Medicine and Health Sciences Commons^™

Evalutaing The Effectiveness Of A Two-Year Nurse Residency Program On Reducing Nursing Turnover In The One To Three Years Tenure, Nancy J. Plum

Doctor of Nursing Practice (DNP) Manuscripts

Background: First-year turnover for new registered nurses continues to take the lead in all tenured categories, accounting for 59% of turnover, carrying with it a financial impact averaging $88,000 per staff nurse lost. A synthesis of the literature finds the research to be ambiguous and anecdotal, with a narrow focus on understanding the causes of turnover, while an underwhelming amount of rigorous research has been conducted on identifying effective solutions. Solutions to mitigate nursing turnover will require an innovative approach.

Purpose: This program evaluation aimed to examine the impact of a two-year nurse residency program (NRP) on registered nurse turnover …

Enhancing Nurses’ Joy And Meaningful Work In A Military Treatment Facility: A Quality Improvement Project, Ann M. Uetz

Doctor of Nursing Practice (DNP) Manuscripts

Background: Prior to the pandemic, there was growing concern regarding nurse burnout and retention – concern which still exists today in healthcare organizations. Purpose and happiness in work ensures staff engagement, positive patient outcomes, improves nurses’ well-being, and decreases burnout. The Institute of Healthcare Improvement’s (IHI) Quadruple Aim emphasizes improving the work life and well-being of healthcare teams. IHI’s white paper, Joy in Work, outlines nine components to guide interventions for enhancing joy and meaningful work. Purpose: This project’s purpose is to determine the impact of implementation of the Joy in Work’s framework on registered nurses and nursing leadership …

The Implementation Of A Pilot Program On Puberty And Menstruation Education For Adolescent Females And Youth Development Specialists For A Gender-Specific Community Organization: A Quality Improvement Project, Cassandra Tavares

Doctor of Nursing Practice (DNP) Manuscripts

Background & Significance: Adolescent girls in the United States (U.S.) often lack adequate education and support regarding puberty and menstruation, despite the importance of this knowledge for healthy development (Schmitt et al., 2022). Only 21% of school systems serving ages 8–12 provide puberty education, and many educators feel unprepared to teach it (Schmitt et al., 2022). Purpose: This quality improvement project aimed to equip youth development specialists (YDS) at a community organization with a structured curriculum and educational tools to confidently educate adolescent females (ages 8–13) on the physical, emotional, and social aspects of puberty and menstruation. Intervention: A four-day …

Staff Education To Reduce Medication Errors In An Outpatient Mental Health Clinic, Oluwatoyin Rotimi

Walden Dissertations and Doctoral Studies

Summary Medication errors are a common concern within the healthcare industry, increasing healthcare costs and harming patients. The Doctor of Nursing Practice (DNP) project focuses on a staff education initiative to improve knowledge regarding using the Bar Code Management System (BCMS) to reduce medication errors in an outpatient mental health clinic. The identified gap in practice was the lack of knowledge on using the BCMS in outpatient mental health. The guiding practice-focused question was “Does educating the intake nurses on the barcode management systems improve knowledge, as evidenced by pre- and post-surveys?” The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) …

Improving Influenza Vaccination Rates In A Teen/School-Based Clinic, Alina Leigh

Doctor of Nursing Practice Final Project Abstract

Purpose: The Centers for Disease Control and Prevention (CDC) states the best way to prevent the flu is through vaccination recommended for everyone 6 months and older. Clinic flu vaccination rates are low, and effective strategies are needed to improve rates and promote knowledge on the benefits of the vaccine. This can be achieved by educational intervention, provider recommendation, improved screening, and obtaining consents for teens and young adults in the teen clinic.

Background: Every year, the influenza virus is responsible for thousands of deaths and billions of dollars in spending in the United States, however immunization rates remain below …

Quality Improvement Project Impact Of Impostor Phenomenon On Medical Personnel, Elizabeth L'Heureux

Doctor of Nursing Practice Projects

The DNP project examined medical healthcare personnel who displayed an impostor phenomenon (IP), as reflected in the Perceived Stress Scale (PSS-10) surveys, identifying a lack of structured support for reducing stress. The aim of the quality improvement project (QI) is to evaluate the impact of a four-week structured mentorship and resilience training intervention on perceived stress levels among medical healthcare personnel experiencing symptoms of the impostor phenomenon. The QI project utilized the Cognitive-Affective framework to shape what needed to change, the origins of IP stress, while Lewin’s Change Theory guided how to implement and sustain those changes. A quasi-experimental study …

