Medicine and Health Sciences Commons^™

Implementation Of The Nurse-Driven Palliative Care Referral Protocol: A Quality Improvement Project, Khrystyna Lacombe

Doctor of Nursing Practice Scholarly Projects

Implementation of the Nurse-Driven Palliative Care Referral Protocol

Background and Purpose: Palliative care enhances quality of life, symptom management, and patient–family communication for individuals with serious illness. Despite strong evidence and national recommendations for early integration, referrals remain inconsistent and often occur late. At Advocate Sherman Hospital, only 17.9% of eligible oncology inpatients received palliative care consults. The absence of standardized referral criteria, reliance on provider discretion, and misconceptions equating palliative care with hospice contributed to delayed or missed consults. The purpose of this quality improvement (QI) project was to increase palliative care referrals by 20% within eight weeks through …

Reducing Acute Care Visits In Oncology: A Pilot Quality Improvement Project, Judy Metropulos

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Patients receiving high-toxicity chemotherapy are at risk for post-infusion complications, which can result in unplanned hospital visits or admissions. Structured post-infusion follow-up may improve symptom management and reduce these events.

Local Problem: At North Region hospital, the 30-day post-infusion revisit rate was 31%, substantially exceeding the national average of 14.7%. A pilot program launched in 2021 reduced hospital visits by 7%; however, following its discontinuation due to staffing shortages and inadequate data collection, the rate subsequently increased, underscoring the need for sustainable interventions.

Methods: A quality improvement project was conducted in two, ten weeks phases. Phase 1 included …

Associations Between Older Hispanics’ Diabetes Control And Their Caregiver’S Health Literacy, Jorge Rico

Nursing Dissertations - Archive

Background: Older Spanish-speaking Hispanics are a rapidly growing population in the United States that face disproportionally high rates of diabetes and inadequate health literacy. Familism is valued among Hispanics and caregivers may play an important role in overcoming the social determinants of health facing this vulnerable population. Methods: This descriptive correlation study sought to explore correlations between the caregiver’s health literacy and the patient’s control of diabetes. Findings: Mixed effects model found a significant correlation between the caregiver’s print literacy and the patient’s hemoglobin A1c. Conclusion: The findings are encouraging for future research to explore interventions that target the caregivers …

Perception Of Spirituality By Intensive Care Unit Nurses, Adejoke Felicia Ogidan

Nursing Dissertations - Archive

ICU nurses are identified as a population of nurses with a high risk of experiencing psychological stress due to the nature of their job in the ICU (Lyndon, 2015; Welp et al., 2015). Psychological stress is detrimental to nurses' mental health and the quality of patient care.

According to Watson’s Transpersonal Human Caring Theory, the spiritual perception of the nurse influences the nurse’s spiritual care practice, which in turn affects their self-care and care provided by the nurse to patients (Watson, 2021)This research explored the ICU-Ns' perception of spirituality and its relationships with spiritual care practices and self-assessed competency in …

The Lived Experiences Of Older Adults With Cancer Who Are Non-Adherent To Prescribed Oral Chemotherapy: A Descriptive Phenomenological Study, Ludmila Kosmari

Nursing Dissertations - Archive

Background: Despite the ease of receiving OCT, patients’ OCT adherence is low. With this low prevalence rate, patients are not likely obtaining the full life-promoting effects of OCT. Since medication adherence is often related to lived experiences and standardized medication adherence instruments may not capture these experiences completely, the purpose of this study was to explore how the lived experiences of older adults with cancer influence their adherence to OCT.

Methods: the researcher used a descriptive phenomenological design and conducted individual interviews with 20 older adults with cancer. All participants were prescribed OCT and reported missing at least one dose. …

Case Management For End-Stage Renal Disease Patients, Jamie L. Andrews

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Social determinants of health (SDOH) and health literacy directly impact adults with end-stage renal disease (ESRD) on hemodialysis (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2022; Ulrich, 2020). Adults with ESRD account for 1.5 million hospital admissions and 500,000 re-admissions within 30 days annually (NIDDK, 2022). Case management is essential in reducing re-admissions for adult ESRD patients, requiring abilities to identify factors affecting adult ESRD patients appropriately.

Methods: Therefore, an evidence-based practice (EBP) project using the IOWA Model framework was implemented to increase the knowledge base in identifying care and resources for ESRD patients for telephonic …

Nursing Workplace Rituals: Communication Before, During, And After Covid-19, Angel Infante

Nursing Dissertations - Archive

ABSTRACT

NURSING WORKPLACE RITUALS: COMMUNICATION BEFORE, DURING, AND AFTER COVID-19

Angel Infante, PhD

The University of Texas at Arlington, 2025

Professors: Dr. Deborah Behan (Committee Chair), Dr. Yungfei Kao (Committee Member), and Dr. Jessica Grace Smith (Committee Member)

Background: According to Griner et al. (2021) many disruptions caused confusion for healthcare workers during the pandemic. Communication is imperative when dealing with everyday disruptions in a hospital setting. However, it is even more important to learn about the different types of communication and what is communicated during a past pandemic to know how and what to communicate in a future pandemic. …

Factors Contributing To Technostress In Nursing Education: A Study Of Master Of Science In Nursing (Msn) Education Students, Jennifer Weber

Nursing Dissertations - Archive

This mixed-methods study examined factors contributing to technostress among Master of Science in Nursing (MSN) Education students enrolled in a fully online program. Guided by the Technostress Trifecta Model, the study explored the relationships among age, grade point average (GPA), years of nursing experience, and self-rated technical skills, as well as students’ perceptions of technology use in learning.

Data were collected from 94 participants using the Technostress Scale by Upadhyaya and Vrinda (2021). Quantitative analyses showed that self-rated technical skill was significantly associated with lower perceived technological complexity, while age was significantly associated with both techno-invasion and techno-uncertainty. GPA and …

Guideline On The Education And Use Of The Cognitive Assessment And Care Planning Services Visit For Patients 65 And Older With Cognitive Impairment, Katherine J. Koonce

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: The lack of education and use of the Cognitive Assessment and Care Planning Services (CACPS) visit creates a gap in care for Medicare patients over the age of 65 with cognitive impairment.

Methods: Recommendations were created from a robust collection of graded, evidence-based literature. The recommendations were presented to a set of stakeholders who rated each recommendation on a Likert scale from 1 (poor) to 4 (excellent).

Results: The twelve stakeholders agreed with the recommendations to support the education and use of the CACPS visit for Medicare patients 65 and older.

Conclusion: This guideline promotes provider education to investigate …

Improving Pediatric Delirium Assessment Documentation And Nursing Knowledge In A Pediatric Cardiovascular Intensive Care Unit, Heather E. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Pediatric delirium is prevalent in the Pediatric Cardiovascular Intensive Care Unit (PCICU). It is associated with longer PCICU stays, extended hospital stays, prolonged duration of mechanical ventilation, and higher hospital costs (Mallick et al., 2022). It has also been associated with increased mortality risk and decreased quality of life after hospital discharge (Rohlik et al., 2021). Due to the adverse sequelae associated with pediatric delirium, routine screening with a validated screening tool is recommended (Flagg & Mauney, 2023). Despite consensus guidelines advocating routine screening for pediatric delirium, routine screening is not being completed (Flagg & Mauney, 2023).

Decreasing Hospital-Acquired Clostridium Difficile Infections, Angel S. Louder

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Clostridium Difficle Infection (CDI) is a significant healthcare threat due to its ability to be transmitted rapidly in healthcare settings. Patient engagement and participation in infection prevention initiatives at admission will lead to early implementation of isolation precautions, diagnosis of infectious pathogens, and treatment. A quality improvement project was implemented at a south-central Texas acute care hospital to engage alert and oriented adult patients, using a bundled approach to screen for the early detection of CDI within 48 hours of hospital admission, thereby reaching the goal of reducing hospital-acquired CDIs. This initiative improved patient engagement with CDI screening, reducing confirmed …

