Implementation Of A Standardized Suicide Risk Screening Protocol Using The Columbia-Suicide Severity Rating Scale (C-Ssrs) In An Outpatient Mental Health Clinic, Kemisola Ebietomiye

Doctor of Nursing Practice Projects

The outpatient mental health clinics across the United States lack consistent suicide risk assessment methods. This project developed standardized procedures which used Columbia-Suicide Severity Rating Scale (C-SSRS) assessment together with provider education and electronic health record systems to evaluate how these elements impacted provider self-efficacy and their ability to record screening results. The project used a pre-post design to examine (n=24) psychiatric providers at an urban outpatient clinic through the combined methods of Lewin's Change Theory and the Plan-Do-Study-Act framework. The General Self-Efficacy Scale measured provider self-efficacy, and structured EHR audits tracked documentation rates pre- and post-implementation over six weeks. …

Quality Improvement Project Standardizing Simulation In Nursing Education: A Faculty Training Initiative, Andrea Reyes

Doctor of Nursing Practice Projects

Simulation-based education is essential in nursing programs as clinical placement opportunities decline. However, inconsistent faculty preparation can compromise the quality of simulation delivery. The purpose of this quality improvement project was to implement and evaluate a standardized simulation faculty training initiative to determine its impact on nursing faculty's confidence in simulation facilitation. Guided by the Jeffries Simulation Framework and Lewin’s Change Theory, a quasi-experimental pre-post design was used to examine changes in faculty confidence following participation in a training program aligned with national standards and guidelines. Faculty confidence was measured using the Simulation Educator Needs Assessment Tool (SENAT) administered pre- …

Quality Improvement Project: Impact Of Mindfulness-Based Stress Reduction On Nurse Burnout In Skilled Nursing Facilities, Chinenye Okafor

Doctor of Nursing Practice Projects

Burnout is a persistent and critical problem in skilled nursing facilities, contributing to reduced job satisfaction, increased turnover, and compromised quality of care. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the impact of a Mindfulness-Based Stress Reduction program on burnout among registered nurses in a skilled nursing facility. Guided by the Job Demands–Resources framework and Lewin’s Change Theory, a quantitative pretest–posttest design was implemented using the Plan–Do–Study–Act. Ten nurses consented to participate in an eight-week intervention, and four completed both pre- and post-intervention measures. Burnout was measured using the Maslach Burnout Inventory–Human Services …

Addressing Faculty Gaps In The Psychiatric Mental Health Nurse Practitioner Program, Shea Brock

Doctor of Nursing Practice Projects

Graduate nursing programs increasingly rely on adjunct faculty to sustain enrollment growth; however, inconsistent onboarding processes may contribute to variability in faculty preparedness and job satisfaction. The purpose of this quality improvement project was to implement a standardized adjunct faculty education program and evaluate its impact on adjunct faculty knowledge and job satisfaction within an online Psychiatric–Mental Health Nurse Practitioner (PMHNP) program. A quantitative, quasi-experimental one-group pre–post design was utilized. Six adjunct faculty members (n = 6) completed a 10-item EXXAT Knowledge Survey and a 10-item Faculty Satisfaction Survey before and after participation in a structured one-hour education session focused …

Quality Improvement Project: Reducing Medication Errors To Improve Patient Safety, Paulina Irish

Doctor of Nursing Practice Projects

Medication administration errors remain a persistent threat to patient safety in emergency department settings, where high acuity, rapid throughput, and workflow interruptions increase vulnerability to preventable adverse events. The purpose of this Doctor of Nursing Practice quality improvement project was to increase medication-safety knowledge scores by at least 10% and reduce medication administration error rates by 20% within eight weeks among registered nurses in a freestanding emergency department in South Texas. The project was grounded in Lewin’s Change Theory as the theoretical framework and implemented using the Plan–Do–Study–Act quality improvement model. A quasi-experimental, single-group pretest–posttest design was used with a …

Quality Improvement Project: Improving Transitional Care Management (Tcm) Follow-Up Through Medical Assistant Education, Oben Assick

