Digital Commons Network^™

Nursing Faculty Orientation And Development Project: A Program Evaluation, Sarah Deshler

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

The transition from nursing clinical practice to academia can be complex, as new faculty must adapt to teaching, curriculum development, and academic expectations. Nursing programs currently face a 7.2% faculty vacancy rate, a shortage expected to worsen as many faculty approach retirement. A structured orientation and development process may support successful transition and improve long-term retention. The purpose of this project was to evaluate the effectiveness of the nursing faculty development process. Does the implementation of a structured orientation and development process improve participant satisfaction, perceived preparedness to teach, and teaching efficacy? A mixed-method, nonexperimental design with purposeful sampling was …

Improving Competency Of Care At End Of Life, Linda J. Perez

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Providing competent care at the end of life (EOL) has been recognized as an essential skill for nursing students transitioning to practice (NSTP). EOL has been defined as the phase in which patients enter the terminal stage of a chronic illness or experience an unexpected health decline that ultimately results in death (Hughes et al., 2024). Due to limited EOL education provided in nursing schools, many NSTP have experienced significant anxiety, which has contributed to decreased self-efficacy and reduced competency when caring for patients at EOL (Jablonski et al., 2020). EOL discussions are often not had or minimally discussed due …

Improving Early Detection Of Dementia In Primary Care, Terry E. Smith

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Dementia remains under-detected in primary care despite recommendations to assess cognitive health during Medicare’s Annual Wellness Visit (AWV). Persistent gaps in clinician knowledge and workflow standardization contribute to delayed diagnosis and missed opportunities for early intervention. Strengthening early detection practices is essential to improving outcomes for individuals with dementia. This project aimed to improve early detection of dementia by implementing a brief clinician education program and evaluating its impact on dementia knowledge, mild cognitive impairment (MCI) diagnostic coding, and utilization of the Cognitive Assessment and Care Planning Visit (CACPV). The DNP (Doctor of Nursing Practice) project was conducted in two …

Addressing Triggers Of Anxiety And Depression In A Mental Health Setting, Jacqueline Elos Wahito Kabukuru

Group: Samford University Moffett & Sanders School of Nursing

In order to improve coping capacity and clinical decision-making. This project evaluated the use of the 15-item Coping Adaptation Processing Scale (CAPS-15) alongside RAM’s four adaptive modes (physiological, self-concept, role function, interdependence) to assess coping responses to stressors and support individualized care planning in a mental health counseling setting.

From Identification To Support: Improving Postpartum Depression Detection And Referral In Postpartum Care, Jennifer M. Hall, Gail W. Salter

Group: Samford University Moffett & Sanders School of Nursing

Postpartum depression (PPD) affects approximately one in seven women in the United States and poses significant risks to maternal well being and infant development. Despite routine use of the Edinburgh Postnatal Depression Scale (EPDS) shortly after childbirth, gaps persist in consistent follow up, early detection, and timely referral particularly during the vulnerable period between hospital discharge and the four to six week postpartum visit. This quality improvement project implemented patient navigator services to strengthen continuity of care and enhance early recognition of PPD. Guided by Cheryl Beck’s Modified Grounded Theory of PPD, “Teetering on the Edge,” and her middle range …

Reflect & Reset Check In: Cultivating Care, Connection, And Culture, Whitney C. Jackson, Tawanda Williams-Hardie, Jamali Stone

Group: Samford University Moffett & Sanders School of Nursing

Nurse burnout remains a critical challenge in healthcare, with national rates exceeding 60% and contributing to turnover, reduced morale, and compromised patient care. Existing end-of-shift practices are largely task-oriented and fail to address emotional decompression or team connection. This quality improvement project implemented the Reflect & Reset (R&R) Check-In Model, a structured, end-of-shift intervention designed to support nurse well-being, enhance psychological safety, and strengthen team communication across two inpatient units.

