Medicine and Health Sciences Commons^™

The Effect Of An Educational Intervention On Pre-Licensure Nursing Students Using The Theory Of Cultural Humility, Margaret Curry

Doctoral Dissertations and Projects

The American population has become more racially and ethnically diverse. Pre-licensure nursing students must have the knowledge, skill, and attitude to meet the needs of this diverse patient population. The purpose of this study was to educate pre-licensure nursing students on the concept of cultural humility using standardized patients from diverse cultural backgrounds in simulation experiences. The 27 students in this study were enrolled in a traditional nursing program in the southern U.S. This one-group quasi-experimental pretest–posttest design used Foronda’s Cultural Humility Scale. These students completed this scale (pretest), participated in simulation experiences with standardized patients from diverse cultural backgrounds, …

The Impact Of Trauma-Informed Care Education On Healthcare Providers And Staff In An Outpatient Clinic: A Holistic Approach To Diversity, Equity, And Inclusion, Ngozi Azu

Doctoral Dissertations and Projects

Trauma is an emotional response that an individual may experience due to exposure to an event beyond their ability to manage. Trauma-informed care (TIC) is essential in health care for creating a supportive and safe atmosphere for individuals with a trauma history, but many health providers and staff lack proper training in TIC. The purpose of this project was to design, implement, and evaluate a comprehensive education program focused on TIC for health care providers and staff in an outpatient clinic setting. A quasi-experimental methodology and the Iowa Model of Evidence-Based Practice were used. Quantitative and qualitative data were collected …

Psychotropic Medication Nonadherence Among Psychiatric Patients Using Motivational Interviewing, Kate Ananga Pabai

Walden Dissertations and Doctoral Studies

This educational intervention involved enhancing knowledge and competency of nursing staff in terms of application of motivational interviewing (MI) techniques to improve adherence to prescribed psychotropic medications among patients with mental health conditions. The project met criteria for a staff education initiative, directly addressing the ongoing issue of psychotropic medication nonadherence, a prevalent and pressing challenge at the project site. Clinicians observed frequent missed doses and treatment discontinuation, leading to symptom relapse, emergency room visits, and avoidable hospital admissions. These outcomes emphasized the need for a targeted intervention to support frontline nursing staff. The practice-focused question guiding the project was: …

Enhancing Medication Communication In The Acute Care Setting To Strengthen Patient Comprehension And Retention, Ashleigh C. Christensen

Student Scholarly Projects

Practice Problem: Research has shown that breakdowns in communication, especially in the context of medication education, play a critical role in the delivery of safe and effective patient care. These findings underscore the need to prioritize effective communication in medication education. In the acute care setting, effective communication is essential for ensuring patient safety, adherence, and improved patient-centered outcomes.

PICOT: In clinical staff providing direct patient care in the acute care setting (P), does the implementation of the evidence-based teach-back method (I), as compared to current practice (C), improve patient knowledge, understanding, and self-management upon discharge (O), over ten weeks …

Controlling Hypertension In The African American Population Through Dash Diet Education, Tanya K. Mccaskill

Doctor of Nursing Practice Projects

Hypertension disproportionately affects African Americans, contributing to elevated risks of stroke, cardiovascular disease, and kidney failure. Despite the well-established benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, its adoption remains limited due to cultural, socioeconomic, and health literacy barriers. This Quality Improvement (QI) project aimed to evaluate the effectiveness of a culturally tailored DASH diet education intervention in improving nutritional knowledge among African American adults with hypertension (HTN). Using a quasi-experimental pre-post intervention design, 50 participants received a structured educational session during a single clinic visit, which included counseling, printed materials, and sample menus. The intervention was guided …

Staff Education To Improve Preceptors’ Knowledge Base To Adapt Teaching Methods Across Generations, Lucretia Dennise Sanders

Walden Dissertations and Doctoral Studies

Today’s nursing workforce consists of individuals from multiple generational cohorts, which creates a dynamic mix of nurses whose behavior and work reflect the cultural and historical events that shaped their generation. As the nursing workforce becomes increasingly multigenerational, nurse educators and leaders face growing challenges in ensuring that onboarding practices meet the needs of diverse learners. In the local organization, leaders and clinical educators observed inconsistencies in preceptorship practices and onboarding experiences, particularly for newly hired nurses. As a result, leaders determined that an educational intervention focused on generational teaching strategies was needed. Thus, the purpose of this Doctor of …

On The Use Of Wearable Continuous Glucose Monitors (Cgms), Jovita Ozonnadi

Walden Dissertations and Doctoral Studies

This DNP project implemented an educational module on the use of continuous glucose monitoring devices (CGM) to increase staff knowledge of diabetic care and glycemic control for the diabetic population in a community healthcare clinic. Diabetes mellitus is a significant health concern that poses a substantial challenge to the community and the American healthcare system with a higher burden of diabetes complications found among the low income, uninsured, and minority populations. Poor glycemic control is a major health issue that significantly increases the risk of developing diabetes-related complications such as heart and kidney diseases, and obesity. The adoption of CGM …

Screening For Bullying In A Middle School Setting, Paige Bernau

Dissertations

Problem: Bullied youth are two and a half times more likely to experience depression and three times more likely to experience anxiety and suicidal ideation than their peers (Li et al., 2024). Schools represent a key access point for mental health support and treatment for youth (Duong et al., 2020). Despite this, schools typically do not have formal bullying screening integrated into student support services.

Methods: This program evaluation used a descriptive, observational design to evaluate a bullying screening program in a suburban middle-school. This program used the California Bullying Victimization Scale (CBVS) to assess for bullying victimization (BV) followed …

Implementation Of An Evidence-Based Postpartum Depression Screening Tool In A Level Iv Neonatal Intensive Care Unit, Morgan A. Takacs

Dissertations

Problem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes.

Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the …

Evaluation Of A Behavioral Response Team To Decrease Use Of Violent Restraint, Katherine Skrade

Dissertations

Abstract Introduction: The purpose of this Quality Improvement project was to evaluate the implementation of the Behavioral Assessment and Response Team (BART) and evaluate its effect on occurrence and duration of violent restraints on non-psychiatric floors in a pediatric hospital. This QI project also aimed to correlate the use of the Broset Violence Checklist (BVC) to the utilization of the BART as a means of predicting patient escalation, as well as to assess the effect of booster education on the BVC and BART on bedside staff confidence in utilization of these resources.

Methods: Data was collected across three time periods: …

Implementing A Standardized Protocol To Screen For Depression In A Gastroenterology Outpatient Clinic, Catherine M. Karle

Dissertations

Problem: There is a lack of mental health screenings for depression taking place in outpatient gastrointestinal (GI) clinics. Outpatient gastrointestinal (GI) offices are not consistently screening patients for depression despite a rise in depression rates and the known adverse impact depression can have on the GI tract.

Methods: This Quality Improvement (QI) study used a descriptive research design guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model. Its purpose was to implement a 10-week PHQ-2/PHQ-8 depression screening protocol at a large midwestern health center's gastroenterology outpatient clinic. The study used purposive sampling, including all GI outpatients aged 18+ with …

Palliative Care Beyond Cancer: The Use Of The P-Cares Tool, Breslin E. Meyer

Dissertations

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 …

Implementation Of Quantitative Blood Loss To Detect Postpartum Hemorrhage After Vaginal Birth, Raven S. Simpson

Dissertations

Problem: In the U.S., postpartum hemorrhage (PPH) is attributed to maternal morbidity and mortality, resulting in long-lasting effects of extended recoveries, surgical interventions, birth-related trauma, interruptions in mother-infant bonding, or death. Performing estimated blood loss (EBL) measurement methods postpartum is subjective and often associated with over- and underestimations of blood volume. The delay in recognition interferes with timely, efficient, and appropriate interventions, yielding a PPH (≥1000ml).

Methods: A quality improvement (QI) project was initiated with a descriptive, pre-implementation/post-implementation focus on a high-risk Labor and Delivery unit to explore the effects of Quantitative Blood Loss (QBL) measurements on the identification of …

Implementation Of A Nurse-Driven Process To Decrease Npo Times In A Geriatric Emergency Department, Luke D. Little

Dissertations

Prolonged nil per os (NPO) status for geriatric patients in the emergency department is a critical safety issue, leading to increased rates of delirium, hypoglycemia, and perioperative complications. A quality improvement project was designed to address this problem through a targeted, nurse-driven intervention. In geriatric patients (age ≥70) in a geriatric emergency department, this project aimed to determine if implementing an electronic health record (EHR)-prompted nursing workflow to obtain a diet order would reduce the length of time patients were kept NPO compared with standard practice. An EHR documentation tool was designed and implemented along with targeted nursing education sessions …

