Nursing Commons^™

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

No central documentation of care plans exists for children with special healthcare needs (CSHCN) in the electronic health record (EHR). Providers of a large pediatric primary care office in St. Louis Missouri were asked to identify CSHCN in the practice. Clinic nurses completed a comprehensive chart review of the patients identified and constructed care coordination documents using a pre-established smart-text phrase. Subsequently, these were documented centrally in the EHR under the Problem List.

Likert score data was obtained from providers on the acceptability, appropriateness, and feasibility of the intervention through the verified tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness …

Implementing A Team-Based Approach To Reduce Blood Culture Contamination Rates In The Emergency Department: A Quality Improvement Initiative, Melissa Lockhart

Doctor of Nursing Practice Projects

Background: Blood culture contaminations (BCC) present significant risks to patients, including adverse drug reactions and the exacerbation of antibiotic resistance. BCC can also result in millions of dollars in financial burdens for hospitals due to the need for follow-up testing, treatment complications, and antibiotic stewardship efforts. At this facility, the contamination rate in the emergency department (ED) consistently exceeds the national benchmark of 3%. Contributing factors include high patient turnover and increased nursing workloads, which can lead to shortcuts in essential practices such as hand hygiene and skin disinfection before collection.

Purpose: This project aimed to evaluate whether implementing a …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Reporting And Tracking Of Occupational Bloodborne Pathogen Exposures, Olivia Smith

Doctor of Nursing Practice Final Project Abstract

Purpose/Background: Underreporting of occupational bloodborne pathogen (BBP) exposures remains a significant patient and employee safety issue. At UT Health, outdated paper-based systems hindered accurate tracking, timely follow-up, and reporting compliance. The aim of this quality improvement (QI) project was to achieve a 30% increase in quarterly BBP exposure reports, from 30 to 39, by implementing an electronic reporting system between January 1 and March 31, 2025.

Methodology: Guided by the Health Belief Model and using the Implementation and Improvement Science (IIS) Framework, the project replaced the existing paper form with an external, user-friendly digital system. Staff received structured training, and …

Spy Quest: Gamifying Quality And Patient Safety Education, Shauna Szyszkowski

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

Cultivating Workplace Wellness: An Evaluation Of Gratitude Card Interventions Among University Faculty, Jeffrey Druck, Patrick Ockerse, Jamal Jones

Journal of Wellness

Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention.

Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to …

Implementation Of A Nurse Practitioner-Led Video Telehealth Program To Improve Triage For Pediatric Patients In An Ambulatory Intestinal Rehabilitation Center, Elizabeth Castle

Doctor of Nursing Practice Scholarly Projects

Background: Children with short bowel syndrome are medically complex, requiring specialized management and coordinated care to address acute triage issues between scheduled visits. Their risk for rapid decompensation and distance from specialty centers often necessitates telephone-based triage—a typically non-reimbursable method. At a leading Northeastern U.S. children’s hospital, the Intestinal Rehabilitation (IR) center manages high-risk telephone triage of these patients’ concerns using experienced nurse practitioners. The inability to directly visualize patients during telephone encounters, however, limits clinical assessment and decision-making, presenting challenges to efficient and safe care delivery. A systematic literature review indicated that telehealth can enhance parental confidence, improve clinician …

Strengthening The Birthing Bridge: Educating Labor And Delivery Nurses On Scope And Impact Of Volunteer Doulas, Catherine H. De La Torre

Master's Projects and Capstones

The objective of this quality improvement project was to address the lack of collaboration between the Labor and Delivery (L&D) nurses and the volunteer doulas on a L&D unit at a Bay Area hospital. There were reports of not understanding the role of the volunteer doula, which may have led to a lack of collaboration between both teams. The aim of this project was to improve the L&D nursing staff's understanding of the scope of practice of the volunteer doula to increase positive perception and collaboration between both professions by 25%, from 63% to 88%, following an educational intervention at …

Enhancing Bedside Mobility Assessment Tool (Bmat 2.0) Competency To Promote Early Mobilization, Ensure Patient Safety, And Maximize Health Outcomes, Shaun C. Cunanan

Master's Projects and Capstones

Objective: Immobility among hospitalized patients is linked to serious complications, including muscle deconditioning, increased risk of falls, and functional decline, particularly in older adults (Boynton et al., 2020). Early mobility interventions can help mitigate these risks and improve patient outcomes (Gabele et al., 2023). Context: The Bedside Mobility Assessment Tool (BMAT 2.0) is a standardized tool designed to assess patient mobility and guide safe mobilization practices. In two medical-surgical units (endocrine and stroke) of a 200+ bed general acute care hospital in Northern California, only 31.4% of staff reported being knowledgeable about BMAT 2.0. This quality improvement project aimed to …

Psychoeducational Training For Community Health Workers To Improve Confidence In Providing Mental Health Services To Migrants, Nimota M. Akintoye

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

There is a higher prevalence of mental health illnesses among migrants. This minority group is faced with challenges in accessing healthcare due to poverty, stigmatization, and fear of discrimination. Research has shown that community health workers (CHWs) bridge the gap between the health and social service sectors and the patients by improving patient access to care and healthcare outcomes. A translational project was implemented to evaluate how psychoeducational training improved the CHWs’ confidence and knowledge level in providing mental health support to the patients and community members. Sister Calista Roy’s Adaptation Model was used to guide the study by incorporating …

Sugammadex For Reversal Of Neuromuscular Blocking Agents Versus Neostigmine - Safety Comparison, Amanda K. Butler, Daniel Belu, Bailey Accardo, Courtney Ayana Bullard, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Sugammadex and neostigmine are two common drugs used to reverse neuromuscular blockade in anesthesia, but they differ in mechanism of action, side effects, and cost.

Sugammadex provides rapid reversal, has fewer side effects, and has a lower risk of bradycardia than neostigmine. This scoping review examines the frequency of bradycardia in adult surgical patients receiving sugammadex versus neostigmine.

Methods

A scoping review was completed of peer-reviewed articles comparing the incidence of bradycardia in adult surgical patients after the administration of sugammadex and neostigmine for neuromuscular blockade reversal. Findings indicate that sugammadex resulted in fewer adverse events, including bradycardia, than …

Pulmonary Embolism Response Team In Acute Care Settings: A Scoping Review Of The Evidence, Tia Glover Bsn, Rn, Leslie Asplund Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Pulmonary embolism (PE) is a critical cardiovascular emergency associated with high morbidity and mortality. Despite its prevalence, traditional PE management often lacks cohesion, leading to suboptimal outcomes. Pulmonary Embolism Response Teams (PERTs) offer a multidisciplinary approach aimed at improving patient outcomes by streamlining diagnosis, facilitating timely interventions, and promoting evidence-based treatment. This scoping review evaluates the evidence supporting PERT efficacy across various clinical and resource-related outcomes with the aim to decrease mortality rates, shorten inpatient length of stay, improve cost efficacy, and minimize adverse events from treatment modalities.

Methods

A comprehensive literature search was conducted using PRISMA guidelines across …

Smoking Cessation Education In Caregivers Of Pediatric Patients Hospitalized With Asthma Exacerbation, Maya Emptage, Kaitlynn Lineberry, Suzanne Kayali, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Michelle Rickard Dnp, Pnpac-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric asthma is rising globally, currently affecting over 300 million individuals and projected to reach 400 million by 2025. This scoping review aims to summarize existing evidence on the impact of providing smoking education to caregivers during hospitalization on reducing pediatric asthma exacerbations, with the goal of encouraging further research.

Methods

The search spanned from August 2022 to November 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on studies involving human participants and caregivers of children receiving smoking cessation education in relation to asthma exacerbation and hospital admission. Databases searched included …

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Ultrasound-Guided Epidural Placement Vs. Conventional Technique - Evaluating Effectiveness: A Scoping Review, Skylar R. Kuehn, Bsn, Rn, Ccrn-Cmc, Jacob B. Morphis, Bsn, Rn, Sarah D. Price, Bsn, Rn, Katherine E. Pritchard, Msn, Rn, Jordan Isaac Dnp, Crna, Sharon Little Dnp, Aprn, Fnp-Bc, Tracy Mcclinton

Doctor of Nursing Practice Projects

Purpose/Background

Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia.

Methods

This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, …

Contamination To Clarity: Reducing Blood Culture Contaminations By Implementing An Initial Specimen Diversion Technique, Giovanna Tiago Bsn, Rn, Jaclyn Godfrey Msn, Rn, Judson Mary, Cj Lucia, Jacqueline Laird, John Brennan, Mason Everlith, Stacey Peace Rn, Anne M. Aquila

Posters

The aims of this initiative were:

• Target a unit with high blood culture contamination rates, with secondarily high central line utilization rates.
• Implement an evidence-based initial specimen diversion technique.
• Determine if technique had an impact on a unit’s blood culture contamination rate.
• Revisit the literature and modify as needed

Gad-7 Screening In Middle School Students: Evaluating The Effectiveness On Referral Rate Scoping Review, Bailey Hall, Cara Dennis, Kayla Drennen-Ferguson, Pamela B. Taylor, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

The prevalence of anxiety disorders among adolescents, mainly middle school-aged students, highlights the critical need for practical screening tools to support early detection and intervention. The Generalized Anxiety Disorder-7 (GAD-7) scale is widely utilized in various settings, but its efficacy in this specific population remains underexplored. This scoping review examines the use of the GAD-7 in middle school-aged students, evaluating its reliability, validity, and impact on referral rates to mental health services. The review also considers factors influencing anxiety and identifies gaps in current research.

Methods

Ten articles, published in peer-reviewed journals within the past decade and involving human …

Postpartum Depression Screening At First Year Well-Child Visits: Evaluating The Rate Of Maternal Ppd Detection, Chidera A. Speight, Bsn, Rn, Katherine Scarbrough, Bsn, Rn, Camille Jones, Bsn, Rn, Laura Reed, Dnp Fnp-C

Doctor of Nursing Practice Projects

Purpose/Background

Postpartum Depression (PPD) is a concerning mental health condition characterized by feelings of extreme sadness, exhaustion, and challenges with maternal-infant bonding. PPD effects mothers’ ability to adequately care for themselves and their newborns. Current research suggests that one in seven women experience symptoms of PPD as late as 12 months postpartum. Despite screening guidelines set forth by the American Academy of Pediatrics, 50% of mothers with PPD will not receive a diagnosis.

This study aims to evaluate the rate of PPD detection at well-child visits occurring within the first 12 months postpartum by administering the Edinburgh Postnatal Depression Scale …

Enhancing The Eden Alternative Model With Well Standards: A Case Study Analysis, Mariah Stoner

Architecture Masters of Science Program: Theses

This thesis investigates the potential for improving the Eden Alternative Model, a person-centered approach to elder care that emphasizes creating a homelike environment and meaningful relationships, using WELL Standards, a building certification system focused on enhancing human health and well-being through improvements in environmental quality. Through a mixed-methods approach involving quantitative data analysis and qualitative case studies, this research examines how WELL Standards, which cover aspects such as air quality, water quality, lighting, and thermal comfort, can improve environmental quality and resident satisfaction within the Eden Alternative Model. This research introduces a tailored approach to elder care by combining these …

Assessing The Efficacy Of Remimazolam Vs. Midazolam In Short-Duration Gastrointestinal Endoscopy Procedures And How They Affect Patient Recovery Time: A Scoping Review, Kelsey Gray, Bsn, Rn, Ccrn, Shannon Guthrie, Bsn, Rn, Ana Grace Holder, Bsn, Rn, Will Howard, Bsn, Rn, Dwayne Accardo Dnp, Crna, Faana, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose

The purpose of this scoping review is to evaluate and compare the efficacy of Remimazolam and Midazolam as sedatives in short-duration gastrointestinal endoscopy procedures.

Efficacy Of Aprepitant And Ondansetron In Managing Postoperative Nausea And Vomiting In Perioperative Obese Patients, Jada Stewart, Reagan Revon, Samantha Castellaw, Ashlee Roberts, Dwayne Accardo Dnp, Crna, Faana, Bobby Belflower Dnsc, Nnp-Bc, Faanp, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Postoperative nausea and vomiting (PONV) is a common adverse event that occurs during the recovery period following anesthesia. PONV has been reported to affect nearly 80% of patients, leading to prolonged hospitalization, increases in cost of care, patient dissatisfaction, dehydration, electrolyte imbalances, acute kidney injury, and pulmonary aspiration. Certain risk factors, including obese patients, female gender, and nonsmoker status, increase the risk of PONV. Traditionally, for all patients going under anesthesia, a prophylactic antiemetic regimen is administered; however, since obese and other high-risk patients are at increased risk of experiencing PONV despite traditional regimens, anesthesia providers should administer multiple …

Social Determinants Of Health Screening – Evaluating Its Influence On Glycated Hemoglobin Levels In The Pediatric Population: A Scoping Review, Lindsay Gibson, Victoria Hutchison, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Ebp-C, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

Social determinants of health (SDOH) have a significant impact on health outcomes. Pediatric patients with type one diabetes mellitus (T1DM) with adverse SDOH have inferior glycemic control, higher healthcare utilization, and increased risks of complications. SDOH screenings are not standard practice in pediatric T1DM care despite literature demonstrating that screening can improve outcomes. This scoping review aims to summarize existing evidence surrounding SDOH screenings and their impact on pediatric T1DM outcomes.

Methods

A scoping literature review was conducted from August 2022 to November 2024 via CINAHL, Cochrane, EBSCO, Elsevier, and PubMed. Inclusion criteria included peer-reviewed articles, English language, publication …

Improving The Patient Care Experience In Residential Eating Disorder Treatment: A Quality Improvement Project, Paige H. Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project was to implement structured biweekly patient check-ins at a residential treatment facility for eating disorders. This project was intended to increase the patient care satisfaction scores on patient discharge surveys from under 80% to over 90%.

