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Implementation Of A Standardized Protocol To Improve Provider Documentation And Initiation Of Guideline-Concordant Hypertension Follow-Up Within 14 Days In Primary Care, Stella Williams

Doctor of Nursing Practice Projects

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality, yet timely follow-up after elevated blood pressure (BP) readings is not consistently documented in primary care. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a standardized hypertension screening follow-up protocol improved provider initiation or documentation of guideline-concordant follow-up within 14 days. The faculty-approved PICOT population was primary care providers in a primary care clinic; we used eligible electronic health record (EHR) encounters as the analytic records to observe provider performance. We used a quantitative pre/post design and retrospectively reviewed 30 eligible EHR encounters: 15 pre-implementation …

The Impact Of Evidence-Based Benzodiazepine Tapering Guidelines In An Outpatient Psychiatric Setting: A Quality Improvement Project, Addeh Tosin

Doctor of Nursing Practice Projects

Long-term benzodiazepine use is associated with dependence, withdrawal, cognitive impairment, falls, and overdose, yet tapering practices remain inconsistent in outpatient psychiatric care. This quality improvement project examined whether evidence-based deprescribing education improved psychiatric mental health nurse practitioners' (PMHNPs) self-efficacy, adherence to benzodiazepine tapering guidelines, and active prescription outcomes. The Plan-Do-Study-Act cycle guided implementation, the ADKAR Model guided change, Bandura’s Self-Efficacy Theory provided the theoretical framework, and the Stetler Model supported evidence translation. The project employed a quantitative, quasi-experimental, single-group pretest-posttest design and involved three PMHNPs from one outpatient psychiatric practice. Participants received one 20-minute educational session based on American Society …

Improving Provider Confidence In Suicide-Risk Screening Through Training On A Safe-T-Guided Pathway At Intake, Shukairo Mack Baker

Doctor of Nursing Practice Projects

Evidence supports structured suicide-prevention education, but inconsistent pathway use at outpatient intake prompted this quality improvement project to evaluate provider confidence. The aim was increased confidence after training on a Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) guided pathway. Donabedian's structure, process, and outcome model and the Awareness, Desire, Knowledge, Ability, and Reinforcement change model guided implementation through one Plan, Do, Study, Act cycle. A single-group pre-test and post-test design involved seven clinicians at one hybrid outpatient behavioral health clinic. All available eligible staff (100%) completed a 2.5-hour training and both surveys. The Suicide Risk Assessment Confidence Scale was administered …

Quality Improvement Project: Telehealth Follow-Up After Psychiatric Hospital Discharge, Ikemi Echeng

Doctor of Nursing Practice Projects

The period following psychiatric hospitalization is a high-risk transition during which inconsistent communication, delayed follow-up, and poorly coordinated referrals can create gaps in continuity of care. This quality improvement project addressed inconsistent post-discharge follow-up processes in a community outpatient mental health clinic. The purpose was to implement staff education and a structured workflow incorporating the Agency for Healthcare Research and Quality Discharge Phone Call Tool to improve staff confidence, telehealth follow-up, and referral coordination over eight weeks. A quantitative, quasi-experimental, one-group pre- and post-intervention design was used. Staff confidence was measured with Grundy’s C-Scale, and telehealth follow-up and referral activities …

Quality Improvement Project: The Impact Of Provider Education On Antipsychotic Medication Side Effects, Anthony Emego

Doctor of Nursing Practice Projects

Weight gain is a frequent and clinically relevant side effect of antipsychotic medication. A needs assessment at the project site found that roughly 55% of patients on an antipsychotic treatment had clinically significant weight gain, and providers had no formal training on how to prevent and manage this. The purpose of this quality improvement project was to determine if a provider-focused educational intervention is effective in increasing provider confidence and decreasing antipsychotic-induced weight gain in adult psychiatric patients. This quantitative, one-group pre-post design utilized Lewin's Change Theory and Bandura's Social Cognitive Theory. It was conducted at an outpatient psychiatric clinic …

Quality Improvement Project: Improve Patient Show Rate For Appointments At The Outpatient Diabetic Clinic, Smitha Mathew

Doctor of Nursing Practice Projects

Missed appointments disrupt diabetes management, delay treatment, and waste healthcare resources. This quality improvement project evaluated whether patient-centered scheduling, staff education, and multimodal communication reduced no-show rates among adults with diabetes. The Plan-Do-Study-Act model provided the theoretical and implementation framework, while Kotter’s Eight-Step Change Model guided practice change. The uncontrolled preintervention-postintervention project occurred from January through July 2026 in a hospital-based outpatient diabetes clinic. The evidence-based intervention included 45-minute staff education, scheduling based on patients’ preferred days and times, verifying contact information and communication preferences, sending telephone and text reminders, and re-engaging patients the same day after missed appointments. Appointment …

Quality Improvement Project: Early Screening For Kidney Disease In Primary Care Clinics, Binsy Easow

Doctor of Nursing Practice Projects

Chronic kidney disease (CKD) is a common complication of diabetes. Evidence-based guidelines recommend urine albumin-to-creatinine ratio (UACR) screening for early identification of albuminuria in patients with diabetes; however, screening was inconsistently completed in an outpatient primary care clinic. This quality improvement project evaluated the impact of a standardized, provider-focused intervention on UACR screening completion and therapy intensification in patients with microalbuminuria. The Iowa Model served as the evidence-based practice framework, Lewin’s Change Theory provided the theoretical framework for practice change, and the Plan-Do-Study-Act cycle guided implementation and evaluation. A quasi-experimental pre- and post-intervention design was used. The intervention was delivered …

Enhancing Healthcare Provider Confidence And Accuracy In Performing And Documenting The Abnormal Involuntary Movement Scale, Victoria Okoani-Nneji

Doctor of Nursing Practice Projects

Monitoring for medication-related movement disorders is essential for adults with schizophrenia receiving antipsychotic medications; however, inconsistent Abnormal Involuntary Movement Scale (AIMS) assessment and documentation can limit timely recognition of abnormal movements. This quality improvement project evaluated a six-week structured AIMS education program designed to improve provider confidence and documentation accuracy in an outpatient behavioral health setting in Central Ohio. Guided by Benner’s Novice-to-Expert Model and Kotter’s Eight-Step Change Model, the project used a one-group pretest-posttest design with 15 licensed behavioral health providers. Weekly sessions included instruction, demonstration, guided practice, case-based learning, scoring, interpretation, and electronic health record (EHR) documentation. Descriptive …

Quality Improvement Project: Determining Impact Of Mental Health Screening Provider Training, Sherri Bennett

Doctor of Nursing Practice Projects

Obesity is frequently associated with mental health concerns, yet these conditions may remain under identified when mental health screening is not consistently incorporated into medical weight-loss care. At the project site, fewer than 2% of patients who are overweight or obese were identified as needing mental health services, demonstrating a practice gap in screening and referral. The purpose of this quality improvement project was to evaluate whether targeted mental health screening education improved provider confidence. The aim was to increase confidence in conducting mental health screening among nurse practitioners in a medical weight-loss program. The Stetler Model provided the theoretical …

Quality Improvement Project: Improving Nurse Discharge Competency Through Standardized Education And Discharge Tools In An Inpatient Behavioral Health Hospital, Valina Williams

Doctor of Nursing Practice Projects

Inconsistent discharge education and variable use of structured discharge tools can affect the consistency of transitions from inpatient behavioral health care. The purpose of this Doctor of Nursing Practice quality improvement project was to improve nurse discharge competency by implementing standardized discharge education and reinforcing use of a structured discharge tool in a rural inpatient behavioral health hospital. A quantitative, quasi-experimental one-group pretest-posttest design was used over 12 weeks with 16 eligible registered and licensed practical nurses. Organizational readiness was assessed at baseline, and nurse self-efficacy was measured before and after implementation. Discharge-tool adherence and 30-day readmissions were also evaluated. …

Quality Improvement Project: Implementing The 2025 Aha Hypertension Guidelines In Rural Primary Care, Johanna M. Alvarez

Doctor of Nursing Practice Projects

Hypertension contributes to cardiovascular morbidity and mortality, and delayed adoption of updated guidelines can increase therapeutic inertia in rural primary care. This Doctor of Nursing Practice quality improvement project addressed an evidence-to-practice gap at a rural Federally Qualified Health Center where clinicians used 2017 American Heart Association/American College of Cardiology hypertension protocols after release of the 2025 guideline. The purpose was to determine whether structured education and point-of-care visual decision aids improved provider knowledge, attitudes, self-reported practices, and selected clinical adherence metrics over 3 months. Guided by the Iowa Model, Lewin’s Change Management Model, and the Plan-Do-Study-Act framework, a quasi-experimental …

Implementing An Evidence-Based Practice Training Program To Impact Nursing Skills Competency And Self-Efficacy In A Long-Term Care Facility, Angela Mcknight

Doctor of Nursing Practice Projects

Long-term care facilities require nursing staff who can competently perform clinical skills; however, the project site relied primarily on written in-service education and attendance verification without direct validation of psychomotor performance. The purpose of this quality improvement project was to evaluate competency-based nursing education in a long-term care facility. The aim was to strengthen demonstrated urinary catheterization competency and evaluate changes in perceived professional nursing competence and general self-efficacy among licensed nurses. A quasi-experimental, one-group pretest-posttest design included 12 registered and licensed practical nurses. Plan-Do-Study-Act guided implementation, Lewin’s Change Theory guided organizational change, and Social Cognitive Theory supported the educational …

