Nursing Commons^™

The Role Of Psychological Capital And Case Management Intensity In Patient Activation In Permanent Supportive Housing Residents., Sarah J. Carter

Electronic Theses and Dissertations

This dissertation explores patient engagement with health, or patient activation, in the formerly homeless population housed in Permanent Supportive Housing (PSH) and receiving case management support. Research is limited on patient activation in PSH residents; consequently, there is minimal understanding of factors contributing to one’s attitudes and behavior towards health care in this group. Psychological Capital refers to the components of hope, self-efficacy, resilience, and optimism. Research in other marginalized groups indicates increasing psychological capital may improve health behaviors. Case management provides support to PSH residents and forms of social support have been associated with improved health outcomes. Applying the …

Reducing Operating Room Turnover Times Through Standardized Workflow, Trinity H. Darnell

Doctor of Nursing Practice Final Project Abstract

Prolonged operating room (OR) turnover times (TOTs) contribute to surgical delays, decreased case volume, and inefficiencies that negatively affect patient care and hospital operations. Lack of coordination in turnover processes and communication among staff are common contributors to extended TOTs. The purpose of this project was to reduce turnover times by implementing a standardized workflow carried out by efficiency teams composed of OR float staff. This project took place in the surgical department of a hospital in Sugar Land, Texas, using a single group pretest-posttest design. Baseline data was collected for 12-weeks prior to implementation and compared to 12-weeks of …

Objective Structured Clinical Examination (Osce) For Interscalene Brachial Plexus Block Utilizing Ultrasound Guidance And Landmark Technique, Madison Mize, Mckayla Moore, Peyton Shell

Doctoral Projects

The purpose of this doctoral project was to create learning and evaluation tools for interscalene brachial plexus blocks (ISBPB) to be used by certified registered nurse anesthetists (CRNAs) and students in the Nurse Anesthesia Program (NAP) at The University of Southern Mississippi (USM). ISBPB is a regional anesthesia technique used to provide anesthesia for procedures of the shoulder and upper arm. CRNAs and students can use these tools to refresh their current knowledge and enhance their regional anesthesia skills.

The objective structured clinical examination (OSCE) and cognitive aid for ISBPB utilizing landmark and ultrasound-guided techniques were evaluated by the USM …

Evaluation Of Migraine Treatment In The Emergency Department, Laura Porben Guzman, Erika Dittmar, Thomas J. Wolfel, Jessica Y. Justiz, Allison Vargas, Stephanie Palma

Nursing & Health Sciences Research Journal

Introduction: Migraines account for approximately 1.2 million U.S. emergency department (ED) visits annually, yet fewer than 25% of individuals achieve sustained relief, underscoring the need for more effective, standardized care. The American Headache Society recommends first-line ED therapy with intravenous fluids, nonopioid analgesics, and antidopaminergic agents; if inadequate, escalation to triptans or dihydroergotamine is appropriate, with adjuncts such as magnesium or valproic acid. Opioids are discouraged due to limited efficacy and safety concerns. We evaluated the impact of implementing an evidence-based ED migraine pathway following provider education.

Methods: We conducted an observational pre-/post-intervention quality improvement project (January–April 2025), including 100 …

Mental Health In Adult Oncology Patients, Jenna Pope

Capstones

Adults with cancer suffer from mental challenges that frequently go under diagnosed and under treated (Fernando et al., 2023). This can lead to lower quality of life, resulting in reduced adherence to treatment, more frequent hospital stays, increased healthcare costs, and increased mortality rates (Matthews et al., 2025). There are currently no policies on mental health screening for adult oncology patients at every outpatient appointment. By consistently utilizing standardized screening tools such as the PHQ-9 and GAD-7 during all oncology appointments, this can close the gap in policy to address mental health needs of these individuals. It is vital to …

Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger

Capstones

No abstract provided.

