Nursing Commons^™

Improving Abnormal Involuntary Movement Scale Screening Consistency In Outpatient Psychiatric Practice, Jeriece Lovelace

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) are potential adverse effects of long-term antipsychotic use that require ongoing monitoring. At the project site, inconsistent staff education, a lack of a standardized screening process, and the absence of electronic health record (EHR) reminders contributed to missed Abnormal Involuntary Movement Scale (AIMS) screenings. Baseline screening compliance was 54.7% (106/194).

Aim of the Project: The aim of this quality improvement project was to increase AIMS screening compliance among adult patients receiving long-term antipsychotic therapy from a baseline of 54.7% to 90.7% within 12 weeks.

Review of the Evidence: Literature review has shown …

Improving Guideline-Directed Sodium–Glucose Cotransporter-2 Inhibitor Use In Reducing Proteinuria In Chronic Kidney Disease, Tamara Martin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Chronic kidney disease (CKD) is a progressive condition associated with increased risk for end-stage kidney disease, cardiovascular complications, hospitalization, and substantial healthcare costs. Proteinuria is an important marker of kidney damage and contributes to CKD progression. Although evidence-based guidelines support sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy in eligible patients with CKD, an outpatient nephrology clinic identified underutilization of SGLT2i therapy among patients with proteinuric kidney disease. Pre-implementation practice relied primarily on renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, with inconsistent use of adjunct SGLT2i therapy.

Aim of the Project: The purpose of this quality improvement (QI) project was to increase guideline-concordant SGLT2i …

Improving Outcomes Through Early Management Of Pre-Eclampsia Risk Factors, Ada Licin-Odnez

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pre-eclampsia is a serious pregnancy condition characterized by high blood pressure and proteinuria, typically occurring after 20 weeks. Pre-eclampsia affects 2–8% of pregnancies globally. Early detection and proper care are essential. The OBGYN clinic reports a 20% rate among high-risk patients, significantly higher than the national 5–8%, attributed to limited education, poor care coordination, and inadequate postpartum support. A medication-only approach without proper education has not effectively reduced the rates.

Aim of the Project: The overarching aim of the Quality Improvement project was to improve maternal and infant outcomes by managing pre-eclampsia risk factors. The QI project reduced the …

Enhancing Suicide Risk Assessment Using The Columbia-Suicide Severity Rating Scale, Elizabeth Gyang

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Suicide risk assessment is a critical component of mental health care; however, inconsistent use of standardized assessment methods can lead to variability in risk identification and clinical decision-making. At the outpatient mental health project site, standardized use of the Columbia-Suicide Severity Rating Scale (C-SSRS) had not been established, indicating a practice gap.

Aim of the Project: The goal of the 12-week Quality Improvement (QI) project was to improve nursing staff knowledge, skills, competence and organizational readiness for standardized suicide risk assessment through structured C-SSRS education and implementation support.

Review of the Evidence: The C-SSRS is a standardized tool with …

Program Evaluation Of A Parkinson’S Multidisciplinary Clinic To Enhance Neurological Care, Krista Naumann

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Patients with Parkinson's disease require coordinated interdisciplinary care to manage complex motor, cognitive, and psychosocial symptoms. Prior to implementation of a multidisciplinary clinic model, care delivery occurred through multiple separate specialty appointments, creating challenges related to care coordination and continuity. Although appointment adherence exceeded organizational benchmarks, the organization lacked formal evidence regarding the clinic's operational effectiveness and utilization.

Aim of the Project: The aim of this summative program evaluation was to assess appointment adherence, clinic utilization, and operational performance of an established multidisciplinary neurology clinic serving adults with Parkinson's disease. Findings were intended to inform organizational decisions regarding program …

Improving Screening And Referral Of Adolescent Depression In Pediatric Primary Care, Eleanor Shaw

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: A practice gap existed in a rural primary care clinic where adolescents aged 12–18 years were not routinely screened for depression during annual well-child visits. A retrospective review of 22 adolescent charts identified no routine PHQ-9 screenings during well-child visits, establishing a baseline routine screening rate of 0%.

Aim of the Project: The aim was to implement a standardized Patient Health Questionnaire-9 (PHQ-9) screening process and increase routine depression screening to at least 90% of eligible adolescents while achieving documented follow-up within 14 days for at least 85% of adolescents with positive screens.

