Other Nursing Commons^™

Improving Graft-Versus-Host Disease Documentation Through Provider Education On An Epic-Based Gvhd Documentation Flowsheet, Emily Shearon

Doctoral Projects

Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Accurate documentation of GvHD severity and management is essential for clinical decision-making, interdisciplinary communication, and regulatory reporting to organizations such as the Foundation for the Accreditation of Cellular Therapy (FACT) and the Center for International Blood and Marrow Transplant Research (CIBMTR). Despite the availability of structured documentation tools within the electronic health record (EHR), their utilization is often inconsistent. The purpose of this quality improvement project was to evaluate whether a targeted provider-focused intervention could improve completion rates of a standardized GvHD documentation flowsheet …

Improving Hyaluronic Acid Filler Safety Through A Structured, Evidence-Based Training Program: A Dnp Educational Initiative, Carlos Sandoval Madrigal

Doctoral Projects

The rapid growth of aesthetic medicine, particularly the use of hyaluronic acid (HA) dermal fillers, has outpaced the development of standardized educational pathways for Health Care Providers (HCPs), contributing to a wide variability in clinical practice and increased risk of adverse events. This Doctor of Nursing Practice (DNP) project aimed to evaluate the effectiveness of a structured, evidence-based educational intervention designed to improve provider knowledge and confidence in the prevention and management of HA filler complications. The intervention was developed using the 10-Point Plan framework and evaluated using the Kirkpatrick Model Levels 1 (Reaction) and 2 (Learning). A quasi-experimental, one-group …

Increasing Near-Miss Reporting: An Evidence-Based Approach, Rosalud H. Sanchez-Lozada

Doctoral Projects

Near-miss events, defined as errors intercepted before reaching the patient, offer valuable opportunities for learning and prevention, particularly in high-acuity intensive care units (ICUs). Despite the availability of electronic reporting systems and national emphasis on patient safety, near-miss reporting remains inconsistent in many critical care settings. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the impact of a structured educational intervention on near-miss reporting within a cardiovascular intensive care unit (CVICU) at a large academic medical center. A single-group pre–post design was used to examine changes in reporting trends following a three-week intervention that included staff education, leadership …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

Exploring Virtual Nurse Perceptions Of Caring Through Acute Care Teleconferencing, Monika Lu

Doctoral Projects

Virtual nursing programs have emerged as innovative solutions to address hospital operational challenges and workforce shortages. However, concerns remain about the potential for decreased human connection in telehealth environments. Limited evidence exists regarding virtual nurses’ perceptions of caring behaviors and their ability to develop therapeutic relationships through teleconferencing technology. Purpose: This exploratory study examined virtual nurses’ (ViRNs) perceptions of caring and identified strategies for fostering patient relationships in telehealth settings. Methods: A mixed-methods custom survey was distributed to 25 eligible ViRNs at Stanford Health Care, with 19 respondents (76% response rate). ViRN caring perceptions were measured quantitatively using a 5-point …

Implementing A Buddy System To Enhance Float Pool Nurses’ Experience And Unit Integration, Nancy Kairia

Doctoral Projects

Float pool nurses play a vital role in maintaining hospital operations; however, they often experience role ambiguity, inconsistent integration, and reduced psychosocial empowerment, which may negatively influence engagement and retention. This Doctor of Nursing Practice project implemented and evaluated a structured buddy program designed to enhance psychological empowerment among float pool nurses in a large academic medical center. Guided by Gretchen Spreitzer’s Psychological Empowerment Framework, the project examined changes across four domains: meaning, competence, self-determination, and impact. A pre-post design was used to assess outcomes before and after implementation. Five nurses completed the preintervention survey; of these, four completed the …

A Peer Support Model For Nursing Faculty: Stay And Thrive, Ngoc N. Hua

Doctoral Projects

Projections show a major nursing shortage over the next decade. Although many state and local efforts aim to expand the workforce, there is often less visibility into the nurse educators responsible for the healthcare pipeline. Moving clinicians into teaching roles presents unique challenges. Specifically, clinical skills do not easily transfer to classroom management,​ which can be jarring for new faculty. This "reality shock" frequently results in faculty turnover​ due to a lack of support during this important transition.​ This project looked at nursing faculty perceptions of a structured peer mentorship​ program at a Northern California community college. The intervention was …

