Nursing Commons^™

Improving Pediatric Delirium Assessment Documentation And Nursing Knowledge In A Pediatric Cardiovascular Intensive Care Unit, Heather E. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Pediatric delirium is prevalent in the Pediatric Cardiovascular Intensive Care Unit (PCICU). It is associated with longer PCICU stays, extended hospital stays, prolonged duration of mechanical ventilation, and higher hospital costs (Mallick et al., 2022). It has also been associated with increased mortality risk and decreased quality of life after hospital discharge (Rohlik et al., 2021). Due to the adverse sequelae associated with pediatric delirium, routine screening with a validated screening tool is recommended (Flagg & Mauney, 2023). Despite consensus guidelines advocating routine screening for pediatric delirium, routine screening is not being completed (Flagg & Mauney, 2023).

Decreasing Hospital-Acquired Clostridium Difficile Infections, Angel S. Louder

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Clostridium Difficle Infection (CDI) is a significant healthcare threat due to its ability to be transmitted rapidly in healthcare settings. Patient engagement and participation in infection prevention initiatives at admission will lead to early implementation of isolation precautions, diagnosis of infectious pathogens, and treatment. A quality improvement project was implemented at a south-central Texas acute care hospital to engage alert and oriented adult patients, using a bundled approach to screen for the early detection of CDI within 48 hours of hospital admission, thereby reaching the goal of reducing hospital-acquired CDIs. This initiative improved patient engagement with CDI screening, reducing confirmed …

Enhancing Patient-Centered Efficiency: Reducing Cardiology Clinic No-Shows Using Technology, Pre-Visit Planning & Patient Resources, Pat Shirey

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Cardiovascular disease (CVD) affects 48% of U.S. adults, requiring regular cardiology visits to manage risk factors and the early detection of complications (American Heart Association, 2019). No-shows disrupt continuity of care, worsen health outcomes (Choi et al., 2020), and decrease clinic efficiency (Goossens et al., 2022). A North Texas cardiology clinic reported a 31.9% overall no-show rate and a 42.1% no-show rate for new patients, costing $1.3 million annually.

Purpose: This quality improvement project aimed to reduce no-show rates through a patient-centered cardiology appointment bundle to improve continuity, patient outcomes, and efficiency.

Methods: This eight-week project utilized the Plan-Do-Study-Act …

Reducing Spinal Induced Hypotension In Cesarean Sections: A Multimodal Approach, Tyran D. Heilig

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Spinal anesthesia is the preferred method for elective cesarean sections due to its rapid onset, ability to keep the mother awake, and lower risk of complications compared to general anesthesia (Shitemaw et al., 2020). However, spinal-induced hypotension (SIH), caused by a sympathetic block, occurs in up to 75% of cases (Sklebar et al., 2019). A 2019 global study conducted in Ethiopia of 410 women found the incidence of SIH in cesarean sections to be 64% (Shitemaw et al., 2020). A Texas study found that 99.4% of cesarean deliveries experienced SIH, and 12% of those cases resulted in severe hypotension, …

Toolkit To Promote Good Hand-Hygiene Among Kenyan School Children, Jo Martinez

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Among healthcare providers and educators in Kenya who work with and educate school-aged children, a toolkit that includes a guideline, educational hand-hygiene posters, handouts, and resources on hand hygiene for children using graded literature, assists educators and healthcare providers with education of school-age children regarding sanitation.

Methods: The recommendations were created using a collection of graded literature. The recommendations were presented to stakeholders of healthcare providers and educators from urban and rural areas. The stakeholders rated each recommendation using a Likert scale from 1 – very poor to 4 – very good.

Results: Five of the six stakeholders who …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Patients’ Experiences And Management Practices Of Hypertension Among The Pastoralist Community Of Marsabit County, Christine Chepkemoi Chesiror

MSc in Advanced Practice Nursing

Hypertension is a global public health challenge and a leading cause of morbidity and mortality, particularly in low- and middle-income countries, where it accounts for 86% of deaths from non-communicable diseases. With over 1.5 billion cases projected by 2025, hypertension significantly increases the risk of heart disease and stroke. Despite this, little is known about the experiences and self-care practices of pastoralist communities living with hypertension.

This study employed a descriptive, exploratory, cross-sectional design to investigate the experiences and self-care practices of individuals managing hypertension among the pastoralist of Marsabit County. Twelve participants receiving follow-up care at Uran and Sololo …

Prioritization Among School Nurses: An Integrative Review Of The Literature, Melissa Calvillo, Susana J. Calderon, Maureen Rabbitte, Cherrill Stockmann, Sheryl Henry

Faculty Publications - Mennonite College of Nursing

With a median caseload of 750–1,000 clients, school nurses face setting-specific challenges involving multiple, competing demands. This necessitates effective prioritization to prevent missed opportunities to provide appropriate care. This integrative review synthesizes the current state of the literature related to prioritization among school nurses in the United States. Three themes were identified relating to prioritization among school nursing: knowledge, attitudes and values; self-efficacy and intention to act; and the nursing process. The prioritization behavior of school nurses can be facilitated by organizational and community collaboration and strong evidence-based practice recommendations. High workloads and inadequate resources among school nurses are the …

Optimizing Pelvic Health: Evaluating The Efficacy Of Prenatal Strength And Resistance Training Combined With Pelvic Floor Muscle Exercises In Reducing Pelvic Organ Prolapse Risk, Samantha Requilman

Nursing | Senior Theses

While postnatal recovery is focused on the newborn, the mother’s health is equally important – particularly in preventing pelvic organ prolapse (POP), a condition that results in pelvic discomfort, incontinence, and a reduced quality of life. Although clinicians encourage pelvic floor muscle exercises (PFME) throughout pregnancy, POP is still prevalent among women, especially those who deliver vaginally. There are limited research studies on the effectiveness of prenatal resistance training in the prevention of pelvic dysfunctions and this study aims to address the gaps in the literature. So the question to address this study is: Does combining prenatal resistance training with …

The Effect Of Length Of Nursing Shift On The Development Of Medical Errors, Andrew J. Hom

Nursing | Senior Theses

The relationship between extended nurse work hours and increased clinical errors is a growing concern in nursing and healthcare systems. This issue has only grown more pronounced since the pandemic, which exacerbated staffing shortages and placed unprecedented demands on the nursing workforce. Longer shifts often lead to fatigue, impaired decision-making, and decreased cognitive performance, creating challenges for both nurses and patients. To better frame the analysis, this thesis relied on The Swiss Cheese Model to better conceptualize risk management. This thesis examined the correlation between consecutive hours worked and the frequency of errors made by nurses while also exploring the …

The Role Of Sexual Assault Nurse Examiners: Addressing The Shortage And Its Implications For Healthcare, Isabel Mary Mccarthy

Nursing | Senior Theses

Background: Sexual Assault Nurse Examiners (SANE) are registered nurses specifically trained to perform forensic examinations and provide medical and emotional support to sexual assault victims. Many nursing programs lack formal education on SANE practices, which can hinder students' preparedness to address such cases in their future careers.

Method: A mixed-methods, three-phase approach to evaluate the effectiveness of a Sexual Assault Nurse Examiner (SANE) training module within the Dominican University of California Nursing Program. 40- 60 nursing students will be separated into two separate community health classes with one given module in SANEs nursing and the other not. Both classes …

Improving The Emotional Wellbeing Of Healthcare Workers In A Homecare Agency, Crystal U. Okafor

Doctor of Nursing Practice Projects

Healthcare workers (HCWs) often have traumatic experiences in the course of care delivery, and these experiences negatively impact their well-being, affecting them emotionally, psychologically, and physically. With the COVID-19 pandemic, healthcare workers have had indelible experiences questioning their choice of profession. This project aimed to teach the factors affecting the emotional well-being of healthcare workers and develop strategies to improve emotional distress in a home care agency. The implementation site was Carolina Homecare Solutions, with 21 participants, including nursing assistants and registered nurses. Sample selection was via a convenient strategy, selecting the most conveniently available participants. The project leader used …

The Use Of Therapeutic Communication To De-Escalate Aggression And Violence In Clients Living In A Homeless Shelter, Tionna S. Felder

Doctor of Nursing Practice Projects

Individuals working at homeless shelters have the daunting task of managing violent/aggressive behaviors with the population they serve. This project focused on educating homeless shelter staff on the use of therapeutic communication to decrease the escalation of aggression and violence when caring for their guests. The DNP Project Leader taught 23 homeless shelter staff members, and the project included three 2-hour educational sessions. The first class focused on understanding what regions in the brain are responsible for aggressive, violent, and emotional behaviors; the second class focused on what the literature says about aggressive behavior in homelessness; and the last class …

Increasing Awareness And Support For Women With Anxiety Disorders In Rural Communities, Candice C. Jones

Doctor of Nursing Practice Projects

Anxiety disorders are among the most common mental health conditions, disproportionately affecting women, particularly those in rural communities with limited access to care. Many women experience perinatal, postpartum, or generalized anxiety, often suffering in silence due to stigma, lack of awareness, and inadequate mental health education. This project focused on increasing awareness and understanding of anxiety disorders among women in rural Randolph County, North Carolina. A comprehensive literature review was conducted to assess the scope of anxiety disorders in women, identify community education needs, and explore evidence-based interventions. Ten relevant studies were analyzed, including randomized controlled trials, cross-sectional studies, and …

Early Recognition In Patient Deterioration: A Quality Improvement Project, Abigail Bell

Doctor of Nursing Practice Projects

This quality improvement project focused on enhancing early recognition of patient clinical deterioration by leveraging a rapid response team to implement targeted strategies that reduce failures in identifying early and subtle signs of physiologic decline. Rapid response teams have been widely adopted across the healthcare system to facilitate efficient interventions and prevent further deterioration in acutely ill patients. Despite their intended purpose, delays in recognizing clinical deterioration continue to exist. Failure to recognize early signs of deterioration contributes to an increased risk of irreversible organ damage, unplanned transfers to the intensive care unit, prolonged hospital stays, and, in severe cases, …

Overdose Response Training For Volunteers In A Homeless Shelter, Heather Lynne Smallwood

Doctor of Nursing Practice Projects

The opioid overdose epidemic is a critical health crisis across the country. The homeless population is substantially more at risk of overdose death compared to the general public. Naloxone is a life-saving medication for reversing opioid overdose and is available to ambulance and emergency care services, but support persons are also in regular contact with opioid users and training (Fine et al., 2022). This DNP Project was created to educate volunteers at a homeless shelter in the event of an opioid overdose. The objective of the project was to increase the knowledge of opioid overdose signs and symptoms and naloxone …

Pantry To Plate: Using Local Food Pantries To Improve Diabetes Self-Care Deficits, Rachelle Zielazienski

Doctor of Nursing Practice Projects

This project aimed to improve food pantry participants’ diabetes self-management and understanding of diabetes nutrition education through a collaborative approach. Over the course of 2 months, the project provided educational resources on diabetes nutrition at a food pantry. The target population included individuals with diabetes, pre-diabetes, and those responsible for preparing meals for diabetic individuals. A certified diabetes specialist was enlisted to ensure the delivery of culturally sensitive, evidence-based educational support tailored to participants’ diabetes health goals. Orem’s Self-Care Deficit Theory served as a framework for this project. A mixed-methods approach was utilized through pre-and post-test design to gather qualitative …

Addressing Physical Inactivity In Cabarrus County, Amy S. Hicks

Doctor of Nursing Practice Projects

Background: 21% of Cabarrus County, North Carolina, residents report complete physical inactivity during their leisure time, contributing to various health problems affecting 29% to 33% of Cabarrus County residents aged 40 to 84.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to implement and evaluate a 3-week community walking challenge (Trim Before the Turkey Walking Challenge) to increase physical activity and social connectedness among Cabarrus County residents aged 50 and older.

Methods: A pre- and post-program survey design was used to evaluate participant-reported physical activity levels and sense of social engagement. Participants were recruited through the …

Hand Hygiene Education For Personal Care Staff In Congregated Care Settings: A Quality Improvement Initiative, Saunders Noel

Doctor of Nursing Practice Projects

For many years, proper hand hygiene has been emphasized as one of the most important defenses in helping to prevent illnesses. The World Health Organization (WHO) is a major organization that stresses the importance of proper hand hygiene and disease prevention. However, hand hygiene education and knowledge must be acquired to successfully utilize the correct steps in combating illnesses and diseases. Hand hygiene is a learned behavior and emphasizing education and awareness is important to successful adoption. This DNP project was implemented to personal care staff in a congregated care setting located in the southeastern part of Virginia. The project …

On The Frontline: Stop The Bleed© Training For School Staff, Mary Michaela Hinson

Doctor of Nursing Practice Projects

The American College of Surgeons’ Stop the Bleed© course was introduced in 2015 following an outcry from the community surrounding the Sandy Hook Elementary School shooting. The Stop the Bleed© course was developed as a tool for training that any person could participate in, despite their medical background or knowledge. The course is comprised of a 30-minute didactic portion followed by a 30-minute hands-on portion where participants can practice applying tourniquets, packing a wound, and applying manual pressure. This DNP project aimed to educate school staff in a high school located in North Carolina on Stop the Bleed© in an …

Nursing Professional Liability: Bridging Rn & Aprn Perspectives On Risk, Coverage & Evolving Practice Authority, Michelle Hileman Msm, Rn, Cnm, Parkview Health

Nursing Publications, Posters, & Presentations

Presented at the 2025 Parkview Nursing Research Symposium.

The purpose of this literature review is to explore professional liability for RNs and APRNs. Specific objectives include:

• Identify patterns in malpractice claims for RNs and APRNs

• Compare employer-provided and personal malpractice coverage

• Examine the impact of scope-of-practice laws on APRN liability

• Clarify principles of vicarious liability

• Recommend lifelong strategies for education, risk management, and professional practice

Pairing Vashe And Cavilon Advanced Skin Protectant For An Innovative Approach To Neonatal Diaper Dermatitis Treatment, Jennifer Thieman Msn, Rn, Accns-P, Rnc-Nic, C-Elbw, Cls

Nursing Publications, Posters, & Presentations

This poster was presented at the 2025 Nursing Research Symposium.

Objective: To implement a new process that allows Vashe and Cavilon Advanced Skin Protectant to be used together in order to improve healing time of diaper dermatitis.

Operation Honor: Honoring Our Veterans In The Medical Intensive Care Unit, Kendra Manns Msn,Rn, Dawn Wind Rn

Nursing Publications, Posters, & Presentations

Presented at the 2025 Parkview Nursing Research Symposium.

A coworker had an impressionable conversation with a patient and their family regarding end of life. During this conversation she found out the patient was a veteran. This conversation made her aware of a care gap we could fill. She approached the NCAT chair to brainstorm ideas. After months of discussion and research, Operation Honor was born.

Two goals of this project: 1)To honor veterans and their families

To improve staff morale surrounding the loss of a patient as well as providing the patient with a “good death”

Delivering Change: A Hospital’S Journey To Midwifery Care, Nataley Frane Bsn, Rn, Shavon Fitts Msn, Rn, Kim Noga Msn, Rn, Rnc-Mnn, Ibclc, C-Efm, Angela Russ Russ Msn, Rn, Rnc-Mnn, Ibclc, Lisa Smith Msn, Rn, Np-C, Agcns-Bc, Rnc-Ob, Allison Thorpe Mba, Msn, Cnm

Nursing Publications, Posters, & Presentations

This poster was presented at the 2025 Parkview Nursing Research Symposium.

The addition of the Certified Nurse Midwife Program at Parkview Randallia’s Family Birthing Center will:

•Increase regional access to the midwifery model of care • Provide additional labor and birth options

• Water immersion during labor & waterbirth

• Nitrous oxide

• Enhanced labor comfort measures (light/sound machines, birthing stools, birthing balls, etc.)

• Help meet increased patient demand for the above services and alleviate bed capacity issues at the regional medical center

Quality Improvement Project: Improving Tardive Dyskinesia Detection And Management Through Aims Scale Utilization In Outpatient Psychiatry Clinic, Judeline Docteur

Doctor of Nursing Practice Projects

Tardive dyskinesia (TD) is a debilitating movement disorder commonly associated with prolonged antipsychotic medication use. The disorder results in functional impairment and reduced quality of life for those affected. Frequent TD screening using scales such as the Abnormal Involuntary Movement Scale (AIMS) for those on antipsychotic medication is recommended. However, its underutilization due to a lack of awareness, confidence, and knowledge of its applicability contributes to delayed detection and management, resulting in poor patient outcomes. The purpose of this quality improvement project was to improve TD detection and management through healthcare provider training to affect their self-efficacy and knowledge and …

Quality Improvement Project - Test Anxiety In Nursing Students: Reducing Stress And Anxiety In The Testing Environment, Aaron Gann

Doctor of Nursing Practice Projects

Nursing student retention is a critical issue due to limited clinical placements and faculty shortages, with many students citing test anxiety as a barrier to success in high-stakes National Council Licensure Examination (NCLEX) testing. The problem the Doctor of Nursing Practice (DNP) project identified is the lack of targeted interventions for test anxiety at the project site, a two-year community college’s associate degree nursing (ADN) program. The DNP project aimed to evaluate the efficacy of an Assessment Technologies Institute (ATI) test anxiety module on students’ course quiz scores and self-reporting of emotional barriers as measured by the depression, anxiety, and …

Building Confidence In Critical Thinking Through Faculty Implementation Of Simulation, Melissa Morris

Doctor of Nursing Practice Projects

Simulation provides nursing students with experiences that are as effective as clinical experiences in a non-threatening environment. Clinical experiences such as obstetrics, pediatrics, and mental health have been observation only at the project site. With observation-only clinicals, students do not have opportunities to master skills specific to nursing, which bridge theory to practice. The purpose of this Quality Improvement (QI) project focuses on educating nursing faculty who may not be simulation experts to learn the skills to build and implement simulations that align with the International Nursing Association Clinical and Simulation Learning (INACSL) simulation standards. The Primary Investigator (PI) utilized …

Enhancing Faculty Confidence And Candidate Selection: Evaluation Of A Standardized Holistic Interview Rubric In Nursing Program Admission, Jennifer M. Bray

Doctor of Nursing Practice Projects

Nursing programs continue to struggle with high attrition rates, which impact student success, program outcomes, and the development of a competent nursing workforce. National data show that associate degree nursing programs report attrition rates as high as 50% in the first year, highlighting the urgency for more effective admission strategies. The problem addressed in this quality improvement project was the use of traditional academic metrics, such as grade point average (GPA) and standardized test scores, as primary admission criteria, which often overlook essential non-cognitive attributes linked to student persistence and success. The purpose of the project was to improve faculty …

The Impact Of Staff Education On Menopausal Care, Oluwatoyosi Olumide

Doctor of Nursing Practice Projects

Natural menopause typically occurs around the age of 51. During this transition, many women experience a variety of vasomotor symptoms, with hot flashes and night sweats being the most common. As women age, diminishing levels of estrogen, progesterone, and testosterone can lead to various health complications. Without proper assessment, diagnosis, and treatment, many may suffer in silence. This quality improvement project sought to evaluate the impact of staff education on menopausal care. The symptom checklist, or the Menopause Rating Scale (MRS), is a standardized, evidence-based tool for assessing menopause symptoms and serves as an essential component of the admission process …