Digital Commons Network^™

Reducing Missed Appointments In An Ambulatory Infusion Center, Jacqueline G. Jones

Doctor of Nursing Practice Projects

Background: Missed appointments at ambulatory infusion centers (AIC) continue to be a problem, even with improved scheduling systems and care coordination efforts. Nationally, missed appointment rates average 10%–12%, and in Central Alabama, the rate is 11.7%. However, one local AIC has a much higher missed-appointment rate of 17.8%. Missed appointments lead to wasted facility resources, increased healthcare costs, and interruptions in infusion therapies.

Purpose: This Doctor of Nursing Practice project used live reminder calls to help lower missed appointments in an AIC. The goal was to improve attendance, reduce missed appointments, and maintain consistent care.

Project Design: Over ten weeks, …

Implementation Of A Nurse-Led Discharge Protocol To Impact Nurse Confidence And Optimize Transitional Care Management, Jessi-Ann Elrod

Doctor of Nursing Practice Projects

Heart failure (HF) remains a leading cause of hospitalization and readmission, with the transition from hospital to home representing a vulnerable period for patients. Variability in discharge education and follow-up scheduling contributes to poor self-management and adverse outcomes. This quality improvement (QI) project evaluated whether implementing a standardized nurse-led HF discharge protocol impacted nurses' confidence and the rate of 7–14-day transitional care management (TCM) follow-up appointments. Guided by Meleis’ Transitions Theory and Lewin’s Change Theory, a one–group pretest–posttest QI design was implemented on a cardiac step-down unit. Twelve discharge nurses participated. The intervention included a structured education session and the …

Educational Interventions To Improve Interpersonal Communication With Icu Family Members, Adriana Szaboova

Doctor of Nursing Practice Projects

Background: Family members of critically ill patients frequently experience significant psychological distress, often compounded by unclear communication and limited understanding of complex care processes in the intensive care unit (ICU). In the cardiovascular intensive care unit (CVICU), staff identified a gap in structured, procedure-specific education for families during the admission process following cardiac surgery.

Aims/Objectives: This quality improvement project aimed to develop and implement a one-page, procedure-specific family education tool for CVICU admissions. The goals were to integrate the materials into the admission workflow with staff education and to enhance HCAHPS communication scores during implementation.

Methods: This quality improvement project …

Improving Pain Assessments In The Medical Icu, Tyler J. Wiorek

Doctor of Nursing Practice Projects

Background 

Approximately half of intensive care unit (ICU) patients experience moderate-to-severe pain during admission, yet pain assessment in non-communicative patients remains inconsistent. Evidence-based behavioral tools such as the Critical Care Pain Observation Tool (CPOT) have been recommended to improve detection and management of pain in this population.

Aims/Objectives 

This quality improvement (QI) project aimed to implement the Critical Care Pain Observation Tool (CPOT) among registered nurses in a 29-bed medical ICU and evaluate its impact on nurse knowledge, acceptability, and documentation of pain assessments.

Methods 

A pre–post quality improvement design was used. A convenience sample of registered nurses in a …

Beat By Beat: Empowering Communities With Lifesaving Cpr Skills, Allyssa Mb Hutchins

Doctor of Nursing Practice Projects

Introduction: This doctoral project was created to increase bystanders' willingness and ability to perform CPR by building their confidence in performing it effectively. A total of 13 participants participated in this project to increase knowledge and confidence in CPR interventions.

Background: Cardiac arrests remain a leading cause of death, yet research indicates that rural communities have lower rates of bystanders trained and willing to assist. Increasing CPR awareness and eliminating barriers to care for classes can improve CPR confidence and have a positive community impact.

Methods: Three 4-hour CPR classes were held in Zirconia, NC, at no …

Quality Improvement Project: Reducing Hospitalizations In The Long-Term Care Setting, Nenna Nzeocha

Doctor of Nursing Practice Projects

Hospitalizations in the long-term care setting can lead to higher costs incurred by skilled nursing home residents and a poorer quality of life. This quality improvement (QI) project evaluated whether an educational intervention on the Reducing Avoidable Facility Transfers (RAFT) model impacted hospitalization rates in the skilled nursing facility (SNF), while also assessing the confidence level of facility staff on the intervention. The project utilized Lewin’s change theory and the Donabedian model framework and was aimed at developing interventions that impact hospitalizations in the SNF using the RAFT model. A quasi-experimental design was used and consisted of a pre-and-post implementation …

