Digital Commons Network^™

Facilitating Timely Hospice Referrals Using A Screening Toolkit In A Rural Hospital: A Quality Improvement Initiative, Jessica Muse

Doctoral Projects

End of life care is often a difficult time for patients, families, and caregivers. Hospice is a valuable resource for individuals who are considered terminally ill and have a life expectancy of six months or less. Many patients who are near the end present to acute care settings for treatment needs. While there are several clinical indicators that may suggest hospice care is the best plan of care for a patient, identifying hospice appropriate patients can be difficult in an acute care setting and there are currently no numerical assessment tools available in the literature that provides a quick reference …

Staff Education To Improve Confidence Of Triage Decision-Making In Hospice After-Hours Care, Kelly Hurst

Walden Dissertations and Doctoral Studies

A quality improvement project addressed variability in after-hours hospice telephone triage through implementation of structured communication and symptom-based decision-support tools. The practice-focused question examined hospice triage nurses’ perceived confidence following implementation of these tools. A descriptive quality improvement design was used. Five hospice triage nurses received education on the CALMER communication technique and symptom-specific decision-support guides for anxiety and dyspnea. Outcomes were evaluated through a postimplementation survey assessing confidence, tool utilization, intervention perceptions, and practice recommendations. Quantitative responses were summarized using descriptive statistics, and qualitative responses were reviewed for themes. All participants reported high baseline confidence in hospice telephone triage. …

Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Strategies For Managing Change In Home Health Care Businesses, Halbert Brown

Walden Dissertations and Doctoral Studies

Home health care agencies may experience financial hardship when regulatory inspections result in deficiencies and administrative penalties. Home health company (HHC) leaders are concerned because ineffective change management strategies may contribute to ongoing regulatory deficiencies, penalties, and reduced business performance. Grounded in Lewin’s change management theory, the purpose of this qualitative pragmatic inquiry project was to explore change management strategies some HHC owners successfully implemented to reduce administrative deficiencies and penalties to augment business performance and profitability. The participants were six leaders from HHC firms in the southwestern region of the United States who had developed effective strategies to improve …

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

The Parkinson's Pathway: Enhancing Knowledge And Care Management In Skilled Nursing, Kaitlyn Chau

Master's Projects and Capstones

Parkinson’s disease (PD) is commonly diagnosed among the older population, contributing to high utilization of skilled nursing facility (SNF) services. Objective: SNF A’s current onboarding and training program for staff discussed general geriatric topics but failed to include structured PD-specific education. This may lead to gaps in competence, confidence, and workflow related to PD care and management, resulting in low quality of patient care, poor health outcomes, and decreased safety and satisfaction. Aim: The project aimed to establish and incorporate a structured PD-specialized education program within a SNF located in Northern California, to increase employees’ self-reported confidence, competence, …

Reducing Copd Readmissions Through An Evidenced-Based Clinical Practice Guideline, Courtney Rye

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and hospital readmissions, with rural critical access hospitals (CAHs) facing unique challenges in delivering consistent, evidence-based care. At the pilot CAH medical–surgical unit, local chart review and practice observation revealed an approximately 18% 30-day COPD readmission rate and significant variation in discharge education, written action plans, inhaler technique assessment, and structured post‑discharge follow‑up. The purpose of this Doctor of Nursing Practice project was to develop and appraise an evidence‑based, Appraisal of Guidelines Research and Evaluation II (AGREE II) and Institute of Medicine–compliant COPD clinical practice guideline (CPG) to …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

Facilitating Palliative Care In The Intensive Care Unit, Crystal Sanchez

Master's Projects and Capstones

Abstract

Problem: Critically ill patients in the intensive care unit (ICU) frequently experience unmet palliative care needs due to inconsistent identification processes and delayed goals‑of‑care (GOC) discussions. Prior to this project, palliative care consultation practices were highly variable and lacked standardized criteria, resulting in missed opportunities for early communication and symptom management. This gap underscored the need for a structured, nurse‑driven approach to improve timely palliative care integration.

Context: This quality improvement project was conducted in a 20‑bed adult ICU within a large community‑based hospital system where palliative care integration was inconsistent and not systematically monitored.

Interventions: A nurse‑driven palliative …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

Sense Of Purpose As The Guiding Light In Nursing Practice: A Grounded Theory Study, Kathleen Casler

Theses & Dissertations

Problem: As a prosocial profession, individuals may enter the practice of nursing because of an interest in helping and caring for others. However, over time, nurses may be challenged with experiences of burnout that can impact both their relationship with the profession and patient outcomes.

