Nursing Commons^™

Standardized Home Blood Pressure Log Implementation For Patients With Hypertension To Increase Patient Awareness And Clinical Action, Ashley Alcala

Doctoral Dissertations & Projects

Background: Home blood pressure monitoring (HBPM) is recommended for hypertension management, yet primary care clinics often lack standardized workflows for distributing, collecting, and using home blood pressure (BP) data. Inconsistent reporting and limited patient understanding of their own BP trends, such as whether readings are stable, elevated, or unchanged, reduce providers ability to make timely clinical decisions.

Problem: Despite evidence supporting HBPM, patients rarely brought usable BP logs to follow‑up visits, limiting providers ability to assess BP control, identify trends, and make timely medication or care plan adjustments.

Approach: This project used a Plan‑Do‑Study‑Act (PDSA) model to implement a standardized …

Utilizing And Optimizing Forecasting Models For Nursing Demand: A Narrative Review, Kalpana Singh, Liyan Ajit D. Souza, Ananth Nazarene, Amane Mounia, Mahmoud Abdelwahab Khedr, Ahmad Mousa, Rebecca Rejo George, Abdulqadir J. Nahwan

Research outputs 2022 to 2026

Background: Accurately forecasting nursing demand is essential for effective workforce planning in the context of increasing patient volumes and the growing complexity of healthcare systems. Reliable forecasting supports optimal staffing, enhances patient care quality, and reduces operational risks. However, traditional forecasting approaches are increasingly challenged by evolving clinical demands, rising chronic disease burden, and rapid technological advancements. Aim: This narrative review aimed to (1) map existing models used for predicting nursing demand, (2) identify key predictive methodologies, data inputs, and evaluation metrics, and (3) highlight existing gaps and implications for healthcare policy and workforce management. Methods: A comprehensive narrative literature …

Collaboration Between People Admitted To Acute Mental Health Units, Their Family Members And Nurses In The Detection Of Mental State Changes And Recovery: A Qualitative Systematic Review, Karen Foster, Coventry, Yvonne Middlewick, Lindsay Smith, Beverley Ewens

Research outputs 2022 to 2026

Mental health nurses can engage with people with mental health challenges and their families due to their presence on acute mental health units. This presence helps to facilitate recovery-focused care within a physically and emotionally safe environment. Mental health care should be person-centred, individualised, and include wherever possible family and other people in the person's support network. The objective of this systematic review was to explore the existing qualitative literature that describes experiences of collaboration between people with lived experience of mental health challenges, their family members, and nurses in relation to changes in mental state during an admission to …

The Effect Of Midwife-Led Continuous Labor Support Care On Delivery Mode And Timely Initiation Of Breastfeeding In Primigravida Women In Northwest Ethiopia: A Hybrid Type I Implementation Study, Mengstu Melkamu Asaye, Aragaw, Eden Bishaw Taye, Kihinetu Gelaye Wudineh, Sara Bayes

Research outputs 2022 to 2026

Midwife-led continuous labor and childbirth support reduces the episiotomy rate and increases the rates of vaginal delivery and early initiation of breastfeeding. However, no studies have yet been conducted in Ethiopia. This study aimed to evaluate the effect of midwife-led continuous labor and childbirth support. A quasi-experimental study involving 419 primigravida women compared an intervention given by trained midwives at two hospitals to routine at two others. Data were collected from July to December 2024 through interviews and record reviews. The McNemar test was used to compare changes, with a p-value of less than 0.05. Midwife-led continuous labor support increased …

An Evidence-Based Educational Intervention To Enhance Nurses' Knowledge Of Metabolic Syndrome In Residential Care Facilities, Marie Tanyi

Doctor of Nursing Practice Scholarly Projects

The project addresses a critical gap in nursing education by implementing a structured, evidencebased educational intervention led by an Advanced Practice Registered Nurse (APRN) to improve nurses’ knowledge of metabolic syndrome in residential care facilities. The purpose was to determine whether this intervention could significantly enhance nurses’ understanding and management of metabolic syndrome, a complex cluster of disorders present in adult populations. Nine nurses participated in targeted educational sessions focusing on definition, diagnosis, complications, and evidence-based prevention and management strategies. Each participant completed the Metabolic Syndrome Knowledge Scale (MSKS) questionnaire before and after the intervention to assess changes in knowledge. …