Patient Reported Outcome Measure Use In Heart Transplant Care, Nichole Côté

Doctoral Projects

Despite growing evidence supporting Patient-Reported Outcome Measures (PROMs) in chronic disease management, no consistent application exists within the international heart transplant community. This Doctor of Nursing Practice project implemented the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) as a PROM within the a large volume heart transplant clinic, evaluating workflow feasibility, the association between Overall Summary Scores (OSS) and visit length, and clinician perceptions of PROM use. The KCCQ-12 was administered via a mobile health application with automated distribution. Workflow integration was assessed by calculating the percentage of scheduled visits with completed PROM documentation. Visit length was measured using electronic medical record …

Building Nurse Managers’ Knowledge And Confidence To Lead Clinical Ladder Success: A Theoretically Informed Educational Framework, Michelle Joann Chlebinski

Doctoral Projects

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post …

A Quality Improvement Project To Strengthen Hospice Spiritual Care Delivery, Patricia Boudreau

Doctoral Projects

Spiritual care is an essential component of holistic end-of-life nursing, yet it is inconsistently provided in home hospice settings. For this Doctor of Nursing Practice (DNP) quality improvement project, we developed and implemented the Compassionate Spiritual Comfort Integration Program (CSCI), a brief, theory-based educational intervention to strengthen hospice nurses' spiritual care practices. Grounded in Kolcaba's Comfort Theory and Jinpa's Compassion Framework, the CSCI was delivered as a prerecorded webinar. A quasi-experimental single–group pretest–posttest design was used to evaluate changes in spiritual care behaviors, measured with the 17-item Nurse Spiritual Care Therapeutics Scale (NSCTS) and a single-item confidence measure. Twenty-two nurses …

Nurturing The Nurturers: Caritas Literacy Wellness Program, Pakeeza Ali

Doctoral Projects

Burnout, compassion fatigue, and emotional exhaustion remain significant concerns among oncology staff in high-demand ambulatory settings. This quality improvement project implemented the Caritas Literacy and Resilience Training Program (CLARITY), a microlearning-based intervention grounded in Watson’s Caring Science Theory, to support self-caring behaviors and emotional resilience among oncology staff in an ambulatory cancer center. A quasi-experimental, mixed-methods design was used, incorporating pre- and post-intervention survey data and qualitative focus group feedback. Quantitative outcomes were assessed using the Watson Caritas Self-Rating Score (WCSR) and post-intervention ratings of perceived effectiveness of the microlearning format. Wilcoxon signed-rank tests were used to examine pre-post change …

Empowering Voices: A Qualitative Exploration Of Shared Governance Among Healthcare Workers In Clinical Practice, Ayman Alhazaymeh

Doctoral Projects

This project intervention evaluated the implementation of shared governance (SG), focused on partnership council activities and staff perception. The shared governance framework has several pillars, such as Partnership, Equity, Ownership, Accountability, and Shared Decision-Making, to support the design of healthcare organizations for excellent patient care (Porter-O’Grady, 2009). To effectively evaluate the SG implementation and ensure the ongoing success of the SG process, the author investigated staff contributions and actively sought feedback. He provided templates and guidelines for the partnership council and collected staff feedback. Murray et al. (2016) stated that the partnership council reported empowering staff to implement innovative solutions …

Evaluating The Impact Of A Meaningful Recognition Bundle On The Health Of The Emergency Department Work Environment And Emergency Nurse Burnout, Sean Truesdell

Doctoral Projects

Background: The health of the work environment significantly influences emergency nurse practice. The Emergency Nurses Association and the American Association of Critical-Care Nurses have called for the establishment of a healthy work environment (HWE) to improve outcomes, reduce burnout and turnover, and increase job satisfaction. Meaningful recognition is consistently among the lowest-performing HWE standards. Purpose: To implement a bundle of meaningful recognition elements in the Emergency Department (ED) and evaluate the outcomes. Methods: A quality improvement project was conducted in the ED of a non-profit community health system in Northern California. The Healthy Work Environment Assessment Tool (HWEAT) and Oldenburg …

Yoga Therapy For Psychological Safety In Healthcare Staff, Kristen Fabiszewski

Doctoral Projects

Establishing a culture of psychological safety is a necessary foundation for creating a High Reliability Organization. Healthcare professionals must practice emotional self-regulation to maintain equanimity and facilitate positive communications with their colleagues. This can be exceptionally challenging when increasing numbers of healthcare professionals are experiencing burnout. Using the framework of Polyvagal Theory, yoga practices have been demonstrated to support emotional self-regulation and reduce symptoms of burnout. The purpose of this project was to implement yoga therapy to increase the perception of psychological safety in healthcare staff. Veterans Affairs Long Beach Healthcare System (VALBHS) staff invited to attend one 45minute yoga …

Using Video Education To Improve Patient Knowledge Of Cellular Therapy Side Effects: Cytokine Release Syndrome, Neurological Toxicities, & Prolonged Pancytopenia, Leslie Bennett

Doctoral Projects

This project evaluated the effectiveness of short educational videos on CAR T-cell therapy, cytokine release syndrome, neurological toxicities, and prolonged pancytopenia for blood cancer patients. At Stanford Health Care in California, in the ambulatory clinic of Blood and Marrow Transplantation and Cellular Therapy (BMT-CT), we obtained a convenience sample of individuals with multiple myeloma or lymphoma preparing for CAR T-cell therapy. A pre-and post-questionnaire assessed the patients' knowledge of CAR T-cell therapy and its side effects. Wilcoxon signed-rank tests were used to determine changes in knowledge. Thirteen patients enrolled, eight completed post-surveys, and four watched the videos. The median knowledge …

Patient Perception Of Nurse Practitioner Care, Nurse Practitioner Scope Of Practice And How That Influences Provider Choice, Naomi Hemp

Doctoral Projects

This project investigates patients' perceptions of nurse practitioner (NP) care versus physician (MD) care, the factors influencing these perceptions, and patients' understanding of NP scope of practice. A cross-sectional design was used, gathering quantitative data through an anonymous one-time survey distributed via Qualtrics, open for three months. Questions were based on The Watson Caritas Patient Score (WCPS) and the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). Data were analyzed using Intellectus Statistics software™, with descriptive statistics summarizing the findings. A two-tailed paired samples t-test revealed statistically significant differences in favor of patients' perceptions of NP care versus …

A Four-Year Longitudinal Study Of Effectiveness Of Evidence-Based Bundle Practices For Preventing Catheter-Associated Urinary Tract Infections In An Academic Health Care Center, May Mei-Sheng Riley

Doctoral Projects

Catheter-associated urinary tract infections (CAUTIs) significantly contribute to morbidity, prolonged hospitalization, and elevated healthcare costs, underscoring the crucial need for prevention to ensure patient safety. Despite ongoing mitigation efforts, CAUTI prevalence remained a concern in our facility at the time of this study. Catheter insertion and maintenance bundles, a recognized framework utilizing teamwork, collaboration, and focused interventions, were implemented to reduce CAUTIs and improve patient safety. This study evaluated the effectiveness of these bundles in reducing CAUTIs and catheter utilization to identify best practices for enhanced catheter management and care quality.

Enhancing Hospital Throughput With The Power Of Reminders: Implementing A Discharge Before Noon Strategy At An Urban Teaching Hospital, Jessie Ventura

Doctoral Projects

The doctoral project deploys a "Discharge Before Noon" strategy at an urban teaching hospital to resolve discharge delays and improve patient throughput efficiency. Hospitals experiencing overcrowding must prioritize timely patient discharges to enhance clinical results and operational performance. The project adopted the PARIHS framework to steer implementation through its emphasis on evidence-based practices, contextual factors, and facilitation strategies. The research gathered discharge data and team coordination results before and after the intervention period. The findings revealed elevated discharge numbers before noon and substantial progress in interdisciplinary team collaboration. The initiative indicated an optimizing trend for discharge procedures, even though statistical …

Unlocking Icu Barriers: Investigating The Challenges Of Early Progressive Mobility, Leslie S. Bigler

Doctoral Projects

Approximately 800,000 patients in the United States annually are admitted to the Intensive Care Unit (ICU) due to critical illnesses and prolonged immobility contributes to poor patient outcomes. While existing data demonstrates early and progressive mobility helps improve outcomes, adherence remains inconsistent for a variety of reasons such as safety concerns, staffing, and lack of knowledge and confidence of mobilization techniques. This quality improvement project, conducted in a 20-bed Medical Intensive Care Unit, asked staff to identify barriers to adherence to mobility protocols. Nurse managers and clinical educators play a crucial role in addressing these issues using strategies such as …

Utilization Of The Reproductive Justice Framework In Contraceptive Counseling With Black And African American Women: A Comparison Of Patient Satisfaction And Provider Knowledge, Simranjeet K. Tagore

Doctoral Projects

Current practice in contraceptive counseling is characterized by great variation in both content and implementation. The literature indicates that African American women desire contraceptive counseling based in respect, trust, and equity. Conducted over 8 weeks, this quality improvement project compared satisfaction in African American and Black patients receiving contraceptive counseling by a provider trained in the Reproductive Justice Framework (RJF) versus those receiving contraceptive counseling by a provider not trained in the Reproductive Justice Framework. This project also evaluated the effects of Reproductive Justice Framework training on clinician knowledge. Inclusion criteria for the patients included identifying as Black and/or African …

A Survey Of Nurse Preceptor Preferences Regarding Training Topics: A Descriptive Study, Janice Yao Valadez

Doctoral Projects

Background: The nurse preceptor role can be as challenging and demanding as it is critical in the context of nursing shortages and burnout. The improvement of nurse preceptor training, based on preferences expressed by the nurses fulfilling this role, therefore represents a potentially important part of the solution to these problems.

Methods: A modified version of the +RN Learning Needs Assessment tool was administered to 24 nurse preceptors who precepted in the nurse residency program on two campuses of a not-for-profit Western US hospital, regarding their preferences for topics to be covered in preceptor training, as well as the sequence …

Implementation Of An Online Suicide Prevention Training Program With Undergraduate And Graduate Students At A California State University, Cheryll May P. Villamor

Doctoral Projects

Background: One of the leading causes of death in the college age population is suicide. While colleges provide opportunities in the acquisition of knowledge and skills for future careers; those same opportunities can also bring about challenges that put students at risk for suicide such as: dealing with their mental health issues, finding and maintaining support system, financial costs, and the pressure from ensuring academic success. One of the ways to help student at risk for suicide is by early intervention by connecting them with mental health support system such as crisis counselors. Question, Persuade, and Refer (QPR) is a …

Utilization Review And Utilization Of Evidence-Based Guidelines, Rosetta E. Hairston

Doctoral Projects

The quality improvement project focused on determining why utilization review nurses submitted epidural steroid injection treatment requests within evidence-based guidelines to peer review. The study reviewed six months of data from June 2022 through December 2022 to develop a pre-training baseline for the number of epidural steroid injection treatment requests approved by the nurse and approved by peer review. Deming's method for quality improvement was identified as the framework for implementing changes. The UR nurses were provided four weeks of refresher training on applying evidence-based guidelines to epidural steroid injection treatment requests. Post-group training sessions reflected a 91% increase in …

Implementation Of Web-Based Patient Education In Newly Transplanted Kidney Recipients, Tabo Mwikisa-Kelly

Doctoral Projects

Kidney transplantation is the preferred treatment for patients suffering from kidney failure. It is a complex process that is intended to improve one’s quality of life by adhering to a lifelong treatment plan of immunosuppressant therapy. Therefore, it is essential for patients or their caregivers to have adequate knowledge to care for themselves following post-transplant, which can contribute to better patient outcomes. In a metropolitan Bay area hospital in Northern California, the current state of practice involves educating newly transplanted kidney recipients through face-to-face interactions with the patient and handing out a transplant booklet during their initial transplant hospital stay. …

