Nursing Commons^™

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 …

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 …

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 …

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 …

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 …

Use Of A Structured Rounding Model To Improve Interprofessional Communication And Collaboration Among Mds And Rns In A Medicine Unit – An Evidence-Based Practice Project, Jackie Raygoza,

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose/Aims

This DNP project aims to improve communication and collaboration between physicians (MDs) and registered nurses (RNs) on medical units by implementing a structured three-step communication-rounding model integrated into the daily workflow and leveraging existing communication tools. As patients’ conditions become more complex and healthcare demands increase, it is crucial to foster an environment where communication among providers and staff is clear, transparent, respectful, and collaborative. By leveraging information technology and evidence-based strategies, the project seeks to strengthen interprofessional collaboration and improve patient satisfaction and the quality of care. The project includes educational sessions for both MDs and RNs to …

Early Mental Health Screening In The Gi Patient Population: A Quality Improvement Project, Jacqueline Sagala

Loma Linda University Electronic Theses, Dissertations & Projects

Aims

This quality improvement project aimed to increase awareness and better integrate mental health screening in a GI clinic by educating staff and providers. The project evaluated changes in depression literacy, attitudes toward mental illness assessment, perceived training effectiveness, use of the training in clinical practice, and referrals to the Resiliency Clinic.

Background

Patients with chronic GI disorders commonly experience anxiety and depression, yet mental health concerns are often overlooked in specialty care. Although annual depression screening was already a part of the standard care at the Digestive Disease Center at Loma Linda University Faculty Medical Clinics, staff education and …

Dexmedetomidine (Precedex) Versus Propofol: In Patients Requiring Sedation While Mechanically Ventilated,, How Does The Use Of Dexmedetomidine (Precedex) Compared To Propofol, Affect Reintubation Within 48 Hours Post Extubation?, Kimberly Barbee, Markela Albright, Malak Amro, Evelyn Caty-Pletcher, Margaret Havey Phd, Aprn, Acnp-Bc, Chfn, Fhrs, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Keywords: dexmedetomidine, propofol, reintubation, sedation2

Abstract Assignment

Background

Sedation management in the ICU plays a key role in extubation readiness and post-extubation outcomes in mechanically ventilated patients. Although both propofol and dexmedetomidine are commonly used in critical care, there is limited evidence comparing their impact on early reintubation. This quality improvement (QI) project examined whether sedative choice was associated with reintubation within 48 hours of extubation.

Methods

A retrospective QI analysis was conducted in a cohort of 38 mechanically ventilated adult patients. Patients received either propofol (n = 31) or dexmedetomidine (n = 7) prior to extubation. Reintubation within …

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 …

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 …

Reducing Humpty Dumpty Syndrome In Pediatric Inpatients, Jeanene Burns

Electronic Theses and Dissertations

The Doctor of Nursing Practice project examined pediatric inpatient falls. The healthcare agency involved in the project identified concerns regarding pediatric inpatient falls. Data were collected on pediatric inpatient falls that occurred on two nursing units at this agency based on the Generalized Risk Assessment for Pediatric Inpatient Falls and the Humpty Dumpty Falls Prevention Scale. Results from the project indicated marginal statistical significance, with approximately a 60% reduction in falls after the implementation of the Humpty Dumpty Falls Prevention Scale. A recommendation for future research is a comparison of the two pediatric fall risk assessment tools after the Humpty …

Implementing Hypertension Guidelines Into Clinical Practice, Misti Michele Mays

Electronic Theses and Dissertations

Hypertension is a complex chronic disease process, and it is essential to educate the patient on the disease process, as well as on all aspects of self-management. It is essential that providers choose an evidence-based guideline by which they will manage their hypertensive patients. In addition, providers must schedule regular follow-up appointments with their patients, along with a wide variety of other multifactorial components in regard to the management of patients diagnosed with hypertension. In addition, providers have a responsibility to stay informed on new approaches to blood pressure management by reviewing the professional literature on a regular basis. Much …

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.