Vap Prevention By Improving Icu Oral Care, Chi Hao Su

Doctor of Nursing Practice Final Project Abstract

Purpose 
To increase night-shift adult ICU nurse compliance with standardized oral care documentation by at least 20% as a core ventilator-associated pneumonia (VAP) prevention process.
Background
VAP is a preventable healthcare-associated infection associated with increased morbidity, mortality, ICU length of stay, and costs. Oral-care documentation is often inconsistent because of competing priorities and workflow barriers.
Methodology
Guided by the Knowledge-to-Action framework, this QI project used three PDSA cycles after a September 2025 baseline in a 16-bed ICU. Interventions included 1:1 simulation, EPIC prompts, and bedside coaching; manual audits addressed EPIC misclassification. Trends and run charts analyzed 183 records; surveys assessed …

Dnp Final Report: An Evidence-Based Project To Decrease Stress In Undergraduate Nursing Students, Elaine Wallace

DNP Final Reports

Stress among undergraduate nursing students is a well-documented concern that negatively affects academic performance, clinical readiness, well-being, and program retention. Stress levels are often heightened before clinical skills check-offs, highlighting the need for practical, evidence-based interventions. This Doctor of Nursing Practice quality improvement project examined whether mindfulness-based mandala coloring could reduce perceived stress in undergraduate nursing students. Using the PICOT framework, the project evaluated whether undergraduate nursing students (P) who participated in mindfulness-based mandala coloring (I), compared with no intervention (C), experienced reduced perceived stress levels (O) over a 12-week implementation period (T).

A comprehensive search of the literature supported …

Safe (Stop-Ask-Feel Empowered), Heather Smith, Allie Dunlap, Madi Rabideaux, Sonia Cardeiro

SPARK Symposium Presentations

The SAFE (Stop–Ask–Feel Empowered) initiative strengthens patient safety by increasing bedside nurses’ confidence and consistency in questioning provider orders and clinical decisions. Hierarchical culture, fear of negative reactions, and low confidence often prevent nurses from seeking clarification, increasing the risk of preventable errors. SAFE directly addresses these barriers by embedding structured inquiry into daily nursing practice. 

Guided by Lewin’s Change Theory, SAFE will be implemented over six months. All unit nurses will receive standardized SAFE badge cards that provide clear, formatted prompts to support respectful, effective communication with the interdisciplinary team. These badge cards serve as a practical, visible reminder …

Peri-Op Protect: A Unified Pre-Op To Pacu Medication Reconciliation System, Tyler G. Van Note, Ariana Amalia Anast, Samantha Ashley Steiner, Tara Gilbert

SPARK Symposium Presentations

Peri-Op Protect: A Unified Pre-Op to PACU Medication Reconciliation System

Peri-Op Protect is a nurse-led change initiative designed to improve medication safety and communication during surgical patient transitions from pre-operative care through the operating room and into the post-anesthesia care unit at a local hospital. Transitions of care are among the most vulnerable moments in the surgical process, as critical medication information – including home medications, last doses, allergies, intraoperative medications, and pain management plans – must be accurately communicated across multiple teams. Communication breakdowns are a leading contributor to adverse events in healthcare, and inconsistent medication handoff processes can …

Free Money And Safer Patients, Kaitlyn R. Livingston, Kennedy G. Crites, Jazmine Razo, Erin Radigan, Kennedy Crites

SPARK Symposium Presentations

This quality improvement project aims to improve consistency of nurse compliance with daily chlorhexidine gluconate (CHG) bathing in a local oncology unit to reduce the risk of central line-associated bloodstream infections (CLABSI’s). CLABSI’s remain a preventable source of patient morbidity, prolonged hospitalization, delayed cancer treatment, and increased healthcare costs, particularly among immunocompromised oncology patients who frequently require central venous access. Evidence supports daily CHG bathing as an effective infection prevention intervention; however, inconsistent completion and documentation across day and night shifts limit reliability in practice. This project addresses both documentation accuracy and actual bathing completion to ensure care consistency. Implementation …

Improving Patient Satisfaction In The Emergency Department Waiting Room Through Enhanced Communication Strategies: A Quality Improvement Initiative, Wael P. Karaki

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project aimed to improve ED waiting room experience by standardizing communication to increase transparency and expectation management, targeting an increase in Net Promoter Score (NPS) from 33.5 to ≥35.4 within three months.

Background: ED waiting room dissatisfaction is driven by uncertainty (unclear wait times, inconsistent updates, and limited understanding of triage and ED flow), supporting structured communication over individual clinician delivery.