The Effects Of A Breastfeeding Educational Program On Nurses’ Self-Efficacy And Knowledge, Amanda Quinn

Doctor of Nursing Practice Projects

Breastfeeding, a cornerstone of maternal and infant health, faces barriers due to inadequate healthcare provider education, contributing to low exclusive breastfeeding rates. The purpose of this quality improvement project was to evaluate the impact of a four-week educational program on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. This project evaluated a four-week educational program’s effect on clinical staff’s knowledge and self-efficacy in supporting breastfeeding in a rural OB/GYN clinic in central Florida. Using a quasi-experimental pre-post design, nine licensed/certified staff (medical assistants, licensed practical nurses, registered nurses, advanced practice registered nurses) …

Quality Improvement Project Evaluating The Impact Of A Structured Training Program On Cultural Competency Among Mental Health Providers In A Local Outpatient Clinic, Adedamola Adefioye

Doctor of Nursing Practice Projects

Culturally responsive care is critical in addressing mental health disparities, but many mental health providers express feeling unprepared to engage with culturally diverse patients. Low cultural competence is associated with communication failures, lack of patient trust, and the possibility of poorer treatment outcomes. This quality improvement project evaluated the impact of a structured cultural competency training program at an outpatient behavioral health clinic. A quasi-experimental, one-group pre-test/post-test design was used with the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R). Eight licensed mental health providers participated in four weekly one-hour interactive training sessions using …

Staff Education Project Building Proficiency In Debriefing And Empowering Healthcare Professionals With Confidence And Knowledge, Kristie Lynn Van Waus

Walden Dissertations and Doctoral Studies

Debriefing is a critical reflective practice in healthcare that facilitates team learning, promotes psychological safety, and supports quality improvement following clinical events. Despite its recognized value, healthcare professionals report limited training and a lack of confidence in participating in debriefing. I conducted this staff education project to increase staff knowledge and confidence related to effective debriefing practices by delivering targeted in-person education and measuring outcomes using a pre- and post-intervention knowledge and confidence assessment. The education focused on the essential elements of effective debriefing and use of a standardized data collection form. Participants completed a preintervention assessment measuring their knowledge …

Implementation Of A Patient Engagement Program In A Federally Qualified Health Center, Cami A. Stone

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project is implementation of a patient engagement program at a Federally Qualified Health Center (FQHC) clinic. This program intends to increase patient self-management of disease without increasing tasks of the clinic staff.

Background

FQHCs have limited resources and staff; their populations are marginalized and transient. The care gap is between the clinic’s resources and patient self-management of disease, specifically hypertension. Evidence shows that personalized coaching of patients aids them with disease self-management.

Methodology

This project delivers personalized coaching via weekly brief phone calls from two assigned nurses to patients, without disrupting clinic duties. Calls involve …

Nursing Education Leadership Succession Planning: Utilization Of Career Mapping For Professional Development, Reba L. Carethers

Doctor of Nursing Practice Final Project Abstract

PURPOSE The focus of this quality improvement project was to identify potential future leaders in the Nursing Professional Development (NPD) department at a large hospital system using a succession planning model, strategy organizations use to cultivate individuals with the potential to assume future leadership roles.

BACKGROUND A gap existed in deliberate career planning within the NPD department. A quality improvement project was developed utilizing evidence-based interventions including development of professional objectives, professional development opportunities, and identification of aspiring leaders in nursing education.

METHODOLOGY Participants developed a career map to outline career goals, created an action plan for their professional development …

Reclaiming Teen Recovery: Tailored Therapeutic Recreation To Boost Engagement, Satisfaction, And Participation, Kabresha R. Potts

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project evaluated the impact of four tailored group therapeutic recreation modules on six recovery outcomes: satisfaction, engagement belief, participation likelihood, motivation to seek help, perceived usefulness, and perceived importance, among adolescents at a residential treatment facility in Houston, TX, targeting ≥ 20% improvement in each domain.

Background: Adolescents in short-term, often court-mandated, treatment lack personalized leisure activities that promote emotional expression and resilience. Structured leisure engagement is linked to positive affect and treatment motivation, yet interest-based programs for court-involved youth remain underexplored.