Grounded in Donabedian’s Structure–Process–Outcome framework and Duffy’s Quality Caring Model, this pre-post, mixed-methods project engaged registered nurses, patient care technicians, and charge nurses over a five-week pilot period. The intervention …

Workplace Health: Blood Pressure Education And Self-Monitoring At The Worksite, Pamela E. Carver

DNP and Student Works

Hypertension (HTN) is the most common diagnosis in the United States and one of the 10 most expensive health conditions for employers. Poorly managed and undiagnosed HTN increases health care costs and contributes to lost employee productivity. The literature strongly supports self-monitoring as key to blood pressure (BP) control, especially when paired with additional interventions such as education. Although much has been done to review various worksite health promotion programs over the last 20 years to 30 years, specific evidence regarding the potential impact of providing BP self-monitoring equipment at the worksite is lacking. The purpose of this study was …

Improving Patient Care And Outcomes With The One-Hour Sepsis Bundle, Catherine H. Gorman

Group: Samford University Moffett & Sanders School of Nursing

The purpose of this project was to improve the timeliness of sepsis recognition and treatment in a rural hospital through the implementation of the SSC one-hour sepsis bundle to reduce sepsis-related mortality and improve patient outcomes.

Enhancing Sun Safety Knowledge In Adolescents And Young Adults Through A Targeted Educational Intervention: A Quality Improvement Project, Manali Patel

DNP and Student Works

This quality improvement (QI) project evaluated the effectiveness of a six-week educational intervention designed to enhance sun safety knowledge among adolescents and young adults (AYAs) in a private dermatology clinic in South Florida. Excessive ultraviolet (UV) exposure remains the primary risk factor for skin cancer, and knowledge deficits persist despite public health efforts. A quasi-experimental pretest–posttest design was used. Participants completed a modified 10-item Skin Cancer and Sun Knowledge (SCSK) Scale before and after the intervention. The intervention included brief provider-led education, printed materials, QR-coded resources, and reminders.

Results showed a slight increase in median knowledge scores; however, statistical significance …

Enhancing Maternal Hypertension Education And Screening, Elysse R. O'Brien, Nancy Semenza, Cynthia Bednarchik, Cheryl Brown

DNP and Student Works

Problem Statement: Maternal morbidity and mortality are a crucial health concern in the United States. Explicitly, in Illinois, from 2008-2017, there was an average of 75 women who died each year amid pregnancy or within one year of pregnancy, with the highest number, 103, reported in 2017 (IDPH, 2021). The Illinois Department of Public Health was the primary reporting organization used for research purposes, as this pertains more towards the DNP project, since the project was implemented in Illinois. Given the significance of this parental health issue, this student has chosen to implement a Doctor of Nursing Practice (DNP) project …

Breaking Down Barriers To Pediatric Respite Care Use, Michelle Montanez

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Parents of children with a life-limiting illness provide constant, around-the-clock care, often leaving little time for their well-being. This responsibility is emotionally, mentally, and physically demanding, and without proper support, parents face increased risk of depression, burnout, and deteriorating health. Respite services offer relief by providing a much-needed break and allowing parents the opportunity for self-care and improved well-being. Though the benefits of respite are well documented, these services remain underutilized due to barriers such as limited provider awareness, lack of access, and emotional challenges the parents face. This Doctor of Nursing Practice (DNP) project aims to address these barriers …

Discharge Preparedness Assessment Using The Path-S Tool With Stroke Patient Caregivers, Sue B. Pugh

Group: Samford University Moffett & Sanders School of Nursing

Background of Project:

• Stroke is the leading cause of disability in the United States.
• Caregivers are a vital component to successful discharge.
• Inpatient rehabilitation facilities (IRF) are designed to prepare individuals and their caregivers for the transition to home.
• IRF’s measure their success using post discharge surveys.
• The IRF involved in this project measured discharge preparedness against a benchmark score.
• A low score of 3.03/5.0 with a benchmark of 3.4/5.0 resulted in the creation of a key performance initiative regarding discharge preparedness. 

The purpose of this project is to utilize an evidence-based tool in the assessment of stroke caregiver preparedness …

Mindfulness-Based Interventions: Improving Quality Of Care In Breast Cancer, Deborah Schindele

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Breast cancer is the second leading cause of death in women and leads to decreased quality of life owing to increased anxiety, depression, fatigue, stress, and a lack of social support. The American Society for Integrative Oncology ranks mindfulness-based interventions (MBI) as the most highly recommended integrative interventions known to decrease anxiety, depression, and fatigue, and improve the quality of life of breast cancer patients. However, they were not regularly used or recommended by support group facilitators of the project. A quality improvement project was implemented with the five support group facilitators to address this deficit. The purpose was to …

Impact Of An Education Intervention Provided To Staff Regarding Depression In The Lgbtq+ Patient Population, John D. Plasch

