Nursing Commons^™

Development Of A Telenursing-Based Self-Assessment Questionnaire For Diabetic Foot Ulcer Risk, Ratna Wirawati Rosyida, Sugiyarto Sugiyarto

Jurnal Keperawatan Indonesia

Development of a Telenursing-Based Self-Assessment Questionnaire for Diabetic Foot Ulcer Risk. Early identification of the risk of diabetic foot ulcers (DFU) is crucial in preventing ulcers. Caring for diabetic patients, including early detection of the risk of DFU with telenursing, will improve accessibility to health facilities and also help the work of nurses. Currently, there are many instruments or tools to detect the risk of DFU, but instruments that apply telenursing and can be used independently and easily by patients are still limited. This study aimed to develop a digital self-assessment questionnaire for DFU risk in type 2 Diabetes Mellitus …

Effectiveness Of Intradialytic Resistance Training On Muscle Mass And Strength In Patients On Hemodialysis, Sandra Vasquien, I Ketut Swarjana, A.A.A. Yuliati Darmini, I Nyoman Arya Maha Putra

Jurnal Keperawatan Indonesia

Hemodialysis (HD) patients with chronic kidney disease (CKD) lose muscle mass and strength due to protein energy wasting (PEW). The purpose of this study was to test the effectiveness of intradialytic resistance training (IRT) in increasing muscle mass and strength. It used a pre-experimental, one-group pretest-posttest design. Based on a sample size estimate using G*power software, 33 CKD patients undergoing HD at a private hospital in Bali were included. The patients were selected using purposive sampling. Muscle mass was measured using Bioelectrical Impedance Analysis (BIA), while muscle strength was measured using the Medical Research Council Muscle Scale. The Wilcoxon test …

Promoting Competence And Confidence: Simulation-Based Basic Life Support Training For Jordanian Nurses, Yousef Shukry Abu-Wardeh, Wan Muhamad Amir W Ahmad, Mohd Shaharudin Shah Che Hamzah, Intan Idiana Hassan

Jurnal Keperawatan Indonesia

Cardiopulmonary arrest is a major health issue that affects healthcare providers. The COVID-19 pandemic has added a new risk to rescuers who may be attempting to resuscitate victims. It is essential to strike a balance between resuscitation and the need to protect oneself from infection. The study aims to evaluate the effectiveness of simulation training in enhancing the Basic Life Support (BLS) knowledge, skills, and confidence levels of newly employed nurses. The study employed a single-masked, prospective, randomized controlled trial design, which consisted of three phases: a pre-test, an immediate post-test, and a post-test conducted three months later. The American …

Quality Improvement Project: Standardized Medication Reconciliation Process Training: A Path To Improve Staff Medication Confidence, Christologus Obi

Doctor of Nursing Practice Projects

Medication reconciliation represents a critical safety process in psychiatric healthcare, where medication discrepancies affect up to 67% of hospitalized patients, with 30-40% potentially causing significant harm. This quality improvement project implemented a standardized medication reconciliation training program at a Texas mental health facility to address knowledge and confidence gaps among clinical staff. Using Kotter's 8-Step Change Model and the Iowa Model of Evidence-Based Practice, this quasi-experimental pre-post intervention study delivered three 30-minute interactive sessions to 12 multidisciplinary healthcare professionals. The evidence-based intervention introduced a 3-phase reconciliation model focused on obtaining accurate medication histories, documentation, and discrepancy resolution. Data collection used …

Assessing The Impact Of Cultural Competence Training For Providers Serving Native Americans, Chinazo Obi

Doctor of Nursing Practice Projects

The United States is a culturally diverse nation, yet many healthcare providers report challenges in delivering care that respects cultural values and traditions. Within mental health settings, this gap is especially concerning for Native American populations, who experience disproportionately high rates of mental health conditions and face barriers to culturally responsive care. The purpose of this quality improvement project was to assess the impact of a cultural competence education and training intervention on mental health providers’ knowledge and self-efficacy in delivering culturally competent care to Native American patients. Guided by Leininger’s Culture Care Theory of Diversity and Universality and the …

Quality Improvement Project: The Impact Of Staff Education On Utilization Of The Phq-9 Tool And Follow-Up Management Protocol, Shuntak Jerideau

Doctor of Nursing Practice Projects

Depression is a prevalent mental health disorder that affects daily functioning. Timely screening enables the identification of symptoms, monitoring treatment efficacy, and informs additional treatment such as referrals. The practice site reported low screening rates of patient’s post-psychiatric hospitalization, which was attributed to inadequate knowledge of the PHQ-9 tool. The purpose of this quality improvement project was to evaluate the impact of staff education on the utilization of the PHQ-9 tool and follow-up management protocol in a mental health clinic. A quasi-experimental design method was used in an outpatient mental health clinic. Pretest knowledge of the PHQ-9 was obtained from …

The Mechanism Of Action Of Remote Electrical Neuromodulation (Ren) In Treating Migraine And Potentially Other Idiopathic Pain Conditions, Marius Birlea, Christopher L. Robinson, Eden Mama, Alit Stark-Inbar, Alon Ironi, Daniel Atashsokhan, Thomas Berk

College of Nursing Faculty Papers & Presentations

Purpose of Review

This review provides evidence for the mechanism of action (MOA) of Remote Electrical Neuromodulation (REN), a non-pharmacological therapeutic technology for treating migraine and other symptoms manifested by certain idiopathic pain diseases. It discusses the main physiological and anatomical aspects associated with conditioned pain modulation (CPM), and how REN is applied for the treatment of migraine pain and other symptoms.

Recent Findings

The REN wearable device (Nerivio®) is FDA cleared for acute and preventive treatment of migraine in patients aged 8 years and above, and CE marked in patients aged 12 and above. In brief, the REN MOA …

Quality Improvement Project: Impact Of Simulation Training On The Self-Efficacy Of Registered Nurses During A Code Stroke, Kakeya James

Doctor of Nursing Practice Projects

Self-efficacy levels affect decision-making skills and overall confidence in handling critical situations. However, knowledge gaps often hinder the maintenance of high self-efficacy. (Farčić, et al., 2020). The project site provides limited training opportunities that may not adequately prepare registered nurses with the confidence and skills needed to respond to stroke emergencies, potentially causing delays in patient care and adverse health outcomes. As a result, the quality improvement project aims to examine how simulation-based training impacts registered nurses’ self-efficacy in managing stroke emergencies. The project employed a quasi-experimental pretest/posttest design and was guided by the Plan-Do-Study-Act (PDSA) cycle, the Jeffries Simulation …

Exploring Recruitment Strategies For Place-Based Research In Rural Areas Of Australia: A Comparative Case Study Analysis, Tracy L. Schumacher, Anna K. Jansson, Lucy Kocanda, Jennifer May Phd, Rn, Anp-Bc, Leanne J. Brown, Clare E. Collins

Publications

BACKGROUND: Recruitment of participants into research studies is commonly challenging and becomes more difficult when targeting underrepresented population groups. Recruiting individuals living in rural locations, must use appropriate strategies if the sample size is to be achieved. The aim of this case study was to explore factors associated with research capacity, and to determine their impact on recruitment strategies, including timeframe and participant recruitment outcomes.

METHODS: This case study investigated the recruitment outcomes of four rurally based research projects performed between 2016-2024. Participants were enrolled either directly by the researchers (face-to-face method [f2f]), or through General Practitioners as trusted local …

Quality Improvement Project: Effects Of Ongoing Clinical Education Training On Nursing Faculty’S Self-Efficacy In Clinical Education, Sarah Ferguson

