Implementation Of A Tracheostomy Discharge Education Class For Nicu Nurses, Todd N. Chamoy

Doctor of Nursing Practice Final Manuscripts

Infants who are ventilator-dependent or have anatomic anomalies of their airway frequently require tracheostomy placement prior to discharge from the hospital in order to be cared for safely at home. At this large quaternary children’s hospital in Southern California, preparing these infants for discharge after tracheostomy placement has not been the role of the NICU nurse. There was no system in place on how to train caregivers, and the NICU staff felt unprepared. Evidence supports use of intensive educational programs to improve nurse knowledge and skills of tracheostomy care, allowing NICU nurses to provide improved care and pre-discharge teaching.

A …

Suprathel Burn Dressing Versus Standard Care: Impact On Hospitalization Duration And Post- Discharge Outpatient Visits, Isaac Awolola

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project is to determine the effectiveness of Suprathel a synthetic, one-time application, wound dressing that acts as a temporary skin substitute, particularly effective for partial-thickness burns and deep dermal burns vs, the standard of either Polysporin or Santyl, Xeroform, gauze on the frequency of outpatient (OP) visits after a patient’s discharge. A secondary aim of this project was to investigate whether Suprathel burn dressing significantly decreases the length of stay (LOS) for patients with second-degree burns involving < 20% total body surface area (TBSA). The results showed that the use of Suprathel dressings resulted in a shorter hospital stay 7.05 vs 9.35 days with a higher number of outpatient visits 5.47 vs 2.69 visits, compared to conventional dressings. The use of Suprathel dressings as a standard practice reduces inpatient hospitalization but increases outpatient visits and resource utilization. The use of Suprathel dressings shortens the length of hospitalization and may augment patient comfort, and decrease overall healthcare costs associated with hospitalization. Due to the reduction in need for painful daily dressing changes, Suprathel dressings constitute a potentially preferred option in burn care and could thereby influence treatment protocols and enhance patient outcomes.

Keywords: Wound care, Suprathel dressing, total body surface area, Outpatient Visits, Second-degree Burn, Length of stay, Gauze

Implementation Of One Key Question® Screening Tool To Increase Reproductive Life Planning At A Community Health Clinic, Laura D. Adams

Doctor of Nursing Practice Final Manuscripts

Introduction: This evidence-based practice project implemented and evaluated the One Key Question® (OKQ) screening tool to improve pregnancy intention screening and reproductive health counseling in primary care. The goal was to better identify reproductive health needs among women of reproductive age and enhance provider engagement in preconception and contraceptive counseling.

Background: Nearly half of all pregnancies in the U.S. are unintended, and many women do not receive timely reproductive health counseling. Despite national recommendations, pregnancy intention screening is often missed in primary care. Early identification of reproductive goals supports better outcomes through tailored education, contraception, or preconception care. OKQ is …

Utilizing A Clinical Resource Hub To Improve Access And Workflow For Retinopathy Screenings In The Veteran Population, Erin Kelly Pope

Doctor of Nursing Practice Final Manuscripts

Abstract

Utilizing a Clinical Resource Hub to Improve Access and Workflow for Retinal Screenings in the Veteran Population

Erin K. Pope, MSN, RN, AGCNS-BC, AMB-BC

Scot Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, SCRN, FCNS

Background: Diabetic retinopathy (DR), a progressive complication of diabetes mellitus (DM), is the leading cause of blindness among working-age adults. As DR can remain asymptomatic until advanced stages, annual screenings are critical for early detection and management. Teleretinal imaging is an evidence-based method for DR screening, offering cost efficiency and reduced demand on ophthalmology clinics. At the Veterans Administration’s (VA) Loma Linda Healthcare System …

Implementing The Fib-4 Tool For Liver Fibrosis Screening In Diabetic Patients In Primary Care, Robert I. Montillano

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-non-alcoholic fatty liver disease (NAFLD), affects over 1 in 3 adults with type 2 diabetes mellitus (T2DM) and is a leading cause of advanced liver fibrosis. Despite guideline support from the American Diabetes Association (ADA) and American Association for the Study of Liver Diseases (AASLD), screening practices remain inconsistent in primary care. The Fibrosis-4 (FIB-4) index is a validated, low-cost, noninvasive tool for fibrosis risk stratification, yet it remains underutilized despite its availability in many electronic health record (EHR) systems.

Purpose: This Doctor of Nursing Practice (DNP) evidence-based practice (EBP) project …

Personalized Nutrition Program For Microbiome Restoration: A Functional Approach To Gut Health, Digestive Function, And Weight Management, Maria Camila Trujillo

Department of Nutrition Student Projects

The gut microbiome has emerged as a fundamental influencer of digestion, metabolism, human health, and weight management. Dysbiosis and imbalance in gut microbial composition are associated with various health disorders, including obesity, metabolic dysfunction, and gastrointestinal disturbances. Considering the high incidence of weight-related health concerns among dietary clients, personalized microbiome interventions offer a promising therapeutic approach. This project aimed to develop evidence-based medical nutrition therapy guidelines grounded in individualized microbiome analysis via stool testing. As a structured protocol, the RISE method (reset, identify, support, excel) was established based on the current literature review and specialized microbiome training. The methodology incorporates …

Life In The Fast Lane: Improving Patient Intermittent Fasting Compliance, William C. Moreo

Doctor of Nursing Practice Final Manuscripts

Background: In the United States, 2 in 5 adults are obese. The U.S. spends approximately $147 billion annually on healthcare related to obesity. Intermittent Fasting (IF) has emerged as an evidence-based, safe, and cost-effective approach to weight loss. When instructed correctly, it has been shown to improve patient BMI and total weight over a short-term duration.

Purpose of the Project: The purpose of this study was to determine the effectiveness of a standardized time-restricted eating (TRE) intermittent fasting education protocol for primary care providers (PCP) and its impact on their confidence levels in managing patients. This project aims to enhance …

Electronic Medical Record Clinical Decision Support Across The Ob Continuum Of Care: Enhancing Doula Education And Usage, Jonese D. Randall

Doctor of Nursing Practice Final Manuscripts

Background: The United States is seeing an uptick in maternal deaths by 159% since 2019, with maternal mortality higher with cesarean procedures (Hoyert, 2020; Riches et al., 2024[LC1] ). UC San Diego Health NTSV C-Section rates between September 2024 – October 2024 ranged between 22-54%, well above the benchmark of 23.4% in California (Slone, n.d.). Doulas are trained to care for the mother before, during, and after birth by being an advocate, providing physical and emotional support, and being a continuous support person (Dekker, 2017). Doulas have been shown to improve birthing outcomes by providing these support mechanisms, particularly …

Increase Knowledge And Competency Of Point Of Care Ultrasound (Pocus) Among Emergency Nurse Practitioner Students Incorporating Web-Based Videos And Clinical Benchmarks., Andrew N. Walsh

Doctor of Nursing Practice Final Manuscripts

Background: Point of care ultrasound (POCUS) is a critical skill in Emergency Medicine (EM), and Emergency Nurse Practitioner (ENP) students are increasingly expected to demonstrate proficiency. ENP students often face limited opportunities for hands-on practice compared to EM residents. Research suggests that the didactic component of POCUS training delivered through e-learning is as effective as in-person instruction. The American College of Emergency Physicians (ACEP) supports the flipped classroom model, which maximizes simulation time and focuses on psychomotor skills and clinical application, allowing didactic portions to be delivered online. Additionally, ACEP recommends a benchmark of at least 25 POCUS examinations to …

Parent’S Health Literacy And Stress Level In The Inpatient Pediatric Setting, Tina C. Smith

Dissertations

Purpose: This study examined the relationship between parent health literacy and stress levels during their child’s inpatient hospitalization.

Background: In 2019, over five million pediatric hospitalizations occurred in the United States. Parents are central to their child’s care, but stress and sociodemographic factors may hinder their ability to understand and apply health information. This study explored how stress and other variables impact parent health literacy during hospitalization.

Methods: A cross-sectional design included a demographic survey, the Perceived Stress Scale (PSS-10), and the Newest Vital Sign (NVS). Bivariate analyses (Chi-square, t-tests) and logistic regression were used to assess …

Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett

Dissertations

Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study …

Enhancing Access To Medication-Assisted Treatment (Mat) For Minority Inmates In The San Diego Prison System: A Quality Improvement Through Culturally Competent Approach, Douglas Seangmany

Doctor of Nursing Practice (DNP) Projects

Abstract

Background The opioid crisis disproportionately affects racial and ethnic minority groups, particularly in correctional settings. In San Diego’s prison system, only 20% of incarcerated individuals with Opioid Use Disorder (OUD) receive Medication-Assisted Treatment (MAT), highlighting significant care disparities.

