Nursing Commons^™

Facilitating Timely Hospice Referrals Using A Screening Toolkit In A Rural Hospital: A Quality Improvement Initiative, Jessica Muse

Doctoral Projects

End of life care is often a difficult time for patients, families, and caregivers. Hospice is a valuable resource for individuals who are considered terminally ill and have a life expectancy of six months or less. Many patients who are near the end present to acute care settings for treatment needs. While there are several clinical indicators that may suggest hospice care is the best plan of care for a patient, identifying hospice appropriate patients can be difficult in an acute care setting and there are currently no numerical assessment tools available in the literature that provides a quick reference …

Evaluation Of Spontaneous Awakening And Breathing Trials Prior To Mechanical Ventilator Extubation To Enhance Intensive Care Unit Liberation, Shelby Taranto

Doctoral Projects

Spontaneous Awakening and Breathing Trials (SAT/SBT) might be central to early extubation by decreasing total ventilator time and reducing the intensive care unit (ICU) length of stay (LOS). Unfortunately, these trials often have not been conducted consistently in the ICU. The purpose of this research was to evaluate the frequency of SAT/SBT performed prior to mechanical ventilator extubation on total ventilator time in hours and LOS. Quality improvement aims were: (1) to ascertain if an extubation readiness tool could be easily followed and documented, and (2) to evaluate if an extubation readiness tool would add value in clinical practice. A …

Exploring Clinical Ladder Program Participation Among Operating Room Nurses, Camille Sistoso-Lorenzana

Doctoral Projects

Continuous professional development among nurses is vital, yet not all nurses embark on this career journey. The Clinical Ladder Program (CLP) is a retention strategy among various health institutions to retain talent and improve nurses' satisfaction, but this plan is unappealing or indifferent to some nurses. While the CLP is a motivation tool for nurses to focus on clinical expertise in bedside care (Riley et al., 2009), and resources are available to increase a nurse's chances of successfully advancing the ladder, participation in and perspectives on the CLP remain unknown, especially among operating room nurses. This project is guided by …

Improving Graft-Versus-Host Disease Documentation Through Provider Education On An Epic-Based Gvhd Documentation Flowsheet, Emily Shearon

Doctoral Projects

Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Accurate documentation of GvHD severity and management is essential for clinical decision-making, interdisciplinary communication, and regulatory reporting to organizations such as the Foundation for the Accreditation of Cellular Therapy (FACT) and the Center for International Blood and Marrow Transplant Research (CIBMTR). Despite the availability of structured documentation tools within the electronic health record (EHR), their utilization is often inconsistent. The purpose of this quality improvement project was to evaluate whether a targeted provider-focused intervention could improve completion rates of a standardized GvHD documentation flowsheet …

Improving Hyaluronic Acid Filler Safety Through A Structured, Evidence-Based Training Program: A Dnp Educational Initiative, Carlos Sandoval Madrigal

Doctoral Projects

The rapid growth of aesthetic medicine, particularly the use of hyaluronic acid (HA) dermal fillers, has outpaced the development of standardized educational pathways for Health Care Providers (HCPs), contributing to a wide variability in clinical practice and increased risk of adverse events. This Doctor of Nursing Practice (DNP) project aimed to evaluate the effectiveness of a structured, evidence-based educational intervention designed to improve provider knowledge and confidence in the prevention and management of HA filler complications. The intervention was developed using the 10-Point Plan framework and evaluated using the Kirkpatrick Model Levels 1 (Reaction) and 2 (Learning). A quasi-experimental, one-group …

Headset To Reset: Virtual Reality Therapy In Postoperative Heart And Lung Transplant Patients, Michaela Sanchez

Doctoral Projects

Postoperative heart, lung, and heart-lung transplant recipients are at increased risk for anxiety and depression, both of which have been associated with increased risk of complications and higher mortality rates. The purpose of this quality improvement project was to implement a mindfulness-based virtual reality (VR) therapy intervention for postoperative transplant recipients at a Northern California academic medical center and to evaluate its feasibility, tolerability, and acceptability during the index hospitalization. Over a 15-week period, five participants completed a total of eight VR sessions. Participants selected from immersive mindfulness-based environments, including guided meditation and other relaxation experiences. Anxiety and depression were …

Increasing Near-Miss Reporting: An Evidence-Based Approach, Rosalud H. Sanchez-Lozada

Doctoral Projects

Near-miss events, defined as errors intercepted before reaching the patient, offer valuable opportunities for learning and prevention, particularly in high-acuity intensive care units (ICUs). Despite the availability of electronic reporting systems and national emphasis on patient safety, near-miss reporting remains inconsistent in many critical care settings. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the impact of a structured educational intervention on near-miss reporting within a cardiovascular intensive care unit (CVICU) at a large academic medical center. A single-group pre–post design was used to examine changes in reporting trends following a three-week intervention that included staff education, leadership …

Implementation Of A Nurse-Driven Early Mobility Algorithm In Critically Ill Adults, Andrea Saito

Doctoral Projects

Background: Early mobilization of critically ill patients is recommended in clinical practice guidelines to mitigate ICU-acquired weakness, delirium, and improve recovery. This intervention is inconsistently implemented in many health systems due to a variety of barriers. One frequent barrier is uncertainty regarding whether patients meet safety criteria for mobilization. Purpose: The purpose of this quality improvement project was to implement a nurse-driven early-mobility algorithm with a clinical safety screen in an adult medical-surgical ICU and evaluate its impact on patient mobility scores, delirium rates, and ICU length of stay.​ Methods: The intervention was evaluated using a quasi-experimental before and after …

Improving Health Literacy And Self-Management In Adults With Heart Failure: A Nurse-Led Virtual Intervention In Outpatient Support Groups, Vivian Efosa Osunde

Doctoral Projects

Heart failure is a leading cause of morbidity and hospital readmissions, with limited health literacy contributing to poor self‑management and adherence challenges. The purpose of this Doctor of Nursing Practice project was to evaluate the feasibility and preliminary outcomes of a nurse‑led, virtual education-intervention designed to improve health literacy, self‑care behaviors, and medication adherence among adults with chronic heart failure who participate in an outpatient support group. A quality improvement design was used. Convenience sampling yielded nine adult participants with a documented diagnosis of chronic heart failure who attended at least one virtual support group session. The intervention consisted of …

Weighted Blankets: Implementation Of A Quality Improvement Pilot Project In The Neurosciences Intensive Care Unit, Anita Musafar

Doctoral Projects

The weighted blanket quality improvement pilot project was implemented at Stanford Healthcare (SHC) to address the limited number of nonpharmacological interventions available for agitation management in the critical care setting. Patients within the Neurosciences ICU (NSICU) at SHC are clinically complex and uniquely vulnerable to experiencing agitation. The objectives of this initiative were to understand nurses' perceptions surrounding weighted blanket use in the critical care setting and assess whether there was a decrease in Richmond Agitation-Sedation Scale (RASS) scores with this intervention. From September 2025 to December 2025, the nurses within the NSICU implemented the use of weighted blankets for …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

Exploring Virtual Nurse Perceptions Of Caring Through Acute Care Teleconferencing, Monika Lu

Doctoral Projects

Virtual nursing programs have emerged as innovative solutions to address hospital operational challenges and workforce shortages. However, concerns remain about the potential for decreased human connection in telehealth environments. Limited evidence exists regarding virtual nurses’ perceptions of caring behaviors and their ability to develop therapeutic relationships through teleconferencing technology. Purpose: This exploratory study examined virtual nurses’ (ViRNs) perceptions of caring and identified strategies for fostering patient relationships in telehealth settings. Methods: A mixed-methods custom survey was distributed to 25 eligible ViRNs at Stanford Health Care, with 19 respondents (76% response rate). ViRN caring perceptions were measured quantitatively using a 5-point …

Two-Year Retrospective Evaluation Of Frailty To Optimize Postoperative Spinal Fusion Outcomes In Adults Aged 65 And Older, Sheri Loo

