Learning Theory and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR) Change Model. The PI evaluated knowledge and competence …

Quality Improvement Project Impacting Provider Self-Efficacy And Use Of Cbt For Depression Treatment, Tony Orafunam

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice (DNP) quality improvement project was conducted at a mid-sized outpatient psychiatric clinic in Hempstead, New York, focusing on strengthening providers’ self-efficacy in delivering Cognitive Behavioral Therapy (CBT) to young adults (aged 19–35) diagnosed with Major Depressive Disorder (MDD). Rather than targeting MDD directly, the initiative aimed to impact provider self-efficacy and skill in CBT to improve access to evidence-based treatment and reduce the need for external referrals. Employing Bandura’s Social Cognitive Theory and the ADKAR change model, the project used a quasi- experimental, one-group pre-test/post-test design. Six advanced practice providers participated in a structured, interactive …

Quality Improvement Project Improving Faculty Support For First-Generation Rural Nursing Students, Charlotte Dowdy

Doctor of Nursing Practice Projects

The barriers to academic success among first-generation rural nursing students are substantial, including a lack of knowledge of academic resources, ineffective study strategies, and difficulty navigating the higher education system. These challenges are documented in the literature as resulting in higher attrition rates and lower graduation rates. This quality improvement project was intended to implement and analyze a faculty training module designed to increase faculty awareness and confidence in supporting first-generation rural nursing students at the project site. The project adopted a pre-post intervention design based on High-Reliability Organization principles and Lewin’s Change Model, to determine the effectiveness of targeted …

Quality Improvement Project Implementing Teamstepps 3.0: Impact On Perception Of Teamwork, Angela Allen

Doctor of Nursing Practice Projects

The clinical practice site is a rural health clinic that has experienced 28% staffing turnover in the last year, and opportunities for improvement in communication and teamwork were identified. The principal investigator (PI) used the Iowa Model Revised (IMR) as a theoretical framework and Lippitt’s change theory to promote change for the identified priority issue. TeamSTEPPS is an evidence-based program designed to improve communication and teamwork in healthcare teams with the goal of improving patient outcomes and safety. The quality improvement project utilized a quasi-experimental design with pre- and post-intervention surveys to answer the question: among staff at a rural …

Quality Improvement Project Providing Accessible Evidence-Based Education To Nurses Throughout A National Healthcare System, Bailey Wells

Doctor of Nursing Practice Projects

The pursuit of ongoing professional development and learning is crucial to ensure nurses remain well-informed about healthcare trends and have access to the most up-to-date evidence-based materials. This quality improvement project aimed to implement a monthly educational series for nursing personnel within the Veterans Health Administration (VHA) through expansion of the Veterans Administration (VA) – Extension for Community Healthcare Outcomes (ECHO) program. Using Bandura’s Self-Efficacy Theory of Motivation in Psychology, participants’ previous knowledge was linked to continued professional development. The plan, do, study, act (PDSA) framework provided structure for the project, with the awareness, desire, knowledge, ability, and reinforcement (ADKAR) …

Quality Improvement Project Unlocking Critical Thinking: The Use Of Guided Reflection In Nursing Education, Alissa Wheat

Doctor of Nursing Practice Projects

Nursing education is at a crossroads as the demand for practice-ready nurses increases in a rapidly evolving healthcare environment. Despite high licensure pass rates, graduates often demonstrate gaps in clinical judgment and critical thinking, key competencies for safe nursing practice. This project addressed the problem of limited structured strategies to develop these competencies among pre-licensure nursing students in a Houston-based nursing program. The purpose was to evaluate guided reflection, implemented as a competency-based education (CBE) tool, to determine its effect on faculty perceptions of supporting critical thinking and clinical judgment. A quasi-experimental, one-group pretest–posttest design was conducted with clinical faculty …

Ready Or Not? An Autoethnography Of A Midwife’S Preparedness And Readiness Journey, Kristen Graham

The Qualitative Report

This emotive autoethnography explores my experiences working as an Australian midwife in low- and middle-income countries, which led to a Doctor of Philosophy journey exploring primary care midwives' preparedness and readiness in rural and remote communities in this context. I use the midwifery tradition of storytelling to explore personal experiences of preparedness and readiness as a way towards researcher reflexivity, understanding and meaning. Emerging themes of preparation for practice, resource limitations, heartache, and emotional resilience offer insights to inform midwifery education, research, and practice.

Implementing Patient Health Questionnaire-9 Screening In Adult Mental Health: A Staff Education Initiative, Precious Nmachi Adaso

Walden Dissertations and Doctoral Studies

This project was a staff education program aimed at the use of the Patient Health Questionnaire-9 (PHQ-9) as a universal depression screening instrument within a mental health facility. The project was conducted in an urban area of the United States at an outpatient behavioral health facility and was focused on addressing the stagnation in the staff’s correct use of evidence-based measures of depression screening that inhibits the prompt detection and treatment of major depressive disorder (MDD). The practice focused question was: Following participation in a staff education program, will staff demonstrate increased knowledge on depression screening and use of the …

Educating Correctional Nurses On The Use Of A Mindfulness Program To Reduce Work Stress, Victoria Ngozi Emelogu

Walden Dissertations and Doctoral Studies

Correctional nurses deliver care in environments marked by violent incidents, chronic understaffing, and moral distress. These conditions heighten occupational stress, jeopardize patient safety, and accelerate staff turnover, yet few U.S. jails provide evidence-based training in rapid self-regulation strategies. The purpose of this staff education project was to evaluate whether a 2-week curriculum could increase correctional nurses’ knowledge, attitudes, and self-reported skills (KAS) for on-shift mindfulness use. Pender’s health promotion model framed the intervention, Bloom’s taxonomy and Kirkpatrick’s evaluation model informed learning objectives and outcome levels. Five correctional nurses at a large urban jail completed an anonymous 10‑item KAS survey before …

Staff Education For Health Care Providers On Improving Health Care Outcomes For Lgbtq+ Youth And Adolescent Patients, Sheila Shafer

Walden Dissertations and Doctoral Studies

This project was focused on the significant challenges faced by LGBTQ+ adolescents and young adults, specifically those aged 12 to 25 years, who seek mental health care services. Research indicated that discrimination and stigma against this demographic contribute to disproportionately poorer mental health outcomes, underscoring the urgent need for culturally competent health care delivery. The purpose of this project was to educate professionals on the necessary skills and knowledge about the unique needs of LGBTQ+ patients. The question was the following: Would an educational intervention improve providers’ knowledge and confidence in diagnosing and treating the mental health needs of LGBTQ+ …

Quality Improvement Project Simulation Orientation For Nursing Faculty, Emily Harvey

Doctor of Nursing Practice Projects

Many nursing faculty are expected to teach using SIM without adequate preparation, which can limit competence in SIM-based teaching. A university-level school of nursing identified this gap and initiated a quality improvement project to strengthen faculty readiness through a structured online orientation. The intervention used the Massive Open Online Course (MOOC) Essentials in Clinical SIMs Across the Health Professions and was guided by Benner’s Novice to Expert Model, Lewin’s Change Theory, and the Plan-Do-Study-Act cycle. A quasi-experimental pretest–posttest quantitative design was conducted with nursing faculty participants. The Facilitator Competency Rubric (FCR) assessed competence across five domains: preparation, prebriefing, facilitation, debriefing, …

Quality Improvement Project Enhancing Provider Education On Phq-9 Depression Screening To Improve Compliance, Obianuju Okafor

