Nursing Commons^™

Policy Review Of The Aha Clinical Practice Guideline For Congestive Heart Failure: Evaluating Best Practices, Brenda E. Garcia

Student Scholarly Projects

Practice Problem: Congestive heart failure (CHF) is a significant public health challenge that impacts various populations and contributes to rising hospital admission rates.

PICOT: The PICOT question that guided this scholarly project was: For healthcare policymakers and interprofessional teams (P), how does a policy review of the American Heart Association’s Clinical Practice Guidelines for Heart Failure (I), guided by the CDC’s Polaris Framework (C), conducted over a 12-week period (T), evaluate alignment with evidence-based practices and potential for adoption in the care of patients with congestive heart failure (O)?

Evidence: This scholarly project focused on reviewing the current clinical guidelines …

Providing Evidenced Based Practice Interventions To Direct Care Providers In Long-Term Facilities To Increase Knowledge Of Mental Health Care In Older Adults: An Educational Toolkit, Chelisa Ann Crabtree

Doctoral Dissertations and Projects

The purpose of this scholarly project is to increase the knowledge of mental health (MH) care among direct care providers in long-term facilities by developing an educational toolkit focused on evidence-based education and training, with the goal of enhancing staff competencies in MH care, improving the management of residents’ MH needs, and ultimately optimizing care and quality of life. With the increasing number of younger and sicker individuals, particularly those with MH issues, residing in long-term facilities and lack of specialized training for direct care providers which leads to inadequate/complicated care and poor patient outcomes, there is a pressing need …

Staff Education On Early Diagnosis And Management Of Hypertensive Crisis, Sharon Fairweather

Walden Dissertations and Doctoral Studies

Summary This project is a Doctor of Nursing Practice initiative to educate healthcare professionals at a primary healthcare clinic. The focus was on improving staff knowledge of hypertensive crises in African American patients aged 20 to 40. The project included face-to-face training sessions and educational resources to empower providers and enhance patient outcomes. Hypertensive crises are a significant health risk, especially in African Americans. This group has higher rates of hypertension, leading to serious health complications. Addressing this issue is crucial in nursing practice. Early diagnosis and timely interventions can significantly improve care. Equipping nurses with the necessary skills is …

Emergency Nurses’ Perceptions Of A Trauma-Informed Organizational Climate: A Cross-Sectional Study, Audrey Kobina

Nursing Theses and Dissertations

Healthcare leaders face numerous challenges in today’s complex healthcare environment. The most pressing issues are staffing shortages and burnout among healthcare workers. By 2025, the U.S. healthcare system could experience a shortfall of up to 450,000 nurses, or 20% fewer nurses than needed to provide adequate patient care. High job dissatisfaction and burnout levels are significant factors driving many nurses away from the profession. This three-paper dissertation portfolio addressed how trauma-informed approaches and practices can enhance the work environment by establishing trauma-informed organizational climates to mitigate burnout. Understanding the impact of trauma-informed practices within healthcare systems supports the nursing workforce. …

Oncology Nurse Self-Assessment Of Caring Behaviors Following Telehealth And In-Person Visits, Maryann Connor

Walden Dissertations and Doctoral Studies

Oncology nurses coordinate care, ensure the safe administration of treatments, manage symptoms, and support those newly diagnosed with cancer. Traditionally, oncology care included in-person visits, but the COVID-19 pandemic accelerated the adoption of telehealth, transforming how oncology care is delivered. The purposes of this study, guided by Watson’ theory of human caring, were to determine (a) if there is a difference in oncology RNs’ self-assessments of applying caring behaviors during in-person visits compared to oncology RNs’ self-assessments of applying caring behaviors of telehealth visits with newly diagnosed cancer patients, and (b) if there is a difference in self-assessment of caring …

Improving Staff Knowledge Of Insulin Protocols, Farzana Dalal

Walden Dissertations and Doctoral Studies

A midwestern inpatient hospital experienced a rise in insulin-induced hypoglycemic events on an acute medical-surgical floor as evidenced by 6-23 incidences per month between September 2024 to February 2025. A gap in practice revealed deficiencies in knowledge on the use of insulin protocols, which led to the project question addressing if nursing education on the use of insulin protocols would improve nursing staff knowledge as measured by pre- and post-educational surveys, thus resulting in decreased hypoglycemic events. This educational project utilized the ADDIE pedagogy, the John Hopkins evidence-based practice (JHEBP) model, and the Walden University's DNP Project Process Guide. This …