Harnessing The Communities Of Resilience And Excellence Framework To Advance Population Health: The Healthy West Kendall Experience, Cristina Brito, Simone Cheong, Stephanie Norling, Michelle Mejia, Sandra R. Mclean, Carlos E. Hernandez, Lourdes Boue, Zuanel Diaz, Javier Hernandez-Lichtl

Nursing & Health Sciences Research Journal

Introduction: Fragmented community efforts often dilute health‐improvement initiatives. The Communities of Resilience and Excellence (C.O.R.E) Guide offers a Baldrige-based systems approach that aligns cross‐sector partners around shared metrics and continuous improvement cycles for collective impact. West Kendall, an unincorporated area of Miami-Dade County with over 340,000 residents, adopted the framework in response to rising chronic disease burden and socioeconomic disparities.

Methods: West Kendall Baptist Hospital served as the backbone organization that aligned multi-sector partners, implemented evidence-based interventions, and tracked community-level outcomes. We conducted a cross-sectional evaluation of the Healthy West Kendall initiative's impact across various regions in Miami-Dade County and …

Pilot Testing The Reliability And Validity Of The Modified Obstetric Fall Risk Assessment System, Geraldine F. Lamoglia, Ashley H. Hurtado, Yasmin Solis, Deborah Pol, Natalie Bermudez

Nursing & Health Sciences Research Journal

No abstract provided.

Letter From The Editors: The Value Of Research, Quality Improvement And Evidence-Based Practice Projects, And Innovations In Clinical Practice, Nohemi Sadule Rios, Stephen Breazeale

Nursing & Health Sciences Research Journal

No abstract provided.

The Effect Of Simulation On Nurses’ Confidence With Providing Post-Fetal Death Support To Bereaved Parents, Monique Scholine, Shannon Zalewski, Erin M. Franklin, Sandria Jamieson, Janelle Diaz, Donna Davis, Kristi Vargo, Nicole Adokou, Kettia Antoine, Natalie Bermudez

Nursing & Health Sciences Research Journal

Introduction: Fetal death (FD) affects one in 10 women worldwide and is associated with negative sequelae such as complicated grief. The negative effects of FD may potentially be mitigated through provision of bereavement support (BS) by trained healthcare workers.

Purpose: The purpose of this study was to explore the effect of simulation on registered nurses’ (RN) confidence in providing BS following FD.

Methods: This was a quasi-experimental study conducted within a South Florida community hospital. Nurses were recruited via email/flyers. Participation in the study entailed attending a post-FD simulation session, and completion of the Perinatal Bereavement Care Confidence Scale (PBCCS) …

Promoting Healthy Diet Adherence Using A Multisensory Approach For Post-Stroke Patients: A Pilot Randomized Controlled Trial, Stacey Myers, Yuki Asakura Strempek, Sarah Kaster, Clare Hall

Nursing & Health Sciences Research Journal

Introduction: Evidence supports a healthy diet for secondary stroke prevention; however, programs to implement nutrition education remain inconsistent. This study assessed the feasibility and efficacy of using a multisensory approach called the “Hands-on Training” program (HOT) to improve healthy diet adherence among patients rehabilitating after stroke.

Methods: This pilot randomized controlled study was conducted at an inpatient rehabilitation facility. Stroke patients were randomly assigned to either an experimental group who received HOT or a control group who received conventional education. The HOT group received real-time meal choice coaching, a healthy meal preparation experience, and additional written education. The Mediterranean Eating …

A Descriptive Study Of Non-Pharmacological Interventions In Early Labor In Nulliparous Term Singleton Vertex (Ntsv) Women, Candida R. Bell, Acklin Gordon, Dianna Hill, Elba Rivera, Heather R. Cowherd, Ivette Ramos, Martha Valdes, Maureen Gordon, Silvia Foltan, Silvia Medina, Catherina C. Chang Martinez

Nursing & Health Sciences Research Journal

Introduction: Positional changes may contribute to progression of labor in nulliparous women. We investigated the use of non-invasive, non-pharmacological interventions during the first stage of labor in nulliparous, term, singleton, vertex (NTSV) women at a community hospital in the U.S. Another aim was to compare the times from the first intervention to completion of the first stage of labor across three interventions.