Enhancing Patient-Centered Efficiency: Reducing Cardiology Clinic No-Shows Using Technology, Pre-Visit Planning & Patient Resources, Pat Shirey

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Cardiovascular disease (CVD) affects 48% of U.S. adults, requiring regular cardiology visits to manage risk factors and the early detection of complications (American Heart Association, 2019). No-shows disrupt continuity of care, worsen health outcomes (Choi et al., 2020), and decrease clinic efficiency (Goossens et al., 2022). A North Texas cardiology clinic reported a 31.9% overall no-show rate and a 42.1% no-show rate for new patients, costing $1.3 million annually.

Purpose: This quality improvement project aimed to reduce no-show rates through a patient-centered cardiology appointment bundle to improve continuity, patient outcomes, and efficiency.

Methods: This eight-week project utilized the Plan-Do-Study-Act …

Reducing Spinal Induced Hypotension In Cesarean Sections: A Multimodal Approach, Tyran D. Heilig

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Spinal anesthesia is the preferred method for elective cesarean sections due to its rapid onset, ability to keep the mother awake, and lower risk of complications compared to general anesthesia (Shitemaw et al., 2020). However, spinal-induced hypotension (SIH), caused by a sympathetic block, occurs in up to 75% of cases (Sklebar et al., 2019). A 2019 global study conducted in Ethiopia of 410 women found the incidence of SIH in cesarean sections to be 64% (Shitemaw et al., 2020). A Texas study found that 99.4% of cesarean deliveries experienced SIH, and 12% of those cases resulted in severe hypotension, …

Toolkit To Promote Good Hand-Hygiene Among Kenyan School Children, Jo Martinez

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Among healthcare providers and educators in Kenya who work with and educate school-aged children, a toolkit that includes a guideline, educational hand-hygiene posters, handouts, and resources on hand hygiene for children using graded literature, assists educators and healthcare providers with education of school-age children regarding sanitation.

Methods: The recommendations were created using a collection of graded literature. The recommendations were presented to stakeholders of healthcare providers and educators from urban and rural areas. The stakeholders rated each recommendation using a Likert scale from 1 – very poor to 4 – very good.

Results: Five of the six stakeholders who …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Patients’ Experiences And Management Practices Of Hypertension Among The Pastoralist Community Of Marsabit County, Christine Chepkemoi Chesiror

MSc in Advanced Practice Nursing

Hypertension is a global public health challenge and a leading cause of morbidity and mortality, particularly in low- and middle-income countries, where it accounts for 86% of deaths from non-communicable diseases. With over 1.5 billion cases projected by 2025, hypertension significantly increases the risk of heart disease and stroke. Despite this, little is known about the experiences and self-care practices of pastoralist communities living with hypertension.

This study employed a descriptive, exploratory, cross-sectional design to investigate the experiences and self-care practices of individuals managing hypertension among the pastoralist of Marsabit County. Twelve participants receiving follow-up care at Uran and Sololo …

Prioritization Among School Nurses: An Integrative Review Of The Literature, Melissa Calvillo, Susana J. Calderon, Maureen Rabbitte, Cherrill Stockmann, Sheryl Henry

Faculty Publications - Mennonite College of Nursing

With a median caseload of 750–1,000 clients, school nurses face setting-specific challenges involving multiple, competing demands. This necessitates effective prioritization to prevent missed opportunities to provide appropriate care. This integrative review synthesizes the current state of the literature related to prioritization among school nurses in the United States. Three themes were identified relating to prioritization among school nursing: knowledge, attitudes and values; self-efficacy and intention to act; and the nursing process. The prioritization behavior of school nurses can be facilitated by organizational and community collaboration and strong evidence-based practice recommendations. High workloads and inadequate resources among school nurses are the …

Optimizing Pelvic Health: Evaluating The Efficacy Of Prenatal Strength And Resistance Training Combined With Pelvic Floor Muscle Exercises In Reducing Pelvic Organ Prolapse Risk, Samantha Requilman

