Medicine and Health Sciences Commons^™

Eat, Sleep, Console Care For Infants With Neonatal Abstinence Syndrome: A Multisite Evaluation, Amanda Fout

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Opioid use in pregnancy continues to rise, leading to increasing cases of neonatal abstinence syndrome (NAS). Traditional management with the Finnegan Neonatal Abstinence Scoring System (FNASS) often results in pharmacologic treatment, prolonged hospitalizations, and higher costs. Inconsistent FNASS scoring at the hospital system contributed to unnecessary NICU admissions and variable outcomes. Eat, Sleep, Console (ESC) was introduced as an alternative approach, but its effectiveness had not been formally evaluated.

Aim of the Project: The aim of the quality improvement initiative was to evaluate the effectiveness of the ESC model in improving outcomes for infants with NAS across three hospitals …

Implementing A Sepsis Questionnaire To Reduce Readmissions…A Health Plan’S Experience, Vernita L. Kelley

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Sepsis is a life-threatening condition with high readmission risk, threatening patient recovery and survival. In the managed care organization (MCO) where this DNP project was implemented, sepsis ranks among the top five readmission diagnoses. The organization's 30-day readmission rate of 15.5% is substantially higher than the benchmark of 9.29%, highlighting a clinical quality issue, a strain on patient outcomes, and a strain on healthcare resources.

Aim of the Project: This quality improvement (QI) project aimed to reduce sepsis readmissions by embedding a sepsis questionnaire into case management workflows to identify clinical risks and social determinants of health, improve transitions, …

Quality Improvement Initative To Reduce Falls Among Geriatric Patients In The Inpatient Mental Health Setting, Regina Johnson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are widely recognized as a leading cause of injury and hospitalization among older adults, with geriatric psychiatric patients at particularly high risk due to polypharmacy, cognitive impairment, and mobility challenges. At the project site, baseline audits revealed inconsistent use of structured fall risk tools, limited nurse-driven medication review, and gaps in post-fall documentation. The absence of an embedded electronic health record feature for medication review highlighted a significant practice gap requiring intervention.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce fall risk in a geriatric psychiatric hospital through structured post-fall medication …

Fall Reduction Utilizing Fall Tailored Intervention For Patient Safety In Acute Care, Lauren Poindexter

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospitalized patient falls cause physical, psychological, and financial harm and persist despite prevention bundles. A Midwest Ohio acute medical unit experienced higher-than-benchmark fall rates (1.53–7.58 falls/1,000 patient days; unit rate 113% of the national median), with a rising trend in FY25. Reliance on the Schmid tool and existing interventions lacked structured patient/family engagement, as well as comprehensive medication assessment, leading to under-recognition of risk and limited nurse-driven prevention.

Aim of the Project: The aim of the project was to reduce inpatient fall rates and fall-related injuries on a medical unit by implementing the Agency for Healthcare Research and Quality …

Implementing Pain Reassessment Workflow To Improve Timely Pain Management In Hospice Patients: A Quality Improvement Project, Oluremi Omodara

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.

Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours …

Improving Patient Portal Messaging Workflow, Tanya M. Fitzpatrick

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inefficiencies in patient portal secure messaging between providers and patients in a large primary care practice led to delayed resolution times, averaging 5.6 days per message. Most messages were closed by physicians or advanced practice providers, resulting in imbalanced workload distribution, increased provider burden, and reduced communication efficiency. The lack of standardized guidelines for message use, character limits, or triage processes contributed to workflow disruptions, a diminished patient experience, and unreimbursed provider time.

Aim of the Project: The aim of the project was to reduce average portal message closure times by at least 38% through the implementation of standardized …

Fall Prevention In Home Care: The Introduction Of The Steadi Initiative As Evidence-Based Tool, Margarida Barbosa - Barreiro

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls continue to be one of the leading causes of injury and mortality among older adults and remain a significant driver of healthcare utilization and cost. Within the home health setting, inconsistent practices in fall risk assessment and intervention have contributed to care gaps and increased patient vulnerability. The absence of a standardized, evidence-based process created the need for a structured quality improvement initiative to strengthen patient safety.

