Nursing Commons^™

Improving Adolescent Antidepressant Medication Adherence In An Outpatient Psychiatric Clinic Through Teach-Back And Motivational Interviewing, Sandra Ajao

Walden Dissertations and Doctoral Studies

Antidepressant medication adherence among adolescents is a significant concern in outpatient psychiatric care. Adolescents may miss doses because of stigma, forgetfulness, side effects, limited understanding of medication instructions, or inconsistent caregiver support. The purpose of this Doctor of Nursing Practice project was to improve antidepressant medication adherence and adherence-focused communication among adolescents in an outpatient psychiatric clinic through staff education on teach-back and motivational interviewing. The practice-focused question examined how teach-back combined with motivational interviewing, compared with usual care, affected medication adherence and depressive symptoms during the implementation period. Staff education included use of a previsit questionnaire, structured visit script, …

Standardized Metabolic Monitoring Protocol For Adult Outpatients Who Are Prescribed Antipsychotic Medications, Abel Bueno Gonzalez

Walden Dissertations and Doctoral Studies

This doctoral project was an organization change process evaluation of a quality improvement initiative in a masked outpatient mental health clinic. The practice challenge was poor metabolic monitoring and documentation among adult outpatients taking antipsychotics that were not in line with guidelines. This problem is relevant to nursing practice because use of antipsychotic medications raises risk for weight gain, dyslipidemia, hypertension, and glucose abnormalities, and not monitoring risks may delay referral or management. The practice-focused question was: According to evidence, among adult patients who are prescribed antipsychotic medications in an outpatient mental health clinic, what is the impact of implementing …

Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea

Walden Dissertations and Doctoral Studies

Inconsistent use of standardized whiteboards in patient rooms may contribute to ineffective nurse communication and lower patient experience scores. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether an evidence-based staff education program improved nursing knowledge, intent to use standardized whiteboards, and whiteboard utilization on a medical-surgical unit. Guided by the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model, the intervention included a standardized educational presentation, pre- and post-education knowledge assessments, a workflow integration guide, competency validation, and weekly compliance audits. Thirty-five staff members, including registered nurses and patient care technicians, participated in the project. Following …

Implementation Of Standardized Suicide Risk Screening With Staff Education In An Outpatient Psychiatric Clinic, Gwendoline Nfotiog

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was a quality improvement staff education initiative focused on improving suicide risk screening and documentation in an outpatient psychiatric clinic. Inconsistent use of validated screening tools and documentation practices created risks for missed identification of patients at risk for suicide. Addressing this gap was essential to improve patient safety and support evidence-based behavioral healthcare. In the project, I examined whether implementing standardized suicide risk screening with staff education would improve screening and documentation consistency over 12 weeks. The purpose was to increase staff knowledge, screening compliance, and documentation accuracy. Pre- and postimplementation chart audits, …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Optimizing Life Care Planning For Palliative Home Health Care Patients, Lilian Muraya

Master's Projects and Capstones

Problem: In this home health palliative microsystem, many seriously ill patients begin care without timely goals‑of‑care conversations or documented advance directives, leading to fragmented communication and potentially avoidable emergency visits and rehospitalizations.

Context: This quality improvement project took place in a hospital-based home health palliative care program in Northern California, where an interdisciplinary team identified inconsistent Life Care Planning (LCP) practices and variable staff comfort with conducting goals‑of‑care discussions.

Intervention: A structured LCP workflow was developed so that newly admitted palliative home health patients receive a goals‑of‑care discussion and advance directive review within 7 days of start …

Emergency Nurses' Perceptions Of Interpersonal Empathy When Caring For Department Superusers, Makeba K. Cavette

Walden Dissertations and Doctoral Studies

Compassion fatigue syndrome (CFS) is a significant challenge for healthcare professionals, particularly nurses in the emergency department (ED), due to the demanding, high-pressure nature of their work environment and their increased exposure to human suffering. The purpose of this qualitative phenomenological descriptive study, guided by Nursing Theory of Personal Empathy, was to describe the meaning of ED nurses' interactions with superuser patients and how these interactions affect ED nurses' empathy and susceptibility to developing CFS. A purposive sample of 8 ED nurses with at least 3 years of experience as ED staff nurses working with superuser patients participated in semistructured …

Improved Depression Screening In An Outpatient Mental Health Clinic Using The Phq-9, Meghan Rey Young

