Other Nursing Commons^™

Optimizing Efficiency In Joint Injections In An Outpatient Orthopedic Oncology Clinic Using Lean Six Sigma, William Alexander Byrd

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Prolonged in-room wait time in an outpatient orthopedic oncology clinic was identified as an important driver of dissatisfaction and operational inefficiency. Baseline in-room times in this setting were reported as M=96.2 minutes for patients receiving injections and M=92.9 minutes for those not receiving injections. This quality improvement project used Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, Control) framework to streamline clinic workflow for the joint injection process. Over an eight-week period, four key interventions were introduced: a standardized order set for medications, pre-bundled supplies and portable supply toolbox, telephone pre-consenting of patients, and optimized scheduling of …

A Chronic Pain Self-Management Quality Improvement Bundle For Veterans, Srijana D. Baniya

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: Veterans often face challenges accessing care services due to limited awareness of available resources for support, Self-care, and mental health (Harding et al., 2019; Patel et al., 2024). Given the high prevalence of Chronic pain and opioid use in this population, Self-management (SM) education and non-pharmacologic interventions are required to address the biological, psychological, and social effects of pain (Bair et al., 2015; Mumba et al., 2024; Nahin, 2017; Higgins et al., 2020). This Quality improvement project aims to determine whether implementing an evidence-based SM bundle for chronic pain improved Pain severity scores and increased understanding of SM strategies. …

Poorly Controlled Type 2 Diabetes (T2dm) In A Rural County In Texas: A Diabetes Intervention Bundle, Roxanne Morales

Doctor of Nursing Practice (DNP) Scholarly Projects

Type 2 diabetes mellitus (T2DM) remains a significant public health concern, particularly in rural and underserved communities where patients often face barriers to effective self-management. This quality improvement (QI) project evaluated the impact of a diabetes intervention bundle consisting of individualized diabetes education, biweekly support phone calls, and digital self-monitoring tools on glycemic control, body weight, diabetes knowledge, medication adherence, diet compliance, and physical activity. The project was implemented over an eight-week period in a rural family medicine clinic and included 18 adults with uncontrolled T2DM (HgbA1c >7%). Participant outcomes were evaluated using pre- and post-intervention clinical measures, the Diabetes …

Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

A Quality Improvement Project: Nurse-Led Nutritional Support To Reduce Missed Chemotherapy Appointments, Eva Balboa

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction/Background

Malnutrition affects approximately 43% of cancer patients nationally and is associated with missed chemotherapy appointments, treatment interruption, and poor clinical outcomes. At a 30-chair outpatient cancer center in South Texas, a retrospective chart review revealed that 45% of patients experienced malnutrition-related symptoms contributing to appointment disruptions. Despite evidence-based recommendations for routine nutritional screening and support, no standardized protocol existed at this site.

Objectives

 The purpose of this quality improvement project was to implement a nurse-led nutritional support protocol and evaluate its effectiveness in (1) reducing the missed chemotherapy appointment rate from 10% to 5%, (2) achieving 100% compliance with …

Does Guideline-Directed Breast Mri Improve Early Identification In The High-Risk Breast Cancer Population, Cemile Littlepage

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction: In the United States, one in eight women will be diagnosed with breast cancer. The American Cancer Society's 2007 guidelines (Onishi & Kataoka, 2020) and the American College of Radiology recommend that MRI screening, alongside annual mammography, be used for women at high risk for breast cancer (Lamb et al., 2023; Sardanelli et al., 2024). Currently, there are various screening models, and no standardized tool or national guideline exists for MRI screening in high-risk patients. This guideline project aims to establish a screening model and recommendations for MRI screening in high-risk women for use in primary care.

Methods: A …

Exploring The Association Between Nurse Characteristics And Intent To Leave Their Current Position In Counties With Rural Hospital Closures, Caroline A. King

2025 Fall Honors Capstones Projects - Archive

Increased rural hospital closures and nursing burnout may lead to greater morbidity/mortality for rural residents. Current literature fails to capture whether rural hospital closures influence nurses’ intent to leave their current position. In this cross-sectional study, descriptive and correlational statistical analyses were conducted on survey responses from a sample of nurses who lived in a rural county that experienced a hospital closure. 66% of nurses stated that, at one point, they had considered leaving their primary nursing position. Logistic regression model results revealed that nurse-reported age and gender were significant predictors of a nurse’s intention to leave their current position. …

Bridging Disability Studies And Nursing Education: A Curricular Intervention, Serena Karim

2025 Fall Honors Capstones Projects - Archive

Although one in four Americans experience disability in their lifetimes, the majority of nurses and other healthcare professionals feel ill-prepared to care for patients with disabilities (PWD). Factors such as inaccessible healthcare facilities, insufficient clinical knowledge, and biases about the quality of life of PWD contribute to mounting health inequities between PWD and non-disabled people. To further understand how education can impact nursing students’ comfortability and confidence toward caring for PWD, a 30-minute disability studies lesson was implemented for junior-level nursing students. 51 students who attended the lecture provided anonymous pre- and post-lecture surveys, which contained Likert scale and free …

Perception Of Spirituality By Intensive Care Unit Nurses, Adejoke Felicia Ogidan

Nursing Dissertations - Archive

ICU nurses are identified as a population of nurses with a high risk of experiencing psychological stress due to the nature of their job in the ICU (Lyndon, 2015; Welp et al., 2015). Psychological stress is detrimental to nurses' mental health and the quality of patient care.

According to Watson’s Transpersonal Human Caring Theory, the spiritual perception of the nurse influences the nurse’s spiritual care practice, which in turn affects their self-care and care provided by the nurse to patients (Watson, 2021)This research explored the ICU-Ns' perception of spirituality and its relationships with spiritual care practices and self-assessed competency in …

Case Management For End-Stage Renal Disease Patients, Jamie L. Andrews

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Social determinants of health (SDOH) and health literacy directly impact adults with end-stage renal disease (ESRD) on hemodialysis (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2022; Ulrich, 2020). Adults with ESRD account for 1.5 million hospital admissions and 500,000 re-admissions within 30 days annually (NIDDK, 2022). Case management is essential in reducing re-admissions for adult ESRD patients, requiring abilities to identify factors affecting adult ESRD patients appropriately.

Methods: Therefore, an evidence-based practice (EBP) project using the IOWA Model framework was implemented to increase the knowledge base in identifying care and resources for ESRD patients for telephonic …

Factors Contributing To Technostress In Nursing Education: A Study Of Master Of Science In Nursing (Msn) Education Students, Jennifer Weber

Nursing Dissertations - Archive

This mixed-methods study examined factors contributing to technostress among Master of Science in Nursing (MSN) Education students enrolled in a fully online program. Guided by the Technostress Trifecta Model, the study explored the relationships among age, grade point average (GPA), years of nursing experience, and self-rated technical skills, as well as students’ perceptions of technology use in learning.

Data were collected from 94 participants using the Technostress Scale by Upadhyaya and Vrinda (2021). Quantitative analyses showed that self-rated technical skill was significantly associated with lower perceived technological complexity, while age was significantly associated with both techno-invasion and techno-uncertainty. GPA and …

Decreasing Hospital-Acquired Clostridium Difficile Infections, Angel S. Louder

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Clostridium Difficle Infection (CDI) is a significant healthcare threat due to its ability to be transmitted rapidly in healthcare settings. Patient engagement and participation in infection prevention initiatives at admission will lead to early implementation of isolation precautions, diagnosis of infectious pathogens, and treatment. A quality improvement project was implemented at a south-central Texas acute care hospital to engage alert and oriented adult patients, using a bundled approach to screen for the early detection of CDI within 48 hours of hospital admission, thereby reaching the goal of reducing hospital-acquired CDIs. This initiative improved patient engagement with CDI screening, reducing confirmed …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

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 …

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 …

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 …

Resilience And Compassion Fatigue Among Medical Nurses In Acute Care, Angela M. Vallier

Nursing Dissertations - Archive

Compassion fatigue impacts nurses of all backgrounds and specialties. This non-experimental, descriptive, correlational study design involved three research questions that examined medical registered nurses’ association between resilience and compassion fatigue. This study examined organizational factors, work-system factors, and individual factors that are influential to compassion fatigue and resilience among nurses working in general medicine units.

