Nursing Commons^™

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Environmental Exposure Risk Education To Enhance Chronic Kidney Disease Prevention And Screening For Nurse Practitioners, Kelsea J. Carrier

Doctor of Nursing Practice Scholarly Projects

Chronic kidney disease (CKD) affects approximately 36 million adults in the United States, with nearly 90% of individuals unaware of their diagnosis until advanced stages. While diabetes and hypertension remain the primary causes, increasing evidence highlights environmental exposures as significant and underrecognized contributors to CKD onset and progression. Exposures such as heavy metals, per- and polyfluoroalkyl substances (PFAS), air and water pollution, microplastics, and heat exposure have been linked to impaired renal function. Despite this growing body of evidence, environmental health content remains limited in nursing education, resulting in gaps in environmental health literacy (EHL) among nurse practitioners (NPs) and …

Inactive Nurses In New Mexico: Insights Into License Lapse And Inactive Reserve Status, Kiyoko Dell Davis

Doctor of Nursing Practice Scholarly Projects

Nursing shortages have varied over the decades, yet persist at local, national, and global levels. Nurses report leaving the workforce for many reasons, including professional environment factors resulting from these shortages, further exacerbating a shrinking workforce and population growth. Recent efforts include recruitment and education incentives and implementation of the New Mexico Board of Nursing (NMBON) Inactive Reserve Licensure option, which allows retiring nurses to maintain a reduced-scope nursing license with fewer barriers. Despite these efforts, questions remain: why are nurses in New Mexico leaving the profession and would this licensure category have impacted retention? The purpose of this project …

Improving Continuity Of Care: Evaluating Universal Nursing Handoff Sheets, Elizabeth Ifeloluwa Sanya

Doctor of Nursing Practice Scholarly Projects

Effective communication during nursing handoffs is essential for safe, patient-centered care, as breakdowns in communication are a leading cause of adverse patient outcomes. At a large academic level I trauma center, inconsistent nursing handoff practices were identified across progressive care units following the COVID-19 pandemic. This variability contributed to incomplete transfer of patient information and was associated with increased patient safety incidents, including delayed wound care, central line dressing lapses, and medication errors involving high-alert therapies. The purpose of this DNP project was to plan, implement, and evaluate the use of  standardized nursing handoff sheet and its impact on continuity …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Implementation Of A Provider-Focused Multimodal Educational Initiative To Address Polypharmacy And High-Risk Medication Use In A Home And Community Medicare Advantage Setting, Jennifer Butler-Rickard, Kellie Olsen, Eileen Stuart-Shor, Craig Drew

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Community-dwelling adults are at risk for adverse drug events such as falls, hospitalizations, cognitive decline, drug-to-drug interactions, and mortality related to high-risk medication use and polypharmacy, often defined as concurrent use of five or more different medications. Lack of provider knowledge of polypharmacy and high-risk medication use as well as suboptimal communication with primary care providers can lead to gaps in medication management in this vulnerable population.

LOCAL PROBLEM: Patients seen by the Comprehensive Annual Health Assessment Program advanced practice clinicians (APCs) at the project Medicare Advantage insurer organization often experience polypharmacy. Given the lack of provider knowledge of …

Dexmedetomidine And The Prevention Of Emergence Agitation In Military Veterans With Post-Traumatic Stress Disorder, Taylor P. Ranegar

Doctor of Nursing Practice Scholarly Projects

Emergence agitation (EA) is a post-anesthetic complication that occurs when the patient is in a self-limited, nonfluctuating state of excitement while transitioning into a state of consciousness. EA can lead to negative adverse outcomes including, accidental invasive line removal, bleeding, respiratory depression, unintentional extubation, and injury to the staff and the patient. EA is often observed in military veterans who have a medical history of post-traumatic stress disorder (PTSD). For patients with a history of military exposure undergoing elective general anesthesia who also have PTSD, anxiety, and or depression, the incidence of EA was estimated to be around 27%. The …

Evidence-Based Clinical Practice Guidelines For Postspinal Hypotension In Pregnant Women, Grace Mackey