Review of the Evidence: Evidence supports …

Improving Prn Pain Medication Reassessment For Veterans In Acute Care, Safo Adu-Gyamfi

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Chronic pain is a significant health problem, and veterans experience higher pain severity than nonveterans. On an acute care unit of a Veterans Affairs Medical Center, pro re nata (PRN) pain medication reassessment was inconsistent and below the facility’s 92% benchmark. PRN pain reassessment compliance averaged 81.6% from November 2025 to January 2026. The Joint Commission requires timely pain assessments. The facility’s Medical Center Policy (MCP) mandates reassessing PRN pain medication within 120 minutes of administering it. The acute care unit leadership identified limited visual or electronic prompts as contributing factors to the practice gap.

Aim of the Project: …

Improving Hospital Throughput Through Early Mobilization And Proactive Case Management, Sadaf Mir

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged length of stay (LOS) reflected through throughput inefficiency at a Level II trauma center in western United States. Average hospital LOS was 5.3 days, exceeding the organizational benchmark and national average of 4.9 days. Gap analysis identified lack of standardized early mobilization (EM) and inconsistent case management (CM) participation in rounds, contributing to delayed progression, reactive discharge planning, higher costs, reduced bed capacity, and complication risk.

Aim: To reduce hospital LOS by targeting adult trauma patients as a pilot population, aiming to decrease average LOS from 5.3 to 4.9 days over 12 weeks through an early mobility bundle …

Program Evaluation: Effectiveness Of Case Management Carehub For Skilled Nursing Facility Transitions, Rachel Choudhury

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Ineffective communication during transitions from acute care hospitals to skilled nursing facilities (SNFs) contributes to avoidable bed days (ABDs), prolonged length of stay (LOS), and discharge delays. Although evidence-based tools such as InterQual and Milliman Care Guidelines supported clinical decision-making, a standardized communication process among case managers, social workers, payers, and SNF partners was lacking. This program evaluation examined the effectiveness of a standardized CareHub communication workflow designed to improve discharge coordination and transitions to SNFs.

Methods: Guided by the Centers for Disease Control and Prevention Program Evaluation Framework, a 90-day program evaluation (February-April 2026) was conducted in a …

A Policy Analysis Of Nurse Practitioner Requirements In California Children’S Services Programs, Erna Josiah-Davis

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

California Children’s Services (CCS) is a state and federally funded program administered by the Department of Health Care Services that provides care coordination, therapy services and referrals for residents under the age of 22 years. CCS Numbered Letter 07-0123 outlines the requirements for nurse practitioner (NP) practice in CCS’ Special Care Centers. The Numbered Letter (NL) policy may have workforce and operational impacts that have not been assessed.

Aim of the Project:

The policy analysis’ aims were to describe policy impacts of the Numbered Letter on CCS programs, clients and providers, communicate impacts with stakeholders, and share policy recommendations …

Implementing Medication-Focused Fall Risk Assessment To Reduce Falls In Acute Care, Jill Shultz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a significant patient safety concern among hospitalized older adults. The existing fall risk assessment did not evaluate medications, creating a gap in identifying fall-risk-increasing drugs (FRIDS).

Aim of the Project: The aim was to improve FRID identification by implementing a medication-focused fall risk assessment tool (MFRAT) for older adults admitted to an orthopedic and neurological medical-surgical unit. The American Society of Consultant Pharmacists & National Council on Aging Falls Risk Checklist was the chosen tool.

Review of the Evidence: Evidence identified three recurring themes: standardized MFRAT use, FRID identification, and healthcare worker education on FRIDs. Findings supported …

Implementation Of The Tailored Interventions For Patient Safety (Tips) Program To Reduce Falls, Jeremy Zobell

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inpatient falls on a 48-bed orthopedic medical-surgical unit exceeded the organizational benchmark. Before implementation, the unit fall rate was 5.34 falls per 1,000 patient-days, compared with the benchmark of 2.45. Variation in bedside communication, documentation, and patient understanding created an evidence-to-practice gap.

Aim of the Project: The project aimed to reduce inpatient falls by implementing the Fall TIPS program to improve the reliability of individualized fall-prevention planning and integration of evidence-based strategies into daily nursing workflows.

Review of the Evidence: Evidence supports multifactorial fall-prevention strategies that combine individualized risk assessment, patient education, visual cues, and shared decision-making. Fall TIPS …

Fall Prevention In The Inpatient Oncology Unit Using Fall Boards And Visual Cues, Rachel Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls remain a significant patient safety concern in hospitals. In an inpatient oncology unit at a large academic medical center, falls increased from 33 in 2024 to 46 in 2025, while the fall rate increased from 2.86 to 3.95 falls per 1,000 patient days. A gap analysis revealed that only 5% of high fall-risk patients had fall boards and visual cues in place.

Aim of the Project: The aim of this quality improvement (QI) project was to increase the utilization of fall boards and visual cues for high fall-risk patients through implementation of a standardized fall prevention education bundle …

Strengthening Post-Fall Huddle Practices In Long-Term Care, Janette Perry

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: High resident fall rates and repeat falls caused by an unreliable nurse-only post-fall huddle (PFH) process that lacked structure, interdisciplinary participation, and timely root-cause analysis.

Aim of the Project: To reduce falls and fall-related injuries in long-term care units by implementing a standardized, evidence-based PFH workflow that strengthens root-cause analysis, improves interdisciplinary communication, and increases PFH reliability.

Review of the Evidence: Evidence from fourteen high-quality, peer-reviewed studies demonstrates that structured, interdisciplinary post-fall huddles are more effective than informal, nurse-only approaches in improving fall analysis and reducing repeat falls in long-term care settings. Structured PFHs strengthen root-cause analysis; interdisciplinary participation …

Loss Of An Adolescent Peer By Suicide Through The Lens Of Qualitative Interpretive Description, Kristin S. Burgess

Nursing Theses and Dissertations

Adolescence is an important period of development during which relationships and life experiences influence mental health and well-being. Understanding these experiences is essential to providing individualized, developmentally informed nursing care. This portfolio dissertation examines adolescent connectedness, mental health, and the lasting influence of peer suicide through three manuscripts that collectively contribute to nursing knowledge and future research. Chapter 1 introduces the background, significance, and problem of adolescent peer suicide bereavement, establishes the gap in understanding its long-term developmental impact, and presents the purpose and research questions guiding the dissertation. Chapter 2, Connectedness in Adolescence: A Concept Analysis, clarifies the defining …

Loma Linda Nurse - Vol. 35, Loma Linda University School Of Nursing

Loma Linda Nurse

FEATURES

4 | From Behind the Lens to by the Bedside—Nicole Mackey

6 | Coming Home— CRNA Alumni Faculty Feature

8 | From NICU Miracle Baby to Nurse—Nito Gil

10 | Change the Game— Miguel Aguayo

12 | Standing in the Shadow of a Miracle—Joyce Rusch

LLUSN HIGHLIGHTS

14-21 | ALUMNI NEWS

22-29 | ACADEMICS

30-33 | HOMECOMING

34-38 | FACULTY UPDATES

Midwifery Student Attrition In Australia: A Scoping Review, Terri Downer, Tanya Capper, Olav Muurlink

Research outputs 2022 to 2026

Problem: Global literature suggests that attrition rates from entry-to-practice midwifery programs are increasing. However, little is known about student attrition in the Australian context.

Background: Australia faces a growing midwifery shortage, prompting calls to increase program enrolments. Evidence from the United Kingdom shows high and rising attrition in entry-to-practice programs. In Australia, the scale of midwifery student attrition and the factors influencing it remain largely underexplored.

Aim: To identify and synthesise existing Australian literature on factors influencing midwifery student attrition.

Methods: A search of PubMed, Medline, CINAHL Ultimate, Embase, MIDIRS, EBSCO, and Google Scholar databases was conducted with key data …

Navigating Study Demands In First-Year Midwifery Education: Mixed-Methods Insights From Students, University Lecturers And Clinical Mentor Midwives, Chantal Soyka, Julia Berger, Dorothee Herrmann, Ruth Martis, Claudia Plappert, Niclas Schaper, Martina Schlüter-Cruse, Dorothea Tegethoff, Marina Weckend, Mechthild M. Gross

Research outputs 2022 to 2026

Aim: To examine:(1) study-related demands faced by first-year midwifery students; and (2) support provided to help them cope with demands.

Background: The recent national transition from vocational training into tertiary midwifery education in Germany resulted in a new teaching environment and adjusted clinical placement settings. Capacity building at tertiary level enabled innovative services to foster supportive learning environments for midwifery students, including processes for onboarding. However, little is known about students’ perceived challenges during this time.

Design: Convergent mixed-methods study.

Methods: An online survey of 304 first-year direct-entry midwifery students from 31 German higher-education institutions and semi-structured interviews with lecturers …

Effectiveness Of An Integrated Activity-Based And Tele-Monitoring Intervention On Mental Health Literacy And Resilience Among Urban Older Adults In Thailand: A Quasi-Experimental Study, Khunatpakorn Makkabphalanon, Pramote Thangkratok, Jutamast Wongjan, Natchaya Palacheewa

Journal of Health Research

Background: Mental health problems among older adults are a growing public health concern, particularly in urban areas. Mental health literacy can enhance problem recognition, self-help, and help-seeking. This study examined changes in mental health literacy and resilience among urban older adults following an integrated activity-based and tele-monitoring intervention.

Methods: A one-group quasi-experimental repeated-measures study was conducted among 30 adults aged 60 years and older in urban communities in Thailand. Participants received a structured 3-hour activity-based mental health literacy intervention followed by 1 month of tele-monitoring support. Data were collected at baseline, immediately after the intervention, and at 1-month follow-up. Changes …

The Impact Of Evidence-Based Benzodiazepine Tapering Guidelines In An Outpatient Psychiatric Setting: A Quality Improvement Project, Addeh Tosin

Doctor of Nursing Practice Projects

Long-term benzodiazepine use is associated with dependence, withdrawal, cognitive impairment, falls, and overdose, yet tapering practices remain inconsistent in outpatient psychiatric care. This quality improvement project examined whether evidence-based deprescribing education improved psychiatric mental health nurse practitioners' (PMHNPs) self-efficacy, adherence to benzodiazepine tapering guidelines, and active prescription outcomes. The Plan-Do-Study-Act cycle guided implementation, the ADKAR Model guided change, Bandura’s Self-Efficacy Theory provided the theoretical framework, and the Stetler Model supported evidence translation. The project employed a quantitative, quasi-experimental, single-group pretest-posttest design and involved three PMHNPs from one outpatient psychiatric practice. Participants received one 20-minute educational session based on American Society …

Improving Provider Confidence In Suicide-Risk Screening Through Training On A Safe-T-Guided Pathway At Intake, Shukairo Mack Baker

Doctor of Nursing Practice Projects

Evidence supports structured suicide-prevention education, but inconsistent pathway use at outpatient intake prompted this quality improvement project to evaluate provider confidence. The aim was increased confidence after training on a Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) guided pathway. Donabedian's structure, process, and outcome model and the Awareness, Desire, Knowledge, Ability, and Reinforcement change model guided implementation through one Plan, Do, Study, Act cycle. A single-group pre-test and post-test design involved seven clinicians at one hybrid outpatient behavioral health clinic. All available eligible staff (100%) completed a 2.5-hour training and both surveys. The Suicide Risk Assessment Confidence Scale was administered …

Quality Improvement Project: Telehealth Follow-Up After Psychiatric Hospital Discharge, Ikemi Echeng

Doctor of Nursing Practice Projects

The period following psychiatric hospitalization is a high-risk transition during which inconsistent communication, delayed follow-up, and poorly coordinated referrals can create gaps in continuity of care. This quality improvement project addressed inconsistent post-discharge follow-up processes in a community outpatient mental health clinic. The purpose was to implement staff education and a structured workflow incorporating the Agency for Healthcare Research and Quality Discharge Phone Call Tool to improve staff confidence, telehealth follow-up, and referral coordination over eight weeks. A quantitative, quasi-experimental, one-group pre- and post-intervention design was used. Staff confidence was measured with Grundy’s C-Scale, and telehealth follow-up and referral activities …

Quality Improvement Project: Improving Nurse Confidence In Managing Patient Aggression Using The Brøset Violence Checklist And Team-Based Strategies, Grace Amakulor

Doctor of Nursing Practice Projects

Workplace violence remains a concern in psychiatric nursing, particularly when changes in patient behavior are not recognized early or communicated consistently. This quality improvement (QI) project was conducted at a psychiatric recovery center in Central Ohio after identifying a practice gap in aggression risk assessment and response. The purpose was to implement and evaluate a multicomponent aggression-management approach using the Brøset Violence Checklist (BVC), structured team huddles, and individualized aggression care plans. The aim was to improve nurse confidence (primary outcome) and reduce aggressive behavioral incidents (secondary outcome) over four weeks. Bandura’s Social Cognitive Theory and Lewin’s Change Theory guided …

Quality Improvement Project: Enhancing Suicide Recognition Protocols With The Use Of Columbia-Suicide Severity Rating Scale In An Outpatient Mental Health Practice, Pamela Oxley

Doctor of Nursing Practice Projects

Suicide prevention in outpatient mental health settings requires prompt recognition of and an appropriate response to suicide-related concerns, including those initially communicated to administrative staff. Frontline administrative phone staff may first encounter patients expressing suicidal thoughts; however, evidence supports education and standardized processes to facilitate effective recognition and response. At the project site, a practice gap existed in administrative staff preparation and confidence in responding to suicide-related concerns. The quality improvement project addressed this gap through structured, standardized Columbia-Suicide Severity Rating Scale (C-SSRS) education paired with a standardized suicide-risk stratification and escalation protocol. The project aimed to improve administrative staff …

Quality Improvement Project: Improving Psychiatric Provider Confidence In Prescribing Long-Acting Injectable (Lai) Antipsychotics Through A Structured Education Program, Emile Bihnyuy

