Nursing Commons^™

Exploring The Relationship Between Burnout, Professional Fulfillment, And Individual And Organizational Factors In Nurse Managers Across Ambulatory And Inpatient Settings, Yulia Romazanova Lopez

MUSC Theses and Dissertations

Nurse managers play a vital role in the functioning and stability of healthcare systems, yet their well-being remains an underexplored area of research. The COVID-19 pandemic brought renewed attention to occupational burnout, including in nursing leadership, where nurse managers reported high levels of stress, emotional exhaustion, and organizational strain. While the literature on burnout has grown rapidly in recent years, there is limited research that addresses what comes next, what sustains nurse managers in their roles and how organizations might foster their long-term well-being and engagement. This dissertation compendium explores professional fulfillment (PF) as a proactive and constructive lens for …

Staff Education To Addressing Medication Nonadherence Amongst Patients With Mental Health Challenges, Euphemia Mah

Walden Dissertations and Doctoral Studies

Walden University College of Nursing This is to certify that the doctoral study by Euphemia Mah has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Corinne Wheeler, Committee Chairperson, Nursing Faculty Dr. Robert McWhirt, Committee Member, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2025 Summary Poor adherence to medication regimens among patients who have a mental illness leads to multiple adverse outcomes, which include symptom exacerbation, decreased quality of life, and repeated hospitalizations. To address this …

Strengthening Communication Between Staff And Health Providers In A Mental Health Setting, Michael Tricoli

Doctoral Dissertations and Projects

Communication between nursing staff and providers is essential for supporting optimum patient outcomes. Each component of the communication process needs to be clearly defined to create an environment of safety for both patients and caregivers. The SBAR (situation, background, assessment, recommendation) is a nurse-driven protocol that is widely used as a communication and documentation template in health care organizations. This format is currently not being used effectively on the mental health units where the evidence-based project was implemented. Recognizing and reiterating the value of SBAR as a communication tool is necessary when communication deficits are noted. The purpose and scope …

Quality Improvement Project: Perioperative Recruitment Process Improvement Through Nursing Student Clinical Experience, Traci Boren

Doctor of Nursing Practice Projects

Perioperative nursing is experiencing greater shortages than any other specialty and has been largely removed from undergraduate education. This DNP quality improvement project aimed to impact the recruitment of perioperative nurses through undergraduate nursing clinical exposure and experience. The project addressed the lack of clinical nursing student opportunities in the perioperative department at the partner site to increase interest in perioperative nursing and recruit core staff nurses from the pool of new graduates. Kotter’s Eight-Step Change Model and the Social Career Cognitive Theory framed the project’s design and implementation for two cycles, between January and March 2024 and 2025. Using …

Implementing An Antibiotic Stewardship Program For Acute Respiratory Tract Infections In Urgent Care, John Childree

Doctor of Nursing Practice Projects

Antibiotic overprescription for acute respiratory tract infections (ARTIs) remains a persistent challenge in urgent care, contributing to antimicrobial resistance and increased healthcare costs. This quality improvement project evaluated whether a structured educational intervention an Antibiotic Stewardship Program (ASP) could improve providers’ knowledge and self-efficacy in evidence-based prescribing. A quasi-experimental, single-group pre-post design was used with seven urgent care clinicians. Data were collected through a custom Antibiotic Stewardship Questionnaire and a Self-Efficacy Survey administered before and after the intervention. Results demonstrated a 17% increase in knowledge scores (from 9.3 to 10.6 out of 11) and a statistically significant improvement in self-efficacy …

Quality Improvement Project Education And Implementation Of I-Pass Handoff Between Critical Care Clinicians And Anesthesia Staff, Kimberly Woody

Doctor of Nursing Practice Projects

Medical errors, specifically communication errors, cause adverse patient outcomes, death, and an estimated annual cost to institutions of over two million dollars. Despite numerous studies highlighting the need for standardized communication during patient transfers and recommendations from regulatory bodies such as the Joint Commission, the gaps in standardized handoffs remain. The Doctor of Nursing Practice's (DNP's) quality improvement project aimed to increase knowledge of the intensive care unit (ICU) and anesthesia clinicians through interprofessional education (IPE) about the illness severity, patient summary, action plan, situational awareness/contingency plan, synthesis by receiver (I-PASS) handoff tool to promote consistent, complete tool use during …

Respectful Patient-Provider Communication And Patient Portal Usage In Pregnant People Of Color, Amy H. Goh, Christopher Lee, Chisolum Nkenke, Joyce K. Edmonds

College of Health Professions Faculty Papers

BACKGROUND: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.

METHODS: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on …

Lived Experiences Of Nurses Caring For Patients With Opioid Use Disorder, Oneatha Alexander

Walden Dissertations and Doctoral Studies

Opioid abuse is a significant problem in the United States. People with opioid use disorder (OUD) visit the emergency room (ER) for pain management. OUD is the overuse and abuse of opioids, which can result in dependence, relapses, and death. Nurses in the ER and medical-surgical units face challenges in distinguishing OUD from chronic pain. The purpose of this qualitative interpretive phenomenological study, guided by Benner’s novice-to-expert framework, was to explore the lived experiences of ER and medical-surgical nurses who provide care to OUD patients. Eight ER and medical-surgical nurses were interviewed using semi-structured interviews. The main themes from coding …

Staff Education On Strategies To Eliminate Medication Errors And Promote Medication Compliance In The Community And Healthcare Settings, Rita Nyongkah Yeba

Walden Dissertations and Doctoral Studies

Patient health is highly influenced by non-adherence to medications and faults in them. Longer diseases, unneeded hospital visits, and growing healthcare expenses are the effects of these problems. Medication errors can arise from incorrect prescriptions, too low or too high doses, poor administration, or inconsistent provider communication. Patients may also neglect their prescriptions for several reasons, including lack of motivation, forgetfulness, or worries about side effects. This initiative aimed to provide medical staff members with techniques meant to help lower errors in the healthcare environment and enhance medication adherence. The aim of this initiative was to instruct the staff members …

Implementation Of An Educational Intervention To Improve Antibiotic Stewardship In An Urgent Care Setting, Evelyn Jane Clinton

Doctoral Dissertations and Projects

Antimicrobial resistance is a leading threat to global health. Resistance to antibiotics in the United States continues to increase contributing to rising numbers of resistant infections and subsequent deaths. This highlights the critical need for increased focus on antibiotic stewardship efforts. Urinary tract infections are one of the leading indications for antibiotic prescription in the outpatient setting and research suggests that there is an opportunity for improvement in antibiotic stewardship efforts in this area. The PICOT question for this project is as follows: In an urgent care setting, does provider education on the current evidence for urinary tract infection diagnosis …

Improving New Graduate Nurse Clinical Judgment By Training Preceptors On The Use Of The Tanner Model, Denise E. Carr

Doctoral Dissertations and Projects

New graduate nurses (NGNs) often enter the workforce with deficits in clinical judgment, which has been further exacerbated by pandemic-related limitations in clinical education. This project aimed to improve NGN clinical judgment by training preceptors to use the Tanner Clinical Judgment Model (TCJM) and Lasater Clinical Judgment Rubric (LCJR). A quasi-experimental evaluation design was used to compare outcomes between two groups of preceptor–preceptee pairs. Half of the preceptor participants received training on the TCJM and LCJR, while the other half did not. Clinical judgment development was measured using the LCJR pre- and post-orientation. Additional preceptor feedback regarding the implementation and …

Do Perceived Social Support And Positive Religious Coping Moderate Any Relationship Between Post-Intensive Care Syndrome–Family Symptoms And Quality Of Life In Informal Caregivers Of Intensive Care Unit Survivors?, Carol R. Hirschkorn

Doctoral Dissertations and Projects

Family members and close friends often act as informal caregivers (CGs) for survivors of critical illness, assisting with activities of daily living, ongoing care needs, and adjustment to life after critical illness. These CGs simultaneously cope with their own mental, physical, and social sequelae, including significant changes (to roles and responsibilities) in everyday life. Qualitative researchers have examined this constellation of CG symptoms, which constitute post-intensive care syndrome–family (PICS-F), to understand the experiences, needs, and coping of CGs of intensive care unit (ICU) survivors. None have looked at the impact of religious coping and perceived social support on PICS-F and …

Humanizing The Icu: Implementation Of Personalized Communication Boards In The Sicu Drives Enhanced Patient And Family Experience, Stephen D. Hoefler

Master's Theses

Objective: Research has established the importance of personalized communication in critical care settings, where standardized tools like whiteboards can improve patient and family engagement.

Aim: This project aims to develop a personalized communication board in the surgical intensive care unit (SICU) at a Bay Area academic quaternary care facility that, once implemented, will achieve at least 75% utilization in patient rooms by May 2025, enhancing communication and patient experiences.

Methods: Surveys were conducted with patients, families, and staff to gather stakeholder input and guide the design of a new standardized whiteboard model with personalized elements. Results: Based on stakeholder feedback, …

Psychometric Evaluation Of The Thai Version Of Emotional Labor Scale (T-Els) In Thai Nurses, Vachira Posai, Wisarut Srisintorn, Paramee Thongsuksai, Chanokporn Jitpanya

Journal of Health Research

Background: Nurses often face emotional strain due to emotional labor (EL), which involves concealing or modifying genuine feelings to meet their job requirements. This response can lead to physical, psychological, and behavioral issues. The Emotional Labor Scale (ELS), originally in English, has not been translated into Thai, leaving its psychometric properties unexamined in the Thai context. This study aimed to translate the ELS into Thai and evaluate its psychometric properties among Thai nurses.

Methods: A cross-sectional study design was used. The 14-item scale, which includes surface acting, deep acting, and expression of naturally felt emotions dimensions, was translated using forward …

A Clinical Practice Guideline For Enhanced Rehabilitation Assessment In Poststroke Patients, Chanda Honeywood

Walden Dissertations and Doctoral Studies

This doctoral project aimed to develop clinical practice guidelines (CPG) to strengthen the assessment of poststroke patients for rehabilitation. The project sought to adopt an evidence-based approach to develop standardized recommendations that can help in the timely and appropriate rehabilitation of stroke survivors, thereby reducing the risk of long-term disability and readmissions. Stroke is a significant cause of disability and poor functional recovery, increased healthcare costs, and lower quality of life for patients occur because of poor rehabilitation assessment. While rehabilitation protocols already exist, discrepancies in patient evaluations result in intervention delays and ineffective uptake of rehabilitation programs, limiting the …

Using The Token Economy To Improve Show Rates In An Outpatient/Community Mental Health Clinic, Gertrude Nabila Ndansi

Walden Dissertations and Doctoral Studies

The type of project was a quality improvement intervention. The identified practice problem was limited appointment shows among patients with appointments. Outpatient clinics often struggle with patients not showing up for appointments. Addressing this gap was critical for improving patient outcomes and resource efficiency. The practice problem must be addressed within the context of nursing practice by enhancing access to consistent mental health care and giving patients more timely support, leading to better outcomes and overall wellbeing.

Staff Education Program On Care Transitions For The Elderly, Emmanoela Mugha

Walden Dissertations and Doctoral Studies

This project was developed as a staff education program using the analyze, design, develop, implement, and evaluate (ADDIE) model with a focus on discharge planning in a medical clinic in northern Maryland. There is a gap in discharge planning for older adults due to shortage of providers and inadequate education related to care transitions among the elderly. The care transition process can be improved through education. The practice focused question was: “Does an educational project for nurses on care transitions for the elderly increase knowledge as compared pre-to post education?” The Johns Hopkins evidence-based practice model (Appendix A) was the …

Nurses’ Role In Reducing Mental Health Stigma In Healthcare, Olufunmilayo Elizabeth Adeloye

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project implemented a targeted educational intervention to reduce mental health stigma among healthcare providers. Mental health stigma, often resulting in misdiagnosis, delayed treatment, and decreased patient engagement, represents a significant barrier to effective nursing practice. The project’s practice-focused question examined whether an educational program could improve provider knowledge and attitudes toward mental illness. Using the ADDIE model (analysis, design, development, implementation, and evaluation), a needs assessment at a family practice and behavioral healthcare clinic identified gaps such as judgmental perceptions, avoidance behaviors, and lack of empathy among providers. An extensive literature review supported the …

Preoperative Clinical Practice Guidelines For Patients Undergoing Coronary Artery Bypass Graft Surgery, Marjorie Badong Yumul

Walden Dissertations and Doctoral Studies

Walden University College of Nursing This is to certify that the doctoral study by Marjorie B. Yumul has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Patricia Schweickert, Committee Chairperson, Nursing Faculty Dr. Diane Whitehead, Committee Member, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2025 Executive Summary: Clinical Practice Guideline Preoperative Clinical Practice Guidelines for Patients Undergoing Coronary Artery Bypass Graft Surgery by Marjorie B. Yumul MS, University of the Philippines Manila, 2003 BS, La Concordia, …

Registered Nurses’ Perceptions Of Patient Safety In Critical Care Units, Martha Benghie Hyacinthe

Walden Dissertations and Doctoral Studies

Patient safety is a cornerstone of effective healthcare delivery, particularly in critical care units (CCUs) where patients are at heightened risk of complications due to their complex medical conditions. The purpose of this study, guided by Watson’s theory of human caring, was to explore RNs’ perceptions of patient safety in CCUs. Data on eight RNs working in CCUs were collected through semi-structured interviews, allowing for an in-depth exploration of nurses’ perspectives. Data were collected through semi-structured interviews, allowing for an in-depth exploration of nurses’ perspectives. Using Saldana’s method of thematic analysis, three overarching themes emerged: patient safety, resource allocation, and …

Maternal Access For Depression In Rural Environments, Simone Parlier

Dissertations

Significance –As many as 25% of birthing persons experience postpartum depression (PPD) within the first year after childbirth making this one of the most common postpartum disorders. PPD is prevalent, incapacitating, and treatable. The first step is identifying those at risk. Rural birthing persons are understudied, and may have unique predisposing characteristics as well as geographic challenges for optimal detection and treatment of PPD. Purpose -The long-term goal is to improve the health of rural families. Using The Theory of Unpleasant Symptoms, the purpose of this descriptive, cross-sectional research was to describe the prevalence of PPD in rural birthing persons …

Assessment Of Relationships Between Quality And Staffing In The Ambulatory Care Environment, Rachel E. Start

Dissertations

ABSTRACT Background The United States healthcare system underperforms compared to other industrialized countries where cost and quality are concerned. Nursing is accountable, as a profession recognized by society, to ensure health and livelihood in the patients and populations served. Advancing the role of the ambulatory care nurse and providing valid strategies to measure the contribution of the nursing profession in this setting is a tactic that many organizations are pursuing to achieve this paradigm shift. The assessment of relationships between measures of structure, process, and outcome within the ambulatory care setting across a variety of organizations may have the potential …

Comparison Of Two Injection Techniques On Pain Perception Among Adult Patients Receiving Intramuscular Injection: A Randomized Controlled Trial, Dr.Sindhu L, Dr. Bindu R. Nayar, Dr. Rajamohanan Pillai K

Manipal Journal of Nursing and Health Sciences

Introduction: The administration of intramuscular injection is a common procedure performed by nurses that causes pain to the patient. The way nurses administer injections is one of the factors associated with increased client discomfort. Aspiration has been ingrained in the intramuscular injection procedure, and even though many policies no longer endorse it, it is often frequently taught and used. Injections without aspiration are considered more comfortable for patients. Aspiration in the injection is a controversy concerning its perceived benefits and indications due to a paucity of available data, there is no evidence that this procedure is essential or truly …

Staff Education On Uti Screening, Antimicrobial And Antibiotic Resistance, And Poor Regimen Adherence, Shereen Robinson

Walden Dissertations and Doctoral Studies

This staff education project focused on enhancing nurses’ knowledge of urinary tract infections (UTIs) and antibiotic and antimicrobial resistance intended to promote screening for UTIs. The practice problem addressed was lack nurses’ knowledge of UTI screening and antibiotic resistance. Inadequate screening contributed to increased UTI rates, re-occurrences, and complications such as delirium. It was essential to address the issue because nurses are at the frontline regarding educating, screening, and providing care to patients with UTIs. Knowledgeable nurses can implement standard practices to ensure adequate screening for UTIs. Effective screening would enhance early treatment and minimize misuse and unnecessary antibiotic prescriptions. …

Bereavement Needs Of Parent-Child Dyads Following Sibling Death, Shannon V. D'Alton

MUSC Theses and Dissertations

In the United States, nearly 62,000 children and adolescents experience the death of a sibling each year and sibling bereavement is one of the most distressing life events during childhood; however, it has received less attention in research compared to other forms of childhood loss. Bereaved siblings and parents are at increased risk for negative physical and psychological outcomes, yet little is known about their support and resource needs during the early years following the death. A limitation in understanding sibling bereavement is the methodological and ethical challenges of researching this vulnerable population. Consequently, the bereavement needs of surviving siblings …

Policy Paper Assessing The Risk Of Obstructive Sleep Apnea In The College Football Player, Joseph C. Archer

Doctor of Nursing Practice Projects

Sleep is a vital yet often overlooked component of athletic performance, particularly in collision sports such as football. Despite growing evidence connecting obstructive sleep apnea (OSA) with cognitive impairment, cardiovascular risk, and injury, standardized screening is rarely implemented in collegiate athletics. This project aimed to assess the risk of obstructive sleep apnea (OSA) in college football players aged 18–25 using the STOP-BANG screening tool and to evaluate the impact of an educational intervention on the knowledge of athletic trainers. The purpose was to identify at-risk athletes early, promote timely intervention, and improve athletic trainers' understanding of OSA. The project addressed …

Staff Education On Substance Use Screening In An Outpatient Mental Health Clinic, Kelvin Okwudiogor

Walden Dissertations and Doctoral Studies

This DNP project aimed to enhance the quality of care by improving healthcare providers’ knowledge and fostering confidence in the utilization of screening, brief intervention, and referral to treatment (SBIRT). At the practice site, patients were not screened for substance use due to the lack of provider knowledge on evidence-based screening tools. The practice-focused question for this project was, Among healthcare providers in outpatient mental health clinics, does education on the use of the SBIRT screening tool increase their knowledge and skill after educational intervention? The project used a sample of 12 healthcare professionals, including four mental health practitioners and …

Staff Education To Registered Nurses On An Inpatient Pediatric Unit Regarding Pediatric Burn Principles, Qwinnetta Janae Stokes

Walden Dissertations and Doctoral Studies

The purpose of this staff education project was to improve nurses’ knowledge on burn care using an educational intervention. The project site became the children's hospital designated burn unit. Children with burns were a new patient population that the project unit had never cared for, and there was no formal training or competencies for nurses caring for these patients. Nurses requested formal education before being expected to care for these patients. This project utilized a single group, pre-post design comparing knowledge of bedside surgical nurses about pediatric burn care management principles before and after the educational intervention. The intervention was …

Clinical Practice Guideline For Systemic Lupus Erythromatosus And Lupus Nephritis, Seleaina A. Thomas

Walden Dissertations and Doctoral Studies

Summary This project addressed the critical practice problem of delayed and inaccurate diagnosis of systemic lupus erythematosus (SLE), which has been linked to increased morbidity and mortality, particularly among marginalized populations. These diagnostic challenges have been recognized globally, with international research highlighting inconsistencies in care and the absence of standardized guidelines. Implementing inclusive and equitable clinical practice guidelines (CPGs) that consider social determinants of health, political determinants of health and actively involve diverse populations in research can play a crucial role in reducing racial disparities and improve outcomes for all lupus patients. Thus, the development of a CPG focused on …

Standardizing Discharge Planning To Reduce Readmission Rates In Outpatient Mental Health Clinics, Navasha Martin

Walden Dissertations and Doctoral Studies

Psychiatric readmission rates remain a major concern in outpatient mental health clinics, often resulting from inconsistent discharge practices and limited patient education. This Doctor of Nursing Practice (DNP) project aimed to develop and evaluate a clinical practice guideline (CPG) to standardize discharge planning and reduce psychiatric readmission rates. Guided by the question: Does evidence support the quality of an evidence-based standardized discharge planning protocol to reduce readmissions?, this project integrated findings from a structured literature review and expert panel evaluation. The CPG was developed using evidence-based strategies and evaluated using the AGREE II instrument, a validated tool for assessing the …