Assessing And Improving Provider Knowledge And Comfort With Palliative Care Consultations: A Quality Improvement Project, Summer R. Hess

Doctor of Nursing Practice Projects

Palliative care remains significantly underutilized in the management of heart failure, despite national guidelines supporting its early integration. This underuse limits opportunities for person-centered care in cardiology settings. The purpose of this quality improvement project was to improve provider knowledge and comfort in implementing palliative care consultations. The problem addressed was the low consultation rates for advanced heart failure patients, largely driven by provider misconceptions and a lack of formal training. A quasi-experimental design was initiated by using a brief, evidence-based educational article. Sixteen advanced practice providers at a high-volume cardiology clinic completed pre- and post-intervention surveys using the End-of-Life …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Implementing A Screening Tool To Increase Palliative Care Referrals For Patients With Metastatic Cancer, Rebecca N. Hegwood

Doctor of Nursing Practice Projects

Background: Palliative care (PC), when prescribed early for patients with metastatic cancer, has proven beneficial to the oncology patient and family by improving quality of life, decreasing stressors, and preventing premature discontinuation of therapy.

Purpose: This Doctor of Nursing quality improvement project aimed to determine if implementing a screening tool for patients newly diagnosed with metastatic cancer would increase PC referrals.

Project Design: The Five Item Palliative Care Screening Tool evaluated patients with a new metastatic cancer diagnosis. Secondary data was used to initiate a PC referral if the patient scored a five or greater on the screening tool. Project …

Decreasing Burdensome Transitions In Hospice Care By Increasing Nursing Visits, Kristin S. Rivers

Doctor of Nursing Practice Projects

Background: Burdensome transitions occur when hospice patients discontinue hospice services to seek hospital treatment, often disrupting end-of-life goals and creating distress for patients and caregivers. These transitions continue to rise throughout the country, highlighting the need for strategies to support patients in remaining at home throughout the dying process.

Purpose: This quality improvement project aimed to decrease hospital transitions by increasing nursing visits for hospice patients at high-risk for burdensome transitions.

Project Design: This quality improvement project used a Plan-Do-Study-Act methodology to form and implement an intervention to reduce burdensome transitions. Patients were already identified as low or high-risk …

Quality Improvement Project Improving Employee Satisfaction And Retention Through A Structured Training Process, Dawn Lundgren

Doctor of Nursing Practice Projects

The DNP project aimed to evaluate the impact of a structured new-hire training program on employee retention and job satisfaction within a hospice organization. Insufficient training for new employees can lead to a high staff turnover rate, stress, decreased job satisfaction, and poor quality of care. The quality improvement project utilized a pre-post intervention design over an eight-week period, comparing retention rates and job satisfaction scores before and after project implementation. Employee retention was measured as a binary outcome (retained or left), and job satisfaction was assessed through a seven-item survey rated on a five-point Likert scale. A total of …

Quality Improvement Project Impact Of Multidisciplinary Patient Education On Heart Failure 30-Day Readmission Rate, Jeanne P. Williams

Doctor of Nursing Practice Projects

Patients diagnosed with heart failure are at an increased risk for readmission to the hospital within 30 days of discharge, and their care costs are projected to continue to increase. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to implement an evidence-based initiative to mitigate the increased heart failure 30-day readmission rate on a 30-bed medical-surgical telemetry unit in an acute care facility. Using the teach-back communication method, multidisciplinary patient education was implemented to prepare patients diagnosed with heart failure to manage their condition once discharged home. The theoretical and implementation frameworks used were Lewin’s Change Model, …

Policy Project Optimizing Post-Discharge Process: Creating A Policy For Improved Efficiency, Deniece S. Parkinson

Doctor of Nursing Practice Projects

The immediate period following hospital discharge is critical for ensuring continuity of care and reducing adverse outcomes. However, the current post-discharge processes utilized in community care could be more effective. The fragmented approach involves multiple individuals, often leading to patient confusion, missed visits, and inefficient communication. These issues contribute to high rehospitalization rates, frequent emergency room visits, and increased healthcare costs. This project proposes a streamlined post-discharge policy managed by a centralized team of one provider and a Nurse Care Manager. The policy aims to refine the processes currently used in each market into a consolidated, well-defined care model to …

Bridging The Gap: Enhancing Palliative Care Knowledge And Self-Efficacy Among Acute Care Nurses: A Dnp Project, Amira Dewitt

Doctor of Nursing Practice Projects

Background: Acute care nurses face complex end-of-life situations but are not adequately prepared with comprehensive palliative care training after undergraduate coursework. This knowledge gap affects nurses' ability to manage patients holistically and effectively, undermining their knowledge level and self-efficacy.