Background

The project was implemented at a 12-bed residential treatment facility for adolescents and adults diagnosed with eating disorders located in Cypress, Texas.

Methodology

The Baird 2007 concept of scripting during rounds was utilized as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) patient care experience survey questions when creating the script used during …

Implementation Of Houdini Guidelines Nurse-Driven Protocol To Lower Catheter-Associated Urinary Tract Infections And Foley Utilization Days, Tammie N. Collins

Electronic Theses and Dissertations

Catheter-associated urinary tract infections are a common issue in healthcare settings. These issues contribute to hospital-acquired infections and can lead to complications and increased healthcare costs. The quality project evaluated the impact of the HOUDINI guidelines nursedriven protocol to reduce infection rates and Foley utilization days. A structured guideline for Foley catheter safe removal was implemented using a quantitative method. Catheter-associated urinary tract infection rates and Foley utilization days pre- and postintervention were tracked. Data were collected using the electronic health records, infection control data sheets, and the HOUDINI checklists. A baseline assessment of catheter-associated urinary tract infections rates was …

Toward The Application Of Natural Language Processing In Electronic Health Record Analysis For Taxonomy Development, Latoya Mcdonald

All Dissertations

Electronic health records (EHRs) are pivotal resources for nurse practice because they increase the timeliness and reliability of patient information at the point of care and support access by multiple healthcare providers and the individual patients themselves. However, it is widely recognized that data extraction from EHRs is challenging due to the variability in the language used in clinical care notes and the lack of standardized terminology across healthcare systems. The broad objective of this dissertation is to develop taxonomy-based classification models for nursing care by applying feature engineering approaches to EHRs that include nursing care of ostomy patients following …

Social Determinants Of Health Screening In The Pediatric Population: Evaluating The Effectiveness Of Staff Education, Brenda Awuah, Kansas S. Logan, Sally Humphrey Dnp, Aprn, Cpnp-Pc, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Social Determinants of Health (SDOH) are conditions that influence health outcomes. SDOHs are screened and addressed in many clinics and hospitals to reduce patients' social needs. Research indicates how unaddressed SDOH can negatively impact chronic illness, along with the daily life of pediatric patients. SDOH's role in pediatric patients includes food security, housing stability, access to healthcare, caregiver education, and parental mental health. Previous research has addressed these factors; however, the lack of staff education prevents effective compliance and follow-up on SDOH screening. Challenges remain in implementing and integrating SDOH into routine well-child visits. This scoping review will evaluate and …

Evaluating Referral Rates For Positive Postpartum Depression Screenings At Telehealth And Well-Child Visits: A Scoping Review, Rachel Macklin Barber, Mph, Bsn, Rn, Damaris Amber Brooks, Bsn, Rn, Ashli-Emeria Gary, Bsn, Rn, Margaret Harvey, Phd, Acnp-Bc, Chfn, Kate Fouquier Phd, Aprn, Cnm, Pmh-C, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Postpartum depression (PPD) affects one in nine women. It has distressing impacts, including behavioral and attachment issues and toveruse of healthcare services. PPD occurs within 4 weeks to 12 months postpartum. A scoping review was conducted to compare referral rates to mental health providers after PPD screenings were conducted via telehealth versus those completed at well-child visits.

Methods

Peer-reviewed articles published within five years before the initial search, beginning September 2022 and ending November 2024, were selected. Articles were sourced from several publications using an online library database with various MeSH terms and Boolean operators. Search results were narrowed …

Assessing The Efficacy Of Tranexamic Acid In Adjunct To Oxytocin In Reducing Blood Loss During Cesarean Deliveries: A Scoping Review, Hilary Clair Ray Bsn, Rn, Shelbie Freeman Hendrix Bsn, Rn, Lauren Elizabeth Hubbard Bsn, Rn, Helen Maisen Conley Bsn, Rn, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Globally, postpartum hemorrhage (PPH) is the leading cause of morbidity and mortality during the peripartum and postpartum period in delivering people. Emerging evidence suggests that combining second-line uterotonics with tranexamic acid (TXA) improves maternal outcomes, reduces blood loss, and lowers morbidity and mortality related to PPH (Jones et al., 2023; Al-dardery et al., 2023). TXA, an antifibrinolytic, enhances clotting, reduces blood loss, transfusion needs, hemoglobin drop, and the use of additional uterotonics (Bellos & Pergialiotis, 2021). This review highlights the benefits of TXA.

Methods

A scoping review required a literature search conducted from August 2023 to February 2024 using …