Doctor of Nursing Practice Scholarly Projects

Abstract

Postspinal hypotension (PSH) in pregnant women undergoing a cesarean delivery is a common yet significant problem for the safety of the mother and fetus. The physiological effects of a spinal injection may compromise uteroplacental flow, predisposing the fetus to hypoxia and acidosis. Maternal consequences of prolonged hypotension include unstable hemodynamics, loss of consciousness, and nausea. Historically, healthcare providers have used crystalloid preloads and reactive phenylephrine boluses to correct hypotension. However, recent evidence suggests that these interventions have limited effectiveness. Thorough research led to the development of clinical guidelines that propose providing a 500 mL 6% hydroxyethyl starch preload or …

Evidence-Based Practice Guidelines For The Risk Stratification And Anesthetic Management Of Geriatric Surgery Patients At High Risk For Postoperative Cognitive Dysfunction Undergoing Non-Cardiac Surgery, Patrick M. Garvey

Doctor of Nursing Practice Scholarly Projects

As the global geriatric surgical population rapidly expands, managing complications like postoperative cognitive dysfunction is increasingly essential, given its adverse impacts on recovery, quality of life, and healthcare costs. Postoperative cognitive dysfunction can lead to extended hospital stays, delayed recovery, and significant cognitive decline, particularly among elderly patients exposed to general anesthesia. This quality improvement final scholarly project develops and hypothetically implements evidence-based practice guidelines for anesthetic management in geriatric patients at high risk for postoperative cognitive dysfunction undergoing non-cardiac surgery. This Doctor of Nursing Practice (DNP) project uses preoperative cognitive assessments, such as the Mini-Cog tool, to identify patients …

Practice Considerations For Perioperative Ondansetron Use In Parturients Undergoing Cesarean Sections With Spinal Anesthesia, Mackenzie Glaros

Doctor of Nursing Practice Scholarly Projects

Elective cesarean sections are often performed with spinal anesthesia, a form of neuraxial anesthesia that offers superior pain relief and reduces the risks associated with general anesthesia. However, over 50% of parturients experience side effects from spinal anesthesia, including shivering, hypotension, nausea, and vomiting, which can cause both physiological and psychological issues for the laboring mother and be detrimental to the fetus. Preventing these side effects is vital for improving safety, patient satisfaction, and minimizing complications. While various interventions and medications have been explored to manage these effects, no standardized guidelines exist for their prevention. A review of existing literature …

Evidence-Based Practice Guidelines For Lung Protective Ventilation In Adult Patients Undergoing Abdominal Laparoscopic Surgery, Marco A. Spada

Doctor of Nursing Practice Scholarly Projects

The rise in abdominal laparoscopic surgeries has underscored the need for improved ventilation strategies to reduce postoperative pulmonary complications, such as atelectasis, ventilator-induced lung injury, and pneumonia. These complications can increase hospital stays, healthcare costs, and mortality. This final scholarly project investigates the impact of lung protective ventilation in adult patients undergoing abdominal laparoscopic procedures and proposes guidelines for implementation. Lung protective ventilation strategies, including low tidal volume ventilation, individualized positive end-expiratory pressure, and recruitment maneuvers. Current research shows potential in mitigating postoperative pulmonary complications by improving intraoperative oxygenation and lung compliance. Using the Johns Hopkins Evidence-Based Practice model, this …

Evidence-Based Guidelines For Intraoperative Quantitative Neuromuscular Monitoring, Noah Graham

Doctor of Nursing Practice Scholarly Projects

Nondepolarizing neuromuscular blocking agents are routinely used medications vital to anesthetic care. When administering neuromuscular blocking agents, monitoring neuromuscular blockade depth and degree of recovery is a standard of nurse anesthesia practice to facilitate adequate recovery. If not adequately reversed, postoperative residual neuromuscular blockade can cause severe complications. Traditional qualitative neuromuscular monitoring practices largely contribute to the continuing high incidence of postoperative residual neuromuscular blockade, as supported by research that qualitative monitoring methods are insensitive to the depth of blockade and clinical situations, providing unreliable physiologic information. As recommended in practice guidelines by the American Society of Anesthesiologists, quantitative neuromuscular …