Nursing | Senior Theses

While postnatal recovery is focused on the newborn, the mother’s health is equally important – particularly in preventing pelvic organ prolapse (POP), a condition that results in pelvic discomfort, incontinence, and a reduced quality of life. Although clinicians encourage pelvic floor muscle exercises (PFME) throughout pregnancy, POP is still prevalent among women, especially those who deliver vaginally. There are limited research studies on the effectiveness of prenatal resistance training in the prevention of pelvic dysfunctions and this study aims to address the gaps in the literature. So the question to address this study is: Does combining prenatal resistance training with …

The Effect Of Length Of Nursing Shift On The Development Of Medical Errors, Andrew J. Hom

Nursing | Senior Theses

The relationship between extended nurse work hours and increased clinical errors is a growing concern in nursing and healthcare systems. This issue has only grown more pronounced since the pandemic, which exacerbated staffing shortages and placed unprecedented demands on the nursing workforce. Longer shifts often lead to fatigue, impaired decision-making, and decreased cognitive performance, creating challenges for both nurses and patients. To better frame the analysis, this thesis relied on The Swiss Cheese Model to better conceptualize risk management. This thesis examined the correlation between consecutive hours worked and the frequency of errors made by nurses while also exploring the …

The Role Of Sexual Assault Nurse Examiners: Addressing The Shortage And Its Implications For Healthcare, Isabel Mary Mccarthy

Nursing | Senior Theses

Background: Sexual Assault Nurse Examiners (SANE) are registered nurses specifically trained to perform forensic examinations and provide medical and emotional support to sexual assault victims. Many nursing programs lack formal education on SANE practices, which can hinder students' preparedness to address such cases in their future careers.

Method: A mixed-methods, three-phase approach to evaluate the effectiveness of a Sexual Assault Nurse Examiner (SANE) training module within the Dominican University of California Nursing Program. 40- 60 nursing students will be separated into two separate community health classes with one given module in SANEs nursing and the other not. Both classes …

Improving The Emotional Wellbeing Of Healthcare Workers In A Homecare Agency, Crystal U. Okafor

Doctor of Nursing Practice Projects

Healthcare workers (HCWs) often have traumatic experiences in the course of care delivery, and these experiences negatively impact their well-being, affecting them emotionally, psychologically, and physically. With the COVID-19 pandemic, healthcare workers have had indelible experiences questioning their choice of profession. This project aimed to teach the factors affecting the emotional well-being of healthcare workers and develop strategies to improve emotional distress in a home care agency. The implementation site was Carolina Homecare Solutions, with 21 participants, including nursing assistants and registered nurses. Sample selection was via a convenient strategy, selecting the most conveniently available participants. The project leader used …

The Use Of Therapeutic Communication To De-Escalate Aggression And Violence In Clients Living In A Homeless Shelter, Tionna S. Felder

Doctor of Nursing Practice Projects

Individuals working at homeless shelters have the daunting task of managing violent/aggressive behaviors with the population they serve. This project focused on educating homeless shelter staff on the use of therapeutic communication to decrease the escalation of aggression and violence when caring for their guests. The DNP Project Leader taught 23 homeless shelter staff members, and the project included three 2-hour educational sessions. The first class focused on understanding what regions in the brain are responsible for aggressive, violent, and emotional behaviors; the second class focused on what the literature says about aggressive behavior in homelessness; and the last class …

Increasing Awareness And Support For Women With Anxiety Disorders In Rural Communities, Candice C. Jones

Doctor of Nursing Practice Projects

Anxiety disorders are among the most common mental health conditions, disproportionately affecting women, particularly those in rural communities with limited access to care. Many women experience perinatal, postpartum, or generalized anxiety, often suffering in silence due to stigma, lack of awareness, and inadequate mental health education. This project focused on increasing awareness and understanding of anxiety disorders among women in rural Randolph County, North Carolina. A comprehensive literature review was conducted to assess the scope of anxiety disorders in women, identify community education needs, and explore evidence-based interventions. Ten relevant studies were analyzed, including randomized controlled trials, cross-sectional studies, and …

