Nursing Commons^™

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Anesthesia Informed Consent: An Objective Structured Clincial Examination, Joshua Powell

Doctoral Projects

Informed consent is a fundamental component of anesthesia practice and is recognized as professional Standard IV by the American Association of Nurse Anesthesiology (AANA). Despite its importance, anesthesia providers often face challenges in effectively obtaining consent from patients. Within The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP), a need was identified to strengthen student competency in conducting anesthesia informed-consent discussions. This project developed and implemented an Objective Structured Clinical Examination (OSCE) as a standardized, evidence-based approach to teach and assess informed-consent skills in alignment with the American Association of Nurse Anesthesiology (AANA, 2019) standards. The intervention was designed …

Bridging Disability Studies And Nursing Education: A Curricular Intervention, Serena Karim

2025 Fall Honors Capstones Projects - Archive

Although one in four Americans experience disability in their lifetimes, the majority of nurses and other healthcare professionals feel ill-prepared to care for patients with disabilities (PWD). Factors such as inaccessible healthcare facilities, insufficient clinical knowledge, and biases about the quality of life of PWD contribute to mounting health inequities between PWD and non-disabled people. To further understand how education can impact nursing students’ comfortability and confidence toward caring for PWD, a 30-minute disability studies lesson was implemented for junior-level nursing students. 51 students who attended the lecture provided anonymous pre- and post-lecture surveys, which contained Likert scale and free …

The Fascia Iliaca Regional Nerve Block Using Ultrasound And Landmark Technique: An Objective Structured Clinical Examination For Nurse Anesthetists, Braxton T. Beech, Parker F. Rigby

Doctoral Projects

The fascia iliaca block (FIB) is an effective regional anesthesia technique used in various clinical settings, including operating rooms, emergency departments, and pain management clinics. Despite its advantages in reducing postoperative complications and minimizing opioid use, FIB remains underutilized among Certified Registered Nurse Anesthetists (CRNAs), primarily due to limited exposure and training. This doctoral project examines the implementation of an Objective Structured Clinical Examination (OSCE) as an educational intervention to enhance CRNA proficiency in performing FIB using both ultrasound-guided and landmark techniques.

A pre- and post-test study design was conducted with 18 CRNA participants attending a continuing education workshop. Demographic …

Enhancing Crna's Knowledge Of Radiation Safety Through Online Education, Angela Iledan, Madeline Pousson

Doctoral Projects

Although ionizing radiation is frequently used in anesthesia-related procedures, many CRNAs receive minimal training in radiation safety principles and protective measures. This knowledge gap increases the risk of cumulative radiation exposure for providers and patients. To address the issue, this doctoral project developed and implemented an online educational intervention designed to enhance CRNAs’ understanding of radiation safety, ultimately promoting safer practices in radiation-prone environments.

The doctoral project follows a QI and EBP approach that incorporated diverse adult learning styles to enhance engagement and knowledge retention of CRNAs. The online educational module was designed and delivered to CRNAs that currently practice …

Mental Health In Adult Oncology Patients, Jenna Pope

Capstones

Adults with cancer suffer from mental challenges that frequently go under diagnosed and under treated (Fernando et al., 2023). This can lead to lower quality of life, resulting in reduced adherence to treatment, more frequent hospital stays, increased healthcare costs, and increased mortality rates (Matthews et al., 2025). There are currently no policies on mental health screening for adult oncology patients at every outpatient appointment. By consistently utilizing standardized screening tools such as the PHQ-9 and GAD-7 during all oncology appointments, this can close the gap in policy to address mental health needs of these individuals. It is vital to …

Nursing Students As Advocates: Addressing Social Determinants Of Health Through Service-Learning, Rebekah Mullins

Nursing Theses and Dissertations

Advocacy is at the heart of nursing practice, and advocating for the social determinants of health (SDOH) is crucial when providing care to patients from vulnerable populations. Service-learning is a strategy that can be used to teach students advocacy skills. Chapter 2 of this dissertation portfolio presents a concept analysis that explores the definition of advocacy using the Walker and Avant method (2019). The concept analysis informed the development of the case study presented in Chapter 3 and the research study presented in Chapter 4. The portfolio includes original, qualitative research that was guided by the interpretive descriptive method. The …

Improved Patient Outcomes With Continuous Video Monitoring, Ethan Morrison, Drake May, Jack L. Rideout

Scholars Week

Improved Patient Outcomes with Continuous Video Monitoring

Objective

The use of human sitters has been the normal policy in hospitals across the United States for years. Recently, there has been an introduction to remote video monitoring systems that are aimed at replacing the need for human sitters. Our goal is to change the policy of a local hospital in our area to adjust their stance on human sitters and implement remote video monitoring.