Doctoral Projects

Many older adults over the age of 65 have both spinal stenosis requiring spinal fusion surgery and frailty. As life expectancy has increased, many older individuals will undergo elective spinal fusion surgery to decrease their chronic pain in pursuit of improved quality of life. There is currently an underutilization of frailty screening for risk stratification of postoperative complications. A retrospective chart review over a two-year period from July 2023 to June 2025of adults aged 65 and older who underwent posterior spinal fusion surgery, involving 126 participants, was completed. We assessed the correlation between frailty and postoperative outcomes, discharge disposition, and …

Evaluating The Effectiveness Of A Nurse-Initiated Post-Discharge Phone Call In The Prevention Of Hospital Readmissions For Type 2 Diabetes Mellitus, Sierra Kane

Doctoral Projects

Background: Hospital readmissions are widely recognized as a key metric of quality care, reinforced by Centers for Medicare and Medicaid (CMS) incentive programs (U.S. Centers for Medicare & Medicaid Services, 2025). Despite these incentives, achieving a meaningful reduction of readmissions remains a challenge, especially for chronic conditions such as type 2 diabetes mellitus (T2DM), where readmission is fueled by gaps in medication management, patient confidence in symptom management, and access to timely follow-up care. Purpose: Evaluate the impact of a nurse-initiated post-discharge telephone outreach, conducted at 48 hours, by the outpatient endocrinology clinic, on 7- and 30-day readmission rates for …

Implementing A Buddy System To Enhance Float Pool Nurses’ Experience And Unit Integration, Nancy Kairia

Doctoral Projects

Float pool nurses play a vital role in maintaining hospital operations; however, they often experience role ambiguity, inconsistent integration, and reduced psychosocial empowerment, which may negatively influence engagement and retention. This Doctor of Nursing Practice project implemented and evaluated a structured buddy program designed to enhance psychological empowerment among float pool nurses in a large academic medical center. Guided by Gretchen Spreitzer’s Psychological Empowerment Framework, the project examined changes across four domains: meaning, competence, self-determination, and impact. A pre-post design was used to assess outcomes before and after implementation. Five nurses completed the preintervention survey; of these, four completed the …

A Peer Support Model For Nursing Faculty: Stay And Thrive, Ngoc N. Hua

Doctoral Projects

Projections show a major nursing shortage over the next decade. Although many state and local efforts aim to expand the workforce, there is often less visibility into the nurse educators responsible for the healthcare pipeline. Moving clinicians into teaching roles presents unique challenges. Specifically, clinical skills do not easily transfer to classroom management,​ which can be jarring for new faculty. This "reality shock" frequently results in faculty turnover​ due to a lack of support during this important transition.​ This project looked at nursing faculty perceptions of a structured peer mentorship​ program at a Northern California community college. The intervention was …

A Quality Improvement Initiative Evaluating Factors Influencing Patient Experience With Virtual Reality During Awake​ Interventional Radiology Procedures, Quynh Dao-Payne

Doctoral Projects

Procedural anxiety and pain are common among pediatric patients undergoing awake interventional radiology (IR) procedures and may negatively affect patient comfort, cooperation, and overall patient experience. Virtual reality (VR) has emerged as a promising nonpharmacologic intervention to reduce anxiety and improve patient-centered outcomes. The purpose of this quality improvement project was to evaluate patient-reported experiences and perceived outcomes associated with VR use during awake pediatric IR procedures at Children’s Hospital Los Angeles.​ A qualitative descriptive quality improvement design was utilized. Twenty pediatric​ patients ages 10–21 years undergoing awake IR procedures with VR as part of standard clinical​ care completed structured …

Patient Reported Outcome Measure Use In Heart Transplant Care, Nichole Côté

Doctoral Projects

Despite growing evidence supporting Patient-Reported Outcome Measures (PROMs) in chronic disease management, no consistent application exists within the international heart transplant community. This Doctor of Nursing Practice project implemented the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) as a PROM within the a large volume heart transplant clinic, evaluating workflow feasibility, the association between Overall Summary Scores (OSS) and visit length, and clinician perceptions of PROM use. The KCCQ-12 was administered via a mobile health application with automated distribution. Workflow integration was assessed by calculating the percentage of scheduled visits with completed PROM documentation. Visit length was measured using electronic medical record …