Aim of the Project: The purpose of this quality improvement project was to integrate the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit into home health visits to enhance the …

Advancing Medical Education With Lifestyle Medicine: A Comprehensive Program Evaluation Using The Kirkpatrick Framework, Shanna L. Mello

Electronic Theses and Dissertations

This dissertation examined how a U.S. national lifestyle medicine residency curriculum influenced resident learning and practice using a program evaluation paradigm with a convergent mixed methods design guided by Kirkpatrick’s four-level evaluation model. The problem addressed was the persistent gap between evidence for lifestyle interventions and the limited preparation residents receive to deliver lifestyle counseling in routine care. The purpose of the study was to evaluate changes in residents’ reactions, learning, and clinical behaviors and to identify early patient-level signals and the implementation conditions that enabled or constrained behavior change. Quantitative methods analyzed archived pre- and posttraining surveys from 148 …

Quality Improvement Project Improving Faculty Support For First-Generation Rural Nursing Students, Charlotte Dowdy

Doctor of Nursing Practice Projects

The barriers to academic success among first-generation rural nursing students are substantial, including a lack of knowledge of academic resources, ineffective study strategies, and difficulty navigating the higher education system. These challenges are documented in the literature as resulting in higher attrition rates and lower graduation rates. This quality improvement project was intended to implement and analyze a faculty training module designed to increase faculty awareness and confidence in supporting first-generation rural nursing students at the project site. The project adopted a pre-post intervention design based on High-Reliability Organization principles and Lewin’s Change Model, to determine the effectiveness of targeted …

Staff Education And Implementation Of Phq-9 And Gad-7 In An Adult Psychiatric Private Practice, Exta Oppong Tweneboa

Walden Dissertations and Doctoral Studies

The PHQ-9 and the GAD-7 are short screening instruments used for the detection of depression and anxiety symptoms in various settings, including general and mental health care settings (Pranckeviciene, et al., 2022). The purpose of this Doctor of Nursing Practice (DNP) project was to educate staff on the implementation of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) into an adult psychiatric private practice to standardize screening, improve diagnostic accuracy, and support measurement-based care for depression and anxiety. A structured staff education program was conducted with five nurse practitioners, one psychiatrist, two therapists, and two front-end administrative staff. …

Quality Improvement Project Implementing Teamstepps 3.0: Impact On Perception Of Teamwork, Angela Allen

Doctor of Nursing Practice Projects

The clinical practice site is a rural health clinic that has experienced 28% staffing turnover in the last year, and opportunities for improvement in communication and teamwork were identified. The principal investigator (PI) used the Iowa Model Revised (IMR) as a theoretical framework and Lippitt’s change theory to promote change for the identified priority issue. TeamSTEPPS is an evidence-based program designed to improve communication and teamwork in healthcare teams with the goal of improving patient outcomes and safety. The quality improvement project utilized a quasi-experimental design with pre- and post-intervention surveys to answer the question: among staff at a rural …

Quality Improvement Project Improve Staff Knowledge On Spravato For Treatment Resistant Depression, Cynthia Barraza Guerra

Doctor of Nursing Practice Projects

Treatment-resistant depression (TRD), defined as major depressive disorder unresponsive to at least two adequate antidepressant trials, is linked to higher morbidity, diminished quality of life, and increased healthcare utilization. Spravato (intranasal esketamine), approved by the U.S. Food and Drug Administration, provides a novel mechanism of action through N-methyl-D-aspartate (NMDA) receptor modulation but requires strict safety oversight due to risks including dissociation and hypertension. This Doctor of Nursing Practice (DNP) quality improvement (QI) project evaluated whether a targeted educational intervention improved staff knowledge and confidence in Spravato safety protocols. Guided by Lewin’s Change Theory, Bandura’s Social Learning Theory, and implemented with …

Quality Improvement Project High-Quality Simulation Training For High-Quality Nurse Educators, Cherrelle Hawkins

Doctor of Nursing Practice Projects

The Associate of Applied Science in Nursing (AASN) faculty use simulation as a teaching modality to assist nursing students in preparing for their clinical experiences by transitioning knowledge into practice. To successfully facilitate simulations, faculty must possess knowledge and competence in facilitating simulation sessions. Faculty at the practice site lacked these characteristics due to the nonexistence of a simulation training program. This quasi-experimental quality improvement project aimed to implement formal simulation training for faculty to influence self-perceived knowledge and competence in facilitation constructed by the Adult Learning Theory and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR) Change Model. The PI evaluated knowledge and competence …