Quality Improvement Project: Empowering Change: Evidence-Based Strategies To Improve Ai Use In Pedagogy, Amanda Boyle

Doctor of Nursing Practice Projects

Artificial intelligence (AI) continues to integrate into healthcare and higher education; however, Health Science faculty at the project site lacked formal training to operate or teach AI responsibly. This Doctor of Nursing Practice quality improvement project evaluated whether computer-based AI literacy education improved Health Science faculty members’ self-reported AI literacy. It was predicted that faculty AI literacy scores would improve after completing the intervention. Kotter’s change model and Benner’s novice-to-expert framework informed implementation of change and faculty professional development. The Plan–Do–Study–Act model supported evaluation. In a one-group, quasi-experimental preintervention–postintervention study design at a North Texas two-year college, 19 eligible Health …

Integrating Interprofessional Education To Strengthen Team-Based Mental Health Care, Adebisi Tijani

Doctor of Nursing Practice Projects

Fragmented interprofessional collaboration in outpatient mental health settings compromises care coordination and patient engagement. This quality improvement (QI) project implemented a structured interprofessional education (IPE) workshop series to improve team collaboration and reduce patient no-show rates in an outpatient mental health clinic. Guided by Bandura's Social Cognitive Theory and Lewin's Change Management Model, the project used a pre-post, single-group design with 12 licensed mental health professionals. The team measured collaboration with the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II) and collected aggregate patient no-show rates from the electronic health record. The intervention consisted of four monthly, one-hour workshops covering role …

You Haven’T Been Forgotten: Driving Improvements In Trust, Transparency, And Accountability Through A Patient-Centered Communication Initiative In The Emergency Department, Ellie Mead

Master's Projects and Capstones

Objective: In Spring 2026, the Emergency Department (ED) at Hospital X identified difficulties securing high levels of patient satisfaction. Over one third of patients did not feel adequately “informed about delays,” and observation of nurse-patient interactions in front-end care areas confirmed these communication gaps: in 87% of interactions, nurses did not explain next steps to the patient, and in none of the 51 interactions observed did nurses proactively inform patients about possible delays. Aim: This quality improvement initiative sought to improve the patient experience in the ED and drive a 10% increase in Press Ganey patient satisfaction survey results relating …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Impacting Competency In C-Ssrs Suicide Risk Screening On An Inpatient Psychiatric Unit, Fidelis Sangye

Doctor of Nursing Practice Projects

Suicide remains a leading public health concern, and inconsistent application of the Columbia-Suicide Severity Rating Scale (C-SSRS) may contribute to variability in suicide risk assessment and delayed intervention within inpatient psychiatric settings. The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a standardized C-SSRS-guided educational intervention on staff competency in suicide risk screening. Guided by Lewin’s Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, this quantitative pretest-posttest QI project was conducted on an adult inpatient psychiatric unit. The intervention consisted of a 25-minute instructor-led PowerPoint presentation on standardized C-SSRS administration and evidence-based suicide risk …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Dnp Final Report: Impact Of Education For Public School Caregivers On Reducing Complications In Type 1 Diabetes, Jena Decanter

DNP Final Reports

Abstract Background: Children with Type 1 diabetes (T1D) rely on school personnel to recognize symptoms and respond to diabetes-related emergencies during the school day. However, many rural school districts lack standardized training for staff responsible for supporting students with chronic health conditions. Purpose: This quality improvement project evaluated the feasibility and educational impact of a brief, self-paced, evidence-based diabetes education program designed to improve school personnel knowledge and response confidence related to T1D management. Methods: A quality improvement design was used in which school personnel with direct student contact completed an asynchronous educational module. Outcome measures included the Michigan Diabetes …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

Leading Healthcare Improvement: An Implementation Strategy, Kelley Arredondo, Anthony Ecker, Lindsay Vaclavik, Jacquelene Shahin, Ashley Thompson, Molly Horstman, David Ramsey, Kyler M Godwin

Faculty, Staff and Students Publications

Introduction: Healthcare professionals often implement quality improvement (QI) initiatives but lack training to implement and sustain QI initiatives. Leading Healthcare Improvement (LHI) is a course that combines principles from change management, team science, and leadership effectiveness into an implementation strategy to enable clinicians to lead sustainable change.

Methods: LHI is a 6-session, 4-month interactive training. Learners work on an active QI project throughout the course. A Wilcoxon signed-rank test was conducted to evaluate pre- and post-course changes in learners' self-reported confidence across five QI competencies.

