Nursing Commons^™

Evaluation Of A Streamlined Insurance Advocacy And Pre-Authorization Process For Hormone Replacement Therapy, Ellison Edwards

Walden Dissertations and Doctoral Studies

This organizational process evaluation project addressed the high rate of insurance denials for hormone replacement therapy (HRT) for women with symptomatic menopause and "normal" laboratory values within a private primary care setting. The practice problem involved bureaucratic barriers in the front office and a lack of structured advocacy, which delayed patient access to evidence-based care. The purpose of this project was to evaluate the impact of a streamlined insurance advocacy and pre-authorization process on access to therapy. The project utilized a standardized "Insurance Advocacy Toolkit" and evidence-based templates aligned with the 2023 North American Menopause Society (NAMS) guidelines. Analytical strategies …

A Proposal For A Nurse-Led Continuity Of Care Program, Belinda Siri Mesape

Walden Dissertations and Doctoral Studies

At an outpatient primary care and behavioral health clinic, the practice problem is the high rate of patient no-shows and late appointment cancellations. Missed appointments are a problem, disrupting continuity of care and follow-up and potentially affecting patient outcomes. A comprehensive literature search was performed using PubMed/MEDLINE, CINAHL Complete, the Cochrane Library, PsycINFO, and Google Scholar. The search revealed 26 peer-reviewed studies. Literature consistently supports the use of multifaceted interventions to improve appointment adherence in outpatient settings. The project proposal consists of the development of an evidence-based practice (EBP) program proposal to address the gap in practice in improving appointment …

Alcohol Withdrawal Management Practices And Prevention Of Escalation Events In Hospitalized Adults, Danielle Logan

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an organizational process evaluation examining alcohol withdrawal management among hospitalized adults. Alcohol withdrawal can cause severe agitation, seizures, delirium, behavioral emergencies, transfers, and prolonged hospitalization, making early recognition and evidence-based management essential to patient safety. The practice-focused question examined whether hospitalized adults experiencing alcohol withdrawal were assessed and treated proactively based on risk factors and clinical presentation or reactively after symptom escalation, and whether management practices contributed to Code Green activation and higher-level-of-care transfers. The purpose was to identify practice gaps and develop evidence-based recommendations to improve safety and consistency of care. A …

Development Of A Proposal For An Occupational Safety And Wellness Program, Lodie Rogers

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) evidence-based practice project was a quality improvement initiative focused on developing and implementing an occupational safety and wellness program (OSWP) in an industrial organization. The practice problem was the absence of a formal, standardized program for injury prevention, near-miss reporting, hazard identification, employee wellness, safety education, and leadership accountability. Evidence from scholarly databases, Occupational Safety and Health Administration (OSHA) reports, organizational safety data, incident reports, near-miss documentation, and compliance measures supported the project. I examined how a 10-week OSWP can reduce employee incidents, improve safety culture, decrease injuries, increase engagement, and sustain wellness practices. …

Staff Education About Prescribing Glucagon-Like Peptide-1s (Glp1s), Deenis Garcia

Walden Dissertations and Doctoral Studies

Obesity is a growing health concern that affects many people. In recent years, the use of glucagon-like peptide-1 (GLP1s) has become increasingly popular to combat obesity. The use of GLP1s has shown successful outcomes, yet there are inconsistencies when prescribing the medication for weight loss. The practice problem identified at the organization was the lack of consistent and evidence-based guidance for providers to utilize when prescribing GLP1s for weight loss. The practice-focused question was to determine whether education on structured guidance tools for clinical staff who prescribe GLP1 medications improves their knowledge and intent to use these tools when prescribing …

Early Post-Cesarean Anxiety, Nausea, Vomiting, And Pain Under Spinal Anesthesia: Trajectories And Modifiable Predictors, Indah Susanti, Eza Kemal Firdaus, Septian Mirova Sebayang, Amelia Andini, Alicia Dumes Berg, Margaret Atwood, Rantiningsih Sumarni, Mesya Mesya, Asmat Burhan

Jurnal Keperawatan Indonesia

Recovery after caesarean under spinal anesthesia remains a quality gap, with scarce evidence on modifiable anesthetic practices improving recovery. Data linking the neuraxial technique, nausea, anxiety, and pain remain limited. The objective of this study was to describe postoperative nausea and vomiting, anxiety, and pain at 6, 12, and 24 hours after caesarean section under spinal anesthesia and to examine whether intrathecal adjuvant use, sensory block level, fasting duration, and American Society of Anesthesiologists (ASA) physical status were associated with these outcomes. Cross-sectional study across five hospitals; 534 women undergoing caesarean under spinal anesthesia. Exposures: intrathecal adjuvant, sensory level (≤ …

Effects Of Montessori-Based Stimulation On Fine And Gross Motor Development Among Children With Stunting: A Quasi-Experimental Study, Indah Rahmadaniah, Tukimin Bin Sansuwito, Rini Anggeriani, Rinda Lamdayani, Ade Marlisa Rahmadayanti, Aris Citra Wisuda

Jurnal Keperawatan Indonesia

Stunting affects not only physical growth but also several aspects of child development, including gross and fine motor skills. Early stimulation interventions, such as Montessori-based activities, have been proposed to enhance developmental outcomes through structured sensorimotor experiences. This study aimed to evaluate the effects of Montessori-based stimulation on motor development among children with stunting and to compare its outcomes with those of conventional stimulation. A quasi-experimental study with intervention and control groups was conducted among 120 children with stunting aged 36–59 months. Participants were allocated to either a Montessori group (n = 60) or a conventional stimulation group (n = …

Emotional Intelligence, Work Engagement, And Turnover Intention Among Hospital Nurses: A Hierarchical Component Analysis, Catrin Catrin, Christopher Wisnu, Pauline Henriette Pattyranie Tan

Jurnal Keperawatan Indonesia

High turnover intention among hospital nurses poses serious challenges to healthcare organizations, affecting service quality and workforce stability. Understanding the psychological and organizational factors associated with turnover intention is essential for developing effective retention strategies. This study aimed to examine the relationships among emotional intelligence, work engagement, and turnover intention among hospital nurses, including health-promoting leadership, workload, and burnout as contextual variables within the model. A cross-sectional study was conducted among 98 nurses working in inpatient units using validated questionnaires. The data were analyzed using partial least squares structural equation modeling (PLS-SEM) with hierarchical component analysis. Emotional intelligence significantly predicted …

Evaluating Mobile Palliative End-Of-Life Advanced Care Enhancement (Mpeace) Usability And Technology Acceptance: Mixed-Methods Design, Ni Luh Putu Inca Buntari Agustini, I Gede Putu Darma Suyasa, Israfil Israfil

Jurnal Keperawatan Indonesia

Palliative End-of-Life Care (PEoLC) is a process requiring timely assessment, effective communication, and personcentered decision-making to support patients and families. Although the process can be strengthened through digital health innovations such as Mobile Palliative End-of-Life Advanced Care Enhancement (M-PEACE), its use in PEoLC remains limited. Therefore, this study aimed to evaluate M-PEACE usability and technology acceptance through an explanatory sequential mixed-methods design and explore user experiences in describing quantitative results. The quantitative phase was conducted to assess usability through an adapted System Usability Scale (SUS), and technology acceptance was measured using a modified Technology Acceptance Model (TAM) questionnaire. A total …

Knowledge, Attitudes, And Practices By Women In Cartagena Regarding Breast Self-Examination, Rafael Arnedo Martínez, Keidis Ruidiaz Gómez

Jurnal Keperawatan Indonesia

Breast self-examination (BSE), especially when adopted by vulnerable populations, serves as a vital mechanism for the timely detection of breast abnormalities indicative of cancer. As a result, this decreases the public health burden associated with treatment at advanced stages. Therefore, assessing knowledge, attitudes, and practices (KAP) regarding this simple early detection method is a priority. This study examines the relationship between KAP concerning BSE among women in Cartagena, Colombia. A cross-sectional correlational study was conducted with 322 women attending a healthcare facility. Data were gathered using two tools: a sociodemographic profile and a KAP questionnaire. Results showed that most participants …

Development Of Perineal Electric Massager Experience (Pem-X) To Improve Perineal Elasticity, Suryani Manurung, Amalia Mely, Yetty Mariani Tambun

Jurnal Keperawatan Indonesia

Perineal injury remains a common concern in vaginal childbirth, with a prevalence of 30.6%. Low maternal perineal massage practice is a contributing factor to decreased perineal elasticity and an increased risk of perineal trauma. This pilot study aimed to develop the Perineal Electric Massager Experience (PEM-X) to support mothers in self-guided perineal massage. The research employed a level 4 Research and Development (R&D) method with a one-group pretestposttest design. The study sample consisted of two parts: the PEM-X prototype and postpartum mothers who had vaginal deliveries. A purposive sampling technique was used to recruit 10 postpartum mothers who had vaginal …

Supportive And Palliative Care: Addressing The Unspoken Burden Of Cancer On Significant Others, Esmeraldo C. De Las Armas Iv

Jurnal Keperawatan Indonesia

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges …

Development Of A Culturally Tailored Care Model For Chronic Disease Management In The Coastal Community: A Modified Delphi Study, Laode Saltar, Heltty Heltty, Sitti Mikarna Kaimuddin

Jurnal Keperawatan Indonesia

Chronic noncommunicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, are increasing in Indonesia’s coastal communities including the Bajo population in Southeast Sulawesi. Limited healthcare access, cultural barriers, and low preventive health engagement exacerbate the disease burden in these communities. Culturally tailored interventions are needed to enhance self-awareness and improve chronic disease management. This study aimed to develop and validate a culturally sensitive care model for chronic disease management in the Bajo coastal community. A three-round modified Delphi method was used with 26 panelists representing health professionals, community leaders, policymakers, and family members recruited through community health centers and …

Environmental Exposure Risk Education To Enhance Chronic Kidney Disease Prevention And Screening For Nurse Practitioners, Kelsea J. Carrier

Doctor of Nursing Practice Posters and Presentations

Chronic kidney disease (CKD) affects approximately 36 million adults in the United States, with nearly 90% of individuals unaware of their diagnosis until advanced stages. While diabetes and hypertension remain the primary causes, increasing evidence highlights environmental exposures as significant and underrecognized contributors to CKD onset and progression. Exposures such as heavy metals, per- and polyfluoroalkyl substances (PFAS), air and water pollution, microplastics, and heat exposure have been linked to impaired renal function. Despite this growing body of evidence, environmental health content remains limited in nursing education, resulting in gaps in environmental health literacy (EHL) among nurse practitioners (NPs) and …

Environmental Exposure Risk Education To Enhance Chronic Kidney Disease Prevention And Screening For Nurse Practitioners, Kelsea J. Carrier

Doctor of Nursing Practice Scholarly Projects

Chronic kidney disease (CKD) affects approximately 36 million adults in the United States, with nearly 90% of individuals unaware of their diagnosis until advanced stages. While diabetes and hypertension remain the primary causes, increasing evidence highlights environmental exposures as significant and underrecognized contributors to CKD onset and progression. Exposures such as heavy metals, per- and polyfluoroalkyl substances (PFAS), air and water pollution, microplastics, and heat exposure have been linked to impaired renal function. Despite this growing body of evidence, environmental health content remains limited in nursing education, resulting in gaps in environmental health literacy (EHL) among nurse practitioners (NPs) and …

Standardizing Safe Sleep Education In An Outpatient Pediatric Cardiology Clinic: A Quality Improvement Initiative, Casey Hrbacek

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement (QI) project aimed to increase the reliability of standardized, evidence-based safe sleep education for caregivers of infants aged 0–12 months in an outpatient pediatric cardiology clinic within an academic health system

Background: Sleep-related death is the leading cause of death among infants aged 1-11 months and the third leading cause of infant mortality overall and is closely associated with modifiable unsafe sleep practices. Safe sleep education is delivered inconsistently across settings, particularly during the hospital-to-home transition for infants with complex cardiac disease.

Methodology: A caregiver-completed Safe Sleep Screening Checklist was embedded into clinic workflow. A medical …

Bridging The Gap In Science Research: Preparing Students For College- Level Research In The Sciences, Victoria Helwig, Yaoguang Li

UConn Library Presentations

Many first-year students enter college unprepared to fully engage with scientific literature and academic library resources. Drawing on experiences from academic librarians working with STEM students, this session explores common gaps in science research skills, including navigating databases, identifying scholarly sources, and understanding the structure of scientific literature. Participants will be introduced to practical strategies and classroom-ready activities to better prepare students for college-level research. Discussion questions: What science research skills do students struggle with most when entering college? How can high school instruction better support these skills? Where can librarians and educators collaborate to support student success?

Staff Education To Improve Nurse Competency In Phq-9 And Gad-7 Screening Using A Standardized Behavioral Assessment In An Outpatient Mental Health Setting, Ernest Ogbeide

Walden Dissertations and Doctoral Studies

Evidence-based practice was the basis for this quality improvement project, which involved developing and implementing a staff education program to enhance nurses' competency in administering, scoring, and interpreting behavioral health screening tools (PHQ-9 and GAD-7) for outpatient mental health services. Variability in competency amongst clinical staff to use these standardized screening tools for evaluating anxiety and depression was identified as a problem, as there was no structured, evidence-based education and competency validation process for clinical staff to use, which has the potential to decrease early identification of anxiety and depression among patients and impact clinical assessment and decision-making. The practice …

The Fourth Trimester: Enhancing Postpartum Depression Detection In Primary Care Through Early Screening And Patient Education, Riley Goldschmidt

DNP Projects

Background:
Postpartum depression (PPD) is a common and often underrecognized complication, with many cases going undetected due to inconsistent screening practices in primary care. Delayed identification can negatively impact maternal well-being, infant bonding, and overall family health outcomes. This quality improvement project aimed to improve early detection of PPD by implementing routine screening and patient education during newborn visits in a primary care clinic.

Methods:
The intervention integrated the Edinburgh Postnatal Depression Scale (EPDS) into the existing newborn visit workflow and introduced an evidence-based educational toolkit containing information on PPD symptoms, guidance for seeking care, and a QR code for …

Improving Outpatient Provider Preparedness Through Simulation-Based Training: A Quality Improvement Project, Kristina Weyer

DNP Projects

Introduction:
Simulation-based training is an effective educational strategy, particularly for high-acuity, low-frequency events such as patient decompensation in outpatient settings. However, there is a gap in both literature and practice regarding provider participation in simulation, as competing clinical demands often limit engagement. Local organizational leaders identified limited opportunities for outpatient providers to practice management of acute decompensating patients. The purpose of this project was to evaluate provider competence and confidence in managing a decompensating patient in the outpatient setting and to assess perceptions of the value of time spent in simulation.

Methods:
This quality improvement project evaluated providers who participated …

Targeted Nursing Bootcamps For Critical Access Hospital Nurses: A Program Evaluation., Nicholas Popp

DNP Projects

Background: Registered Nurses employed in critical access hospital settings are required to care for patients across the lifespan with varying levels of acuity. The registered nurse (RN) must be competent in providing medical, surgical, pediatric, obstetric, and intensive care-level services. However, the additional training they receive to care for their patients may be minimal or nonexistent, leading them to seek employment at other facilities due to safety concerns. Leadership within the organization believed that implementing targeted monthly nursing skills boot camps could increase nurses’ competence, confidence, and retention in critical access hospital settings.

Aims: This program evaluation project aimed to …

Bridging The Gap: Development And Implementation Of A Caregiver Educational Guide For Post-Lung Transplant Caregivers, Megan Aller

DNP Projects

Background: Caregivers of post-lung transplant recipients play a critical role in postoperative recovery, as patients require continuous support during the first three months after transplant. Despite this responsibility, caregivers frequently experience burden, stress, and challenges adapting to the complex demands of the caregiving role.

Aim: To evaluate the feasibility and preliminary outcomes of a tailored caregiver education and support guide for caregivers of lung transplant recipients.

Local Problem: Within the local transplant program, caregiver education primarily relied on verbal instruction with limited caregiver-specific take-home resources.

Methods: This quality improvement project used a two-group pretest–posttest design to evaluate the …

Nurse-Led Quality Improvement Asthma Self-Management In Primary Care, Jolene Steinert-Abderhalden

DNP Projects

Background:
Poorly controlled asthma contributes to preventable morbidity, yet many adults lack consistent self-management support. Local Problem: Baseline assessment at a rural Midwestern clinic revealed limited asthma knowledge, inconsistent action-plan use, and low confidence among adults with Asthma Control Test (ACT) scores below 20.

Methods:
This quality improvement project used a pre- and post-intervention design guided by Lean methodology and the Plan-Do-Study-Act (PDSA) framework. Interventions: Registered nurses delivered standardized asthma education, inhaler-technique review, and action plan reinforcement with monthly structured follow-up for 16 weeks.

Results:
Among four enrolled participants, three completed follow-up. Mean ACT scores improved from 17.5 at baseline …

Evaluating Preoperative Education Modalities For Orthopedic Surgery Patients, Hannah Johnson

DNP Projects

Effective preoperative education is essential as total joint arthroplasty (TJA) procedures shift to outpatient care, yet traditional education methods may not be meeting patients’ diverse learning styles. This Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of multimodal preoperative education (in-person, virtual, hybrid video modules, or a combination) on patient-reported anxiety and discharge readiness, as well as length of stay (LOS), surgical site infections (SSIs), and 30-day readmissions. The in-person portion could not be implemented due to staffing constraints. The pre-post evaluation was conducted with a sample of 273 patients undergoing elective hip and knee arthroplasty (pre …

Evaluating An Educational Intervention On Penicillin Allergy De-Labeling Among Graduate Nursing Students, Allison Desmond

DNP Projects

Background
Approximately 10% of patients report a penicillin allergy; however, up to 90% of these individuals are not truly allergic. Inaccurate penicillin allergy labels contribute to inappropriate antibiotic use, increased healthcare costs, and antimicrobial resistance. Education on penicillin allergy testing remains limited among future Family Nurse Practitioners (FNPs).

Methods
A quantitative quality improvement project using a pretest-posttest design was conducted among second- and third-year Doctor of Nursing Practice–Family Nurse Practitioner (DNP-FNP) students enrolled in Pharmacology II or Advanced Practice Nursing III at a Midwestern liberal arts college. Participants completed a 15-minute voiceover PowerPoint educational intervention on penicillin allergy testing and …

Improving Provider Knowledge And Confidence In Hormone Replacement Therapy Through A Quality Improvement Educational Intervention, Caitlin Schmidt

DNP Projects

Background
Menopause is associated with symptoms that can significantly diminish quality of life. Hormone replacement therapy (HRT) remains the most effective intervention for moderate to severe menopausal symptoms. Despite evidence-based guidelines endorsing its use in appropriately selected patients, HRT utilization remains limited.

Local Problem
A gap in provider knowledge and confidence regarding HRT prescribing was identified in a rural primary care clinic in the Midwestern United States. The clinical needs assessment revealed an absence of standardized menopause-specific education and highlighted an opportunity to improve evidence-based menopause management.

Methods
This quality improvement project employed a pre-post educational design guided by the …

Registered Nurse Procedural Sedation In Operating Room: An Analysis Of Patient Safety And Nurse Confidence Efficacy Of 2 Years Post Implementation, Cassandra Fredrickson

DNP Projects

Background
A Midwest hospital implemented a registered nurse (RN) procedural sedation program to provide safe, cost-effective sedation for selected operating room procedures under physician supervision, improving patient access while optimizing anesthesia resources.

Methods
A retrospective descriptive program evaluation examined 1,117 patients who received RN-administered procedural sedation for vascular and neurovascular procedures during 2022 and 2024. Outcomes included anesthesia consultation, anesthesia takeover, reversal agent use, and adverse events. Patient demographics and procedure duration were analyzed. Six procedural sedation nurses completed a self-efficacy survey assessing confidence in sedation-related competencies. Descriptive statistics and qualitative review of adverse event narratives were performed.

Results
Among …

Enhancing Nursing Self-Efficacy In Advance Care Planning Conversations Through Role-Play Education: A Quality Improvement Project, Rachel Williams

DNP Projects

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the …

Enhancing Surgical Team Readiness: Simulation Training For Power Failure Response In Robotic Procedures, Heather Marie Sorton

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice (DNP) project, I used a quality improvement design to implement and evaluate a simulation-based education aimed at improving perioperative staff knowledge related to robotic power-loss events. A practice gap was identified in staff preparedness for robotic system failures due to limited education on emergency protocols, communication, team roles, and Association of PeriOperative Registered Nurses (AORN)-aligned response processes, impacting patient safety during robotic-assisted procedures. I examined whether implementation of a simulation-based educational intervention improved staff knowledge related to robotic power-loss management. The purpose of the project was to improve staff knowledge and standardize responses to …

Dnp Final Report: Improving Rehospitalization Rates And Caregiver Quality Of Life In Outpatient Hospice, Carrie M. Judd

DNP Final Reports

Background: Hospital readmissions among home hospice patients disrupt continuity of care, increase healthcare costs, and may compromise end-of-life preferences.

Purpose: This quality improvement project evaluated the feasibility of implementing a telehealth communication intervention in an outpatient hospice organization. Project aims were to reduce Type I live hospice discharges by at least 2.5% and improve caregiver quality of life (QOL).

Methods: Zoom for Healthcare® video visits and three-way telephone communication supplemented standard nurse practitioner hospice visits during a three-month implementation period. Type I live discharge rates were compared with the organization's baseline quality metrics. Caregiver QOL was measured pre- and post-intervention …