Nursing Commons^™

Knowledge, Attitudes, And Practices Of Healthcare Workers Regarding Early Childhood Development: A Mixed-Methods Study At Secondary Care Maternal And Child Care Hospitals In Karachi, Pakistan, Sarosh Hirani, Shelina Bhamani, Hajra Malik, Samira Lakhani, Adeeb Kanji, Khairunnissa Hooda

Journal of Asian Midwives (JAM)

Introduction: Early childhood development (ECD) is a critical period that lays the foundation for a child's future growth and overall well-being. Healthcare settings play a significant role in shaping these developmental outcomes. However, there is limited research evaluating healthcare professionals' knowledge, attitude, and practices on ECD in Pakistan. This study aims to assess the awareness, attitudes, and practices of healthcare providers working in secondary hospitals regarding ECD.
Methods: A sequential explanatory mixed-methods approach was used. The study initially recruited healthcare workers, including physicians, nurses, trainees, and midwives from two secondary care hospitals. Participants completed the Caregiver Knowledge of Child Development …

Peer Mentorship Of Midwifery Faculty In Bangladesh: A Process Evaluation, Pronita Raha, Joy Kemp, Farida Begum, Rowsan Ara, Vibhavendra S. Raghuvanshi, Nabila Purno, Daniel Novak, Hoque Emdadul Hoque

Journal of Asian Midwives (JAM)

Development of midwifery faculty is key to strengthening quality midwifery education. This article presents a process evaluation of a peer mentorship programme, implemented between 2021 and 2023, for around 370 midwifery faculty in Bangladesh, including 40 newly deployed faculty. 20 peer mentors, prepared by international midwifery faculty, conducted quarterly visits to public midwifery education institutions (MEIs) to provide mentorship support to midwifery faculty and to monitor the quality of midwifery education. A digital community of practice was also created. Data were collected with a checklist based on the World Health Organization (WHO) midwifery educator competencies and entered into a digital …

Effects Of World Health Organization’S Educational Interventions On Clinical Competency Of Community Midwives In Managing Postpartum Hemorrhage, Afifah Abu-Ul-Hayat, Sarfaraz Masih, Madiha Mukhtar

Journal of Asian Midwives (JAM)

Background: Postpartum hemorrhage (PPH) is considered to be one of the most important causes of maternal mortality especially in low resource countries such as Pakistan. Community midwives (CMWs) have a very important role in the provision of midwifery care and their clinical competency are very crucial for the handling of PPH. This study evaluates the effect of a World Health Organization (WHO)-based educational intervention on the clinical competency of CMWs in Hazara Town, Quetta, in managing PPH.
Objective: This study aimed to determine the effectiveness of a WHO based educational intervention on improving the clinical competency of CMWs in managing …

Perceptions Of Risky Sexual Behavior Among Female Students: A Qualitative Analysis Of Contributing Factors, Consequences, And Prevention Strategies, Leila Bozorgian, Fatemeh Ansari, Fatemeh Janipour, Solmaz Mohammadi

Journal of Asian Midwives (JAM)

Background: Risky behaviors among young people are a significant concern for societies worldwide, leading to physical and psychosocial damage. Despite efforts to raise awareness about such risky behaviors over the past two decades, their prevalence continues to rise. Therefore, this study aimed to explain perceptions of the prevalence of risky sexual behaviors among female students.
Methods: A qualitative descriptive study using a conventional content analysis approach was conducted from August to mid-September 2024 in Yasoj, Iran. The study participants were selected using purposive sampling. The data were collected using semi-structured interviews conducted with 18 female students. Data collection …

Development And Validation Of Risk Assessment Tools For Hypertensive Disorder In Pregnancy, Vanitha K, Hepsibah Sharmil, Vijayalakshmi Kandasamy

Journal of Asian Midwives (JAM)

Aims and Background: Hypertensive disorders in pregnancy (HDP) have significant impact on both mothers and newborns leading to complications such as Eclampsia, Preterm delivery, Renal and cardiac problems, Intra Uterine Growth Retardation (IUGR) and Intra Uterine Fetal Death (IUFD). Early screening of hypertensive disorders in pregnancy is essential in the prevention and management of these complications. This research study aims to develop and validate a risk assessment tool for hypertensive disorders in pregnancy.
Materials and methods: A mixed-method research was carried out from December 2023 to December 2024 consisting of two steps. Step one involved the development of …