Doctor of Nursing Practice Projects

The underutilization of Transitional Care Management (TCM) services in primary care significantly contributes to preventable hospital readmissions and revenue loss. Despite established Centers for Medicare & Medicaid Services (CMS) guidelines, execution often fails due to knowledge gaps among frontline staff. This quality improvement project addressed low TCM task completion rates by implementing a structured educational intervention for medical assistants (MAs). The purpose was to evaluate whether targeted training improves timely patient follow-up, visit scheduling, and billing accuracy. The project utilized Kotter’s 8-Step Change Model to guide organizational change and the Health Belief Model to address behavioral barriers. A quantitative, quasi-experimental …

Implementing An Antibiotic Stewardship Bundle In An Urgent Care Center, Christianah Ogunleye

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inappropriate antibiotic prescribing for upper respiratory infections (URIs) remains a major contributor to antimicrobial resistance, adverse drug events, and unnecessary healthcare costs, particularly in urgent care settings characterized by high patient volume and rapid clinical decision-making. The purpose of this quality improvement project was to implement and evaluate a multifaceted antibiotic stewardship program aimed at improving evidence-based antibiotic prescribing practices for URIs in an urgent care setting. A bundled intervention was implemented that included provider education, evidence-based clinical decision guidelines, patient education materials, and audit-and-feedback strategies. Pre- and post-intervention data were collected and analyzed to assess changes in antibiotic prescribing …

Implementing A Nurse-Led Multimodal Pain Management Toolkit To Enhance Recovery After Outpatient Urologic Surgery, Danielle Cirlos-Valles

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose To evaluate the impact of a nurse-led multimodal postoperative pain management toolkit on recovery outcomes among adults undergoing same-day urologic surgery.

Design Quality improvement project using a pre–post implementation design in an outpatient perioperative setting.

Methods An evidence-based toolkit grounded in Enhanced Recovery After Surgery (ERAS) principles was implemented over eight weeks, incorporating scheduled non-opioid analgesics, nonpharmacologic strategies (thermal therapy, guided breathing, early mobilization), standardized patient education, and 24-hour follow-up calls. Outcomes included Visual Analog Scale (VAS) pain scores at discharge and 24 hours, escalation pathway utilization, and nurse knowledge competency. Descriptive statistics and paired t tests were used. …

Optimizing Efficiency In Joint Injections In An Outpatient Orthopedic Oncology Clinic Using Lean Six Sigma, William Alexander Byrd

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Prolonged in-room wait time in an outpatient orthopedic oncology clinic was identified as an important driver of dissatisfaction and operational inefficiency. Baseline in-room times in this setting were reported as M=96.2 minutes for patients receiving injections and M=92.9 minutes for those not receiving injections. This quality improvement project used Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, Control) framework to streamline clinic workflow for the joint injection process. Over an eight-week period, four key interventions were introduced: a standardized order set for medications, pre-bundled supplies and portable supply toolbox, telephone pre-consenting of patients, and optimized scheduling of …

Reducing Live Discharges In Hospice Care Through A Bundled Intervention, Fiona P. White

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

 Among Medicare fee-for-service hospice beneficiaries, the national live discharge rate increased from 16.9% in FY2021 to 19.1% in FY2025. At a Medicare-certified hospice agency in a southern state, the pre-intervention live discharge rate of 35.3% substantially exceeded national norms, with 68.7% of events representing patient-initiated revocations.

Methods

 A pre-post quality improvement design guided by the Plan-Do-Study-Act framework was implemented over 8 weeks at a single site with 106 newly admitted hospice patients and 15 clinical staff. The four-component bundled intervention comprised Revocation Risk Assessment administration within 24 hours of admission, structured patient and caregiver education within 72 hours of …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Improving Psychiatric Paraprofessional Preparedness Through Mental Health First Aid Training In An Outpatient Mental Health Clinic, Anisha Hampton

DNP Scholarly Projects

BACKGROUND: Paraprofessional staff in outpatient mental health clinics play a critical role in monitoring clients with serious mental illness (SMI) and supporting continuity of care in community-based settings. However, the absence of standardized training contributes to variability in staff knowledge, confidence, and ability to recognize early signs of mental health deterioration. Mental Health First Aid (MHFA) is an evidence-based training designed to improve mental health literacy and crisis response skills among frontline workers.

