Psychiatric and Mental Health Nursing Commons^™

Reducing The Readmission Rate In Adult Psychiatric Patients With Bipolar Disorder, Jessica Nwokocha

Doctor of Nursing Practice Final Project Abstract

Purpose: 

The goal of this project was to reduce the readmission rate among patients by improving attendance to the post-hospitalization program through phone call reminders.

Background: 

Review of baseline data at the project site showed a 60% increase in the readmission rate among adult patients with bipolar disorder in May 2025. This analysis demonstrates that the readmission rate in psychiatric hospitals continues to be an issue.

Methodology: 

The project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation over a six-week period, with readmission rates monitored for a 30-day period. Data collected and tracked included patient attendance, completed phone calls, and …

Implementation Of Phq-9 To Improve Depression Identification In Icu, Jenny C. Manoly Bsn, Rn

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement project aimed to improve depression identification by screening 80% of eligible adults admitted to two heart failure intensive care units (ICU) using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS Screening compliance increased from 42.1% to 85% by Week 13, exceeding the project goal. Of 101 patients screened, 16.8% screened positive for depression. Workflow changes, leadership support, and peer engagement improved compliance, though psychiatric referrals remained inconsistent.

BACKGROUND Depression is common among critically ill patients but is frequently underrecognized because ICU care primarily focuses on physiologic stabilization. Existing admission screening was limited to suicide risk assessment, delaying identification …

Enhancing Well-Being: Implementing Weekly Social Interventions For Older Adults In Independent Living, Rosa Huang

Dissertations

Loneliness and social isolation significantly impact the physical and mental well-being of older adults. This quality improvement project implemented an eight-week social intervention designed to reduce loneliness and enhance well-being through weekly sessions incorporating mindfulness exercises, gratitude journaling, and structured socialization activities. The intervention was delivered by nursing students to a sample of residents in a Midwestern independent living community. While most standardized measures of loneliness and mood did not show statistically significant changes, the project resulted in a statistically significant increase in social network engagement as measured by the Lubben Social Network Scale-6 (LSNS-6). The findings suggest that group-based …

Enhancing Medication Timeliness Through Structured Handoff In A Mental Health Facility, Belinda Zinhu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Delayed medication administration in an adult inpatient mental health facility exceeded organizational benchmarks and posed risks to patient safety, treatment effectiveness, and continuity of care. Baseline electronic health record (EHR) audits showed that about 30% of scheduled medications were administered outside the organization's acceptable timeframe, and inconsistent nurse shift handoffs contributed to the delays.

Aim of the Project: The aim of the quality improvement project was to improve patient outcomes by implementing the I-PASS standardized handoff communication tool to reduce late medication administration from 30% to 15% within 12 weeks.

Review of the Evidence: Evidence supports structured handoff frameworks …

Implementing A Mindfulness Mobile Application, Smiling Mind To Reduce Stress Experienced By Inpatient Psychiatric Nurses, Emma Jade Mowery, Justin D. Ruiz

Doctor of Nursing Practice Final Project Abstract

Purpose: To investigate the impact of implementing use of the Smiling Mind app (a free and easily accessed mobile application that teaches mindfulness skills) in inpatient psychiatric nurses. The aims: A 20% reduction in Perceived Stress and improved Workplace Satisfaction after 10 weeks.

Background: Workplace stressors experienced by psychiatric nurses include high patient acuity, emotional strain, environmental factors, and new policies. Unmanaged stress can harm nurse's well being and affect quality of care.

Methodology: Using a pre-post implementation design, 7 dayshift and 10 night-shift nurses used the Smiling Mind app for 10 weeks. Perceived stress (PSS-10) and workplace satisfaction (WPS) …

Improving Restraint Care Plan Documentation Among Nursing Staff, Samson E. Okotie

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to improve nursing compliance with restraint care plan documentation standards using bundled interventions, including targeted education, electronic health record (EHR) prompts, and unit-based audit and feedback processes. The goal was to achieve at least a 70% improvement in documentation compliance within 12 weeks.

Background: Accurate restraint documentation is essential for patient safety, ethical practice, interdisciplinary communication, and regulatory compliance. Despite existing policies and education, institutional audits revealed compliance rates of 50% or less, demonstrating a persistent gap in practice and the need for structured interventions.

Methodology: The project used the Plan-Do-Study-Act (PDSA) framework across …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Improving Throughput: A Quality Improvement Initiative To Expedite Inpatient Psychiatric Placement From The Emergency Room, Candice J. Battle

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this quality improvement project was to evaluate the effectiveness of a standardized psychiatric transfer workflow designed to reduce emergency room (ER) boarding time for psychiatric patients in a 30-bed acute care hospital from an average of 3-5 days to an average of 2-3 days.

Background

Psychiatric patients often experience prolonged ER boarding while awaiting inpatient psychiatric placement. These delays contribute to delayed treatment, worsening psychiatric symptoms, ER overcrowding, and increased healthcare costs.

Methodology

This four-week quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework. Interventions included a standardized psychiatric transfer protocol, simplified transfer checklist and staff education. …

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 …

Quality Improvement Initative To Reduce Falls Among Geriatric Patients In The Inpatient Mental Health Setting, Regina Johnson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are widely recognized as a leading cause of injury and hospitalization among older adults, with geriatric psychiatric patients at particularly high risk due to polypharmacy, cognitive impairment, and mobility challenges. At the project site, baseline audits revealed inconsistent use of structured fall risk tools, limited nurse-driven medication review, and gaps in post-fall documentation. The absence of an embedded electronic health record feature for medication review highlighted a significant practice gap requiring intervention.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce fall risk in a geriatric psychiatric hospital through structured post-fall medication …

Enhancing Nurse Competence And Self-Efficacy In Delivery Of Medication Education At Discharge: A Quality Improvement Project Using The Teach-Back Method., Quinesia James

Doctor of Nursing Practice Papers

Medication nonadherence in pediatric psychiatric care contributes to worsening symptoms, delayed developmental progress, and increased hospitalizations. Adherence rates remain as low as 30–60%, accounting for up to $300 billion in avoidable healthcare costs annually. Low health literacy and inconsistent education strategies further complicate adherence. This quality improvement project took place on the child and adolescent psychiatric units at the project site, a large teaching hospital in a metropolitan area in the south-central United States, which serves patients aged 5–17 with complex mental health needs. The initiative aimed to improve nurses’ competence, self-efficacy, and time efficiency in delivering medication discharge education …

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 …

The Impact Of High Deductible Health Plans On Mental Health Treatment, Kristian D. Dambrino

SPARK Symposium Presentations

Project Title: The Impact of High Deductible Health Plans on Mental Health Treatment

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 …

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 …

Implementing A Routine Patient Health Questionnaire-9 (Phq-9) Screening Bundle For Adults (18-65 Years) Scheduled For A Psychiatric Evaluation, Olivier Bertrand Djoumessi

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Depression affects 21 million American adults (8.4%), yet only 28% receive appropriate screening. In Texas, where 20.8% of adults experience depression, systematic screening remains inconsistent. This quality improvement project addressed a critical gap at an outpatient mental health clinic in the Dallas-Fort Worth metroplex, where Patient Health Questionnaire-9 (PHQ-9) screening occurred in only 40% of psychiatric evaluations, resulting in missed diagnoses and inconsistent treatment. Using the Plan-Do-Study-Act framework, the project implemented a comprehensive PHQ-9 screening bundle consisting of staff training, electronic health record integration, and a treatment algorithm based on severity thresholds. The intervention targeted adults, aged 18-65, scheduled for …

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, …

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 …

Optimizing Laboratory Appointment Adherence Among Patients Prescribed Psychoactive Medications, Tamara N. Blake

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The purpose of this scholarly project was to implement a standardized nurse-driven phone call reminder protocol to improve adherence to scheduled laboratory appointments among patients prescribed psychoactive medications requiring bloodwork. This protocol is aimed to increase appointment adherence and reduce no-show rates within the clinic.

BACKGROUND

The project was implemented within a small outpatient community-based clinic in Round Rock, Texas which provides mental health services. The clinic experienced high no-show rates for scheduled laboratory appointments among patients prescribed psychoactive medications. Monitoring these patients is essential to ensure medication safety and prevent potential adverse effects.

METHODOLOGY

The six-week quality improvement …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

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 …

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 …

Increasing Music Therapy Referrals In A Surgical Intensive Care Unit., Brandi Cecil

Doctor of Nursing Practice Papers

Medications have been the primary intervention in intensive care unit patients due to the fact that the patients are often unconscious, critically medically ill, or unable to actively participate in nonpharmacological treatment. Researchers have found the integration of music therapy in patient care has helped ease pain, anxiety, and stress, and has been useful in vital control, such as decreasing heart rate and respiration count. A study was conducted in a surgical intensive care unit (SICU) to examine the benefits of increasing music therapy consults. Critical care nurses were educated on the advantages of utilizing interdisciplinary care by consulting music …

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 …

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 An Adhd Electronic Portal In Pediatric Primary Care, Heather Cathey

Epsilon Sigma at-Large Research Conference

Clinical practice guidelines (CPGs) for Attention Deficit Hyperactivity Disorder (ADHD) recommend documentation of symptom scales and comorbidity screenings at the time of diagnosis and routinely throughout care. Rates of documentation for these tools in pediatric primary care are consistently low, creating a gap in care that impairs diagnosis, management, and patient outcomes. The purpose of this quality improvement project was to implement an online ADHD portal that emails, collects and scores these tools. The aims of the project are to improve utilization of CPGs by increasing documentation rates of symptom scales and comorbidity screenings for pediatric patients with ADHD. One …

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 …

A Quality Improvement Initiative To Improve Depression Screening In Prenatal And Postpartum Mothers, Britanni Greene

Doctor of Nursing Practice

Screening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operations Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …