Nursing Commons^™

Dnp Final Report: Improving Diabetes Self-Efficacy Through Nutrition Education: A Quality Improvement Project, Lakimberely S. Wooten

DNP Final Reports

Diabetes affects 12.7% of residents in Northeast Texas and is the 7th leading cause of death. Internal evidence indicates low health literacy and a heavy disease burden in the service area, underscoring the need for a standardized, low-cost, and feasible approach to nutrition education. This quality improvement project evaluated the feasibility of implementing an instructor-led nutrition education session. Guided by the Johns Hopkins Evidence-Based Practice Framework and the ADKAR behavioral change model, adult participants with Type 2 diabetes received instruction on the Plate Method. Participants enrolled in a 4-week, instructor-led diabetes education class completed a 1-hour, nutrition education session using …

Dnp Final Report: Improving Rehospitalization Rates And Caregiver Quality Of Life In Outpatient Hospice, Carrie M. Judd

DNP Final Reports

Background: Hospital readmissions among home hospice patients disrupt continuity of care, increase healthcare costs, and may compromise end-of-life preferences.

Purpose: This quality improvement project evaluated the feasibility of implementing a telehealth communication intervention in an outpatient hospice organization. Project aims were to reduce Type I live hospice discharges by at least 2.5% and improve caregiver quality of life (QOL).

Methods: Zoom for Healthcare® video visits and three-way telephone communication supplemented standard nurse practitioner hospice visits during a three-month implementation period. Type I live discharge rates were compared with the organization's baseline quality metrics. Caregiver QOL was measured pre- and post-intervention …

Dnp Final Report: Improving Length Of Stay Outcomes Using Structured Barrier Rounds: A Quality Improvement Project, Martha Kwamboka Apella

DNP Final Reports

Prolonged length of stay (LOS) in the acute care setting is a challenging issue driven by multiple factors. Increased LOS is associated with mortality, hospital-acquired infections, patient safety events, functional impairment, decreased quality of life, social isolation, and increased cost of care. The causes of increased LOS in the medical-surgical unit are unclear, necessitating an evidence-based project to address the problem. The purpose of this quality improvement initiative was to implement structured interdisciplinary barrier rounds and evaluate their effect on LOS, opportunity days, and estimated cost of care in a medical-surgical unit. The facility complex care coordinator (CCC) was identified …

Dnp Final Report: Enhancing Self-Regulated Learning And Metacognition For First-Semester Undergraduate Nursing Students, Carla S. Biondillo

DNP Final Reports

Background. First-year undergraduate nursing students often struggle to adapt their learning strategies to the higher-order thinking and clinical reasoning demands of nursing education. Ineffective study habits, low academic self-efficacy, and limited self-regulated learning (SRL) skills are consistently identified as predictors of attrition, which ranges from 20–50% nationally and internationally.

Purpose. At an academic medical center in rural East Texas, first-semester students report academic overwhelm and inadequate study strategies, consistent with national trends. A structured, evidence-based faculty coaching intervention targeting SRL and metacognition was found to be feasible within the collaborative, student-centered organizational culture.

Methods. A quality improvement (QI) design …

Dnp Final Report: Community-Based Advance Care Planning Education For Older Adults: A Quality Improvement Project, Teresa Hill

DNP Final Reports

Background: Advance care planning (ACP) supports patient autonomy and promotes care aligned with individual values and preferences. Despite these benefits, fewer than half of adults aged 50–80 have completed formal ACP documentation, and community-dwelling older adults rarely engage in ACP before serious illness, representing a persistent gap in early engagement.

Purpose: This quality improvement (QI) project evaluated the effectiveness of a community-based ACP educational intervention in improving ACP knowledge, confidence, and engagement among older adults.

Methods: A nurse facilitator trained in the Five Wishes framework delivered a structured, 60-minute ACP workshop at a senior center in North Texas. A pre–post …

Dnp Final Report: Enhancing Radiation Oncology Training For Advanced Practice Providers, Katherine A. Bukolt

DNP Final Reports

Background: Rising cancer incidence and improved survivorship are straining the oncology workforce, increasing reliance on Advanced Practice Providers (APPs). However, there is a lack of standardized educational resources for APP radiation oncology training across practice settings. Most APPs receive variable, resource-dependent, and on-the-job training. Evidence shows that the lack of standardized training leads to gaps in foundational knowledge, reduced confidence in toxicity management, inconsistent role development, and variable satisfaction with training and transition into practice.