Doctor of Nursing Practice Projects

Schizophrenia is a disorder that affects about 24 million people globally and needs regular antipsychotic drug management to prevent relapse. Although long-acting injectable (LAI) antipsychotics are associated with better adherence to and fewer relapses than oral antipsychotics, their use is underutilized in outpatient psychiatric care. This quality improvement project aimed to increase psychiatric providers' confidence in the prescribing of LAIs by implementing a structured 12-week education program in an outpatient psychiatric clinic in Texas. The implementation was guided by the Iowa Model of Evidence-Based Practice and the change process informed by Lewin's Change Model. Four psychiatric providers completed the modified …

Impact Of Cannabis Use Screening And Early Intervention In Outpatient Psychiatric Settings, Theresa Chibuoke

Doctor of Nursing Practice Projects

Cannabis use can complicate psychiatric assessment, treatment planning, and clinical outcomes, yet standardized cannabis-use screening remains inconsistently implemented in behavioral health practice. This quality improvement (QI) project addressed inconsistent cannabis screening and referral practices in an outpatient psychiatric clinic by implementing a standardized workflow to improve screening documentation to at least 80% and timely referral completion to at least 75%. A quantitative, quasi-experimental pretest-posttest design included 10 outpatient psychiatric providers over six weeks. Lewin’s Unfreeze-Change-Refreeze model guided change, the Plan-Do-Study-Act framework supported implementation, and Donabedian’s Structure-Process-Outcome model guided the project. The evidence-based intervention incorporated provider education, the valid and reliable …

Quality Improvement Project: The Impact Of Proper Utilization Of Suicidal Ideation Screening Tools, Anuoluwapo Bode-Oloye

Doctor of Nursing Practice Projects

Suicide remains a significant public health concern, emphasizing the importance of consistent and evidence-based suicide risk assessment in outpatient mental health settings. The purpose of this Doctor of Nursing Practice quality improvement project was to determine how the provider’s implementation of the Columbia Suicide Severity Rating Scales (CSSRS) according to the recommendations of the Substance Abuse and Mental Health Services Administration would impact the confidence and the rate of completion of suicidal screening tools (Columbia Suicide Severity Rating Scales) compared to current clinic policy in an outpatient mental health clinic for over twelve weeks. This project used Lewin’s change model …

Quality Improvement Project: The Impact Of Provider Education On Antipsychotic Medication Side Effects, Anthony Emego

Doctor of Nursing Practice Projects

Weight gain is a frequent and clinically relevant side effect of antipsychotic medication. A needs assessment at the project site found that roughly 55% of patients on an antipsychotic treatment had clinically significant weight gain, and providers had no formal training on how to prevent and manage this. The purpose of this quality improvement project was to determine if a provider-focused educational intervention is effective in increasing provider confidence and decreasing antipsychotic-induced weight gain in adult psychiatric patients. This quantitative, one-group pre-post design utilized Lewin's Change Theory and Bandura's Social Cognitive Theory. It was conducted at an outpatient psychiatric clinic …

Quality Improvement Project: Improve Patient Show Rate For Appointments At The Outpatient Diabetic Clinic, Smitha Mathew

Doctor of Nursing Practice Projects

Missed appointments disrupt diabetes management, delay treatment, and waste healthcare resources. This quality improvement project evaluated whether patient-centered scheduling, staff education, and multimodal communication reduced no-show rates among adults with diabetes. The Plan-Do-Study-Act model provided the theoretical and implementation framework, while Kotter’s Eight-Step Change Model guided practice change. The uncontrolled preintervention-postintervention project occurred from January through July 2026 in a hospital-based outpatient diabetes clinic. The evidence-based intervention included 45-minute staff education, scheduling based on patients’ preferred days and times, verifying contact information and communication preferences, sending telephone and text reminders, and re-engaging patients the same day after missed appointments. Appointment …

The Impact Of Provider Education On Medication Adherence In An Outpatient Psychiatric Clinic: A Quality Improvement Project, Tina Ezeh

Doctor of Nursing Practice Projects

Medication adherence is important in psychiatric care, as nonadherence can contribute to poor health outcomes and increased use of healthcare services. A needs assessment at an outpatient psychiatric clinic identified inconsistent medication adherence education, with only 30% of providers routinely providing education and 20% using a structured approach. The purpose of this quality improvement project was to evaluate structured provider education, with the aim of assessing changes in provider confidence and the frequency of medication adherence education over eight weeks. Kotter’s 8-Step Change Model guided project implementation, while the Donabedian Model was used for project evaluation. A quantitative, one-group pretest-posttest …