Speak Up For Hand Hygiene And Decrease Healthcare Associated Infections, Bernadette Priya Pandya-Orozco

Doctoral Projects

Background: Hand hygiene (HH) is one of the most cost-effective and simplest ways to reduce healthcare associated infections (HAIs). Incorporating Speak Up for hand hygiene enables healthcare workers (HCW) to communicate without fear when they observe noncompliance with HH requirements.
Objective: To increase HH compliance by utilizing Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS education to encourage Speak Up for HH and lead to reduction in HAIs.
Methods: The researcher provided educational training on “Speak Up for Hand Hygiene” and performed regular audits to examine its effects on one hospital unit in a California Bay Area healthcare system. A …

Nursing Professional Development Practitioner’S Experience Of Use Of Instructional Design Industry Standards, Denise Renfro

Doctoral Projects

Instructional design (ID) is a critical skill for nursing professional development practitioners (NPDs). Instructional design seeks to solve gaps in knowledge or skill by identifying both the educational issue and the outcomes by designing how to achieve the outcomes. There are complex and advanced instructional design needs for problem solving that requires an educational foundation in instructional design and experience. The purpose of the quality-improvement project was to assess the changes in NPD practitioners’/nurse educators’ adaptation to industry standards for ID pre- and post-implementation of a standardized instructional design model. The Nurse Educator Self-Assessment in Measuring Learning survey was developed …

An Evaluation Of A Structural Competency Training For School Nurses, Rachel J. Torres

Doctoral Projects

The aim of this quality improvement project was to use structural competency as a tool to highlight the broad social, political, and economic structures that influence health and subsequent inequities and disparities. A one group, pre-and post-design quality improvement project was used to determine whether the Structural Competency Working Group curriculum influenced school nurses’ thought processes regarding the factors that influence health outcomes. The curriculum was adapted to a 1.5-hour training and delivered to a group of school nurses from a highly populated and socially, economically, and culturally diverse urban county in northern California. The results showed that after the …

Reducing Catheter-Associated Urinary Tract Infection Rates By Educating Staff On Bundle Interventions, Tirath Kaur

Master's Projects

PURPOSE: Catheter associated urinary tract infection is an undesired burden to the patients and healthcare system. This systematic review explores the published literature and determines the impact of educating nursing staff on the indication of urinary catheter, insertion of foley catheters, maintenance of urinary catheters, and periodical communication between nurses and physicians for changing foley catheters can reduce the CAUTI rates in adult patients in the acute care hospital setting. METHOD: A systemic review was conducted using CINHAL, Science Direct, PubMed, and MEDLINE within the time period of ten years from 2012 to 2022. Eight published articles are reviewed and …

A Roadmap To Safer Hyaluronic Acid Injections, Mandi Lonergan

Master's Projects

Non surgical aesthetic treatments have become increasingly more popular in the United States (2020 Plastic Surgery Statistics Report 2021). Hyaluronic acid (HA) fillers are the second most popular non-surgical aesthetic treatment behind Botulinum toxin injections (The Aesthetic Society, 2021). The increased use of these fillers has led to increased rates of complications With the release of new long lasting fillers in 2014, providers began to see an increase in delayed onset nodules (DON). A DON is considered in the aesthetic field to be a nodule that occurs 30 days to years after filler injection (Convery et al., 2021). A …

Resilience Training For Healthcare Professionals: A Literature Review, Michelle Dictor

Master's Projects

Purpose: An exploration of various resilience training programs to determine if there is a significant impact on the psychological resilience of health care professionals.
Method: An electronic systematic review using San Jose State University’s OneSearch database search engine was completed. The review contains published research articles between 2011-2022. Nine published articles were reviewed and used for this systematic review.
Results: There is limited data related to resilience training and resources in accredited nursing programs. Resilience training programs are both a feasible and acceptable way of building psychological resilience among interdisciplinary health care professionals.
Conclusion: Mindfulness-based resilience training programs can be …