Doctor of Nursing Practice Projects

Clinical education is essential for bridging theory and practice in nursing education, yet many clinical instructors transition from expert bedside nurses to novice educators without adequate orientation and training. This quality improvement project examined the effects of ongoing clinical education training on nursing faculty self-efficacy at a satellite nursing school in North Texas. This project, guided by Patricia Benner’s Novice to Expert framework and Lewin’s change model, aimed to determine whether continuous professional development throughout the term would increase clinical faculty confidence compared to standard onboarding alone. A descriptive pre/post design was used, with the Clinical Nursing Teacher Self-Efficacy Scale …

Quality Improvement Project: Improving Providers’ Self-Efficacy In Facilitating Mat Usage Through Educational Training, Joshua W. Moore

Doctor of Nursing Practice Projects

Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) are common diseases treated in detox facilities around the world. Medication-assisted treatment (MAT) is the most effective treatment for OUD and AUD. Despite the need for MAT, many providers do not prescribe lifesaving medications due to a lack of knowledge and confidence. The purpose of this quality improvement project at a local detox facility is to answer the question: What effect on providers’ self-efficacy in facilitating MAT usage upon discharge does educational training have? Under the Social Cognitive Theory (SCT), self-efficacy was targeted using the Plan-Do-Study-Act (PDSA) change model. The aim …

Exploring The Experiences Of Bahamian Men Diagnosed With Hypertension And Medication Adherence, Bianca Edwards

Walden Dissertations and Doctoral Studies

Hypertension (HTN) is associated with significant health complications, including stroke, myocardial infarction, heart failure, and kidney disease. Despite advances in the treatment and management of HTN, a lack of medication adherence contributes to the persistence of HTN-related morbidity and mortality affecting men in The Bahamas. The purpose of this qualitative descriptive phenomenological study, guided by Pender’s health promotion model and Bandura’s social cognitive theory, was to explore the lived experiences of Bahamian men diagnosed with hypertension regarding their adherence to prescribed medications. Using Giorgi’s descriptive phenomenological method, in-depth, semistructured interviews were conducted with 11 participants. Data were analyzed through repeated …

Development Of An Evidence-Based Guideline For Nurse-Led Interventions To Improve Medication Adherence In Patients With Severe Mental Illness, Grace Uche Kalu

Walden Dissertations and Doctoral Studies

I conducted this Doctor of Nursing Practice (DNP) project to address medication nonadherence among adults with severe mental illness (SMI) in a psychiatric care setting by developing an evidence-based clinical practice guideline (CPG) for nurse-led interventions. The identified practice gap was the absence of a standardized, evidence-informed framework to guide nurses in enhancing pharmacotherapy adherence, which is a critical issue linked to relapse, rehospitalization, and diminished quality of life in this population. This project was guided by the following practice question: Will an evidence-based guideline on nurse-led interventions to improve medication adherence in patients with SMI be approved by a …

Advancing Cardiorespiratory Care In The Heart Center: Development Of A Specialized Cardiac Curriculum For Respiratory Therapists, Alexandra Birely, Andrea Torzone, Jill Kleiber, Elysia Harshman, Melinda Cory

2025

INNOVATION & LEADERSHIP

Background: As innovations advance the outcomes and survival of pediatric patients with heart disease, an evolving patient population is increasing the complexity of inpatient heart care. The Heart Center at Children’s Health Dallas has seen a twofold increase in ventilator dependent tracheostomy patients since 2022, illustrating just one example of the shifting acuity profile of patients being cared for on the Acute Care Cardiology Unit (ACCU). Providing safe and high-quality care within a pediatric Heart Center requires enhanced resources and expertise across the entire multidisciplinary team. The need for increased respiratory therapy support was identified on …

Advancing Health Equity Through Comprehensive Haircare Training To Reduce Pediatric Hospital-Acquired Pressure Injuries, Afra Evans, Adrienne Johnson, Adrienne Davis

2025

QUALITY IMPROVEMENT

Background: Increased awareness of health equity and a rise in hospital-acquired pressure injuries (HAPIs) to the scalp and head—particularly among pediatric patients with textured hair—prompted a comprehensive initiative at a pediatric healthcare organization. Environmental scanning revealed that while new haircare products had been introduced into clinical areas, staff lacked the training and resources to use them effectively. A current-state analysis survey of 133 staff members (86% clinical) revealed significant gaps: 69% had never received training in diverse haircare, 51% did not feel equipped to provide appropriate care, and 36% felt nervous or intimidated when caring for hair …

