Nursing Commons^™

Quality Improvement Project Assessment Of Emergency Department Staff Knowledge On Use Of Emergency Severity Index In A Critical Access Hospital: Implementation Of Emergency Department-Based Education Program., Amanda Taylor

Doctor of Nursing Practice Projects

In rural emergency departments, accurate triage is vital to ensuring patient safety and maximizing limited resources. This quality improvement project aimed to strengthen triage practices by enhancing nurses’ understanding and confidence in using the Emergency Severity Index (ESI), a standardized tool for assessing patient acuity. Ten registered nurses at a seven-bed critical access hospital participated in a structured educational program, guided by Lewin’s Change Theory and Benner’s Novice to Expert Theory. The intervention included hands-on training, real-world scenarios, and self-assessment surveys. After the program, nurses showed significant gains in both knowledge (mean scores rose from 70.0 to 88.9, p < .001) and confidence (from 13.5 to 23.2 out of 25). While the small sample size and short timeline were limitations, the results highlight the value of ongoing education in improving triage accuracy and patient care. This project offers a practical model for rural hospitals seeking to enhance emergency nursing practice and promote consistent, evidence-based decision-making.

Social Determinants Of Health, Jennifer Simoes

MSN Student Capstones

No abstract provided.

Enhancing Hypertension Management: Ambulatory Nurse-Led Home Blood Pressure Monitoring Initiative, Kristen Hanks

MSN Student Capstones

No abstract provided.

Improving Employee Satisfaction Through The Implementation Of Unit Based Council, Colleen A. Claffey

MSN Student Capstones

No abstract provided.

Improving Oral Chemotherapy Adherence, Jessica Bynum

MSN Student Capstones

No abstract provided.

Quality Improvement Project: Impact Of Educational Intervention On Post-Acute And Long-Term Care Staff's Confidence And Accuracy In Aims Screening For Tardive Dyskinesia, Tana Whitt

Doctor of Nursing Practice Projects

Tardive dyskinesia (TD) is a chronic, often irreversible movement disorder associated with prolonged antipsychotic use. In post-acute and long-term care (PALTC) settings, inconsistent Abnormal Involuntary Movement Scale (AIMS) screening practices and limited clinician education contribute to under recognition and delayed treatment. This Doctor of Nursing Practice (DNP) quality improvement (QI) project evaluated whether an educational intervention impacted clinicians’ knowledge, confidence, and perceived importance of AIMS screening among licensed and unlicensed PALTC staff. Guided by Donabedian’s Model of Quality and Kotter’s 8-Step Change Model, the project used a pre-test/post-test design to measure outcomes before and after completion of the Drug-Induced Movement …

Improving Cauti Prevention In Long-Term Care: An Educational Intervention To Enhance Staff Confidence And Reduce Infection Rates, Diana Meseha

Doctor of Nursing Practice Projects

Catheter-associated urinary tract infection (CAUTI) is a common preventable healthcare-associated infection in long-term care. knowledge gaps and inconsistent catheter care by staff and increased catheter-associated urinary tract infection rates. The purpose of this quality improvement project aims at testing whether using a structured educational intervention led to improved confidence of staff and reduced catheter-associated urinary tract infection rates. The project employed Bandura's Social Cognitive Theory and Lewin's change model in guiding the behavior and organizational change. A quasi-experimental pretest post-test design was used with the enrolment of nursing employees such as registered nurses, licensed practical nurses and certified nursing assistants …

Quality Improvement Initative To Reduce Falls Among Geriatric Patients In The Inpatient Mental Health Setting, Regina Johnson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are widely recognized as a leading cause of injury and hospitalization among older adults, with geriatric psychiatric patients at particularly high risk due to polypharmacy, cognitive impairment, and mobility challenges. At the project site, baseline audits revealed inconsistent use of structured fall risk tools, limited nurse-driven medication review, and gaps in post-fall documentation. The absence of an embedded electronic health record feature for medication review highlighted a significant practice gap requiring intervention.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce fall risk in a geriatric psychiatric hospital through structured post-fall medication …

Enhancing Nursing Documentation Accuracy For Female External Urinary Collection Devices Through Structured Documentation Huddles, Tiffany Ealy

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Accurate documentation of female external urinary collection devices (EUCDs), such as the PureWick, is crucial for maintaining continuity of care and ensuring efficient resource utilization. However, inconsistent nursing documentation practices have led to gaps in regulatory compliance and communication among healthcare teams. Baseline data revealed frequent omissions and inaccuracies in female EUCD charting, indicating a significant practice gap that requires targeted improvement.