Implementing A Team-Based Approach To Reduce Blood Culture Contamination Rates In The Emergency Department: A Quality Improvement Initiative, Melissa Lockhart

Doctor of Nursing Practice Projects

Background: Blood culture contaminations (BCC) present significant risks to patients, including adverse drug reactions and the exacerbation of antibiotic resistance. BCC can also result in millions of dollars in financial burdens for hospitals due to the need for follow-up testing, treatment complications, and antibiotic stewardship efforts. At this facility, the contamination rate in the emergency department (ED) consistently exceeds the national benchmark of 3%. Contributing factors include high patient turnover and increased nursing workloads, which can lead to shortcuts in essential practices such as hand hygiene and skin disinfection before collection.

Purpose: This project aimed to evaluate whether implementing a …

National Patient Safety Goals: Reducing Health Care Disparities In Adult Patients With Alcohol Misuse, Jolie M. Carpenter

Doctor of Nursing Practice Projects

Background: An estimated 76 million people worldwide suffer from alcohol use disorder, accounting for almost two million deaths annually. The Joint Commission has made it a requirement to screen all patients admitted to an inpatient facility for health-related social needs, including alcohol use. By doing so, outpatient resources can be provided appropriately.

Purpose: The facility of interest does not currently have a discharge follow-up protocol. The purpose of this project was to implement an evidence-based protocol to follow-up one week after discharge to determine if patients accessed the community resources provided for alcohol use disorder and to determine whether the …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Implementing A Screening Tool To Increase Palliative Care Referrals For Patients With Metastatic Cancer, Rebecca N. Hegwood

Doctor of Nursing Practice Projects

Background: Palliative care (PC), when prescribed early for patients with metastatic cancer, has proven beneficial to the oncology patient and family by improving quality of life, decreasing stressors, and preventing premature discontinuation of therapy.

Purpose: This Doctor of Nursing quality improvement project aimed to determine if implementing a screening tool for patients newly diagnosed with metastatic cancer would increase PC referrals.

Project Design: The Five Item Palliative Care Screening Tool evaluated patients with a new metastatic cancer diagnosis. Secondary data was used to initiate a PC referral if the patient scored a five or greater on the screening tool. Project …

Implementation Of A Triage Assessment Area To Decrease Left Without Being Seen Rates In The Emergency Department, Margaret Mary T. Steed

Doctor of Nursing Practice Projects

Background: Left without being seen (LWBS) is a concern for emergency departments (EDs) nationwide. LWBS involves patients who sign into the ED and leave prior to being seen by a medical provider. LWBS has been linked to increased wait times in the ED.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project is to aid with decreasing LWBS rates in a local ED. Many tools aid with decreasing LWBS rates, including nurse-initiated protocols and standardized order sets. Despite available tools, LWBS rates remain elevated at 0.95% for the local ED.

Project Design: The evidence-based DNP quality improvement project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Improving The Detection Of Refractive Errors In First And Third Graders, Tameka J. Bolden

Doctor of Nursing Practice Projects

Background: Vision is a crucial component of the learning process, with academic tasks being heavily dependent on visual acuity. Undetected or diagnosed visual impairments can significantly alter a student’s educational performance and overall development. Currently, in Alabama, kindergarten, second, and fourth grade students are the only students to receive routine vision screenings; therefore, regular screening for visual acuity and eye issues is critical for school health programs. Early screening, diagnosis, and correction of refractive errors prevent permanent visual impairment and support academic success by reducing educational barriers and delayed cognitive impairment.

Purpose: This project aims to improve the early detection …

Influenza And Chronic Obstructive Pulmonary Disease: Correlating Adult Immunization With Exacerbation Reduction After Implementation Of The Global Initiative For Obstructive Lung Disease Recommendations In A Rural Clinic, Jessica Semyonova

Doctor of Nursing Practice Projects

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations of the disease, leading to disease progression, decreased lung function, increased mortality, and decreased quality of life. However, one of the clinician’s best tools in preventing exacerbations may be the distribution of annual influenza immunizations.

Purpose: This project aimed to determine whether implementing an influenza vaccination protocol would increase influenza vaccination uptake and decrease COPD exacerbation rates.