Transportation: A Barrier To Healthcare Access Among Disabled, Older Adults With Diabetes And Hypertension In Rural Areas, Anne G. Mwangi-Amann

Dissertations

Problem: Transportation is essential for health service utilization (clinic appointments, diagnostic services, and picking up medications from the pharmacy (Hansmann & Razon, 2024). Shekelle et al. (2022) in their systematic review and meta-analysis indicated that the U.S. rural population is 60 million. Rural areas continue to experience transportation as a significant barrier to health, a key social determinant of health. It causes delayed or foregone care in approximately 3.6 million people annually, resulting in more than 25% of missed appointments. Methods: This quality improvement project utilized a descriptive and observational design. A convenience sample of Medicaid patients receiving care at …

Bowel Regimen Protocol Implementation For Pediatric Patients Following Cardiac Surgery, Eryn Watson

Dissertations

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients …

Implementation Of A Human Papillomavirus Vaccination Toolkit Postpartum, Emily R. Leone

Dissertations

Problem: Human papillomavirus (HPV) is the most common sexually acquired infection in the world (DeCherney et al., 2018). Even a single dose of the HPV vaccine can provide up to 97% protection against HPV 16 and 18, which are the strains that cause 70% of all cervical cancers (Barnabas et al., 2022). Missouri ranks 35th in the country for HPV vaccination (Office of Disease Prevention and Health Promotion, 2020).

Methods: This quality improvement project implemented an HPV toolkit consisting of: 1) staff nurse education in the form of a written presentation 2) patient and provider education in the form of …

Motivational Interviewing For Weight Loss: A Review Of Evidence-Based Outcomes In Overweight And Obese Adults, Marian Dover

Dissertations

Obesity is a significant clinical problem affecting 41.9% of adults in the United States, with profound implications for individual health and healthcare economics. Standard weight loss interventions, often limited to pharmacological treatments and dietary guidance, frequently fail to achieve sustained adherence and meaningful longterm outcomes. This quality improvement (QI) project evaluated the integration of motivational interviewing (MI), a patient-centered counseling strategy, into routine clinical practice at Innovafusion, a medically supervised weight loss clinic in Aubrey, Texas. The aim was to enhance adherence to lifestyle modifications, promote intrinsic motivation, and improve weight loss outcomes among adults aged 18–65. Using a retrospective …

Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

Race-Neutral Pft: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing, Ann M. Way

Dissertations

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient …

Implementing A Turn Team Process To Reduce Hospital-Acquired Pressure Injuries On A Telemetry Unit At A Hospital In The Midwest, Sally Wang

Dissertations

Problem: Pressure injuries (PI) are localized wounds to the skin and soft tissues that typically result from sustained pressure on specific areas of the body (Zaidi & Sharma, 2024). Hospital-acquired pressure injury (HAPI) refers to pressure injuries that develop while a patient is in the hospital (Rondinelli et al., 2018). PI can cause patients to experience pain, decreased feelings of dignity, increased feelings of depression and anxiety, reduced levels of social activity, difficulty sleeping, and impaired cognitive function (Roussou et al., 2023). The Advanced Cardiac Care Unit (ACCU) at Missouri Baptist Medical Center experienced an increase in HAPI cases: …

The Psychological Impact Of Parenting Child Victims Of Trauma, Stephanie Faulkingham

Dissertations

Abstract

Research indicates that non-offending caregivers of traumatized children (NOC) is a population with an elevated risk for increased levels of depression and anxiety and are an underserved population for mental health services. The purpose of this quality improvement project was to determine if screening caregivers of traumatized children using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder (GAD-7) improves identification of depression and anxiety. Participants of this investigation were individuals enrolled in the Children’s Advocacy Services of Greater St. Louis’ 12-week parenting group, TASK (Trauma, Assessment, Skills, and Knowledge). Each participant was asked to complete the PHQ-8 and …

Depression Screening In The Adult Inpatient Oncology Population, Erica Bizub

Dissertations

Routinely screening oncology patients for depression is recommended due to the higher rates of depression in this population as well as the negative impact of untreated depression. The goal of this QI project is to implement a standard depression screening protocol for patients admitted to this hospital, where there is currently no standard screening protocol. There were 110 patients included in this study, and 67 (60.91%) of patients received a PHQ-9 screening. Of the patients who completed the PHQ-9, 21 (19.09%) had a positive screening, which was a score of seven or higher. While there were high rates of provider …

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

No central documentation of care plans exists for children with special healthcare needs (CSHCN) in the electronic health record (EHR). Providers of a large pediatric primary care office in St. Louis Missouri were asked to identify CSHCN in the practice. Clinic nurses completed a comprehensive chart review of the patients identified and constructed care coordination documents using a pre-established smart-text phrase. Subsequently, these were documented centrally in the EHR under the Problem List.