Methodology: Using Plan-Do-Study-Act cycles and Self-Determination Theory, weekly 90-minute modules (mindfulness trivia, art Jeopardy, music …

Improving Effective Assistant Nurse Manager Communication In Obstetrics, Julie Marie Glover

Master's Projects and Capstones

Abstract

Problem: This quality improvement project addresses inconsistent leadership communication among Assistant Nurse Managers (ANMs) in the Obstetrics (OB) department of a hospital in Northern California. ANM and staff concerns around shift handoff, huddles, and leadership responsiveness have created confusion and hindered team coordination. The project aims to improve communication effectiveness scores among OB ANMs from 50% to 75% by July 11, 2025.

Context: The project was conducted in the Maternal-Child-Health (MCH) unit of a hospital in Northern California, specifically targeting communication practices among OB ANMs. Concerns around communication practices were voiced by both ANM leadership and frontline staff, signaling …

Education Plan On Colonoscopy Preparation And Communication To Improve Colonoscopy Prep And Ensure Better Outcomes, Maryam Pourjalil

Walden Dissertations and Doctoral Studies

This Doctor of Nursing practice (DNP) staff education project introduced a formalized staff education program to refine colonoscopy preparation quality at a community gastroenterology clinic. Suboptimal bowel preparation in 20%–30% of colonoscopies resulted in missed lesions, higher costs, and decreased satisfaction of the provided quality of care, which highlighted the need for enhanced staff education in nursing practice. The project question was: Does the education of staff on colonoscopy preparation procedures bridge the existing knowledge gap regarding modern colonoscopy techniques? My goal was to increase staff knowledge regarding standardize prep instructions. The project was designed using best practice evidence and …

Quality Improvement Project Implementing Comprehensive Foot Exams In Pediatric Patients With Diabetes, Jimmy Penn

Doctor of Nursing Practice Projects

Pediatric patients with diabetes face many of the same long-term complications as adults, including neuropathy. Yet screenings are often overlooked in this population. Research shows that pediatric patients with diabetes experience neuropathy symptoms, yet screening in this population remains underperformed. The purpose of this quality improvement project was to implement a comprehensive foot exam for eligible pediatric patients with diabetes and improve provider adherence through education. The project addressed the question: “Among providers in a pediatric endocrinology clinic, how does implementing education on foot exams, compared to no education, impact provider knowledge and compliance with performing pediatric foot exams over …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Implementing A Multi-Faceted Approach To Reduce Falls And Enhance Safety In Psychiatric Patients While Improving Nurses Perception While Improving Nurses Perception Of Fall Risk Identification, Shanika King

Doctor of Nursing Practice Final Project Abstract

Purpose: The goal of this quality improvement project was to decrease falls in inpatient psychiatric units by at least 5% within six months, utilizing a multifaceted approach while increasing nurses' ability to identify patients at risk for falls. This project incorporated fall risk assessment, staff education, visual identifiers, and debriefings. Nurse confidence was measured post-intervention using a Likert scale survey.

Background: Psychiatric fall rates range from 13 to 25 per 1,000 hospital days, compared to 3 to 4 in general hospitals. These rates highlight the importance of tailored interventions. This project was completed in an inpatient psychiatric facility in …

Heart Failure And Home Health Care Referral Utilization, Tatiana Le

Doctor of Nursing Practice Final Project Abstract

Heart Failure and Home Health Care Referral Utilization

Purpose

The purpose was to increase provider awareness of the benefits of home health care (HHC) referrals for heart failure patients. It aimed to increase HHC referral utilization intention to maintain compliance with the American Heart Association’s (AHA) recommendation for early follow-up within seven days post-discharge.

Background

Heart failure is a major cause of readmissions in older adults. HHC has been shown to reduce readmissions and improve outcomes post-discharge. HHC referrals remain underused despite its benefits, due to limited provider awareness. This project addressed the gap at a Southeast Texas suburban hospital …

Enhancing Adherence To Oxytocin Administration Guidelines To Reduce Postpartum Hemorrhage Rates In A Labor And Delivery Unit, Maya Denny

Master's Projects and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) remains a critical challenge in maternal care. It shows a 13% PPH incidence rate in a high-risk labor and delivery unit in a northern California medical center, exceeding the national benchmark of 5%–10% based on 2021 ACOG data from 150 patient records.