The Compassion Fatigue Short Scale® and Connor-Davidson Resilience Scale® were used to measure compassion fatigue and resilience among the participants in this study. The study included 98 registered nurses who worked in general medicine units in Southeast Texas. The results indicated a negative significant correlation …

Increasing Colorectal Cancer (Crc) Screening In Hispanic Adults Using An Evidence-Based Social Determinants Of Health-Oriented Guide For Patient Navigation, Joyce A. Acquah Dnp, Aprn, Fnp-C

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. It affects over 140,000 individuals and results in over 50,000 deaths per year. It is estimated that increasing screening to 80% could potentially prevent approximately 300,000 new cases and over 200,000 deaths by 2030. Screening disparity among the Hispanic population is influenced by socio-economic and socio-cultural factors. The aim of this project was to develop a balanced scorecard (BSC), using publicly available data and research files from three databases (Behavioral Risk Factor Surveillance System [BRFSS], Texas Health Care Information Collection [THCIC], and Healthy North Texas …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Impact Of A Discharge Bundle On Boarding Hours In Acute Care Hospitals, Monica L. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

The national epidemic of boarding hours in the emergency departments prompted the implementation of a discharge bundle in an acute care hospital. This bundle included an ADT nurse, discharge orders written prior to 11AM, and EVS shifting employee hours. Initial findings indicated a reduction in boarding time by 126 minutes.

Using The Electronic Medical Record To Improve Nurse Workload, Sharon C. Le Roux

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background

Equitable nurse-patient assignments have been associated with improved nurse well-being, patient satisfaction and outcomes. Despite this, in an academic medical center in the southwestern United States, there is no standardized process to create equitable nurse-patient assignments.

Objectives

The aim of this project was to improve inpatient oncology nurse well-being and satisfaction through the implementation of an EMR based nurse-patient assignment tool.

Methods

The IOWA Model-Revised for evidence-based practice was used as the basis for this project. Data collected included demographics, the Well-Being Index Survey, perception of satisfaction with manual workload tool, along with knowledge and use of the …

Bundle For Left Ventricular Assist Device (Lvad) In The Ed, Tina Morris

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose

Left Ventricular Assist Device (LVAD) is a high-risk, low-volume patient population with admission rates of up to 72%. The purpose of this study was to provide a care bundle to increase the knowledge of the emergency department (ED) staff and decrease the door to consult times to the advanced heart failure (AHF) team for LVAD patients presenting to the ED at a level I trauma center in Texas.

Methods

In collaboration with emergency clinical staff, the project team implemented a bundle that included a pathway for the LVAD patients upon presentation to the ED, targeted education for clinical staff …

Developing Toolkit For Adults With Autism Spectrum Disorder In An Oncology Outpatient Clinic, Brittany J. Johnson Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Autistic adults are at higher risk of being diagnosed with co-occurring health conditions, and yet they are a vulnerable group for disparities in access and outcomes. One of the key barriers to better outcomes is poor patient-provider communication. This study the use of AASPIRE’s AHAT communication toolkit as a channel between healthcare workers and autistic adults to facilitate their appointments within the outpatient oncology department, as well as assessing healthcare providers’ knowledge and self-efficacy in caring for the patients. Sixteen healthcare providers (12 registered nurses and four patient care assistants) completed pre and post intervention surveys and utilized the AHAT …

Establishing Guidelines For Implementing Electronic Hand Hygiene Monitoring Systems, Olaoti Opaleye

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Healthcare-associated infections (HAIs) in hospitals threaten patient safety and quality of care, which leads to increased healthcare costs. Despite national and state-level progress in hand hygiene compliance (HHC), the 2022 CDC annual report on HAIs highlighted ongoing concerns for standard infection ratios (SIRs) and called for improved HHC to reduce HAIs. Many hospitals use trained observers to collate HHC data; their audits are limited and often skewed by the Hawthorne Effect (HE) and observer bias, resulting in inaccurate HHC data. This project aimed to create guidelines for implementing electronic hand hygiene monitoring systems (EHHMSs) to help hospital inpatient units adopt …