Nursing Commons^™

Exploring Virtual Nurse Perceptions Of Caring Through Acute Care Teleconferencing, Monika Lu

Doctoral Projects

Virtual nursing programs have emerged as innovative solutions to address hospital operational challenges and workforce shortages. However, concerns remain about the potential for decreased human connection in telehealth environments. Limited evidence exists regarding virtual nurses’ perceptions of caring behaviors and their ability to develop therapeutic relationships through teleconferencing technology. Purpose: This exploratory study examined virtual nurses’ (ViRNs) perceptions of caring and identified strategies for fostering patient relationships in telehealth settings. Methods: A mixed-methods custom survey was distributed to 25 eligible ViRNs at Stanford Health Care, with 19 respondents (76% response rate). ViRN caring perceptions were measured quantitatively using a 5-point …

A Quality Improvement Project To Increase Identification And Treatment Of Obstructive Sleep Apnea In Patients With Type 2 Diabetes In A Rural Clinic, Paige Spence

Evidence-Based Practice Project Reports

No abstract provided.

Patient Reported Outcome Measure Use In Heart Transplant Care, Nichole Côté

Doctoral Projects

Despite growing evidence supporting Patient-Reported Outcome Measures (PROMs) in chronic disease management, no consistent application exists within the international heart transplant community. This Doctor of Nursing Practice project implemented the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) as a PROM within the a large volume heart transplant clinic, evaluating workflow feasibility, the association between Overall Summary Scores (OSS) and visit length, and clinician perceptions of PROM use. The KCCQ-12 was administered via a mobile health application with automated distribution. Workflow integration was assessed by calculating the percentage of scheduled visits with completed PROM documentation. Visit length was measured using electronic medical record …

Evaluating The Efficacy Of The Confusion Assessment Method For The Icu (Cam-Icu) In Reducing Length Of Stay Among Critically Ill Patients: A Scoping Review, John Simmons, Fay Nelson, Keith Hunt, Lindsey Waller, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is a prevalent complication among critically ill patients in intensive care units (ICUs), associated with increased mortality, prolonged hospital stays, and higher healthcare costs. The Confusion Assessment Method for the ICU (CAM-ICU) is a validated tool designed to aid in the early identification of delirium; however, systematic screening remains low among healthcare professionals. This scoping review aims to evaluate the efficacy of the CAM-ICU in identifying delirium and its potential impact on reducing ICU length of stay.

Method

            This scoping review began by establishing inclusion criteria to ensure the results were applicable to the researchers’ patient population, including …

Building Nurse Managers’ Knowledge And Confidence To Lead Clinical Ladder Success: A Theoretically Informed Educational Framework, Michelle Joann Chlebinski

Doctoral Projects

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post …

Medication-Assisted Treatment For Patients With Substance Use Disorder And Depression: A Scoping Review, Josiane Deguenon Bsn-Rn, Elisabeth Fritz Bsn-Rn, Jesse Jean Bsn-Rn, Tucker Mckinney Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Substance use disorder (SUD) frequently co-occurs with depression and increases relapse risk and healthcare utilization. Although medication-assisted treatment (MAT) is an evidence-based intervention for SUD, outcomes for adults with co-occurring depression remain inconsistently reported due to variation in study designs, treatment settings, and measures. This scoping review examines evidence on MAT use among adults with co-occurring depression and SUD and summarized reported clinical and healthcare utilization outcomes.

