Nursing Commons^™

Clinical Practice Guideline For A Capstone‑To‑Residency Transition Program, Rebecca Ginika Chinonso

Walden Dissertations and Doctoral Studies

The transition from student nurse to professional practice remains a vulnerable period marked by role ambiguity, stress, and early turnover. At a large medical center, the lack of a structured bridge between the final capstone experience and the residency program contributed to inconsistent onboarding, reduced confidence, and diminished resilience among new graduates. Addressing this gap is essential for strengthening retention, supporting workforce stability, and improving patient outcomes within nursing practice. An evidence‑based clinical practice guideline (CPG) outlining best‑practice recommendations for a new graduate transition program from capstone to residency was developed for the facility. The practice‑focused question asked whether the …

Standardized Proactive Glp-1 Prior Authorization Workflow, Ebote Etape

Walden Dissertations and Doctoral Studies

Summary This quality improvement project evaluated an organizational process change from a reactive, pharmacy-initiated prior authorization (PA) process to a standardized, proactive PA workflow for glucagon-like peptide-1 (GLP-1) receptor agonists in an outpatient primary care clinic. The evidence-based practice PICOT question was: In adult primary care patients prescribed GLP-1 receptor agonists (P), does a standardized, proactive prior authorization workflow (I), compared with a reactive pharmacy-initiated process (C), reduce time to approval and improve approval rate (O) over a 4-week period (T)? Baseline data showed that 3 of 19 PA requests were approved, while 16 were denied, resulting in a 15.8% …

Reducing Hospital-Acquired Pressure Injuries In Acute Care Using Structured Prevention Strategies, Yemisi Adesuyi Akinfenwa

Walden Dissertations and Doctoral Studies

Pressure injuries that patients develop while hospitalized continue to be a major safety concern in hospitals treating very sick patients. These wounds hurt, make infections more likely, keep people in the hospital longer, and increase expenses. On many units, the steps meant to stop these injuries, like checking each patient's risk level and turning patients regularly are not carried out the same way for everyone. Because of this inconsistency, some patients develop preventable pressure injuries. The purpose of this Doctor of Nursing Practice (DNP) project was to create a clinical practice guideline (CPG) for organized pressure injury prevention and to …

Reducing Seclusion In Inpatient Psychiatric Units Through Staff Education, Amaka Nkala

Walden Dissertations and Doctoral Studies

Seclusion remains a restrictive intervention used in inpatient psychiatric settings despite evidence linking it to psychological trauma, physical harm, and adverse patient outcomes. This Doctor of Nursing Practice (DNP) staff education project evaluated the effectiveness of a trauma-informed care and de-escalation education program in improving nurses' confidence in managing patient escalation. The project used a pre- and post-intervention quality improvement design with 24 inpatient psychiatric nurses. Participants completed a 10-item, 5-point Likert-scale confidence survey before and after a 30-minute educational session delivered via PowerPoint. Descriptive statistics were used to compare pre- and post-intervention confidence scores. Mean confidence scores increased from …

Staff Education To Increase Knowledge For Reducing Hospital-Acquired Pneumonia, Tenika Monique Mcmillan

Walden Dissertations and Doctoral Studies

The purpose of this Doctor of Nursing Practice (DNP) project was to address a critical gap in nursing knowledge regarding oral care and its role in preventing hospital-acquired pneumonia (HAP) through staff education. Although the relationship between oral care and pneumonia is well established, staff knowledge at the site varied, leading to inconsistencies in oral care practices. To address this problem, a targeted educational session using a pre- and post-test design was delivered to nursing staff. The practice-focused question was “Among nursing staff working in community living centers, does the implementation of targeted education on evidence-based oral hygiene guidelines, compared …

Staff Education Project To Teach Mobility And Sensory Aid Optimization Delirium Prevention Bundle For Older Patients In A Hospital Health System, Lerato Catherine Modise

Walden Dissertations and Doctoral Studies

Delirium is a preventable and manageable neuropsychiatric condition characterized by acute fluctuations in attention, awareness, and cognition. The burden of this acute confusion syndrome among older adults aged > 65 years is disproportionate higher, due to age-related neurocognitive vulnerabilities. Nurse-led delirium prevention interventions can reduce incidence from 70% to 20% following structured education, gaps persist in nursing knowledge around evidence-based prevention strategies. The purpose of this project was to evaluate whether a structured nursing education intervention on enhanced mobility and sensory aid optimization strategies, as components of the ABCDEF bundle, improved nursing knowledge compared to standard care practices. Nineteen registered nurses …

Staff Education On Improving Staff Knowledge Of Medication Adherence In An Outpatient Psychiatric Facility, Okechukwu Chidiadi

Walden Dissertations and Doctoral Studies

This project was a staff education initiative designed to improve staff knowledge of medication adherence at an adult psychiatric outpatient clinic. Addressing this matter is critical because it directly impacts the quality of patient care. The practice focus question was: Among psychiatric mental health staff in a behavioral health facility, what is the impact of a staff educational program on teaching medication adherence to patients on the staff’s knowledge? The purpose of this staff education project was to improve staff knowledge of medication adherence by equipping them with the tools and strategies needed to help patients manage their treatment plans …

Reducing No-Show Rates In An Outpatient Behavioral Health Clinic Through A Multimodal Patient Engagement Intervention, Gwendoline Osong

Walden Dissertations and Doctoral Studies

Reducing No-Show Rates in an Outpatient Behavioral Health Clinic Through a Multimodal Patient Engagement Intervention

Development And Implementation Of A Clinical Practice Guideline To Standardize Social Determinants Of Health Screening And Social Services Referrals In Primary Care, Patricia Pottinger

Walden Dissertations and Doctoral Studies

Social determinants of health (SDOH) significantly influence health outcomes, yet many primary care organizations lack a standardized, evidence-based process for identifying patients' social needs and facilitating referrals to appropriate community resources. The purpose of this Doctor of Nursing Practice executive leadership project was to develop and implement a clinical practice guideline (CPG) to standardize SDOH screening and social services referrals in a primary care setting. The practice-focused question asked whether a CPG designed to standardize social services referrals would be approved by a panel of subject matter experts using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. …

Staff Education To Improve Staff Knowledge, Confidence, And Competency In The Use Of The Zung Self-Rating Depression Scale, Theresa Buabeng

Walden Dissertations and Doctoral Studies

Staff Education to Improve Staff Knowledge, Confidence, and Competency in the Use of the Zung Self-Rating Depression Scale

Improving Medication Adherence Through Structured Telephone Follow-Up To Reduce 30-Day Readmissions Among Adult Patients With Heart Failure, Angela Dean Hamilton

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) evidence-based quality improvement (QI) project addressed high 30-day hospital readmission rates among adults with heart failure (HF), a problem associated with poor medication adherence and inadequate transitional care that nurses are uniquely positioned to address through discharge education, medication reconciliation, and postdischarge follow up to improve patient safety and quality of care. The practice-focused question asked: In adult patients discharged with HF, how does a structured, nurse-led, telephone follow-up intervention focused on medication adherence, compared with usual discharge care, affect 30-day hospital readmission rates over a 90-day implementation period? The purpose of this DNP …

Staff Education To Improve Skills In Detecting And Addressing Medication Nonadherence Among The Psychiatric Nursing Staff, Uchenna Owunna

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education project focused on addressing the knowledge gap of medication nonadherence patterns by the psychiatric nurses in outpatient settings. Nonadherence to psychiatric medications is a major health issue that leads to disruptions of care and symptom relapse, hospitalization, and suboptimal treatment outcomes as well as high healthcare costs. Thus, improving the capacity of the psychiatric nurses to enhance medication adherence through staff education is essential. The purpose of this DNP project was to determine if a comprehensive medication adherence education program would increase psychiatric nurses’ knowledge and skills in assessing …

Implementation Of A Standardized Columbia-Suicide Severity Rating Scale Screening Process In An Outpatient Psychiatric Practice, Dela Mensah Frimpong

Walden Dissertations and Doctoral Studies

This doctoral project was an organizational change initiative designed to implement a standardized suicide risk screening process in an outpatient psychiatric practice. The identified practice problem was inconsistent staff use and documentation of suicide risk screening, which could result in missed warning signs, delayed provider notification, incomplete documentation, and inconsistent follow-up care. Suicide risk identification is an essential nursing responsibility and a key component of patient safety (The Joint Commission, 2024; Zero Suicide, n.d.). The practice-focused question examined whether staff education and implementation of a standardized Columbia-Suicide Severity Rating Scale (C-SSRS) workflow would improve staff compliance, documentation completion, and knowledge …

Staff Education On Medication Nonadherence In Primary Care Clinic, Priscillia Adaugo Obasi