Methods: Ours was a descriptive, retrospective study of 98 NTSV women from January to June 2025. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences version 27.

Results: Most women were Hispanic (71%), averaging 31 …

Longitudinal Associations Between Maternal And Child Screen Use At 1 Year Of Age And Child Behavior And Development At 3 Years Of Age, Stephanie Sim, Juliana Zabatiero, Natasha Bear, Amber Beynon, George Thomas, Ravisha Srinivasjois, Brad Jongeling, Desiree Silva, Leon Straker

Research outputs 2022 to 2026

Background: Young children are increasingly exposed to evolving screen technology. International guidelines recommend no screen use for children under the age of 2 years, due to the potential for detrimental effects on behaviour and development. However, evidence for these guidelines is limited by inadequate consideration of device-specific effects (TV and mobile phone/tablet computer), maternal screen use, confounders such as maternal mental health and importance of effect sizes. Our aim was to investigate longitudinal associations of device-specific maternal and child technology use and covariates (including maternal mental health) with behavioural and developmental outcomes, to guide adults on screen use behaviours by …

Staff Education To Improve Nursing Knowledge On Fall Prevention, Mary Del Riffe

Walden Dissertations and Doctoral Studies

Summary Falls in health care facilities constitute the most prevalent incidents among all safety-related mishaps. If unaddressed, falls can result in severe consequences and perhaps fatal outcomes for patients. The Doctor of Nursing practice (DNP) project was developed to address the issue of patient falls in a long-term acute care hospital (LTACH). The practice-focused question was: Will implementation of an educational evidence-based staff fall prevention program improve nurses’ knowledge on fall prevention? The 1-hour staff education program was created based on review of recent evidence. Twelve nurses attended the staff education program. A pre- and posttest were used to evaluate …

Reduction In Patient Falls: A Quality Improvement Project, Jotis J. Lee

Doctor of Nursing Practice Projects

Patient falls remain one of the most frequent adverse events in hospital settings, leading to injury, prolonged hospital stays, and increased healthcare costs. The identified problem was high fall rates at a specialty hospital. The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project was to evaluate the effectiveness of an evidence-based (EB) educational intervention, using the Fall TIPS (Tailoring Interventions for Patient Safety) toolkit, in improving direct care nursing staff’s knowledge, confidence, and perceived ability to implement fall prevention strategies for high-risk patients. The aim was to improve the nursing staff’s knowledge, confidence, and perceived ability …

Evaluating A Blood Warming Device For Packed Red Blood Cell Transfusions To Decrease Hypothermia In Very Preterm Infants: A Randomised Control Trial Protocol, Kayla C. Everhart Phd, Rn, Michael D. Wirth Msph, Phd, Face, Victor N. Iskersky, Robin B. Dail Phd, Rn, Faan

Publications

Background: This protocol describes a study to test a commercial blood warming device in warming blood transfusions to prevent hypothermia associated with packed red blood cell (PRBC) transfusions in very preterm infants. Objectives: Very preterm infants receiving blood transfusions warmed by a commercial blood warmer will have less central body hypothermia post transfusion (abdominal temperatures < 36.5°C) and/or a higher mean abdominal temperature for the hour after the transfusion is complete compared to those receiving blood transfusions by standard of care. This trial has been registered with Clinicaltrials.gov (trial number NCT05170633). Methods: In this trial, which is funded by The Gerber Foundation and adhered to the SPIRIT2013 checklist, 140 very preterm infants with an order to receive PRBCs will be randomised into a standard of care group to receive one PRBC transfusion over 3 h with blood in a syringe at room temperature or into the intervention group to receive one PRBC transfusion over 3 h using a Hotline® Blood and Fluid Warmer. Abdominal skin temperatures will be measured every minute through a blood transfusion using a skin thermistor and datalogger. Data analysis: Descriptive statistics will be computed for each group to compare demographics and all infant pre-, during, and post-transfusion body temperatures. A student t-test will be used to compare the groups on mean post-transfusion temperatures as a primary outcome variable. To examine thermal change over time between the two groups, linear mixed models with a random intercept will be utilised. Results: This trial began in January 2022, in a South Carolina neonatal intensive care unit and is ongoing. Discussion: This RCT will determine if warming PRBC transfusions will prevent hypothermia in preterm infants during and after blood transfusions. Results from this trial will be used to design national standards for blood transfusions in preterm infants to decrease morbidity and mortality.

Addressing Nursing Student Burnout Through Mindfulness And Zen Den At University Of The Pacific, Jeremy Seaton, Tanairi Ingram, Natalia Zelayandia

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background:

Burnout among nursing students is a critical issue that negatively impacts academic performance, mental well-being, and long-term professional retention. Entry-Level Master of Science in Nursing students at University of the Pacific experience heightened stress due to rigorous coursework, clinical demands, and underdeveloped institutional mental health support.

Aim:

This Quality Improvement project aimed to reduce stress and strengthen emotional resilience among nursing students through Mindfulness-Based Stress Reduction education and the creation of a peer-supported wellness space, the “Zen Den.”

Methods:

A pre- and post-intervention design was implemented, utilizing surveys to measure mindfulness knowledge, attitudes toward self-care, and stress awareness. Zen …

Enhancing Pediatric Sun Safety: A Parent-Focused Intervention In El Dorado County, Ashley Riley, Calvin Nauer, Alaina Godwin

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background:

Childhood ultraviolet (UV) exposure is the most significant modifiable risk factor for skin cancer, yet proper sun protection remains inconsistently practiced by parents. In El Dorado County, California, where high altitude and intense sun exposure amplify UV risk, knowledge gaps and misinformation persist despite resource availability. This quality improvement (QI) project aimed to strengthen parental knowledge, confidence, and modeling of sun-safe behaviors for their children through an evidence-based community education program.

Aim:
The goal of this QI initiative was to improve parental attitudes, self-efficacy, and photoprotective behaviors by implementing a three-part, nursing-led educational intervention focused on UV risk awareness, …

Mapping The Mortality-To-Incidence Ratios Of Alzheimer’S Disease And Related Dementias (Adrds): Evidence From The South Carolina Alzheimer’S Disease Registry, Eric Mishio Bawa, Daniel A. Amoatika, Margaret C. Miller Ms, Ph.D., Bankole A. Olatosi Ph.D., Lorie Donelle Phd, Rn, Fcan, Sue E. Levkoff Scd, Msw, Sm, James W. Hardin Ph.D., Xiaoming Li Ph.D., Leonardo Bonilha, Daniela B. Friedman Ph.D., Swann Arp Adams Ph.D., Ms, Face

Publications

Introduction Mortality-to-incidence ratios (MIRs) are useful in assessing disease burdens and illustrating disparities. Unlike cancer, MIRs have not been applied to ADRDs. Therefore, we estimated and mapped the MIRs for ADRDs to show disparities in South Carolina. Methods Using data from the South Carolina Alzheimer’s Disease Registry (2017−2021), ADRD MIRs were calculated by demographic and geospatial characteristics. To account for the influence of the COVID-19 pandemic, data from 2015 to 2019 were also examined. MIRs were calculated as age-adjusted mortality rates divided by age-adjusted incidence rates. Results Overall, Black people and rural individuals consistently experienced higher MIRs, with the COVID-19 …

Building Adult-Gerontology Acute Care Nurse Practitioner Student Competencies For Telemental Health Treatment Through Simulation, Amy Dievendorf Dnp, Aprn, Fnp-Bc, Agacnp-Bc, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Beverly Baliko Phd, Rn, Pmhnp-Bc, Abbas Tavakoli Drph, Mph, Me

Publications

Depressive disorders are common mental health conditions that are often undiagnosed or undertreated. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) are educated in the management of acute and critically ill patients but are often uncomfortable identifying and treating mental health conditions. Telehealth instruction is useful in mental healthcare and is required as part of the AGACNP’s efficient patient care competencies. This article reports findings from a mental health-focused telehealth instructional activity integrated into an existing AGACNP curriculum. This instructional activity was designed to introduce students to telehealth delivery and build AGACNP competencies using telehealth technology to assess patients with depressive mood …

Improving Early Detection Of Suicidal Ideation Through Routine Screening In Adults With General Anxiety Disorder, Brittanie N. Bush

Doctor of Nursing Practice

Suicide is a leading cause of death in the United States, with anxiety and depression recognized as independent risk factors for suicidal ideation (Centers for Disease Control and Prevention, 2024 September 26; Grant et al., 2023; Li et al., 2022; Moon et al., 2025; Wiebengo et al., 2021). Incorporating valid screening tools like the General Anxiety Disorder-7 and the Columbia-Suicide Severity Rating Scale can help identify suicidal ideation early, enabling quicker provider intervention (Johnson et al., 2019; O’Connor et al., 2022). The purpose of this project was to implement the Columbia-Suicide Severity Rating Scale as a standardized screening tool for …

Hygiene Heroes: Strengthening Oral Hygiene To Reduce Central Line-Associated Bloodstream Infections In Pediatric Hematology/Oncology Patients, Sidney Clymer-Engelhart, Kirstie Shulman

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Central line-associated bloodstream infections (CLABSIs) impact pediatric patient outcomes, increasing mortality, hospital stays, and healthcare costs. At Sutter Medical Center Sacramento (SMCS), the CLABSI prevention bundle includes proper line care, dressing assessments, and hygiene practices, including twice-daily oral care, daily linen changes, and chlorhexidine gluconate (CHG) bathing. Sutter found their CLABSI bundle compliance at approximately 76–78%, with oral hygiene identified as the most frequent gap in care.

Aim: This quality improvement project, partnered with SMCS, targeted oral care compliance to enhance overall bundle adherence, strengthen staff-leadership communication, and ultimately reduce CLABSI rates in the hematology/oncology units. In a wider …

Fall Prevention In The Lobby Of The Emergency Department At Sutter Medical Center Sacramento, Tanya Rodriguez Duarte, Vaneza Espino, Roshni Hayer, Yajari Mendoza

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: In 2024, Sutter Medical Center Sacramento (SMCS) reported 17 patient falls in the Emergency Department (ED) lobby, with 94% (n = 16) occurring in the triage area. Patients awaiting placement after triage are not classified as admitted and thus are not included in CMS’s inpatient fall reporting program. However, due to the known safety risk, SMCS ED leadership began tracking lobby falls locally and partnered with University of the Pacific nursing students to address this issue.. Aim: This quality improvement project aimed to reduce the incidence of falls in the ED lobby through enhanced fall risk identification, timely reassessment, …

The Kangaroo Care Project: Implementation Of Skin-To-Skin (Sts) In Sutter Medical Center, Sacramento, Neonatal Intensive Care Unit, Bianca Wong, Katherine Do, Martha Calero, Lydia Nambala

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Skin-to-skin contact, also known as kangaroo care or kangaroo mother care, is an intervention typically done after birth to promote physiologic stability, bonding, and breastfeeding.

Aim: The Kangaroo Care project aimed to increase the incidence of skin-to-skin contact in the neonatal intensive care unit at Sutter Medical Center, Sacramento.

Methods: A pre-survey was conducted to assess staff comfort with skin to skin. Interventions to increase skin-to-skin rates included staff e-learning, unplanned extubation mock codes, nurse champions, and a policy change to Sutter Medical Center, Sacramento’s handbook.

Results: TBD. Preliminary results indicated use of STS in the NICU and post-results …

Staying Ahead Of The Pressure: A Multimodal Intensive Care Unit Hospital-Acquired Pressure Injury Quality Improvement Project At Sutter Medical Center, Sacramento, Mijung Lim, Daniela Tobler, Raquel Youkhana

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Hospital-acquired pressure injuries (HAPIs) are a major quality and safety concern, particularly in the intensive care units (ICUs) where critically ill and immobile patients face elevated risk. At Sutter Medical Center Sacramento (SMCS), nine confirmed HAPIs and two under investigation were reported within the medical ICU, cardiac ICU, and neurosurgical ICU by May 2025, exceeding the hospital’s target and prompting a system-wide quality improvement initiative.