Methods

From August 2023 to November 2025, a scoping literature review was conducted on PubMed/MEDLINE, CINAHL, and the Cochrane Library, using MeSH search terms and Boolean operators to link the concepts defined …

Improving Emergency Department Throughput: Implementation Of A Nurse-Driven Protocol In Pediatric Fast-Track Patients Presenting With Fever, Kerrigan A. Teeple

Evidence-Based Practice Project Reports

Overcrowding in the emergency department presents significant operational challenges and is associated with adverse patient outcomes (Gottlieb et al., 2020). Despite throughput initiatives, increasing patient acuity and rising census levels continue to strain emergency department efficiency. This quality improvement project evaluated whether implementing a fever-reduction standing order protocol could reduce door-to-provider and door-to-disposition times for pediatric fast-track patients presenting to the emergency department. A review of evidence across 6 databases identified nurse-initiated standing orders as a best-practice strategy to expedite care, improve throughput, and reduce delays in disposition. Guided by this evidence, a standing order protocol for acetaminophen administration was …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Nurse-Driven Infusion Protocols In Diabetic Ketoacidosis: A Scoping Review, Nicholas Morrell Pierce Msn, Rn, Cen, Ccrn, Mary Cassandra Scott Bsn, Rn, Ccrn, Cen, Alvertis Demetreis Warren Bsn, Rn, Ccrn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, …

2025 Nursing Annual Report, Children's Health System Of Texas

2025

No abstract provided.

Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization In An Adaptable Acuity Unit At An Academic Health Center, Moses Albaniel

Doctoral Projects

Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic …

Remimazolam As A Sedative For Endoscopic Procedures: A Scoping Review, Hamzha Aysheh, Megan Henderson, Megan Hinkle, Sara Holton, Spencer Turner, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Propofol is commonly used for procedural sedation during endoscopic procedures because of its rapid onset and short duration; however, its use is frequently associated with adverse effects such as hypotension, hypoxemia, respiratory depression, bradycardia, and injection site pain. As diagnostic endoscopic procedures continue to increase, particularly among older and medically complex patients, there is a growing need for sedative agents that provide effective sedation while minimizing perioperative risk. Remimazolam, a novel ultra–short-acting benzodiazepine metabolized by tissue esterases, has demonstrated favorable hemodynamic stability and a reduced adverse effect profile in recent literature. The purpose of this evidence-based quality improvement project …

Impact Of Nitrous Oxide Analgesia On Labor Experience, Kierra Jones Rn, Bsn, Elyzabeth Morales Rn, Bsn, Lanitra Ray Rn, Bsn, Rhonda Johnson Dnp, Cne, Cnm, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Nitrous oxide (N₂O) has re-emerged in the United States as a labor analgesia option that supports mobility, autonomy, and patient-centered care. As nurses increasingly support low-intervention and physiologic birth approaches, understanding the effectiveness and safety of nitrous oxide for low-risk laboring individuals is essential. This scoping review examines current evidence on nitrous oxide use during labor, focusing on maternal pain management, satisfaction, and neonatal outcomes to inform evidence-based nursing and midwifery practice.

Methods

A scoping review was conducted using PubMed, CINAHL Complete, and the Cochrane Library between September and October 2023. Inclusion criteria consisted of English-language studies published within …

Ai Literacy In The Nursing Informatics Community: A Needs Assessment, Jerri Westphal

Doctoral Projects

Nursing informatics professionals are required to lead AI integration in healthcare, yet their baseline AI literacy, competency, and educational needs have not been formally assessed. This descriptive needs assessment examined AI literacy, competency, adoption readiness, and engagement among nursing informatics professionals, concurrently identifying educational priorities and preferred learning modalities. A cross-sectional survey was administered to members of the American Nursing Informatics Association (ANIA) and the broader community (N = 194). The N.U.R.S.E.S. framework (Hoelscher & Pugh, 2025) informed the survey instrument's domain structure. Five composite indices were developed: AI Familiarity, Knowledge, Attitude, Competency, and Use. Descriptive statistics and Pearson correlation …

The Effect Of Fall Prevention Programs With Hourly Rounding On Fall Rates Among Adults Patients In Neurological Unit, Oyinlola A. Ogundeji

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this QI project was to evaluate the effect of a structured hourly rounding program on patient fall rates in an adult neurological inpatient unit.