Aim of the Project: The purpose of the evidence-based practice (EBP) project was to improve nursing documentation accuracy for female EUCDs by implementing structured documentation huddles, thereby enhancing organizational compliance.

Review of the Evidence: A …

Improving Pain Assessment After Bedside Percutaneous Endoscopic Gastrostomy (Peg) Placement, Sherman Cotton

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Baseline audits at a 44-bed critical-illness recovery hospital showed low reliability in two post-PEG practices: (1) pain reassessment within 90 minutes of an intervention and (2) complete PEG-site documentation (skin, drainage, tube position/measurement). Baseline performance averaged 55% and 62%, both of which were below the organization’s 90% benchmark.

Aim of the Project: From May to July 2025 (12 weeks), improve on-time pain reassessment and ensure PEG-site documentation reaches at least 90%, maintaining this level for three or more consecutive weeks; monitor workload to prevent increases in perceived charting time and ensure safety by avoiding a rise in PEG-related …

Implementing Pain Reassessment Workflow To Improve Timely Pain Management In Hospice Patients: A Quality Improvement Project, Oluremi Omodara

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.

Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours …

Advancing University Student Health And Wellbeing Through Peer-Led Health Promotion: A Quality Improvement Project​ ​, Rojeda Merani, Elizabeth Page, Elizabeth Roth

DNP Projects

Background: Peer-led health promotion is widely recognized as an effective strategy for increasing engagement, trust, and health literacy among university students. However, few frameworks guide development and implementation of these programs.

Objective: To evaluate the feasibility, implementation process, and perceived effectiveness of a peer-led health promotion model supported by Doctor of Nursing Practice (DNP) mentorship at a mid-sized private university.

Participants: Thirteen undergraduate students from a diverse set of academic programs were recruited as Peer Health Ambassadors (PHAs) and paired with DNP student mentors.

Methods: Guided by the Implementation Research Logic Model, the project used a four-phase QI process: targeted …

Quality Improvement Project Improving Faculty Support For First-Generation Rural Nursing Students, Charlotte Dowdy

Doctor of Nursing Practice Projects

The barriers to academic success among first-generation rural nursing students are substantial, including a lack of knowledge of academic resources, ineffective study strategies, and difficulty navigating the higher education system. These challenges are documented in the literature as resulting in higher attrition rates and lower graduation rates. This quality improvement project was intended to implement and analyze a faculty training module designed to increase faculty awareness and confidence in supporting first-generation rural nursing students at the project site. The project adopted a pre-post intervention design based on High-Reliability Organization principles and Lewin’s Change Model, to determine the effectiveness of targeted …

Quality Improvement Project Providing Accessible Evidence-Based Education To Nurses Throughout A National Healthcare System, Bailey Wells

Doctor of Nursing Practice Projects

The pursuit of ongoing professional development and learning is crucial to ensure nurses remain well-informed about healthcare trends and have access to the most up-to-date evidence-based materials. This quality improvement project aimed to implement a monthly educational series for nursing personnel within the Veterans Health Administration (VHA) through expansion of the Veterans Administration (VA) – Extension for Community Healthcare Outcomes (ECHO) program. Using Bandura’s Self-Efficacy Theory of Motivation in Psychology, participants’ previous knowledge was linked to continued professional development. The plan, do, study, act (PDSA) framework provided structure for the project, with the awareness, desire, knowledge, ability, and reinforcement (ADKAR) …

Quality Improvement Project Improving Fall Risk Protocol Compliance Through A Structured Fall Prevention Program In A Skilled Nursing Facility, Lakeesha Jenkins

Doctor of Nursing Practice Projects

Falls remain a persistent patient-safety threat in skilled nursing facilities (SNFs). At a Dallas–Fort Worth SNF, a needs assessment identified rising unassisted falls and inconsistent protocol adherence. This quality improvement (QI) project examined whether a structured, evidence-based bundle could improve staff knowledge and fall-prevention processes and reduce falls over four weeks. Guided by Lewin’s Change Theory and implemented with Plan–Do–Study–Act (PDSA) cycles, the pre–post design engaged direct-care staff (registered nurses, licensed vocational nurses, certified nursing assistants; n = 20). The intervention included standardized risk screening with the Morse Fall Scale (MFS), targeted staff education, high-risk visual identifiers, and post-fall huddles. …

Quality Improvement Project Enhancing Provider Education On Phq-9 Depression Screening To Improve Compliance, Obianuju Okafor

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide; however, screening in primary care remains inconsistent. Even though the Patient Health Questionnaire-9 (PHQ-9) is a validated screening tool, its use is often limited by insufficient provider training. This quality improvement (QI) project aimed to evaluate the impact of structured provider education on PHQ-9 screening practices, with the purpose of improving provider knowledge, confidence, and adherence to screening guidelines in a primary care setting. Guided by Donabedian's Model of Quality Care and Lewin's Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, the project used a one-group pre/post design at an outpatient …

Quality Improvement Project Enhancing Nursing Faculty Competency In Dimensional Analysis: A Quality Improvement Initiative, Kimberly Mcdonald

Doctor of Nursing Practice Projects

Medication dosage calculation errors remain a persistent concern in nursing education and practice, often tied to inconsistent teaching methods that leave students unsure and underprepared. Dimensional analysis (DA) has been shown to improve accuracy and confidence in solving dosage problems, yet many faculty have not received structured training in this method. To address that gap, a quality improvement (QI) project introduced a six-week DA training program for nursing faculty in a pre-licensure program. The initiative was guided by the Roy Adaptation Model and Bandura’s Self-Efficacy Theory, with change supported through Kotter’s 8-Step Model and the Plan-Do-Study-Act framework. Using a quasi-experimental, …

Quality Improvement Project Diabetes Self-Management Education Training Program, Guylene Lucien

Doctor of Nursing Practice Projects

Diabetes is among the leading causes of morbidity and mortality in the United States; therefore, effective Diabetes Self-Management Education (DSME) is vital in improving patient outcomes. A needs assessment of the Practice site identified gaps in provider confidence and frequency and consistency of delivering DSME that correlated with poor patient adherence and readmissions. The purpose of this quality improvement (QI) project was to implement a structured, evidence-based DSME training program to improve healthcare provider self-efficacy to provide DSME. The project utilized Bandura's Social Cognitive Theory and the ADKAR change model and employed a quasi-experimental, one-group pretest–posttest design. Ten providers (six …

Quality Improvement Project The Role Of Targeted Education And Its Impact On Self-Efficacy And Cognitive Impairment Recognition Among Medical Assistants, Jicky Guzman

Doctor of Nursing Practice Projects

Primary care teams develop lasting relationships with patients that can reveal subtle cognitive changes during routine visits (e.g., identity verification and brief mobility checks). Yet, cognitive decline often goes unnoticed and poorly documented, which can lead to delayed care. This quality improvement (QI) project addressed a gap in the detection of mild cognitive impairment (MCI), such as Alzheimer’s disease (AD), among frontline staff. It assessed whether an educational intervention could improve self-efficacy in recognizing early cognitive impairment, measured by the General Self-Efficacy Scale (GSES). Guided by Bandura’s Self-Efficacy Theory and Lewin’s change model, a quasi-experimental pretest–posttest study was conducted at …

Raising Provider Awareness Of Fluid Status In Women Undergoing Elective Cesarean Section Through The Use Of A Preoperative Checklist To Assess Fluid Status: A Quality Improvement Project, Marcus Miller, Michael Sorge

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Abstract

Maternal hypotension following neuraxial anesthesia during cesarean section is a common and potentially harmful complication. While vasopressors are often used for this issue, they carry risks to fetal well-being. Goal-directed fluid therapy (GDFT) provides an individualized approach that may improve outcomes by optimizing fluid status perioperatively. This quality improvement project aimed to increase provider awareness of fluid status through the implementation of a preoperative checklist that assessed fluid status in women undergoing cesarean section. A preoperative fluid assessment checklist was developed using evidence-based predictors of fluid status and integrated into anesthesia workflow. The project followed the Plan-Do-Study-Act cycle and …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

Quality Improvement Initiative For Emergency Cesarean Delivery: Implementation Of Rapid Sequence Spinal Anesthesia, Hunter L. Baselj, Joseph A. Gabster

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Abstract

Background: General anesthesia (GA) for emergency cesarean sections (EmCS) poses potential risks Rapid Sequence Spinal Anesthesia (RSSA) offers a promising alternative that preserves benefits of neuraxial anesthesia while accommodating the urgency of EmCS. This quality improvement (QI) project aimed to implement and evaluate the use of RSSA at a teaching hospital, utilizing a decision-tree tool to enhance clinical efficiency and assess provider perceptions regarding its impact on airway complications and post-operative pain outcomes. Methods: A RSSA decision-making chart was developed and introduced to anesthesia providers at a teaching hospital. A total of 16 providers, including CRNAs, SRNAs, and anesthesiologists, …

Implementing A Delirium Risk Assessment Protocol For Older Adults To Reduce Post-Operative Delirium, Toni-Ann Thompson

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to reduce post-operative delirium (POD) in patients aged 65 years and older in a post-anesthesia care unit (PACU) through the implementation of the Confusion Assessment Method (CAM) tool.

BACKGROUND

POD is a significant issue in the PACU, especially among older adults. POD can increase the length of stay in the PACU and hospital, and also increase rates of morbidity and mortality. Prior to this QI project, there was no standardized test being used to screen patients.

METHOLOGY

The Plan-Do-Study-Act (PDSA) cycle was used throughout the implementation of the confusion assessment tool to guide quality …

Quality Improvement Project Evidence-Based Practice For The Use Of Lower Fio2 Concentration Amongst Pediatric Anesthesia Providers, Brittany Raines

Doctor of Nursing Practice Projects

Hyperoxia during pediatric anesthesia is linked to postoperative pulmonary complications such as atelectasis and oxidative lung injury. Despite strong evidence supporting the use of lower inspired oxygen concentrations (FiO2), many providers habitually administer 100% oxygen during induction and emergence due to tradition and lack of formal guidelines. This quality improvement project aimed to reduce unnecessary hyperoxia by educating pediatric anesthesia providers on evidence-based FiO2 titration strategies. Guided by Kolb’s Experiential Learning Theory and Lewin’s Change Theory, a quasi-experimental one-group pretest/posttest design was employed. Sixteen certified registered nurse anesthetists (CRNAs) and physician anesthesiologists completed baseline surveys, participated in a targeted educational …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Enhancing Adherence To Oxytocin Administration Guidelines To Reduce Postpartum Hemorrhage Rates In A Labor And Delivery Unit, Maya Denny

Master's Projects and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) remains a critical challenge in maternal care. It shows a 13% PPH incidence rate in a high-risk labor and delivery unit in a northern California medical center, exceeding the national benchmark of 5%–10% based on 2021 ACOG data from 150 patient records.

Problem: There is inconsistent adherence to oxytocin administration guidelines, with only 60% of 100 audited charts documenting fetal and uterine activity, contributing to the elevated rate. The team is looking for a target rate of 90%.

Intervention: This involves implementing a checklist, providing training for 25 clinicians, and conducting two 30-minute simulation scenarios …

Improving Medication Adherence In Patients With Uncontrolled Hypertension, Suzanne Cockrell

Doctor of Nursing Practice Final Project Abstract

The project’s purpose was to improve medication adherence and blood pressure with an educational packet. The project was necessary due to patient’s elevated blood pressure readings during visit encounters. Implementation occurred at a clinic in Central Texas and included established patients ages 18 or older with uncontrolled hypertension and employed staff members. The Health Belief Model provided a framework to form a hypertension educational packet. The packet was provided at varying locations within the clinic and via staff handouts. Visual aids were intentionally selected to depict the damaging effects of hypertension, hypertension monitoring, and guidance on medication reminder apps. The …

Enhancing Patient Safety: Fall Prevention Through Video Education, Fithawit T. Zere

Master's Projects and Capstones

Abstract

Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.

Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.

Interventions: A …

Implementation Of A Standardized Onboarding Program, Sarah J. Wall

Doctor of Nursing Practice Final Project Abstract

Purpose: To evaluate the impact of a standardized onboarding program on Advanced Practice Provider (APP) retention and productivity within an academic department.

Background: High APP turnover in specialized settings disrupts care and leads to financial losses. Previously, onboarding lacked structure, leading to early attrition and delayed productivity. A 24-week phased, competency-based orientation program was developed to improve retention, job satisfaction, and clinical performance.

Methods: The program, implemented in April 2024, included clinical precepting, didactic modules, and mentorship. Retention and Relative Value Units (RVUs) were measured before and after implementation. Qualitative data was collected through mentorship surveys and APP focus groups. …

Enhancing Nurse Well-Being Through Mandatory Rest Breaks At A Hospital, Elise Njang

Doctor of Nursing Practice Projects

Nurses are essential to the healthcare system, yet their demanding 12-hour shifts in hospital settings often leave little opportunity for adequate rest. The absence of structured rest breaks not only endangers nurses' well-being but may also compromise the quality of patient care. This quality improvement (QI) project aimed to evaluate the effects of implementing structured, mandatory 15-minute rest breaks on nurse burnout and job satisfaction. The initiative addressed a critical gap at the project site, where nurses typically received only one 30-minute lunch break per shift, despite evidence supporting the benefits of more frequent rest breaks. A quasi-experimental pre- and …