Quality Improvement Project Impacting Provider Self-Efficacy And Use Of Cbt For Depression Treatment, Tony Orafunam

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice (DNP) quality improvement project was conducted at a mid-sized outpatient psychiatric clinic in Hempstead, New York, focusing on strengthening providers’ self-efficacy in delivering Cognitive Behavioral Therapy (CBT) to young adults (aged 19–35) diagnosed with Major Depressive Disorder (MDD). Rather than targeting MDD directly, the initiative aimed to impact provider self-efficacy and skill in CBT to improve access to evidence-based treatment and reduce the need for external referrals. Employing Bandura’s Social Cognitive Theory and the ADKAR change model, the project used a quasi- experimental, one-group pre-test/post-test design. Six advanced practice providers participated in a structured, interactive …

Quality Improvement Project Providing Accessible Evidence-Based Education To Nurses Throughout A National Healthcare System, Bailey Wells

Doctor of Nursing Practice Projects

The pursuit of ongoing professional development and learning is crucial to ensure nurses remain well-informed about healthcare trends and have access to the most up-to-date evidence-based materials. This quality improvement project aimed to implement a monthly educational series for nursing personnel within the Veterans Health Administration (VHA) through expansion of the Veterans Administration (VA) – Extension for Community Healthcare Outcomes (ECHO) program. Using Bandura’s Self-Efficacy Theory of Motivation in Psychology, participants’ previous knowledge was linked to continued professional development. The plan, do, study, act (PDSA) framework provided structure for the project, with the awareness, desire, knowledge, ability, and reinforcement (ADKAR) …

Quality Improvement Project Unlocking Critical Thinking: The Use Of Guided Reflection In Nursing Education, Alissa Wheat

Doctor of Nursing Practice Projects

Nursing education is at a crossroads as the demand for practice-ready nurses increases in a rapidly evolving healthcare environment. Despite high licensure pass rates, graduates often demonstrate gaps in clinical judgment and critical thinking, key competencies for safe nursing practice. This project addressed the problem of limited structured strategies to develop these competencies among pre-licensure nursing students in a Houston-based nursing program. The purpose was to evaluate guided reflection, implemented as a competency-based education (CBE) tool, to determine its effect on faculty perceptions of supporting critical thinking and clinical judgment. A quasi-experimental, one-group pretest–posttest design was conducted with clinical faculty …

Quality Improvement Project De-Escalation Techniques Applied In The Classroom: A Faculty Onboarding Quality Improvement Initiative, Jennifer Lanza

Doctor of Nursing Practice Projects

The nursing shortage persists, and the lack of trained nurse educators exacerbates the issue. Adequate training of novice nurse educators transitioning from bedside to academia is essential for smooth role-transitioning, which impacts intent to stay; however, the content of the mentoring is undefined in literature. Using Bandura’s Social Cognitive theory as the theoretical framework and Havelock’s Process of Change theory, this Quality Improvement project aims to determine how providing de-escalation training adapted for the classroom impacts self-efficacy of novice nurse educators dealing with incivility in the classroom. The method includes incorporating the Plan-Do-Study-Act implementation framework for a quasi-experimental intervention which …

Quality Improvement Project Improving Fall Risk Protocol Compliance Through A Structured Fall Prevention Program In A Skilled Nursing Facility, Lakeesha Jenkins

Doctor of Nursing Practice Projects

Falls remain a persistent patient-safety threat in skilled nursing facilities (SNFs). At a Dallas–Fort Worth SNF, a needs assessment identified rising unassisted falls and inconsistent protocol adherence. This quality improvement (QI) project examined whether a structured, evidence-based bundle could improve staff knowledge and fall-prevention processes and reduce falls over four weeks. Guided by Lewin’s Change Theory and implemented with Plan–Do–Study–Act (PDSA) cycles, the pre–post design engaged direct-care staff (registered nurses, licensed vocational nurses, certified nursing assistants; n = 20). The intervention included standardized risk screening with the Morse Fall Scale (MFS), targeted staff education, high-risk visual identifiers, and post-fall huddles. …

Quality Improvement Project Addressing Healthcare Provider Adherence To Diabetic Foot Exams In A Primary Care Clinic, Olaide Akinyinka

