Nursing Commons^™

From Fear To Familiar: Alleviating Technology Anxiety In Older Adults Through A Community-Based Mentorship Program, Inyoung Jang

Master's Projects and Capstones

This quality improvement project was implemented in a senior residential facility in Richmond, California, catering to older low-income adults who frequently experience elevated levels of technology anxiety. Aim This project aims to reduce the mean modified technology-anxiety score among residents aged 65 and older by at least 25% from baseline by November 5, 2025. Methods The Abbreviated Technology Anxiety Scale (MTAS) was modified to consider the cognitive, linguistic, and experiential differences among target population. The original 11-item instrument, which was validated primarily within college-aged populations, used terms and repeated items irrelevant to older people. The adapted tool included five simplified …

Enhancing Patient Safety In A Skilled Nursing Facility With A Post-Fall Huddle Protocol: A Quality Improvement Initiative, Evelin Yajaira Dominguez Dominguez

Master's Projects and Capstones

Objective To implement a post-fall huddle guide at a San Francisco Bay Area skilled nursing facility to address the 75 resident falls that occurred over an eight-month period. The literature emphasized the positive impact of huddles on staff communication, awareness, and collaboration which ultimately created a safe environment. Aim By November 4, 2025, the overall fall rates among patients in a San Francisco Bay Area SNF will decrease by 25%, from 4.8 falls per 1,000 patient days to 3.6 falls per 1,000 patient days. Methods Pre-implementation and post-implementation surveys were completed by LVNs and CNAs to assess knowledge of post-fall …

From Incomplete To Impactful—Finalizing Unfinished Nursing Projects In Nart And Polypharmacy For Lasting Improvement, Paula Thanh Nhat Pham, Armine Lianna Chamichyan, Anastasia Yerofeyeva, Stelene Alexis Tragus

Master's Projects and Capstones

This quality improvement project addressed the problem of incomplete or unsustained clinical initiatives at a long-term care facility by introducing Kotter’s Change Model, an evidence-based framework designed to support and sustain lasting improvements in clinical practice. Within the context of a religious-based residential community for older adults with complex chronic needs, the objective was to strengthen the facility’s capacity to implement and sustain change more effectively. By using two previously unfinished initiatives, the NaRT triage tool and Polypharmacy management process, the project applied Kotter’s model to evaluate how structured change strategies can improve staff engagement, leadership alignment, and long-term project …

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 …

Improving Pressure Injury Prevention With Educational Programs For Caregivers And Nurses, Michella B. Kahanding

Master's Projects and Capstones

Problem: Pressure injuries are preventable with adequate interventions and knowledge by healthcare staff; however, skilled nursing facilities struggle with pressure ulcer prevention (PUP). Patient suffering and associated costs with treating these injuries are considerable.

Context: Staff education in knowledge regarding PUP is lacking, and annual PUP education is ineffective in reducing the number of pressure injuries in these facilities.

Interventions: Staff education on prevention strategies includes education, pre- and post-knowledge assessments, return demonstration and product use will be implemented

Measures: Results from the baseline knowledge of appropriate PUP in caregivers, pre- and post-test for knowledge retention, teach back techniques to …

Improving Doula Visibility And Integration In The Labor & Delivery Unit Through The Implementation Of Creative Standardized Visual Strategies, Ninna Alessandra Arcena Acebedo

Master's Projects and Capstones

Objective: The 22-bed, Labor and Delivery (L&D) unit lacks a standardized model to introduce doulas, clarify their scope of practice, or communicate the value of the services they provide. To address this gap, the team implemented a standardized doula awareness poster that included each doula’s name, photo, years of experience, and personal interests. Aim: The goal is to enhance visibility and promote integration of doula support to strengthen team collaboration and patient engagement. Methods: A pre- and post- implementation survey was distributed exclusively to the volunteer doulas. After the doula awareness poster was displayed for four weeks, …

Increasing Nursing Staff Confidence And Documentation Compliance For Psychotropic Medication Use, Ei Chit Paing

