Nursing Commons^™

New Graduate Nurse Professional Perseverance Strategies In A Time Of Crisis, Jennifer E. Smith Edd

Dissertations of Practice

This qualitative grounded theory study examined how new graduate nurses who entered practice just prior to and during the COVID-19 pandemic developed and sustained resilience while navigating extraordinary professional and personal challenges. The study focused on associate degree nurses who graduated between December 2018 and May 2022 and were employed in acute and sub-acute care settings with direct patient care responsibilities, including the care of patients with COVID-19. Data were collected through semi-structured interviews and reflective journal entries and analyzed using open, axial, and selective coding.

Findings revealed that resilience was not a static characteristic but an evolving process influenced …

Screening For Relative Energy Deficiency In Sport (Reds) And The Female Athlete Triad In Female Undergraduate Collegiate Athletes: A Quality Improvement Project, Maria A. Marziano

West Chester University Doctoral Projects

This quality improvement (QI) project investigated female collegiate athletes’ knowledge and prevalence of Relative Energy Deficiency in Sport (REDs) and the Female Athlete Triad (Triad). The increase in female athletics brings a growing concern for performance-related health risks, including low energy availability (LEA), menstrual dysfunction, and low bone mineral density (BMD). This study assessed the effectiveness of education and self-screening in identifying at-risk athletes and encouraging resource application for intervention. A mixed-methods design was employed, utilizing retrospective data along with pre- and post-intervention surveys. The study involved 33 female collegiate athletes from lean endurance sports, assessing knowledge, risk factors, and …

A Question For The Ages: The Relationship Between Nurse Staffing And Quality In Appalachian Skilled Nursing Facilities, Eric Jason Pulice

Theses, Dissertations and Capstones

Nurse staffing levels have been shown to have a critical impact on nursing quality in skilled nursing facilities (SNFs). Sociodemographic disparities in Appalachian areas have the potential to impact SNF nurse staffing levels and quality. This study examined the relationship between nurse staffing levels and quality in Appalachian SNFs, as well as compliance with the Biden Administration’s minimum staffing mandates as set forth in CMS-3442-F enacted on June 24, 2024.

The study applied Resource Dependency Theory (RDT) through Donabedian’s Structure-Process-Outcome (SPO) conceptual framework to assess how external resource constraints and regulatory policies impact nurse staffing levels and quality in Appalachian …

The Ethics Of Student Attrition In Healthcare Education Programs, Kent Haina Jr, Peter A. Depergola Ii

Journal of Health Ethics

Student attrition is a problem in healthcare education programs, but there is little in the literature regarding the organizational ethics of lowering it. Some argue that lowering attrition is unethical, because it would lower academic and professional standards, potentially impacting patient care. Others say students deserve to make decisions about when to leave a course of study. However, these arguments ignore inequities in attrition, as well as the conflicts of interest in, and moral obligations of colleges and universities. Lowering attrition rates in healthcare education programs is inherently ethical because it levels the playing field for underrepresented minorities that disproportionately …

Implementing Safe Nurse-To-Patient Ratios, Susan Clark, Molly Peasley, Tessa Pemantell, Grace Fritch

SPARK Symposium Presentations

Our project advocates for state mandated nurse-to-patient ratios in Tennessee critical care units to enhance patient safety, reduce nurse burnout, and improve overall healthcare quality. Research shows that inadequate staffing leads to higher mortality rates, complications, and longer hospital stays, while hospitals with mandated ratios report better patient outcomes and nurse retention. California’s model demonstrates the effectiveness of such policies, highlighting the need for nationwide implementation. The project follows an SBAR approach, outlining the situation of unsafe staffing, the background of financial-driven disparities, and the need for policy change. The plan includes stakeholder engagement, legislative advocacy, and public awareness campaigns. …

Effective Measurement-Based Care For Depression Within Va Health Systems: A Quality Improvement Initiative, Amie L. Doyle

DNP Scholarly Projects

Background: Depression is highly common among U.S. veterans, surpassing civilian rates. Measurement-Based Care (MBC), including the Patient Health Questionnaire-9 (PHQ-9), facilitates systematic symptom monitoring and treatment enhancement. At Manchester VA Medical Center (VAMC), PHQ-9 completion in primary care was low (18.93% in May 2025) due to workflow inefficiencies, provider workload, and dependence on Mental Health Service Line (MHSL) referrals.

Local Problem: Underutilization of the PHQ-9 in primary care hampers early detection and effective treatment of depression among veterans.

Methods: Four primary care teams received training on using the Behavioral Health Laboratory (BHL) software, which facilitates pre-visit electronic completion of the …

Skills Evaluation Of Adjunct Nursing Faculty: A Quality Improvement Project, Ada Dimino Luong

DNP Scholarly Projects

Abstract

BACKGROUND: With rising student enrollment, colleges and universities are relying more on adjunct clinical nursing faculty as Clinical Nurse Educators (CNEs). Recruiting and retaining qualified CNEs is essential to high-quality clinical education. Although clinically proficient, CNEs may face challenges with teaching methods, instructional strategies, and formative feedback. This quality improvement (QI) project evaluated CNE’s competencies and developed a sustainable multimedia educational tool to enhance feedback skills in clinical education.

METHODS: The Academic Clinical Nurse Educator Skill Acquisition Tool (ACNESAT), a validated 40-item Likert-scale instrument created by Shellenbarger and Sebach, was used to assess CNE competencies. Pre and post intervention …

Optimizing Electronic Health Record Capability To Provide Mindfulness Education To Oncology Patients Experiencing Anxiety, Cynthia Arcieri

DNP Scholarly Projects

Background: The impact of a cancer diagnosis is significant. In 2020, the Centers for Disease Control (CDC) reported over 1.6 million new cases of cancer (National Institutes of Health, 2023). Non-traditional approaches to supporting patients should be considered in providing high-quality cancer care. Mindfulness can help reduce stress reactions and may be beneficial for individuals with anxiety (Vinci et al., 2019). To best support patient care in the landscape of mobile health (mHeatlh) technology, it is essential to adopt best practices that promote patient engagement and empowerment.

Purpose: This quality improvement project aimed to provide oncology patients with a cognitive …

A Quality Improvement Project To Enhance Chronic-Condition And Self-Care Knowledge In Adolescents With Spina Bifida, Ann Paris

DNP Scholarly Projects

Background: Spina Bifida is the most common central nervous system disorder in the United States (CDC, 2024). Even with early surgical repair, patients may have chronic, disabling, multisystem needs (Phillips et al., 2017). Adequate care of Spina Bifida requires a multidisciplinary approach. As such, patients with spina bifida require multiple specialty providers, clinic appointments, care-tasks, and interventions (CDC, 2024, Phillips, et al., 2017). Synthesizing information from multiple care providers can be daunting, especially for adolescents as they grow more autonomous in their care, and especially as they enter the age of pediatric-to-adult transition (Psihogios et al., 2015).

Purpose: …

Enhancing Resilience In Oncology Nurses Through The Implementation Of A Peer Support Program, Denise M. Robinson-Smith

DNP Scholarly Projects

ABSTRACT

Background: Oncology nurses face high rates of burnout and compassion fatigue, contributing to significant turnover and threatening the stability of the oncology nursing workforce. The projected increase in cancer incidence and the resulting demand for oncology services underscore the urgent need for interventions that enhance nurse resilience. Local Problem: At a major hospital in Jacksonville, Florida, it was found that oncology nurses face a significant gap in emotional support, especially during critical incidents such as patient deaths or traumatic events. Existing resources were insufficient to address the unique stressors faced by this team. Methods: A quality …

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Design And Implementation Of A Nursing Peer Practice Case Review Program In An Academic Surgical/Trauma Icu, Natalie Tredway

DNP Scholarly Projects

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on …

Promoting Rapid Identification Of Oncological Emergencies In The Emergency Department : A Quality Improvement Project, Christine Hart Brown

DNP Scholarly Projects

BACKGROUND: The American Cancer Society estimates 2,041.90 new cases of cancer in the U.S. (1 in 18 Americans) with a global projection of thirty-five million new cases annually by 2050. With this alarming increase, early recognition of oncological emergencies in the Emergency Departments is essential. Life-threatening conditions require rapid assessment, accurate diagnosis, and immediate interventions. Qualified emergency nurses must understand the effects that cancer and treatment have on the immune, metabolic, and hematologic systems. This quality improvement (QI) project focuses on assessing emergency nurses’ oncological knowledge of acute emergencies and providing a resource for rapid identification.

PROBLEM STATEMENT: …

Loma Linda Nurse - Vol. 33, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | The Strategic Pillars of LLUSN

6 | Building Campaign Update

8 | Scholarship Opportunities

10 | Andreia Lofthouse: Assistant Dean of Student & Alumni Relations

LLUSN HIGHLIGHTS

12-17 | ALUMNI NEWS

18-27 | ACADEMICS

28-32 | HOMECOMING

33-35 | FACULTY UPDATES

Enhancing Faculty Self-Efficacy In Student Retention Through Teas Reading Comprehension Score Education, Katina A. Ennis

Doctor of Nursing Practice Projects

Student retention remains a persistent challenge for Associate Degree in Nursing (ADN) programs, with significant implications for the nursing workforce amid a national shortage. Faculty self-efficacy in interpreting and utilizing academic readiness data, particularly ATI TEAS reading comprehension scores, is often limited, leading to missed opportunities for early intervention. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a targeted educational intervention could enhance faculty self-efficacy in using TEAS reading comprehension scores to support at-risk students and improve retention strategies.

The project employed a quantitative pre- and post-intervention design using the validated Teacher’s Sense of Efficacy Scale (TSES) …

Utilizing Integrative Medicine Services For Yoga To Reduce Cancer Related Fatigue, Leah R. Yeager

DNP Projects

Background: Cancer related fatigue (CRF) is one of the most prevalent and distressing side effects experienced by individuals undergoing cancer treatment. In fact, many patients report CRF as more debilitating than pain itself. CRF is characterized by persistent, severe exhaustion that is not alleviated by sleep and is not linked to prior exertion. Despite its widespread impact, the options available to manage CRF are limited, typically including practices like good sleep hygiene, balanced nutrition, mindfulness, and supplements. Integrative medicine, particularly yoga, has emerged as a promising intervention for reducing CRF. However, yoga is underutilized as a therapeutic approach to combat …

Implementation And Evaluation Of A Competency-Based Phased Orientation Program For Nurse Practitioners In The Intensive Care Unit Setting, Meredith Sherer

DNP Projects

Background: Research has demonstrated that structured orientation helps to integrate new nurse practitioners (NPs) into practice, ease role transition, decrease NP turnover, and lead to better patient care. However, at University of Kentucky HealthCare (UKHC) clinical orientation programs for NPs are not standardized.

Purpose: The purpose of this project was to implement and evaluate a competency-based phased orientation program for NPs in the intensive care unit (ICU) setting at UKHC.

Methods: This project utilized a prospective, single group, presurvey-postsurvey design to examine the effect of a three-phased competency-based orientation program on the outcome variables of NP confidence, autonomy, proficiency of …

Functional And Traditional Medical Management Of Endometriosis: An Integrative Review, Madison G. Daniels

Senior Honors Theses

Endometriosis, a progressive disease that affects many women worldwide, has been managed primarily through hormonal medication, pain management and surgical intervention. However, there is a growing desire among women to use more natural and holistic methods to control the progression of this disease as well as effectively manage the severe symptoms that accompany it. This integrative review examines the efficacy of functional management as compared to traditional medical management. The pathophysiology of each treatment method and provide statistical evidence as to its efficacy. The progression of the disease, symptom management, and related side effects are all taken into consideration in …

Closing Racial And Ethnic Disparity Gaps In Pediatric Asthma Follow Up Care - A Quality Improvement Initiative, Ayodele Ayeko

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Closing racial and ethnic disparity gaps in pediatric asthma follow up care - A quality improvement initiative

Ayodele Ayeko

Introduction/Background: Inadequate management of asthma significantly contributes to poor asthma control, poor quality of life (QOL), and high hospitalization rates among pediatric patients. The Global Initiative for Asthma (GINA) guidelines offer recommendations designed to enhance asthma control and improve the quality of life for those affected (2015), including recommendations for close follow up care. At WVU Medicine Children’s Hospital (WVUMCH), insufficient asthma control has been associated with lower clinic follow-up rates and an increase in hospitalization. Although educational initiatives …

Keep It Quiet: A Quality Improvement Initiative To Reduce Noise In The Operating Room During Anesthesia Induction, Ghislaine Fasseu Kameni

Graduate Theses, Dissertations, and Problem Reports (ETD)

Problem: Excessive noise during the critical phase of anesthesia induction in operating rooms (OR) can significantly impact anesthesia providers' ability to focus, potentially compromising patient safety and quality of care.

Objectives: This project aimed to reduce anesthesia providers' perception of distraction caused by noise during induction by implementing educational interventions and visual cues. The objectives included educating anesthesia and surgical staff on the impact of noise, introducing visual reminders to minimize distractions, and evaluating the effectiveness of these strategies through survey data collection.

Methods: A quality improvement initiative was conducted in the OR department of a nearby hospital. Certified registered …

The Impact Of State-Mandated Certification Of Surgical Technologists On Surgical Site Infection Rates: Evaluating Policy, Practice, And Patient Outcomes, Katherine E. Geiger

Graduate Student Theses, Dissertations, & Professional Papers

Abstract

Chairperson: Matthew Schertz, Ph.D.

Committee Member: Morgen J Alwell, Ph.D.

Committee Member: Jill Davis, M.Ed.

As a surgical technology instructor, I have witnessed firsthand the impact that certified surgical technologists (CSTs) have on patient safety, particularly in the prevention of surgical site infections (SSIs). This professional paper investigates the relationship between state-mandated certification of surgical technologists and SSI rates, with a focus on how standardized education and credentialing influence clinical outcomes. SSIs remain a significant concern in surgical environments, contributing to increased morbidity, longer hospital stays, and greater healthcare costs. The research presented here examines certification requirements across various …

The Association Between Sleep Quality, Depression, Anxiety, And Job-Related Stress Among Nurses In Saudi Arabia, Romeo Jr Patague Mostoles

Makara Journal of Health Research

Background: This study examined the mediating role of sleep quality in the relationship between depression, anxiety, and job-related stress among nurses in Saudi Arabia.

Methods: Sociodemographic information, Pittsburgh Sleep Quality Index, depression, anxiety, and work-related stress were evaluated in 851 nurses. Structural equation modeling was used to investigate the mediation effect of sleep quality on mental health and job stress in nurses.

Results: High rates of anxiety (65.9% severe, 34.1% moderate), depression (37.2% moderate to severe), and poor sleep (51.4%) were found. Sex, marital status, education, nationality, and smoking status significantly influenced mental health outcomes. For example, …

An Evidence-Based Preceptor Development Program For Nurse Anesthetists, Raleigh Todd

Doctoral Projects

Abstract

Problem Statement: The success of the student registered nurse anesthetists (SRNA) is heavily influenced by experiences in the clinical setting, often encompassing a variety of preceptors throughout their respective anesthesia programs. Despite the importance of the preceptor role, many preceptors feel unprepared, and it is estimated most certified registered nurse anesthetists (CRNAs) who precept students have received no formal training in the preceptor role.

Purpose: The purpose of this project is to develop and evaluate an evidence-based preceptor education program for CRNA preceptors, utilizing evidence from literature and input from practicing nurse anesthetists. This program helps provide support by …

Implementation Of An Advanced Practice Provider Into The Outpatient Neurology Clinic To Improve Access To Care And Medication Compliance, Sean O'Laughlin

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The American Association of Neurology (AAN) recommended that post-stroke and TIA patients receive follow-up care within 2–4 weeks of discharge to reduce complications, improve medication adherence, and decrease readmission rates (2023). However, in 2022, a Central Virginia neurology practice reported an average wait time of 98.66 days for outpatient follow-up appointments, significantly exceeding the AAN recommendation, while medication adherence was only 72.23%, compared to the national average of 80%. Research by the American Academy of Neurology Workforce Task Force (2013) and Woo et al. (2017) highlighted that incorporating advanced practice nurses into outpatient settings could enhance access to care and …

Implementation Of A Daily Engagement System Board (Desb) To Improve Hospital Staff Communication, Catherine Villanueva

Master's Projects and Capstones

Implementation of a Quality Improvement (QI) project to help improve staff communication between shifts at an Inpatient Acute Psychiatric Unit was determined to be of immense need. This unit is part of a large acute medical hospital. Currently, the end of shift report consists of a verbal report along with a robust printed end of shift report consisting of shift related information. This printed end of shift report can have as many as seven to nine pages thus causing information overload and decreases prioritized patient information. Furthermore, missed information or too much information can be provided in the verbal shift …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In Adult Oncology Patients, Alexandra Violeta Theodosopoulos

Master's Projects and Capstones

Objective: Cytotoxic chemotherapy places oncology patients at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia. Current literature supports the use of high-quality oral hygiene protocols to reduce the frequency and severity of these complications.

Aim: By end of fiscal year 2025, we will achieve a 0.2% reduction in incidences of aspiration pneumonia, from 1.5% to 1.3% of total patient discharges, among adult cancer patients in the oncology units. Methods: A survey was used to gather baseline oral hygiene compliance data on six acute care oncology units. Based on the results of the survey and discussions with …

Journey To Baby-Friendly Designation: Standardizing Infant Feeding Education, Jasmine Geronimo Ibay

Master's Projects and Capstones

Problem The influence of formula companies in hospitals has caused a decrease in national breastfeeding rates, increasing risks of adverse health outcomes among infants. In response, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 to support breastfeeding practices for infant development and eliminate commercial interests of formula companies from hospitals. Context The quality improvement (QI) project was conducted at Hospital A’s Birth Center, serving a diverse population of patients in the greater East Bay of Northern California. The microsystem has 24 labor beds, 13 antepartum beds, and 33 …

Chronic Disease Screening And Detection In Vulnerable Populations, Courtney J. Seman, Hussein Hadid, Tania Jaimes, Robert Walls

Master's Projects and Capstones

This quality improvement project aims to address gaps in chronic disease screening by implementing standardized protocols for diabetes, hypertension, vision impairment, and scoliosis within the University of San Francisco (USF) Nurse-Led Clinic in Orange County. Problem: The clinic identified a lack of screening practices, which limited early detection and intervention for two specific vulnerable populations. Context: The clinic serves two high-risk groups: older adults, including formerly homeless individuals, and children in two local grade schools. These populations face significant healthcare disparities, making early detection of chronic conditions critical. Interventions: Guided by Kotter’s Change Theory, the project developed and implemented evidence-based …