Project Design: An influenza vaccination protocol was implemented over an eight-week period. During that time, data was gathered and compared to data from the previous year when a vaccination …

Enhancing Patient Outcomes: The Sepsis Navigator Approach, Temeka L. Parker

Doctor of Nursing Practice Projects

Background: Sepsis is the leading cause of hospital mortality, accounting for over $20 billion dollars in total healthcare costs and more than 5 million deaths annually worldwide. The increased burden of sepsis led the Centers for Medicare and Medicaid (CMS) to institute a quality core measure known as the Severe Sepsis and Septic Shock Management Bundle (SEP-1) as a protocol for sepsis treatment. CMS reports national SEP-1 compliance at 62% and 61% for Alabama. The undisclosed project site reports a much lower SEP-1 compliance average of 49% over six months. Compliance with the SEP-1 bundle improves overall patient outcomes and …

Commit To Sit: Does Purposefully Sitting With Adult Medical-Surgical Patients At A Rural Hospital Impact Patient Satisfaction?, Jolie A. Puckett

Doctor of Nursing Practice Projects

Background: Patient satisfaction surveys encourage patients to provide feedback about their experiences with healthcare organizations, and the surveys also play a critical role in identifying gaps in care that may contribute to patient harm. Effective communication between nurses and patients is crucial for delivering high-quality healthcare; therefore, initiatives to enhance this communication should be explored and implemented.

Purpose: This quality improvement project aimed to evaluate whether sitting with patients improved patient satisfaction scores for a medical-surgical unit within a Northwest Georgia inpatient facility.

Project Design: A pre- and post-design method was utilized to compare patient satisfaction scores before and after …

Utilizing Text Messaging To Increase Annual Mammogram Screening Compliance, Lacey B. Santa Cruz

Doctor of Nursing Practice Projects

Background: Routine mammography can lessen breast cancer deaths, but many patients do not follow the current screening guidelines. Limited access to mammography and insufficient awareness lead to missed screening appointments.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve annual mammogram adherence among women aged 40-74 by implementing an electronic medical record (EMR)-based text reminder system.

Project Design: Secondary patient data was collected from a privately owned, rural family practice clinic. Using the Mobilize-Assess-Plan-Implement-Track (MAP-IT) quality improvement framework, the project implemented a text message reminder intervention through the EMR. Eligible patients received a text reminder …

Decreasing Burdensome Transitions In Hospice Care By Increasing Nursing Visits, Kristin S. Rivers

Doctor of Nursing Practice Projects

Background: Burdensome transitions occur when hospice patients discontinue hospice services to seek hospital treatment, often disrupting end-of-life goals and creating distress for patients and caregivers. These transitions continue to rise throughout the country, highlighting the need for strategies to support patients in remaining at home throughout the dying process.

Purpose: This quality improvement project aimed to decrease hospital transitions by increasing nursing visits for hospice patients at high-risk for burdensome transitions.

Project Design: This quality improvement project used a Plan-Do-Study-Act methodology to form and implement an intervention to reduce burdensome transitions. Patients were already identified as low or high-risk …

Dsk2-Mediated Degradation Of F-Box Protein Lao1 And Class I Tcps Modulates The Nitrogen Starvation Response, Yuanyuan Li, Shuyang Cheng, Xu Jin, Ruoxuan Wu, Yiyi Guo, Dezhi Wu, Jie Dong

Publications

Plants have evolved intricate strategies to cope with various abiotic stresses. Ubiquitin-mediated protein degradation plays a key role in plant development as well as abiotic stress tolerance. In this study, we identify LAO1, an F-box protein with unknown function, as a negative regulator of plant fitness during nitrogen starvation. DOMINANT SUPPRESSOR OF KAR 2 (DSK2) interacts with and mediates the autophagic degradation of LAO1 protein during nitrogen starvation. The loss of LAO1 improves the fitness of an autophagy-deficient mutant, atg5-1, under nitrogen starvation. Intriguingly, mutations in DSK2 facilitate rather than reduce plant growth after nitrogen starvation. This unexpected effect of …

Identification Of Milk And Milk Product Adulteration By Molecular Methods, Isam Shaker Haza, Saad Sabah Fakhry

