Medicine and Health Sciences Commons^™

Quality Improvement Project Empowering Outpatient Providers: A Training Initiative On Social Determinants Of Health, Shannon Wrenn

Doctor of Nursing Practice Projects

Healthcare providers play a critical role in assessing social determinants of health (SDOH), yet many lack the knowledge and confidence to effectively address these factors during patient encounters. Research indicates that SDOH contribute to approximately 80% of health outcomes, yet only 41% of providers feel confident in discussing them with patients. This quality improvement project aimed to improve provider knowledge and confidence about SDOH as measured by pre- and post-education assessments. The SDOH targeted training took place at an outpatient interventional nephrology practice in Memphis, Tennessee. A quasi-experimental, one-group pretest-posttest design was used. Ten clinical staff members participated in an …

Effectiveness Of The Use Of An Opt-Out Script To Increase Hiv Screening In Adolescent Clients In Pediatric Primary Care Clinics In West Tennessee: A Scoping Review, Julie Cupples Msn, Rn, Allison Johnson Ms, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.

Methods

A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and …

The Impact Of Automated Text Messaging System Education On The Self-Efficacy Of Medical Office Staff, Jim Jorgensen

Doctor of Nursing Practice Projects

Inadequate patient bowel preparation is a leading cause of canceled or repeated colonoscopies, negatively impacting both outcomes and healthcare costs. While automated text messaging systems have improved patient adherence in other clinical areas, they remain underutilized by endoscopy staff due to low self-efficacy. This quality improvement project aimed to evaluate the effect of structured education on the self-efficacy of endoscopy nursing staff in using an automated text messaging system for outpatient colonoscopy preparation at a rural VA Medical Center (VAMC). Guided by Bandura’s Social Cognitive Theory and using the Plan-Do-Study-Act model, this project implemented a one-day, hands-on training session with …

Improving Access To Mental Health Care Using Telehealth, Lavern Palmer

Doctor of Nursing Practice Projects

More than half of adults with mental illness in the United States live in mental health deserts—geographic areas with limited access to mental health services and persistent barriers to care. This study investigates the impact of telehealth implementation on patient no-show rates at a rural community clinic in Georgia. The aim was to determine whether the use of telehealth for psychiatric care would decrease the no-show rate of mental health appointments. A retrospective analysis was conducted using patient attendance logs collected 12 weeks before and after the implementation of telehealth services. Quantitative data were analyzed using a Pearson correlation to …

Quality Improvement Project Improving Tele-Sitter Usage In The Surgical Trauma Pcu, Stephanie R. Stone

Doctor of Nursing Practice Projects

This project aimed to improve the knowledge and usage of virtual patient sitters/tele-sitters for surgical trauma progressive care nurses in the surgical trauma progressive care unit through the implementation of nursing education, utilizing evidenced based teaching strategies. Nurse leaders identified a need for staff education among the surgical trauma registered nurse staff population. The goal of the project was to increase knowledge of virtual patient sitters/tele-sitters and how to order them, improve the understanding of the benefits of utilizing the device and to increase the overall usage of the devices on the surgical trauma progressive care unit patients that would …

Quality Improvement Project Improving Tele-Sitter Usage In The Surgical Trauma Pcu, Stephanie Stone

Doctor of Nursing Practice Projects

This project aimed to improve the knowledge and usage of virtual patient sitters/tele-sitters for surgical trauma progressive care nurses in the surgical trauma progressive care unit through the implementation of nursing education, utilizing evidenced based teaching strategies. Nurse leaders identified a need for staff education among the surgical trauma registered nurse staff population. The goal of the project was to increase knowledge of virtual patient sitters/tele-sitters and how to order them, improve the understanding of the benefits of utilizing the device and to increase the overall usage of the devices on the surgical trauma progressive care unit patients that would …

Quality Improvement Project Building Confidence In Critical Thinking Through Faculty Implementation Of Simulation, Melissa Morris

Doctor of Nursing Practice Projects

Simulation provides nursing students with experiences that are as effective as clinical experiences in a non-threatening environment. Clinical experiences such as obstetrics, pediatrics, and mental health have been observation only at the project site. With observation-only clinicals, students do not have opportunities to master skills specific to nursing, which bridge theory to practice. The purpose of this Quality Improvement (QI) project focuses on educating nursing faculty who may not be simulation experts to learn the skills to build and implement simulations that align with the International Nursing Association Clinical and Simulation Learning (INACSL) simulation standards. The Primary Investigator (PI) utilized …