Background

Patient falls remain a major safety concern in acute care, particularly among hospitalized neurological patients with impairments in mobility, cognition, and balance. In an adult neurological unit within a Magnet-designated hospital, fall rates exceeded national benchmarks, underscoring the need for a targeted quality-improvement

Methodology

A pre–post QI design, guided by the Plan-Do-Study-Act framework, was implemented over 12 weeks in a 28-bed neurological unit. This intervention featured structured hourly rounding using the …

The Effects Of Sugammadex Vs. Neostigmine On Intraoperative Heart Rate In Pediatric Patients Under Two Years: A Scoping Review, Saumel Abston, Jackson Cobb, Elle Dean, Tanner Dillard, Pauline Dinh, Dwayne Accardo Dnp, Crna, Faana, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Neuromuscular blockade (NMB) reversal is a critical component of anesthesia care, particularly in infants under two years of age who have immature autonomic regulation and heightened vagal tone, predisposing them to bradycardia. Neostigmine, the traditional reversal agent, is associated with parasympathomimetic effects such as bradycardia, requiring anticholinergic co- administration. Sugammadex, a selective relaxant binding agent, offers rapid and predictable reversal of aminosteroidal neuromuscular blocking agents with less cholinergic side effects. Although the safety profile of sugammadex is well established in older pediatric populations, limited evidence exists regarding its cardiovascular effects in infants under two years of age.

Methods

A …

Discharge Education Bundles And Evaluating The Effect On Readmission And Satisfaction Rates: A Scoping Review, Jane Campo Bsn, Rn, Charlotte Edwards Bsn, Rn, Mary Catherine Hall Bsn, Rn, Sarah Moore Bsn, Rn, Allison Walker Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Transitioning children with a chronic medical condition from hospital to home is a critical and difficult process, leaving many families feeling anxious and unprepared. Nationally, 1 in 7 pediatric patients are readmitted within thirty days, making readmission rates an important quality indicator with both clinical and financial implications. To address these challenges, multiple discharge bundles have been developed; however, their effectiveness has not been consistently evaluated. The aim of this project is to summarize the current literature and highlight its positive outcomes, with the intention of promoting further research, reducing 30-day readmission rates, and increasing parental satisfaction (Shermont et …

Improving Access And Early Identification Of Anxiety Disorders Through Annual Gad-7 Screening In High Schools: A Scoping Review, Joshua Richard Yumul Bsn, Rn, Cindy Thao Msn, Rn, Justin Doyle Borden Bsn, Rn, Rebecca Lizette Johnston Bsn, Rn, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Background: Anxiety disorders affect nearly one-third of adolescents in the United States, yet many cases remain undiagnosed due to inconsistent screening and limited access to school-based mental health services. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is a validated screening tool, but its routine use in high school settings is not well established.

Purpose: This scoping review aimed to synthesize current evidence on the use of the GAD-7 in high schools to support early identification of anxiety disorders and improve access to mental health care.

Methods: A comprehensive literature search was conducted using PsycINFO, ERIC, PubMed, CINAHL, and Google Scholar. …

Discharge Process Improvement Initiative Using An N-By-T Strategy In A Progressive Care Unit In An Acute Care Setting, Sukhvir Walia

Doctor of Nursing Practice Projects

Background

Timely and efficient patient discharge processes are crucial for enhancing hospital throughput, reducing emergency department boarding, optimizing inpatient bed utilization, and ensuring safe transitions of care. Delayed hospital discharges contribute to prolonged hospitalizations, operational inefficiencies, increased healthcare expenditures, and decreased patient satisfaction. Progressive care units (PCU) are particularly vulnerable to discharge delays because patients frequently require multidisciplinary coordination before safe discharge can occur.