Al-Esraa University College Journal for Medical Sciences

The polyacrylamide gel electrophoresis sodium dodecylsulfate (SDS-PAGE) has been extensively used to separate native and denaturalized proteins. In various countries this has been useful to detect milk adulteration with whey, which is a fraud according to the current legal standards. The presence of glycomacropeptide (GMP) constitutes a marker of adulteration. It is released to the serum due to the hydrolysis of --casein peptide catalyzed by rennin incheese elaboration. In this work, the GMP detection was standardized as a pasteurized milk adulteration index, by means of GMP isolation with sequential precipitation in trichloroacetic acid at 24% and 50%, treatment with ethanol-ether …

Impact Of Hypocalcemia On Dickkopf-Related Protein 1 And Hmgb1 In Transfusion-Dependent Thalassemia Patients, Haneen Azeez Falih

Al-Esraa University College Journal for Medical Sciences

Background: Transfusion-dependent thalassemia (TDT) is associated with various symptoms including anaemia and bone problems. There is a need for more biomarkers of calcium disorders in TDT patients. In the present study, DKK 1 and HMGB1 are studied in TDT patients with hypocalcemia (TDT+Hypocalcemia) and normocalcemia (TDT+Normocalcemia) as a function of inflammation. Methods: TDT patients were classified according to the cut-off value (2.12 mM) of the adjusted serum calcium (Adj.T.Ca) into TDT+Normocalcemia (n = 54) and TDT+Hypocalcemia (n = 41) groups. Forty healthy controls have participated in the present study. DKK1 and HMGB1 were measured using the ELISA technique. Results: Both …

Implementing A Fast-Track Pathway For Low Acuity Patients To Reduce Patient Length Of Stay In The Emergency Department, Dawnyel Donaldson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Overcrowding and prolonged wait times in emergency departments (ED) negatively affect patient safety, outcomes, and satisfaction. Hospital A, a Level 1 trauma center with over 52,000 annual ED visits, consistently exceeded the national ED length of stay (EDLOS) benchmark of 6 hours, averaging 6.7 hours, with left without being seen (LWBS) rates at 2.89%, surpassing the 2% target. Low-acuity Emergency Severity Index (ESI) level 4 and 5 patients contributed to congestion due to inefficient triage processes and lack of alternative care pathways, delaying timely access to care.

Aim of the Project: The project aimed to implement an evidence-based fast-track …

Preventing Hospital-Acquired Pressure Injuries Using Turn Teams And Verbal Reminders, Joyce O. Blaboe

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospital-acquired pressure injuries (HAPIs) are a preventable, yet persistent issue in healthcare, particularly in the pulmonary and infectious disease unit of a Northeastern U.S. hospital. HAPIs prolong hospital stays, increase healthcare costs, and pose potential legal risks. Despite implementing evidence-based protocols, including the leaf patient monitoring system, the hospital reported six avoidable HAPIs cases in the early fiscal year 2025.

Aim: The quality improvement (QI) project aimed to reduce HAPIs incidents by 10% within 12 weeks by introducing turn teams and verbal reminders to enhance existing protocols.

Evidence Review: Regular turning and repositioning are essential to HAPIs prevention. Additionally, …

Evidence-Based Pain Management Bundle For Pediatric Postoperative Orthopedic Patients, Samantha Firmstone

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Postoperative pain management in pediatric orthopedic patients is often inconsistent due to variability in provider practices and a lack of standardized protocols. At a Central Texas pediatric orthopedic clinic, all patients received opioid prescriptions post-knee surgery regardless of procedure severity, leading to frequent caregiver calls for clarification. This practice revealed a critical gap in preoperative education and multimodal pain management strategies, contributing to patient safety concerns and increased clinic workload.

Aim of the Project: The primary aim of the project was to improve pain control, reduce opioid reliance, and decrease postoperative pain-related follow-up calls by implementing a standardized, evidence-based …

Integrating Kangaroo Care Into Cesarean Delivery Practices: A Pathway To Enhanced Health Outcomes, Julia Swords

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Cesarean deliveries often interrupt early mother-infant bonding, delaying the initiation of breastfeeding and limiting opportunities for skin-to-skin contact. Despite national guidelines promoting immediate postpartum contact, cesarean-born infants receive kangaroo care (KC) at significantly lower rates than those born vaginally. Prior to this project, only 2% of cesarean births at the project site received KC, highlighting a significant gap in care delivery.

Aim of the Project: The aim was to evaluate the feasibility and impact of implementing kangaroo care during cesarean deliveries in a community hospital to improve neonatal outcomes and adherence to evidence-based postpartum practices.