DNP and Student Works

This Doctor of Nursing Practice (DNP) quality improvement project addressed gaps in depression recognition among LGBTQ+ patients by implementing a targeted educational intervention for healthcare staff in a primary care clinic serving a large LGBTQ+ population. LGBTQ+ individuals experience disproportionately high rates of depression, yet missed screening opportunities and limited provider knowledge contributed to underdiagnosis at the project site. Guided by Kurt Lewin's Change Theory and the Plan‑Do‑Study‑Act (PDSA) model, the project used a quasi‑experimental pre‑/post‑design to evaluate changes in staff knowledge and self‑efficacy using the Learning Self‑Efficacy Scale (L‑SES). The training improved staff awareness of LGBTQ+-specific depression risk factors, …

Effects Of Nurse-Led Standardized Kangaroo Mother Care (Kmc) Protocol On Nicu Length Of Stay, Physiological Stability, And Bonding: Evidence-Based Recommendation For Translation Into Practice, Madison Capul, Maria Bejarano, Tionette Kirk-Banks, Kelly Mcmillin, Onyinyechukwu Ubaezuonu, Amabelle Simsuangco, Charity Msamalia Chimwala-Selico

General Submissions: Clinical Settings Materials

Background: Preterm and low birth weight infants in the neonatal intensive care unit (NICU) are at high risk for physiological instability, prolonged hospitalization, impaired bonding and breastfeeding, and increased mortality, with costs reaching up to $233,000 per stay (Broughton et al., 2022). The Kangaroo Mother Care (KMC) protocol improves thermoregulation, stability, bonding, breastfeeding, and survival; however, its implementation remains inconsistent due to the lack of standardized nurse-led protocols.

Purpose: The purpose of this study was to evaluate whether implementation of a standardized nurse-led Kangaroo Mother Care protocol, compared to current inconsistent practice, would improve NICU length of stay, physiological stability, …

The Impact Of Patient Education On Medication Adherence In Hypertensive Patients, Alexis Rodriguez

DNP and Student Works

Hypertension is a major cause of cardiovascular morbidity as well as mortality, and nonadherence to medications has consistently posed significant challenges to the effective management of blood pressure and poses avoidable risks. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether a structured medication adherence education session could enhance adherence in adult hypertension patients in a primary care clinic. As per the Health Belief Model and Johns Hopkins Nursing Evidence-Based Practice framework, a quantitative descriptive pre-test/post-test was employed. The baseline adherence was assessed by using the Morisky Medication Adherence Scale (MMAS-8), and then a 15-minute …

The Impact Of Nurse-Led Universal Depression And Suicide Risk Screening On Adolescent Mental Health Outcomes In Pediatric Primary Care, Malu-Kanoa Hewitt, Briana Morris, Dolly Ukpong, Lula Teklehaimanot, Preet Kamal Singh, Latasha Scott, Charity Msamalia Chimwala-Selico

General Submissions: Clinical Settings Materials

Background: Adolescent depression and suicide are critical public health concerns in the United States. Approximately 20% of youth aged 12–17 experience a major depressive episode annually, yet fewer than half receive treatment (NIMH, 2023). Suicide is a leading cause of death among adolescents and young adults (CDC, 2023). The U.S. Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents aged 12–18 when adequate systems are in place for diagnosis, treatment, and follow-up, but concludes that evidence is insufficient to recommend routine suicide risk screening in children and adolescents (USPSTF, 2022).

Purpose: This literature review evaluates …

Immersive Vr/Ar-Based Learning In Prelicensure Nursing Education: Effects On Cognitive Engagement And Learning Outcomes, Ashton Wilson, Didier Ushijima, Treasure Ngere, Rose Ogunade, Natalia Koretsky, Charity Msamalia Chimwala-Selico

General Submissions: Academic Settings and Education-based Materials

Background: Traditional nursing education may limit active learning, clinical judgment development, and cognitive engagement among prelicensure nursing students. Evidence supporting measurable outcomes in traditional clinical education is limited (Leighton et al., 2021). Emerging technologies, including virtual reality (VR), augmented reality (AR), and artificial intelligence (AI)-enhanced learning, offer alternative approaches.

Purpose: This evidence-based practice review evaluates the effect of immersive VR/AR-based learning with adaptive or automated feedback on cognitive engagement and learning outcomes in prelicensure nursing students compared with traditional instructor and self-directed study.

Methods: A literature review was conducted using databases including PubMed, CINAHL, MEDLINE, PsycINFO, and ERIC. Studies included …

Combined Ema Tools To Assess Stress And Glycemia In Young Adults With Type 1 Diabetes, Jorden G. Rieke

Sigma Foundation for Nursing Research Grant Reports

This study aims to provide preliminary evidence of the feasibility and acceptability of using combined ecological momentary assessment (EMA) tools to assess psychological stress and glycemia in young adults with T1D.