Aims: This project aimed to evaluate the effectiveness of a structured four-week educational intervention delivered in a hybrid format using artificial intelligence (AI) software and evaluated post-training changes and participant satisfaction.

Methods: A pre-post study design was used, involving nurses recruited from acute care units in a community-based hospital. Prior to the intervention, the nurses completed three validated assessment tools: the …

Bridging The Gap: Enhancing Primary Palliative Care Knowledge And Self-Efficacy Among Home Health Interprofessional Staff: A Doctor Of Nursing Practice Quality Improvement Project, Morgan L. Ryan Msn, Chpn, Agpcnp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care is vital for improving the quality of life for individuals with serious illnesses, yet many interprofessional home health providers lack adequate training. Addressing this educational gap is essential for delivering comprehensive, compassionate care to patients with chronic and life-limiting conditions.

Objectives: This Doctor of Nursing Practice (DNP) project aimed to develop, implement, and evaluate a structured primary palliative care training tailored to the needs of interprofessional home health providers. The objectives were to: (1) enhance knowledge of palliative care principles, (2) reinforce each team member’s role in primary palliative care delivery, (3) improve self-efficacy and perceived competence, …

The Implementation Of The Edmonton Symptom Assessment System To Standardize Symptom Assessment, Rachel C. Mea Msn, Rn, Ocn

Doctor of Nursing Practice Projects

Background

Evaluating symptoms in patients with advanced cancer is critical to mitigating symptom burden and improving quality of life. Cancer patients experience an array of physical, emotional, and psychological symptoms, which can significantly impact compliance with treatment, daily functioning, and well-being. Early and thorough assessment enables healthcare providers to identify and address these issues, ensuring symptom management strategies are tailored to the patient's needs.

Objective

This project aimed to implement the Edmonton System Assessment System (ESAS) in an inpatient oncology service and evaluate the acceptability (AIM), appropriateness (IAM), and feasibility (FIM) of the assessment by nurses and palliative care providers. …

Address The Gap In Nursing Knowledge Regarding Patients At End Of Life In An Inpatient Oncology Setting, Sala Oh, Tracey Trinh

Doctor of Nursing Practice Projects

Background: Nurses often lack the knowledge of providing end of life (EOL) care and do not feel adequately prepared to confidently provide care. Identifying barriers to providing quality care could demonstrate improved symptom management for EOL patients and nursing confidence.

Aims: To identify knowledge gaps for oncology nurses working with EOL patients, develop nursing education, and ultimately improve patients’ symptom management.

Methods: This was a needs assessment of nurses (n=79) working in an inpatient oncology unit. A survey was distributed to obtain barriers in nursing knowledge and an educational module was created. A quality improvement study was then performed to …

Patient Autonomy And Treatment Adherence In Esrd:A Study Of Provider & Nurse Perspectives On Barriers And Choices, Christina A. Larkin

Doctor of Nursing Practice Projects

Missed dialysis treatments are commonly attributed to barriers such as transportation, mental health challenges, and limited health literacy. However, emerging evidence highlights the complexity of adherence behaviors, including psychological, relational, and ethical dimensions that remain underexplored—particularly from the perspective of dialysis providers and nurses. This qualitative descriptive study examined how nephrology providers and dialysis nurses perceive barriers to adherence, with a focus on patient autonomy, motivation, and decisionmaking.

Using Self-Determination Theory (SDT) as a guiding framework, an anonymous, open- ended survey was distributed to 17 clinicians via the Qualtrics platform. Responses were analyzed using deductive content analysis, categorizing findings into …

End-Of-Life Care Educational Program For Neuro Nurses, Shiyue (Sophie) Wang, Thu Le

Doctor of Nursing Practice Projects

Introduction: High-quality end-of-life (EOL) care necessitates both effective symptom management and therapeutic communication with patients and families. Nurses often report knowledge gaps in symptom management and discomfort when engaging in sensitive conversations during EOL care.