Enhancing Hypertension Management In Correctional Facilities: Educating Advanced Practice Providers On Effective Strategies, Kimbreya E. Otey

Doctoral Dissertations and Projects

Hypertension is a leading risk factor for cardiovascular disease and remains a significant public health concern, particularly within correctional facilities where access to consistent guideline-based care is often limited. Incarcerated individuals experience higher rates of chronic conditions, including hypertension, yet standardized approaches to management are frequently lacking. To address this gap, an evidence-based educational program was developed for nurse practitioners (NPs) and physician assistants (PAs) working in the correctional setting. Grounded in the International Society of Hypertension (ISH) guidelines, the program was developed to enhance awareness and knowledge among NPs and PAs regarding evidence-based hypertension management practices using the International …

The Effect Of An Educational Intervention On Pre-Licensure Nursing Students Using The Theory Of Cultural Humility, Margaret Curry

Doctoral Dissertations and Projects

The American population has become more racially and ethnically diverse. Pre-licensure nursing students must have the knowledge, skill, and attitude to meet the needs of this diverse patient population. The purpose of this study was to educate pre-licensure nursing students on the concept of cultural humility using standardized patients from diverse cultural backgrounds in simulation experiences. The 27 students in this study were enrolled in a traditional nursing program in the southern U.S. This one-group quasi-experimental pretest–posttest design used Foronda’s Cultural Humility Scale. These students completed this scale (pretest), participated in simulation experiences with standardized patients from diverse cultural backgrounds, …

The Impact Of Trauma-Informed Care Education On Healthcare Providers And Staff In An Outpatient Clinic: A Holistic Approach To Diversity, Equity, And Inclusion, Ngozi Azu

Doctoral Dissertations and Projects

Trauma is an emotional response that an individual may experience due to exposure to an event beyond their ability to manage. Trauma-informed care (TIC) is essential in health care for creating a supportive and safe atmosphere for individuals with a trauma history, but many health providers and staff lack proper training in TIC. The purpose of this project was to design, implement, and evaluate a comprehensive education program focused on TIC for health care providers and staff in an outpatient clinic setting. A quasi-experimental methodology and the Iowa Model of Evidence-Based Practice were used. Quantitative and qualitative data were collected …

Nurse Preceptors' Perceptions Of Effectiveness Precepting Senior Baccalaureate Nursing Students: A Transcendental Phenomenological Study, Kelly Anne Arraf

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to explore how clinical nurse preceptors perceive their effectiveness when working with senior baccalaureate nursing students in East Texas. The study was guided by two theories: Invitational Education Theory, introduced by Purkey and Novak, used to understand how preceptors teach, and Bandura’s Social Learning Theory, used to understand how preceptees learn. The central research question was: What is the lived experience of being a nurse preceptor to senior baccalaureate nursing students in East Texas? Data were collected from semistructured virtual interviews, field and journal notes, and a demographic survey. Braun and Clarke’s …

Psychotropic Medication Nonadherence Among Psychiatric Patients Using Motivational Interviewing, Kate Ananga Pabai

Walden Dissertations and Doctoral Studies

This educational intervention involved enhancing knowledge and competency of nursing staff in terms of application of motivational interviewing (MI) techniques to improve adherence to prescribed psychotropic medications among patients with mental health conditions. The project met criteria for a staff education initiative, directly addressing the ongoing issue of psychotropic medication nonadherence, a prevalent and pressing challenge at the project site. Clinicians observed frequent missed doses and treatment discontinuation, leading to symptom relapse, emergency room visits, and avoidable hospital admissions. These outcomes emphasized the need for a targeted intervention to support frontline nursing staff. The practice-focused question guiding the project was: …

Enhancing Medication Communication In The Acute Care Setting To Strengthen Patient Comprehension And Retention, Ashleigh C. Christensen

Student Scholarly Projects

Practice Problem: Research has shown that breakdowns in communication, especially in the context of medication education, play a critical role in the delivery of safe and effective patient care. These findings underscore the need to prioritize effective communication in medication education. In the acute care setting, effective communication is essential for ensuring patient safety, adherence, and improved patient-centered outcomes.