Methodology: A 3-month, single-site QI project in an urban ED used iterative PDSA cycles and included all ED encounters (n=17,444). The bilingual intervention included orientation pamphlets (print/QR-based), standardized triage verbalization of …

Examining The Relationship Of Work Stressors And Resilience Among Inpatient Oncology Nurses: A Cross-Sectional Study:, Blanca Melida Vasquez-Clarfield

Theses & Dissertations

Burnout among inpatient oncology nurses remains a concern in a specialty marked by high patient acuity, complex care regimens, emotional intensity, and repeated exposure to suffering and death. Resilience is often discussed as a protective resource in nursing, yet less is known about how personal resilience and work resilience relate to work stress and burnout within inpatient oncology practice. This study examined the relationships among perceived work stress, personal resilience, work resilience, and burnout among registered nurses working in inpatient oncology units. It also explored whether selected nurse characteristics were associated with these variables and how nurses described workplace stressors, …

Improving First Time Iv Success Rates In The Emergency Department Through The Implementation Of An Ultrasound-Guided Iv Training Program, Tram Dinh

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project was conducted at a Level III trauma emergency department (ED) in Fort Worth, TX. The aim was to improve first-attempt intravenous (IV) success rates for patients with difficult IV access (DIVA) to at least 50% and reduce average disposition times.

Background

Patients with DIVA frequently experience delays in care, including prolonged time to establish IV access, obtain laboratory studies, perform contrast-enhanced imaging, and administer IV medications. Ultrasound-guided IV (USGIV) access is an evidence-based technique shown to reduce these delays and improve timely care for patients with DIVA.

Methodology

The Plan-Do-Study-Act (PDSA) model guided development …

Improving Throughput: A Quality Improvement Initiative To Expedite Inpatient Psychiatric Placement From The Emergency Room, Candice J. Battle

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this quality improvement project was to evaluate the effectiveness of a standardized psychiatric transfer workflow designed to reduce emergency room (ER) boarding time for psychiatric patients in a 30-bed acute care hospital from an average of 3-5 days to an average of 2-3 days.

Background

Psychiatric patients often experience prolonged ER boarding while awaiting inpatient psychiatric placement. These delays contribute to delayed treatment, worsening psychiatric symptoms, ER overcrowding, and increased healthcare costs.

Methodology

This four-week quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework. Interventions included a standardized psychiatric transfer protocol, simplified transfer checklist and staff education. …

The Benefits Of Glucagon-Like Peptide 1 Agonists In Adult Women With Polycystic Ovary Syndrome, Bethany A. Johnson

Nursing Capstones

Background: PCOS is the most common endocrinopathy in women of reproductive age, affecting 5-6 million women in the United States. Symptoms include hirsutism, acne, hormone imbalances, menstrual irregularity, obesity, infertility, hypertension, and hyperlipidemia. GLP-1s are being studied for their benefits in women with PCOS.

Purpose: To review the current evidence on the efficacy of GLP-1 receptor agonists in improving symptoms and complications of PCOS.

Methods: This scoping literature review used three databases, including CINAHL Ultimate, PubMed, and ClinicalKey. Inclusion criteria were women 18 and older diagnosed with PCOS and studies that evaluated any type of GLP-1 and their effect on …

Analyzing Pressure Injury Trends Among Hospitalized Older Adults From Tarrant County, Oluwafunto M. Olorundare

2026 Spring Honors Capstones Projects

Pressure injuries occur when skin and underlying tissues are damaged due to unrelieved pressure that reduces blood circulation to the affected area. Hospitalized older adults are vulnerable to pressure injuries due to factors such as limited mobility, physiological changes associated with aging, chronic conditions, and longer hospital stays. Despite multiple studies on the prevalence and incidence of pressure injuries at the national and global levels, there is limited research that analyzes trends among hospitalized older adults at the county level, specifically Tarrant County. This research aims to examine pressure injury trends among hospitalized older adults residing in Tarrant County. Using …

Gamification And Serious Games In Undergraduate Nursing Education For Disaster Preparedness In The United States, Jacob Fast

Dissertations

Disaster preparedness is a critical component of undergraduate nursing education, yet traditional instructional approaches often inadequately prepare students for the complexity and uncertainty of real-world emergencies. Emerging literature suggests that gamification and serious games may enhance engagement and applied learning; however, limited research has examined their integration within nursing curricula from the perspective of faculty responsible for instructional design. This convergent mixed-methods study investigated the extent of integration, perceived effectiveness, and practical utility of gamification and serious games in undergraduate nursing education for disaster preparedness. Quantitative data were collected through a national survey of faculty teaching in CCNE- and ACEN-accredited …

Exploring The Relationship Between Workplace Social Capital, Organizational Commitment, And Intent To Stay Among Clinical Nurses In The Acute Care Setting, Leigh Erin Griffis-Cogan

Theses & Dissertations

Background

The persistent nursing shortage, exacerbated by the COVID-19 pandemic and the subsequent “Great Resignation,” continues to challenge healthcare systems nationwide. High turnover rates among acute care nurses negatively affect patient outcomes, organizational stability, and healthcare costs. Prior research highlights the importance of workplace factors, such as social capital and organizational commitment, in shaping nurses’ intentions to stay in their roles. However, limited studies have examined these relationships collectively within the acute care setting.