Stress First Aid: A Foundation For Creating Healthy Work Environments, Richard J. Westphal

Creating Healthy Work Environments (CHWE)

Burnout is not the failure of an individual to cope; it is the expected response to working in unbalanced systems where demands exceed resources.¹ Traditional self-care resilience strategies that include a range of mindfulness and physiological are important individual skills but are not sufficient to address the intensity and duration of occupational stress in health care.² Health workers (HCW) face chronic exposure to fatigue, trauma, loss, and moral distress. These four sources of stress injury can have an independent or cumulative effect that negatively impact patient quality and safety, individual team members well-being, team cohesion, and organizational trust. …

Halo: Interprofessional Wellness Program To Promote Healthy Work Environments, Cecilia Vargas, Paul E. Spector, Lakeshia Cousin

Creating Healthy Work Environments (CHWE)

Purpose: The Healthy Actions for Lifelong Outcomes (HALO) program is an interprofessional wellness initiative at a large academic medical center aimed at improving employee health and fostering a culture of wellness. HALO integrates preventive exams, biometric screening, motivational interviewing (MI), and MI-based coaching to support sustainable health behaviors. This evidence-based practice (EBP) project evaluated biometric and wellness outcomes from HALO’s second cohort over 18 months. The program is grounded in MI’s four processes engaging, focusing, evoking, and planning and aligns with the American Association of Critical-Care Nurses (AACN) Healthy Work Environment Standards.

Background: Unhealthy work environments contribute to burnout, turnover, …

Empowering Novice Nurses Through Teamstepps: Cultivating A Culture Of Safety And Communication, Daphne Thomas, Marie M. Prothero, Kambrie Rankin, Amber Lawrence

Creating Healthy Work Environments (CHWE)

Novice nurses are particularly vulnerable to medical errors, often hesitant to speak up for fear of appearing incompetent. Additionally, many healthcare professionals lack the communication skills necessary for promoting patient safety. To address this, the Agency for Healthcare Research and Quality (AHRQ) and The Joint Commission advocate for standardized communication tools such as TeamSTEPPS—an evidence-based framework designed to enhance team structure, leadership, situation monitoring, mutual support, and communication.

Recognizing the importance of these competencies, nurse educators in a College of Nursing integrated TeamSTEPPS across their undergraduate curriculum's didactic, clinical, and simulation settings. This initiative aligns with the American Association of …

Advocating For Healthy Work Environments: Addressing Workplace Violence Against Nurses With Research, Kendrea Lea Todt, Kathleen Kinser, Hannah Grace Shipp, Florence Weierbach, Kimberly Ferguson, Teresa Carnevale

Creating Healthy Work Environments (CHWE)

Introduction: Nurses globally experience workplace violence (WPV) daily (Kafle, 2022), significantly increasing since the COVID-19 pandemic (National Nurses United, 2024). Nursing is the most trusted profession in the United States of America (USA) (American Nurses Association, 2025) and yet nurses are five times more likely to be assaulted at work than other occupations (Occupational Safety Health Administration, n.d.). WPV creates an unpleasant environment that negatively impacts nurses’ well-being (Kolutek et al., 2024) and perceptions of patient care quality (Shafan Tivka et al., 2024). This highlights the importance of addressing WPV as a workforce and patient care issue.

Background: In Tennessee, …

The Healing Huddle: Preventing Nurse Second Victimization Through Post-Event Debriefing, Sidia Scott

Creating Healthy Work Environments (CHWE)

Background: Nurses regularly encounter traumatic situations that can leave enduring scars, and without a formalized opportunity to reflect on these experiences, the repercussions can be severe, affecting personal health, team unity, and the standard of patient care. Healthcare workers who suffer from traumatic events are dubbed “second victims”. The patients and their families are the first casualties. Nurse leaders may lack insight into how debriefing impacts their teams’ quality of life at work and would benefit from additional clarity of how to incorporate consistent debriefing into their culture and workflows.