Implementation Of Evidenced Based Practice Guidelines For Reducing Emergence Delirium In Elderly Patients Undergoing A Total Hip Replacement, Luke D. Kleinfelder

Doctor of Nursing Practice Scholarly Projects

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the …

Proposed Evidence-Based Practice Guidelines For Using Esmolol To Blunt The Sympathetic Stress Response To Laryngoscopy And Intubation, Maya Kurdi

Doctor of Nursing Practice Scholarly Projects

Direct laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review …

Enhancing The Diversity And Number Of Certified Registered Nurse Anesthetists: A Proposed Pipeline Program For Underrepresented Students, Alexis Lamoreaux

Doctor of Nursing Practice Scholarly Projects

The underrepresentation of minority groups in the Certified Registered Nurse Anesthetist (CRNA) profession impacts healthcare providers’ diversity and cultural competence. This Final Scholarly Project (FSP) proposes a pipeline program to increase diversity within the CRNA field by providing academic support, mentorship, and clinical exposure to students from underrepresented backgrounds. Given the shortage of anesthesia providers, especially in underserved areas, improving access to the CRNA profession for minority students is critical for enhancing patient outcomes. This FSP suggests establishing mentorship and skill development concepts through a 12-month structured program that targets minorities, first-generation college students, or those from rural backgrounds. The …

Evidenced-Based Practice Guideline Development: The Addition Of Adjunctive Dexmedetomidine In Brachial Plexus Blocks For Upper Arthroscopic Surgery, Mylene Louail

Doctor of Nursing Practice Scholarly Projects

Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist increasingly studied as an adjunct in brachial plexus blocks (BPBs) to enhance postoperative pain management. This project examines the efficacy of DEX as an adjunct in BPBs for upper extremity arthroscopic surgeries, focusing on its ability to extend analgesia duration, reduce opioid use, and enhance patient satisfaction. With analgesic and sedative properties, DEX can improve postoperative pain management with minimal side effects, providing shortened hospital stays, decreased costs, and better patient outcomes. Using the Iowa Model for evidence-based practice, baseline data on postoperative pain, analgesia duration, and opioid use will be collected from …

Exploring Policy Change To Support Early Diagnosis Of Congenital Heart Defects (Chd) In New Mexico, Kelsey Carson Leibenhaut

Doctor of Nursing Practice Scholarly Projects

Congenital heart disease (CHD) is not a new or rare problem; it has likely always been a leading cause of childhood morbidity and mortality and clocks in today as the most frequently occurring birth defect, affecting an estimated 1 in 100 newborns (CDC, 2025). Prior to the middle of the 20th century, there was little to be done about CHD, as no treatments existed. Everything changed with the advancement of options for surgical repair of CHDs, significantly prolonging lifespans and improving quality of life for affected individuals. Despite these incredible advancements, babies are born with CHD every day, leading to …

A Planetary Health Approach To Address Food Insecurities In New Mexico, Mariah Kennell

Doctor of Nursing Practice Scholarly Projects

Food insecurity remains a persistent public health concern throughout New Mexico, impacting both rural and urban populations and contributing to significant health disparities. Limited access to affordable, locally sourced fresh foods exacerbates chronic disease burden and undermines community health. The purpose of this Doctor of Nursing Practice project was to conduct a comprehensive policy analysis to identify feasible state-level strategies to improve food access through strengthening local food systems. Using the Centers for Disease Control and Prevention POLARIS policy analysis framework, a structured evaluation of existing and potential state and community-level policies was conducted. The analysis incorporated stakeholder interviews with …

Ambient Air Pollution In New Mexico: Nurse Practitioner Awareness, Mckenzie Hemmes, Grayson Kemp

Doctor of Nursing Practice Scholarly Projects

Ambient air pollution is a significant public health concern in New Mexico and contributes to respiratory disease, cardiovascular illness, and adverse pregnancy outcomes (Dominski et al., 2021; Di et al., 2022). Despite well-established evidence linking environmental exposures to health outcomes, environmental exposure screening is not routinely incorporated into clinical practice. The purpose of this Doctor of Nursing Practice (DNP) project was to improve environmental health literacy (EHL) among advanced practice registered nurses (APRNs) in New Mexico and to increase their intention to integrate ambient air pollution exposure screening and mitigation counseling into routine clinical practice. A virtual educational intervention guided …