Purpose: This quality improvement project evaluated the feasibility of implementing an 18-module Advanced Practice Radiation Oncology (APRO) asynchronous online curriculum to standardize APP radiation oncology …

Dnp Final Report: Can Implementing A Mindfulness-Based Program Help Reduce Stress In Nursing Students?, Shelby Devreeze Msn, Rn, Cpn, Cne-Cl

DNP Final Reports

Stress among nursing students is a well-documented problem that contributes to physical, mental, and emotional issues, substance abuse, and program dropout. A mindfulness-based stress reduction program was implemented with nursing students to evaluate its impact on perceived stress levels over a five-week period. A review of evidence-based articles provides strong evidence that this intervention correlates with reduced reported stress. An MBSRP was implemented with nursing students who completed a Perceived Stress Scale 10 (PSS-10) before the intervention and again after five weeks.

Results from this project showed a statistically significant reduction (t=2.725, p=0.025) in stress among the nursing student population …

Dnp Final Report: An Evidence-Based Project To Decrease Stress In Undergraduate Nursing Students, Elaine Wallace

DNP Final Reports

Stress among undergraduate nursing students is a well-documented concern that negatively affects academic performance, clinical readiness, well-being, and program retention. Stress levels are often heightened before clinical skills check-offs, highlighting the need for practical, evidence-based interventions. This Doctor of Nursing Practice quality improvement project examined whether mindfulness-based mandala coloring could reduce perceived stress in undergraduate nursing students. Using the PICOT framework, the project evaluated whether undergraduate nursing students (P) who participated in mindfulness-based mandala coloring (I), compared with no intervention (C), experienced reduced perceived stress levels (O) over a 12-week implementation period (T).

A comprehensive search of the literature supported …

Dnp Final Report: Poverty Stigma: The Effects Of A Poverty Simulation On Undergraduate Nursing Students And Their Attitudes Toward Caring For Impoverished Patients, Jessica P. Bowen

DNP Final Reports

Background: Current evidence demonstrates that stigma toward individuals living in poverty persists among undergraduate nursing students and negatively influences patient outcomes. Evidence-based educational strategies addressing social determinants of health have been shown to improve nursing students’ perceptions of vulnerable populations.

Purpose: This quality improvement project intended to evaluate the feasibility of integrating an interactive Community Action Poverty Simulation© (CAPS) activity into an undergraduate nursing (BSN) program at an academic health system university in East Texas.

Methods: Guided by the Plan Do Study Act (PDSA) quality improvement framework and The Johns Hopkins Evidence-Based Practice (JHEBP) Model, Missouri's Community Action Poverty Simulation …

Dnp Final Report: Reducing 30-Day Readmissions Through Follow-Up Appointments In An Acute Care Setting, Sukhnandan Kaur

DNP Final Reports

Thirty-day hospital readmissions remain a persistent quality and financial concern for acute care organizations. Poorly coordinated discharge processes, inconsistent follow-up appointment scheduling, and gaps in care transitions may increase the risk of avoidable readmissions among adult medical-surgical patients. The purpose of this quality improvement project was to implement a standardized follow-up appointment scheduling workflow prior to hospital discharge and evaluate its effect on follow-up scheduling compliance and 30-day readmission trends in a 93-bed acute care hospital. The intervention was implemented over 12 weeks on an adult medical-surgical unit from September through December 2025. The standardized workflow included electronic health record …

Barriers And Facilitators Of Diabetes Educational Knowledge Retention Among Black Women: An Exploratory Sequential Mixed Method Study Of Black Diabetes Educators, Alicia Mott

Nursing Theses and Dissertations

Problem: There is a gap in understanding the culturally specific barriers affecting diabetes education knowledge (DEK) among Black women with Diabetes Mellitus (DM). This study explores the barriers and facilitators to improving education retention from the perspectives of diabetes mellitus educators and health care providers.

Theoretical Framework: The Campinha-Bacote Model (CBM) was utilized to identify the facilitators and barriers of Black women with DM.

