Nursing Commons^™

Implementation Of A Standardized Adverse Childhood Experiences Screening Process In A Primary Care Clinic, Tanya M. Wonnacott

Doctoral Dissertations & Projects

Adverse Childhood Experiences (ACEs) are associated with increased risks of chronic disease, mental health disorders, substance use disorders, and premature mortality. Despite growing evidence supporting ACE screening, it remains inconsistent in many primary care settings, particularly among underserved populations. The purpose of this quality improvement project was to evaluate whether implementation of a standardized ACE screening workflow increased ACE screening completion and behavioral health referral within a nonprofit primary care clinic serving uninsured, underinsured, and refugee populations.

This project utilized a pre–post quality improvement design guided by Lewin’s Change Management Model and the Chronic Care Model. Interventions included standardized ACE …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

Implementation Of A Process For Tracking Hgb A1cs In A Community Mental Health Organization, Devin Gill

Doctoral Dissertations & Projects

Background: Individuals with a serious mental illness (SMI) are 2 to 3 times more likely to develop type 2 diabetes, yet are less likely to receive routine screening of hemoglobin A1c (HbA1c) testing. The purpose of this quality improvement project is to implement a standardized workflow process to ensure consistent tracking of HbA1cs in adult consumers greater than 18 years of age with SMI receiving services at a rural community mental health (CMH) organization.

Methods: The primary intervention is a workflow process, with focus on the clinical information systems and organizational system. This quality improvement project was guided utilizing the …

Improving Patient Health Portal Enrollment In The Primary Care Setting, Erika L. Bell

Doctoral Dissertations & Projects

In today’s increasingly digital healthcare environment, patient health portals have become critical tools for enhancing communication, improving care coordination, and empowering patients to actively participate in their health management. These secure, web-based platforms allow patients to access medical records, request prescription refills, view lab results, and message providers. Although patient health portals are offered by a vast majority of U.S. health systems, they remain underutilized, with only 15-30% of patients engaging with these platforms despite their potential to improve patient engagement, health status awareness, and care quality. Enhancing patient health portal use not only empowers patients but also supports broader …

Program Evaluation Of A Digital Outreach Initiative For Improving Well-Child Visit Engagement Among Children And Adolescents Aged 3–21 Years, Eseoghene Odhu

Doctoral Dissertations & Projects

Background: Well-child visits are essential to pediatric preventive care because they support immunizations, developmental screening, anticipatory guidance, and early identification of health concerns (Abdus & Selden, 2022; Theunissen et al., 2022). Despite their importance, engagement in recommended visits remains inconsistent across healthcare systems.

Purpose: This program evaluation examined the impact of a digital outreach initiative on well-child visit engagement among children and adolescents within a Midwestern faith-based healthcare organization.

Methods: A pre–post evaluation design was used with de-identified electronic health record data from periods before and after implementation of the initiative. Outcomes included patient enrollment, scheduled visits, completed visits, no-show …

Standardized Home Blood Pressure Log Implementation For Patients With Hypertension To Increase Patient Awareness And Clinical Action, Ashley Alcala

Doctoral Dissertations & Projects

Background: Home blood pressure monitoring (HBPM) is recommended for hypertension management, yet primary care clinics often lack standardized workflows for distributing, collecting, and using home blood pressure (BP) data. Inconsistent reporting and limited patient understanding of their own BP trends, such as whether readings are stable, elevated, or unchanged, reduce providers ability to make timely clinical decisions.

Problem: Despite evidence supporting HBPM, patients rarely brought usable BP logs to follow‑up visits, limiting providers ability to assess BP control, identify trends, and make timely medication or care plan adjustments.

Approach: This project used a Plan‑Do‑Study‑Act (PDSA) model to implement a standardized …

Fostering Dialogue, Learning, And Reflection: The Role Of Book Discussions For Public Health Professionals, Naomi E. Ervin, Belinda Aberle, Katherine Balint, Lynn Mcdaniels, Paula Tomczak

Michigan Journal of Public Health

Background: The Public Health Nursing (PHN) Section of the Michigan Public Health Association (MPHA) works to improve public health and public health nursing practice in Michigan. In 2021, the PHN Section initiated virtual book discussions to engage public health professionals in meaningful discussion about topics of critical importance to public health and public health nursing; provide continuing education contact hours; and recruit new section members. Methods: The discussions are conducted virtually four times per year. A moderator introduces each book and leads the one-hour discussion. As an added incentive to read the books, the PHN Section sends a limited number …

Improving Admissions Planning In A Specialized Adult Foster Care Program, Jessie Sullivan

Doctoral Dissertations & Projects

Background: Specialized adult foster care (AFC) programs have the unique ability to facilitate and coordinate continuity of care with an interdisciplinary approach internally and with community provider collaboration. The lack of communication in the transition of care admissions process leads to negative patient safety outcomes.