Elevating Nursing Leadership: How Nurse Managers Empower Unit Practice Councils, Katie Fields

2025

EBP

Literature Review: Utilizing OVID and databases CINAHL and PubMed, a comprehensive review of 22 articles, including integrative reviews and qualitative studies, was conducted to examine leadership behaviors that support NPG and UPCs. Across the literature, empowerment, accountability, and presence are consistently highlighted as essential leadership behaviors for effective shared governance that strengthens engagement and professional growth. Clavelle and Tarasenko (2024) emphasized accountability as critical to advancing NPG, while Rollins et al. (2024) underscored the importance of adaptable leadership styles to meet the evolving needs of frontline nurses and practice councils.

PICO: What are the best practices and leadership behaviors …

From Competence To Confidence: Fostering A Culture Of Certification In Nursing, Derhonda Dossett, Sunni Fleming, Amanda Grantham, Johanna Muller

2025

INNOVATION & LEADERSHIP

Background: Nursing certifications help promote excellence in nursing and support the professional identity of nurses. In an urban academic pediatric hospital system, nursing leaders were tasked with increasing professional nursing certification rates within their departments. One team has excelled in increasing their professional certification rate. The team went from 8 to 35 certified nurses which was a 33.75% increase from July 2022 to July 2025. This has elevated the confidence and knowledge base of the nurses and leaders in the Variable Staffing department. Objectives included increasing knowledge and awareness of professional certification, providing resources available to …

Planting Seeds Of Success: Cultivating Cpen Certification In Pediatric Emergency Nursing, Shelby Flusche, Johanna Muller

2025

INNOVATION & LEADERSHIP

Background: Children’s Health Plano campus has faced challenges in supporting nurses preparing for the Certified Pediatric Emergency Nurse (CPEN) exam, with limited resources available for study and preparation. To encourage certification, a certification champion was identified to provide leadership and guidance. However, it soon became evident that additional support was needed, as many nurses were unsure how to obtain a test voucher and reported low confidence levels regarding exam success. In fact, 75% of nurses initially rated themselves as neutral to not confident in their ability to pass the CPEN exam, highlighting a significant gap in …

We Float So You Don’T Sink: Implementation Of Float Nurse Support Role, Amanda Anderson, Caroline Kelley, Mary Moore, Carlie Phillips, Krista Westbrook

2025

INNOVATION & LEADERSHIP

Background: Critical care float pool nurses possess broad clinical expertise and flexibility to support a wide range of patient care areas across the organization. Their familiarity with multiple units, patient populations, and

established relationships with provider teams helps them to facilitate timely and effective clinical support. Acute care staff regard critical care nurses’ judgment with high respect, enhancing interdisciplinary collaboration and trust. Because of a rising patient acuity and census, there is risk for failures in escalation of care, with 16% of serious pediatric adverse events linked to delays is escalation (Sosa et al., 2022). Critical …

A Quality Attack On Hacs, Chasity Tyree-Lee, Krystan Smith, William Gaines, Samantha Frederick, Kendel Richards

2025

QUALITY IMPROVEMENT

Background: Hospital-acquired conditions (HACs) pose a dual challenge to pediatric organizations, compromising patient safety while creating substantial financial burdens, with a single central line-associated bloodstream infection (CLABSI) costing an estimated $48,108 and delaying discharge (Forrester, 2022; Li, 2024). While prior studies have focused on reducing individual HACs through standardized rounding, our pediatric intensive care unit (PICU) adopted a broader, integrated approach.