Background/Significance: A sense of purpose has been associated with positive physical, behavioral, and psychological outcomes. In a professional context, a sense of purpose may provide support for navigating complex work environments. It is currently not known what nurses’ experience of sense of purpose may be in relation to nursing practice and how their sense of …

Optimizing Life Care Planning For Palliative Home Health Care Patients, Lilian Muraya

Master's Projects and Capstones

Problem: In this home health palliative microsystem, many seriously ill patients begin care without timely goals‑of‑care conversations or documented advance directives, leading to fragmented communication and potentially avoidable emergency visits and rehospitalizations.

Context: This quality improvement project took place in a hospital-based home health palliative care program in Northern California, where an interdisciplinary team identified inconsistent Life Care Planning (LCP) practices and variable staff comfort with conducting goals‑of‑care discussions.

Intervention: A structured LCP workflow was developed so that newly admitted palliative home health patients receive a goals‑of‑care discussion and advance directive review within 7 days of start …

A Mixed-Methods Study Of The Lived Experiences Of Patients And Caregivers Receiving Home Health Occupational Therapy Services, Peyton A. Mendias

Student Capstone Papers

Home health occupational therapy (OT) supports individuals’ safety, independence, and participation in their natural environments; however, patients and caregivers may face barriers that affect the implementation of therapy recommendations. This capstone project explored patient and caregiver experiences with home health OT and identified factors influencing implementation of OT recommendations. We used a sequential explanatory mixed-methods design guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model. Eight participants, including three patients and five caregivers, completed an electronic survey, and one caregiver participated in a follow-up semi-structured interview. We analyzed quantitative data using descriptive statistics and qualitative data using reflexive thematic analysis. Findings …

Mission Parkinson Possible: Building Confidence In Parkinson’S Disease Care In Skilled Nursing, Theresa Tran

Master's Projects and Capstones

Objective: Parkinson’s disease (PD) is a progressive neurological disease that requires specialized, interdisciplinary care. Despite this, staff in the skilled nursing setting often receive limited PD-specific education. This contributes to inconsistencies in care, improper medication administration, and reduced confidence in disease management. Aim: This project aimed to improve staff self-reported confidence, competence, and workflow in Parkinson’s disease care and disease management by 15%, from a baseline of 60% to 75%. Methods: The project implemented a PD-specific educational program that consists of an hour-long PowerPoint presentation and distribution of physical brochures to staff, residents, and their families. Pre- and post-surveys were …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Targeted Nursing Bootcamps For Critical Access Hospital Nurses: A Program Evaluation., Nicholas Popp

DNP Projects

Background: Registered Nurses employed in critical access hospital settings are required to care for patients across the lifespan with varying levels of acuity. The registered nurse (RN) must be competent in providing medical, surgical, pediatric, obstetric, and intensive care-level services. However, the additional training they receive to care for their patients may be minimal or nonexistent, leading them to seek employment at other facilities due to safety concerns. Leadership within the organization believed that implementing targeted monthly nursing skills boot camps could increase nurses’ competence, confidence, and retention in critical access hospital settings.

Aims: This program evaluation project aimed to …

Enhancing Nursing Self-Efficacy In Advance Care Planning Conversations Through Role-Play Education: A Quality Improvement Project, Rachel Williams

DNP Projects

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the …

Association Between Opioids And Leukemia/Lymphoma In Adults Living In The United States, Brenda Sue Newberry-Colasanti

Walden Dissertations and Doctoral Studies

Opioid prescribing rates and opioid misuse remain high throughout the United States. Exposure to opioids has been positively associated with various cancers; however, research evaluating associations between opioid exposure and hematologic cancers like leukemia and lymphoma is limited. Using the Socio- Ecological Model as a foundation, this quantitative cross-sectional study aimed to analyze the association between medicinal opioid use, opioid misuse, and leukemia/lymphoma while exploring how selected social determinants of health (SDOH) may modify that relationship. Secondary data were pooled from the 2015–20-year United States National Survey on Drug Use and Health (NSDUH). One thousand three hundred and twenty binary …

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, …

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship In A Long-Term Acute Care Hospital, Lesley Moore

Doctor of Nursing Practice (DNP) Scholarly Project

Problem:

The opioid crisis continues to negatively affect patient safety and healthcare outcomes across the United States. Long-term acute care hospitals (LTACHs) care for medically complex patients who often require prolonged pain management and are at increased risk for opioid-related adverse events. At the project site, a 32-bed LTACH, 72% of reviewed patient charts included an opioid prescription upon admission, exceeding recommended prescribing benchmarks and identifying a gap in opioid stewardship practices. The absence of a standardized opioid stewardship program (OSP) and opioid risk screening process increased the risk of opioid misuse, dependency, and adverse patient outcomes.

Aim of the …

Identifying Palliative Care Needs In The Emergency Department, James Sullivan

Doctor of Nursing Practice (DNP) Scholarly Project

This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met …

A Quality Improvement Approach To Reducing Chronic Obstructive Pulmonary Disease Readmissions, Florwisse Rubio

Doctor of Nursing Practice (DNP) Scholarly Project

Problem:

The problem identified at the project site is that care transitions for patients with COPD lack standardized discharge processes, leading to inconsistent education, limited follow-up, and poor coordination of care.

Aim of the Project:

The primary aim was to improve patient outcomes by reducing the 19.6% 30-day readmissions among older adults diagnosed with COPD at the selected project site by implementing a standardized discharge intervention over 12 weeks, measuring progress, and ensuring appropriate workflow. The initiative of this project sought to foster a sense of proper continuity of care through timely follow-up, interprofessional communication among patients and providers, and …

Improving Timely Hospice Pain Reassessments Through A Quality Improvement Initiative, Brianna Strong-Mosley

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: In a hospice care organization, a practice gap was observed in prompt pain reassessment with an onset or increase of pain, as mandated within a 48-hour timeframe by the Centers for Medicare and Medicaid Services (CMS). Baseline data showed that only 40% of eligible patients with a pain score of ≥ 6 received a documented pain reassessment within 48 hours. Overall patient satisfaction with hospice services was 45%.

Aim of the Project: The quality improvement project aimed to enhance pain management by increasing the percentage of eligible hospice patients with a documented pain score of ≥ 6 from a …

Exploring Primary Care Providers’ Compassionate Care And Their Evidence-Based Practice With Death, Grief, And Loss: Patient Experience And Perspective, Kathryn Krzykala

Dissertations

Research on primary care providers’ (PCPs) education regarding Death, Grief, and Loss (DGL) remains limited. Specifically, data is lacking regarding patients' perceptions and opinions on what they need and expect from their PCPs regarding grief and loss. This exploratory mixed-method study comprised 146 participants who had experienced death and non-death loss. It examined participants' perceptions of 1) PCP compassion, 2) PCP utilization of evidence-based grief and loss practices, 3) their own level of comfort discussing DGL with their PCPs during medical visits, and 4) their personal grief and loss experiences. The findings revealed that PCPs' grief-informed evidence-based treatment, as reflected …

Older Recent Widows’ Physical Activity Before And After Spouses’ Deaths A Qualitative Investigation Of The Impact Of Duration And Intensity Of Care Work And Social Support, Mary Theresa Pagan

Dissertations - ALL

Abstract This study investigates and expands understanding of how care work, widowhood, social support, and physical activity intersect in the lives of older recent widows. The study addresses three primary research questions examining the duration and intensity of care work, pre- and post-death social support, and factors that influenced widows’ physical activity before and after the death of their spouses. Thirty semi-structured, face-to-face interviews conducted with heterosexual widows aged 60 and older residing in Upstate New York who were widowed within 6–24 months prior to interview. Interviews explored care work experiences, social support, widowhood transitions, and both structured and non-structured …

Exploring Grit As A Contributing Factor In Social Work Retention Following Burnout, Denise Rice-Prior

Walden Dissertations and Doctoral Studies

No abstract provided.

Epidemiology And Outcomes Of Geriatric Trauma At Uab, Lindy Reynolds

ETDs from 2020-2029

Adults over the age of 65 are the fastest growing portion of the population and account for a growing percentage of the trauma patient volume at trauma centers around the country. Older adults experience longer length of stays, higher mortality and complication rates than their younger counterparts. As a result, there has recently been an increased focus on models of geriatric trauma care, one of which is the addition of geriatric medicine consults for older trauma patients. The primary objectives of this dissertation were to examine the effect of the consult policy on outcomes using an interrupted time series approach, …

Holding The Dying: Worldview, Community, And The Practice Of End-Of-Life Doula Care, Amy J. Shields

ETDs from 2020-2029

As populations age and chronic illness increasingly characterizes the final stages of life in the United States, end-of-life doulas (EOLDs) have emerged as non-medical practitioners who support dying people and their families through education, companionship, advocacy, and ritualized care. Drawing on a thematic analysis of 18 semi-structured interviews with practicing EOLDs across the United States, this thesis examines how EOLDs conceptualize a “good death,” navigate emotionally intensive work, and sustain themselves in an unregulated and often marginal professional landscape. Situating EOLD practice within anthropological scholarship on death and dying, the study highlights the ways EOLDs challenge dominant biomedical narratives that …

Advance Care Planning In Metastatic Lung Cancer Patients: A Quality Improvement Initiative, Khanh H. Thai

Student Theses

Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.

Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.

Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were …