Building Nurse Managers’ Knowledge And Confidence To Lead Clinical Ladder Success: A Theoretically Informed Educational Framework, Michelle Joann Chlebinski

Doctoral Projects

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post …

A Quality Improvement Project To Strengthen Hospice Spiritual Care Delivery, Patricia Boudreau

Doctoral Projects

Spiritual care is an essential component of holistic end-of-life nursing, yet it is inconsistently provided in home hospice settings. For this Doctor of Nursing Practice (DNP) quality improvement project, we developed and implemented the Compassionate Spiritual Comfort Integration Program (CSCI), a brief, theory-based educational intervention to strengthen hospice nurses' spiritual care practices. Grounded in Kolcaba's Comfort Theory and Jinpa's Compassion Framework, the CSCI was delivered as a prerecorded webinar. A quasi-experimental single–group pretest–posttest design was used to evaluate changes in spiritual care behaviors, measured with the 17-item Nurse Spiritual Care Therapeutics Scale (NSCTS) and a single-item confidence measure. Twenty-two nurses …

Nurturing The Nurturers: Caritas Literacy Wellness Program, Pakeeza Ali

Doctoral Projects

Burnout, compassion fatigue, and emotional exhaustion remain significant concerns among oncology staff in high-demand ambulatory settings. This quality improvement project implemented the Caritas Literacy and Resilience Training Program (CLARITY), a microlearning-based intervention grounded in Watson’s Caring Science Theory, to support self-caring behaviors and emotional resilience among oncology staff in an ambulatory cancer center. A quasi-experimental, mixed-methods design was used, incorporating pre- and post-intervention survey data and qualitative focus group feedback. Quantitative outcomes were assessed using the Watson Caritas Self-Rating Score (WCSR) and post-intervention ratings of perceived effectiveness of the microlearning format. Wilcoxon signed-rank tests were used to examine pre-post change …

Empowering Voices: A Qualitative Exploration Of Shared Governance Among Healthcare Workers In Clinical Practice, Ayman Alhazaymeh

Doctoral Projects

This project intervention evaluated the implementation of shared governance (SG), focused on partnership council activities and staff perception. The shared governance framework has several pillars, such as Partnership, Equity, Ownership, Accountability, and Shared Decision-Making, to support the design of healthcare organizations for excellent patient care (Porter-O’Grady, 2009). To effectively evaluate the SG implementation and ensure the ongoing success of the SG process, the author investigated staff contributions and actively sought feedback. He provided templates and guidelines for the partnership council and collected staff feedback. Murray et al. (2016) stated that the partnership council reported empowering staff to implement innovative solutions …

Evaluating The Impact Of A Meaningful Recognition Bundle On The Health Of The Emergency Department Work Environment And Emergency Nurse Burnout, Sean Truesdell

Doctoral Projects

Background: The health of the work environment significantly influences emergency nurse practice. The Emergency Nurses Association and the American Association of Critical-Care Nurses have called for the establishment of a healthy work environment (HWE) to improve outcomes, reduce burnout and turnover, and increase job satisfaction. Meaningful recognition is consistently among the lowest-performing HWE standards. Purpose: To implement a bundle of meaningful recognition elements in the Emergency Department (ED) and evaluate the outcomes. Methods: A quality improvement project was conducted in the ED of a non-profit community health system in Northern California. The Healthy Work Environment Assessment Tool (HWEAT) and Oldenburg …

Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization In An Adaptable Acuity Unit At An Academic Health Center, Moses Albaniel

Doctoral Projects

Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic …

Ai Literacy In The Nursing Informatics Community: A Needs Assessment, Jerri Westphal

Doctoral Projects

Nursing informatics professionals are required to lead AI integration in healthcare, yet their baseline AI literacy, competency, and educational needs have not been formally assessed. This descriptive needs assessment examined AI literacy, competency, adoption readiness, and engagement among nursing informatics professionals, concurrently identifying educational priorities and preferred learning modalities. A cross-sectional survey was administered to members of the American Nursing Informatics Association (ANIA) and the broader community (N = 194). The N.U.R.S.E.S. framework (Hoelscher & Pugh, 2025) informed the survey instrument's domain structure. Five composite indices were developed: AI Familiarity, Knowledge, Attitude, Competency, and Use. Descriptive statistics and Pearson correlation …

A Pilot Project On Improving Icu Nurses’ Confidence In Early Defibrillation, Adetutu Obadina

Doctoral Projects

Early recognition of shockable cardiac rhythms and timely defibrillation are critical components of effective resuscitation during in-hospital cardiac arrest. Despite established guidelines from the American Heart Association (AHA), nurses may experience uncertainty or reduced confidence when identifying shockable rhythms and delivering timely defibrillation during cardiac arrest events. The purpose of this project was to examine whether a structured educational intervention incorporating simulation-based training could improve intensive care unit (ICU) nurses’ confidence and knowledge in recognizing shockable rhythms and performing timely defibrillation. A pre-and post-intervention design was implemented among ICU nurses at a large academic medical center between September and October …

Pediatric Anesthesia And Virtual Reality: Managing Perioperative Pain And Anxiety– A Scoping Review, Moneer Sharafi, Mason Pham, Alec Wiscombe

Doctoral Projects

Pediatric surgery is common, but it often causes considerable anxiety and pain. A staggering percentage of children experience preoperative anxiety, which can heighten pain, delay recovery, and contribute to complications such as emergence delirium and longer-term behavioral issues (Fortier & Kain, 2015). Virtual reality (VR), which immerses users in computer-generated environments, has been proposed as a distraction technique to reduce these challenges. This Doctor of Nursing Practice (DNP) project conducted a scoping review to examine the effectiveness of VR in reducing perioperative pain and anxiety in pediatric patients. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses …

A Program Evaluation Of Universal Screening For Depression In The Primary Care Setting, Samantha W. Burns

Doctoral Projects

Depression is a chronic condition affecting millions of Americans annually and is often associated with poor clinical outcomes, multiple co-morbidities, a negative economic impact, and an increased mortality rate. Many primary care settings have implemented universal depression screening programs following the recommendations of governing healthcare entities such as the United States Preventive Services Task Force (USPSTF) and Center for Medicare and Medicaid Services (CMS). Due to positive benefit, universal depression screenings have now been included as a quality measure in the Merit-based Incentive Payment System (MIPS) to increase organizational reimbursement. The Patient Health Questionnaire-9 (PHQ-9) is a widely used screening …

The Role Of Multimodal Analgesia In Spine Surgery: A Scoping Review Of Its Impact On Opioid Consumption And Surgical Outcomes, Madison Milam, Kristie Mullins, Tatum Trent

Doctoral Projects

The ongoing opioid epidemic emphasizes the need for alternative perioperative pain management strategies, particularly in high-risk surgical populations such as spine surgery patients. This project proposes a scoping review to examine the role of multimodal analgesia (MMA) in reducing opioid consumption and improving surgical outcomes in adult neurosurgical patients. MMA analgesia involves the use of multiple pharmacologic and nonpharmacologic approaches that target different pain pathways in the human body, aiming to enhance patient comfort while minimizing reliance on opioids.

This review synthesizes current literature on MMA strategies used in spinal surgeries, evaluates reported outcomes such as pain control, postoperative complications, …

Anesthesia Informed Consent: An Objective Structured Clincial Examination, Joshua Powell

Doctoral Projects

Informed consent is a fundamental component of anesthesia practice and is recognized as professional Standard IV by the American Association of Nurse Anesthesiology (AANA). Despite its importance, anesthesia providers often face challenges in effectively obtaining consent from patients. Within The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP), a need was identified to strengthen student competency in conducting anesthesia informed-consent discussions. This project developed and implemented an Objective Structured Clinical Examination (OSCE) as a standardized, evidence-based approach to teach and assess informed-consent skills in alignment with the American Association of Nurse Anesthesiology (AANA, 2019) standards. The intervention was designed …