Design: An exploratory sequential mixed method was used to identify barriers and facilitators of DEK among Black women. A sample of six Black diabetes experts participated in the qualitative study, and seven professionals participated in rounds …

Quadriceps And Ankle Weakness In Inclusion Body Myositis: Impact On Descending Balance Control And Rehabilitation Strategies - A Systematic Review, Woohyoung Jeon, Ashley Dalby, Melinda Hermanns, Manuel Lubinus

Nursing Faculty Publications and Presentations

Background

Inclusion Body Myositis (IBM), a progressive neuromuscular disorder, is characterized by quadriceps and ankle muscle weakness, leading to impaired balance control and increased fall risk during functional activities. Existing research highlights inconsistent evidence on fall risk reduction and a lack of standardized rehabilitation protocols, creating gaps in effective management. This systematic review aims to synthesize evidence on the impact of muscle weakness on balance and fall risk and evaluate rehabilitation strategies, including task-specific interventions, to improve functional outcomes in IBM patients.

Methods

Following PRISMA guidelines, we conducted a systematic search of MEDLINE, Embase, and the Cochrane Library from inception …

Gender Differences In Psychological Strengths Among Rural Adolescents, Angela Preston, Jodi Bullard, Rachel Smith, Ashlyn Peppler

Nursing Faculty Publications and Presentations

Purpose: Rural adolescents often lack access to mental health care along with increased rates of depression and suicide completion. While psychological strengths have been associated with positive outcomes globally, little is known regarding the prevalence of these indicators (hope, self‐efficacy, resilience, optimism, and gratitude) among adolescents living in rural Texas. The purpose of this study was to describe how rural adolescents report their psychological strengths and examine the data for potential gender differences.

Design and Methods: A secondary analysis of cross‐sectional data was performed on the RStudio platform using tests of central tendency and inferential statistics. Results: There were 425 …

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

Nursing Theses and Dissertations

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

Developing Clinical Judgment In Nursing Students Using Discourse With Meaningful Feedback, Explanatory Mixed Methods Design, Annissa C. Jackson

Nursing Theses and Dissertations

The competency of clinical judgment in new nurses leading to safe practice has declined. The integrated clinical education theory posits discourse with meaningful feedback between nurse educators and pre-licensure students during clinical experiences enhances the development of clinical judgment. Quantitative evidence is needed for efficacy of clinical teaching using discourse with meaningful feedback. The hypothesis for this study was implementation of discourse with meaningful feedback between the academic nurse educator and the pre-licensure student nurse in direct patient care will improve the development of clinical judgment in students compared to the development of clinical judgment in students exposed to other …

Development Of A School Nurse Simulation Boot Camp, Jodi S. Bullard, Angela Preston, Jenifer Chilton

Nursing Faculty Publications and Presentations

A school nurse continuing education program was developed by School of Nursing faculty at an East Texas university, providing school nurses with documented competence in nursing skills focused on equitable health outcomes. The 8 hr School Nurse Boot Camp program consisted of a keynote address on local pediatric health topics and a series of 30-min speed simulations focused on mental and physical health issues. A total of 62 school nurses attended the three boot camp offerings during the 2023/2024 academic school year and represented a student population of 78,275. Participants indicated satisfaction with the event and interest in future continuing …

Medication Adherence: A Reimbursable Theory-Guided Evidence-Based Educational Intervention For Patients With Parkinson’S Disease, Amanda E. George, Melinda Hermanns, Diane B. Monsivais, Cheryl D. Parker

Nursing Faculty Publications and Presentations

Background: Parkinson’s disease is a challenging, progressive neurodegenerative process projected to affect more than 1.2 million patients by 2030, with an economic burden that will surpass $79 billion annually in the United States. Pharmacological interventions are the hallmark of treatment for symptom management for this lifelong disease. Multiple medications and a variety of dosing times have an increasingly negative effect on medication adherence. Purpose: This article will discuss medication adherence challenges, describe a theory-guided evidence-based intervention to improve medication adherence, and explore the economic implications in an outpatient clinic setting. Methods: A pilot chart review of 40 cases over 30 …

Emergency Nurses’ Perceptions Of A Trauma-Informed Organizational Climate: A Cross-Sectional Study, Audrey Kobina

Nursing Theses and Dissertations

Healthcare leaders face numerous challenges in today’s complex healthcare environment. The most pressing issues are staffing shortages and burnout among healthcare workers. By 2025, the U.S. healthcare system could experience a shortfall of up to 450,000 nurses, or 20% fewer nurses than needed to provide adequate patient care. High job dissatisfaction and burnout levels are significant factors driving many nurses away from the profession. This three-paper dissertation portfolio addressed how trauma-informed approaches and practices can enhance the work environment by establishing trauma-informed organizational climates to mitigate burnout. Understanding the impact of trauma-informed practices within healthcare systems supports the nursing workforce. …

