Bias In Nursing Students: How Student Exposure Impacts Patient Interactions, Claire Roy

Honors Theses and Capstones

Bias is a pervasive issue in healthcare. It affects all aspects of the healthcare system and affects patients primarily through their interactions with healthcare providers. This study aimed to identify if exposure to various patient populations reduced bias among participants and increased their understanding of the way bias impacts patients. Two participants were recruited from a baccalaureate nursing program course titled “Living with Mental Illness” to participate in a series of two-semi structured interviews to identify bias, perceptions of community-based care, and the growth from the beginning to the end of their clinical experiences. Results showed skill development, increased understanding …

Integrating Brief Cognitive Behavioral Therapy Into Telepsychiatry: A Professional Development Model For Pmhnps, Catherine A. Roberts

DNP Scholarly Projects

Background: Mental illnesses remain among the most prevalent health conditions in the United States, affecting approximately 23% or nearly one in five adults in 2025 (Centers for Disease Control and Prevention [CDC], 2025); National Institute of Mental Health [NIMH], 2024a). Despite this high prevalence, only 50.6% of adults living with mental health disorders receive treatment (NIMH, 2024a); although the expansion of telepsychiatry has improved access to mental healthcare, medication-management visits are frequently brief and primarily focused on pharmacotherapy thereby limiting opportunities for delivery of psychotherapeutic interventions. This limitation highlights the need for structured, evidence-based psychotherapeutic approaches that can be …

Introducing Education For Sensory Approaches In Mental Health-Related Emergency Department Visits: A Quality Improvement Project To Enhance Patient-Centered Care, Jesse O'Neill

Master's Theses and Capstones

Background: Barriers to specialty care access have resulted in emergency departments (ED) operating as temporary psychiatric hold facilities for their communities. Patients boarding in the ED are demonstrated to use a disproportionate percentage of facility resources with minimal benefit to the patient. The Institute for Healthcare Improvement identifies the impact of the healthcare environment on patient outcomes and suggests staff training to foster trauma-informed practice culture (Schall et al., 2020).

Local Problem: High-stress healthcare environments can escalate maladaptive patient behaviors and the use of restrictive interventions. Traditional use of restrictive interventions lacks supportive evidence and contradicts person-centered care goals (Molloy …

Promoting Safe And Effective Ciwa-Ar Protocol Adherence On An Inpatient Psychiatric Unit Through An Educational Reference Poster: A Quality Improvement Project, Kenan J. Gray

Master's Theses and Capstones

Abstract

Background: Alcohol withdrawal syndrome (AWS) can progress to seizures, delirium tremens, and autonomic instability. The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) supports symptom-triggered AWS management, but safe use depends on timely nursing assessment, reassessment, and documentation.

Local Problem: On an adult inpatient psychiatric unit, chart audits identified CIWA-Ar protocol adherence gaps, including missed four-hour assessments and one-hour reassessments after lorazepam.

Methods: This quality improvement project used the Plan-Do-Study-Act model. Three educational reference posters were placed in high-visibility staff areas with QR-linked access to the facility’s AWS protocol and CIWA-Ar scoring guidelines. Outcomes were evaluated using pre- and post-intervention …

Improving Perinatal Outcomes With The Mood Disorder Questionnaire: A Quality Improvement Project To Increase Identification And Referral, Elizabeth R. Bargardo

Master's Theses and Capstones

Abstract

Background: Perinatal mental health is a growing concern, with under identification and lack of access to mental health as contributing factors. Screening tools such as the Mood Disorder Questionnaire are one way to increase identification of patients at risk for bipolar-spectrum disorders and subsequent postpartum psychosis and initiate referrals to appropriate mental health services.

Local Problem: One outpatient women’s health center has a 94% screening rate for the Edinburgh Postnatal Depression Score (EPDS) for anxiety and depression but has not implemented a screening for bipolar disorder. In addition, while approximately one in five perinatal patients struggles with a mental …

Effective Measurement-Based Care For Depression Within Va Health Systems: A Quality Improvement Initiative, Amie L. Doyle

DNP Scholarly Projects

Background: Depression is highly common among U.S. veterans, surpassing civilian rates. Measurement-Based Care (MBC), including the Patient Health Questionnaire-9 (PHQ-9), facilitates systematic symptom monitoring and treatment enhancement. At Manchester VA Medical Center (VAMC), PHQ-9 completion in primary care was low (18.93% in May 2025) due to workflow inefficiencies, provider workload, and dependence on Mental Health Service Line (MHSL) referrals.