Purpose: The purpose of this quality improvement project was to identify barriers to improve communication, continuity of care, reduce negative health outcomes, and provide a culture of safety.

Methods: The Systems Engineering Initiative for Patient Safety (SEIPS) guided this quality improvement project. Assessment of quality measures and outcomes included the administration of pre- and post-implementation …

Implementing A Standardized Colorectal Cancer Screening Protocol To Enhance Screening Rates In A Primary Care Setting, Sam Terranova

Doctoral Dissertations & Projects

Colorectal cancer (CRC) is a significant health concern in the United States, ranking third in incidence and mortality among all cancers. Despite established screening guidelines, adherence often falls short in primary care settings. This quality improvement project aimed to enhance CRC screening rates in a Midwest primary care practice through implementation of a standardized screening protocol. The intervention was two-fold and consisted of the routine ordering of fecal immunochemical test (FIT) kits to eligible patients and the use of electronic health record (EHR)-based patient reminders. Screening completion rates were monitored over a four-month period and compared to pre-intervention rates from …

Developing The Evidence-Based Plan To Implement The Violence Assessment Tool, Yue Zhang

Doctoral Dissertations & Projects

Patient violence against healthcare workers is a prevalent issue in healthcare settings, manifesting through physical assaults, harassment, intimidation, or other disruptive behaviors occurring at the workplace. Workplace violence (WPV) can lead to healthcare worker burnout, decreased job satisfaction, and increased staff turnover. Various strategies exist to prevent WPV, with assessment tools being among the effective measures. This paper aims to develop an evidence-based plan for integrating the Violence Assessment Tool (VAT) into nurses’ daily practices to evaluate patients and reduce the risk of violent incidents.

The Role Of Nurses In Environmental Sustainability, Olivia Monroe

Honors Projects

This project explores the current literature on pollution originating from the United States healthcare sector, with emphasis on greenhouse gas emissions and waste production. Strategies healthcare organizations are implementing to reduce their pollution and actions nurses can take to support these initiatives are discussed.

Early Mobility And Delirium Prevention For Intensive Care Unit Patients At Kingman Regional Medical Center, Lyndsey R. Lehman Ms, Otr/L

Masters Projects

Over five million patients are admitted to the intensive care unit (ICU) annually in the United States, with 50-70% of those developing debilitating physical, cognitive, and mental health issues. Occupational therapy (OT) is a holistic profession that provides evidence-based interventions to improve ICU patients’ function and participation in daily occupations by addressing early mobility and delirium. A needs assessment performed for the Kingman Regional Medical Center (KRMC) ICU revealed a lack of knowledge about early mobility and delirium prevention among nursing staff, underutilization and limited understanding of OT services, and KRMC-specific barriers impacting patient care. This author designed and implemented …

Evaluation Of A Primary Care Community Health Center’S Mammogram Program In Relation To Current Evidence-Based Practice., Brianna Childress

Doctoral Dissertations & Projects

Breast cancer is the second leading cause of cancer deaths among women over 50 years of age. Although mammograms have been proven to be effective in early detection of breast cancer, compliance rates are declining in the United States making it an objective for Healthy People 2030 to achieve and maintain a national compliance rate of 80.3%. For early detection of breast cancer among women between 50 to 74 years old to occur, an effective breast cancer screening program is vital. To understand why mammogram compliance rates were below the national average at a primary care community health center in …

Improving Campus Prescription Delivery Service Process At A Campus Health Center, Monase Chibambo Swanigan

Doctoral Dissertations & Projects

Objective

The Doctor of Nursing Practice (DNP) project aimed to decrease barriers to accessing prescriptions using a free campus prescription delivery service (CPDS) through process improvement and interprofessional collaboration. The target population was the clinic population, focusing on college students residing on campus (SRoC).

