Advance Care Planning In Metastatic Lung Cancer Patients: A Quality Improvement Initiative, Khanh H. Thai

Student Theses

Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.

Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.

Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were …

Enhancing Tardive Dyskinesia Screening In An Outpatient Psychiatry Training Clinic: A Quality Improvement Initiative, Ariel Davalos

Doctor of Nursing Practice Final Manuscripts

Background: Tardive Dyskinesia (TD) is a debilitating, often irreversible movement disorder caused by prolonged exposure to dopamine receptor-blocking agents, affecting 15-30% of patients on long-term antipsychotic therapy. Despite endorsement of the Abnormal Involuntary Movement Scale (AIMS) as the gold standard for TD screening, the condition remains significantly under-diagnosed. Purpose: This quality improvement project evaluated whether a 45-minute educational intervention could improve PMHNP trainees’ confidence and competence in TD recognition and AIMS administration. Methods: Guided by the Iowa Model of Evidence-Based Practice, the project used a pre-post survey design with a planned one-month follow-up across two clinical training sessions. Ten PMHNP …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Closing The Gap: Integrating A Standardized Depression Screening In Primary Care, Cyndy Marie Oreas

Doctor of Nursing Practice Final Manuscripts

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 …

Improving Nursing Compliance With Pressure Injury Prevention In Postoperative Patients In The Cardiovascular Intensive Care Unit, Chingyi Lam

Doctor of Nursing Practice Final Project Abstract

Pressure injuries acquired in the hospital continue to be a major concern in patient safety among critically ill populations. The purpose of the quality improvement project was to improve nursing compliance with pressure injury prevention strategies among postoperative patients in a cardiovascular intensive care unit (CVICU). Patients who undergo cardiovascular surgery are at a high risk of developing pressure injuries due to immobility, sedation, vasopressors, and prolonged positioning on their backs. The quality improvement project was carried out in a 37-bed CVICU using the Institute for Healthcare Improvement (IHI) Model for Improvement and Plan–Do–Study–Act (PDSA) cycles. Data on nursing repositioning …

Standardizing Preoperative Screening: A Color-Coded Triage Tool Quality Improvement Project, Lyn Green

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Ambulatory surgery centers (ASCs) require effective preoperative screening to ensure appropriate patient selection and minimize day-of-surgery (DOS) cancellations, which affect patient safety, operational efficiency, and financial performance.

Local Problem: In a Northern California ASC serving a racially diverse, predominantly older-adult population with a high burden of chronic diseases, the DOS cancellation rate was 3.84%, exceeding the 2.3% institutional benchmark. Inconsistent preoperative screening contributed to avoidable cancellations.

Methods: A pre- and post-intervention quality improvement design evaluated the effect of a standardized screening tool and staff education on DOS cancellations.

Interventions: The Preoperative Stoplight Tool, a color-coded triage system classifying …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

A Quality Improvement Project: The Implementation Of A Nurse Driven Morbidity And Mortality Review In An Emergency Department Setting, Abby Beutel

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Background: Morbidity and mortality reviews/conferences (MMR) are a mandatory curriculum requirement for medical residency programs throughout the United States to identify and reduce medical errors. Only within the past few decades have hospital organizations expanded MMRs to multidisciplinary teams to include medical professionals who are rendering care at the bedside more than medical providers.

Purpose: This quality improvement (QI) project focuses on the application of a nurse drive MMR amongst emergency department (ED) nurses in a community hospital in Northern Bergen County, New Jersey. This ED nurse driven MMR measured the ED nurse’s knowledge and confidence levels as it …

A Warm Welcome: Developing Strategies And Tactics To Address The Resolution Of Neonatal Hypothermia, Sarah J. Musovski

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Aim:

This project aimed to promote the use of a standardized checklist for newborn care that incorporated evidence-based practices. The goal was to maintain newborn temperatures in the normothermic range of 36.5–37.5 °C while receiving care in the hospital setting.

Purpose/Aim:

This project aimed to promote the use of a standardized checklist for newborn care that incorporated evidence-based practices. The goal was to maintain newborn temperatures in the normothermic range of 36.5–37.5 °C while receiving care in the hospital setting.

Description of the Undertaking/Best Practice:

The checklist that was provided included a series of evidence-based actions to promote and advance …

Implementing A Mindfulness Mobile Application, Smiling Mind To Reduce Stress Experienced By Inpatient Psychiatric Nurses, Emma Jade Mowery, Justin D. Ruiz

Doctor of Nursing Practice Final Project Abstract

Purpose: To investigate the impact of implementing use of the Smiling Mind app (a free and easily accessed mobile application that teaches mindfulness skills) in inpatient psychiatric nurses. The aims: A 20% reduction in Perceived Stress and improved Workplace Satisfaction after 10 weeks.

Background: Workplace stressors experienced by psychiatric nurses include high patient acuity, emotional strain, environmental factors, and new policies. Unmanaged stress can harm nurse's well being and affect quality of care.

Methodology: Using a pre-post implementation design, 7 dayshift and 10 night-shift nurses used the Smiling Mind app for 10 weeks. Perceived stress (PSS-10) and workplace satisfaction (WPS) …

Implementation Of A Planned Extubation Nurse-Led Safety Bundle In A Pediatric Cardiac Intensive Care Unit, Broderick Sutton

Doctor of Nursing Practice Final Project Abstract

Purpose: To implement and evaluate a nurse-led planned extubation safety bundle designed to improve nurse preparedness, interdisciplinary communication, workflow consistency, and confidence during planned extubation events in a pediatric Cardiac Intensive Care Unit (CICU).

Background: Planned extubation in critically ill pediatric cardiac patients requires effective interdisciplinary coordination. Variability in nurse preparation, communication, and knowledge of sedation pharmacokinetics contributed to workflow inefficiencies and patient safety concerns. Evidence supports standardized nurse-led protocols to improve extubation readiness and reduce practice variability.

Methodology: A prospective pre-post quality improvement project was conducted over eight weeks in a pediatric CICU. The intervention included a nurse-led planned …

Improving Restraint Care Plan Documentation Among Nursing Staff, Samson E. Okotie

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to improve nursing compliance with restraint care plan documentation standards using bundled interventions, including targeted education, electronic health record (EHR) prompts, and unit-based audit and feedback processes. The goal was to achieve at least a 70% improvement in documentation compliance within 12 weeks.

Background: Accurate restraint documentation is essential for patient safety, ethical practice, interdisciplinary communication, and regulatory compliance. Despite existing policies and education, institutional audits revealed compliance rates of 50% or less, demonstrating a persistent gap in practice and the need for structured interventions.

Methodology: The project used the Plan-Do-Study-Act (PDSA) framework across …

Reducing Intraoperative Hypothermia In Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement With General Anesthesia, Carrigan Collinsworth

Doctor of Nursing Practice Final Project Abstract

Reducing Intraoperative Hypothermia in Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement with General Anesthesia

Background

Intraoperative hypothermia (core temperature < 36°C) is associated with increased surgical site infections, blood loss, prolonged recovery, and longer hospital stays. Because forced-air warming devices are restricted during total joint arthroplasty at the project site due to infection concerns, patients relied on passive warming, resulting in a baseline hypothermia rate of 63.3%

Purpose

The purpose of this quality improvement project was to reduce the incidence of intraoperative hypothermia among adults aged 18-60 undergoing primary elective unilateral total knee arthroplasty with general anesthesia by implementing a conductive warming device in the operating room of a large level 1 trauma hospital

Methodology

This evidence-based quality improvement project implemented a conductive warming blanket following staff education. Data was collected through the electronic health record. Primary outcomes included hypothermia incidence and average intraoperative temperature. Secondary …

Advancing Equitable Nurse Assignments Through Nursing Workload Score Categorization In An Adaptable Acuity Unit At An Academic Health Center, Moses Albaniel

Doctoral Projects

Inpatient nursing shift assignments often rely on clinical judgment, which can lead to inequitable workload distribution on mixed‑acuity units. This quality improvement project evaluated assignment equity using the coefficient of variation (CV) of nursing workload acuity scores and examined the relationship between workload balance and perceived assignment burden. A single‑group pretest–posttest design was implemented on a cardiac adaptable acuity unit at Stanford Health Care over a 12‑week period, encompassing 168 shifts from December 14, 2025, to March 7, 2026. The intervention, implemented with 11 charge nurses, combined structured charge nurse education with an optimized Epic Reporting Workbench tool incorporating dynamic …

Improving The Quality Of Bone Marrow Specimen Collection Through Powered Bone Marrow Device Simulation And Supervised Procedures, Ethel C. Estrada

Doctor of Nursing Practice Final Project Abstract

Improving the Quality of Bone Marrow Specimen Collection Through Powered Bone Marrow Device Simulation and Supervised Procedures

Purpose

This quality improvement (QI) project aimed to implement powered bone marrow simulation training and supervised procedures for the Advanced Practice Provider (APP) proceduralists to increase proceduralists' use of powered bone marrow devices and reduce poor bone marrow sampling.

Background

This project was implemented within the Bone Marrow Aspiration Clinic (BMAC) of an academic cancer center in Houston, Texas.

Methodology

Five APP proceduralists completed powered bone marrow device simulation training on the Bone Marrow (BM) Skills Simulator, followed by supervised procedures. Data were …

Improving Inr Monitoring In Outpatient Cardiology: A Quality Improvement Initiative To Enhance Anticoagulation Safety, Antonette Atori

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to reduce uncaptured INR results by 5% over 12 weeks in an outpatient cardiovascular clinic by implementing a standardized tracking workflow.

Background

Suboptimal anticoagulation management in outpatient settings can lead to uncaptured International Normalized Ratio (INR) results, delayed therapy adjustments, and increased risk of bleeding or thromboembolic events.

Methodology

Guided by the Plan-Do-Study-Act (PDSA) framework, a pre–post intervention design was used. Interventions included an electronic medical record (EMR)-based tracking system using a reminders inbox for overdue results and nurse-led follow-up phone calls. Data was collected from the EMR and analyzed using descriptive statistics, …

Quality Improvement Project: Evaluating The Effectiveness Of Chlorhexidine Gluconate Bathing Education On Staff Perceived Knowledge, Kaonta Spencer

Doctor of Nursing Practice Projects

A community hospital set strategic goals to achieve Vizient top-decile performance and drive continuous improvement by reducing surgical site infection (SSI) rates. The purpose of this quality improvement project was to support this goal by implementing an evidence-based educational intervention to improve nurses' perceived knowledge and self-reported ability with the chlorhexidine gluconate (CHG) bathing protocol for hysterectomy patients. Guided by Lewin's Change Theory, the Iowa Model Revised, and the Iowa Implementation Framework, the educational intervention applied a structured approach to address behavioral and organizational barriers contributing to protocol noncompliance. A quantitative, quasi-experimental pre- and post-intervention design was used to evaluate …

Implementation Of A Nurse-Led Discharge Protocol To Impact Nurse Confidence And Optimize Transitional Care Management, Jessi-Ann Elrod

Doctor of Nursing Practice Projects

Heart failure (HF) remains a leading cause of hospitalization and readmission, with the transition from hospital to home representing a vulnerable period for patients. Variability in discharge education and follow-up scheduling contributes to poor self-management and adverse outcomes. This quality improvement (QI) project evaluated whether implementing a standardized nurse-led HF discharge protocol impacted nurses' confidence and the rate of 7–14-day transitional care management (TCM) follow-up appointments. Guided by Meleis’ Transitions Theory and Lewin’s Change Theory, a one–group pretest–posttest QI design was implemented on a cardiac step-down unit. Twelve discharge nurses participated. The intervention included a structured education session and the …

Quality Improvement Project: Faculty Development For Understanding And Utilization Of Exam Data, Deanne Hutchens

Doctor of Nursing Practice Projects

This quality improvement project focused on inconsistent use and understanding of exam data among Associate Degree in Nursing (ADN) faculty, which can influence teaching decisions and student success. Many nursing faculty enter education with strong clinical backgrounds but limited experience working with exam statistics such as item difficulty, discrimination values, and Kuder-Richardson 20 (KR-20) reliability. Without a consistent approach, exam results may not be fully used to guide remediation or adjust instruction. This Doctor of Nursing Practice (DNP) project examined whether a structured faculty development session could improve faculty confidence and ability to interpret and apply exam data. A pre- …

Establishing A Standardized Suicide Risk Screening Policy For Psychiatric Providers: Closing Gaps In Provider Accountability And Clinical Documentation, Fadekemi Olude

Doctor of Nursing Practice Projects

Psychiatric providers in outpatient settings often experience inconsistent confidence and incomplete documentation when conducting suicide risk screening, contributing to missed opportunities for early identification of at-risk patients. This quality improvement project addressed the need for standardized suicide risk screening at an urban outpatient psychiatric clinic. The purpose was to evaluate documentation using the Columbia-Suicide Severity Rating Scale (C-SSRS). Using a pre-post intervention design guided by Lewin's Change Theory and the Donabedian Model of Quality Improvement, a 60-minute training session was delivered to 31 psychiatric providers. Participants completed pre- and post-intervention General Self-Efficacy Scale (GSES) surveys. Chart audits (N = 1,970) …

Quality Improvement Project Ai-Powered Conversations: Enhancing Nursing Students’ Interview Skills, Judy K. Staley

Doctor of Nursing Practice Projects

Professional communication is an essential skill for nursing students, particularly in job interviews. Deficits in professional communication can negatively impact future employment and accreditation outcomes. Current practices in faculty-led mock interviews can be limited by time constraints and the need for consistent feedback, underscoring the need for a more consistent and effective method supported by current evidence-based literature. The purpose of this quality improvement project is to evaluate whether integrating AI-assisted mock interviews into faculty-led practices influences faculty perceptions of student preparedness. Guided by Kotter’s Change Model and supported by the constructivist framework, the project aimed to enhance the effectiveness …

Quality Improvement Project: Impacting Staff Confidence In Recognizing Hiv Medication Adherence, Joy Nwansi-Iro

Doctor of Nursing Practice Projects

Medication adherence to antiretroviral therapy is essential for viral suppression and improved outcomes among individuals living with human immunodeficiency virus (HIV). Despite advances in treatment, healthcare providers lack confidence in recognizing medication adherence challenges and implementing appropriate interventions. Evidence suggests that provider education using standardized adherence assessment tools improves adherence monitoring and clinical decision-making. The purpose of this quality improvement project is to evaluate whether an educational intervention and a standardized workflow using the CASE Adherence Index would impact healthcare staff confidence in recognizing HIV medication adherence. Lewin’s Change Theory guided the project through the stages of unfreezing, change, and …

Quality Improvement Project: Enhancing Staff Delivery Of Non-Pharmacological Interventions In Serious Mental Illness Care, Kimberly Vann

Doctor of Nursing Practice Projects

Serious mental illness places a significant burden on global healthcare systems, increasing hospital utilization and critically impairing patients' functional status. Often crippling, these illnesses are mostly treated with medication therapy despite proven research to show effective outcomes with holistic and non-pharmacological therapies. Non-pharmacological interventions (NPIs) are often underutilized in outpatient mental health settings. The purpose of this quality improvement project was to determine whether structured training impacted staff confidence in delivering NPIs and impacted documentation frequency in the electronic health record (EHR). The project was guided by the Iowa Model of Evidence-Based Practice and implemented using the Plan-Do-Study-Act (PDSA) cycle, …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Promoting Trauma-Informed Practices Through Staff Education, Ediomi Enebong Oduwole

Doctor of Nursing Practice Projects

Front office staff in outpatient psychiatric settings are often the first point of contact for patients experiencing anxiety and emotional distress. However, existing evidence indicates that non-clinical, front office staff often lack formal training in trauma-informed care (TIC). This gap may limit early recognition and response to patient distress. This quality improvement project addressed this gap by evaluating the impact of a trauma-informed educational intervention of staff confidence and documentation of patient distress. The project was guided by Pender’s Health Promotion Model and Lewin’s Change Theory. It used a pre-and post-intervention quantitative design with sample of five front office staff …

Quality Improvement Project: Improving Provider Workflow And Documentation For Routine Mental Health Screening In An Outpatient Psychiatric Clinic, Sharon Uchechi Joshua

Doctor of Nursing Practice Projects

Depression and anxiety are leading causes of disability and are frequently underdiagnosed in outpatient psychiatric settings due to inconsistent screening and documentation practices. Evidence supports the use of standardized tools, such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), to improve early detection and clinical outcomes. This quality improvement (QI) project evaluated whether implementing standardized electronic health record (EHR) templates and provider education would improve documentation of PHQ-9 and GAD-7 screenings. The aim was to increase the consistency of screening and documentation among psychiatric providers. The project was guided by the Plan-Do-Study-Act (PDSA) framework and Lewin’s Change …

Improving Monitoring And Documentation Of Long-Acting Injectable Antipsychotic Adherence In Patients With Schizophrenia Through Staff Education And Refill History Review, Stacy Ann Bruce

Doctor of Nursing Practice Projects

Schizophrenia is a chronic psychiatric disorder associated with relapse, hospitalization, and poor outcomes when medication adherence is suboptimal. Nonadherence increases morbidity and healthcare utilization (World Health Organization, 2022; Zhao et al., 2025). Long-acting injectable (LAI) antipsychotics improve adherence and reduce hospitalization, but inconsistent monitoring and documentation in outpatient settings hinder early identification of missed doses (Lieslehto et al., 2022). This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate whether staff education and structured refill-monitoring processes improve identification and documentation of nonadherence to LAI antipsychotics. Using Kotter’s Change Management Model and the Plan-Do-Study-Act framework, the project focused on …

Enhancing Shared Decision-Making In Mental Health Care: A Quality Improvement Initiative, Joanna L. Hysler

Doctor of Nursing Practice Projects

Shared decision-making (SDM) is an evidence-based approach that enhances patient engagement, treatment adherence, and clinical outcomes in psychiatric care. Despite strong support in the literature, SDM remains inconsistently implemented in mental health settings due to limited provider training, time constraints, and organizational barriers. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate an educational intervention designed to improve SDM utilization and provider confidence within a private outpatient psychiatric practice. The project was guided primarily by the Plan-Do-Study-Act framework to support structured practice change, with Lewin’s Change Theory providing additional conceptual support. The intervention …

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

Enhancing Provider Self-Efficacy And Documentation In Hypertension Management, Stephanie Nsiah

Doctor of Nursing Practice Projects

Primary care providers often experience inconsistent confidence and incomplete documentation when managing hypertension, contributing to suboptimal blood pressure control. This quality improvement project addressed the need for structured provider education at an outpatient family clinic. The purpose was to evaluate the impact of a structured educational intervention on provider self-efficacy and documentation completeness. Using a quasi-experimental pre-post design guided by the Plan-Do-Study-Act model and Lewin's Change Theory, a 60-minute educational session was delivered to 12 licensed providers. Participants completed pre- and post-intervention self-efficacy surveys using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) and Feasibility of Intervention …