Local Problem: Underutilization of the PHQ-9 in primary care hampers early detection and effective treatment of depression among veterans.

Methods: Four primary care teams received training on using the Behavioral Health Laboratory (BHL) software, which facilitates pre-visit electronic completion of the …

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

DNP Scholarly Projects

ABSTRACT

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

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, …

Nursing Education And Comfort Level In Caring For Patients With Eating Disorders, Jaylyn E. Jewell

Honors Theses and Capstones

Nurses are integral to providing care to patients with eating disorders, who often present to the generalized hospital setting related to physical complications from their disorder. Despite the vital role nurses play, a lack of education is cited. This project sought to assess knowledge on eating disorders of nurses at a local hospital through dissemination of a survey. A total of n=18 responses were gathered. Results supported the fact that many nurses have received inadequate education on eating disorders, and consequently have low knowledge and competency in the care of these patients. This project seeks to identify this lack of …

Student Perspectives On The Adequacy Of Mental Health Curriculum Within The College Of Health And Human Services At Unh, Brianna Lee Meyer

Honors Theses and Capstones

This study aims to understand the confidence students in future healthcare oriented majors feel in regards to treating or interacting with individuals with mental health conditions. It also aims to understand the effect of students' in-major education, outside-major education, and lived experience on this confidence level. Students within the College of Health and Human Services at UNH were the participants who completed a short Qualtrics survey online. The survey collected data from Likert scales and short-answer questions. The Likert scales were then analyzed with a regression and descriptive statistics, while the short-answer questions were analyzed with thematic analysis. The study …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Sensory Modulation Training To Reduce Restrictive Interventions On An Acute Inpatient Psychiatric Unit At A Secure Psychiatric State Hospital: A Clinical Nurse Leader Quality Improvement Project, Fionna Norman

Master's Theses and Capstones

Abstract

Background: Symptoms of severe mental illnesses can result in Personal Safety Emergencies (PSE’s) in the acute in-patient psychiatric setting. As part of treatment of PSE’s, restrictive interventions such as seclusion are utilized in current practice to maintain the safety of the patient, peers, staff, and the environment. Evidence-based research has shown restrictive interventions can cause physical and psychological harm to both patients and staff. Reducing restrictive interventions continues to be a priority to create the most therapeutic environment possible. Evidence-based research has shown that sensory modulation is a non-restrictive intervention that can reduce the use of restrictive interventions, decrease …

Implementing Universal Suicidality Screening In A Critical-Access Emergency Department, Delaney M. Kjendal, Kerry Nolte, Sara Robinson, Kimberly Force

Honors Theses and Capstones

Background: Implementation of a universal suicidality screening is considered best practice as it is associated with improved the detection of occult, or latent, suicide risk and can reduce subsequent risk. This quality improvement (QI) project evaluates the implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) to screen patients over the age of twelve at a regional healthcare system.

Methods: The QI project was conducted at Littleton Regional Healthcare (LRH) emergency department, a critical-access hospital in Littleton, New Hampshire that serves about 206 patients per week. Implementation of suicidality screening was of interest to LRH to promote mental health in the …

Utilizing Outpatient Telehealth As A Treatment Approach For Patients With Substance Use Disorder: A Quality Improvement Project, Veronica Kwegyir-Afful

DNP Scholarly Projects

Background: The issue of substance use disorder (SUD) has demonstrated a growing prevalence both in the United States (U.S.) and globally. Effective treatment modalities have been devised for individuals afflicted by SUD, thereby enabling their post-treatment prognosis to be parallel to that of patients with other chronic diseases, such as diabetes. However, several factors or barriers impede individuals with SUD from assessing treatment. These barriers encompass financial constraints stemming from inadequate insurance coverage and high cost, the stigma surrounding SUD, which results in patient's hesitancy to seek treatment treat, adverse societal attitudes, collateral social percussions like work hour losses and …

Increasing Access And Adherence To Cognitive Behavioral Therapy For Insomnia (Cbti) For Adults: A Quality Improvement Project, Kristen Newell

DNP Scholarly Projects

BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.