Problem: There is inconsistent adherence to oxytocin administration guidelines, with only 60% of 100 audited charts documenting fetal and uterine activity, contributing to the elevated rate. The team is looking for a target rate of 90%.

Intervention: This involves implementing a checklist, providing training for 25 clinicians, and conducting two 30-minute simulation scenarios …

Describing Latent Tuberculosis Infection And Treatment Completion In Virginia: A Social Determinants Of Health Approach, Amber N. Harmon

Electronic Theses and Dissertations

While the treatment of latent tuberculosis infection is a key strategy in tuberculosis elimination nationally and globally, there is a limited understanding of the general prevalence of latent tuberculosis as well as factors related to successful treatment. This dissertation describes the known landscape of latent tuberculosis in Virginia and explores possible factors related to latent tuberculosis infection treatment through three manuscripts. The first manuscript, Chapter 1, outlines the overall proposal for this dissertation research in the style of a National Institute of Health grant proposal. The second manuscript, Chapter 2, describes the current understanding of the factors related to latent …

Exploration Of The Cultural Beliefs, Values, And Practices Of African American/Black Women Or Birthing Persons Regarding Postpartum Depression: A Focused Ethnography, Stephanie Jacobs

Electronic Theses and Dissertations

Introduction: Postpartum depression (PPD) is the most prevalent perinatal mental health illness in women, affecting approximately 10% to 20% of all women in the United States, and a disproportionately higher number of African American women. The aim of this study was to explore the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression.

Research Question: What are the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression?

Methodology: A focused ethnography was chosen for this study and consisted of semi-structured interviews. Data was transcribed and analyzed …

Implementation Of Medication Administration Education To Increase Medication Technician Knowledge And Confidence, Nicole C. Yan

Master's Projects and Capstones

Problem: Medication technicians have minimal formal training and education in medication administration. Insufficient knowledge and a lack of confidence present safety concerns, such as medication errors, which decrease the quality of patient care.

Context: The setting is an assisted living facility in the San Francisco Peninsula that provides around-the-clock patient care, promoting independence in a safe and home-like environment for 53 patients.

Interventions: The proposed intervention involves implementing a quality improvement (QI) project to educate medication technicians on medication administration safety. The educational sessions, completed in two in-person sessions, include a PowerPoint lecture, interactive case studies, and group discussion.

Measures: …

Empowering Medical-Surgical Nurses To Conquer Burnout: Building Resilience And Wellness, Catherine P. Morante

Master's Projects and Capstones

Problem: In the healthcare industry, nurse burnout is a well-documented issue that affects the well-being of both healthcare professionals and their patients. Burnout manifests as intense exhaustion, depersonalization, and diminished personal accomplishment (Okoniewski & Verni, 2024).

Context: Burnout affects patient outcomes and drives up costs (Dall’Ora et al., 2020). When nurses are overwhelmed, attendance is affected (Unpublished confidential document; 2024). Resilient nurses are essential to a healthy, reliable workforce (Unjai et al., 2024).

Interventions: From May to July 2025, a 12-week initiative was launched to reduce the effects of nurse burnout in the workplace. Evidence-based interventions were implemented, incorporating educational …

Illuminating Leadership Excellence: An Evidence-Based Qi Intervention Reigniting Nurse Leaders From Burnout To Brilliance Using Caring Science And Reflective Practice, Matthew S. Elliott

Master's Projects and Capstones

Abstract

Problem: A 2024 assessment at a 250‑bed Northern California medical center revealed that 76% of 16 inpatient nurse leaders met "high‑burnout" criteria on the Maslach Burnout Inventory, and leader turnover had climbed to 25%, more than triple national benchmarks, threatening patient care quality, financial stability, and alignment with Magnet® and employee engagement goals.