Walden Dissertations and Doctoral Studies

Depression is a common mental health disorder in the United States that places significant burden on the individual, the community, and the country. It is estimated that 7.8% of adults in the U.S. experienced major depression in 2019. Having a depression diagnosis places the individual at increased risk for suicide by 31%. Therefore, it is important to screen for depression. In a small outpatient mental health clinic, a gap in practice was identified as a lack of depression screening at patient encounters. The question was asked: In the outpatient clinical setting, what is the impact of improved use of the …

Consistent Phq-9 Administration At Mental Health Watch Initiation And Discharge In A Correctional Setting, Gouni Aicha Bouraima

Walden Dissertations and Doctoral Studies

This staff education project addressed inconsistent Patient Health Questionnaire-9 (PHQ-9) administration and documentation at mental health watch initiation and discharge in a correctional setting. A baseline audit showed 42.1% PHQ-9 documentation compliance (8 of 19 charts), below the 90% organizational benchmark, limiting objective depression severity data needed for clinical decision-making and safe transitions. The practice-focused question was: Among nurses working with incarcerated individuals at mental health watch initiation and discharge, what is the impact of staff education on nurses’ knowledge of PHQ-9 screening protocols? The purpose was to implement structured staff education to improve nurses’ knowledge of PHQ-9 trigger points, …

Improving Suicide Risk Identification Through Standardized Implementation Of The Columbia–Suicide Severity Rating Scale (C-Ssrs) In An Adult Outpatient Behavioral Health Setting, Mirabel Ngwe Boma

Walden Dissertations and Doctoral Studies

Suicide risk may fluctuate throughout treatment, making ongoing assessment essential for timely identification and intervention. At the project site, an adult outpatient behavioral health practice, the Columbia–Suicide Severity Rating Scale (C-SSRS) was administered consistently at intake but inconsistently at follow-up visits, creating gaps in suicide risk reassessment and documentation. The purpose of this quality improvement project was to evaluate the effect of standardized implementation of the C-SSRS during intake and follow-up visits on suicide risk screening compliance over a 9-week period. The practice-focused question asked how standardized implementation of the C-SSRS, compared with current practice, affected suicide risk screening compliance …

Reducing Primary Cesarean Births Among Nulliparous, Term, Singleton, Vertex (Ntsv) Patients Through Structured Multidisciplinary Communication, Toyin Ajani

Master's Projects and Capstones

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a …

Improving Peer Feedback Participation Through Psychological Safety Interventions In Labor & Delivery Nurses, Lindsey C. Hora

Master's Projects and Capstones

Abstract 

Background: Labor and Delivery (L&D) units require effective communication, speaking up, and team learning to support safe care. Psychological safety informed this quality improvement project as a contextual strategy to strengthen peer feedback engagement.  

Problem: Peer feedback participation among eligible L&D registered nurses at a large acute care hospital in Santa Clara, California, was 14.29% (N = 112) below the 30% project target and 80% organizational target. Low participation limited routine feedback for professional development, recognition, and team learning.

Interventions: Interventions included psychological safety education, peer feedback reinforcement, workflow integration, platform navigation support, dedicated completion time, and unit champions. …

Implementation Of Visual Bed Indicator Lights To Improve Fall Prevention Processes, Andrea Leffew

Master's Projects and Capstones

Problem: Inpatient falls remain a significant patient safety concern associated with preventable patient harm, prolonged hospitalization, and increased healthcare costs. Routine fall bundle validations identified inconsistent adherence to safe bed configuration practices, such as beds left raised and bed alarms turned off.

Context: A 3-month quality improvement project was implemented on a 20-bed medical-surgical telemetry unit within an integrated healthcare delivery system at a 130-bed community hospital in Northern California, which was experiencing an increase in inpatient falls and fall-related sentinel events.

Interventions: Implementation of bed-monitoring technology with visual indicator lights that provided real-time feedback on bed configuration.

Measures: The …

Effectiveness Of The Smart Me-De Digital Program On Health Literacy And Glycemic Control In Newly Diagnosed Type 2 Diabetes, Nongnaphat Rungnoei, Siriporn Kruttakart, Natthapan Phianthanyakam, Pakaporn Klinhom, Umaporn Nokpaet, Jintipa Sirikunwiwat, Burong Jaitham

Journal of Health Research

Background: Individuals newly diagnosed with type 2 diabetes often have limited knowledge and self-management skills, leading to poor glycemic control and increased complications. This study evaluated the effectiveness of the Smart ME-DE Digital Program in improving health literacy and glycated hemoglobin levels among newly diagnosed individuals with type 2 diabetes.