Central-Line Dressing Protocols: The Effectiveness Of A Standardized Dressing Change Protocol In Reducing Central-Line Associated Bloodstream Infections (Clabsi) In Critically Ill Patients Requiring Central Lines, Cody Jones, Melissa Marino, Ryan Mcfarland, Asia White, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

In the Intensive Care Units (ICU), central lines are an essential way of life. However, central lines have risks such as central line-associated bloodstream infections (CLABSI), which increase hospital stays and mortality. CLABSI significantly impacts patient outcomes in critical care, increases mortality and morbidity, increases medical costs, increases hospital-acquired infections, and reduces hospital reimbursements. Typically, antimicrobial dressing has been associated with decreased mortality and improved CLABSI rates. The scoping review will evaluate the literature and examine the effectiveness of various antimicrobial dressing strategies on CLABSI rates. This study aims to synthesize these findings to develop improved CLABSI prevention protocols …

Impact Of Hypertension Education On The Self-Efficacy Of Patients With Uncontrolled Hypertension, Sharita Thompson

Doctor of Nursing Practice Projects

Self-efficacy is an essential aspect of patients being able to manage their uncontrolled hypertension. While it is important to give patients medications for their hypertension, it is just as important to educate the patients about their disease process. Teaching patients risk factors, acceptable blood pressure readings, and signs/symptoms of the disease process can help with decreasing further harm that the disease can cause to the body. This quality improvement project aimed to close the knowledge gap and increase self-efficacy among adult individuals, ages 18-75, who have uncontrolled hypertension by generating data that shows that education on the disease process will …

Quality Improvement Project Enhancing Mental Health Clinic Practices: Increasing Healthcare Professionals' Knowledge And Self-Assurance In Opioid Abuse Screening Tools In Healthcare Professionals Treating Adolescents, Festus Obonna

Doctor of Nursing Practice Projects

This study aimed to address the psychiatric mental health nurse practitioner’s unfamiliarity and inadequate confidence in utilizing the CAGE-AID screening tool in detecting opioid use in adolescents undergoing treatment at a psychiatric mental health clinic. The goal was to find out how structured training affected providers' understanding of and confidence in using the screening tool. Eight psychiatric mental health nurse practitioners, participated in a quasi-experimental pre- and post-intervention design. Descriptive statistics, paired t-tests, and Cronbach's alpha reliability analysis were used to look at the data. There was a significant improvement in providers' self-reported familiarity, confidence, and efficacy in using the …

Quality Improvement Project New And Novice Nurse Faculty: Orientation Bootcamp, Megan Titus

Doctor of Nursing Practice Projects

The ongoing shortage of nurse educators across the United States has led to a critical need among nursing programs, particularly in rural areas. A quality improvement project was developed in response to literature regarding the need for new and novice nurse educator orientation programs and limited structured onboarding at the implementation site. The quality improvement project implemented an orientation boot camp for new and novice nurse educators. Guided by Benner’s Novice to Expert Theory (Benner, 2023) and Lippitt’s Phases of Change Theory (Barrow, 2022), the project aimed to enhance faculty preparedness through educational support related to seventeen key nursing education …

Scoping Review Of Algorithms For Electronic Fetal Monitoring, Katherine Sabatier, Kate Fouquier Cnm, Phd, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

The purpose of this scoping review is to review the use of an algorithm in evaluating continuous external fetal heart rate (FHR) monitoring in labor as opposed to clinician judgment for improved fetal outcomes, including earlier recognition of abnormal tracings (Clark et al., 2017). FHR monitoring was created to evaluate for fetal hypoxia in labor and has become standard practice (Gyllencreutz et al., 2018). One of the goals of the use of cardiotocography is to decrease hypoxia-induced fetal metabolic acidemia and neurologic injury. There are multiple options for individual or computer-based algorithms in evaluating FHR to reduce fetal acidemia …

Perinatal Mood And Anxiety Disorders (Pmads): A Scoping Review, Christina Willis Bsn, Rn, Nia Wells Bsn, Rn, Miranda Smith Bsn, Rn, Kate Fouquier Cnm, Phd, Facnm

Doctor of Nursing Practice Projects

Purpose/Background Perinatal Mood and Anxiety Disorders (PMADs), including postpartum depression, anxiety, and psychosis, significantly impact maternal and infant health. This scoping review consolidates current literature on PMADs, emphasizing prevalence, risk factors, screening, and treatment. The primary aim is to identify research gaps and inform clinical guidelines to enhance perinatal care.

Methods A literature search followed PRISMA guidelines from August 2022 to November 2024. Databases searched included PubMed, CINAHL, Scopus, and Google Scholar, using terms such as "perinatal mood disorders" and "maternal mental health." Inclusion criteria were English-language studies from the past decade addressing PMADs during pregnancy and up to one …

Impact Of Hidden Populations Through Faculty Identification And Intervention In Higher Education, Jimmie K. Wetmore

Doctor of Nursing Practice Projects

College students who have endured trauma through experiences in the foster care system, homelessness, justice system involvement, poverty, violence, and/or abuse are at greater risk of not completing college and returning to the circumstances that perpetrated their initial traumas. These students are known as “hidden populations.” Mentorship and resources can help these students to break the social and economic cycles that have placed them in a high-risk category. Higher education faculty are in a unique position to help bridge the gap that exists for these students. The problem can be impacted by more faculty being aware of the population and …

Impact Of Cde Referral On A1c Control In Adult Type 2 Dm Patients., Alivia Watts Bsn, Rn, Yesica Sanchez Bsn, Rn, Morgan Hilliard Bsn, Rn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Type II Diabetes Mellitus is a chronic health condition impacting many adults in Tennessee. Certified Diabetic Educators (CDEs) are specifically trained in educating and addressing the health care needs of patients with diagnoses of Type I or Type II Diabetes. Research has shown that education conducted by CDEs leads to improved outcomes and self- care in those with diabetes (Bowen, et al., 2016, King et al., 2019). Not only are CDEs cost effective services leading to a decrease in healthcare costs, but they also aid in the improvement of hemoglobin A1C (Hgb A1C) levels and decrease complications associated with Type …

Evaluating The Effectiveness Of A Non-Pharmacological Sleep Bundle For The Prevention Of Delirium In Geriatric Patients In The Intensive Care Unit: A Scoping Review, Morgan Wilkins Bsn, Rn, Vanessa D'Amico Bsn, Rn, Alyssa Goyda Bsn, Rn, Seema Janga Bsn, Rn, Kaylin Story Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is an acute disorder yielding cognitive deficits, such as disruption in attention and awareness. It impacts approximately 50% of individuals over the age of 65 who are admitted to the hospital and is prevalent with patients in the intensive care unit (ICU). ICU delirium is associated with adverse outcomes, including higher morbidity, prolonged hospital stays, and chronic neurocognitive deficits. Research demonstrates that implementation of a non-pharmacological sleep bundle can reduce the overall occurrence of delirium. The purpose of this scoping review is to examine the efficacy of a non-pharmacological sleep bundle on the incidence of ICU delirium in …

The Effectiveness Of Gad-7 Screening In High School Students, Tamara L. Smith, Allison Darnell, Margaret Harvey, Phd, Acnp-Bc, Chfn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students.

Methods

A comprehensive search was conducted across …

Evaluating The Efficacy Of Predischarge Referrals In Preventing Emergency Mental Health Hospital Readmissions: A Scoping Review, Pretia Carpenter Bsn, Rn, Stephanie Mays Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon H. Little, Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Background

Emergency mental health hospital readmissions present significant challenges to healthcare systems, often resulting in increased costs, prolonged hospital stays, and poor patient outcomes. Continuity of care through predischarge referrals to outpatient mental health services, psychosocial support, and community resources has been proposed as a strategy to reduce readmissions. However, the effectiveness of these interventions remains inconsistent across different populations and settings.

Objective

This scoping review aims to evaluate the effectiveness of predischarge referrals in reducing 30-day emergency mental health hospital readmissions, identify key components of successful programs, and assess the influence of demographic factors on readmission rates.