Purpose

The purpose of this quality improvement project was to evaluate the effectiveness of implementing a structured discharge readiness checklist combined with an n-by-T discharge planning strategy during multidisciplinary patient progressive rounds (PPRs) to improve discharge …

Motivational Interviewing Vs. Educational Handouts For Caregiver Smoking Cessation In Pediatric Asthma Patients: A Scoping Review, Michael Stefano, Hannah Marsh, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Secondhand smoke exposure can significantly worsen asthma outcomes in pediatric patients, leading to increased exacerbations and healthcare utilization. Caregivers can play a critical role in reducing secondhand smoke exposure, however sustained smoking cessation can be challenging to achieve. Two powerful healthcare interventions to assist in caregiver smoking cessation include motivational interviewing and educational handouts, however their compared effectiveness has not yet been fully reviewed. This scoping review compared the effectiveness of motivational interviewing and educational handouts in promoting smoking cessation among caregivers of children hospitalized for asthma exacerbations over the course of 90 days.

Intraoperative Aspiration Risk Reduction Of Diabetic Patients Through Gastric Ultrasound: A Scoping Review, Dakota Sellers Bsn, Rn, Kristy Speight Bsn, Rn, Ginger Chastain Bsn, Rn, Tyler Stone Bsn, Rn, Claudia Bursi Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap, Margaret Harvey Phd, Acnp-Bc, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Patients with diabetes mellitus are significantly more prone to delayed gastric emptying, which can increase their risk for aspiration events in the operating room despite following standard fasting guidelines set by the American Society of Anesthesiologists (ASA). Using point-of-care gastric ultrasound, trained providers can quickly and accurately evaluate gastric volumes and risk-stratify patients based on these findings. However, these methods have not been clearly assessed in the diabetic population. The purpose of this scoping review is to map the existing evidence on the use of gastric ultrasound findings among adult patients with diabetes undergoing anesthesia.

Methods

A scoping review …

Mortality Risk Comparison Of Doacs And Warfarin In Geriatric Adults With Dementia And Atrial Fibrillation, Laraya Gunter Bsn, Rn, Mariah Cloud Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Atrial fibrillation and dementia frequently coexist in older adults, creating complex challenges for anticoagulation management. Although anticoagulation is recommended to reduce thromboembolic risk in atrial fibrillation, current clinical guidelines lack dementia specific recommendations. Resulting in uncertainty regarding optimal therapy in this population. The purpose of this scoping review was to examine and synthesize current evidence comparing mortality risk and adverse events associated with direct oral anticoagulants (DOACs) versus warfarin in adults age 65 and older with atrial fibrillation and dementia.

Methods

A scoping review was conducted using PRISMA-ScR methodology. Peer-reviewed articles published between 2019 and 2023 were identified through …

Evaluating The Screening And Referral Process For The Use Of Phq-9 Screening Tool In Middle-School Aged Students: A Scoping Review, Kaythi Soe, Msn, Pmhnp-Bc, Fnp-Bc, Margaret Harvey Phd, Acnp-Bc, Fhrs, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

No abstract provided.

Optimizing Glycemic Control In Type Ii Diabetes: Continuous Glucose Monitoring : A Scoping Review, Sarah Poe, Bsn, Rn, Bailey Li, Bsn, Rn, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Individuals with Type II diabetes mellitus (T2DM) experience increased risk of cardiovascular disease and higher mortality rates relative to non-diabetic populations. Continuous glucose monitoring (CGM) enables more precise analysis of glucose patterns and trends compared to conventional self-monitoring of blood glucose (SMBG). CGM provides frequent measurements and generate meaningful metrics, such as time in range (TIR), time above range (TAR), and time below range (TBR), allowing evaluation of glucose stability and variability. Despite these advantages, evidence comparing CGM and SMBG remains inconsistent. This scoping review aims to evaluate how CGM compares with SMBG across reported outcomes, including TIR, TAR, …

How Does Cognitive Behavioral Therapy (Cbt) And Antipsychotics Compare To Antipsychotics Alone Impact Inpatient Length Of Stay: A Scoping Review, Morgan E. Johnson, Hailey M. Wade, Y'Esha V. Williams-Click, Rocquell Duncan, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Background

Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on …

Home-Based Vs Clinic-Based Stool Testing For Detecting Early Cancer Markers: A Scoping Review, S. Elizabeth Brock, Jacqueline Giles, Sydney James, Cha'landria Mccall, Bobby Bellflower Dnsc, Nnp-Bc-Faanp, Fnap, Faan

Doctor of Nursing Practice Projects

Purpose/Background 

Colorectal cancer (CRC) remains a significant public health concern in the United States, with screening rates below national targets due to persistent socioeconomic and structural barriers, particularly among underserved populations. Stool-based screening modalities offer accessible alternatives to colonoscopy, and emerging evidence suggests that home-based delivery models may improve screening uptake; however, implementation strategies vary and comparisons between home-based and clinic-based approaches remain limited. This scoping review examines current evidence on strategies that support CRC screening uptake, with a focus on stool-based modalities, including fecal immunochemical testing (FIT), fecal occult blood testing (FOBT), and multitarget stool DNA testing (mDNA), and …

Moving Toward Standardization Of Breast Cancer Screening: A Scoping Review Comparing Uspstf And Acs Recommendations For Women Aged 40–74, Gerita F. Perry, Krystal D. Hester-Smith, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose 

To compare U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines for women aged 40–74, and to recommend adopting one consistent, standardized guideline in practice. Standardization can improve care continuity, patient adherence, reduce anxiety, support early detection, and lower mortality.

Background 

Breast cancer is the second leading cause of cancer-related death amongst women. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The ACS recommends an annual mammogram. Differences between the two organizations for screening emphasize the need for a common alignment to reduce breast cancer mortality. As breast …

Organizational Governance Capacity And Organizational Resilience In Hospitals: A Cross-Sectional Study, Leyla Afşar, Selim Yazıcı

Makara Journal of Health Research

Background: This study aims to examine the relationship between organizational governance capacity (OGC) and organizational resilience (OR) in hospitals, with a focus on cross-institutional differences.

Methods: A cross-sectional study was conducted among 1,143 employees from six hospital types in Istanbul, including university, Ministry of Health (state, training and research, and city), and private hospitals. Validated scales were used to measure OGC and OR. Data were analyzed using descriptive statistics, nonparametric tests, and structural equation modeling (SEM) to assess the relationships between these dimensions.

Results: Private hospitals demonstrated the highest levels of both OGC and OR (70%), followed …

Mapping The Evidence On The Maternal–Fetal Triage Index (Mfti): A Scoping Review, Taylor Harris, Kelsey Downie, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Maternal morbidity and mortality remain persistent challenges in the United States, with obstetric triage serving as a critical point of entry for timely recognition and management of high-acuity maternal-fetal conditions. Despite recommendations for acuity-based triage models, many obstetric units continue to rely on non-specific emergency triage tools, such as the Emergency Severity Index (ESI), which inadequately account for pregnancy-specific physiological changes and fetal status. To address these limitations, the Association of Women’s Health, Obstetric and Neonatal Nurses developed the Maternal-Fetal Triage Index (MFTI), a five-level obstetric-specific triage tool. Although the MFTI has been increasingly adopted in clinical practice, the …

Building Connections For Care: A Practical Guide For Novice Nursing Professional Development Practitioners, Debra Hunt

Student Dissertations

Building Connections for Care is a practical textbook designed to support novice Nursing Professional Development Practitioners (NPDPs) as they transition from expert bedside clinicians to educational leaders within complex healthcare systems. Grounded in the Association for Nursing Professional Development (ANPD) practice model, the book integrates ethical foundations, communication strategies, leadership frameworks, and inquiry methods to build confidence and competence in the NPDP role. Chapters trace a developmental pathway from role transition and Benner’s novice-to-expert model through ethics and just culture, incivility and workplace culture, and communication skills including feedback, SMART goals, SBAR, and professional digital conduct. Subsequent chapters expand NPDP …