Background

A utilization review and social influencers of health (SIoH) screenings revealed barriers to filling prescriptions among acutely ill students at a local university in a Midwestern rural college town.

Methods

A quality improvement project was implemented. An SIoH and a CPDS tool identified at-risk students who were then referred to a pharmacy delivery service. The …

Enhancing Metabolic Syndrome Surveillance For Adults Taking Second Generation Antipsychotic Medication, Ilanit Marx

Doctoral Dissertations & Projects

Background: Individuals prescribed Second-Generation Antipsychotics (SGAs) face an increased risk of developing metabolic syndrome (MetS), characterized by a higher prevalence of metabolic abnormalities such as diabetes, dyslipidemia, hypertension, and obesity. This heightened susceptibility significantly raises the chances of developing cardiovascular disease and type 2 diabetes (Abdulhaq et al., 2021; Chen & Nasrallah, 2019).

Objectives: This quality improvement project aims to address the management of MetS in patients with severe psychiatric disorders prescribed SGAs. Applying the theory of planned behavior (TPB) framework, this project seeks to gain insights into the determinants shaping clinician behavior and provide a comprehensive understanding of the …

Preyemary Care Optical Coherence Tomography: Increasing Adherence To Retinopathy Screening, Henry Junior Peña

Doctoral Dissertations & Projects

Background: Diabetic retinopathy (DR) is a leading cause of preventable blindness in working age adults in the United States. Nonadherence to screening recommendations persists due to significant barriers. Early detection is crucial to mitigate economic burdens and improve patient outcomes. This quality improvement project aimed to increase DR screening access for patients with diabetes at an urban Midwest safety net clinic by implementing an optical coherence tomography (OCT) screening program. Methods: A 12-week, cross-sectional study design using convenience sampling to recruit adult diabetic patients, type-1, or type-2, at a Midwest primary care clinic. Intervention involved retinal imaging scans of participants …

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations & Projects

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

The Significance Of Palliative Care Education And Areas For Improvement, Lindsey Bunday

Honors Projects

Palliative care is vital in prioritizing quality of life for patients with serious illnesses. Such care is crucial to help patients understand their prognosis, address needs, and meet goals of care. However, physician shortages, improper utilization, and non-standardized medical curriculum amplify the gaps in care and demonstrate significant room for improvement. Innovative curriculum and opportunities for knowledge advancement can refine education and improve patient care.

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Masters Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

Adolescent Depression Management: An Inner City Federally Qualified Health Center Program Evaluation, Aurora Wernette

Masters Projects

Background: Within the state, approximately 119,000 adolescents aged 12-17 have depression, and it is estimated that 57.8% do not receive any mental health care (National Alliance on Mental Illness [NAMI], 2021).

Objectives: The purpose of this program evaluation is to evaluate the management of adolescent depression. This evaluation focused on adolescent depression screening rates, medication prescribing and adherence, counseling referrals and initiation, barriers to treatment, follow-up visits, and parent feedback about the care received.

Methods: All adolescents who did not have previously diagnosed depression or developmental delay were included in this program evaluation., A weekly manual chart review was used …

Formalized Diabetes Self-Management Education In A Safety-Net Clinic, Emanpreet Kaur

Masters Projects

Diabetes is a complex and chronic illness requiring continuous medical care with multifactorial risk reduction strategies (American Diabetes Association [ADA], 2021). More than 37 million Americans are suffering from diabetes and 90% of them have Diabetes Mellitus Type 2 (DMT2) (Centers for Disease Control and Prevention, 2021). The purpose of this article is to review the background, an organizational assessment, a literature review, and the results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included 16 patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, Body …

Brining Point-Of-Care Ultrasound To A Rural Primary Care Clinic, Caleb E. Migda

Masters Projects

Background and Objectives: In the rural primary care setting, the process for outpatient

ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing.

Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient …

Type 2 Diabetes Nutrition: A Video-Based Education Approach, Erin Russell

Masters Projects

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease associated with life- threatening outcomes. To prevent such outcomes, people with diabetes must possess the knowledge and skills required to manage their chronic disease. Objectives: To evaluate the impact of video-based education (VBE) on participant Diabetes Self-Management Education Skills (DSMES). Methods: The experimental study was conducted in a primary care office in a Midwest state. A convenience sample of 55 participants was selected. Pre- and post-implementation surveys were administered to measure change in self-efficacy between DMSES scores after viewing the VBE intervention. The Wilcoxon Rank Sum test was performed using …

Improving Adherence To Annual Retinal Screening Among Adult Diabetics In Rural Midwest, Sarah Hunger

Doctoral Dissertations & Projects

Background: Diabetic retinopathy (DR) affects millions of people worldwide and is a main cause of preventable blindness. Experts recommend annual retinal screenings on all diabetic patients. Studies show continuing trends of non-adherence, as well as significant barriers to screenings. Recommendations to overcome barriers and methods to improve adherence among diabetics are topics of interest among healthcare providers. The purpose of this project was to increase annual retinal screening adherence among adult diabetics at a privately owned primary care practice in the rural Midwest.

Methods: Staff and 59 patients, chosen through convenience sampling were involved. Pre- and post- implementation surveys were …

Revising The Team Huddle Process In A Federally Qualified Health Center, Donna Demann

Masters Projects

Abstract Background: Interdisciplinary team collaboration is a component of the patient centered medical home (PCMH) and can be met by completion of a daily team huddle (DTH). Local Problem: A federally qualified health center (FQHC) requested help revising the team huddle process to make it more beneficial for staff and patients. Goal was to improve team cohesion, collaboration, and communication and ultimately improve patient outcomes. Methods: The problem was addressed through revision of the huddle process. Process changes were guided using the actions from an evidence-based huddle framework and implementing additional teamwork strategies. Interventions: This project reconstructed the current huddle …

Challenges To Coordination Of Care In The Diabetic Homeless Population, Melissa K. Smith

Doctoral Dissertations & Projects

Abstract

Diabetes mellitus (DM) significantly impacts the lives of Americans and the healthcare industry. Clinicians and patients utilize significant time, effort, and resources to combat the challenges faced. Homeless patients have additional burdens not experienced by those of housed individuals. A Midwest homeless shelter recognized the ongoing unmet needs for primary care and behavioral health services for their clinic patients. It was postulated that implementing a streamlined referral process to primary care services, enabling patients to be seen same day or next day, would increase utilization of services by this population. To increase the probability of patients presenting for their …

Development Of An Advanced Practice Provider Diagnostic Clinic Within An Oncology Practice, Abigail Jean Voss

Masters Projects

Background: The process of diagnosing cancer and the time to treatment can influence a patient’s experience with diagnosis of cancer at a later stage being associated with poorer cancer outcomes and decreased quality of life post-treatment. With increasingly complex oncologic imaging and pathology findings, effective interventions for early diagnosis of cancer requires a cohesive approach including referral, diagnosis, staging, and treatment phases. Objectives: The aim of this article is to outline the program development efforts initiated to apply current literature findings and organizational assessment to create a program development toolkit and business plan for an Advanced Practice Provider …

Staff Education To Increase Confidence In Caring For Lgbtqi Cancer Patients: A Quality Improvement Initiative, Clara C. Beaver

Masters Projects

This project was to provide education to promote a welcoming environment, increase staff knowledge, and confidence in caring for LGBTQI cancer patients. Methods: An educational session was provided to increase staff competence and knowledge about LGBTQI cancer patient uniqueness. A pre- and post-test was administered to measure staff knowledge, comfort in discussing with coworkers, and confidence in caring for LGBTQI patients. Results: After the session, there was a 42% increase in staff responses to the importance of knowing about a patient’s sexual orientation when providing care, 58% increase in knowledge about cancer issues related to LGBTQI population, and 39% increase …

Improving Adherence To Annual Diabetes Guidelines In Rural Primary Care, Ashley Barney

Masters Projects

Background: The American Diabetes Association (ADA) (2022) identifies comorbidity risk assessments and treatment planning as key health maintenance components for diabetic patients. However, many providers do not adhere to the recommended national guidelines (Brenner et al., 2020).

Objectives: At a rural primary care clinic, the effectiveness of implementing a checklist was evaluated to improve provider adherence to the annual diabetes guidelines set by the ADA.

Methods: A quality improvement project was initiated and guided by the Lean Six Sigma framework. The checklist was implemented to assess if providers adhered to the recommended annual diabetes guidelines. The project …