Psychiatric and Mental Health Nursing Commons^™

Implementing Lean Methodology To Decrease Wait Times In A Psychiatric Emergency Department, Kristina S. Baxter

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement project aimed to implement Lean strategies to optimize the intake process in a psychiatric emergency department, thereby reducing patient wait times, minimizing left-without-being-seen (LWBS) occurrences, and improving access to timely psychiatric care.

Background

The project was conducted in a hospital-based psychiatric emergency department in Southeast Texas, serving adults and children six years and older.

Methodology

Lean methodology and PDSA cycles were employed to refine the intake process and eliminate inefficiencies. Key interventions included patient transport by technicians to minimize delays, using tele-clinicians for assessments to reduce staff burden, and restructuring nursing assessments to prioritize telehealth consultations …

Gad-7 Screening In Middle School Students: Evaluating The Effectiveness On Referral Rate Scoping Review, Bailey Hall, Cara Dennis, Kayla Drennen-Ferguson, Pamela B. Taylor, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

The prevalence of anxiety disorders among adolescents, mainly middle school-aged students, highlights the critical need for practical screening tools to support early detection and intervention. The Generalized Anxiety Disorder-7 (GAD-7) scale is widely utilized in various settings, but its efficacy in this specific population remains underexplored. This scoping review examines the use of the GAD-7 in middle school-aged students, evaluating its reliability, validity, and impact on referral rates to mental health services. The review also considers factors influencing anxiety and identifies gaps in current research.

Methods

Ten articles, published in peer-reviewed journals within the past decade and involving human …

To Heal A Mind: A Comparison Of Functional And Conventional Treatments In Major Depressive Disorder, Gillian Chambers

Senior Honors Theses

Incidence of major depressive disorder is increasing year over year, with little able to be done to halt the spread of the condition. However, there are many treatment possibilities considered unconventional by the healthcare system. This thesis examines the respective benefits and risks, in comparison to one another, between conventional pharmacological treatment and functional, holistic treatment of depression. This was done via integrative review of available clinical literature, synthesizing evidence on both conventional and functional treatments for depression, as dictated by Whittemore and Knafl (2005). Exploratory search methods revealed 758 records fulfilling inclusion criteria, which were screened and narrowed down …

Experiences Of Women In The Labour Room: The Untold Story, Emmanuel Dziwornu, Belinda Kpodo, Ophelia Anarfi, Enyonam Afi Adzato, Anita Fafa Dartey

Patient Experience Journal

Background: Childbirth experiences are some of the most sensitive indicators of the utilisation of health facilities. Women who go through the child-birthing process are reported to be faced with a range of experiences. Aim: This study described women's experiences in the labour room. Methods: The study employed a qualitative research approach with a descriptive design. Purposive sampling was used in this study and data saturation was reached after the 18^th participant. In-depth interviews were used to obtain information from recently delivered women. Interviews were audio recorded and transcribed verbatim. Thematic content analysis (TCA) was done and the results were …

Evaluating Referral Rates For Positive Postpartum Depression Screenings At Telehealth And Well-Child Visits: A Scoping Review, Rachel Macklin Barber, Mph, Bsn, Rn, Damaris Amber Brooks, Bsn, Rn, Ashli-Emeria Gary, Bsn, Rn, Margaret Harvey, Phd, Acnp-Bc, Chfn, Kate Fouquier Phd, Aprn, Cnm, Pmh-C, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Postpartum depression (PPD) affects one in nine women. It has distressing impacts, including behavioral and attachment issues and toveruse of healthcare services. PPD occurs within 4 weeks to 12 months postpartum. A scoping review was conducted to compare referral rates to mental health providers after PPD screenings were conducted via telehealth versus those completed at well-child visits.

Methods

Peer-reviewed articles published within five years before the initial search, beginning September 2022 and ending November 2024, were selected. Articles were sourced from several publications using an online library database with various MeSH terms and Boolean operators. Search results were narrowed …

Evaluation Of Depression Screening Tools For Utilization In Adolescents: A Scoping Review, Helen Whitaker Bsn, Rn, Jade Bray Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Anxiety and depression are prevalent mood disorders among the adolescent population with significant impacts on academic performance, social interactions, and mental well-being. With depression rates continuing to rise and suicide among the leading causes of death in adolescents, there is an urgent need for effective screening and intervention. While depression screening is recommended in the primary care setting, many adolescents do not have regular access to healthcare, complicating early identification and treatment. The purpose of this scoping review is to compare the effectiveness of two depression screening tools, the Patient Health Questionnaire (PHQ-9) and the Beck Depression Inventory (BDI), …