Likert score data was obtained from providers on the acceptability, appropriateness, and feasibility of the intervention through the verified tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness …

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ In Primary Care To Reduce Pediatric Behavior Concerns, Katie Anderson

Dissertations

Abstract for:

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ in Primary Care to Reduce Pediatric Behavior Concerns

Problem: Parents of children 2-5 years-old increasingly reach out to PCPs for escalating behavior concerns, including when the child doesn’t listen well, is inattentive, having tantrums, meltdowns, hitting, yelling, etc. Referrals to psychiatry and/or play therapy result in long waits, or referrals not accepted. Coincidingly, toddler and preschool aged children continue to exceed daily screen time recommendations. This results in a gap of care for families with young children and externalizing behavior.

Methods: This quality improvement project addressed …

Best Practice Toolkit For Burnout Prevention In Emergency Department Nurses, Moises A. De Oleo

Student Scholarly Projects

Practice Problem: Burnout Syndrome (BS) is a serious problem in emergency department (ED) nurses and is associated with higher nurse turnover rates. A burnout prevention toolkit is needed.

PICOT: The project was guided by the following PICO question: "For emergency department nurses (P), how does the development of the best practice burnout prevention toolkit (I), compared to the absence of a structured intervention (C), support the establishment of nurse burnout best practices when evaluated using the CDC Program Evaluation Framework? (O)".

Evidence: The analysis of the literature supported the implementation of active interventions in the form of workshops.

Intervention: A …

Promoting Pre-Exposure Prophylaxis (Prep) Regimen Adherence Through A Multifaceted Approach To Increase Adherence: A Quality Improvement Project, Queen C. Ezenwome

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to implement the use of daily text message reminders to promote PrEP medication regimen adherence, thereby reducing the risk of HIV acquisition in an at-risk population. Patient interviews and surveys were also conducted to obtain valuable information regarding barriers and facilitators to PrEP regimen adherence.

Background

The project was implemented at a homeless shelter in Harris County, Houston, Texas, that houses homeless youth ages 18-24 while also providing medical, educational, and financial services or assistance. Due to risky behaviors prevalent in this population, coupled with living in the Houston area, these patients …

Quality Improvement Project Educating Nursing Faculty On The Lasater Clinical Judgment Rubric In Simulation, Tiffany Shivers

Doctor of Nursing Practice Projects

This quality improvement project aimed to enhance nursing faculty preparedness in simulation-based education by increasing knowledge and self-efficacy using the Lasater Clinical Judgment Rubric (LCJR). A quasi-experimental, one-group pre-/post-intervention design was used to evaluate outcomes among ten faculty participants. The intervention consisted of an educational session introducing the LCJR and structured debriefing techniques. Data were collected using a knowledge assessment and the General Self-Efficacy Scale. Descriptive statistics and the Wilcoxon Signed-Rank Test were used to analyze changes in scores. Results demonstrated statistically significant improvements in both knowledge (Z = –2.805, p = .005) and self-efficacy (Z = –2.666, p = …

Impact Of Primary Care Healthcare Providers Patient Electronic Medical Records Completion Rates Using Speech Recognition Dictation, Pepper Losely

Student Scholarly Projects

Practice Problem: Completion of electronic medical records (EMRs) is an ongoing problem for providers, facilities, and insurance reimbursement. Current completion of EMRs lack standardized processes to make EMRs completion easier for providers with their busy workday and allow optimal time for patient care.

PICOT: For healthcare providers at primary clinics (P) will implementing speech recognition dictation (SRD) for data entry into the electronic medical records (EMRs) (I) compared to the current practice of manually typing all data causing long medical record turnaround times (c) improve medical record completion within 30 days (O) over 10-weeks (T).

Evidence: Evidence that was …