Methods/Results

Our method of accomplishing this involved a PowerPoint presentation and an evidence-based practice paper with three different scholarly research articles that have been peer-reviewed. We presented …

Preventing Falls On Trauma Units: A Nurse-Led Initiative For New Graduates, Callie Brown, Erin Mytt

Scholars Week

Patient falls are a leading cause of preventable injury in hospital trauma units. This nurse-led initiative introduces a structured educational program based on Dorothea Orem's Self-Care Deficit Theory to strengthen new nurses' skills and act as reinforcement for veteran nurses in fall prevention. The program includes risk assessment, envrionmental safety checks, patient education, nurse education and safe transfer training. Evidence from recent studies supports edcuation based, multidisciplinary interventions as the most effective strategy to reduce hospital falls. Implemented in phases, the intiative requires all new graduate trauma nurses to complete fall prevention training within six months of hire. Expected outcomes …

Implementing Diabetes Education And Prevention Protocol, Lilyanna B. Conkle, Alyssa M. Woodall

Scholars Week

This Evidence-Based Practice project proposes the implementation of a diabetes education and prevention protocol in school systems to address the rising prevalence of diabetes among students. The initiative includes mandatory pre-academic year training for school staff to improve recognition and response to diabetes related emergencies. To support school nurses, often the sole healthcare provider on campus; a mobile app will be introduced to alert personnel during emergencies and provide evidence-based intervention steps. This approach aims to enhance student safety, improve health outcomes, and ensure timely, coordinated care.

Loma Linda Nurse - Vol. 34, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | Jordan Robison Profile

6 | LLUSN Mission Service— A Living Legacy

10 | Steps to a New School

12 | Entry Level Master’s at Murietta

LLUSN HIGHLIGHTS

14-21 | ALUMNI NEWS

22-27 | ACADEMICS

28-33 | HOMECOMING

34-37 | FACULTY UPDATES

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 …

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, …

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 …

Differences In Peer Social Connections Between Traditional And Online Nurse Residency Programs, Tatum Leonard

Electronic Theses and Dissertations

The anticipated retirement of baby boomer nurses by 2030 will intensify the global nursing shortage, a crisis that demands innovative strategies for onboarding and retaining new graduate nurses. Nurse residency programs (NRPs) are designed to ease the transition from student to practicing nurse, reduce turnover, and foster professional resilience. Amid the COVID-19 pandemic, many NRPs rapidly transitioned from traditional, in-person seminars to synchronous, online formats. This study explored differences in peer social connections between traditional and online NRPs, focusing on three constructs: sense of community, collaborative learning, and peer social support. Using a quasi-experimental, mixed methods approach, this secondary data …

Promising Practices To Address Healthcare Needs Voiced By Local Native Americans, Noelle Taylor, Mykin R. Higbee, Raiden Gaul

Transforming Communities

Purpose

To examine barriers and facilitators to nursing education among Native Americans and identify evidence-based strategies to increase the number of Native American nurses working in their local communities to address health disparities.

Background

Native Americans experience significantly higher rates of chronic illnesses such as diabetes and heart disease, and lower life expectancies. Only 4% of registered nurses identify as Native American, with no growth despite increased funding for diversity in nursing education. This underrepresentation contributes to culturally insensitive care and persistent healthcare inequities stemming from historical marginalization and trauma.

Methods

A comprehensive literature review was conducted using CINAHL, PubMed, …

Living With Disability After Spinal Cord Injury: A Grounded Theory Methodology, Diaa K. Abd Ali

Al-Ameed Journal for Medical Research and Health Sciences

Study Design: A Grounded Theory Methodology is employed to investigate the study phenomenon. the entire study started from Jan. 15^th. 2021 to March, 1^st. 2022.

Aim: The study is conducted to explore the concepts that shape the experience of living with disability among patients with spinal cord injury, and to formulating a grounded theory regarding nursing care for patients with spinal cord injuries.

Setting: The study is conducted in Ibn Alkuf Hospital for Spinal Cord Injuries, Baghdad, Iraq.

Methods: A non-probability purposive sampling technique was used to select (12) patients with chronic (more than 5 years) …

Digital-Based Nutrition Interventions Employing The Dietary Approaches To Stop Hypertension (Dash) Diet: A Systematic Scoping Review, Elizabeth Dodge, Patricia J. Kelly, Basil H. Aboul-Enein

College of Nursing Faculty Papers & Presentations

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is an internationally recognized anti-hypertensive dietary model. This systematic scoping review examines the effectiveness of digital-based interventions utilizing the DASH dietary pattern. Methods: A search was conducted using 14 databases to include relevant studies from 1997 to January 2025 using PRISMA guidelines for scoping reviews. Results: The review included 24 studies with almost 7000 participants, including randomized controlled trials and cohort studies conducted in several countries. Interventions using the DASH dietary pattern positively affected blood pressure (BP), nutrition behavior, and weight. Some studies also reported secondary outcomes such as reduced healthcare …

Evalutaing The Effectiveness Of A Two-Year Nurse Residency Program On Reducing Nursing Turnover In The One To Three Years Tenure, Nancy J. Plum

Doctor of Nursing Practice (DNP) Manuscripts

Background: First-year turnover for new registered nurses continues to take the lead in all tenured categories, accounting for 59% of turnover, carrying with it a financial impact averaging $88,000 per staff nurse lost. A synthesis of the literature finds the research to be ambiguous and anecdotal, with a narrow focus on understanding the causes of turnover, while an underwhelming amount of rigorous research has been conducted on identifying effective solutions. Solutions to mitigate nursing turnover will require an innovative approach.

Purpose: This program evaluation aimed to examine the impact of a two-year nurse residency program (NRP) on registered nurse turnover …

Implementation Of A Patient Engagement Program In A Federally Qualified Health Center, Cami A. Stone

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project is implementation of a patient engagement program at a Federally Qualified Health Center (FQHC) clinic. This program intends to increase patient self-management of disease without increasing tasks of the clinic staff.

Background

FQHCs have limited resources and staff; their populations are marginalized and transient. The care gap is between the clinic’s resources and patient self-management of disease, specifically hypertension. Evidence shows that personalized coaching of patients aids them with disease self-management.

Methodology

This project delivers personalized coaching via weekly brief phone calls from two assigned nurses to patients, without disrupting clinic duties. Calls involve …

Empowering Medical-Surgical Nurses To Conquer Burnout: Building Resilience And Wellness, Catherine P. Morante

Master's Projects and Capstones

Problem: In the healthcare industry, nurse burnout is a well-documented issue that affects the well-being of both healthcare professionals and their patients. Burnout manifests as intense exhaustion, depersonalization, and diminished personal accomplishment (Okoniewski & Verni, 2024).

Context: Burnout affects patient outcomes and drives up costs (Dall’Ora et al., 2020). When nurses are overwhelmed, attendance is affected (Unpublished confidential document; 2024). Resilient nurses are essential to a healthy, reliable workforce (Unjai et al., 2024).

Interventions: From May to July 2025, a 12-week initiative was launched to reduce the effects of nurse burnout in the workplace. Evidence-based interventions were implemented, incorporating educational …

Enhancing Client Intake Efficiency In The Removal Defense Program: A Nursing-Led Quality Improvement Initiative, Johnny Linares, Julia Tran Ngo, Daniel Orea, Atheana Yadira Lopez

Master's Projects and Capstones

This quality improvement project focuses on optimizing the intake process for the Removal Defense Program at a nonprofit immigration legal office serving asylum-seeking clients. The existing intake relied on unstructured, phone-call-based intake interviews that gathered incomplete information, leading to inconsistent documentation, reduced efficiency, and significant client processing delays. A structured, multilingual, and multiplatform new-client admission protocol coupled with the implementation of a client-facing resource guide for waitlist clients were co-developed and implemented using the Lippitt Change Theory framework. Utilizing a mixed methods approach, the study involved staff interviews and observational assessments with staff members from the program. Baseline intake process …

Implementation Of Medication Administration Education To Increase Medication Technician Knowledge And Confidence, Nicole C. Yan

Master's Projects and Capstones

Problem: Medication technicians have minimal formal training and education in medication administration. Insufficient knowledge and a lack of confidence present safety concerns, such as medication errors, which decrease the quality of patient care.

Context: The setting is an assisted living facility in the San Francisco Peninsula that provides around-the-clock patient care, promoting independence in a safe and home-like environment for 53 patients.

Interventions: The proposed intervention involves implementing a quality improvement (QI) project to educate medication technicians on medication administration safety. The educational sessions, completed in two in-person sessions, include a PowerPoint lecture, interactive case studies, and group discussion.

Measures: …

Illuminating Leadership Excellence: An Evidence-Based Qi Intervention Reigniting Nurse Leaders From Burnout To Brilliance Using Caring Science And Reflective Practice, Matthew S. Elliott

Master's Projects and Capstones

Abstract

Problem: A 2024 assessment at a 250‑bed Northern California medical center revealed that 76% of 16 inpatient nurse leaders met "high‑burnout" criteria on the Maslach Burnout Inventory, and leader turnover had climbed to 25%, more than triple national benchmarks, threatening patient care quality, financial stability, and alignment with Magnet® and employee engagement goals.

Context: Root causes included pandemic‑era promotions without development support, a task‑oriented leadership culture, and eroding psychological safety (Press Ganey engagement ≈ 30%). An integrative logic model positioned Watson's Caring Science as the theoretical base, Schön's Reflective Model for adaptive learning, and the Prosci ADKAR change framework …

Preventing Hospital-Acquired Pneumonia In Non-Ventilated Oncology Patients, Carmi Villanueva

Master's Projects and Capstones

Problem - Hospital Acquired Pneumonia (HAP) remains the leading cause of death among hospital-acquired infections, underscoring the need for effective prevention strategies. Between October 2023-2024, six HAP infections occurred in non-ventilated oncology patients. A routine audit revealed zero adherence to the existing evidenced based ROUTE “bundle” to prevent HAP. ROUTE indicates Respiratory care (R), Oral Care (O), Up in bed (U), Tube care (T), Education (E).

Context – In a 325-bed hospital in Northern California, a 26-bed telemetry/oncology microsystem serves a mixed population including immunocompromised, non-ventilated oncology patients at higher risk for developing HAP. A quality improvement project was initiated …

Best Practices To Prevent Nurse Burnout And Reduce Turnover In The Hospital, Bernice Marie Yale

Master's Projects and Capstones

Abstract

Problem Nursing is facing a crisis in workforce well-being, and trends indicate signs and symptoms of burnout. Increasing turnover rates, emotional exhaustion, staff depersonalization, and team disengagement have resulted in a perceived toxic environment in a hospital-based microsystem.

Context A 4-month project was initiated to improve morale and communication. Several assessment tools were utilized to foster a high-performing team and reinforce principles of Watson’s theory of caring.

Interventions Optimization of required daily leader rounds to encourage patient participation, and monthly 1:1 “direct report” rounds (n=65) were conducted to assess well-being, workplace stressors, and promote job satisfaction.

Measures To improve …

Does The Addition Of Digital Care Along With Standard Chemotherapy Teaching That Is Provided At City Of Hope Increase Patient Satisfaction And Confidence?, Sheridan Wendy Lomeli, Brooklin Mize, Tatyana Franco, Daniela Naemi

Master's Projects and Capstones

Chemotherapy education is critical when it comes to improving patient confidence, reducing anxiety, and enhancing symptom management. However, there is still a variety of patients who begin their infusion therapy with a limited understanding of what to expect. This quality improvement project was conducted at an outpatient infusion center, exploring whether combining traditional nurse-led chemotherapy education calls with a digital care platform would enhance patient satisfaction and confidence compared to standard care alone. A total of forty-one adult oncology patients participated in an educational survey at the end of each follow-up phone call, which was completed three days after their …

Implementation Of A Standardized Onboarding Program, Sarah J. Wall

Doctor of Nursing Practice Final Project Abstract

Purpose: To evaluate the impact of a standardized onboarding program on Advanced Practice Provider (APP) retention and productivity within an academic department.

Background: High APP turnover in specialized settings disrupts care and leads to financial losses. Previously, onboarding lacked structure, leading to early attrition and delayed productivity. A 24-week phased, competency-based orientation program was developed to improve retention, job satisfaction, and clinical performance.

Methods: The program, implemented in April 2024, included clinical precepting, didactic modules, and mentorship. Retention and Relative Value Units (RVUs) were measured before and after implementation. Qualitative data was collected through mentorship surveys and APP focus groups. …

Organizational Health Literacy In Pediatric Cardiovascular Programs, Eva Gomez

Graduate Doctoral Dissertations

Health literacy refers to a person’s ability to access, understand and use health-related information in order to effectively manage one's health and navigate healthcare experiences. This responsibility does not rest solely upon the individual; healthcare organizations also have a vital role in assisting individuals in accessing, understanding and using health information through their interactions with the healthcare system. Organizational health literacy (OHL) can serve as a strategy to ensure that all individuals have equitable access to health information and services. The Ten Attributes of a Health Literate Healthcare Organization established the foundational principles of organizational health literacy. The present study …