METHODS: This quality improvement project utilized a pre-post design within a Plan-DoStudy-Act (PDSA) framework at an outpatient mental health clinic. Paraprofessional staff completed the Mental Health Literacy …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …

Strengthening Workforce Stability And Operational Efficiency In The Transition To Practice: A Quality Improvement Project, Alana L. Lemoine

Master's Theses and Capstones

Abstract 

Background: The transition to professional practice is a challenging period for new graduate nurses, and inadequate support can contribute to high turnover and reduced job satisfaction. Structured mentorship programs have been proposed as an effective strategy to improve retention, support professional development, and enhanced perceived impact during the first year of practice for new graduate nurses.

Local problem: Within a single microsystem, new graduate nurses faced challenges related to access to formal mentorship and support throughout the transition to practice. Baseline data indicated that only 50% of nurses had access to active mentorship, and retention rates in 2024 were …

Improved Daily Communication To Reduce On-Time First Case Start (Fcots) Delays In The Operating Room: A Quality Improvement Project, Autumn Tourangeau

Master's Theses and Capstones

BACKGROUND: First Case On-Time Starts (FCOTS) are a key indicator of perioperative efficiency and influence operating room (OR) utilization, staff productivity, patient satisfaction, and healthcare costs. Baseline data from an ambulatory perioperative unit demonstrated persistent variability in FCOTS performance and inconsistent interdisciplinary communication regarding surgical delays.

Local Problem: Inconsistent communication and documentation of first-case delays limited interdisciplinary awareness of workflow barriers and contributed to ongoing variability in FCOTS performance.

Intervention: A standardized, HIPAA-compliant daily communication process was implemented, consisting of an end-of-day email summarizing FCOTS delays and the documented reasons for delays. Educational materials and standardized documentation tools were introduced …

Combating Pressure Injuries In Critical Care: A Dnp Project On Nursing Education And Prevention Strategies In The Icu, Tijuana M. Johnson

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) are preventable complications that significantly increase patient morbidity, mortality, length of stay, and healthcare costs, particularly in intensive care units (ICUs). At a rural 146-bed hospital, the ICU pressure injury rate of 1.17 per 1,000 discharges exceeded the national benchmark of 0.58 per 1.000 discharges, identifying a critical gap in prevention practices. This Doctor of Nursing Practice (DNP) project aimed to improve ICU nurses' knowledge of pressure injury prevention and reduce unit-based educational intervention grounded in Patricia Benner’s Novice to Expert Theory and implemented using the Plan-Do-Study-Act (PDSA) quality improvement framework.

A pre-and post-intervention design was …

Resiliency For Nurse Educators: Incorporating Resiliency Training For Nursing Faculty, Rachael Holder

Doctor of Nursing Practice Projects

Nursing faculty frequently experience high levels of stress, workload demands, and burnout, which can negatively affect teaching effectiveness and retention. Literature supports resilience as a protective factor that enhances well-being and professional sustainability. The purpose of this quality improvement project was to impact resilience levels among full-time undergraduate nursing faculty through a self-paced online resiliency training program. Guided by Pender’s Health Promotion Model and Lewin’s Change Theory, this pre- and post-intervention design used the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) to assess changes in resilience. Eleven faculty members completed the pre-survey, and two completed the post-survey. The post-survey mean CD-RISC-10 scores …

Quality Improvement Project: Educating Nursing Faculty On Medication Administration Labs To Improve Student Competency, Chelsea Pacheco

Doctor of Nursing Practice Projects

Medication administration errors are a leading cause of preventable harm in healthcare. Faculty play a critical role in ensuring nursing students develop the knowledge and confidence to give medications safely. A needs assessment at the project site revealed that only course coordinators were teaching medication administration and dosage calculation, leaving other faculty uncertain about how to teach these skills. This quality improvement project aimed to strengthen faculty confidence and create consistency in first-year instruction through a recorded educational video. Constructivist Learning Theory provided the foundation for active, experience-based learning. Lewin’s Change Theory guided the structured implementation process to support adoption …

Shared Decision Making In Women's Health: A Quality Improvement Project, Brittney Butler

