Medicine and Health Sciences Commons^™

Determining Impact On Provider Adherence To Current Diabetes Guidelines: A Quality Improvement Project, Rashemia Suber

Doctor of Nursing Practice Projects

The delivery and documentation of evidence-based adult lifestyle counseling for patients with type 2 diabetes mellitus (T2DM) were found to be inconsistent in a clinic that serves an underserved population. This quality improvement (QI) project assessed whether a provider education program based on the 2025 American College of Lifestyle Medicine (ACLM) Diabetes Guidelines would improve provider confidence and documentation of lifestyle recommendations. A quasi-experimental, pretest-posttest design was guided by both Pender's Health Promotion Model as the theoretical framework and Lewin's Change Theory as the change theory. The Plan Do Study Act (PDSA) cycle guided this project as the implementation framework. …

The Impact Of Provider Medication Reconciliation Education On Hospital Readmissions In A Skilled Nursing Facility, Vivian Nwozu

Doctor of Nursing Practice Projects

Aging causes frailty and multiple comorbidities, necessitating polypharmacy. Complicated drug regimens predispose patients to adverse drug events and hospital readmissions. The practice problem was high rates of medication-related readmissions due to inadequate provider knowledge of medication reconciliation and the lack of a standardized tool. This project aimed at evaluating the impact of provider medication reconciliation education on hospital readmissions in a skilled nursing facility. A pretest-posttest study design was utilized. The Donabedian Model of Healthcare Quality guided the translation of evidence into practice, whereas Lewin’s Change Model and Plan-Do-Study-Act models guided implementation. Eight providers were educated on medication reconciliation using …

Staff Education On Early Cpi-Based De-Escalation Strategies And Unit-Based Resources, Doris Onyenji Lerama

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education evidence-based practice initiative implemented at a state-operated adult inpatient psychiatric facility in California. The practice gap was inconsistent nursing staff knowledge of early Crisis Prevention Intervention-based de-escalation strategies and available unit-based resources despite an established crisis-prevention framework. The practice-focused question asked whether a standardized staff education activity would increase staff knowledge, as measured by anonymous pre-education and immediate post-education scores. The purpose was to develop, implement, and evaluate the education using staff knowledge change as the sole measurable outcome. The Johns Hopkins Evidence-Based Practice Model guided appraisal and synthesis of 11 evidence sources …

Effectiveness Of Pancreatic Cancer Screening In High-Risk Elderly Individuals In Florida, Adeleke A. Aromolaran

Walden Dissertations and Doctoral Studies

Routine preventive care supports early identification and management of health conditions among adults at high risk for pancreatic cancer. Evidence is limited regarding socioeconomic and health care access factors associated with engagement in routine preventive care among Florida adults aged 65 years and older at high risk for pancreatic cancer. The purpose of this quantitative cross-sectional correlational study was to examine these associations among this population. The health belief model served as the theoretical framework. Secondary data from the 2022 Florida Behavioral Risk Factor Surveillance System were analyzed for N = 4,032 participants using two multivariable binary logistic regression models …

Quality Improvement Project: The Impact Of Self-Assessed Quality Of Sleep On Illness Experience And Job Satisfaction Among Night Shift Nurses, Eunice Ikpekpe

Doctor of Nursing Practice Projects

Compromised sleep quality, illness experience, and job satisfaction are important concerns among registered nurses working night shifts. The purpose of this quality-improvement project was to evaluate changes in self-assessed sleep quality, illness experience, and job satisfaction following participation in the six-week Sleep Hygiene and Recovery Program (SHRP) among night-shift registered nurses at a large, urban, Level I trauma academic teaching medical center. The project used a quantitative, quasi-experimental, single-group pretest–posttest design guided by the Plan-Do-Study-Act framework and Lewin’s Change Management Theory, with the Neuman Systems Model and Pender’s Health Promotion Model providing the theoretical foundation. SHRP was a structured, evidence-informed …

Staff Education To Improve 7-Day Post-Discharge Psychiatric Follow-Up, Michael Curtis Kwashie

Walden Dissertations and Doctoral Studies

Too many psychiatric patients leave the hospital without a follow-up appointment, a gap that may cost lives. Research has consistently shown that the days immediately after discharge from psychiatric inpatient or emergency care are among the most dangerous in a patient’s trajectory, marked by elevated suicide risk, relapse, and avoidable readmission. Yet, across behavioral health settings, completion of outpatient follow-up within 7 days of discharge remains inconsistent; typically, standardized processes are often missing. This doctoral project in staff education was created to fill that gap and examined whether implementing a standardized discharge transition protocol, supported by targeted, interdisciplinary staff education, …