Results: Veterans Healthcare Administration clinicians and fellows completed the LHI pre- (n = 111) and …

Quality Improvement Project: Implementation Of Trauma-Informed Care Education In An Outpatient Psychiatric Clinic, Ornela Claude Ika

Doctor of Nursing Practice Projects

Trauma-informed care (TIC) is an evidence-based approach that promotes safe, patient-centered care for individuals with a history of trauma. Many patients receiving services in psychiatric settings have experienced trauma, placing them at risk for retraumatization during healthcare encounters. Despite the recognized benefits of TIC, the outpatient psychiatric clinic involved in this project lacked a formal trauma-informed care education program for staff. The purpose of this quality improvement project was to determine whether implementation of a structured trauma-informed care educational intervention improved staff attitudes toward trauma-informed care. Lewin’s Change Theory and the Plan-Do-Study-Act framework guided project implementation. A quantitative pre-intervention and …

Quality Improvement Project The Impact Of The Interact “Stop And Watch Tool” In A Skilled Nursing Facility, Lorraine Hicks

Doctor of Nursing Practice Projects

Avoidable hospitalizations from skilled nursing facilities (SNF) contribute to increased healthcare costs, resident distress, and adverse health outcomes. Many readmissions result from delays in identifying and communicating early signs of resident deterioration. The purpose of this project was to implement an evidence-based intervention to recognize early changes in residents’ conditions, empower nursing staff to detect and promptly communicate concerns, and impact 30-day hospital readmission rates. Problems identified included delayed recognition of early changes in residents’ conditions, fragmented staff communication, and the absence of standardized reporting practices, which were associated with preventable hospital readmissions. A quasi-experimental pre-/post-intervention design guided by Jean …

Implementation Of A Standardized Adverse Childhood Experiences Screening Process In A Primary Care Clinic, Tanya M. Wonnacott

Doctoral Dissertations & Projects

Adverse Childhood Experiences (ACEs) are associated with increased risks of chronic disease, mental health disorders, substance use disorders, and premature mortality. Despite growing evidence supporting ACE screening, it remains inconsistent in many primary care settings, particularly among underserved populations. The purpose of this quality improvement project was to evaluate whether implementation of a standardized ACE screening workflow increased ACE screening completion and behavioral health referral within a nonprofit primary care clinic serving uninsured, underinsured, and refugee populations.

This project utilized a pre–post quality improvement design guided by Lewin’s Change Management Model and the Chronic Care Model. Interventions included standardized ACE …

A Warm Welcome: Developing Strategies And Tactics To Address The Resolution Of Neonatal Hypothermia, Sarah J. Musovski

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Aim:

This project aimed to promote the use of a standardized checklist for newborn care that incorporated evidence-based practices. The goal was to maintain newborn temperatures in the normothermic range of 36.5–37.5 °C while receiving care in the hospital setting.

Purpose/Aim:

This project aimed to promote the use of a standardized checklist for newborn care that incorporated evidence-based practices. The goal was to maintain newborn temperatures in the normothermic range of 36.5–37.5 °C while receiving care in the hospital setting.

Description of the Undertaking/Best Practice:

The checklist that was provided included a series of evidence-based actions to promote and advance …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Quality Improvement Project: Improving Provider Workflow And Documentation For Routine Mental Health Screening In An Outpatient Psychiatric Clinic, Sharon Uchechi Joshua

Doctor of Nursing Practice Projects

Depression and anxiety are leading causes of disability and are frequently underdiagnosed in outpatient psychiatric settings due to inconsistent screening and documentation practices. Evidence supports the use of standardized tools, such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), to improve early detection and clinical outcomes. This quality improvement (QI) project evaluated whether implementing standardized electronic health record (EHR) templates and provider education would improve documentation of PHQ-9 and GAD-7 screenings. The aim was to increase the consistency of screening and documentation among psychiatric providers. The project was guided by the Plan-Do-Study-Act (PDSA) framework and Lewin’s Change …

Improving Monitoring And Documentation Of Long-Acting Injectable Antipsychotic Adherence In Patients With Schizophrenia Through Staff Education And Refill History Review, Stacy Ann Bruce

Doctor of Nursing Practice Projects

Schizophrenia is a chronic psychiatric disorder associated with relapse, hospitalization, and poor outcomes when medication adherence is suboptimal. Nonadherence increases morbidity and healthcare utilization (World Health Organization, 2022; Zhao et al., 2025). Long-acting injectable (LAI) antipsychotics improve adherence and reduce hospitalization, but inconsistent monitoring and documentation in outpatient settings hinder early identification of missed doses (Lieslehto et al., 2022). This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate whether staff education and structured refill-monitoring processes improve identification and documentation of nonadherence to LAI antipsychotics. Using Kotter’s Change Management Model and the Plan-Do-Study-Act framework, the project focused on …