Exploring Veteran And Non-Veteran Nursing Student Satisfaction Utilizing Marginality And Financial Stress, Juanita Nickols

Nursing Theses and Dissertations

It is widely recognized that there is a nursing shortage in the U.S. due to a growing aging population, nurses retiring, and a low nursing school capacity. Nursing schools can ameliorate part of this shortage by devising ways to increase nursing student success and graduation rates. This three-manuscript paper aims to present various ideas to help nursing schools in this endeavor. A relatively unstudied population is the veteran nursing student (VNS), the focus of this paper. The first chapter, Chapter 2: A Concept Analysis of Overload: Implications for Undergraduate Nursing Students Success, discusses the concept of overload so the …

Dnp Final Report: Improving Adherence With Cms Sep-1 Sepsis Bundle In The Emergency Department, Emmanuel Bernards

DNP Final Reports

Adherence to the CMS SEP-1 Sepsis bundles is critical to sepsis management and leads to lower sepsis mortality, lower incidence of readmission, reduced length of hospital stay, and improved patient outcomes. This medical center has struggled to meet the required 71% adherence rate set by the Center for Medicaid and Medicare, representing the benchmark of acceptable care of sepsis patients. Therefore, the following PICOT question arises: among the hospitals’ ED physicians and nursing staff (P), how does a multimodal approach consisting of education, visual reminders, and audit and feedback (I) compared to a single approach (education) (C) affect adherence to …

Understanding Weight Loss Maintenance In Postmenopausal Women: A Qualitative Exploration, Amy M. Field

Nursing Theses and Dissertations

Postmenopausal women are treasures in our community. They contribute to society in countless ways, often using their life experience, wisdom, and resilience to serve as caregivers, mentors, and educators. As women age, hormonal changes contribute to increased abdominal adiposity and subsequent metabolic disorders, cardiovascular disease, cancers, and bone and joint problems. Weight loss and maintenance of that loss likely contribute to decreased risk factors of comorbidities associated with excess weight and increased daily functioning and fulfillment of desired tasks. Weight management strategies are well-studied. However, postmenopausal women are more likely to regain weight lost. This work explores the gap in …

Timing End-Of-Life Care Education For New Graduate Icu Nurses, Annelies J. Harrison

Nursing Theses and Dissertations

Problem: New graduate nurses (NGNs) in the intensive care unit (ICU) experience a readiness to-practice gap when providing end-of-life (EOL) care.

Research Question: What is the effect of differences in timing EOL education in an ICU NGN’s first year and their self-efficacy to provide EOL care, emotional exhaustion, and reality shock?

Design: This pilot study used a complex experimental mixed methods design with the qualitative strand embedded after the quantitative intervention.

Methods: Pre- and post-intervention data were collected from 135 nurse residents (62 ICU nurses), 34 of whom were trained within 4 months of practice and 28 of whom were …

Dnp Final Report: An Evidence-Based Initiative To Improve Bowel Preparation Quality For Colonoscopy, Jennifer L. Gassett

DNP Final Reports

Good colonic bowel preparation (CBP) is an important component of colonoscopy but is often inadequate. Improving CBP can help increase detection of precancerous polyps, prevent procedures from being canceled or repeated, and decrease medical expenses. A quality improvement project was implemented to increase adequate CBP rates at an ambulatory surgery center specializing in endoscopy. Several factors correlate with suboptimal CBP, but the practice question focused on patient education. The PICOT question guiding evidence synthesis was posed: In adult patients preparing for outpatient colonoscopy, how do revised instructions with visual aids compared to written instructions affect CBP adequacy and patient satisfaction? …

Dnp Final Report: Stress Less, Teach More: A Stress Reduction Initiative Utilizing A Mindfulness-Based Approach For Nursing Faculty, Jewelle Johnetta Welleh

DNP Final Reports

This paper explores the pervasive issue of stress among nursing faculty, particularly within the context of the Central Texas two-year college. Analyzing the nature, causes, and effects of stress experienced by nursing educators, the Doctor of Nursing Practice (DNP) project emphasizes the important elements contributing to this phenomenon, including workload, administrative duties, and the most recent difficulties brought on by the COVID-19 epidemic. The initiative emphasizes the need for efficient stress management strategies to improve faculty well-being and job satisfaction by utilizing internal and external evidence. The DNP Scholarly project aims to reduce stress levels among nursing faculty by implementing …