PICOT: In clinical staff providing direct patient care in the acute care setting (P), does the implementation of the evidence-based teach-back method (I), as compared to current practice (C), improve patient knowledge, understanding, and self-management upon discharge (O), over ten weeks …

Controlling Hypertension In The African American Population Through Dash Diet Education, Tanya K. Mccaskill

Doctor of Nursing Practice Projects

Hypertension disproportionately affects African Americans, contributing to elevated risks of stroke, cardiovascular disease, and kidney failure. Despite the well-established benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, its adoption remains limited due to cultural, socioeconomic, and health literacy barriers. This Quality Improvement (QI) project aimed to evaluate the effectiveness of a culturally tailored DASH diet education intervention in improving nutritional knowledge among African American adults with hypertension (HTN). Using a quasi-experimental pre-post intervention design, 50 participants received a structured educational session during a single clinic visit, which included counseling, printed materials, and sample menus. The intervention was guided …

Staff Education To Improve Preceptors’ Knowledge Base To Adapt Teaching Methods Across Generations, Lucretia Dennise Sanders

Walden Dissertations and Doctoral Studies

Today’s nursing workforce consists of individuals from multiple generational cohorts, which creates a dynamic mix of nurses whose behavior and work reflect the cultural and historical events that shaped their generation. As the nursing workforce becomes increasingly multigenerational, nurse educators and leaders face growing challenges in ensuring that onboarding practices meet the needs of diverse learners. In the local organization, leaders and clinical educators observed inconsistencies in preceptorship practices and onboarding experiences, particularly for newly hired nurses. As a result, leaders determined that an educational intervention focused on generational teaching strategies was needed. Thus, the purpose of this Doctor of …

On The Use Of Wearable Continuous Glucose Monitors (Cgms), Jovita Ozonnadi

Walden Dissertations and Doctoral Studies

This DNP project implemented an educational module on the use of continuous glucose monitoring devices (CGM) to increase staff knowledge of diabetic care and glycemic control for the diabetic population in a community healthcare clinic. Diabetes mellitus is a significant health concern that poses a substantial challenge to the community and the American healthcare system with a higher burden of diabetes complications found among the low income, uninsured, and minority populations. Poor glycemic control is a major health issue that significantly increases the risk of developing diabetes-related complications such as heart and kidney diseases, and obesity. The adoption of CGM …

Screening For Bullying In A Middle School Setting, Paige Bernau

Dissertations

Problem: Bullied youth are two and a half times more likely to experience depression and three times more likely to experience anxiety and suicidal ideation than their peers (Li et al., 2024). Schools represent a key access point for mental health support and treatment for youth (Duong et al., 2020). Despite this, schools typically do not have formal bullying screening integrated into student support services.

Methods: This program evaluation used a descriptive, observational design to evaluate a bullying screening program in a suburban middle-school. This program used the California Bullying Victimization Scale (CBVS) to assess for bullying victimization (BV) followed …

Implementation Of An Evidence-Based Postpartum Depression Screening Tool In A Level Iv Neonatal Intensive Care Unit, Morgan A. Takacs

Dissertations

Problem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes.

Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the …

Evaluation Of A Behavioral Response Team To Decrease Use Of Violent Restraint, Katherine Skrade

Dissertations

Abstract Introduction: The purpose of this Quality Improvement project was to evaluate the implementation of the Behavioral Assessment and Response Team (BART) and evaluate its effect on occurrence and duration of violent restraints on non-psychiatric floors in a pediatric hospital. This QI project also aimed to correlate the use of the Broset Violence Checklist (BVC) to the utilization of the BART as a means of predicting patient escalation, as well as to assess the effect of booster education on the BVC and BART on bedside staff confidence in utilization of these resources.

Methods: Data was collected across three time periods: …

Implementing A Standardized Protocol To Screen For Depression In A Gastroenterology Outpatient Clinic, Catherine M. Karle

Dissertations

Problem: There is a lack of mental health screenings for depression taking place in outpatient gastrointestinal (GI) clinics. Outpatient gastrointestinal (GI) offices are not consistently screening patients for depression despite a rise in depression rates and the known adverse impact depression can have on the GI tract.

Methods: This Quality Improvement (QI) study used a descriptive research design guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model. Its purpose was to implement a 10-week PHQ-2/PHQ-8 depression screening protocol at a large midwestern health center's gastroenterology outpatient clinic. The study used purposive sampling, including all GI outpatients aged 18+ with …

Palliative Care Beyond Cancer: The Use Of The P-Cares Tool, Breslin E. Meyer

Dissertations

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 …

Implementation Of Quantitative Blood Loss To Detect Postpartum Hemorrhage After Vaginal Birth, Raven S. Simpson

Dissertations

Problem: In the U.S., postpartum hemorrhage (PPH) is attributed to maternal morbidity and mortality, resulting in long-lasting effects of extended recoveries, surgical interventions, birth-related trauma, interruptions in mother-infant bonding, or death. Performing estimated blood loss (EBL) measurement methods postpartum is subjective and often associated with over- and underestimations of blood volume. The delay in recognition interferes with timely, efficient, and appropriate interventions, yielding a PPH (≥1000ml).

Methods: A quality improvement (QI) project was initiated with a descriptive, pre-implementation/post-implementation focus on a high-risk Labor and Delivery unit to explore the effects of Quantitative Blood Loss (QBL) measurements on the identification of …

Implementation Of A Nurse-Driven Process To Decrease Npo Times In A Geriatric Emergency Department, Luke D. Little

Dissertations

Prolonged nil per os (NPO) status for geriatric patients in the emergency department is a critical safety issue, leading to increased rates of delirium, hypoglycemia, and perioperative complications. A quality improvement project was designed to address this problem through a targeted, nurse-driven intervention. In geriatric patients (age ≥70) in a geriatric emergency department, this project aimed to determine if implementing an electronic health record (EHR)-prompted nursing workflow to obtain a diet order would reduce the length of time patients were kept NPO compared with standard practice. An EHR documentation tool was designed and implemented along with targeted nursing education sessions …

Transportation: A Barrier To Healthcare Access Among Disabled, Older Adults With Diabetes And Hypertension In Rural Areas, Anne G. Mwangi-Amann

Dissertations

Problem: Transportation is essential for health service utilization (clinic appointments, diagnostic services, and picking up medications from the pharmacy (Hansmann & Razon, 2024). Shekelle et al. (2022) in their systematic review and meta-analysis indicated that the U.S. rural population is 60 million. Rural areas continue to experience transportation as a significant barrier to health, a key social determinant of health. It causes delayed or foregone care in approximately 3.6 million people annually, resulting in more than 25% of missed appointments. Methods: This quality improvement project utilized a descriptive and observational design. A convenience sample of Medicaid patients receiving care at …

Bowel Regimen Protocol Implementation For Pediatric Patients Following Cardiac Surgery, Eryn Watson

Dissertations

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients …

Implementation Of A Human Papillomavirus Vaccination Toolkit Postpartum, Emily R. Leone

Dissertations

Problem: Human papillomavirus (HPV) is the most common sexually acquired infection in the world (DeCherney et al., 2018). Even a single dose of the HPV vaccine can provide up to 97% protection against HPV 16 and 18, which are the strains that cause 70% of all cervical cancers (Barnabas et al., 2022). Missouri ranks 35th in the country for HPV vaccination (Office of Disease Prevention and Health Promotion, 2020).

Methods: This quality improvement project implemented an HPV toolkit consisting of: 1) staff nurse education in the form of a written presentation 2) patient and provider education in the form of …

Motivational Interviewing For Weight Loss: A Review Of Evidence-Based Outcomes In Overweight And Obese Adults, Marian Dover

Dissertations

Obesity is a significant clinical problem affecting 41.9% of adults in the United States, with profound implications for individual health and healthcare economics. Standard weight loss interventions, often limited to pharmacological treatments and dietary guidance, frequently fail to achieve sustained adherence and meaningful longterm outcomes. This quality improvement (QI) project evaluated the integration of motivational interviewing (MI), a patient-centered counseling strategy, into routine clinical practice at Innovafusion, a medically supervised weight loss clinic in Aubrey, Texas. The aim was to enhance adherence to lifestyle modifications, promote intrinsic motivation, and improve weight loss outcomes among adults aged 18–65. Using a retrospective …

Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

Race-Neutral Pft: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing, Ann M. Way

Dissertations

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient …

Implementing A Turn Team Process To Reduce Hospital-Acquired Pressure Injuries On A Telemetry Unit At A Hospital In The Midwest, Sally Wang

Dissertations

Problem: Pressure injuries (PI) are localized wounds to the skin and soft tissues that typically result from sustained pressure on specific areas of the body (Zaidi & Sharma, 2024). Hospital-acquired pressure injury (HAPI) refers to pressure injuries that develop while a patient is in the hospital (Rondinelli et al., 2018). PI can cause patients to experience pain, decreased feelings of dignity, increased feelings of depression and anxiety, reduced levels of social activity, difficulty sleeping, and impaired cognitive function (Roussou et al., 2023). The Advanced Cardiac Care Unit (ACCU) at Missouri Baptist Medical Center experienced an increase in HAPI cases: …