Methods: A quasi-experimental study was conducted with seventy participants recruited from diabetes clinics at three hospitals in a central province of Thailand. They were selected using simple random sampling and matched by gender, age, and baseline HbA1c levels, and allocated to an experimental or comparison group. The experimental group received …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Quality Improvement Project Simulating Ethics: Improving Ethical Decision-Making In Nursing Undergraduates Through Simulation And Faculty Training, Shannon Brown

Doctor of Nursing Practice Projects

Nursing faculty often report limited confidence in teaching ethical principles, despite the essential role ethics plays in preparing students for complex clinical decision-making. This quantitative, quasi-experimental pre/post quality improvement project evaluated whether a structured ethics education module incorporating simulation could impact faculty confidence in teaching ethical principles. Guided by Lewin’s Change Theory and the Jeffries Simulation Framework, the project examined how organizational readiness for change and structured simulation design influence faculty development outcomes. Nursing faculty in a baccalaureate program participated in a single simulation-enhanced ethics session. Data were collected through anonymous pre/post Qualtrics surveys, and faculty confidence was measured using …

Improving Exam Scores: Alternative Next Generation Questions In Curriculum, April Morgan

Doctor of Nursing Practice Projects

Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on …

Hypothermia Management In Adult Trauma Patients: Enhancing Nursing Knowledge And Self-Efficacy In The Emergency Department, Shannon M. Rapert

Doctor of Nursing Practice Projects

Trauma-induced hypothermia is a significant, preventable condition that contributes to increased mortality. Evidence suggests that inconsistent recognition and management of hypothermia persist in the emergency department (ED), highlighting the need to strengthen ED nurses’ knowledge and self-efficacy in evidence-based warming strategies. The purpose of this quality improvement project was to evaluate the impact of an educational intervention on ED nurses’ knowledge and self-efficacy in managing trauma-induced hypothermia. Guided by the Iowa Model of Evidence-Based Practice, the ADKAR Change Model, and the Plan-Do-Study-Act framework, this quantitative, quasi-experimental, pretest–posttest project evaluated the effect of an instructor-led educational intervention in ED nurses at …

Reducing The Readmission Rate In Adult Psychiatric Patients With Bipolar Disorder, Jessica Nwokocha

Doctor of Nursing Practice Final Project Abstract

Purpose: 

The goal of this project was to reduce the readmission rate among patients by improving attendance to the post-hospitalization program through phone call reminders.

Background: 

Review of baseline data at the project site showed a 60% increase in the readmission rate among adult patients with bipolar disorder in May 2025. This analysis demonstrates that the readmission rate in psychiatric hospitals continues to be an issue.

Methodology: 

The project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation over a six-week period, with readmission rates monitored for a 30-day period. Data collected and tracked included patient attendance, completed phone calls, and …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Telling Their Intensive Stories: Black/African American Intensive Care Unit Nurses And Their Perceived Encounters With Icu Workplace Racism, Sharon M. Butler

Theses & Dissertations

The 2022 American Nurses Association (ANA) study on racism and racial inequality within the nursing profession both acknowledges the presence of racism in nursing and provides evidence of the diverse negative social and psychological effects of racism on minority nurses. Although the 2022 ANA study sets a precedent and shows evidence of racism’s effects across the broader professional nursing workforce, there is limited nursing research literature that offers a focused presentation and understanding of the lived experiences of minority nurses and their personal perceptions of workplace racism. There is also limited nursing research on how workplace racism impacts cultural and …

Nurse Manager Perceptions Of Strategies To Overcome The Underutilization Of Nonpharmacological Pain Control Methods In Adult Acute Care, Landen M. Bonnell

Undergraduate Honors Theses

A basic patient right is to have pain adequately managed. However, research consistently indicates that many adult patients in acute care experience inadequately managed pain, which may contribute to adverse patient outcomes. Studies have shown that nonpharmacological pain management can lead to increased patient satisfaction, shorter hospital stays, and better patient outcomes. However, many barriers exist to nurses providing effective nonpharmacological pain control therapy, primarily including heavy workload and a lack of education and support. Currently, there is insufficient research on how to overcome these barriers. Four nurse managers with experience in nursing leadership were interviewed using a qualitative descriptive …

Online Group Neurobehavioral Therapy (Nbt) For Veterans With Epilepsy And Major Depressive Disorder (Mdd), Melissa F. Fadipe

Dissertations and Theses (Open Access)