INTERVENTION: Patients that …

Promoting Safety Of Medication Administration And Reducing Medication Errors Using Photographic Patient Identification In An Inpatient Psychiatric Setting: A Quality Improvement Initiative, Kyla Kelly

Master's Theses and Capstones

Abstract

Background: Medication errors pertaining to patient wristband workarounds in a behavioral and mental health inpatient unit can affect patient outcomes, safety and can even be fatal. The proper verification of the five rights of medication administration, patient acuity, diagnosis, and unit staffing can impact the need for patient wristband workarounds to occur. Improving staff and patient education and reducing the need for wristband workarounds through the utilization of patient photographic identification significantly reduces the number of medication errors relating to wristband workarounds during the medication administration process. Additionally, a significant reduction in the time it takes to administer medications …

Reducing Violence In The Workplace: A Quality Improvement Project, Molly Mcqueeney

Master's Theses and Capstones

Abstract

BACKGROUND: Violence in the United States has significant impacts on the healthcare system. On average, there are about 7.8 per 1,000 workers yearly that experience violent injuries (Grossman & Choucair, 2019). In 2016, it was estimated that approximately $429 million was added to treat and prevent injuries to healthcare workers (Grossman & Choucair, 2019). By implementing the Broset Violence Checklist (BVC) as a screening tool for early identification of risk for violence, there is a possibility for a reduction in the number of violent occurrences in the workplace.

LOCAL PROBLEM: Within the given microsystem, there is a lack of …

Implementation Of A Standardized Suicide Risk Screening Tool: An Improvement Project In A University Counseling Center, Clint Emmett

DNP Scholarly Projects

This article describes a quality improvement project undertaken at the University of Idaho Counseling and Testing Center (CTC). This quality improvement project describes the use of the Ask Suicide Questions (ASQ) screening tool to accurately assess the severity of suicide risk during an initial assessment or crisis visit. Clinicians were provided with education and demonstration of the ASQ and shown how to incorporate this tool into their practice. 86 eligible appointments were included in the project for analysis. Simple descriptive statistics were used to present the resulting data. Results indicate that 30.3% of eligible appointments were screened. 43.8% of clinicians …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …

Standardizing Nursing Hand-Off Report Using I-Pass On A Behavioral Health Unit: A Quality Improvement Project, Sarah Pennisten

Master's Theses and Capstones

Background: Deficient or ineffective communication in clinical hand-off has been established by prominent international health organizations as a significant cause of adverse clinical events, compromising clinical safety, an ongoing common problem for healthcare professionals and institutions. Existing literature unanimously called for improvement in hand-off communication to improve patient outcomes and recommended beginning such efforts by building various types of structure into hand-off (McCloughen et al., 2008).

Aim: The aim of this quality improvement project was to improve clinical communication among nurses transferring care of patients in acute psychiatric care.

Methods: Utilizing the Plan, Do, Study, Act framework over a total …

Using A Psychopharmacology Education Program To Increase Primary Care Provider Comfort With Treating Basic Psychiatric Disorders, Latesha Reed

DNP Scholarly Projects

BACKGROUND: Almost 1 in 5 people have been diagnosed with a mental health illness but the supply of psychiatric providers does not meet patient’s needs. Multiple reasons contribute to this shortage and nurse practitioners are part of the solution. Even with nurse practitioners specializing in psychiatric mental health there is still a shortage. Primary care is where most patients first present their mental health issues.

METHODS: Literature review informed the development of the educational intervention presented to the primary care providers using a digital, asynchronous learning format. A gap analysis of organizational needs and weaknesses was used to determine the …

Addressing Medical Mistrust In In-Patient Psychiatric African American (Aa) Patients, Eselle Molua

DNP Scholarly Projects

Abstract

Background: Medical Mistrust (MM) is associated with patient dissatisfaction, treatment nonadherence, and poor health outcomes. In the United States, MM is prevalent in African American patients in In-Patient Psychiatric settings. Caregiver training and education on MM and cultural sensitivity can help identify mistrust and provide strategies to increase trust and reduce mistrust.

Purpose: The aim of this project was to implement an educational tool to improve caregiver awareness about knowledge of MM. By doing so, it was the goal to enhance cultural sensitivity skills and patient-centeredness in the African American population at the adult psychiatric unit in Northwest …

Improving Employee Mental Health: Addressing Depression At The Workplace, Gerald G. Chia Dr.

DNP Scholarly Projects

Abstract Background: Depression is a serious mental health challenge in the US. As frontline workers who are responsible for taking care of a myriad of patients daily, health workers are usually exposed to depressive situations which eventually results in them developing the mental health condition. The purpose of the current project was, therefore, to develop an intervention which helps to improve employee mental health in healthcare settings with focus on depression and examine workplace factors which influence depression among employees of the Outpatient Mental Health Clinic in Washington District of Columbia. Methods: A pre-intervention survey was conducted among 43 employees. …

Improving The Diagnosis Of Major Depression In A Primary Care Practice Using The Patient Health-9 Questionnaire, Chukwudi C. Orji

DNP Scholarly Projects

Abstract

Background: Major depression is a serious health problem that affects both children and adults. It is a leading cause of disability worldwide. Most cases of major depression are treated in primary care settings. Many cases of major depression presenting in primary care are missed. Many PCPs do not routinely use screening tools. The aim of this project is to improve the diagnosis of major depression in adults in a primary care practice through routine use of the Patient Health Questionnaire-9 (PHQ-9) during initial encounter with patients and during follow-up visit for patients who are receiving treatment for depression to …

Improving Care Transitions For Individuals With Suicide Risk After Discharged From Acute Unit, Maureen Ndu

DNP Scholarly Projects

Background: Suicide is a public health problem and the 10th leading cause of death in the US. Suicide accounted for more than 47,5000 deaths in the US in 2017, translating to about 130 suicide deaths each day. An average of 20 veterans commits suicide each day compared to 93 suicides in the general population in the US. Individuals with suicide risks are 300 times at an increased rate of suicide death in the first week and 200 times in the first month of hospital discharge. Nurses are in a strategic position to improve the care transition of individuals with suicide …

Improving Emergency Department Nurses' Self-Perceived Self-Efficacy In Early Recognition Of Patients In A Mental Health Crisis, Mary Kay Silverman

DNP Scholarly Projects

Abstract

The two largest counties within Southwest Florida (SWFL) are Lee and Collier where mental health evaluations for children under the state’s Baker Act have more than doubled between 2011 and 2017 (Gluck & Zeitlin, 2019, p. 4). Given the marked increase in mental health evaluations, early recognition, assessment with initiation of treatment by nurses in the pediatric emergency department (ED) who present with behavioral health complaints must be a priority for emergency department leaders. Purpose: This quality improvement (QI) project proposed to improve a nurses’ self-efficacy through expanding knowledge in the recognition and identification of the signs and symptoms …

Peer Support For Addiction In The Inpatient Setting, Rebecca Sweeney

DNP Scholarly Projects

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered …

Depression Screening And Care Management In Diabetes Patients At Rural Health Clinics In Primary Care: Quality Improvement, Marcy Doyle

DNP Scholarly Projects

Depression is one of the leading causes of disease and disability, often found in patients with long-term chronic physical conditions such as diabetes. Collaborative care, which includes care managers, has shown to improve depression outcomes in patients; usual care has been shown to be inadequate. This quality improvement project screened patients with diabetes for depression. Patients with an elevated depression screening score were provided care management support and rescreened every two weeks to evaluate depression symptoms. A small cohort of patients from two rural health clinics participated in the improvement project. The practices noted improvement in depression screening; patients who …

Decreasing Duration Of Mechanical Restraint Episodes By Increasing Registered Nurse Assessment And Surveillance In An Acute Psychiatric Hospital, Diane Allen

DNP Scholarly Projects

Background

Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital.

Purpose

The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse …

Implementation Of A Physical Activity Group At A Community Mental Health Center: A Pilot Quality Improvement Project To Reduce Depressive Symptoms In Adolescents With Major Depressive Disorder, Nancy Gallagher

DNP Scholarly Projects

Major Depressive Disorder is a debilitating illness that affects millions of Americans, including adolescents. The majority of adolescents with Major Depressive Disorder (MDD) do not receive treatment. There may be a variety of reasons for this including stigma, access to care, and potential adverse reactions. People suffering from MDD are known to be at high risk for suicide. Lack of treatments adds the risk of suicide for adolescents with MDD. Identifying and implementing treatment options that are more acceptable and accessible are of the utmost importance. Although there is limited research regarding exercise/physical activity, depressive symptoms, and adolescents with MDD, …