Local Problem Limited access to MAT among minority inmates contributes to poorer health outcomes, higher overdose rates, and increased healthcare costs. Addressing these disparities is crucial for improving health equity within the prison system.

Methods A review of 10 studies emphasized the importance of culturally competent care in improving treatment engagement and outcomes among minority populations. To address disparities, the intervention …

Staff Education On Physical Activity As A Therapeutic Option For Anxiety And Depression, Suja Paul

Walden Dissertations and Doctoral Studies

This project’s aim was to educate staff on physical activity (PA) as a therapeutic option for anxiety and depression to relieve psychotic symptoms, enhancing patients’ quality of life. PA enhances cognitive functioning, reduces anxiety and depression, and decreases the risk of cardiovascular conditions and early death. Patients with severe mental illnesses face barriers to PA and exercise, so providers and policymakers must create an environment that encourages participation. A knowledge gap for staff exists in promoting PA in mental health patients. Healthcare professionals should recommend the right amount of PA for each patient. This initiative aims to increase staff confidence …

Clinical Practice Patient Education Guideline For Patients With Substance Use Disorders, Josephine Nandzo

Walden Dissertations and Doctoral Studies

The Veteran’s hospital for which this DNP clinical practice patient education guideline (CPPEG) was developed has made strides in addressing the needs of patients with substance use disorders (SUDs). However, the problem identified for this project was the need for veterans with SUDs to obtain information about resources available in the hospital, community, or state to manage their recovery. The project question was as follows: Will a CPPEG on resources for patients with SUDs meet the optimal threshold of 7 on the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument? The purpose was to plan, implement, and evaluate …

Evaluating The Impact Of Anti-Vaccine Online Search Trends During The Covid-19 Pandemic On Adolescent Pertussis-Containing Vaccine Completion, Deborah L. Fisher

Walden Dissertations and Doctoral Studies

Adolescent completion of pertussis-containing vaccines is a public health concern, especially with rising online anti-vaccine misinformation. Incomplete vaccination increases risk for preventable diseases and impacts community health. A gap in the literature on the relationship between online anti-vaccine search trends during the COVID-19 pandemic and adolescent pertussis vaccine completion was addressed in this quantitative, repeated cross-sectional study. Andersen’s behavioral model of health services use guided the study. Secondary data from the 2019 and 2022 National Immunization Survey-Teen (NIS-Teen) compared adolescents aged 13–17 in the five U.S. states with the highest (n=5,464) versus the five with the lowest (n=3.031) population-adjusted anti-vaccine …

Pain Management Educational Module For Nursing Staff, Kathyrina Lucy Pham

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed a practice gap in pain management among nursing staff in the rehabilitation unit. Frequent pain-related patient calls contributed to inconsistent clinical practices. This project aimed to evaluate whether a brief, evidence-based educational intervention could enhance nurses’ knowledge of pain management. 47 registered nurses participated in an educational module delivered during both day and night shifts. Pre- and post-test scores were collected and analyzed to assess knowledge acquisition. T-test results indicated a statistically significant improvement in nurses’ pain management knowledge. The findings support the effectiveness of brief, targeted education in promoting clinical outcomes …

Staff Education To Improve Quality Of Life For Patients With Dementia, Vanessa Ann Soda

Walden Dissertations and Doctoral Studies

Dementia is a chronic neurodegenerative disease that is incurable and unpredictable. Patients with dementia experience a decline in functional abilities, communication, and social skills. Fifty-five million people worldwide live with dementia with over 6.9 million people over 65 years of age diagnosed in the United States. The practice problem identified by a 25-bed assisted living facility in the north-central United States was staff’s lack of knowledge of dementia diagnosis, person-centered care approaches, and optimal care strategies supporting a positive quality of life for patients with dementia. The practice-focused question addressed whether an education program consisting of evidence-based practices using the …

Staff Education On Documentation For Hospice Registered Nurses, Sharon Spencer Cunningham