Master's Projects and Capstones

Objective: Psychotropic medications place a high risk for side effects such as confusion, dizziness, falls, and death in older adults above age 65 (Seifert et al., 2024). Educational training on appropriate psychotropic drug use to nursing staff is linked to a decrease in penalties (Jung et al., 2021), side effects, and an increase in staff knowledge in caring for patients with behavioral and psychological symptoms (Pinazo-Clapés et al, 2020). Aim: Facility A in Northern California is currently non-compliant with the Centers for Medicare and Medicaid Services (CMS) guidelines for appropriate psychotropic use due to limited staff understanding of regulations and …

Improving Knowledge To Improve Care: Strengthening Nurse Expertise In The Emergency Management Of Diabetic Ketoacidosis, Minda Murphy

Master's Projects and Capstones

Abstract

Setting: A high acuity emergency department within a large hospital system. Problem: Nurses in the emergency department reported inconsistent understanding and utilization of the existing Diabetic Ketoacidosis (DKA) protocol. Pre-intervention survey results showed that 84% of nurses identified the DKA order set as confusing, and only 15% reported feeling “very comfortable” with the protocol. These knowledge gaps contributed to delays in glucose monitoring, inconsistent insulin administration, uncertainty about order-set responsibilities, and variable adherence to evidence-based management. Context: DKA is a time-sensitive, high-risk emergency that requires precise, protocol-driven actions to prevent complications such as electrolyte imbalance, cerebral edema, prolonged hospitalization, …

Nurses’ Voices In Prevention: Evaluating Enhanced Bedside Signage To Reduce Hospital-Acquired Pressure Injuries, Jorge Pinzon Figueroa

Master's Projects and Capstones

Abstract

Objective: Hospital-acquired pressure injuries remain a patient safety concern despite standard practice of nurses’ prevention protocols (National Pressure Injury Advisory Panel, 2022). Barriers include: inconsistent two-hour repositioning, documentation burden, inadequate staffing, lack of visual cues of patient risk level, and inconsistent compliance with the overall comprehensive prevention bundle (Agency for Healthcare Research and Quality, 2023).

Aim: HAPIs occur within two adult medical-surgical and telemetry units at a tertiary hospital. In response, staff were surveyed on potential interventions, resulting in the production of a visual cuing system.

Methods: Pre- and post-surveys were conducted on the two medical-surgical units to assess …

Improving Dka Protocol Adherence In The Emergency Department, Anjolaoluwa Lawani

Master's Projects and Capstones

Problem There was inconsistency in implementation of the DKA protocol by nurses in the emergency department at the Hospital A. Only 58% of the nurses reported feeling comfortable following the DK protocol, and 84% of the nurses described the DKA order set as confusing. Context Hospital A is a large magnet-recognition hospital system in the Bay Area. The emergency department at Hospital A averages about 12 DKA patients per quarter. Intervention Education sessions were held during pre-shift cuddles across day and night shifts to clarify the DKA protocol and answer any questions or nurses may have. Measures Baseline surveys and …

Matrescence: An Emerging Concept For Birth Worker Practice, Kelsey B. Green

DNP Qualifying Manuscripts

The maternal mental health (MMH) crisis, affecting up to 25% of birthing individuals, is exacerbated by significant gaps in perinatal support. While birth workers are uniquely positioned to provide care, they often lack specialized training beyond basic screening checklists to address the complex transition to motherhood, defined as matrescence. This clinical innovation proposal outlines a matrescence-informed educational curriculum, guided by the Comprehensive Model of Mental Health during the Perinatal Period. The intervention is designed to build tangible, implementable skills, training birth workers to: (1) operationalize matrescence as a psychoeducational tool to normalize distress; (2) use clinical differentiation to distinguish the …

Integrating Sbirt Training Into The Family Nurse Practitioner Curriculum: A Pilot Dnp Project, Fiji Simmons