Doctor of Nursing Practice Projects

Healthcare providers performing foot examinations are a crucial component in assisting Type II diabetic patients to maintain their health. The purpose of this quality improvement project was to determine how the providers' implementation of Inlow’s 60-second Diabetic Foot screen, compared to current practice standards, impacts the number of foot exams among Type II diabetic patients at a primary care clinic over 12 weeks. Therefore, it was unknown if or to what degree the provider implementing Inlow’s 60-second Diabetic Foot Screen impacts the number of foot exams conducted compared to the current practice among Type II diabetic patients. Wiedenbach’s Helping Art …

Staff Education For Health Care Providers On Improving Health Care Outcomes For Lgbtq+ Youth And Adolescent Patients, Sheila Shafer

Walden Dissertations and Doctoral Studies

This project was focused on the significant challenges faced by LGBTQ+ adolescents and young adults, specifically those aged 12 to 25 years, who seek mental health care services. Research indicated that discrimination and stigma against this demographic contribute to disproportionately poorer mental health outcomes, underscoring the urgent need for culturally competent health care delivery. The purpose of this project was to educate professionals on the necessary skills and knowledge about the unique needs of LGBTQ+ patients. The question was the following: Would an educational intervention improve providers’ knowledge and confidence in diagnosing and treating the mental health needs of LGBTQ+ …

Educating Correctional Nurses On The Use Of A Mindfulness Program To Reduce Work Stress, Victoria Ngozi Emelogu

Walden Dissertations and Doctoral Studies

Correctional nurses deliver care in environments marked by violent incidents, chronic understaffing, and moral distress. These conditions heighten occupational stress, jeopardize patient safety, and accelerate staff turnover, yet few U.S. jails provide evidence-based training in rapid self-regulation strategies. The purpose of this staff education project was to evaluate whether a 2-week curriculum could increase correctional nurses’ knowledge, attitudes, and self-reported skills (KAS) for on-shift mindfulness use. Pender’s health promotion model framed the intervention, Bloom’s taxonomy and Kirkpatrick’s evaluation model informed learning objectives and outcome levels. Five correctional nurses at a large urban jail completed an anonymous 10‑item KAS survey before …

Implementing Patient Health Questionnaire-9 Screening In Adult Mental Health: A Staff Education Initiative, Precious Nmachi Adaso

Walden Dissertations and Doctoral Studies

This project was a staff education program aimed at the use of the Patient Health Questionnaire-9 (PHQ-9) as a universal depression screening instrument within a mental health facility. The project was conducted in an urban area of the United States at an outpatient behavioral health facility and was focused on addressing the stagnation in the staff’s correct use of evidence-based measures of depression screening that inhibits the prompt detection and treatment of major depressive disorder (MDD). The practice focused question was: Following participation in a staff education program, will staff demonstrate increased knowledge on depression screening and use of the …

Quality Improvement Project Simulation Orientation For Nursing Faculty, Emily Harvey

Doctor of Nursing Practice Projects

Many nursing faculty are expected to teach using SIM without adequate preparation, which can limit competence in SIM-based teaching. A university-level school of nursing identified this gap and initiated a quality improvement project to strengthen faculty readiness through a structured online orientation. The intervention used the Massive Open Online Course (MOOC) Essentials in Clinical SIMs Across the Health Professions and was guided by Benner’s Novice to Expert Model, Lewin’s Change Theory, and the Plan-Do-Study-Act cycle. A quasi-experimental pretest–posttest quantitative design was conducted with nursing faculty participants. The Facilitator Competency Rubric (FCR) assessed competence across five domains: preparation, prebriefing, facilitation, debriefing, …

Staff Education To Increase Nursing Staff Knowledge On Handoff Tool Kit For Medication Reconciliation, Mode Hilaire

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project aimed to enhance medication safety by implementing a structured staff education initiative focused on standardized handoff communication using a medication reconciliation tool kit. Medication errors during transitions of care contribute to adverse drug events and patient harm. A lack of consistency in handoff processes was identified as a critical gap in practice. The practice-focused question guiding this project was: In an inpatient hospital setting, how does implementation of a standardized handoff tool kit affect nursing staff knowledge and communication practices related to medication reconciliation? The purpose was to educate nurses on utilizing a …

Quality Improvement Project Enhancing Provider Education On Phq-9 Depression Screening To Improve Compliance, Obianuju Okafor

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide; however, screening in primary care remains inconsistent. Even though the Patient Health Questionnaire-9 (PHQ-9) is a validated screening tool, its use is often limited by insufficient provider training. This quality improvement (QI) project aimed to evaluate the impact of structured provider education on PHQ-9 screening practices, with the purpose of improving provider knowledge, confidence, and adherence to screening guidelines in a primary care setting. Guided by Donabedian's Model of Quality Care and Lewin's Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, the project used a one-group pre/post design at an outpatient …

Native Hawaiian Culturally Appropriate Substance Use Disorders Formative Program Evaluation, Kelly J. Penn

Walden Dissertations and Doctoral Studies

Substance use disorders (SUDs) disproportionately affects Native Hawaiians, yet conventional treatments often overlook the cultural, spiritual, and relational foundations of well-being for Native Hawaiians. This gap represents a human services problem, as it perpetuates health disparities, limits recovery, and slows social change within Native Hawaiian communities. The purpose of this qualitative single case study was to identify culturally relevant components for an SUD treatment program tailored to Native Hawaiians. The research question guiding this study was, what are culturally appropriate components for a SUD program for Native Hawaiians. The Nā Pou Kihi framework grounded the exploration of Indigenous approaches to …

Quality Improvement Project Empowering Nursing Instructors: Faculty Self-Efficacy & Consistency In Simulation Grading, April Guerin

Doctor of Nursing Practice Projects

This quality improvement (QI) project aims to evaluate the effectiveness of structured training on the Creighton Competency Evaluation Instrument (C-CEI) in improving nursing faculty self-efficacy and grading consistency in clinical student evaluations. Inconsistent clinical grading practices among nursing faculty create barriers to reliable competency evaluation and undermine student outcomes. Guided by the Donabedian Model and Lewin’s Change Theory, with implementation structured by the Plan-Do-Study-Act (PDSA) cycle, a quasi-experimental pre-post intervention design was used. Participants include nursing faculty responsible for clinical evaluations, who completed structured C-CEI training delivered via self-paced modules in a learning management system. Faculty self-efficacy was measured using …

Untangling The Roles Of Pulmonary Vagal Afferent Subsets With Inhaled Irritants, Teresa Darcey

USF Tampa Graduate Theses and Dissertations

The sensory nerves in the airways directly regulate critical defenses and indirectly regulate vital gas exchange. Airway function is largely controlled by the autonomic nervous system, and our understanding of its sensory regulation is directly connected to our ability to treat respiratory and cardiovascular pathologies. Airway sensory afferents are heterogeneous with respect to their electrophysiological properties, peptidergic capacity, and stimuli sensitivity, which at least in part dictate some of their various functions. There is evidence that embryological origin impacts reflex function: activation of the neural crest-derived population of sensory afferents has been shown to evoke the cough reflex whereas activation …

Quality Improvement Project Using Standardized Teaching Tools To Improve Skills Proficiency, Katrina Walker

Doctor of Nursing Practice Projects

Studies show that inconsistencies in teaching and evaluating skills proficiency in nursing programs can lead to student failure, delayed progression, and decreased faculty satisfaction. The purpose and aim of this quality improvement project was to determine whether the use of an evidence-based, standardized tool for teaching and evaluating Foley catheter insertion improved faculty satisfaction and teaching confidence compared to faculty-created checklists. The project utilized a quasi-experimental design guided by the Iowa Model of Evidence-Based Practice and Kotter’s 8-Step Change Model. The Bachelor of Science in Nursing (BSN) faculty implemented the standardized tool and completed pre- and post-intervention Likert-scale surveys measuring …

Improving Staff Knowledge On Hourly Rounding Using The 4ps To Reduce The Fall Rate, Chukwuemeka Igboanugo

Walden Dissertations and Doctoral Studies

I designed this Doctor of Nursing Practice (DNP) project to develop an educational program that increases staff knowledge of hourly rounding using an evidence-based approach, specifically pain, position, potty, and possession (the 4Ps), to prevent falls among residents in a long-term care facility. According to facility leadership, the observed gap in practice was the nursing staff members’ lack of knowledge in performing hourly rounding. The facility’s fall records for the lockdown units indicated a surge in fall rate, with 32 falls among 62 residents per month, reflecting a need for action. The practice-focused question guiding the project was: For staff …