Nursing Commons^™

Staff Education To Improve Behavioral Health Integration In Primary Care, Nelly Endah Atu

Walden Dissertations and Doctoral Studies

This staff education project addressed a persistent gap in the delivery of integrated physical and mental healthcare for patients with co-occurring conditions. Fragmented care in primary care contributes to untreated mental health needs, increased patient distress, higher costs, and poor outcomes. The aim of this project was to develop, deliver, and evaluate a staff education program equipping nurses, nurse practitioners, and interdisciplinary team members with the knowledge, skills, and practical strategies needed to improve behavioral health integration in primary care. The practice question was, among interdisciplinary staff in a community health setting, did the implementation of an evidence-based, ADDIE-designed staff …

Relationship Between Hospital Case Management Leadership Style And Employee Engagement, Malinda Ellis

Walden Dissertations and Doctoral Studies

Employee engagement among hospital-based nurse case managers is important because these nurses support discharge planning, utilization management, care coordination, and safe patient transitions. Although leadership style has been studied in nursing, limited research has examined its relationship to engagement among nurse case managers. The purpose of this quantitative, nonexperimental, correlational study, using House’s path-goal theory, was to examine the relationship between transformational, transactional, and laissez-faire leadership styles and employee engagement among hospital-based nurse case managers. Data were collected from 89 registered nurse case managers in acute care settings in the United States, who completed the Multifactor Leadership Questionnaire, Short Form, …

Frailty And Activities Of Daily Living In Older Adults In Primary Care: A Cross-Sectional Study, Öznur Adadıoğlu, Ahmet Seven, Esin Danç

Makara Journal of Health Research

Background: This study aimed to examine frailty status and activities of daily living among older adults.

Methods: This descriptive and cross-sectional study was conducted with 306 voluntary participants aged 65 years and older who were registered at a primary healthcare center in a city in Türkiye. Data were collected using the Participant Information Form, the FRAIL Scale, and the Katz Index of Activities of Daily Living.

Results: Among the participants, 36.9% were non-frail, 42.2% were pre-frail, and 20.9% were frail. The mean Katz Index score was 5.42 ± 1.35. The mean scores of activities of daily living …

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …

Validity And Reliability Of The Turkish Nursing Students’ Self-Perceptions About Safe Medication Management, Derya Şimşekli, Bedriye Cansu Koyunoğlu, Elanur Yilmaz Karabulutlu

Makara Journal of Health Research

Background: Safe medication management is central to nursing education and patient safety. To the best of our knowledge, there is currently no validated Turkish instrument specifically designed to assess nursing students’ self-perceptions regarding safe medication management. This study aimed to evaluate the validity and reliability of the Turkish version of the Nursing Students’ Self-Perceptions about Safe Medication Management (NURSPeM).

Methods: This methodological study was conducted at a single university using convenience sampling. Data were collected from a sample of 400 nursing students using the NURSPeM. Construct validity was examined with confirmatory factor analysis (CFA). Internal consistency was evaluated …

Needlestick Injury Risk And Preventive Behaviors Among Nursing Students, Angga Wilandika, Riandi Alfin, Rosa Intan Khoerunnisa

Makara Journal of Health Research

Background: Needlestick injury (NSI) remains a persistent occupational safety risk for nursing students during clinical practice, with implications for worker safety, patient care, and healthcare safety systems. Understanding preventive safety behavior within clinical training environments is essential for improving workplace safety in healthcare settings.

Methods: A cross-sectional study was conducted among nursing students undertaking hospital-based clinical placements. Using a purposive sampling, participants completed a structured self-administered questionnaire assessing NSI exposure, preventive safety behaviors, clinical supervision, safety training, and perceived safety within the clinical learning environment. Data was analyzed to identify patterns of NSI risk and associated preventive behaviors. …

Staff Education On Frailty And Senior Surgical Safety, Kimberly Buhay Gibu

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed a practice gap involving limited education on frailty assessment and senior surgical safety within the general surgery department of a large, integrated healthcare system. Frailty is associated with increased postoperative complications, hospitalizations, readmissions, and mortality among older adults, making early recognition essential to improving surgical outcomes. The practice-focused question project was: Does education on frailty screening and senior surgical safety improve the knowledge, confidence, and intent of general surgery staff in a large, integrated health system? The purpose was to develop, implement, and evaluate an evidence-based educational intervention. The project was guided by the …

Staff Education To Improve Blood Pressure Reassessment And Referral Practices In An Urgent Care Setting, Carolyn Denise Kluttz

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education and quality improvement initiative designed to improve blood pressure (BP) reassessment and referral compliance among adult patients presenting with elevated BP readings in an urgent care setting. Elevated blood pressure is frequently identified during urgent care visits; however, provider responses and follow-up recommendations are often inconsistent, creating missed opportunities for early identification and intervention. The practice-focused question guiding this project was: In adult patients presenting to urgent care settings, how does implementing a standardized nurse-led hypertension screening and referral protocol, compared with usual care, affect the identification and follow-up …

Staff Education On Improving Medication Adherence, Oneil Dobgima Galega

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed a practice gap in an outpatient behavioral health setting involving inconsistent use of structured communication strategies to support medication adherence among psychiatric patients. Although nurses routinely provided medication instructions, approaches such as motivational interviewing and psychoeducation were underutilized, limiting patient engagement, understanding, and adherence, and ultimately affecting care continuity and outcomes. The purpose of the project was to improve psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation to enhance medication adherence. The guiding practice-focused question examined whether a structured educational intervention could strengthen nurses’ competencies in these communication strategies. …

Staff Education To Improve Nursing Knowledge On Pressure Injury Prevention, Kheeda Kimberly Gopaul

Walden Dissertations and Doctoral Studies

Staff education in this project was focused on improving nursing staff’s knowledge on pressure injury prevention, inspired by the persistent care quality gap. The gap in practice as of 2024 related to hospital-acquired pressure injury (HAPI) at the host health organization was reported to be approximately 0.2 per 1,000 discharges. It was apparent that education could benefit the nursing staff to improve their knowledge in pressure injury prevention. The education in service focused on continuous nursing skin assessments, to ensure over prolonged hospitalization, patients’ skin does not deteriorate with the development of pressure injuries or advancing of pre-existing pressure ulcers. …

Addressing Implicit Bias Toward Patients With Substance Use Disorders Through A Staff Education Quality Improvement Initiative, Jeanne Baleng Okuwobi

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education quality improvement (QI) initiative designed to reduce implicit bias among healthcare providers toward patients with substance use disorder (SUD) at a community mental health center. Provider implicit bias toward patients with SUD contributes to stigma, inequitable care, reduced treatment engagement, and poorer health outcomes; addressing this bias is essential to advancing patient safety, health equity, and quality nursing care. The practice-focused question guiding this project asked whether a 9-week evidence-based staff education program incorporating didactic instruction and reflective practice would reduce provider implicit bias toward patients with SUD compared with current practice, which …

Staff Education For Medication Adherence Among Adults With Major Depressive Disorder In A Private Outpatient Psychiatric And Mental Health Practice, Judith Timbui Eta

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project implemented a staff education initiative to improve medication adherence among adults with major depressive disorder (MDD) in a private outpatient psychiatric and mental health practice. Medication nonadherence remains a significant barrier to effective depression treatment and is associated with symptom relapse, increased healthcare utilization, and poorer patient outcomes. Evidence supports provider education as an effective strategy for improving adherence-related practices. The project examined whether a targeted educational intervention could improve staff knowledge and confidence in promoting medication adherence over a 12-week implementation period. Guided by the Johns Hopkins Evidence-Based Practice Model and the …

Registered Nurses’ Knowledge, Self-Efficacy, And Willingness To Assess Near-Fatal Strangulation: Development Of The Near-Fatal Strangulation Self-Efficacy Scale, Morgan Kenady Mcmahon

Walden Dissertations and Doctoral Studies

Near-fatal strangulation (NFS) is a time-critical clinical presentation associated with elevated risk of stroke, delayed airway compromise, and future intimate partner homicide, yet no validated instrument existed to assess nurses' NFS-specific knowledge or self-efficacy. The purpose of this cross-sectional study, guided by Bandura's social cognitive theory and Benner's novice to expert theory, was to develop and pilot test the Nurses' Near-Fatal Strangulation Self-Efficacy Scale (NFS-SES) and to examine whether knowledge and self-efficacy predicted nurses' willingness to conduct an NFS assessment. A convenience sample of 150 registered nurses in emergency, labor and delivery, and obstetric emergency departments completed the NFS-SES, a …

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

Fireready Oc: Developing A Public Health Protocol For Wildland-Urban Interface (Wui) Fire Events In Orange County, Christian Andre O. Gequillo, Allyson Hayakawa, Selin Erdogan, Natalie Albarran

Master's Projects and Capstones

Objective/Problem: Wildland-Urban Interface (WUI) fires expose communities to a greater number of hazardous pollutants than traditional wildfires and can pose significant health risks; however, Orange County does not have a standardized public health protocol to address WUI fires. A review of the literature identified the need for standardized WUI fire guidance that is focused on improved preparedness and response. Aim: The FireReady OC quality improvement project aimed to develop an evidence-based public health protocol to improve Orange County’s public health preparedness and response for WUI fire events from 0% to 10% during the 12-week period from May 27, 2026, to …

Food For Thought: Building Confidence In Healthy Food Choices Among Seniors In A Residential Facility Through Nutrition Education, Amy Rodríguez

Master's Projects and Capstones

This quality improvement project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence among independently living older adults residing in a low-income senior housing community. Aim By August 10, 2026, this project aimed to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthy meals by 20% among senior housing facility residents. Methods A microsystem assessment, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide project development and implementation. Weekly nutrition education workshops were conducted over a 10-week period and included presentations, group discussions, …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Standardizing Gestational Diabetes Group Education In An Outpatient Maternal-Fetal Medicine Clinic: A Quality Improvement Project, Nina Prieto

Master's Projects and Capstones

Gestational diabetes mellitus (GDM) requires timely and consistent education to support effective self-management and reduce maternal and fetal complications. Baseline assessment of an outpatient maternal-fetal medicine clinic identified variation in educational materials, teaching approaches, referral processes, scheduling, and workflows across English- and Spanish-language GDM group visits. This quality improvement project aimed to standardize the group visit process and increase staff compliance with standardized materials and workflows from 0% to 50% over a 12-week period. Data were collected through direct observation of group and individual education sessions, stakeholder feedback, review of existing materials, referral and attendance patterns, and workflow analysis. These …

Improving Nursing Adherence To Chg Bathing And Pivc Maintenance Practices To Reduce Hospital-Onset Bacteremia In An Adult Medical-Surgical Unit, Mohabat Barikzai, Dinazar Altamirano, Edward Rivas, Sarah Trilles

Master's Projects and Capstones

Preventing hospital-onset bacteremia (HOB) is a healthcare priority given its association with increased morbidity, mortality, prolonged hospitalization, and healthcare costs. Literature identifies inconsistent adherence to evidence-based practices for chlorhexidine gluconate (CHG) bathing and peripheral intravenous catheter (PIVC) maintenance as a modifiable risk factor for HOB. This quality improvement (QI) project evaluated whether implementing standardized nurse education, routine compliance audits, and performance feedback would improve adherence to evidence-based CHG bathing and PIVC maintenance practices. The project aimed to achieve at least 90% nursing compliance with HOB prevention practices over an intended 8-week implementation period. A pre-post quality improvement design was implemented …

Improving Pressure Injury Prevention Through Braden Scale Compliance And Education In The Emergency Department, Joycelyn Lee, Kira Simone Faerstain, Alyssa Kristine Ortiz, Ashley Briseida Cruz

Master's Projects and Capstones

Pressure injuries are a major burden in healthcare, particularly in the Emergency Department (ED). Patients can be sedentary for prolonged periods of time and don't always get their skin checked promptly. Patients visiting the ED often have comorbidities and patient-specific medical needs, such as seniors with fragile skin, malnourishment, immobility, etc. At a Southern Los Angeles Hospital, leadership found that there was a need for improvement in this area. Implementing standardized risk assessment methods can help to improve the consistent use of the Braden Scale as a predictive and preventive tool for identifying patients' risk for pressure injuries and promoting …

Cultivating Civility: A Multicomponent Approach To Reducing Workplace Incivility In An Assisted Living Facility, Sanam Bral, Kaylyn Chang, Catherine Dinh, Sanjil Kumar, Truc Mai Moon

Master's Projects and Capstones

Workplace incivility remains a common challenge in healthcare, negatively affecting communication, staff well-being, and the quality and safety of resident care. Baseline survey findings from a faith-based assisted living facility in Southern California identified concerns related to workplace incivility, psychological safety, and gaps in staff knowledge of available reporting resources. This project aimed to reduce workplace incivility by improving staff knowledge and recognition of uncivil behaviors, with a target of at least 90% staff training attendance among nursing, assistive nursing, and medical technicians, and 80% attendee-reported high confidence level (agree or strongly agree) in recognizing incivility and understanding reporting options. …

Breaking The Silence: Standardizing Routine Intimate Partner Violence Screening At A Community Clinic Serving The Latinx Community, Victoria M. Hall

Master's Projects and Capstones

Intimate partner violence (IPV) affects the Latinx population disproportionately due to socioeconomic status, cultural stigma, and language barriers. However, routine screening remains inconsistent and unstandardized at a local community clinic in San Francisco’s Mission District, despite evidence-based practices recommending it. The gap in IPV screenings across the Adult, Teens, and Women’s clinics resulted in only 1.6% of patients being screened in July 2025 and 4.1% in June 2026. This quality improvement project aimed to address low screening rates by standardizing IPV screening through a printed bilingual screener, a 60-minute staff in-service on IPV and the new screening protocol, and by …

The Parkinson's Pathway: Enhancing Knowledge And Care Management In Skilled Nursing, Kaitlyn Chau

Master's Projects and Capstones

Parkinson’s disease (PD) is commonly diagnosed among the older population, contributing to high utilization of skilled nursing facility (SNF) services. Objective: SNF A’s current onboarding and training program for staff discussed general geriatric topics but failed to include structured PD-specific education. This may lead to gaps in competence, confidence, and workflow related to PD care and management, resulting in low quality of patient care, poor health outcomes, and decreased safety and satisfaction. Aim: The project aimed to establish and incorporate a structured PD-specialized education program within a SNF located in Northern California, to increase employees’ self-reported confidence, competence, …

Standardizing Group Visits For Gestational Diabetes Education: A Quality Improvement Initiative In An Outpatient Maternal-Fetal Medicine Clinic, Nha Nguyen

Master's Projects and Capstones

Objective: At an outpatient maternal-fetal medicine clinic in Northern California, gestational diabetes mellitus (GDM) education is delivered inconsistently across nurse practitioners (NPs) and registered dietitians (RDs), with no standardized curriculum, referral criteria, or educational materials. Aim: By August 12, 2026, this project aimed to develop and implement a standardized GDM group visit framework for NPs, RDs, and scheduling staff in maternal-fetal medicine clinic, increasing compliance with standardized referral, enrollment, and educational processes from a baseline of 0% to 50%. Methods: Using baseline observations, workflow assessment, stakeholder input, and a literature review, the QI team developed standardized bilingual slide …

Reducing Variation, Improving Outcomes: Standardizing Gestational Diabetes Mellitus Education In A Clinical Microsystem, Thanh Le

Master's Projects and Capstones

Objective: Variations in referral, scheduling, delivery of educational information, patient materials, and documentation hampered the quality of gestational diabetes mellitus (GDM) education in the outpatient maternal-fetal medicine clinic. Purpose: The aim of the quality improvement project was to boost adherence to a standardized GDM group education framework from 0 to 50% in the course of 12 weeks and assess attendance at group visits. Methods: The microsystem analysis was conducted based on observations of group visits conducted in Spanish and English, examination of current processes and resources in use, educator pre-survey, SWOT analysis, and cause and effect analysis. The implementation of …

Addressing Food Insecurities Through Staff Education In The Rural Health Setting, Angela Dawn Suttle

Walden Dissertations and Doctoral Studies

Rural America, including Arkansans, face a number of social determinants of health (SDOH) including food insecurities (FIs) and the inability to access nutritious food. FIs contribute to poor outcomes and increases healthcare utilization. Inconsistent screenings for FIs in adults living in the rural health clinic (RHC) setting, lack of standardized workflows, and failure to provide community resources when FI is identified represents a significant gap in practice. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to increase utilization of screening tools for FI, implement a standardized workflow, and provide patients with resources to improve …

Implementation Of A Nurse-Led Self-Measured Blood Pressure Program In Rural Primary Care, Stephanie Marie Montgomery

Walden Dissertations and Doctoral Studies

Hypertension remains a leading modifiable risk factor for cardiovascular morbidity and mortality, yet blood pressure control remains suboptimal among many adults, particularly those receiving care in rural primary care settings. Reliance on office-based blood pressure measurements may limit opportunities to identify uncontrolled hypertension and actively engage patients in disease self-management. This Doctor of Nursing Practice quality improvement project evaluated the implementation of a standardized self-measured blood pressure (SMBP) program for adult patients with hypertension in a rural primary care practice. The intervention included validated home blood pressure monitors, standardized patient education, teach-back to verify measurement competency, structured home blood pressure …

Staff Education To Improve Hand Hygiene And Personal Protective Equipment Compliance, Suliat Oluwa

Walden Dissertations and Doctoral Studies

This doctoral project is a staff education initiative designed to strengthen hand hygiene and personal protective equipment (PPE) practices among interdisciplinary staff in a long-term care (LTC) facility. The practice problem addressed inconsistent hand hygiene and PPE use across shifts and departments, contributing to healthcare-associated infections (HAIs). Because LTC residents are highly vulnerable due to advanced age, multiple comorbidities, and shared living environments, improving adherence to infection prevention practices is essential for enhancing resident safety, reducing preventable infections, and supporting compliance with Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) infection prevention standards. …

Staff Education To Improve Staff Knowledge Of Evidence-Based Strategies That Support Medication Adherence Among Patients Diagnosed With Depression In The Outpatient Clinic Setting, Comfort Aziwung Awungafac

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an evidence-based practice staff education initiative designed to improve staff knowledge of evidence-based strategies that support medication adherence among patients diagnosed with depression in an outpatient clinic. Medication nonadherence is associated with poor treatment outcomes, symptom relapse, and reduced quality of life, highlighting the need for staff education on adherence-promoting interventions. The practice-focused question examined whether a structured educational intervention would improve staff knowledge of evidence-based medication adherence strategies over an 8-week period.