Nursing Commons^™

Identifying And Exploring Successful Leadership Strategies To Improve Nurse Retention, Jennifer Triggs Rickerson

Walden Dissertations and Doctoral Studies

Nurse turnover has become a critical concern in healthcare, as low retention rates lead to decreased patient care quality and increased operational costs. A critical issue for hospital stakeholders is that many nursing leaders lack strategies to improve nursing retention. Grounded in the leader-member exchange theory, the purpose of this qualitative pragmatic inquiry was to identify and explore successful leadership strategies used by nurse managers in the Pacific South region of the United States to improve nurse retention. The study included interviews with six nurse managers who successfully implemented retention strategies. Data were collected through semistructured interviews and publicly available …

Bkk1/Bak7 And Tcp21 Form A Positive Feedback Loop To Facilitate Submergence Tolerance In Plants, Yiyi Guo, Yuanbin Zhang, Yuanyuan Li, Jie Liu, Yiyang Hu, Jiazhi Jiang, Qi Li, Yeke Chen, Weizhen Hu, Lixi Jiang, Ronghui Pan, Dezhi Wu, Jie Dong

Publications

Submergence poses a deleterious threat to plant development and the agricultural production of Brassica napus (B. napus), an important worldwide oil crop. However, the molecular mechanisms underlying submergence tolerance in B. napus remain elusive. Here, through a genome-wide association study, we identify a SOMATIC EMBRYOGENESIS RECEPTOR-LIKE KINASE, BKK1/BAK7, which is crucial for plant survival after submergence stress. Submergence rapidly activates the expression of BAK7 and induces the accumulation of its kinase domain in the nucleus. BAK7 interacts with and phosphorylates class I TEOSINTE BRANCHED1, CYCLOIDEA, PROLIFERATING CELL FACTOR 1 and 2 (TCP) transcription factor TCP21, thereby stabilizing it and modulating …

Staff Education Project On Genetic Testing In A Psychiatric Facility, Chinenye Vivian Akpuaka

Walden Dissertations and Doctoral Studies

The project was an educational DNP project that aimed to improve staff knowledge on genetic testing. The practice focused question was “Will an education module on best practices for genetic testing increase self-reported knowledge among health care professionals in a mental health clinic?” The purposes of genetic testing in psychiatry are to improve pharmacological therapy through better prescription of the right medications (Pinzón-Espinosa et al., 2022). The implementation of genetic testing at the project site is limited due to gaps in knowledge and attitudes as well as efficacy of this intervention. The leaders at the practicum site supported the potential …

Measuring Nursing Student’S Performance, Attitude And Psychological Impact Of Different Evaluation Approaches In Simulation Education At Arab American University- Palestine, Mohammad Asia, Maysa Kassabry

Journal of the Arab American University مجلة الجامعة العربية الامريكية للبحوث

This study aimed to compare the competency and psychological impact of using the objective structured clinical examination (OSCE) to the traditional evaluation methods (TEM) in evaluating cardiology skills among nursing simulation students. Thirty-two students were initially assessed using TEM, and one week later using the OSCE. Scores of the student competency were compared using paired sample t-tests, while semi-structured interviews were used to expand on qualitative measures. Students' mean scores were significantly higher in using OSCE than in TEM (p< 0.001). Students' attitudes and perceptions of both approaches showed favorable attitudes towards OSCE on most of the items. The qualitative data showed that students with lower GPAs and utilizing the OSCE approach experienced higher anxiety. The psychological impact of evaluation approaches requires additional investigation.

Quality Improvement Project Enhancing Communication Perceptions Among Nursing Staff In The Operating Room, Denis Awu

Doctor of Nursing Practice Projects

Effective communication in the operating room (OR) is crucial for ensuring patient safety and optimal surgical outcomes. Communication breakdowns among surgical teams are a leading cause of sentinel events and procedural errors. This quality improvement (QI) project aimed to enhance communication perception among OR nursing staff through a structured training program focused on verbal, non-verbal, active listening, and communication under pressure. Grounded in Social Cognitive Theory and implemented using both Kotter’s 8-Step Change Model and the Plan-Do-Study-Act (PDSA) cycle, the intervention included interactive workshops and simulation exercises delivered over a six-week period. A total of 50 registered nurses participated in …

Quality Improvement Project Enhance Self-Efficacy And Knowledge In Pediatric Emergency Care For Nurses In An Adult Acute Care Facility, Tiffany Daniel