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide; however, screening in primary care remains inconsistent. Even though the Patient Health Questionnaire-9 (PHQ-9) is a validated screening tool, its use is often limited by insufficient provider training. This quality improvement (QI) project aimed to evaluate the impact of structured provider education on PHQ-9 screening practices, with the purpose of improving provider knowledge, confidence, and adherence to screening guidelines in a primary care setting. Guided by Donabedian's Model of Quality Care and Lewin's Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, the project used a one-group pre/post design at an outpatient …

The Relationship Between Nursing Faculty Sense Of Belonging And Faculty Intent To Stay, Heather M. Bowers

Doctoral Dissertations and Projects

The purpose of this quantitative causal-comparative and correlational study was to evaluate the relationship between workplace sense of belonging and intent to stay in the current nursing faculty role among full-time nursing faculty. The shortage of nursing faculty impacts the ability to prepare the next generation of nurses needed to meet worldwide nursing demands. Strategies to effectively recruit and retain nursing faculty are important considering the current shortage and increasing retirements of nursing faculty. While sense of belonging has been studied for student retention and studies are beginning to explore the importance of workplace belonging, the impact of organizational sense …

The Lived Experiences Of Micu Nurses During The Covid-19 Pandemic: A Qualitative Study, Thomas Hopkins

Doctoral Dissertations and Projects

The purpose of this phenomenological study was to explore the lived experiences of MICU nurses during the COVID-19 pandemic and how these experiences may inform disaster preparedness in the nursing curriculum. This research is guided by Watson’s (1979) theory of human caring. The theory emphasizes the importance of interpersonal relationships and emotional support in nursing practice, and how these elements can be integrated into disaster preparedness training. Using interpretive phenomenological analysis, data were collected through semi-structured interviews, field notes, and guided journaling. The interviews were conducted via digital conferencing software over the internet. Field notes were recorded during the interviews. …

Enhancing Patient Understanding And Reducing Readmissions: Implementing A Structured Discharge Teaching Protocol In A Medical-Surgical Unit, Jawany Joseph

DNP Projects

Background

Hospital readmissions remain a critical challenge in healthcare, especially in medical-surgical units. The high rates of hospital readmissions are often linked to inadequate patient understanding of discharge instructions. Many patients struggle with deciphering discharge plans, leading to medication errors, missed follow-up appointments, and poor self-care management. A structured discharge teaching protocol has the potential to enhance patient comprehension, improve adherence to port-discharge care, and reduce readmission rates.

Project Goals

This project aimed to improve understanding of discharge instructions, reduce hospital readmissions, and enhance patient satisfaction with the discharge process. Specific objectives included increasing patient comprehension from 65% to 90% …

Improving Staff Knowledge On Hourly Rounding Using The 4ps To Reduce The Fall Rate, Chukwuemeka Igboanugo

Walden Dissertations and Doctoral Studies

I designed this Doctor of Nursing Practice (DNP) project to develop an educational program that increases staff knowledge of hourly rounding using an evidence-based approach, specifically pain, position, potty, and possession (the 4Ps), to prevent falls among residents in a long-term care facility. According to facility leadership, the observed gap in practice was the nursing staff members’ lack of knowledge in performing hourly rounding. The facility’s fall records for the lockdown units indicated a surge in fall rate, with 32 falls among 62 residents per month, reflecting a need for action. The practice-focused question guiding the project was: For staff …

Active Learning And Nclex-Rn Pass Rate On First Attempt In Bsn And Adn Programs, Janette Tingson

Walden Dissertations and Doctoral Studies

Failing the NCLEX-RN on the first attempt affects not only the students and their families but also nursing programs. To increase NCLEX-RN pass rates, nursing programs are shifting from traditional teaching to active learning in their aim to produce nursing graduates who will pass the NCLEX-RN exams on the first attempt. The purpose of this descriptive, correlational study, guided by theory of constructivism, was to determine if there is a relationship between faculty’s use of active learning strategies (ALS) and nursing students’ NCLEX-RN pass rates on the first attempt in bachelor of science in nursing (BSN) and associate degree in …