Walden Dissertations and Doctoral Studies

Summary Documentation is a part of a daily task that all nurses undertake. Its purpose is to provide validation of care rendered to patients. In the hospice setting, nurses’ documentation is crucial, as it supports whether a patient qualifies to receive hospice services. If proper documentation is not recorded, patients can lose services and organizations can face a loss of revenue and potential fines. At a hospice organization in the Southeast United States, there was little emphasis of the importance of documentation that adheres to guidelines set by Centers for Medicare and Medicaid Services (CMS). Therefore, nurses’ documentation lacked the …

Improving Patients' Confidence In Self-Care Management And Preventing Hospital Readmission Within 30 Days Of Discharge In The Heart Failure Population, Kelly Carroll

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Heart failure (HF) is a chronic, progressive condition and a leading cause of hospital admissions nationwide. The 30-day readmission rate for HF patients is approximately 23.4%, contributing to increased morbidity, mortality, and significant healthcare costs. Each HF-related readmission is estimated to result in a financial loss of $15,789 per patient due to reduced reimbursement from both private and public insurers. This underscores the critical need for timely follow-up care, particularly within the first 30 days post-discharge.Without adequate follow-up and patient education, many individuals lack the confidence and knowledge necessary for safe and effective self-management in the outpatient setting, …

Policy Proposal For Integrating Pediatric Mental Health Into Nursing Practice In Uganda, Giselle S. Perez

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Mental health disorders affect over 1 in 7 individuals aged 10 to 19 globally. In low- and middle-income countries like Uganda, limited access to mental health specialists and pervasive stigma exacerbate the gap in care. Nurses, often the first point of contact, typically lack adequate pediatric mental health training. The proposal aims to address this gap by equipping nurses with the knowledge and competencies to identify, intervene, and support children with mental health disorders. Purpose: This proposal advocates for implementing targeted, continuing education in pediatric mental health for Ugandan nurses. The goal is to enhance the quality of …

Beyond The Bmi: An Educational, Family-Centered Approach To Identifying Risk For Childhood Obesity, Michelle J. Mak

Doctor of Nursing Practice Final Manuscripts

Background: In the United States, the increasing prevalence of obesity has caused public health concerns. From 2017 to 2020, 14.7 million children ages 2 to 19 were considered obese. The main parameter for diagnosis is a body mass index (BMI) at or above the 95th percentile on the growth chart. Additionally, overweight is defined as a BMI between the 85th and 95th percentiles. At a pediatric primary care clinic in San Diego, CA, over a third of patients are considered overweight or obese. Obesity comorbidities can include type 2 diabetes, hypertension, and hyperlipidemia. Overweight adolescents have a 70% likelihood of …

From Fee For Service To Outcome Based Care: A Policy Proposal To Reduce Provider Burnout In Assertive Community Treatment, Amanda M. Thompson

Doctor of Nursing Practice Final Manuscripts

Purpose: This project examines the impact of the fee-for-service (FFS) reimbursement models on provider burnout within Assertive Community Treatment (ACT) programs and proposes a hybrid reimbursement framework that integrates case-rate and outcome-based payment structures. The goal is to enhance care quality, improve provider retention and optimize patient outcomes by addressing financial and administrative inefficiencies inherent in the current model.

Background: Mental illness affects over 59 million U.S. adults with serious mental illness (SMI) presenting significant challenges in healthcare delivery. ACT is an evidence-based, multidisciplinary approach designed to provide intensive, community-based psychiatric care to individuals with serious mental illness (SMI). However, …

Clinical Practice Guideline For Wound Care Management In Primary Healthcare Settings Across The British Virgin Islands To Minimize Clinical Practice Variations, Trorisia Shanika John

Walden Dissertations and Doctoral Studies

This quality improvement (QI) initiative in a British Virgin Islands (BVI) primary healthcare setting involved the problem of inconsistent wound care management among registered nurses, which was a concern that was identified in a 2023 audit. The BVI Health Service Authority (HSA)’s diverse nursing staff, which is recruited across the Caribbean, contributed to varied wound care approaches, negatively impacting healthcare delivery and quality. These inconsistencies led to unequal resource access, increased infection and complication risks, and potential financial and legal liabilities. Furthermore, it could negatively affect staff and patient perceptions, potentially decreasing patient satisfaction, highlighting the urgent need for standardized …