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice (DNP) project addresses the significant gap in emergency nursing preparedness for managing pediatric emergencies in adult-focused emergency departments. A quasi-experimental pre/ post intervention design was used to implement a pediatric-specific training intervention consisting of didactic education and simulation-based learning. A total of 87 night shift ED nurses participated. Knowledge and self-efficacy were measured using pre- and post-intervention surveys and assessments. The training equipped nurses with critical skills to manage pediatric emergencies more confidently and competently, addressing both clinical and emotional barriers. Knowledge scores significantly improved, t = -20.45, p < 0.001, with post-test means rising from 5.56 (SD = 1.58) to 9.03 (SD = 0.32). Post-intervention self-efficacy scores also increased significantly, t(86) = -21.57, p < .001, indicating greater confidence in pediatric emergency care. These findings validate the effectiveness of structured pediatric emergency training in enhancing nurse competency and self-efficacy. Lewin's change theory and Newman’s systems model guided this quality improvement project. The results support the continuation of the program in population-specific education and simulation as part of annual competency development. This project demonstrated that targeted pediatric training improves nurse preparedness and has the potential to enhance patient outcomes in a setting traditionally focused on adult care.

Quality Improvement Project Supporting Novice Nurse Faculty Through Mentorship, Lorna Deardeuff

Doctor of Nursing Practice Projects

Current literature suggests that a lack of support to assist novice faculty in their socialization to academia can lead to increased attrition among faculty members. However, novice nursing faculty, when transitioning from the role of clinical expert, require much support to successfully meet the demands of preparing nursing students. This quality improvement project aimed to develop and implement a structured novice nurse faculty mentorship program, with the use of a mentorship toolkit, to improve job satisfaction levels and the intent of the novice faculty members to remain in their current positions. This quasi-experimental project utilized a pre-and-post intervention survey designed …

Enhancing Education In Nursing Skills: The Impact Of Simulation Use On Faculty Self -Efficacy, Annie Kyle

Doctor of Nursing Practice Projects

This quality improvement (QI) project aimed to improve nursing faculty self-efficacy in teaching nursing skills using medium- and high-fidelity simulation. The problem addressed was the increasing number of students requiring multiple attempts to pass skills checkoffs, with some ultimately being withdrawn from the program. Faculty at the project site reported a lack of training and confidence in utilizing simulation technology effectively. A quasi-experimental design was used with a single group of full-time faculty (n=6), who received simulation training and completed the Self-Efficacy Towards Teaching Inventory for Nurse Educators (SETTI-NE) before and after the intervention. The data analysis was conducted using …

Improving Patient Outcomes Post-Discharge: Implementing Evidence-Based Discharge Planning For High-Risk Mental Health And Substance Use Disorder Populations, Margaret Phillips

Doctor of Nursing Practice Projects

A significant gap in standardized discharge procedures was identified at a nonprofit, community-based clinic serving male residential patients with substance use disorder (SUD) and co-occurring mental health conditions. The lack of a standardized discharge process led to poor follow-up appointment adherence, poor medication adherence and increased risk of relapse. This quality improvement (QI) project aimed to address these issues through the implementation of a cross-departmental discharge process that produced tailored Individualized Discharge Plans (IDP) or each patient, using the Donabedian and Kotter’s 8-Step Change models as guiding frameworks. Data were collected using custom-built tracking tools over two four-week periods, pre- …

Quality Improvement Project The Introduction Of Gratitude Journaling To Decrease Test Anxiety In Prelicensure Bachelor Of Science In Nursing Students, Jourdan Scoggins

Doctor of Nursing Practice Projects

Test anxiety is a substantial barrier to success among prelicensure nursing students, given the heavy course load and high academic pressure of the educational environment. The purpose of this quality improvement project was to measure the impact of gratitude journaling on levels of test anxiety in first-semester Bachelor of Science in Nursing (BSN) enrolled in a nursing math course at a regional university in Arkansas. Following a quasi-experimental design, students participating in the project completed the Westside Test Anxiety Scale (WTAS) before and after five weeks of gratitude journaling. Thirty-two students participated in the intervention and 24 of those completed …

Quality Improvement Project Building Community Of Practice Through An Affiliate App Virtual Forum, Patricia J. Pease