Review of the Evidence: …

Patient-Centered Approach To Decrease Length Of Stay, Erika Beck

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Unmet social needs contribute to hospital readmissions and extended inpatient stays, placing strain on care coordination and hospital throughput. Social Determinants of Health (SDOH), such as housing instability, lack of transportation, or food insecurity, are often unaddressed in clinical workflows. At the project site, a gap in effectively integrating SDOH into the discharge planning process led to delayed discharges and increased length of stay (LOS). Additionally, 41.20% exceeded the Geometric Mean Length of Stay (GMLOS), surpassing the organizational benchmark of 40.17%. Gaps in standardized assessment and communication of SDOH data limited the ability to plan timely discharges and connect …

Optimizing Transfer Classification: Enhancing Accuracy And Reducing Readmission Rate Penalties For Cardiovascular Care In Short-Term Rehab, Aeshia Hicks

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In a short-term rehabilitation (STR) setting, misclassification of planned hospital transfers as unplanned readmissions among elderly cardiovascular patients inflated CMS-reported readmission rates, distorted performance metrics, and led to financial penalties under the Hospital Readmissions Reduction Program (HRRP). A gap analysis revealed a 14% misclassification rate, significantly higher than the CMS benchmark of 8.65%, which was attributed to inconsistent documentation and a lack of standardized classification criteria.

Aim of the Project: To reduce transfer misclassification by 20% through the implementation of a standardized electronic health record (EHR) template and targeted staff education, thereby improving CMS compliance and documentation integrity in …

Enhancing Diabetes Care In Adult Patients With Type 2 Diabetes In An Outpatient Setting, Osayanmo Ojo

All Doctor of Nursing Practice (DNP) Scholarly Projects

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition associated with significant morbidity, particularly among underserved populations. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to improve diabetes care among adult patients with poorly controlled T2DM (A1C > 9%) in an outpatient primary care clinic by increasing referrals to the Diabetes Self-Management Education (DSME) program. Guided by the Plan-Do-Study-Act (PDSA) cycle and the OhioHealth Change Management (OHCM) model, the project implemented structured interventions including standardized DSME referral workflows, electronic health record (EHR) prompts, provider education, and culturally tailored communication strategies.

The 12-week initiative targeted 68 eligible patients. …

Improving Depression Screening For Young Adults In Outpatient Settings, Addie Smith

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Depression among young adults aged 25 to 35 years in the United States has been among the second highest at 19.9%. Depression underdiagnosis stems from many patient-level causes, including a lack of standardized screening, inadequate provider education, and stigma of mental illness. Untreated depression results in low quality of life, comorbidities, suicidality, and socioeconomic issues.

Aim of the Project: The aim of this project was to address the gap in practice by implementing a standardized screening process for young adults to enhance diagnoses and increase screening rates.

Review of the Evidence: A comprehensive review of the evidence …

Improving Provider Documentation For Procedure Authorizations: A Nursing Perspective On Enhancing Outcomes And Compliance, Juli Legg

All Doctor of Nursing Practice (DNP) Scholarly Projects

Insurance denials resulting from non-standardized documentation and communication gaps in the prior authorization process adversely impacted financial performance and patient care within the electrophysiology (EP) department of a large Midwest academic medical center. High denial rates for costly procedures revealed a need for improved alignment with payer medical necessity criteria. This quality improvement (QI) project aimed to enhance provider documentation, reduce denials, improve care delivery, and increase revenue by implementing standardized documentation templates. A review of the literature supports that standardized documentation and clinical decision support tools enhance consistency, reduce errors, and improve prior authorization success rates. Guided by the …

Improving Hospital Throughput Through Flash Rounds And Standardized Discharge Readiness Assessments, Erin D. Dobda

All Doctor of Nursing Practice (DNP) Scholarly Projects

• Problem: The target hospital faced serious throughput challenges, with emergency department overcrowding and discharge inefficiencies impacting patient outcomes and organizational performance. Discharge order to depart times exceeded the 90-minute benchmark, averaging 154 minutes, while 41.2% of patients exceeded the geometric mean length of stay (GMLOS) target of 40.17%. Gaps included inconsistent discharge planning, poor communication, and limited follow-through on barriers.
• Aim of the Project: The project aimed to improve hospital throughput by reducing GMLOS and discharge order to depart times on Unit A. This was achieved through implementation of proactive, evidence-based interventions to streamline discharges, reduce delays, and support safe …