Aim: The aim of this project was to: (a) reduce ICU-acquired HAPIs to fewer than four cases per quarter by December 2025 and (b) increase nursing compliance with early and ongoing prevention strategies, including …

Improving Maternal Mental Health Awareness And Support In Perinatal Black And Latina Women, Jasman Hans, Lesly Carrillo, Kayla Huynh, Brianna Harrison

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Black and Latina women in California experience disproportionately high rates of perinatal mental health disorders due to limited access to care, stigma, and systemic inequities.

Aim: In collaboration with BeMomAware, this Quality Improvement project aimed to enhance maternal mental health literacy among Black and Latino individuals in the Oak Park community of Sacramento. The project sought to increase awareness, knowledge, and access to culturally appropriate mental health resources through an educational video and community session.

Methods: Interventions included a short educational video and an in-person community session providing culturally relevant information about perinatal depression and anxiety disorders, available resources, …

Metabolic Screening In Veterans On Antipsychotics Mood Stabilizer, Joy Nneka Eke

Walden Dissertations and Doctoral Studies

Summary This Doctor of Nursing Practice project was conducted to examine a quality improvement initiative that sought to address metabolic syndrome screening consistency for veterans on antipsychotic medications at a U.S. Department of Veterans Affairs health system located in the Midwest region of the United States. The project centered on whether the quality improvement program assessing compliance with the current metabolic syndrome screening process reflects increased early detection of metabolic syndrome to prevent cardiovascular complications. Data collection involved comprehensive chart reviews of 50 veterans’ records. The data collected were analyzed using a specially designed quality improvement initiative assessment form developed …

Executive Summary: Executive Leadership System Improvement Workplace Violence, Mercedes Ivette Tejada

Walden Dissertations and Doctoral Studies

Introduction This Doctor of Nursing Practice (DNP) Executive Leadership Project is focused on the reduction of workplace violence in a critical access hospital using an organized prevention program. Workplace violence in nursing is increasing, exposing the health of staff, patient safety, and quality of care in critical access hospitals. The question of the DNP project is: In nurses (P) in small critical access hospitals, how does implementing a structured workplace violence prevention program (I) compared to having no formal violence prevention strategy (C) impact the occurrence of workplace aggression and perceptions of safety among staff (O)? This practicum project used …

Preventing Psychotropic Medication Duplication: Improving Communication Between Primary Care And Psychiatric Providers, Linda Nwachuku

Walden Dissertations and Doctoral Studies

This project is an education-based initiative designed to address the persistent problem of psychotropic medication duplication in integrated care settings. Duplication occurs when patients receive multiple prescriptions of the same or similar psychotropic drugs. The practice gap exposes patients to adverse drug events, complications of polypharmacy, and reduced adherence, and subjects the providers to liability. The practice-focused question guiding this project is: For primary care and psychiatric providers, will an education program on structured communication and medication reconciliation, compared to current usual practices, increase provider confidence and awareness of the risks of duplication, communication strategies, and increased the use of …

Improving Post-Resuscitation Debriefing Completion Rates In An Acute Care Community Hospital: A Quality Improvement Project, Tiffany Tolden

Doctor of Nursing Practice Projects

Background: Post-resuscitation debriefing improves team dynamics and CPR quality and can identify systemic barriers to quality care delivery. However, completion rates remain low in acute care settings. Purpose: This quality improvement project evaluated whether a one-hour training session for rapid response nurses and charge nurses, combined with weekly reminder emails, would increase completion rates of post-resuscitation debriefings and influence nurses’ perceptions of their usefulness in an acute care community hospital. PICOT Questions: Will a one-hour training session (I) with rapid response nurses and unit charge nurses (P), along with a weekly reminder system (I), increase the completion rate (O) of …