Methodology: In 2022, we launched a nursing-led initiative to reduce multiple HACs—catheter-associated urinary tract infections (CAUTI), CLABSI, hospital-acquired pressure injuries (HAPI), and peripheral intravenous catheter infiltration and extravasations (PIVIE)—simultaneously. The program empowered Quality Champions (QCs), …

Precision In Practice: Subject Matter Expert Integration To Support Excellence In Population-Specific Documentation, Sara Pump, Lauren Spain, Virginia Kasenic, Meagan Talent, Alivia Stewart, Carrin Shaw, Chad Gautreaux, Dori Cousin, Ronesea Allen, Jonathan Rowe

2025

QUALITY IMPROVEMENT

Background: An initial internal pilot audit of patient charts, performed by the Plano psych RN team within the Emergency department in November 2024 revealed significant gaps in documentation compliance for behavioral health patients. Many areas of required charting were found to be incomplete, partially completed, or inconsistently documented across disparate sections of the electronic medical record. This fragmentation not only impedes the ability to efficiently locate critical information but also fails to meet the documentation standards outlined in Children’s Health organizational policies. These deficiencies pose risks to continuity of care, clinical decision-making, regulatory compliance, patient and staff …

Community Health Worker (Chw) Initiative To Address Low Acuity Pediatric Emergency Department Utilization, Jana Neal, Danielle Hayle

2025

INNOVATION & LEADERSHIP

Background: A Medicaid payor-funded collaborative was initiated in partnership with Children’s Health System of Texas to reduce low-acuity emergency department (ED) visits—defined as triage levels 4 or 5—among Medicaid patients, who account for the largest share of ED use, with nearly 50% of visits considered low acuity. To address this, certified Community Health Workers (CHWs) were deployed in the Dallas and Plano EDs to engage eligible caregivers. CHWs provide education on insurance benefits, assist with establishing primary care provider (PCP) relationships, and promote appropriate healthcare utilization. They also work to identify barriers preventing the use of …

Engaging The Night Shift To Sustain A Healthy Work Environment, Kelsey Walsh, Delaney Dewolf, Annie Tolliver

2025

INNOVATION & LEADERSHIP

Background: Night shift nurses often feel overlooked, leading to disengagement and higher turnover. The common question, “What about for the night shift?” highlights gaps in recognition, communication, and collaboration. In 2024, a large pediatric health system launched a Night Shift Forum (NSF) to improve the work environment for this critical group. Results from the AACN Healthy Work Environment Assessment Tool (HWEAT) showed true collaboration (3.41) and meaningful recognition (3.73) as the lowest-scoring areas. Recent studies show that night-shift nurses consistently report lower scores on healthy work environment domains, while organizations with dedicated night councils demonstrate stronger …

A Nurse-Led Investigation Into Rising Cardiology Clinic Admission Holds And A Multidisciplinary Strategy To Reduce Them, Jennifer Dickson, Haley Byrne, Katherine Harris, Leah K. Toombs

2025

INNOVATION & LEADERSHIP

Background: The Dallas Cardiology Clinic, the only hospital-based clinic within the Heart Center’s outpatient network, serves specialized, high-acuity cardiac patients who often require direct admission. Due to inpatient bed constraints in the Acute Care Cardiology Unit and Cardiac ICU, rising patient complexity, patients are increasingly held in the ambulatory space, not intended for, or equipped for prolonged care. In 2024, average admission wait times rose to 118 minutes (often taking 200+ minutes) up from 97 minutes in 2022. Long admit wait times can lead to treatment delays, raise nursing concerns about safety, and disrupt outpatient flow. …

Addressing Gaps In Breastfeeding Education Among Pediatric Nurses, Bethany Stokes, Shannon Abbott

2025

INNOVATION & LEADERSHIP

Background: Breastfeeding is a modifiable health-related behavior widely recognized for its short-and long-term health benefits (Standish, 2022). The American Academy of Pediatrics (AAP) recommends breastfeeding for at least two years or as long as mutually desired (Meek, 2022). Despite this guidance, pediatric nurses outside of neonatal units often receive minimal breastfeeding education, creating a gap in care for breastfeeding families admitted to other areas of the hospital. This project aimed to assess the breastfeeding knowledge needs of pediatric nursing staff across two hospital campuses. A lack of standardized breastfeeding education was identified. To quantify this gap, …