Doctor of Nursing Practice Projects

Establishing community and support for pediatric hematology and oncology Advanced Practice Providers can be challenging. Asynchronous working schedules, lack of protected time, and geographical distance hinder these efforts. Extending professional support and collaboration to providers is vital to ensure communication, interprofessional teaming, and collaborative care of the high-acuity patient population. Given the availability of virtual forums, this project explores the ability of a virtual, synchronous Community of Practice (VCoP) to enhance interprofessional collaboration for affiliated Advanced Practice Providers (APPs). This project utilizes the validated Assessment of Interprofessional Team Collaboration II (AITCS-II) to assess pre- and post-intervention interprofessional collaboration via a …

Peer Mentor Training Program: A Policy Proposal, Laura Paul

Doctor of Nursing Practice Projects

Peer mentoring is an evidence-based strategy to improve student retention. However, for this approach to be sustainable, the students providing mentoring must be intentionally prepared for this role. This project introduces an evidence-based policy for training Bachelor of Science (BSN) students as peer mentors to enhance student outcomes and retention of first-year students. This policy was created for a small BSN program at a work-study college with a financially disadvantaged student body, which places the students at increased risk of not persisting in their degree. The training policy is intended to be implemented with nursing lab staff who are students …

Clinical Practice Guideline: Appropriate Selection Of Mental Health Conditions For Telepsychiatry Visits, Oluwatoyin Sowunmi

Walden Dissertations and Doctoral Studies

This doctoral project was a clinical practice guideline (CPG) aimed at addressing the practice problem of inappropriate selection of patients for telepsychiatry visits. The issue is significant in nursing practice, as the misalignment between patient needs and telehealth capabilities often results in appointment cancellations. The practice focus question guiding this project was “Does the evidence support development and expert panel validation via the Appraisal of Guideline for Research and Evaluation II (AGREE II) of a CPG for appropriate selection of mental health conditions for telepsychiatry visits that is also approved for use in practice by end users?” The project successfully …

Reducing Readmission Rates In A Mental Health Hospital, Zamzam Mohamed

Walden Dissertations and Doctoral Studies

Summary I designed this clinical practice guideline (CPG) doctoral project to address the critical practice problem of high readmission rates in a mental health unit at a large academic medical center. This quality improvement initiative focused on developing and evaluating CPG to improve discharge planning. I aimed to address gaps in continuity of care, inadequate discharge education, and limited post discharge follow-up, which had been identified as contributing factors to early psychiatric readmissions. The practice-focused question guiding this project was: What evidence supports the development of a discharge planning CPG designed to reduce readmission rates in a mental health unit? …

Educating Staff On Using Medication-Assisted Treatment (Mat) In Opioid Use Disorder (Oud), Demie Alaekwe

Walden Dissertations and Doctoral Studies

Medication-assisted treatment (MAT) programs, especially those led by providers, can expand access to care for persons with opioid use disorder (OUD). The gap in practice at the site was the insufficient knowledge among nurses on how to effectively use MAT in treating OUD. The purpose of this staff educational project was to design and implement a training module to educate mental health providers on the principles and interventions of MAT. The practice-focused question was: Does educating nurses on MAT principles while incorporating evidence from the literature improve their knowledge as measured by pre- and post-test? The ADDIE pedagogy model was …

Clinical Practice Guideline For Intentional Rounding, Julia Griggs

Walden Dissertations and Doctoral Studies

This is a quality improvement clinical practice guideline (CPG) to address the inconsistent staff rounding practices, developed following recognition of a fall rate of 3.2 per 1000 patient days and declining patient satisfaction in the project facility. I developed the CPG using current evidence-based practices to establish standardized procedures for purposeful rounding to enhance patient safety, satisfaction, and care quality. Three experts, including an educator, clinician, and administrator, evaluated the CPG using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), a tool consisting of seven domains used for measuring the methodological rigor and transparency in which a …

Exploring The Relationship Between Burnout, Professional Fulfillment, And Individual And Organizational Factors In Nurse Managers Across Ambulatory And Inpatient Settings, Yulia Romazanova Lopez

MUSC Theses and Dissertations

Nurse managers play a vital role in the functioning and stability of healthcare systems, yet their well-being remains an underexplored area of research. The COVID-19 pandemic brought renewed attention to occupational burnout, including in nursing leadership, where nurse managers reported high levels of stress, emotional exhaustion, and organizational strain. While the literature on burnout has grown rapidly in recent years, there is limited research that addresses what comes next, what sustains nurse managers in their roles and how organizations might foster their long-term well-being and engagement. This dissertation compendium explores professional fulfillment (PF) as a proactive and constructive lens for …

Staff Education To Addressing Medication Nonadherence Amongst Patients With Mental Health Challenges, Euphemia Mah

Walden Dissertations and Doctoral Studies

Walden University College of Nursing This is to certify that the doctoral study by Euphemia Mah has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Corinne Wheeler, Committee Chairperson, Nursing Faculty Dr. Robert McWhirt, Committee Member, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2025 Summary Poor adherence to medication regimens among patients who have a mental illness leads to multiple adverse outcomes, which include symptom exacerbation, decreased quality of life, and repeated hospitalizations. To address this …

Quality Improvement Project: Perioperative Recruitment Process Improvement Through Nursing Student Clinical Experience, Traci Boren

Doctor of Nursing Practice Projects

Perioperative nursing is experiencing greater shortages than any other specialty and has been largely removed from undergraduate education. This DNP quality improvement project aimed to impact the recruitment of perioperative nurses through undergraduate nursing clinical exposure and experience. The project addressed the lack of clinical nursing student opportunities in the perioperative department at the partner site to increase interest in perioperative nursing and recruit core staff nurses from the pool of new graduates. Kotter’s Eight-Step Change Model and the Social Career Cognitive Theory framed the project’s design and implementation for two cycles, between January and March 2024 and 2025. Using …

Implementing An Antibiotic Stewardship Program For Acute Respiratory Tract Infections In Urgent Care, John Childree

Doctor of Nursing Practice Projects

Antibiotic overprescription for acute respiratory tract infections (ARTIs) remains a persistent challenge in urgent care, contributing to antimicrobial resistance and increased healthcare costs. This quality improvement project evaluated whether a structured educational intervention an Antibiotic Stewardship Program (ASP) could improve providers’ knowledge and self-efficacy in evidence-based prescribing. A quasi-experimental, single-group pre-post design was used with seven urgent care clinicians. Data were collected through a custom Antibiotic Stewardship Questionnaire and a Self-Efficacy Survey administered before and after the intervention. Results demonstrated a 17% increase in knowledge scores (from 9.3 to 10.6 out of 11) and a statistically significant improvement in self-efficacy …

Quality Improvement Project Education And Implementation Of I-Pass Handoff Between Critical Care Clinicians And Anesthesia Staff, Kimberly Woody

Doctor of Nursing Practice Projects

Medical errors, specifically communication errors, cause adverse patient outcomes, death, and an estimated annual cost to institutions of over two million dollars. Despite numerous studies highlighting the need for standardized communication during patient transfers and recommendations from regulatory bodies such as the Joint Commission, the gaps in standardized handoffs remain. The Doctor of Nursing Practice's (DNP's) quality improvement project aimed to increase knowledge of the intensive care unit (ICU) and anesthesia clinicians through interprofessional education (IPE) about the illness severity, patient summary, action plan, situational awareness/contingency plan, synthesis by receiver (I-PASS) handoff tool to promote consistent, complete tool use during …

Respectful Patient-Provider Communication And Patient Portal Usage In Pregnant People Of Color, Amy H. Goh, Christopher Lee, Chisolum Nkenke, Joyce K. Edmonds

College of Health Professions Faculty Papers

BACKGROUND: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.

METHODS: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on …

Lived Experiences Of Nurses Caring For Patients With Opioid Use Disorder, Oneatha Alexander

Walden Dissertations and Doctoral Studies

Opioid abuse is a significant problem in the United States. People with opioid use disorder (OUD) visit the emergency room (ER) for pain management. OUD is the overuse and abuse of opioids, which can result in dependence, relapses, and death. Nurses in the ER and medical-surgical units face challenges in distinguishing OUD from chronic pain. The purpose of this qualitative interpretive phenomenological study, guided by Benner’s novice-to-expert framework, was to explore the lived experiences of ER and medical-surgical nurses who provide care to OUD patients. Eight ER and medical-surgical nurses were interviewed using semi-structured interviews. The main themes from coding …

Staff Education On Strategies To Eliminate Medication Errors And Promote Medication Compliance In The Community And Healthcare Settings, Rita Nyongkah Yeba

Walden Dissertations and Doctoral Studies

Patient health is highly influenced by non-adherence to medications and faults in them. Longer diseases, unneeded hospital visits, and growing healthcare expenses are the effects of these problems. Medication errors can arise from incorrect prescriptions, too low or too high doses, poor administration, or inconsistent provider communication. Patients may also neglect their prescriptions for several reasons, including lack of motivation, forgetfulness, or worries about side effects. This initiative aimed to provide medical staff members with techniques meant to help lower errors in the healthcare environment and enhance medication adherence. The aim of this initiative was to instruct the staff members …

Strengthening Communication Between Staff And Health Providers In A Mental Health Setting, Michael Tricoli

Doctoral Dissertations and Projects

Communication between nursing staff and providers is essential for supporting optimum patient outcomes. Each component of the communication process needs to be clearly defined to create an environment of safety for both patients and caregivers. The SBAR (situation, background, assessment, recommendation) is a nurse-driven protocol that is widely used as a communication and documentation template in health care organizations. This format is currently not being used effectively on the mental health units where the evidence-based project was implemented. Recognizing and reiterating the value of SBAR as a communication tool is necessary when communication deficits are noted. The purpose and scope …

Do Perceived Social Support And Positive Religious Coping Moderate Any Relationship Between Post-Intensive Care Syndrome–Family Symptoms And Quality Of Life In Informal Caregivers Of Intensive Care Unit Survivors?, Carol R. Hirschkorn

Doctoral Dissertations and Projects

Family members and close friends often act as informal caregivers (CGs) for survivors of critical illness, assisting with activities of daily living, ongoing care needs, and adjustment to life after critical illness. These CGs simultaneously cope with their own mental, physical, and social sequelae, including significant changes (to roles and responsibilities) in everyday life. Qualitative researchers have examined this constellation of CG symptoms, which constitute post-intensive care syndrome–family (PICS-F), to understand the experiences, needs, and coping of CGs of intensive care unit (ICU) survivors. None have looked at the impact of religious coping and perceived social support on PICS-F and …

Implementation Of An Educational Intervention To Improve Antibiotic Stewardship In An Urgent Care Setting, Evelyn Jane Clinton

Doctoral Dissertations and Projects

Antimicrobial resistance is a leading threat to global health. Resistance to antibiotics in the United States continues to increase contributing to rising numbers of resistant infections and subsequent deaths. This highlights the critical need for increased focus on antibiotic stewardship efforts. Urinary tract infections are one of the leading indications for antibiotic prescription in the outpatient setting and research suggests that there is an opportunity for improvement in antibiotic stewardship efforts in this area. The PICOT question for this project is as follows: In an urgent care setting, does provider education on the current evidence for urinary tract infection diagnosis …

Improving New Graduate Nurse Clinical Judgment By Training Preceptors On The Use Of The Tanner Model, Denise E. Carr

Doctoral Dissertations and Projects

New graduate nurses (NGNs) often enter the workforce with deficits in clinical judgment, which has been further exacerbated by pandemic-related limitations in clinical education. This project aimed to improve NGN clinical judgment by training preceptors to use the Tanner Clinical Judgment Model (TCJM) and Lasater Clinical Judgment Rubric (LCJR). A quasi-experimental evaluation design was used to compare outcomes between two groups of preceptor–preceptee pairs. Half of the preceptor participants received training on the TCJM and LCJR, while the other half did not. Clinical judgment development was measured using the LCJR pre- and post-orientation. Additional preceptor feedback regarding the implementation and …

Humanizing The Icu: Implementation Of Personalized Communication Boards In The Sicu Drives Enhanced Patient And Family Experience, Stephen D. Hoefler

Master's Theses

Objective: Research has established the importance of personalized communication in critical care settings, where standardized tools like whiteboards can improve patient and family engagement.

Aim: This project aims to develop a personalized communication board in the surgical intensive care unit (SICU) at a Bay Area academic quaternary care facility that, once implemented, will achieve at least 75% utilization in patient rooms by May 2025, enhancing communication and patient experiences.

Methods: Surveys were conducted with patients, families, and staff to gather stakeholder input and guide the design of a new standardized whiteboard model with personalized elements. Results: Based on stakeholder feedback, …

Psychometric Evaluation Of The Thai Version Of Emotional Labor Scale (T-Els) In Thai Nurses, Vachira Posai, Wisarut Srisintorn, Paramee Thongsuksai, Chanokporn Jitpanya

Journal of Health Research

Background: Nurses often face emotional strain due to emotional labor (EL), which involves concealing or modifying genuine feelings to meet their job requirements. This response can lead to physical, psychological, and behavioral issues. The Emotional Labor Scale (ELS), originally in English, has not been translated into Thai, leaving its psychometric properties unexamined in the Thai context. This study aimed to translate the ELS into Thai and evaluate its psychometric properties among Thai nurses.

Methods: A cross-sectional study design was used. The 14-item scale, which includes surface acting, deep acting, and expression of naturally felt emotions dimensions, was translated using forward …