Doctor of Nursing Practice Projects

Shared decision-making (SDM) is the best practice in contraceptive counseling, yet it remains underutilized in primary care, particularly within underserved communities. Limited SDM use reduces patient autonomy, weakens satisfaction, and contributes to inconsistent documentation. This quality improvement (QI) project aimed to evaluate whether an educational intervention on SDM for contraceptive counseling improved provider self-efficacy and the electronic medical record (EMR) documentation of SDM practices. Guided by Bandura’s Social Cognitive Theory and Lewin’s Change Management Model, the project sought to enhance provider confidence and foster sustainable behavioral change. A quasi-experimental, one-group pretest–posttest design was implemented at a rural Federally Qualified Health …

Quality Improvement Project Enhancing Documentation Practices In Community Mental Health Clinics, Carol Parker

Doctor of Nursing Practice Projects

Accurate and timely documentation are essential for safe, high-quality care in community mental health settings. This quality improvement (QI) project addressed inconsistent documentation practices among licensed, unlicensed, and Qualified Mental Health Specialist (QMHS) staff at an outpatient clinic. The purpose of the QI project was to implement and assess a structured in-service training program using the Accountable Health Communities–Health-Related Social Needs (AHC-HRSN) screening and documentation tool to improve staff knowledge, enhance documentation accuracy, and facilitate care coordination. Guided by the Iowa Model of Evidence-Based Practice and Lewin’s Change Management Model, a pre- and post-intervention design was used. Fifteen staff members …

Implementing Phq-2 In An Outpatient Mental Health Practice, Krishona Poignard

Doctor of Nursing Practice Projects

Depression remains widely underidentified in outpatient behavioral health settings, where variable screening practices limit early recognition and appropriate treatment. This quality improvement project addressed this gap by standardizing screening through targeted clinician education. The purpose was to improve clinician confidence and adherence to validated tools, specifically the Patient Health Questionnaire-2 (PHQ-2) and, when indicated, the Patient Health Questionnaire-9 (PHQ-9). The project aimed to increase consistent tool use through an evidence-based educational intervention guided by Lewin’s Change Theory and the Iowa Implementation for Sustainability Framework. A quasi-experimental, single-group pretest–posttest design was employed with licensed clinical staff, including licensed social workers (LSWs), …

Quality Improvement Project: Impact Of Educational Intervention On Post-Acute And Long-Term Care Staff's Confidence And Accuracy In Aims Screening For Tardive Dyskinesia, Tana Whitt

Doctor of Nursing Practice Projects

Tardive dyskinesia (TD) is a chronic, often irreversible movement disorder associated with prolonged antipsychotic use. In post-acute and long-term care (PALTC) settings, inconsistent Abnormal Involuntary Movement Scale (AIMS) screening practices and limited clinician education contribute to under recognition and delayed treatment. This Doctor of Nursing Practice (DNP) quality improvement (QI) project evaluated whether an educational intervention impacted clinicians’ knowledge, confidence, and perceived importance of AIMS screening among licensed and unlicensed PALTC staff. Guided by Donabedian’s Model of Quality and Kotter’s 8-Step Change Model, the project used a pre-test/post-test design to measure outcomes before and after completion of the Drug-Induced Movement …

Improving Cauti Prevention In Long-Term Care: An Educational Intervention To Enhance Staff Confidence And Reduce Infection Rates, Diana Meseha

Doctor of Nursing Practice Projects

Catheter-associated urinary tract infection (CAUTI) is a common preventable healthcare-associated infection in long-term care. knowledge gaps and inconsistent catheter care by staff and increased catheter-associated urinary tract infection rates. The purpose of this quality improvement project aims at testing whether using a structured educational intervention led to improved confidence of staff and reduced catheter-associated urinary tract infection rates. The project employed Bandura's Social Cognitive Theory and Lewin's change model in guiding the behavior and organizational change. A quasi-experimental pretest post-test design was used with the enrolment of nursing employees such as registered nurses, licensed practical nurses and certified nursing assistants …

Implementing Pain Reassessment Workflow To Improve Timely Pain Management In Hospice Patients: A Quality Improvement Project, Oluremi Omodara

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.

Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours …

Quality Improvement Project Improving Fall Risk Protocol Compliance Through A Structured Fall Prevention Program In A Skilled Nursing Facility, Lakeesha Jenkins

Doctor of Nursing Practice Projects

Falls remain a persistent patient-safety threat in skilled nursing facilities (SNFs). At a Dallas–Fort Worth SNF, a needs assessment identified rising unassisted falls and inconsistent protocol adherence. This quality improvement (QI) project examined whether a structured, evidence-based bundle could improve staff knowledge and fall-prevention processes and reduce falls over four weeks. Guided by Lewin’s Change Theory and implemented with Plan–Do–Study–Act (PDSA) cycles, the pre–post design engaged direct-care staff (registered nurses, licensed vocational nurses, certified nursing assistants; n = 20). The intervention included standardized risk screening with the Morse Fall Scale (MFS), targeted staff education, high-risk visual identifiers, and post-fall huddles. …

Quality Improvement Project Diabetes Self-Management Education Training Program, Guylene Lucien

Doctor of Nursing Practice Projects

Diabetes is among the leading causes of morbidity and mortality in the United States; therefore, effective Diabetes Self-Management Education (DSME) is vital in improving patient outcomes. A needs assessment of the Practice site identified gaps in provider confidence and frequency and consistency of delivering DSME that correlated with poor patient adherence and readmissions. The purpose of this quality improvement (QI) project was to implement a structured, evidence-based DSME training program to improve healthcare provider self-efficacy to provide DSME. The project utilized Bandura's Social Cognitive Theory and the ADKAR change model and employed a quasi-experimental, one-group pretest–posttest design. Ten providers (six …

Quality Improvement Project Evidence-Based Practice For The Use Of Lower Fio2 Concentration Amongst Pediatric Anesthesia Providers, Brittany Raines

Doctor of Nursing Practice Projects

Hyperoxia during pediatric anesthesia is linked to postoperative pulmonary complications such as atelectasis and oxidative lung injury. Despite strong evidence supporting the use of lower inspired oxygen concentrations (FiO2), many providers habitually administer 100% oxygen during induction and emergence due to tradition and lack of formal guidelines. This quality improvement project aimed to reduce unnecessary hyperoxia by educating pediatric anesthesia providers on evidence-based FiO2 titration strategies. Guided by Kolb’s Experiential Learning Theory and Lewin’s Change Theory, a quasi-experimental one-group pretest/posttest design was employed. Sixteen certified registered nurse anesthetists (CRNAs) and physician anesthesiologists completed baseline surveys, participated in a targeted educational …

Enhancing Patient Safety: Fall Prevention Through Video Education, Fithawit T. Zere

Master's Projects and Capstones

Abstract

Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.

Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.

Interventions: A …

Enhancing Nurse Well-Being Through Mandatory Rest Breaks At A Hospital, Elise Njang

Doctor of Nursing Practice Projects

Nurses are essential to the healthcare system, yet their demanding 12-hour shifts in hospital settings often leave little opportunity for adequate rest. The absence of structured rest breaks not only endangers nurses' well-being but may also compromise the quality of patient care. This quality improvement (QI) project aimed to evaluate the effects of implementing structured, mandatory 15-minute rest breaks on nurse burnout and job satisfaction. The initiative addressed a critical gap at the project site, where nurses typically received only one 30-minute lunch break per shift, despite evidence supporting the benefits of more frequent rest breaks. A quasi-experimental pre- and …

Quality Improvement Project Evaluation Of The Effectiveness Of The Institute For Healthcare Improvement’S Joy In Work Framework On Burnout Experienced By Dialysis Staff, Bernice Jones

Doctor of Nursing Practice Projects

Burnout continues to pose a pervasive and escalating challenge in healthcare, with its severity further amplified in the aftermath of the COVID-19 pandemic. Dialysis professionals are especially vulnerable, facing elevated patient volumes, extended work hours, and frequent encounters with complex clinical needs. These ongoing stressors highlight the critical importance of this quality improvement (QI) project, as there exists an urgent need for evidence-based strategies to alleviate burnout among dialysis professionals. This QI project aimed to enhance joy in the dialysis work setting and reduce burnout experienced by dialysis staff through the implementation of the Institute for Healthcare Improvement’s (IHI) Joy …