Context: Root causes included pandemic‑era promotions without development support, a task‑oriented leadership culture, and eroding psychological safety (Press Ganey engagement ≈ 30%). An integrative logic model positioned Watson's Caring Science as the theoretical base, Schön's Reflective Model for adaptive learning, and the Prosci ADKAR change framework …

Enhancing Client Intake Efficiency In The Removal Defense Program: A Nursing-Led Quality Improvement Initiative, Johnny Linares, Julia Tran Ngo, Daniel Orea, Atheana Yadira Lopez

Master's Projects and Capstones

This quality improvement project focuses on optimizing the intake process for the Removal Defense Program at a nonprofit immigration legal office serving asylum-seeking clients. The existing intake relied on unstructured, phone-call-based intake interviews that gathered incomplete information, leading to inconsistent documentation, reduced efficiency, and significant client processing delays. A structured, multilingual, and multiplatform new-client admission protocol coupled with the implementation of a client-facing resource guide for waitlist clients were co-developed and implemented using the Lippitt Change Theory framework. Utilizing a mixed methods approach, the study involved staff interviews and observational assessments with staff members from the program. Baseline intake process …

Quality Improvement Project Increasing Job Satisfaction Among Nurses, Sarah Hines

Doctor of Nursing Practice Projects

Ineffective nurse leadership has been attributed to low nurse satisfaction, a decrease in morale, and can increase nurse turnover rates. Patient care and safety can be affected when nurses are dissatisfied with their workplace. The purpose of this quality improvement project was to increase nurses’ satisfaction rates on three behavioral health units by providing leadership classes for nursing leaders to attend to help combat nurse dissatisfaction rates. The methods utilized a quantitative design with pre- and post-intervention measurements. Pre- and post-intervention Likert-scale questionnaire data collected from direct-patient care registered nurses who met inclusion criteria on three behavioral health units by …

Staff Education To Promote Medication Adherence In Hypertension, Amie Sankoh

Walden Dissertations and Doctoral Studies

A primary care medical clinic experienced an increase in hospital readmission for hypertensive patients, as evidenced by a consistent lack of standardized patient education on medication adherence and a notable increase in readmission rates for uncontrolled hypertension. Hypertension is a significant public health problem associated with an elevated risk of heart disease, stroke, and kidney disease. The gap in practice identified was a lack of knowledge among the medical staff in teaching patients about hypertension medication adherence. The practice-focused question was: Does educating primary care medical staff on the importance of medication adherence in hypertension improve knowledge, as evidenced by …

Staff Education On Blood Glucose Monitoring Protocols For Assisted Living Facility Staff, Musa Ahmed Mugenyi

Walden Dissertations and Doctoral Studies

At the practice site, older residents face inconsistent and untimely blood sugar assessments, contributing to avoidable complications such as hypoglycemia, hyperglycemia, and hospitalizations. Many caregivers lack standardized training in blood glucose monitoring, which poses a significant risk to residents with diabetes or prediabetes. To address this practice problem, a staff education program on blood glucose monitoring protocols was initiated. The practice-focused question was the following: Will staff knowledge and confidence increase after participating in an education program on monitoring blood glucose levels? As part of the education program, staff received evidence-based instruction on proper techniques for blood glucose testing, recognizing …

Sbar: Handoff Communication Technique For Nurses, Carrie Jane Barnett

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project aimed to address inconsistent and ineffective handoff communication among healthcare staff in a 44-bed observation unit. ​ The project focused on implementing an education program centered on the SBAR (Situation-Background-Assessment-Recommendation) communication technique to improve staff knowledge and communication practices. ​ Using a pretest/posttest design, the program demonstrated significant knowledge gains among participants, with a cohort-normalized gain of 0.85 and statistically significant improvements in test scores (p < .05). The intervention highlighted the importance of structured communication in enhancing patient safety, reducing errors, and fostering interdisciplinary collaboration. ​ Despite limitations such as a small sample size and time constraints, the project highlighted the value of SBAR as a reliable tool for enhancing communication and improving patient outcomes. ​ Recommendations include ongoing SBAR training, integration into onboarding programs, and expansion to other departments to sustain long-term improvements in communication and care quality. ​

Implementation Of Cognitive Therapy Online Modules To Impact Advanced Practice Leader Burnout: A Quality Improvement Project, Courtney Cambell

Doctor of Nursing Practice Projects

Advanced Practice Provider (APP) leaders face unique stressors due to their dual roles as clinicians and administrators, which places them at an elevated risk for burnout. This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate the impact of self-paced cognitive behavioral therapy (CBT) programs, specifically Learn to Live and Lyra, on burnout among APP leaders at a medical center affiliated with a university and a children's hospital. Theproject spanned over six weeks, during which participants completed the Mini-Z Worklife Questionnaire for Leaders, assessing the effectiveness of the CBT programs. Although the original statistical analysis plan included a …