Purpose: This integrative review aims to explore the evidence regarding …

Interventions Targeting Nurse Burnout: A Review Of Current Strategies With Future Recommendations, Hannah Grace Shipp, Katherine Christine Hall

Creating Healthy Work Environments (CHWE)

Intro: Patient care delivery is at risk when nurses experience unmanaged burnout (World Health Organization, 2019). Burnout affects approximately 30% of nurses worldwide (Ge et al., 2023) and 65% in the United States (Cross Country Healthcare, 2025). Researchers posit that burnout is primarily driven by systemic issues rather than individual deficiencies (Cao et al., 2025; O’Hara et al., 2024). Research on interventions to treat nurse burnout is abundant yet there is a gap regarding the translation of current evidence to practical recommendations.

Purpose: To (1) summarize existing systematic reviews on interventions addressing nurse burnout, and (2) translate this evidence into …

Boosting Nursing Engagement At An Fqhc Through Extended Onboarding And Standardized Preceptorship, Vivian Thuy Vi Min Nguyen, David Tilford, Laura Shouse, Harold Giron, Marvin Alexis Ayala, Olive Mae Zacarias, Lorraine Flores

Creating Healthy Work Environments (CHWE)

AltaMed is one of the largest Federally Qualified Health Centers (FQHC) serving Los Angeles and Orange County areas with over half a million patients primarily from underserved and minoritized communities. AltaMed's mission is to eliminate disparities in health care access by providing quality health and human services through an integrated delivery system for communities in Southern California. The organization has identified concerns related to readiness, confidence, and retention among newly hired nursing staff.

New hires reported that the onboarding process did not adequately prepare them for clinical practice, resulting in low confidence and increased turnover. Many shared that they needed …

Self-Guided Stress Reduction Program Among New Graduate Nurse Residents, Allison A. Norful, Yilei Yang, Simon Paul P. Navarro, Marin Skariah

Creating Healthy Work Environments (CHWE)

Background: Evidence suggests that younger, less experienced nurses have higher burnout risk, thus yielding higher turnover rates, poorer psychological health, and decreased resilience or job satisfaction. To address this, it is critical to support new nurses by providing training aimed at building resilience and stress management. However, formal curricula designed to help nurses adapt to high-stress environments and unexpected changes are limited. Thus, the purpose of this study was to assess the acceptability, feasibility, and preliminary efficacy of an online self-guided resiliency training curriculum.

Methods: Using a pragmatic trial design, we recruited a pilot sample of 26 nurse residents (with …

Burnout & Moral Injury Metrics Inform Evidence-Based Nursing Workplace Solutions, Sarrah Spohnholtz, Brian Douthit, Carolyn Audit

Creating Healthy Work Environments (CHWE)

Purpose: To implement real time burnout data that enables nurse leaders to identify and respond based on environmental risk factors.

Background: Burnout and moral injury among nurses are driven by increased demands and emotional toll of care delivery. These conditions compromise nurse well-being and affect patient outcomes and safety.⁴ Many contributing factors stem from under-resourced environments where nurses cannot provide the care they believe patients need. Resilience training can help mitigate stress, but systemic reform is needed to prevent burnout and moral injury before they occur.²

Methods: In September 2025, the WellNurse Program implemented environmental risk metrics into …

From Achievement To Adaptation: Women’S Career Narratives Across The Midlife Transition, Michelle M. Ness

Creating Healthy Work Environments (CHWE)

Midlife represents a significant transition for women characterized by the onset of menopause, shifting family dynamics, and evolving professional roles that affect physical and emotional well-being, relationships, and overall quality of life (QoL). This study examines how women in midlife navigate career considerations and future aspirations, emphasizing the interplay of achievement, transition, and reorientation. Drawing on qualitative interviews with cisgender women aged 39–57, the analysis identified four central themes: (1) established success and aspirations for growth, (2) redirection and pursuit of new opportunities, (3) reevaluation of work and identity, and (4) future planning and sustainability. For some, midlife represented the …

A New Day: How The 2026 Joint Commission Performance Indicators Elevate Hospital Staffing Systems, Brittany Nettles, Julie Baker-Townsend, Amy Howell

Creating Healthy Work Environments (CHWE)

As nurses face mounting pressures in clinical environments, challenges such as insufficient staffing ratios, excessive workloads, and limited organizational support contribute to declining employee well-being, increased stress levels, and burnout. These factors not only impact the mental health of nursing professionals but also have significant implications for patient safety, care delivery, and staff retention (Aiken, 2025). Internationally, the burden of excessive workloads negatively impacts patient safety, as each patient added to a nurse's assignment is associated with a 7% increased risk of hospital mortality (Aiken, 2014). A survey conducted by the American Nurses Foundation (2022) found that nine out of …