The Significance Of Vaccine Education In Vaccination Status, Emma Webb

Honors College Theses

In recent years, more of the general population of the United States has become skeptical about vaccines and overall vaccination numbers have declined. Since the Covid-19 pandemic, vaccines have become somewhat of a controversial topic due to varying opinions about the adverse reactions and effectiveness of vaccines. The purpose of this study was to determine if there is a correlation between a person’s overall knowledge of vaccinations and a person’s vaccination status by asking a series of questions about the science used in vaccines and identifying the participant’s vaccination status in regards to influenza and Covid-19. This study also asked …

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, …

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 …

A Market Of Care Skills: Profiting From Professional Education And Practice, Yasmin Y. Ortiga

Research Collection School of Social Sciences

Who profits from the commodification of care and how does such accumulation occur? Focusing on the case of the nursing care market, this paper shows how professional schools and local hospitals within source nations like the Philippines profit from nurses seeking the credentials to qualify for jobs overseas. While existing studies show how nursing skills are exploited and undervalued, this paper argues that it is the process of skilling itself that allows for the accumulation of profit, regardless of whether nurses leave their origin countries to work abroad. This study reveals how global care economies are tightly linked to local …

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 …

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. …

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 …

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 …

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 …

Educating Nurses On Caring For Patients With Intellectual And Developmental Disabilities – An Evidence-Based Practice Project, Amyela Adarlo

Loma Linda University Electronic Theses, Dissertations & Projects

Intellectual and developmental disabilities (IDD) refer to a range of conditions that begin before age 18 and impact physical, cognitive, and socioemotional development. Patients with IDD often experience poorer health outcomes due to healthcare providers’ limited training in effective communication strategies. This evidence-based project aims to evaluate whether educating nurses on effective communication with IDD patients improves nurse self-efficacy and confidence in communication and enhances caregiver perceptions of nursing care.

Optimizing Communication In The Periprocedural Area: Implementing Sbar: A Quality Improvement Project, Autumn Chang

Loma Linda University Electronic Theses, Dissertations & Projects

The primary aim of this project is to improve standardized nurse-to-nurse communication at the electrophysiology lab of a large Los Angeles hospital. By providing nursing education on a unit-specific, structured handoff communication framework (SBAR) and incorporating a procedure-specific handoff form for electrophysiology (EP) across pre-, intra-, and post-procedure units, this project aims to improve nurses’ perceptions of the handoff process and the effectiveness of handoff education across the periprocedural units. The project further aims to assess nursing incorporation of the training four weeks post-education and changes in patient satisfaction related to nursing teamwork and communication.

Abstract Only: Teaching The Handoff: A Psychiatric-Specific Handoff Intervention For Pre-Liecnsure Nursing Students, Kevin Kim

Loma Linda University Electronic Theses, Dissertations & Projects

This quality improvement project evaluated the impact of a psychiatric-specific handoff educational intervention in pre-licensure nursing students’, their perceptions of handoff competency, communication quality, and teamwork effectiveness. Using the PSYCH mnemonic tool, a structured educational session was provided to  students during their psychiatric nursing course. Pre- and post-intervention surveys included the Nursing Handoff Competency Scale, Handover Evaluation Scale, and TeamSTEPPS communication items. Post-intervention findings were associated with more favorable student perceptions across multiple communication and handoff competency domains. Results support integrating psychiatric-specific handoff education for pre-licensure nursing curricula can strengthen communication preparedness to promote patient safety in psychiatric settings.

Implementing A Noise Reduction Protocol To Reduce Perceived Noise In The Icu – An Evidence-Based Practice Project, Soh Jeon

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims:

This project aims to reduce perceived noise in the ICU and promote a healing environment through a multi-interventional noise-reduction protocol and nursing staff education.

Rationale/Background:

The World Health Organization (WHO) recommends that hospital noise levels remain below 35 decibels during the day and 30 decibels at night. However, ICU noise often exceeds 50-70 decibels. Increased noise levels are primarily caused by conversations, monitoring alarms, and routine care activities, such as cleaning and procedures. These high noise levels directly affect patients’ sleep, which is essential to recovery. Insufficient rest can lead to immunosuppression, prolonged mechanical ventilation, and elevated stress …