Enhancing Schizophrenia Treatment Outcomes: Integrating Cbt With Medication Therapy To Reduce Hospital Readmission, Kamauri Fleming Msn, Rn, Grace Adeniji-Ilesanmi Fnp-Bc, Zillah Anagho Tah Fnp-C, Alex Cook Msn, Rn, Margaret Harvey Phd, Acnp-Bc, Chfn, Sharon Little Dnp, Aprn, Fnp-Bc, Jacqueline Sharp Dnp, Aprn, Pmhnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Schizophrenia is a chronic mental illness that disrupts cognition, emotion, and social functioning, imposing significant personal and societal burdens. While antipsychotic medications are effective in alleviating psychotic symptoms, they are often associated with side effects, poor adherence, and relapse risk. Cognitive behavioral therapy (CBT) has shown promise as an adjunct to medication, addressing persistent symptoms and improving outcomes. This scoping review examines the integration of CBT with medication therapy to reduce hospital readmissions and improve quality of life for adult patients hospitalized with schizophrenia.

Methods A systematic search of databases, including PubMed, PsycINFO, Embase, and Cochrane Library, was conducted …

The Impact Of High Deductible Health Plans On Mental Health Treatment, Kristian D. Dambrino, Laura Gray, R. David Phillippi

DNP Projects

Background and Rationale: High Deductible Health Plans (HDHPs) are designed to reduce overall healthcare spending by shifting more upfront costs to patients to discourage overutilization of care, yet HDHPs often increase financial burden, particularly in outpatient mental health care. Patients covered by HDHPs often face substantial out-of-pocket costs before reaching their deductible. This can lead to potential delays or discontinuation of psychiatric treatment. Financial transparency interventions by the mental health provider may mitigate these barriers through more-informed patient decision-making regarding payment options. This project evaluates the impact of a financial transparency intervention on reducing payment responsibility for HDHP patients in …

Factors Associated With Quality Of Intrapartum Care In Kenya: A Complex Samples Analysis Of The 2022 Kenya Demographic And Health Survey, Lilian Nuwabaine, Earnest Amwiine, Quraish Sserwanja, Joseph Kawuki, Mathius Amperiize, Angella Namulema, Ahmed Sarki, John Baptist Asiimwe

School of Nursing & Midwifery, East Africa

Background

The provision of quality intrapartum care increases women’s utilization of skilled birth attendants in health facilities and improves maternal and newborn health. This study aimed to investigate the factors associated with the quality of intrapartum care using the 2022 Kenya Demographic and Health Survey (KDHS).

Methods

Secondary data from the 2022 KDHS of 11,863 participants, who were selected by multistage stratified sampling, was used. Based on literature and the availability of indicators within the 2022 KDHS, the quality of intrapartum care was operationalized as receiving all the three clinical components of intrapartum care including a mother having a facility-based …

Perinatal Mood And Anxiety Disorders (Pmads): A Scoping Review, Christina Willis Bsn, Rn, Nia Wells Bsn, Rn, Miranda Smith Bsn, Rn, Kate Fouquier Cnm, Phd, Facnm

Doctor of Nursing Practice Projects

Purpose/Background Perinatal Mood and Anxiety Disorders (PMADs), including postpartum depression, anxiety, and psychosis, significantly impact maternal and infant health. This scoping review consolidates current literature on PMADs, emphasizing prevalence, risk factors, screening, and treatment. The primary aim is to identify research gaps and inform clinical guidelines to enhance perinatal care.

Methods A literature search followed PRISMA guidelines from August 2022 to November 2024. Databases searched included PubMed, CINAHL, Scopus, and Google Scholar, using terms such as "perinatal mood disorders" and "maternal mental health." Inclusion criteria were English-language studies from the past decade addressing PMADs during pregnancy and up to one …

