Nursing Commons^™

Enhancing Resilience In Oncology Nurses Through The Implementation Of A Peer Support Program, Denise M. Robinson-Smith

DNP Scholarly Projects

ABSTRACT

Background: Oncology nurses face high rates of burnout and compassion fatigue, contributing to significant turnover and threatening the stability of the oncology nursing workforce. The projected increase in cancer incidence and the resulting demand for oncology services underscore the urgent need for interventions that enhance nurse resilience. Local Problem: At a major hospital in Jacksonville, Florida, it was found that oncology nurses face a significant gap in emotional support, especially during critical incidents such as patient deaths or traumatic events. Existing resources were insufficient to address the unique stressors faced by this team. Methods: A quality …

Maternal-Infant Attachment, Depression, Anxiety, And Breastfeeding Self-Efficacy Among Marginalized Populations, Leslie B. Lantz, Merilyn Arikkat, Amy Salisbury, Sara Moyer, Sally Russell, Leroy Thacker, Candice Gault, Josselyn Valenzuela, Kimberly Cruz-Lopez, S Bodnar-Deren, Patricia Kinser

School of Nursing Publications

No abstract provided.

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Management Of Obesity In Adults 18 And Older, Donna Callicoat

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Obesity is a significant public health concern in the United States, with increasing prevalence and substantial healthcare costs. Despite evidence-based guidelines for obesity management, primary care clinics often fail to implement them effectively, leading to missed opportunities in preventing obesity-related comorbidities such as cardiovascular disease, type 2 diabetes, and certain cancers.

Purpose: This evidence-based project aimed to implement the American Heart Association/American College of Cardiology/Obesity Society (AHA/ACC/TOS) obesity guidelines in a rural Texas primary care clinic. The goal was to assess the effectiveness of these guidelines in reducing weight, body mass index (BMI), and waist circumference among adults with …

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

Reducing Caregiver Burden For The Caregivers Of Heart Failure Patients, Joyce W. Kimani

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Family members and friends of heart failure patients serve as informal caregivers for many heart failure patients, helping with the management of day-to-day heart failure care. Many caregivers of heart failure patients experience stressors associated with caregiving, including social, psychological, financial, emotional, and physical stress. Reducing caregiver burden is important in improving both patient and caregiver well-being. Healthcare systems can improve caregiver outcomes and encourage the long-term sustainability of informal caregivers by addressing caregiver needs through focused support strategies. The Agency for Healthcare Research and Quality framework was used to develop an evidence-based guideline that healthcare professionals can follow in …

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Tips Toolkit To Prevent Falls In Hospitalized Older Adults: A Rural Hospital Approach, Viridiana G. Gonzalez Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Falls remain the leading cause of injury-related deaths among hospitalized older adults, contributing to significant morbidity, extended hospital stays, and increased healthcare costs. Implementing effective fall prevention strategies is especially challenging in rural hospitals due to staffing shortages, limited funding, and variability in clinical practice.

Local Problem: A 30-bed Medical-Surgical Unit in a rural Southwest Texas hospital experienced a rise in patient falls among older adults aged 65 and older, including several incidents requiring advanced medical treatment and one resulting in serious injury. A gap analysis revealed inconsistent implementation of tailored fall prevention strategies.

Methods: A quality improvement (QI) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

A Comprehensive Exploration Of Stress And Depressive Symptoms In Farm Populations, Julie C. Derringer

Theses and Dissertations--Nursing

High rates of depression and suicide continue to be a concern, despite four decades of growing research into the mental health of farmers. Most farmers have an awareness of a need for improved mental health, but a lack of knowledge persists. As agricultural production demands increase and the number of family farms decreases, the stress placed upon farmers to support the food chain is higher than ever. Understanding the association between farm demands and resources among farmers is key for the development and implementation of programs to decrease occupational stress and depressive symptoms to improve mental health outcomes across farming …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

Recognizing And Responding To Moral Distress: Using Transformational Leadership To Increase Nurse Leader Thriving, Miriam Dowling-Schmitt

DNP Scholarly Projects

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High …

Critical Incident Debriefing: Impact On Oncology Nurses And The Infusion-Related Reaction Care Bundle, Megan A. Corbett

DNP Scholarly Projects

Background: A critical incident is a sudden, unexpected, emotionally distressing event commonly experienced by oncology nurses. Debriefing is an evidence-based best practice that facilitates communication, reflection, and learning to identify quality improvement opportunities to enhance clinical practice, patient safety, and quality of care. However, debriefing within oncology care settings is inconsistent despite the demonstrated benefit and availability of frameworks. Infusion-related reaction management follows an algorithm that directs care delivery, aligning with a care bundle approach. Care bundles, when consistently and reliably applied, help identify connections between the critical incident (i.e., infusion-related reaction) and opportunities for improvement to ensure clinicians follow …

Design And Implementation Of A Nursing Peer Practice Case Review Program In An Academic Surgical/Trauma Icu, Natalie Tredway

DNP Scholarly Projects

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on …

Promoting Rapid Identification Of Oncological Emergencies In The Emergency Department : A Quality Improvement Project, Christine Hart Brown

DNP Scholarly Projects

BACKGROUND: The American Cancer Society estimates 2,041.90 new cases of cancer in the U.S. (1 in 18 Americans) with a global projection of thirty-five million new cases annually by 2050. With this alarming increase, early recognition of oncological emergencies in the Emergency Departments is essential. Life-threatening conditions require rapid assessment, accurate diagnosis, and immediate interventions. Qualified emergency nurses must understand the effects that cancer and treatment have on the immune, metabolic, and hematologic systems. This quality improvement (QI) project focuses on assessing emergency nurses’ oncological knowledge of acute emergencies and providing a resource for rapid identification.

PROBLEM STATEMENT: …

Improving The Effectiveness Of Post-Anesthesia Care Unit Transitions: A Quality Improvement Initiative Using A Standardized Nurse Handoff Report Sheet, Myra Mcauley

Master's Theses and Capstones

Background: Effective communication during patient handoff in the post-anesthesia care unit (PACU) is essential to ensuring patient safety and continuity of care. Unstructured or inconsistent handoff processes can lead to information omissions and care delays.

Methods: This quality improvement project implemented a structured nurse-to-nurse handoff report tool in the PACU. A pre- and post-intervention survey design was used to assess nurses’ perceptions of handoff clarity, completeness, and satisfaction. Educational sessions supported implementation.

Results: Pre-intervention survey data revealed dissatisfaction with the current handoff process, citing frequent information gaps. Following implementation of the structured tool, post-survey results showed improved communication clarity, increased …

A Quality Improvement Project Reinforcing Nursing Education On Support Resources For Families In The Icu, Emily Siel

Master's Theses and Capstones

BACKGROUND: The Intensive Care Unit (ICU) is often a source of psychological, physical, social, financial, and spiritual distress for families of patients. Multidisciplinary support resources are available but are often underutilized. Nurses are uniquely positioned to assess needs and integrate resources into care. Therefore, enhancing nurses' ability to guide families to appropriate support resources may alleviate distress and promote holistic well-being for patients and their families.

METHODS: The Plan-Do-Study-Act (PDSA) model was used to guide this project. A pre-intervention survey assessed awareness, utilization, and perception of ownership. Following dissemination of the intervention, a post-survey evaluated improvements in knowledge and integration. …

College Health Provider Experiences With Inclusive And Affirming Care Of Sexual And Gender Minorities, Somatra Lynn Connolly

Open Access Dissertations

Increasing numbers of individuals in the U.S. are identifying as sexual and gender minorities (SGM). Approximately 17-21% of U.S. college students identify as SGM, comprising a sizable portion of minoritized groups on college campuses. College students who identify as SGM are at significant risk for physical and mental health issues, experiences of victimization, and poorer health outcomes. It is essential that colleges and universities ensure their campuses are meeting the needs of their entire student body, including SGM students. This study aims to: (1) obtain an in-depth understanding of college healthcare provider (HCP) experiences and their perceptions with inclusive and …

Diabetes Device Knowledge And Confidence Among School Nurses: A Mixed Methods Study, Cassandra F. Moffitt

Nursing Theses and Dissertations

Problem: Type 1 diabetes is one of the most common chronic medical conditions in childhood. While manageable, these children may spend half of their day in the school setting and often need assistance from a school nurse to manage their care.

Theory: Bandura’s Social Cognitive Theory (1977) served as the theoretical framework for this study.

Research Questions: The research questions explored knowledge, confidence, and additional predictors of confidence related to diabetes devices.

Design/Methods: An explanatory sequential mixed methods design was used. The Diabetes Device Confidence Scale (DDCS) was used to measure device confidence, while Subscale 10 of the KAT-1 instrument …

Mindfulness In Homeless Women Experiencing Anxiety, Ally Bennion, Amanda Ho, Elina Le, Elizabeth Tsamous, Jaeda Yamasaki, Madi Ourada, Sara Nemera

Nursing Leadership in Community Engagement Projects

Mindfulness in Homeless Women Experiencing Anxiety

Half of Washington's homeless population resides in Seattle, King County (Axios, 2024). In response, seven Seattle Pacific University nursing students conducted an assessment on homeless women in Seattle. Partnering with a women’s day center, we assessed their health needs and barriers as part of a nursing leadership project. Through activities like bingo, we aimed to build trust and surveyed the women and staff on health concerns. Our findings revealed chronic anxiety as a key issue, leading to underutilization of health resources. Such resources include a mobile emergent dental van that previous nursing students earned …

Enhancing Medication Storage Protocols For Safety Optimization In Cardiac Care Unit Inpatients, Baothu Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to enhance medication security in the cardiac care unit by implementing a standardized storage protocol to reduce unsecured medications by 20% by December 6, 2024, following a 93-day implementation period. Additionally, the project sought to achieve 100% staff competency in the protocol by September 30, 2024.

Background: Unsecured medications pose significant patient safety risks, including unauthorized access, incorrect administration, and treatment delays. This project aligned with the Patient-Centered Caritas Model and addressed compliance deficiencies identified by the Joint Commission and the hospital’s quality control team.

Methodology: A Plan-Do-Study-Act (PDSA) framework guided the project, integrating …

Improving Pituitary Lab Evaluation Following Radiation Therapy For Sinonasal/Nasopharyngeal Malignancies, Brandon M. Mcanulty, Msn, Aprn, Agacnp-Bc, Rnfa

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this QI project was to create a standardized order set aiming to increase consistency in lab work completion for improved monitoring of pituitary dysfunction in patients diagnosed with sinonasal and nasopharyngeal malignancies. Background: Radiation therapy is important in the treatment plan for this population. The hypothalamic-pituitary axis is frequently included within the radiation field, contributing to radiation induced pituitary dysfunction. There is no established order set for outpatient pituitary lab monitoring at the organization. Methods: Established order sets were modified to include pituitary labs to create a centralized ordering workflow among providers from all three departments …

Adapting The Minority Stress Model Among Middle-Aged And Older Adults With And Without Hiv: Understanding The Interplay Between Minority Stress, Mental Health, And Sexual Risk Behaviors, Alexis R Long Thompson

All ETDs from UAB

This dissertation aims to adapt Meyer’s Minority Stress Model to understand the interplay between minority stress, mental health, and sexual risk behaviors among middle-aged and older adults with and without HIV. The study utilizes data from the MACS WIHS Combined Cohort Study, focusing on adults aged 40 and older. It examines the relationships between perceived stress, psychosocial factors (depression, substance use, social support), and sexual risk behaviors, considering the impact of minority identities such as race, gender, sexual orientation, and HIV status. The findings highlight significant differences in perceived stress, depressive symptoms, substance use, and social support across different intersectional …

Factors Associated With Health Decision-Making Autonomy On Own Healthcare Among Tanzanian Women: A 2022–2023 Demographic Health Survey Study, Tausi Seleman Haruna, Henry Ofori Duah, Rebecca Lee

College of Nursing Faculty Research and Publications

Background

Women’s health decision-making autonomy is fundamental for the health and well-being of women and their children. It empowers women to make health decisions and exercise their rights and choices surrounding their health. Like most parts of Africa, women’s autonomy in Tanzania remains contentious, with an estimated 19% prevalence of health decision-making autonomy in 2015. Given the impact of women’s health decision-making autonomy on women’s health outcomes and the fact that women’s health decision-making autonomy is an ongoing process affected by advancements in technology, economic growth, and social and cultural shifts, understanding the sociodemographic correlates of women’s autonomy is imperative. …