Walden Dissertations and Doctoral Studies

This doctor of nursing practice (DNP) project was a staff education initiative designed to address the practice problem of a lack of evidence-based approaches to patient education on medication compliance in a primary care clinic. A literature search was conducted using PubMed, CINAHL, MEDLINE, and the Cochrane Library search engines/databases, revealing nine studies that supported the premise that patient education can promote medication compliance. A practice-focused question underpinning this project was: Will staff education on evidence-based methods for educating patients about the importance of medication adherence result in increased staff knowledge? Baseline staff knowledge and educational needs were obtained using …

Improving Pcu Nurses’ Knowledge Of Evidence-Based Mindfulness Techniques Through Targeted Education, Dairia Moore Mohammed

Walden Dissertations and Doctoral Studies

The progressive care unit (PCU) is a high-acuity setting in which nurses manage patients with complex health conditions, respond to rapid changes in clinical status, and navigate ongoing physical and emotional demands. The practice problem that I addressed was, presently, stress-management support is typically informal, optional, and reactive rather than systematic, evidence-based, and preventive. The purpose of this project was to implement and evaluate a structured educational intervention designed to increase nurses’ knowledge of evidence-based mindfulness breathing techniques that could be integrated into the daily PCU workflow. The practice-focused question was: In PCU nurses in an acute care setting, how …

Reducing Urinary Tract Infections In Long-Term Care Residents, Felicity Antwi

Walden Dissertations and Doctoral Studies

This quality improvement (QI) project addressed delays in diagnosing urinary tract infections (UTIs) at a skilled nursing facility (SNF), where reliance on urine culture testing and patient monitoring resulted in an average diagnostic period of 72 hours. A high UTI incidence and UTI-involved hospitalization rate are both nurse-sensitive indicators that are important to address in the nursing practice context because they portend negatively for nursing quality and safety. This quality improvement (QI) project addressed the practice-focused question: among long term care (LTC) residents with suspected UTIs in a nursing home (NH), how does reducing the diagnostic period from 72 hours …

Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu

Walden Dissertations and Doctoral Studies

Quality Improvement Initiative Implementation of an Electronic GAD-7 Screening Tool to Improve Anxiety Screening Completion and Documentation

Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph

Walden Dissertations and Doctoral Studies

This executive summary presents the final plan for implementation of an evidence-based fall-prevention clinical practice guideline on an open neurological rehabilitation unit. It does not propose a new device, a new electronic platform, or a separate education-only initiative. The practice change is the implementation and evaluation of a structured interdisciplinary clinical practice guideline designed to reduce inpatient falls and improve the reliability of daily prevention practices. The unit reports a baseline fall rate of 6.3 falls per 1,000 patient days. Thirty-five staff members from nursing, therapy, and support roles completed the survey, and 57% reported that patients had experienced falls …

Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of a structured staff educational intervention on ambulatory surgery center (ASC) staff knowledge of Universal Protocol and SOAP (Surgeon, Operating Room, Anesthesia, and Preprocedure Ready) documentation. A practice gap was identified in staff knowledge of perioperative safety processes that are essential for preventing surgical safety events. The purpose of this doctoral project was to improve ASC staff knowledge of Universal Protocol and SOAP readiness documentation through an evidence-based educational intervention designed to strengthen perioperative safety practices. The practice-focused question was: According to the evidence, in multi-specialty ASC staff, what is …

Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim

Walden Dissertations and Doctoral Studies

Emergency departments (EDs) are essential access points to healthcare for patients with urgent and emergent conditions. Yet, many EDs face persistent challenges, including overcrowding, prolonged wait times, and delays in care. These challenges can significantly affect patient safety, quality of care, and overall healthcare outcomes. Patients presenting with symptoms, such as cardiac, pulmonary, or abdominal discomfort, may initially appear clinically stable, but their conditions can deteriorate rapidly while awaiting evaluation by a provider. Without structured reassessment processes and efficient communication systems, early warning signs of clinical decline may be missed. ED crowding has become a widespread operational and patient safety …

Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye

Walden Dissertations and Doctoral Studies

Summary The type of project is a staff education project, specifically on evidence-based weight loss strategies that the facility can use to manage adults with type 2 diabetes mellitus (T2DM) and co-morbid mental health disorder(s). The evidence-based practice (EBP) question is: Does educating staff on weight loss strategies for T2DM with mental health disorder(s) improve staff knowledge and confidence within one month of staff education program implementation? The facility’s staff managed these patients using standardized diabetes management practices and have no formal staff education program that focuses on evidence-based weight loss strategies for this population. The staff has a vast …

Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson

Walden Dissertations and Doctoral Studies

This doctoral project was an evidence-based staff education intervention designed to improve healthcare team knowledge, attitudes, and clinical practices related to the management of uncontrolled hypertension within a federally qualified health center (FQHC). The practice problem addressed was the persistent challenge of uncontrolled hypertension among patients receiving primary care services, which contributes to increased risk for cardiovascular disease, stroke, and preventable health disparities. Thus, the practice-focused question that guided the project asked whether a multidisciplinary staff education program at a rural FQHC improve healthcare staff’s knowledge, skills, attitudes, and workflow related to the management of uncontrolled hypertension? Findings demonstrated statistically …

A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans

Walden Dissertations and Doctoral Studies

This doctor of nursing practice (DNP) executive leadership project is a practice-focused quality improvement initiative to reduce avoidable 30-day hospital readmissions in a skilled nursing facility by implementing the INTERACT communication tools, SBAR and STOP & WATCH. The practice problem is the lack of a standardized communication process for recognizing changes in resident conditions, contributing to preventable hospitalizations. The project's purpose was to develop an evidence-based communication process that promotes early recognition and timely provider intervention. The practice-focused question asked whether implementing INTERACT communication tools would improve communication and reduce avoidable acute care transfers. A focused literature search was conducted. …

Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa

Walden Dissertations and Doctoral Studies

Evidence-based chronic disease monitoring is essential for improving outcomes among adults with diabetes and hypertension; however, inconsistent application of clinical practice guidelines may result from gaps in healthcare providers' knowledge, confidence, and competency. Staff education is an effective strategy for strengthening evidence-based practice and promoting consistent guideline implementation. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to develop, implement, and evaluate a structured educational program to improve healthcare providers' understanding, knowledge, confidence, self-efficacy, and competency in applying evidence-based chronic disease monitoring guidelines in a primary care clinic. Methods: The educational intervention was developed using …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

Sense Of Purpose As The Guiding Light In Nursing Practice: A Grounded Theory Study, Kathleen Casler

Theses & Dissertations

Problem: As a prosocial profession, individuals may enter the practice of nursing because of an interest in helping and caring for others. However, over time, nurses may be challenged with experiences of burnout that can impact both their relationship with the profession and patient outcomes.

Background/Significance: A sense of purpose has been associated with positive physical, behavioral, and psychological outcomes. In a professional context, a sense of purpose may provide support for navigating complex work environments. It is currently not known what nurses’ experience of sense of purpose may be in relation to nursing practice and how their sense of …

Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton

Walden Dissertations and Doctoral Studies

Burnout is a recurrent problem for healthcare workers and is associated with staff turnover, a decline in the quality of care, emotional fatigue, and risks to patient safety. This Doctor of Nursing Practice (DNP) staff education initiative created a mindfulness-based training program to expand the knowledge of registered nurses, nurse practitioners, and medical assistants on mindfulness practices in a behavioral health setting. Baseline assessment data identified a need for support to address emotional fatigue, absenteeism, and staff disengagement, with a mean pre‑education knowledge score of 66%. A structured, in‑person educational program addressing burnout awareness, stress reactivity, and helpful mindfulness methods …

A Proposal For A Program To Deliver Equitable Nursing Assignments, Laporsha Glover

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was conducted at an inpatient rehabilitation hospital that provides comprehensive interdisciplinary rehabilitation services for adults. Due to the diverse clinical needs of the rehabilitation patient population, nursing workload varies considerably based on patient acuity, functional status, cognitive impairment, medical complexity, and the intensity of nursing interventions required. This creates a practice gap that contributes to inequitable nursing assignments. A comprehensive literature search was conducted using PubMed, CINAHL, Cochrane Library, and Google Scholar. Nine studies were critically appraised using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Appraisal Tools (Bissett et al., 2025). The …

A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project focuses on modernizing an acute care hospital’s surgical suite, enhancing environmental safety, and supporting the growing complexity of surgical care. As surgical procedures become more advanced, the physical environment must evolve to maintain sterile technique and reduce microbial presence. Current operating room configuration, characterized by overcrowding and outdated ventilation systems, introduces environmental risks that compromise patient safety and limit perioperative efficiency. Modernization is essential to align the surgical environment with contemporary safety expectations and organizational performance goals. The proposed initiative includes a comprehensive renovation and expansion of surgical spaces, integrating advanced air decontamination technologies, …