Implementation Of An Evidence-Based Multifactorial Fall-Prevention Staff Education Program In A Long-Term Care Facility., Peter Mufua Tumenta

Walden Dissertations and Doctoral Studies

Walden University College of Nursing This is to certify that the doctoral study by Peter Mufua Tumenta has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Melanie Braswell, Committee Chairperson, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2026 Executive Summary Falls are a significant patient safety concern among older adults in long-term care (LTC) facilities. This Doctor of Nursing Practice quality improvement project implemented and evaluated a standardized, evidence-based multifactorial fall-prevention staff education program to improve …

Relationship Between High-Risk Cytogenetic Abnormalities And Tent5 Mutations And Disease Outcomes Of Multiple Myeloma Patients, Erica Lea Richardson

Walden Dissertations and Doctoral Studies

Multiple myeloma (MM) patients have the lowest 5-year cancer survival rates due, in part, to the time it takes for symptoms to develop and the presence of one to four high-risk cytogenetic abnormalities (HRCA). The Terminal Nucleotidyltransferases 5 (TENT5) subfamily, which regulates myeloma cell migration and tumorigenesis, may also increase the risk for developing MM and impact survival rates. The purpose of this study was to investigate the association between the number of HRCA and TENT5 mutation hits with disease outcomes in MM patients while controlling for the stage of the disease (i.e., I, II, or III) at diagnosis. The …

Staff Education To Improve Sleep Hygiene Knowledge And Competency Among Nursing Staff On An Inpatient Behavioral Health Unit, Jennings Ubadi Mekoba

Walden Dissertations and Doctoral Studies

This staff education project addressed the gap in standardized knowledge and implementation of evidence-based sleep hygiene interventions among nursing staff on an inpatient behavioral health unit. Sleep disturbances affect 80%–90% of psychiatric patients and directly impact treatment outcomes and recovery. I developed the practice-focused question to consider whether an evidence-based sleep hygiene education program would enhance the awareness, knowledge, and practices of the nursing staff regarding sleep hygiene interventions. A thorough literature review of 23 high-quality sources formed the background for the development of a structured educational intervention that encompassed assessment methodologies, nonpharmacological interventions, environmental interventions, and patient education interventions. …

Sociodemographic And Geographic Factors Underlying Breast Cancer Survival Disparities Among Women In The United States, Colletta Brabham-Orr

Walden Dissertations and Doctoral Studies

Breast cancer-specific mortality in the United States remains higher among women in rural and socioeconomically disadvantaged areas, yet few population-based studies have been conducted to jointly scrutinize demographic and structural determinants of this disparity. Informed by the social determinants of health framework, this secondary data analysis, using records from the SEER Research Plus database, examined the association between age at diagnosis, race and ethnicity, rural/urban residence, county-level median household income, and breast cancer-specific mortality among U.S. women aged 18 and older diagnosed with malignant invasive breast cancer between 2010 and 2020 (N = 285,865). Bivariate chi-square tests and binary logistic …

A Quality Improvement Project: Impacting Communication Perceptions Among Nursing Staff And Providers Regarding Perioperative Medication Management Impacting Anesthesia Care, Demetria Jefferson

Doctor of Nursing Practice Projects

Medication-related surgical cancellations disrupt patient care, increase healthcare costs, and contribute to inefficient use of perioperative resources. Evidence supports standardized education and communication to improve perioperative medication safety. This quality improvement project aimed to improve staff self-efficacy in communicating medication instructions and reduce surgical cancellations associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and phentermine. Bandura’s Social Cognitive Theory and Lewin’s Change Model guided the project. A quasi-experimental one-group pretest-posttest design included perioperative staff who provided medication instructions across two settings within an academic health sciences center. Using the Plan-Do-Study-Act framework, interventions included standardized staff education, patient …

Integrating Interprofessional Education To Strengthen Team-Based Mental Health Care, Adebisi Tijani

Doctor of Nursing Practice Projects

Fragmented interprofessional collaboration in outpatient mental health settings compromises care coordination and patient engagement. This quality improvement (QI) project implemented a structured interprofessional education (IPE) workshop series to improve team collaboration and reduce patient no-show rates in an outpatient mental health clinic. Guided by Bandura's Social Cognitive Theory and Lewin's Change Management Model, the project used a pre-post, single-group design with 12 licensed mental health professionals. The team measured collaboration with the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II) and collected aggregate patient no-show rates from the electronic health record. The intervention consisted of four monthly, one-hour workshops covering role …