Early Recognition In Patient Deterioration: A Quality Improvement Project, Abigail Bell

Doctor of Nursing Practice Projects

This quality improvement project focused on enhancing early recognition of patient clinical deterioration by leveraging a rapid response team to implement targeted strategies that reduce failures in identifying early and subtle signs of physiologic decline. Rapid response teams have been widely adopted across the healthcare system to facilitate efficient interventions and prevent further deterioration in acutely ill patients. Despite their intended purpose, delays in recognizing clinical deterioration continue to exist. Failure to recognize early signs of deterioration contributes to an increased risk of irreversible organ damage, unplanned transfers to the intensive care unit, prolonged hospital stays, and, in severe cases, …

Overdose Response Training For Volunteers In A Homeless Shelter, Heather Lynne Smallwood

Doctor of Nursing Practice Projects

The opioid overdose epidemic is a critical health crisis across the country. The homeless population is substantially more at risk of overdose death compared to the general public. Naloxone is a life-saving medication for reversing opioid overdose and is available to ambulance and emergency care services, but support persons are also in regular contact with opioid users and training (Fine et al., 2022). This DNP Project was created to educate volunteers at a homeless shelter in the event of an opioid overdose. The objective of the project was to increase the knowledge of opioid overdose signs and symptoms and naloxone …

Pantry To Plate: Using Local Food Pantries To Improve Diabetes Self-Care Deficits, Rachelle Zielazienski

Doctor of Nursing Practice Projects

This project aimed to improve food pantry participants’ diabetes self-management and understanding of diabetes nutrition education through a collaborative approach. Over the course of 2 months, the project provided educational resources on diabetes nutrition at a food pantry. The target population included individuals with diabetes, pre-diabetes, and those responsible for preparing meals for diabetic individuals. A certified diabetes specialist was enlisted to ensure the delivery of culturally sensitive, evidence-based educational support tailored to participants’ diabetes health goals. Orem’s Self-Care Deficit Theory served as a framework for this project. A mixed-methods approach was utilized through pre-and post-test design to gather qualitative …

Addressing Physical Inactivity In Cabarrus County, Amy S. Hicks

Doctor of Nursing Practice Projects

Background: 21% of Cabarrus County, North Carolina, residents report complete physical inactivity during their leisure time, contributing to various health problems affecting 29% to 33% of Cabarrus County residents aged 40 to 84.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to implement and evaluate a 3-week community walking challenge (Trim Before the Turkey Walking Challenge) to increase physical activity and social connectedness among Cabarrus County residents aged 50 and older.

Methods: A pre- and post-program survey design was used to evaluate participant-reported physical activity levels and sense of social engagement. Participants were recruited through the …

Hand Hygiene Education For Personal Care Staff In Congregated Care Settings: A Quality Improvement Initiative, Saunders Noel

Doctor of Nursing Practice Projects

For many years, proper hand hygiene has been emphasized as one of the most important defenses in helping to prevent illnesses. The World Health Organization (WHO) is a major organization that stresses the importance of proper hand hygiene and disease prevention. However, hand hygiene education and knowledge must be acquired to successfully utilize the correct steps in combating illnesses and diseases. Hand hygiene is a learned behavior and emphasizing education and awareness is important to successful adoption. This DNP project was implemented to personal care staff in a congregated care setting located in the southeastern part of Virginia. The project …

On The Frontline: Stop The Bleed© Training For School Staff, Mary Michaela Hinson

Doctor of Nursing Practice Projects

The American College of Surgeons’ Stop the Bleed© course was introduced in 2015 following an outcry from the community surrounding the Sandy Hook Elementary School shooting. The Stop the Bleed© course was developed as a tool for training that any person could participate in, despite their medical background or knowledge. The course is comprised of a 30-minute didactic portion followed by a 30-minute hands-on portion where participants can practice applying tourniquets, packing a wound, and applying manual pressure. This DNP project aimed to educate school staff in a high school located in North Carolina on Stop the Bleed© in an …