Methods

A …

Connecting Through Activities: How Social Engagement Impacts Isolated Older Adults, Lekisha Wilde

Doctor of Nursing Practice Projects

Executive Summary

Problem Description: Loneliness and social isolation are associated with higher rates of depression and contribute to a variety of mental and physical conditions. In socially isolated older adults, managing depression and chronic medical conditions can lead to negative outcomes that include poor quality of life, increased disability and morbidity leading to higher healthcare costs, and elevated mortality rates.

Setting: Project took place in a community behavioral health clinic in the Pacific Northwest.

Rationale: This project is guided by the Iowa Model. The model was tailored to assist in identifying the problem, gathering and evaluating relevant evidence from the …

Closing The Wellness Gap: Distribution Of Health & Wellness Resources To Families Of High School Students During Summer Break, Danielle Harvey

Doctor of Nursing Practice Projects

Closing the Wellness Gap

Background: During summer break, when schools are closed, students in K-12 schools lose critical resources to support their social, emotional, and physical wellbeing. This project addresses the critical gap in rural Southeastern Washington, where schools act as the primary support system by providing activities, food security, and wellness services.

Aim: Increase families’ awareness and confidence accessing resources to support students when schools are closed.

Methods: To identify key resources a Community Resource Gap Questionnaire was distributed to families. Eight weekly community resource guides were shared electronically with families based on the top priorities identified in the …

Addressing Organizational Factors Contributing To The Underreporting Of Workplace Violence In Nursing, Jason K. Blomquist

Doctor of Nursing Practice Projects

Background: Nurses routinely face threats, verbal abuse, and physical violence, yet widespread underreporting obscures the full scale of the problem, hindering efforts to address workplace culture and protect nurses.

Aim: Through leadership engagement and targeted staff education, this quality improvement project sought to increase workplace violence reporting rates on a 35-bed medical/surgical unit.

Methods: Over eight weeks, a three-phase intervention was implemented. Phase one equipped charge nurses with uniquely designed training (DIVER framework) to strengthen leadership support. In phase two, staff received micro-education through established communication channels. Phase three reinforced learning via interactive staff meetings. Pre- and post-intervention surveys assessed …

Needs Assessment: Examining Nurse Mentorship In A Military Treatment Facility, Laurie E. Chavez

Doctor of Nursing Practice Projects

Background

Despite 4.3 million registered nurses (RNs) in the United States, nearly a third are not practicing, exacerbating nursing workforce shortages across the nation’s healthcare settings. The Military Health System (MHS) reported significant attrition, with some specialties losing up to 37% annually. Research shows mentorship boosts job satisfaction and retention, yet the MHS lacks a formal program to support and sustain its nursing workforce long-term.

Aim

This needs assessment investigates the feasibility of establishing a nurse mentorship program at a Military Treatment Facility (MTF) to help elevate job satisfaction and strengthen nursing retention.

Methods

Anonymous questionnaires, structured interviews, and stakeholder …

Program Evaluation: Family Centered Rounding To Support Communication In Pediatric Care, Kristy M. Schmidt

Doctor of Nursing Practice Projects

Background: Family centered rounding (FCR) is a pediatric evidence-based practice intended to bring healthcare teams, patients, and families together at the bedside in a collaborative approach to care planning. FCR emphasizes communication and shared decision-making between healthcare teams and families, leading to improved patient outcomes. Despite well-documented benefits of FCR, challenges such as inconsistent nursing participation, variability in practices, and workflow disruptions hinder implementation and sustainability of FCR.

Aim: This program evaluation was designed and conducted at an urban pediatric hospital to assess the processes, perceptions, and impact of FCR. The overall quality of FCR and the strengths and barriers …

Traumatic Brain Injury Prevention Through Helmet Safety Education For Parents And Free Helmets For Elementary-Aged School Children, Kelli E. Camp

Doctor of Nursing Practice Projects

Problem Description: Head injuries from bicycle accidents are a leading cause of emergency visits among elementary-aged children, particularly in rural areas (Safe Kids Worldwide, 2017). Helmets significantly reduce traumatic brain injuries (TBIs) up to 88% (Field Neurosciences Institute, n.d.). However, low-income families, especially in rural areas, often lack access to helmets and safety education, resulting in lower helmet use and higher injury rates. These challenges are amplified in communities facing high traffic injury rates, limited access to safety resources, and economic constraints (Gilna et al., 2022; World Health Organization, 2023).

Setting: This project took place in Othello, WA (pop. 8,915), …

The Impact Of Automated Text Messaging System Education On The Self-Efficacy Of Medical Office Staff, Jim S. Jorgensen

Doctor of Nursing Practice Projects

Abstract

Inadequate patient bowel preparation is a leading cause of canceled or repeated colonoscopies, negatively impacting both outcomes and healthcare costs. While automated text messaging systems have improved patient adherence in other clinical areas, they remain underutilized by endoscopy staff due to low self-efficacy. This quality improvement project aimed to evaluate the effect of structured education on the self-efficacy of endoscopy nursing staff in using an automated text messaging system for outpatient colonoscopy preparation at a rural VA Medical Center (VAMC). Guided by Bandura’s Social Cognitive Theory and using the Plan-Do-Study-Act model, this project implemented a one-day, hands-on training session …

The Effects Of An Onboarding Checklist On Nursing Faculty Satisfaction, Taressa W. Poole

Doctor of Nursing Practice Projects

Nurse educators play an integral part in combating the nursing shortage. Transitioning clinical nurses to the academic setting can be challenging because experienced clinical nurses often enter the academic setting as novice nurse educators. A literature review suggested that the lack of structured onboarding programs contributes to the satisfaction, retention, and professional development of nurse educators. The Doctor of Nursing Practice (DNP) project aims to improve new nurse faculty onboarding by implementing a checklist to structure the onboarding process at the DNP project site. The process change project assesses the effects of a checklist on faculty satisfaction with the onboarding …

Provider Burnout Related To Patient Satisfaction, Sherita A. Lee

Doctor of Nursing Practice Projects

Provider burnout is a critical issue in healthcare, often intensified by increasing demands to meet patient satisfaction benchmarks. This quality improvement project aimed to examine whether a structured stress reduction program could reduce provider burnout and positively influence patient satisfaction scores in a small outpatient clinic. Guided by the PICOT question—In the clinic setting (P), does the implementation of a stress reduction program for providers (I), compared to no intervention (C), lead to improved patient satisfaction scores (O) over a six-week period (T)? —the project used a pre- and post-intervention design. The intervention included mandatory provider breaks, communication training, and …

Colorectal Cancer Screening And Correlating Gender Disparities, Kara Marr, Megan Janssen, Margaret Payne, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

In 2023, colorectal cancer (CRC) was the second leading cause of cancer-related deaths in the US, equating to approximately 50,000 total deaths (National Cancer Institute, 2024). Further, it is estimated that an additional 1.4 million Americans are living with CRC (National Cancer Institute, 2024). Early detection screening modalities remain imperative since the NIH has released a combined survival rate of 70% when utilized (National Cancer Institute, 2024). Different derivatives of CRC develop from pre-cancerous polyps and are often without signs or symptoms of disease progression; this asymptomatic period emphasizes the importance of early detection and prevention of colorectal cancer …

Written Reminders For Mammogram Compliance, Kristine Cholly, Marcus Barksdale, Rachel Gates, Mabel Olaya, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Breast cancer remains the second leading cause of cancer death among women in the United States, with a median age of mortality at 68 years old. Mammography has been shown to improve early detection and reduce mortality rates. Current United States Preventive Services Task Force (USPSTF) recommends biennial mammograms for women aged 50-74. However, compliance with biennial mammogram screenings remains inconsistent. This project aims to evaluate the effectiveness of written reminder letters in improving mammogram compliance among women aged 50-74 years old. The study focuses on comparing mammogram adherence rates among patients who received reminder letters compared to those …

Using Ehr Reminders To Control Hypertension, Umme Kulsoom Ghous, Logan Mcculley, Danielle C. Hall, Linda Katherine Lambert, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Hypertension is a significant risk factor for cardiovascular and kidney diseases but is often under-diagnosed and poorly managed. Electronic Health Records (EHR) can help by providing automated reminders to recheck elevated blood pressure (BP) readings, ensuring accurate measurements, and guiding clinical interventions. This study aims to determine if EHR-based reminders improve BP control in adult patients aged 21 and older, focusing on hypertension diagnosis accuracy and timely management.

Methods

After a literature review, the study took place in a primary care clinic and only included patients with an existing diagnosis of hypertension. Thirty patients were included in the study. …