Staff Education On Gad-7 Screening Tool Implementation, Sandra Oghomwen Osemwonta

Walden Dissertations and Doctoral Studies

As a staff educational project, I addressed a critical issue in nursing practice. In many clinical settings, medical personnel are unprepared to use screening instruments such as the Generalized Anxiety Disorder 7-Item (GAD-7) tool because they do not possess the requisite expertise, which often leads to missed or delayed identification of anxiety symptoms. Timely and accurate mental health assessments are essential for effective patient care and improved clinical outcomes. Does an educational program of a Psychiatric outpatient clinic increase staff knowledge and confidence in using the General Anxiety Disorder (GAD-7) tool, compared to baseline knowledge before training? was the central …

Staff Education On Importance Of Medication Adherence For Patients Living With Schizophrenia, Sonia Obehi Okojie

Walden Dissertations and Doctoral Studies

This DNP project aimed to address the lack of staff knowledge regarding medication adherence in patients with schizophrenia to better support these patients and to address a critical organizational knowledge gap. Schizophrenia is a chronic illness that impacts quality of life and medication noncompliance, often causing relapses and hospitalization. Evidence has shown that medication compliance improves symptoms, reduces hospital visits, and leads to better overall disease outcomes. A review on the project site indicated a wide knowledge deficit for the staff on interventions to enhance compliance to medication regimens by schizophrenia patients. It is an important issue to address in …

Increasing Depression Risk Screening In Hospice And Palliative Care Patients, Elizabeth Kanini Michaels

Walden Dissertations and Doctoral Studies

This doctoral project was conducted as a staff education project. The practice problem involved inconsistent depression risk screening in hospice and palliative care patients. It was crucial to address this, as depression can be pervasive in this population. The practice-focused question was, For registered nurses who work in a palliative or hospice care unit, does education on depression risk screening increase depression screening rates as compared 12 weeks before to 12 after the education? The project aimed to improve depression risk screening rates through staff education. The Johns Hopkins nursing evidence-based practice model was used to assess 13 supporting articles …

Prearrival Phone Call Initiative To Decrease Procedural Cancellations And Delays, Fazali Nkoloma

Walden Dissertations and Doctoral Studies

This doctor of nursing practice project evaluation of an organizational quality improvement initiative focused on evaluating the effectiveness of implementing a prearrival phone call process for interventional radiology patients scheduled for procedures requiring moderate sedation or anesthesia. Adherence to NPO guidelines is crucial for patient safety before moderate sedation and anesthesia. The practice problem identified was the number of procedures that were canceled or delayed because of patient nonadherence with NPO guidelines. The practice-focused question that guided this project was, Can the implementation of prearrival phone calls in the preprocedural radiology surgical services help improve patient adherence with NPO protocol …

Staff Education To Improve Patient Outcomes And Treatment Compliance Through Use Of Motivational Interviewing In The Mental Health Setting, Rachel Nardi

Walden Dissertations and Doctoral Studies

Summary: Treatment noncompliance is a significant problem within the realm of mental health care. Recurrent noncompliance increases symptom severity, the likelihood of a crisis, and the burden placed on mental health care resources. Motivational interviewing (MI) is an evidence-based practice (EBP) demonstrated through extensive research to positively affect patient outcomes. Teaching MI to mental health care providers is one option organizational leaders can choose to address treatment noncompliance. In order for MI to become standard nursing practice, a method of education must be developed and implemented. This necessitates the identification of effective education delivery methods. A staff education project was …

Staff Educational Program On The Patient Health Questionnaire-9 Depression Screening Tool In A Psychiatric Outpatient Clinic, Chinwe Genevive Nwaigwe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project focused on improving the knowledge and confidence of psychiatric outpatient clinic staff in administering and interpreting the Patient Health Questionnaire-9 (PHQ-9), a critical tool for depression screening. Given the high prevalence of depression and disparities in mental health care, inconsistent PHQ-9 use can lead to delayed diagnoses and unequal access to treatment. Addressing this gap is both a clinical priority and a matter of social justice. I delivered a 2-hour educational program for 17 staff members to improve screening practices. The session included a PowerPoint presentation, role playing, and an interactive …

Increasing Advance Directive Completion: A Future Initiative For All, Hilda A. Lince

Doctor of Nursing Practice Final Manuscripts

Abstract

Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.

Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE …