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 …

Anesthesia Informed Consent: An Objective Structured Clincial Examination, Joshua Powell

Doctoral Projects

Informed consent is a fundamental component of anesthesia practice and is recognized as professional Standard IV by the American Association of Nurse Anesthesiology (AANA). Despite its importance, anesthesia providers often face challenges in effectively obtaining consent from patients. Within The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP), a need was identified to strengthen student competency in conducting anesthesia informed-consent discussions. This project developed and implemented an Objective Structured Clinical Examination (OSCE) as a standardized, evidence-based approach to teach and assess informed-consent skills in alignment with the American Association of Nurse Anesthesiology (AANA, 2019) standards. The intervention was designed …

The Fascia Iliaca Regional Nerve Block Using Ultrasound And Landmark Technique: An Objective Structured Clinical Examination For Nurse Anesthetists, Braxton T. Beech, Parker F. Rigby

Doctoral Projects

The fascia iliaca block (FIB) is an effective regional anesthesia technique used in various clinical settings, including operating rooms, emergency departments, and pain management clinics. Despite its advantages in reducing postoperative complications and minimizing opioid use, FIB remains underutilized among Certified Registered Nurse Anesthetists (CRNAs), primarily due to limited exposure and training. This doctoral project examines the implementation of an Objective Structured Clinical Examination (OSCE) as an educational intervention to enhance CRNA proficiency in performing FIB using both ultrasound-guided and landmark techniques.

A pre- and post-test study design was conducted with 18 CRNA participants attending a continuing education workshop. Demographic …

Enhancing Crna's Knowledge Of Radiation Safety Through Online Education, Angela Iledan, Madeline Pousson

Doctoral Projects

Although ionizing radiation is frequently used in anesthesia-related procedures, many CRNAs receive minimal training in radiation safety principles and protective measures. This knowledge gap increases the risk of cumulative radiation exposure for providers and patients. To address the issue, this doctoral project developed and implemented an online educational intervention designed to enhance CRNAs’ understanding of radiation safety, ultimately promoting safer practices in radiation-prone environments.

The doctoral project follows a QI and EBP approach that incorporated diverse adult learning styles to enhance engagement and knowledge retention of CRNAs. The online educational module was designed and delivered to CRNAs that currently practice …

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 …

An Evidence-Based Preceptor Development Program For Nurse Anesthetists, Raleigh Todd

Doctoral Projects

Abstract

Problem Statement: The success of the student registered nurse anesthetists (SRNA) is heavily influenced by experiences in the clinical setting, often encompassing a variety of preceptors throughout their respective anesthesia programs. Despite the importance of the preceptor role, many preceptors feel unprepared, and it is estimated most certified registered nurse anesthetists (CRNAs) who precept students have received no formal training in the preceptor role.

Purpose: The purpose of this project is to develop and evaluate an evidence-based preceptor education program for CRNA preceptors, utilizing evidence from literature and input from practicing nurse anesthetists. This program helps provide support by …

Prescription For Change: Tackling Inappropriate Antibiotic Use In Urgent Care Settings, Lachundra Mosley

Doctoral Projects

A pressing global health issue that significantly contributes to antibiotic resistance is the inappropriate antibiotic prescribing for Upper Respiratory Infections (URI’s) in urgent care settings (World Health Organization [WHO], 2022). The purpose of this doctoral project was to reduce inappropriate antibiotic prescriptions for URI at an urgent care in D’Iberville, Mississippi through the implementation of an educational pamphlet.

A pre-post intervention project was conducted, collecting data on antibiotic prescribing practices via retrospective chart reviews before and after the educational intervention. Data was collected using a researcher developed screening tool based on Evidence based guidelines to distinguish viral vs bacterial infections. …

Comparison Of Two Learning Methodologies: Virtual Reality And Osce Simulation, Connor Blackwell, Tabor Mcgee

Doctoral Projects

Anesthesia education has evolved immensely over the past twenty years, and with the new virtual reality (VR) simulations created by SIMVANA, the exponential growth can continue. The anesthesia program at The University of Southern Mississippi (USM) currently utilizes an educational platform known as the Objective Structured Clinical Examination (OSCE) for their students’ clinical curriculum. With the development of technology and education models, the purpose of the doctoral project is to determine if VR simulation can produce more effective learning than the OSCE modules. To determine the effectiveness, pharmacologic lessons for intraoperative hypotension were administered through both platforms and then tested …

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. …