Blinatumomab Without Borders: Taking Life-Saving Treatment Home, Susan Mccollom, Tami Beaudin, Shareta Jackson, Jamie Gebhard

2025

INNOVATION & LEADERSHIP

Background: Blinatumomab administration has become a standard treatment for acute lymphoblastic leukemia (ALL), following promising early outcomes from the AALL1731 study. The randomized groups in this trial demonstrated a 3-year disease-free survival (DFS) rate of 96% in those receiving blinatumomab, compared to 87.9% in the non-blinatumomab arms. Blinatumomab is administered in two non-consecutive 28-day blocks with ideally approximately 24 days of treatment at home.

Implementation: The staff at the Center for Cancer and Blood Disorders (CCBD) at Children’s Health faced a significant challenge due to the volume and urgency of the therapy to start. We …

Defying Gravity: Fall Prevention Quality Improvement Project, Taylor Ryan, Madeline Bartush

2025

QUALITY IMPROVEMENT

Background: In March of 2025, an increase in inpatient falls led to a hospital-wide containment period. In response, a fall prevention nurse role was created to identify gaps, provide targeted education and lead improvement efforts. Initial surveys of 101 nurses revealed that while 91% reported using the teach-back method of education as part of their practice with patients and families, only 36.6% reported they always use this method, and just 19.8% reported feeling very comfortable doing so. Direct observations revealed families unable to teach-back fall prevention strategies despite nurse documentation of education completion. A gap analysis also …

Development Of A Continuous Renal Replacement Therapies (Crrt) Team, Lainey Segovia, Taelor Pena, David Zolezzi, Tami Turrubiarte, Keri Drake

2025

INNOVATION & LEADERSHIP

Background: Our organization identified an opportunity to provide Continuous Renal Replacement therapy (CRRT) to more patients while simultaneously reducing time to initiation by building a dedicated CRRT team. Although CRRT has been provided for years, it lacked formal standardized education and oversight.

Implementation: Recognizing these gaps in care we formed a CRRT team in May 2024, consisting of three RN coordinators, one Advanced Practice Provider (APP), a nursing director, and a nephrology medical director. The aim was to improve CRRT delivery by authoring guidelines, providing formal in-person education for nurses and providers, creating a centralized …

Embedding Health Literacy Practices Through A Champion Program: A Strategic Expansion, Diana Montoya, Cameron Stine, Kelli Williams, Leslie Moore, Carol Howe

2025

QUALITY IMPROVEMENT

Background: The importance of becoming a Health-Literate Organization gained momentum in our pediatric organization, driven by the Healthy People 2030 initiative, Social Determinants of Health Screening and organizational strategies focused on enhancing patient outcomes. The Health Literacy Champion Program (HLCP) was expanded in 2024-2025 to embed subject matter experts into inpatient care units, thereby infusing health literacy best practices to enhance patient communication.

Methodology: The initial phase involved aligning the HLCP interventions with organizational strategic priorities and establishing shared goals among stakeholders. The program leads identified key priority indicators and metrics to evaluate the program. The …

Empowering Nurses: A Training Initiative On Essential Oils For Pediatric Neurosurgery Patients, Sheri Sacks

2025

EBP

Literature Review: Pediatric neurosurgery patients often face increased anxiety and agitation. Nurses may lack knowledge of non-pharmacological interventions to reduce agitation and anxiety in their patients. Literature review used MeSH Headings and keywords to find recent English articles. Evidence shows EO reduces anxiety. Lavender inhalation lowers anxiety, pain, and vital signs in pediatric dental patients. In adults, aromatherapy decreases anxiety, pain, blood pressure, and improves sleep, also reducing pain and extubation time.

PICO: In pediatric neurosurgical bedside nurses, does education on lavender essential oil, compared to no education, improve knowledge, confidence and intent to integrate it as a complementary …