Hypothermia Prevention In Major Trauma Patients, Alaina Hostetler

Doctor of Nursing Practice Scholarly Projects

Traumatic injuries present a significant health challenge for providers, often resulting in hypothermia, coagulopathy, and acidosis, referred to as the trauma triad of death. Hypothermia significantly impacts trauma patients' outcomes and exacerbates morbidity and mortality rates, particularly in trauma cases with high injury severity scores who require immediate surgical intervention. Despite the detrimental effects of hypothermia, evidence-based approaches to treating hypothermia in this population are lacking. Traditional warming methods heavily rely on provider preference and can lead to inconsistent care. Rapid, reliable, and effective resuscitation interventions are essential in the immediate care of major trauma patients. The proposed project will …

An Evidence-Based Educational Intervention To Enhance Nurses' Knowledge Of Metabolic Syndrome In Residential Care Facilities, Marie Tanyi

Doctor of Nursing Practice Scholarly Projects

The project addresses a critical gap in nursing education by implementing a structured, evidencebased educational intervention led by an Advanced Practice Registered Nurse (APRN) to improve nurses’ knowledge of metabolic syndrome in residential care facilities. The purpose was to determine whether this intervention could significantly enhance nurses’ understanding and management of metabolic syndrome, a complex cluster of disorders present in adult populations. Nine nurses participated in targeted educational sessions focusing on definition, diagnosis, complications, and evidence-based prevention and management strategies. Each participant completed the Metabolic Syndrome Knowledge Scale (MSKS) questionnaire before and after the intervention to assess changes in knowledge. …

Combating Obesity: Creating A Comprehensive Wellness Plan For Uninsured & Low-Income Populations, Kayla C. Berrios

Doctor of Nursing Practice Scholarly Projects

Aim: The aim of this project was to research the specific barriers encountered by obese patients that are low-income and uninsured. The goal of this data collection was to inform the stakeholders involved in creating a comprehensive wellness plan for obese patients.

Background: The staff at Good Neighbor Clinic have struggled to support their support their obese patients with weight reduction. Many of the ailments that patients seek care for correlate to their obesity. Health promotion in this community clinic needs a more comprehensive program to support patients during their weight loss experience, providing support and resources to allow for …

Exploring Barriers To Patient Care In A South Carolina Free Clinic, Jonathan G. Green

Doctor of Nursing Practice Scholarly Projects

Access to healthcare remains a persistent challenge for medically underserved populations who rely on free medical clinics for primary care services, particularly in non-Medicaid expansion states such as South Carolina. Free clinics serve as critical safety-net providers, yet patients frequently encounter barriers that limit access, continuity, and quality of care. The purpose of this Doctor of Nursing Practice (DNP) project was to explore and identify the structural, social, and interprofessional barriers to patient care within a South Carolina free medical clinic to inform targeted, evidence-based interventions. A mixed-methods needs assessment design was used, combining a retrospective chart review of forty …

Empowering Mothers: A Digital Intervention For Perinatal Mental Wellness, Morgan Edmunds

Doctor of Nursing Practice Scholarly Projects

Aim: The aim of this project was to develop a smartphone application prototype for peripartum mental health. The goal of this application was to enhance access to education and quality mental health care.

Background: Currently, in the United States, peripartum mental health conditions are the leading cause of maternal morbidity and mortality (The Joint Commission, 2023). There is a gap in education, screening, and treatment for peripartum mental health due to distrust and a lack of resources, including a lack of mental health providers (Dossette et al., 2024; Feldman & Perret, 2023). Therefore, there is a significant number of women …

Community Health Workers: Key To Decreasing Food Insecurity In Pregnant Individuals, Linda Waggener Dnp

Doctor of Nursing Practice Scholarly Projects

Objectives: Food insecurity (FI) in pregnant individuals (PI)s is a global threat to birthing individuals and fetuses with potential immediate and intergenerational impacts on family and community. Community Health Workers (CHWs) facilitate support including food resources for FIPIs. The Family Fresh Rx (FFRx) program, within Food as Medicine (FaM) model provides fresh fruits and vegetables, optimize nutrition, and mitigates threats to health. This Doctor of Nursing Practice (DNP) Quality Improvement (QI) project’s two objectives were CHWs’ FFRx program and referral process satisfaction evaluation through a pre, post, and four-week post refresher presentation (RP) modified System Usability Scale (mSUS) …

Speak Now With The Courage To Confront: An Educational Intervention To Address Bullying, Dominique Desiree Gomez

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Nurse-to-nurse bullying is a critical issue within the nursing profession, impacting close to half of all nurses. This phenomenon, articulated by the phrase "nurses eat their young," detrimentally influences employee retention, job satisfaction, morale, and ultimately, patient care. Furthermore, nurse-to-nurse bullying significantly affects the well-being of nursing professionals, particularly targeting novice nurses. This targeting raises substantial concerns regarding their retention, as many consider leaving the profession within their initial years of practice due to experiences of bullying. The educational intervention project titled “Speak Now with the Courage to Confront” is designed to mitigate bullying among novice nurses through …

A Tailored Approach To Prep Screening For Awareness And Readiness, Keionda Crumblin Caldwell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Human immunodeficiency virus (HIV) is a serious health concern in the United States (U.S). Pre-Exposure Prophylaxis (PrEP) is a vital intervention in the prevention of HIV, yet its uptake and adherence are suboptimal due to barriers in identifying individuals who are most at risk and would benefit most from this preventive measure.

Purpose: This evidence-based project aimed to evaluate whether implementing a PrEP readiness tool at a walk-in clinic would identify at-risk adults and adolescents and lead to an increase in referrals for PrEP initiation.

Method: A PrEP Questionnaire from the Department of Wisconsin Public Health was given …

Improving Depression Screening Of Correctional Institution Inmates, Thelma Chidimma Ozigbu

Doctor of Nursing Practice Scholarly Projects

Problem: Depression significantly impacted on the quality of life of incarcerated individuals within correctional facilities, where rates of the disorder far exceed those in the broader community, increasing self-harm and suicide risks.

Purpose: This quality improvement project aimed to improve early identification of depressive symptoms and facilitate timely mental health referrals by implementing the Patient Health Questionnaire (PHQ-9) as a screening tool upon admission.

Method: Using the Iowa Model of Evidence-Based Practice (Iowa Model) as a guiding framework, this project involved training nursing staff to administer the PHQ-9 during initial health assessments. PHQ-9 is a nine-item questionnaire that assesses depression …

Improving Completion Of Diabetes Management Measures In Primary Care, Ashley Tyner Divers

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adults with type 2 diabetes are at a risk of multiple comorbidities that can be prevented with proper screenings performed as recommended by the American Diabetes Association.

Purpose: Determine if using a checklist on the patient router will improve completion of urine microalbumin, diabetic eye exam, and diabetic foot exam.

Methods: The MA/LPN asked the patient about the last eye exam performed and requested a record from the previous provider if performed within the last year. If the microalbumin was not current, the MA/LPN obtained a urine specimen and placed the order into EPIC. If a diabetic foot …

Enhancing Glycemic Control, Patient Knowledge, And Self-Care Through Structured Diabetes Education, Amanda Suzanne Clark

Doctor of Nursing Practice Scholarly Projects

The rising prevalence of diabetes, particularly in South Carolina, revealed a significant gap in structured diabetes education programs, contributing to poor glycemic control and elevated A1C levels. In response, this project aimed to assess the integration of a comprehensive diabetes education program into standard care, potentially reducing A1C levels while improving patient knowledge and self-care behaviors in adults with diabetes over four months. The study used a pretest-posttest design to evaluate the effectiveness of this innovative intervention by comparing participants' outcomes before and after the program. Purpose: To determine if a comprehensive diabetes education program could reduce Hemoglobin A1C levels …