Doctor of Nursing Practice (DNP) Projects

Background: Substance Use Disorder (SUD) and Alcohol Use Disorder (AUD) are major public health concerns, particularly in underserved populations. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is evidence-based models that promote early detection and care. Integrating SBIRT into Family Nurse Practitioner (FNP) curricula prepares future providers to address substance use in primary care. Local Problem: Despite the effectiveness of SBIRT, its use in primary care remains inconsistent. Barriers, including limited training, low confidence, and unfamiliarity with referral resources, hinder implementation. Structured education and protocols are needed to support provider readiness. Methods: SBIRT was integrated into the FNP curriculum of …

Improving Cpr Confidence And Competence Of Medical-Surgical Nurse Residents, Anthony Joseph Alvarado

DNP Qualifying Manuscripts

Novice nurses often lack cardiac arrest training, jeopardizing patient outcomes and staff confidence. This pilot project addressed gaps in CPR preparedness, early recognition, timely response, and confidence among nurse residents. The goal was to develop, implement, and evaluate a competency-based code blue simulation to strengthen the residents’ knowledge and skills. Professional Development Specialists will learn strategies for integrating a code blue simulation experience into a nurse residency curriculum to enhance patient safety.

Targeted Depression Screening For At-Risk High School Students: An Integrated Review, Joseph Calub

DNP Qualifying Manuscripts

Depression in high school students is underrecognized because symptoms can present not only as mood issues but also behavioral or academic problems. This integrated review examined literature from 2010-2015 using PsycInfo, ERIC, CINAHL, and PubMed to evaluate the effectiveness of targeted depression screening for students referred for behavioral, academic, or social concerns. Studies meeting inclusion criteria assessed targeted or clinically referred screening methods, with a focus on validated tools such as the Patient Health Questionnaire modified for Adolescents (PHQ-A). Findings indicate that targeted screening effectively identifies depressive symptoms in at-risk students and is more feasible in resource-limited schools than universal …

An Integrated Literature Review Examining Nurse Burnout Interventions, Wislande Joseph

DNP Qualifying Manuscripts

Nurse burnout has detrimental consequences for patients, nurses, and organizations and can negatively impact patient outcomes, nurse quality of life, and organizational costs. This integrated literature review aimed to examine interventions for nurse burnout in order to identify what characterizes effective interventions, whether evidence supports implementing such interventions, and how the most commonly-implemented intervention type (mindfulness-based) in particular impacts signs and symptoms of nurse burnout. A two-part search was conducted of CINAHL, PubMed, Google Scholar, and APA PsychInfo. Part one investigated burnout interventions broadly using the primary search terms nurse burnout and interventions; part two focused specifically on mindfulness-based interventions …

Implementing Age-Appropriate, School-Based Comprehensive Sexuality Education, Emira Romero

DNP Qualifying Manuscripts

Background: Sexual and reproductive health (SRH) education is a critical component of early health literacy and health promotion. Yet, there are no federal education requirements for sexuality education in the United States, leading to inconsistent and inadequate instruction.

Methods: In an effort to better understand the barriers beyond policy variability that affect successful implementation of SRH education, a literature search was conducted on CINAHL and ERIC with the following search terms and Boolean operators: (sex* education OR reproductive educat*) AND (elementary school OR school based) AND (United States OR California). The years of publication were limited to the past five …

Improving Effective Assistant Nurse Manager Communication In Obstetrics, Julie Marie Glover

Master's Projects and Capstones

Abstract

Problem: This quality improvement project addresses inconsistent leadership communication among Assistant Nurse Managers (ANMs) in the Obstetrics (OB) department of a hospital in Northern California. ANM and staff concerns around shift handoff, huddles, and leadership responsiveness have created confusion and hindered team coordination. The project aims to improve communication effectiveness scores among OB ANMs from 50% to 75% by July 11, 2025.