Methods: Neuro-nurses at a tertiary care hospital were invited to participate in an educational intervention focused on EOL symptom management and communication. The training occurred during both day and night clinical shifts. Effectiveness was measured using pre- and postintervention assessments adapted from validated questionnaires. All responses collected anonymously via REDCap.

Results: Post-intervention, 83% of participants showed improved scores in the knowledge assessment, with an average …

Impact Of Educational Sessions On Compassion Fatigue Among Home Healthcare Nurses: An Evidence-Based Practice Project, Adebimpe Blessing Ogunsefunmi

Doctor of Nursing Practice Projects

Background: Nurses are compassionate professionals who provide critical care, often at the expense of their own well-being. As the healthcare system faces rapid changes due to an aging population, nursing shortages, and the impact of COVID-19, compassion fatigue has become increasingly common. Despite its prevalence, few healthcare institutions address this issue. Objective: The objective of this DNP project was to evaluate whether weekly educational sessions enhanced perceptions of a positive quality of life, which typically declines with increased compassion fatigue, as measured by the Professional Quality of Life (ProQOL) scale. PICOT Question: Do weekly educational sessions on compassion fatigue …

Enhancing Family Nurse Practitioner Education Through End-Of-Life Simulation: A Quality Improvement Project, Deborah Jamison

Doctor of Nursing Practice Projects

Providing compassionate and effective end-of-life care is a crucial skill for Family Nurse Practitioners (FNP) students (Collins & Small, 2019). However, many students experience significant anxiety and lack confidence in such challenging situations. The problem identified for the Doctor of Nursing Practice (DNP) Quality Improvement (QI) project is the lack of training focused on end-of-life care in the FNP program at a College of Nursing (CON) within an academic clinical center. The project’s purpose was to improve confidence and anxiety levels among FNP students in providing end-of-life care. The project aimed to create an inventive and immersive end-of-life simulation with …

The Implementation Of Comfort Medication Kits In Hospice Patients’ Homes To Reduce Hospice Revocations, Brandi J. Parker

Doctor of Nursing Practice Projects

Background: When hospice patients experience a symptomatic crisis at the end of life, unmanaged symptoms can lead to unwanted hospitalizations and the revocation of their hospice benefits. Strategies to reduce the incidents of hospice revocation are needed to improve patient care and quality of life.

Purpose: The quality improvement project aimed to reduce hospice revocation rates by implementing comfort medication kits in eligible hospice patients’ homes.

Methods: The project’s intervention included identifying patients at high risk for revocation, patients with a cancer diagnosis, and patients with a prognosis of two weeks or less. Comfort medication kits were placed in the …

Reducing No-Show Rates In An Outpatient Gi Endoscopy Lab, Mwaba Chisela

Doctor of Nursing Practice Projects

Background: Patients who do not attend their scheduled appointments cost the healthcare industry approximately $150 billion annually. They are at higher risk of missed diagnoses, delay in care, and increased morbidity and mortality.

Purpose: This quality improvement project aimed to determine the effectiveness of serial reminders using phone calls and electronic messaging to reduce no-shows for patients scheduled for gastrointestinal (GI) endoscopy.

Methods: No-show data was retroactively analyzed from June 2023 to December 2023 and compared to post-implementation data from February 2024 to March 2024. For eight weeks, a trained staff team called patients scheduled for endoscopic procedures seven days …

A Behavioral Intervention Checklist To Reduce Re-Hospitalizations In Residents With Mental Illness, Jeffery Davis

Doctor of Nursing Practice Projects

Skilled nursing facilities are an essential component of the continuum of care and, with the rapidly aging population, represent an increasing cost to the healthcare system. The policies beginning in the 1960s promoting the deinstitutionalization of mental health institutions have resulted in increasing numbers of individuals with serious mental illnesses now residing in skilled nursing facilities. The complex needs of individuals with mental illness have been associated with an even greater cost of care, deficient quality, and safety concerns. This quality improvement project analyzed the impact of an evidenced-based, structured behavioral intervention checklist on rehospitalization rates in individuals with mental …

Implementing Distress Screening And Hospital Management Of Oncology Patients With Distress, Rhezarie Mae Agtarap