Evaluating The Effectiveness Of A Non-Pharmacological Sleep Bundle For The Prevention Of Delirium In Geriatric Patients In The Intensive Care Unit: A Scoping Review, Morgan Wilkins Bsn, Rn, Vanessa D'Amico Bsn, Rn, Alyssa Goyda Bsn, Rn, Seema Janga Bsn, Rn, Kaylin Story Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is an acute disorder yielding cognitive deficits, such as disruption in attention and awareness. It impacts approximately 50% of individuals over the age of 65 who are admitted to the hospital and is prevalent with patients in the intensive care unit (ICU). ICU delirium is associated with adverse outcomes, including higher morbidity, prolonged hospital stays, and chronic neurocognitive deficits. Research demonstrates that implementation of a non-pharmacological sleep bundle can reduce the overall occurrence of delirium. The purpose of this scoping review is to examine the efficacy of a non-pharmacological sleep bundle on the incidence of ICU delirium in …

The Effectiveness Of Gad-7 Screening In High School Students, Tamara L. Smith, Allison Darnell, Margaret Harvey, Phd, Acnp-Bc, Chfn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students.

Methods

A comprehensive search was conducted across …

The Impact Of Covid-19 On Nurses' Feelings, Stress, Coping, And Motivation In Palestinian Treatment Centers Of Corona, † Wafaa Menawi, Shatha Mari, Ahmad Adel Hanani

An-Najah University Journal for Research - B (Humanities)

Background: Frontline nurses of COVID-19 found themselves in an unfamiliar new disease work environment, fighting to adapt and control the stress while working at covid-19 centers in Palestine. Aim: To investigate the impact of COVID-19 on nurses' feelings, stress, coping, and motivation in COVID-19 Palestinian treatment Centers. Method: A descriptive cross-sectional design was conducted between Mid of July to the end of October 2021 by recruiting a purposive sample of 390 nurses who worked at the Ministry of Health during COVID-19 pandemic treatment centers. The nurses filled out the COVID-19 Health Personnel Questionnaire with Cronbach's Alpha > 0.9. Results: Palestinian frontline …

Evaluating The Efficacy Of Predischarge Referrals In Preventing Emergency Mental Health Hospital Readmissions: A Scoping Review, Pretia Carpenter Bsn, Rn, Stephanie Mays Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon H. Little, Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Background

Emergency mental health hospital readmissions present significant challenges to healthcare systems, often resulting in increased costs, prolonged hospital stays, and poor patient outcomes. Continuity of care through predischarge referrals to outpatient mental health services, psychosocial support, and community resources has been proposed as a strategy to reduce readmissions. However, the effectiveness of these interventions remains inconsistent across different populations and settings.

Objective

This scoping review aims to evaluate the effectiveness of predischarge referrals in reducing 30-day emergency mental health hospital readmissions, identify key components of successful programs, and assess the influence of demographic factors on readmission rates.

Methods

A …

Integrating Workplace Violence Prevention Into Nursing Curriculum: Preparing Future Nurses For Safer Practice ​, Noah Briere, Sarah Kegerreis, Molly Lasyone, Savannah Orris

SPARK Symposium Presentations

Nurses are under attack. 80% of nurses have experienced some form of workplace violence (WPV), which is seen as “part of the job.” Unfortunately, the agency responsible for protecting nurses, the Occupational Safety and Health Administration (OSHA), only offers voluntary guidelines. We have determined that nursing students are the best group to educate about WPV prevention in healthcare. Including this teaching to fit within their pre-clinical requirements, only needing one faculty to teach with an average salary of $80k, to further help set what should be foundational skills. By adding WPV de-escalation techniques and adequately preparing students prior to graduation. …

Management If Aggressive And Disruptive Behavior In The Emergency Department Using De-Escalation Techniques And Simulation: A Quality Improvement Project To Improve The Knowledge And Confidence Of Emergency Department Nurses And Clinical Staff, Ernestine Darby-Littlejohn

Electronic Theses and Dissertations

Abstract

Approximately 40% of all healthcare workers have reported episodes of violence by patients over the last 2 years. This Veteran’s Health Agency reported 824 disruptive events reported in the last 5 years, of which 56 occurred in the emergency department. Research shows that interventions are not always timely, resulting in the clinical staff requesting the Veteran’s Health Agency Police to intervene when a veteran’s level of stress is escalating. The gap in practice is shown to be related to a lack of knowledge in the clinical staff in managing high stress levels exhibited by some veterans, limited knowledge of …

Adverse Childhood Experiences: Healing Through Storytelling And Mindful Narrative Therapy, Julie Kemp

Mindfulness Studies Theses

This study presents research about the nature and prevalence of adverse childhood experiences (ACEs), the mental and physical impacts to individuals exposed to ACEs, and incorporating mindfulness practices into therapeutic approaches to treating them, particularly Mindfulness-Based Narrative Therapy (MBNT). It is important because ACEs have become a global crisis, with the potential for interfering with psychological and physical development, early mortality, and other harmful life outcomes. This thesis provides critical information for mindfulness teachers and practitioners, therapists, educators, regulators, parents, and individuals subjected to ACEs.