Context: The project was conducted in the Maternal-Child-Health (MCH) unit of a hospital in Northern California, specifically targeting communication practices among OB ANMs. Concerns around communication practices were voiced by both ANM leadership and frontline staff, signaling …

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: …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

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 …

Enhancing Adherence To Oxytocin Administration Guidelines To Reduce Postpartum Hemorrhage Rates In A Labor And Delivery Unit, Maya Denny

Master's Projects and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) remains a critical challenge in maternal care. It shows a 13% PPH incidence rate in a high-risk labor and delivery unit in a northern California medical center, exceeding the national benchmark of 5%–10% based on 2021 ACOG data from 150 patient records.

Problem: There is inconsistent adherence to oxytocin administration guidelines, with only 60% of 100 audited charts documenting fetal and uterine activity, contributing to the elevated rate. The team is looking for a target rate of 90%.

Intervention: This involves implementing a checklist, providing training for 25 clinicians, and conducting two 30-minute simulation scenarios …

Implementation Of A Pre-Discharge Screening Program For Fracture Prevention, Sarah J. Russell

Master's Projects and Capstones

Problem Osteoporotic fractures are a major public health concern in the United States; 1 in 2 women and 1 in 4 -5 men will experience a fracture due to low bone density. Despite established clinical guidelines, many patients in this managed care health system do not receive timely osteoporosis screening or treatment, placing them at increased risk for costly readmissions averaging $50,000 per hospitalization especially among those discharged to skilled nursing facilities.

Context The improvement project targeted patients admitted with fractures and integrated DEXA scanning during the acute care stay to avoid delays in diagnosis and bisphosphonate therapy. Barriers included …

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 …

Kid Power: Mastering Asthma Management To Keep Hospitals Away!, Kriste L. Moret

Master's Projects and Capstones

Problem: Pediatric asthma remains a leading cause of preventable hospitalizations, particularly in California’s Central Valley, where environmental and health disparities worsen symptoms. Many children are discharged without understanding their Asthma Action Plan (AAP) or feeling confident in symptom management.

Context: On a unit in a community hospital in this high-risk region, asthma-related admissions persisted. Gaps in discharge education highlighted the need for a structured intervention. The Institute for Healthcare Improvement (IHI) Model for Improvement (MFI) guided this effort.

Intervention: A nurse-led, developmentally appropriate asthma education bundle was implemented. Teaching began on admission and was reinforced using teach-back, color-coded AAPs, culturally …

Red Room Redesign: Improving Operating Room Workflow For Urgent And Emergency Procedures, Hipolito Jamilan

Master's Projects and Capstones

Problem: Limited operating room (OR) availability is a significant challenge in many healthcare facilities. Overbooked or understaffed ORs can lead to delays in surgical procedures, which are particularly detrimental in urgent and emergency situations (Cholewa et al., 2024). The OR is among the costliest areas in a hospital; it is essential to improve efficiency in surgical throughput to deliver timely care for urgent and emergent cases, enhance patient outcomes, and manage healthcare costs effectively.

Context: The microsystem for this project is a Northern California OR that handles a high volume of surgical procedures. There is a dedicated red room for …

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 …

Implementation Of A Triage System For The Residents At A Residential Facility To Improve Triage Assessment Skills Of The Staff As Well As Improve The Level And Timeliness Of Care, Andrew J. Choi Rn, Neha Gopal Rn, Andres N. Padilla Rn, Dana Son

Master's Projects and Capstones

Triage is an integral part of the clinical process which involves assessing patients and determining their level of care in order to get them appropriate, timely treatment. Several countries utilize a standardized triage system with established criteria to aid staff in their decision-making during assessments (Peta et al., 2023). The Nursing and Residential Triage (NaRT) tool, from the Manchester Triage System (MTS), was shown to enhance staff clinical assessment skills and help avoid inappropriate ED transfers during a study among older adults in a residential facility (Markey et al., 2024). For this project, the main issue identified at the residential …

Enhancing Patient Safety: Fall Prevention Through Video Education, Fithawit T. Zere

Master's Projects and Capstones

Abstract

Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.

Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.

Interventions: A …