Duty To Care And Job Turnover Intention In The Post-Pandemic Nursing Workforce, Cathleen A. Lopez

Nursing Theses and Dissertations

Natural and human-made disasters are increasing in number and intensity. In 2020, approximately 688.3 million people required assistance from disaster response personnel. During a disaster or pandemic, nurses must weigh their personal and/or family safety against the ethical code of caring for others. The purpose of this convergent mixed-methods study was to examine duty to care and job turnover intention of registered nurses working in patient-facing roles. A convergent mixed method design was used to address research questions by employing the Nash Duty to Care Scale (NDCS) and the Turnover Intent Scale (TIS-6). Open-ended survey questions were used to explore …

Effects Of The Vitality Acupunch Exercise Program On Older Adults With Probable Sarcopenia: A Mixed Methods Pilot Study, Brittany Murley, Kuei-Min Chen, Christine S. Gipson, Kevin Gosselin, Jenna Thornhill, Allison Ross, Kennedy Gladding, Beth Mastel-Smith

Nursing Faculty Publications and Presentations

Purpose: Age-related loss of muscle mass and strength is a highly prevalent condition in older adults in long-term care (LTC) facilities. This pilot study aimed to test the effects of a vitality acupunch (VA) exercise program on muscle mass, muscle strength, muscle endurance, functional fitness, activities of daily living, quality of life, and sleep quality of older adults in LTC facilities with probable sarcopenia in the United States and understand the experiences of residents who participated in the VA program. Design: A mixed-methods experimental design was used for this study. Methods: The quantitative phase included a sample of 27 participants …

Diabetes Device Knowledge And Confidence Among School Nurses: A Mixed Methods Study, Cassandra F. Moffitt

Nursing Theses and Dissertations

Problem: Type 1 diabetes is one of the most common chronic medical conditions in childhood. While manageable, these children may spend half of their day in the school setting and often need assistance from a school nurse to manage their care.

Theory: Bandura’s Social Cognitive Theory (1977) served as the theoretical framework for this study.

Research Questions: The research questions explored knowledge, confidence, and additional predictors of confidence related to diabetes devices.

Design/Methods: An explanatory sequential mixed methods design was used. The Diabetes Device Confidence Scale (DDCS) was used to measure device confidence, while Subscale 10 of the KAT-1 instrument …

“Everybody Has A Soul”: People With Dementia And Nursing Students Co-Creating Life Stories, Beth Mastel-Smith, Michelle Kimzey, Amy Ahlbrand Robinson, Melinda Hermanns

Nursing Faculty Publications and Presentations

Lack of meaning and purpose in life can increase disability, stress, mortality, and the risk of cognitive impairment. Finding meaning and purpose helps people with dementia adjust to the diagnosis and can be accomplished via expressions of identity such as life review, a formal process of systematically reviewing and reflecting on one’s lived life. Digital storytelling involves telling a story using computer technology to record and share an individual’s narrative. The purpose of this study was to understand the perceived benefits of nursing students and people with dementia (the mentors) described after digitally co-creating the mentors’ life story. Allport’s Intergroup …

Examining Well-Being And Healthy Lifestyle Interventions Among Nursing Students Worldwide: A Scoping Review, Christine S. Gipson, Belinda Deal, Michael Skinner

Nursing Faculty Publications and Presentations

Purpose: The purpose of this scoping review was to identify intervention studies related to well-being and healthy lifestyles in nursing students to identify research gaps in the literature for future research. Methods: The review followed the Joanna Briggs Institute (JBI), JBI Manual for Evidence Synthesis, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Five databases were searched to retrieve the articles assessed by this review: APA PsycINFO, CINAHL Complete, PubMed, Scopus, and Web of Science. Inclusion criteria included articles with a sample population of nursing students; addressed the well-being, wellness, health, or healthy lifestyle(s) …

Preceptor Toolkit Effects On New Graduate Nurse Orientation Experience, Ashley Dunnier

MSN Capstone Projects

The role of the nurse preceptor is vital to the successful onboarding of new graduate nurses to the organization. By focusing on preceptor support methods in addition to the established nursing preceptor programs, organizations can improve the nurse preceptor’s confidence and competency levels. The opportunities for improvement, solution recommendation, timeline, and associated costs are provided in this summary.

Many organizations have seen an increase in new graduate nurses leaving their jobs within their first year of hire. The transition period of new graduate nurses is often a period of transition shock while they acclimate into professional practice from academia (Fink …