The methodology includes extensive literature searches for narrative therapy and mindfulness-based interventions (MBIs) in peer-reviewed …

Psychological Impact Of Ulcerative Colitis On Pregnancy And Postpartum Period, Stephanie C. Carver

Nursing | Senior Theses

Background

Ulcerative colitis (UC) poses significant challenges during pregnancy, affecting both physical and mental health. While the physiological effects of UC during pregnancy are well documented, less is known about its impact on maternal mental health. This study aims to investigate the psychological effects of UC on pregnant women, focusing on stress levels, postpartum depression (PPD) incidence, and the role of multidisciplinary care in improving mental health outcomes.

Objective

The primary objective of this research proposal is to evaluate the psychological impact of UC during pregnancy and determine whether disease activity increases the risk of PPD and stress. A secondary …

Improving Maternal Mental Health: The Role Of Specialized Support For Queer Women With Postpartum Depression, Dan-Tam Pham

Nursing | Senior Theses

Queer women face disproportionately high rates of postpartum depression compared to heterosexual and cisgender individuals. Studies showed that queer women face heightened mental health challenges, including higher rates of depression and anxiety due to factors like discrimination, limited support systems, and negative healthcare experiences. There is a need for culturally competent, LGBTQ+-affirming interventions to improve maternal mental health outcomes; despite the health disparities faced by this population, research on specialized postpartum interventions is limited, revealing gaps in effective mental health care for queer mothers. The key search terms for the articles used in the study included: postpartum depression, queer women, …

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 …

Enhancing Patient-Centered Suicide Prevention: A Quality Improvement Project Addressing Educational Gaps In Staff Caring For Veterans, Shayla Craigue

Master's Theses and Capstones

Veterans are at significantly higher risk for suicidal ideation (SI) than the general population and often encounter barriers to care such as stigma, trauma, and distrust in healthcare systems. This quality improvement project, conducted at a Veterans Affairs (VA) Urgent Care Clinic, aimed to enhance trauma-informed care by addressing educational gaps among clinical staff. Using the Plan-Do-Study-Act (PDSA) model, the intervention included a pre-intervention survey to assess baseline knowledge, a targeted educational poster informed by survey findings, and a post-intervention survey to measure changes in staff confidence, resource awareness, and understanding of the role of the mental health response team, …

Nurses’ Perception On The Gut-Brain Axis And Its Implications On Mental Health, Geethika Manoj, Celine Bautista

Nursing | Senior Theses

Background: Most medical interventions recommended for patients with anxiety and depression include pharmacological treatments and psychotherapy. Thus, undermining the existence of modifiable risk factors, such as diet. Despite being an area of growing research, the gut-brain axis is a very broad topic among the healthcare field. Purpose: The purpose of this study is to investigate registered nurses’ perceptions and understanding of the gut-brain axis and its implications for mental health management. Methods: This proposed exploratory descriptive study will conduct research among fifteen registered nurses, each with at least two years of experience in specialties such as gastroenterology, psychiatry, or hospital …

The Impact Of Structured Weekend Group Therapy On Restraints, Seclusion And Length Of Stay On Inpatient Psychiatric Units, Victoria Grau

West Chester University Doctoral Projects

Group therapy is an essential part of inpatient psychiatric treatment, with documented positive effects including better medication compliance, lower readmission rate, and improved self- esteem. Patients who are admitted for an inpatient psychiatric stay have a small window of time in which behavioral health staff can work with them. Group therapy can help patients develop a plan for these issues and provide a foundation for successful discharge and symptom management. The project site is a mid-size teaching hospital in an urban community with higher rates of mental health diagnoses than the national average. Group therapy was conducted initially Monday – …

The Effect Of A Hospital Community Garden On Healthcare Workers’ Professional Quality Of Life, Madelyn Renee Cline

DNP Projects

Background: Healthcare professionals experience a variety of stressors which negatively impact their professional quality of life (ProQOL) potentially leading to increased turnover and nurse shortages in hospitals. There are growing studies addressing ways to improve healthcare ProQOL, yet few have examined the impact of alterations to the workplace on these outcomes.