Purpose

The purpose of the quantitative cross-sectional study was to examine the relationships between workplace social capital, organizational commitment, and intent to stay among clinical nurses …

Understanding The Experiences Of Black Women Becoming Single Mothers By Choice Using Assisted Reproductive Technology, Jessica Chantal Prepetit

Theses & Dissertations

The term Single Mothers by Choice (SMBC) refers to women who choose to have a child without a partner. According to the American Society for Reproductive Medicine (ASRM), ovarian reserve decreases with a woman’s age. Women are born with approximately 1 million eggs; this number decreases over time. When a woman reaches 35 years of age, which is considered advanced maternal age, their egg count and quality decline. These factors of low ovarian reserve can place a woman in a category of infertility. Also, a woman may unknowingly suffer from uterine abnormalities that may hinder a successful pregnancy. As women …

Modeling Early Indicators For Success In An Associate Degree In Nursing Program, Joseph D. Moss

Educational Leadership & Workforce Development Theses & Dissertations

Persistent nursing workforce shortages across the United States have increased the importance of Associate Degree in Nursing (ADN) programs as primary entry points into the profession. Community colleges prepare a substantial portion of the nursing workforce; however, attrition within ADN programs limits the number of graduates entering practice. Understanding factors associated with academic performance and program completion is essential for strengthening nursing education pathways and supporting workforce development. The purpose of this quantitative study was to examine early academic and sociodemographic factors associated with successful completion of an ADN program at a suburban community college.

Guided by Becker’s Human Capital …

Introducing The Ppco Framework, Children's Health

PPCO Resources & Education

Haven't heard of the PPCO Framework yet? It is a framework developed by nurses for nurses that fits nursing questions when searching for literature to support EBP. 

To learn just a little more, we've created a short cheat sheet, with tips, and some examples, and most importantly - links to the original works.

Reducing Unplanned Copd Readmissions Through Utilization Of A Nursing Discharge Checklist, Rachael Mcallister

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The quality improvement (QI) project aimed to decrease readmission rates at the project site through implementation of a nurse-driven disease-specific discharge checklist when compared to the same timeframe the year prior.

BACKGROUND

The project site’s 2024 national ranking declined due to unplanned chronic obstructive pulmonary disease (COPD) readmissions. COPD readmissions remained at national average and was not nationally competitive. This metric increased cost to the hospital and contributed to worse quality outcomes for the patient.

METHODOLOGY

Project design used the IOWA Model Revised framework and supported with an evidence-based review of the literature. PDSA cycles were conducted during implementation. …

Optimizing Vbac Outcomes Through A Structured Tolac Pathway, Alexandra E. Williams

Doctor of Nursing Practice Final Project Abstract

Evaluate whether implementing a structured TOLAC clinical pathway improves VBAC success, increases TOLAC attempts among eligible patients, and improves maternal and neonatal outcomes. The project was conducted at a Southeast hospital in Houston, Texas. 

Women with a prior cesarean often have limited labor options because many hospitals default to repeat cesarean delivery. TOLAC remains underutilized due to safety concerns, limited provider education, and lack of standardized protocols. Evidence shows that appropriate counseling, standardized management, and close maternal–fetal monitoring can support safe vaginal birth after cesarean (VBAC).

A pre–post implementation design guided by the RE-AIM framework was used. Eligible participants included …

Streamlining Patient Workflow: Enhancing The Screening Process For Social Determinants Of Health To Ensure Consistent Patient Intake In A Medical Clinic, Candice L. Bruce

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement project was to increase social determinants of health (SDOH) screening rates by incorporating an enhanced patient history form into the patient intake process in a women’s health clinic.

Background: The project was implemented in a small, rural clinic led by advanced practice providers that is affiliated with a large academic healthcare institution in southeast Texas. Addressing SDOH is essential for improving health outcomes and supporting value-based care initiatives, yet screening is often inconsistent in outpatient settings.

Methodology: The Plan–Do–Study–Act (PDSA) framework was used for implementation. A brief SDOH screening tool was embedded …

Reducing Computed Tomography Delay In A High-Volume Emergency Department, Sarah Ouedraogo

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

Delays in computed tomography (CT) imaging contribute to prolonged emergency department (ED) length of stay and delayed clinical decision-making. At the project site, baseline data demonstrated an average ASAP CT order-to-scan time of approximately 116 minutes for non-critical ED patients, with CT readiness compliance rates of 0%. Gap analysis identified inconsistent patient preparation and fragmented communication between ED nursing and radiology as key contributors to avoidable delays. PICOT question: In non-emergent emergency department (ED) patients (P), how does the use of a CT readiness checklist by ED nurses (I), compared with no standardized readiness checklist (C), affect patient readiness …

Improving Documentation Efficiency Through Implementation Of Emr Note Templates In A Multidisciplinary Stroke Clinic, Mirriam Hijazi

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to increase documentation efficiency in a multidisciplinary stroke clinic through implementation of standardized neurological note templates within the electronic medical record (EMR) system.

Background: EMR documentation is essential for safe and coordinated patient care, but can be time-consuming for healthcare providers. Neurological documentation requires detailed clinical information, contributing to increased documentation burden. At the multidisciplinary stroke clinic, providers reported spending significant time on documentation, with some notes finalized up to 48 hours after patient encounters.

Methodology: Standardized neurological note templates were developed with provider input. Documentation efficiency metrics included note completion time, proportion of …

Improving Bedside Nurse Central Line Policy Compliance And Combating Clabsis, Keyshawna N. Chambers

Doctor of Nursing Practice Final Project Abstract

Central line-associated bloodstream infections (CLABSIs) are a problem, both globally and locally at this 20-bed pediatric cardiovascular ICU in Houston, TX. Bedside nursing staff had gaps in knowledge of central line policies and were often unaware of when dressings needed to be changed. This posed a significant concern, as this nosocomial infection is among the most life-threatening and costly complications in healthcare. Leadership attempted to correct this issue with weekly multidisciplinary rounds, but with high turnover, this was not a long-term fix. This quality improvement project aimed to increase central line policy compliance among bedside nursing staff to 93%, from …

The Use Of A Safety Screening Tool To Improve Sedation Holiday Compliance And Nurse Confidence, Shelby Marchisio

Doctor of Nursing Practice Final Project Abstract

Purpose

This project sought to evaluate the impact of a safety screening tool on sedation holiday compliance and nurse confidence.

Background

This project was conducted within a 42-bed intensive care unit at a large academic hospital in Houston, Texas. Despite having a nurse-led sedation holiday protocol, compliance averages varied from 50-85%. In alignment with evidence-based practice, it was determined that integrating a safety screening tool into the sedation holiday process may improve compliance.

Methodology

The FADE Model for Quality Improvement guided project development. An anonymous survey was conducted using Likert-scale ratings to assess nursing perceptions and confidence related to sedation …

Reduction Of Waste And Cost In A Cardiac Intensive Care Unit, Jincy C. Skaria

Doctor of Nursing Practice Final Project Abstract

Purpose:
To reduce medical supply waste and associated costs in a Cardiac ICU using a standardized supply cart system.
Background:
Pre-packed post-operative recovery kits were routinely opened for all admissions in the Cardiac ICU, resulting in disposal of unused supplies due to infection control and single-use policies. This practice contributed to avoidable waste, increased costs, and poor resource stewardship.
Methodology:
This quality improvement project was conducted in a 20-bed Cardiac ICU from September 28 to December 6, 2025. The intervention replaced routine opening of full recovery kits with selective retrieval of supplies by nurses from a standardized cart located outside …

Dna Methylation Of Slc6a4 And Nr3c1 In Term And Preterm Infants: A Pilot Study Of Nicu-Associated Stress, Kathryn J. Malin, Yvette P. Conley, Aleigha Barry, Rosemary White-Traut

College of Nursing Faculty Research and Publications

Background: Preterm infants requiring prolonged hospitalization in the neonatal intensive care unit (NICU) are often exposed to early-life stress, which may contribute to long-term health consequences. Epigenetic markers, particularly DNA methylation (DNAm) of stress-related genes such as SLC6A4 and NR3C1, have been identified as potential biomarkers of early-life stress. Limited research has compared DNAm patterns between term and preterm infants or examined associations between NICU-related stress and DNAm in preterm populations. Objectives: This pilot study aimed to (1) compare DNAm patterns between preterm and term infants, (2) examine relationships between NICU-related stress and DNAm alterations in preterm infants, and …