Quality Improvement Project: Improving Nursing Knowledge And Confidence Of Dysglycemia In Pediatric Oncology Patients, Lindley Abrams

Doctor of Nursing Practice Projects

Treatment-induced dysglycemia is a frequently underrecognized complication of pediatric cancer therapy. Pediatric oncology nurses play a critical role in recognizing and managing dysglycemia; however, limited exposure to specialized dysglycemia education may contribute to gaps in knowledge and confidence. A site needs assessment found that 53% of nurses reported discomfort with glycemia-related concepts, supporting the need for targeted education. The purpose of the project was to evaluate changes in pediatric oncology nurses’ knowledge and confidence in recognizing and responding to treatment-induced dysglycemia. The project aimed to provide a structured educational intervention and measure pre- and post-intervention changes. Newman’s Health as Expanding …

Quality Improvement Project: Electronic Consent's Influence On Consent Error Rates, Alexis Fogle

Doctor of Nursing Practice Projects

Surgical consent errors increase the risk of inaccurate documentation, compromise patient safety, and disrupt procedure times. Evidence indicates that adopting electronic consent can optimize workflow, support accurate and complete documentation, improve readability, and enhance record reliability. This project evaluated whether initiating electronic consent, compared with handwriting surgical consent forms, reduced the number of improper surgical consent forms completed over six weeks. Roy’s Adaptation Model guided the change process, and the Theory of the Person as an Adaptation System provided the theoretical basis. The Plan-Do-Study-Act model supported evidence-based implementation of the electronic consent intervention. The quality improvement project was conducted on …

Training Faculty For Skills Evaluation: A Quality Improvement Project, Shelley Leezer

Doctor of Nursing Practice Projects

There is an identified gap between nursing knowledge learned in academic settings and application of clinical skills in practice settings. Literature contributes this gap to poor knowledge retention, lack of constructive feedback, and inability to apply knowledge to clinical practice. The purpose of this project was to address skill mastery and retention in nursing students within a university. The project aim was to improve faculty feedback and evaluation to best support skill mastery in the skills laboratory. Lewin’s Change Management Model and Dr. Patricia Benner’s Novice-to-Expert Theory guided project design and progress. This pre- and post-intervention study followed a PDSA …

Quality Improvement Project Stress First Aid: Equipping Nurse Leaders, Bethany Russell

Doctor of Nursing Practice Projects

Stress among nurses can negatively affect well-being, workforce stability, and the quality of patient care, highlighting the need for nurse leaders to effectively recognize and respond to stress within their teams. The purpose of this quality improvement project was to evaluate whether education on the 7 Cs of Stress First Aid (SFA) improved leadership self-efficacy among nurse leaders at an urban acute-care hospital. Watson’s Theory of Human Caring provided the theoretical foundation, while Lewin’s Change Theory guided implementation of the practice change. A one-group pretest-posttest design was used, with the Plan-Do-Study-Act framework supporting project implementation. Participating nurse leaders completed an …

Implementing An Evidence-Based Practice Training Program To Impact Nursing Skills Competency And Self-Efficacy In A Long-Term Care Facility, Angela Mcknight

Doctor of Nursing Practice Projects

Long-term care facilities require nursing staff who can competently perform clinical skills; however, the project site relied primarily on written in-service education and attendance verification without direct validation of psychomotor performance. The purpose of this quality improvement project was to evaluate competency-based nursing education in a long-term care facility. The aim was to strengthen demonstrated urinary catheterization competency and evaluate changes in perceived professional nursing competence and general self-efficacy among licensed nurses. A quasi-experimental, one-group pretest-posttest design included 12 registered and licensed practical nurses. Plan-Do-Study-Act guided implementation, Lewin’s Change Theory guided organizational change, and Social Cognitive Theory supported the educational …

Quality Improvement Project: Implementing A Standardized Psychiatric Handoff Tool To Impact Nurse-To-Nurse Communication In An Acute Care Psychiatric Setting, Andrea Ranglin-Johnson

Doctor of Nursing Practice Projects

Evidence supports that inconsistent nurse-to-nurse handoff communication may contribute to omitted information, workflow inefficiencies, and patient safety concerns in acute psychiatric settings. The practice problem was the absence of a standardized psychiatric handoff process, which contributed to inconsistent shift report communication. This quality improvement project examined whether the PSYCH (Patient Profile, Situation, Your Clinical Assessment, Care Plan/ Critical Information, and Hindrance for Discharge) standardized handoff tool impacted nurses' perceptions of nurse-to-nurse communication over six weeks. Lewin's Change Theory guided implementation, while the Donabedian Structure-Process-Outcome Model provided the theoretical framework. The Plan-Do-Study-Act cycle supported implementation. A pre- and post-implementation design was …

Quality Improvement Project: Empowering Change: Evidence-Based Strategies To Improve Ai Use In Pedagogy, Amanda Boyle

Doctor of Nursing Practice Projects

Artificial intelligence (AI) continues to integrate into healthcare and higher education; however, Health Science faculty at the project site lacked formal training to operate or teach AI responsibly. This Doctor of Nursing Practice quality improvement project evaluated whether computer-based AI literacy education improved Health Science faculty members’ self-reported AI literacy. It was predicted that faculty AI literacy scores would improve after completing the intervention. Kotter’s change model and Benner’s novice-to-expert framework informed implementation of change and faculty professional development. The Plan–Do–Study–Act model supported evaluation. In a one-group, quasi-experimental preintervention–postintervention study design at a North Texas two-year college, 19 eligible Health …

Quality Improvement Project: Impacting Clinical Competency Through Faculty Preparation: A Standardized Teaching Guide Initiative, Caroline White

Doctor of Nursing Practice Projects

Variability in clinical teaching practices can contribute to inconsistent faculty preparation and student learning experiences. This quality improvement project addressed the absence of a standardized clinical teaching resource within an Associate Degree Nursing (ADN) program at a public technical college in the southeastern United States. The purpose was to implement a standardized, evidence-based clinical teaching guide to improve faculty confidence and clinical educator skill acquisition. Social Cognitive Theory provided the theoretical framework, and Lewin’s Change Theory guided practice change. A quantitative, quasi-experimental one-group pretest-posttest design was used. Fourteen eligible nursing faculty and clinical instructors were invited to participate; 10 participated, …

Impact Of Sexual Orientation On Syphilis Diagnosis Among African American Men In Colorado, Emmanuel Bhatti

Walden Dissertations and Doctoral Studies

Syphilis remains an ongoing public health concern among African American men. Elevated rates during the COVID-19 pandemic further underscored the need for focused attention on this population. The risk factors driving syphilis diagnosis among African American men during a pandemic like COVID-19 remain poorly understood. The purpose of this quantitative cross-sectional study was to examine the association between sexual orientation and syphilis diagnosis among African American men in Colorado. Social cognitive theory was applied to understand the interaction among sexual orientation, HIV status, age, and syphilis diagnosis. Sexual orientation categories include men who have sex with men (MSM), men who …

Nurse-Led Remote Patient Monitoring In Outpatient Heart Failure, Jackline Ukadike

Walden Dissertations and Doctoral Studies

Chronic heart failure (HF) remains a leading cause of avoidable hospital readmissions and emergency department visits due to delayed recognition of early symptom exacerbation between routine outpatient encounters. This doctoral quality improvement project evaluated whether the implementation of an evidence-based, nurse-led remote patient monitoring (RPM) standard operating procedure (SOP) improved early identification of symptom exacerbation compared to standard episodic care among adult heart failure patients (NYHA Class II–III) in an outpatient primary care setting over a 10-week period. Guided by the Plan-Do-Study-Act (PDSA) framework, an evidence-based clinical practice guideline (CPG) and escalation protocol were developed and appraised by a 3-member …

Staff Education On Teaching Evidence-Based Chronic Pain Management, Valdane Eleonu Robinson

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project focused on educating providers to fill in knowledge gaps in how to effectively manage chronic pain. The lack of knowledge about the evidence-based recommendations for treating chronic pain was the practice gap. Standardized training protocols to instruct pain management professionals and address disparities in chronic pain management care should be in place to guarantee that all patients in need of chronic pain management have access to culturally appropriate education.

Degree Assortativity And Estimation Of Degree Distribution In A Contact Network Of People Who Inject Drugs, Peter Geissert

Dissertations and Theses

This dissertation analyzes data from a respondent driven sampling (RDS) study of people who inject drugs in Portland, OR.  The objective was to assess assumptions for the use of weighted estimators to estimate a population physical contact (syringe sharing) network degree distribution.

Visualization of degree distribution for social and physical networks, Kolmogorov-Smirnov tests of difference, and kernel tests of equivalence were used for comparison of distributions. Spearman's rho and GAM non-parametric regression models were used to test for association and assess non-monotonic relationship. The validity of Markov chain assumptions for RDS was assessed using a transition matrix, Markov chain graphs, …

Standardized Screening And Monitoring Of Bioidentical Hormone Replacement Therapy In Women Ages 35–50, Amanda Ellen Hampton

Walden Dissertations and Doctoral Studies

In this quality improvement project, I evaluated a pilot implementation of a standardized bioidentical hormone replacement therapy (BHRT) screening and monitoring tool embedded within the electronic health record (EHR) at an integrative medicine practice in the southeastern United States. Grounded in the Johns Hopkins evidence based practice (EBP) model, the project addressed a documented gap in consistent screening, initiation, and monitoring of hormone replacement therapy (HRT) for women ages 35 to 50 presenting with menopausal symptoms. The practice focused question examined whether a standardized, EHR embedded BHRT screening and monitoring tool could improve screening rate compliance, laboratory monitoring adherence, and …

Prostate Cancer Survival Among Young Males Within The United States, Maxine M. Findlay

Walden Dissertations and Doctoral Studies

Prostate cancer incidence has increased among younger men in the United States, and treatment affects both patient survival and family well-being. This quantitative retrospective study examined survival among young men diagnosed with prostate cancer who received chemotherapy, radiation therapy, and/or prostatectomy, while accounting for socioeconomic factors of residence and ethnicity. Social cognitive theory was the framework. Ordinal logistic regression was used to determine whether treatment method, socioeconomic factors of residence and ethnicity predicted survival among young men diagnosed with prostate cancer. Data was sourced from the National Cancer Database Participant User File 2004-2021 specific to prostate cancer. The study cohort …

Enhancing Early Detection Of Suicide Risk In Outpatient Settings Through Standardized Implementation Of The Ask Suicide Screening Questions Tool, Shayla Lee

Doctor of Nursing Practice Projects

Suicide is a leading cause of death in the United States, highlighting the need for routine suicide risk identification. Evidence supports standardized suicide screening can promote early identification of suicide risk. A needs assessment at an outpatient mental health clinic identified the absence of a standardized suicide screening and referral process. The purpose of this quality improvement project was to implement the Ask Suicide-Screening Questions (ASQ) Tool and a standardized referral protocol. The aim was to evaluate ASQ documentation, referral rates, and staff self-efficacy over four weeks. Peplau’s Interpersonal Relations Theory, Lewin’s Change Theory, and the Plan-Do-Study-Act (PDSA) framework guided …

Socioecological Factors Associated With Advanced Primary Tumor Category At Diagnosis Among Adults With Head And Neck Cancer Residing In Pennsylvania And New Jersey, Diane Elizabeth Crawford

Walden Dissertations and Doctoral Studies

Disparities in head and neck cancer (HNC) diagnosis may contribute to poorer outcomes among socially and economically disadvantaged populations. This quantitative secondary data analysis examined associations between socioecological factors and advanced primary tumor category among adults with HNC residing in Pennsylvania and New Jersey. Guided by the socioecological model, deidentified data (N = 350) from two Fox Chase Cancer Center research protocols were analyzed using three domain-specific multivariable logistic regression models. Primary tumor category was classified as lower (Tis–T2) or advanced (T3–T4) based on tumor size and/or local extent. Black participants had greater adjusted odds of advanced primary tumor category …

Enhancing Hiv Knowledge And Resource Awareness Among Chief Nursing Officers, Susan Louise Cooper Bailey

Walden Dissertations and Doctoral Studies

Human immunodeficiency virus (HIV) remains a significant public health concern in rural communities, where limited specialty care, geographic isolation, transportation barriers, and stigma may delay testing and entry into care. The Texas Panhandle is a geographically expansive rural region served by rural hospitals with limited resources. Although area HIV services are available, they are inconsistently utilized. Although chief nursing officers (CNOs) influence practice and care coordination, knowledge gaps regarding HIV guidelines, prevention strategies, and regional resources may limit identification, referral, and continuity of care. The purpose of this doctor of nursing practice (DNP) project was to determine whether a targeted …

Development Of An Evidence-Based Clinical Practice Guideline For Glp-1 Medication Management And Weight-Loss Monitoring In Adults, Jeannette Mariela Pena

Walden Dissertations and Doctoral Studies

This doctor of nursing practice project addressed the lack of a standardized clinical practice guideline for glucagon-like peptide-1 (GLP-1)-based medication management and weight-loss monitoring in an outpatient functional health setting. The purpose was to develop an evidence-based guideline to improve provider consistency, patient education, monitoring, documentation, and treatment safety for adults receiving GLP-1-based weight-management therapy. The Johns Hopkins Evidence-Based Practice Model guided question development, evidence appraisal, synthesis, translation, and implementation planning. The guideline incorporated evidence related to adult obesity management, GLP-1-based pharmacotherapy, lifestyle intervention, eligibility assessment, medication selection and titration, adverse-effect monitoring, follow-up, and documentation. Three content experts—a nurse practitioner …