Background: Veterans with epilepsy experience high rates of psychiatric comorbidity, most commonly major depressive disorder (MDD). Barriers to accessing mental health care—including geographic distance, transportation limitations related to seizure-related driving restrictions, and fragmented care between neurology and psychiatry, contribute to the underdiagnosis and undertreatment of MDD in this population. Neurobehavioral Therapy (NBT), a Cognitive Behavioral Therapy (CBT)-informed psychotherapy developed for individuals with seizures, has demonstrated benefits for psychological distress and quality of life. Internet-based interventions and short message service (SMS) text messaging offer promising strategies to address access barriers; however, limited research has examined the feasibility and acceptability of delivering …

From Birth To Better Health: Educating Mothers With Gestational Diabetes On Breastfeeding Benefits And Glucose Management, Jesse A. Soria Jr, Sarah Smith, Audrey Nolan Smith, Keeley Kosier

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

Gestational diabetes mellitus (GDM) increases a mother's risk of developing type 2 diabetes mellitus (T2DM) later in life and can affect an infant's future health. Breastfeeding can help improve a mother's blood sugar control and may lower her future risk of diabetes, but many mothers with GDM do not know about these benefits. This quality improvement (QI) project evaluated a standardized education program on breastfeeding and diabetes prevention for postpartum mothers with GDM at the Family Birthing Center at St. Joseph's Medical Center (SJMC) in Stockton, California. The intervention included a 10- to 15-minute education session and an evidence-based educational …

Improving Mobility Awareness And Jh-Amp Tool Utilization On A Cardiac Care Unit, Courtney Joe, Clarissa Chaires, Jocelyn Martin, Eunice Sanchez

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

The quality improvement project evaluated the impact of staff education and a unit-wide mobility awareness campaign on the use of the Johns Hopkins Activity and Mobility Promotion tools and patient mobilization in a 48-bed Cardiac Care Unit (CCU). The project involved registered nurses, nursing assistants, unit leaders, and adult cardiac patients represented by aggregate mobility data. A preliminary survey completed by 42 CCU staff members, CCU Partnership Council focus group, meetings with clinical nurse specialists, and a baseline unit audit identified inconsistent mobility practices, uncertainty regarding Johns Hopkins Highest Level of Mobility tool, and limited completion of in-room mobility signs. …

Mind Over Scrubs – A Peer-Led Anxiety Reduction Program, Nhi T. Tran, Angelica Dirige, Adeleke Fashola

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

Nursing students experience elevated anxiety during the transition into accelerated programs, which can negatively affect academic performance, well-being, and retention. This quality improvement project evaluated Mind Over Scrubs, a peer-led anxiety reduction program for incoming Entry-Level Master of Science in Nursing students at the University of the Pacific, consisting of four 45-minute sessions on evidence-based coping strategies. Generalized Anxiety Disorder-7 surveys were administered at baseline, before and after each session, and at two- and four-week follow-ups; Wilcoxon signed-rank tests evaluated matched changes. Thirty-one of 62 enrolled students (50%) attended at least one session. Post-session scores fell below individual baselines for …

Know Your Birth, Jasmine Mckelvey, Reagan L. Hunt, Michaela M. David

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

Maternal mortality remains a significant public health concern in rural Kenya because of limited healthcare resources, inadequate emergency obstetric training, and barriers to accessing timely, high-quality maternal care. This quality improvement project evaluated the implementation of the Know Your Birth educational intervention, a culturally responsive, simulation-based training program designed to improve healthcare providers' knowledge, confidence, and competency in evidence-based maternal and newborn care. The project was conducted at Sega Dispensary in Sega, Siaya County, Kenya, and included 26 healthcare staff members. Guided by the Plan-Do-Study-Act framework, participants completed a brief educational presentation followed by three interactive skills stations focused on …

Attrition Of The Midwifery Workforce: Understanding Factors Associated With Leaving The Profession, E. Brie Thumm, Amy H. Goh, Elizabeth G. Phillips, Zachary Giano

College of Health Professions Faculty Papers

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who …

The Effects Of An Educational Intervention To Enhance Knowledge And Awareness Of The Prevention Of Sexually Transmitted Infections Among College Students, Darcy Yates

Doctor of Nursing Practice Projects

Purpose

The DNP student implemented a single group pretest-postest design underpinned by the Health Belief Model to address the PICOT question: Among a purposive sample of college students at a mid-west college (Population) to what degree does participation in an evidence-based intervention providing information about STIs (Intervention), compared with before that intervention (Comparison), result in to an increase in knowledge and awareness regarding STI infections and associated risks and treatment options (Outcomes) over a six-week period (Time)?

Methods

The pretest and postest scores of 15 students for the 27 items in the Sexually Transmitted Diseases Knowledge Questionnaire (STD-KQ) were evaluated. …