Doctor of Nursing Practice Projects

Of the nearly 2 million new cancer cases projected to occur in the United States in 2022, up to 65% of patients may be hospitalized in the first year of their diagnosis. Hospitalized oncology patients have been documented to experience psychological distress during their hospitalization related to physical and emotional challenges related to their disease. In ***, a tertiary hospital located in ***, Oregon, hospitalized cancer patients with hematologic malignancies and aggressive or advanced solid cancers have verbalized distress, including depression, anxiety, feelings of isolation, and fatigue during prolonged hospital stays. According to the National Comprehensive Cancer Network (NCCN), distress …

Increasing Early Patient-Centered Advance Care Planning In An Outpatient Oncology Clinic Through A Nurse-Driven Workflow: A Quality Improvement Project, Ellen Legrand Dnp, Rn, Ocn

Doctor of Nursing Practice Projects

Background: Current practice for advance care planning (ACP) in oncology patients does not align with best practice, which is early, repeated, and interdisciplinary.

Objective: The purpose of this quality improvement project was to evaluate the process, feasibility, acceptability, and appropriateness of a nurse-driven ACP workflow in an outpatient breast cancer clinic. The project team further sought to evaluate the impact of the workflow on advance directives and ACP notes.

Methodology: This project followed the Plan-Do-Study-Act quality improvement framework. Breast cancer patients seen by two outpatient physicians received an email to assess interest in completing the Our Care …

A Wellness Initiative: Mindfulness Training For Unlicensed Assistive Personnel To Promote Self-Care And Enhanced Well-Being, Julia Aurora Clarke Msn, Rn, Cns

Doctor of Nursing Practice Projects

Background: Burnout leads to decreased staff engagement, productivity, and high attrition rates. The nursing staff most impacted are Unlicensed Assistive Personnel (UAP); therefore, to combat burnout, resilience is to be cultivated. Resilience begins with self-care, which is nurturing the self: mind, body, and soul to safeguard well-being.

Objectives: This project provided mindfulness training as a wellness initiative to promote self-care skills and enhance well-being among the UAP within a healthcare facility.

Methods: This project followed an evidenced-based quality improvement practice framework ( Mindful Self-Care Scale-Brief and IHI- Well-Being Assessment Survey) and used a pre-post-test design to compare …

The Implementation Of The Ahrq Teach-Back Tool Kit On A Same Day Surgery Unit, Hanh Tran

Doctor of Nursing Practice Projects

Background: Patient education is an essential part of caring for patients. Failure to properly educate our patients can result in negative outcomes. To confirm patients have understood their treatment plan healthcare providers use the Teach-Back Method (TBM) to have patients state back in their own words what they need to know or do to take care of themselves.

Aims/Objectives: The purpose of this quality improvement (QI) project is to provide education for the Same Day Surgery nurses on the TBM to increase confidence and conviction when using the TBM to improve patients’ understanding of discharge instructions. Outcomes for …

Improving End-Of-Life Patient Care Through The Implementation Of A Standardized Assessment Tool And Bedside Nurse Education, Kaitlynn Foltz

Doctor of Nursing Practice Projects

Problem: Lack of a standardized assessment tool (SAT) in the acute care setting that correlates pharmacological interventions with assessment findings negatively impact patients who have transitioned to “End-of-life” (EOL) level of care. Bedside nurses are left to interpret their own subjective assessment findings and implement interventions they feel appropriate, leading to a variance in the treatment provided to patients. It has been identified there is an issue in the current practice at one acute care organization in which medication indications are not specific as to which type and dosage of medication to administer to the EOL patient. EOL patient …

Mindfulness-Based Intervention To Improve Caregiver Well-Being, Mary Tanner

Doctor of Nursing Practice Projects

Background: Burnout among healthcare workers is one of the most complex and costly challenges in healthcare and has adverse effects on individuals’ well-being. Mindfulness-Based Interventions (MBI) are one evidence-based method organizations have used to promote self- care and improve well-being.

Objectives: The purpose of this project was to develop, implement, and evaluate the effectiveness of a four-week MBI at a senior care organization to improve caregiver well-being and mindful self-care.

Methods: A pretest and posttest design was utilized for data collection and analysis. All current employees were recruited to complete the Well-Being Index (WBI) and Mindful Self-Care …