Purpose: The purpose of this project was to evaluate the effect of a dedicated outdoor green space for nurses during shift breaks on their ProQOL.

Methods: This project used a one-group pretest-posttest design. Data analysis was completed using descriptive and inferential statistics using SPSS software. The Professional Quality of …

Nurse-Led Cbt For Depression In Heart Transplant Patients: A Feasibility Study, Matthew R. Wallace

DNP Projects

Background: Heart transplant recipients are at an elevated risk of experiencing depressive symptoms compared to the general population. Those with depression post-transplant face increased complications, e.g., infection, organ rejection, prolonged hospitalization, and higher mortality rates. However, specific psychotherapeutic interventions tailored for heart transplant recipients remain limited. Nevertheless, there is substantial evidence supporting the effectiveness of various interventions for adults with heart failure, a condition frequently diagnosed in these patients. This suggests that successful strategies for managing depressive symptoms in heart failure patients could be adapted for heart transplant recipients.

Purpose: The purpose of this project was to evaluate …

Navigating Sexual And Gender Diversity: A Quality Improvement Project To Increase Provider Cultural Competencies For Sexual And Gender Minorities In Mental Health Outpatient Facilities, Shermeen Chandani

Doctor of Nursing Practice Final Project Abstract

Purpose: Sexual and gender minority (SGM) populations experience healthcare disparities related to stigma, discrimination, and limited provider cultural competency. In outpatient psychiatric settings, non-affirming practices can negatively affect patient engagement, trust, and continuity of care. This quality improvement project aimed to enhance staff sexual and gender minority cultural competency (SGMCC) and strengthen affirming clinical processes.

Background: The project was implemented across two outpatient psychiatric clinics with approximately 28 multidisciplinary staff members. At baseline, no formal SGM cultural competency training or standardized documentation practices for preferred names and pronouns existed.

Methodology: A Plan–Do–Study–Act framework with a pre/post-test design was used. The …

The Association Between Sleep Quality, Depression, Anxiety, And Job-Related Stress Among Nurses In Saudi Arabia, Romeo Jr Patague Mostoles

Makara Journal of Health Research

Background: This study examined the mediating role of sleep quality in the relationship between depression, anxiety, and job-related stress among nurses in Saudi Arabia.

Methods: Sociodemographic information, Pittsburgh Sleep Quality Index, depression, anxiety, and work-related stress were evaluated in 851 nurses. Structural equation modeling was used to investigate the mediation effect of sleep quality on mental health and job stress in nurses.

Results: High rates of anxiety (65.9% severe, 34.1% moderate), depression (37.2% moderate to severe), and poor sleep (51.4%) were found. Sex, marital status, education, nationality, and smoking status significantly influenced mental health outcomes. For example, …

Empowering Schools: Suicide Prevention Education For School Nurses, Navjot K. Singh

DNP Qualifying Manuscripts

Introduction: Suicide among adolescents and youth is such a serious issue that immediate, appropriate interventions are needed to reduce rates of suicide ideation and suicide mortality. The increasing rate of suicide among this population profoundly affects families, friends, and the community. Identifying and implementing appropriate interventions in schools could identify individuals who are suffering from mental illness and support suicide prevention.

Aim: The purpose of this integrative literature review was to examine the literature on suicide prevention interventions for young adolescents and teenagers aged 12-17 years old and identify the best, evidence-based practices for the school setting. The aim …

Promoting Confidence And Evidence-Based Practices For Attention-Deficit/Hyperactivity Disorder Among Integrated Primary Care Providers: A Qualitive Improvement Education Initiative, Omar Samateh, Margaret Emerson, Kayla Meisinger, Taylor Wilson, Leeza Struwe

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Primary Care Providers (PCPs) are seeing growing number of patients presenting for adult attention-deficit/hyperactivity disorder (ADHD) evaluations as a result of social media influences highlighting ADHD. Yet, PCPs report lacking confidence and education with adult ADHD. The purpose of this quality improvement study was to develop educational materials to promote confidence, competence, and adherence to ADHD evidence-based recommendations among integrated care PCPs. Methods: A literature review and retrospective chart review of 19 patients were used to create 1) Baseline ADHD Provider Education (PE) tool, 2) Standardized ADHD Diagnosis (SAD) referral process, 3) ADHD Assessment, Treatment, and Monitoring …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …