Nursing Commons^™

Quality Improvement Project Simulating Ethics: Improving Ethical Decision-Making In Nursing Undergraduates Through Simulation And Faculty Training, Shannon Brown

Doctor of Nursing Practice Projects

Nursing faculty often report limited confidence in teaching ethical principles, despite the essential role ethics plays in preparing students for complex clinical decision-making. This quantitative, quasi-experimental pre/post quality improvement project evaluated whether a structured ethics education module incorporating simulation could impact faculty confidence in teaching ethical principles. Guided by Lewin’s Change Theory and the Jeffries Simulation Framework, the project examined how organizational readiness for change and structured simulation design influence faculty development outcomes. Nursing faculty in a baccalaureate program participated in a single simulation-enhanced ethics session. Data were collected through anonymous pre/post Qualtrics surveys, and faculty confidence was measured using …

Improving Exam Scores: Alternative Next Generation Questions In Curriculum, April Morgan

Doctor of Nursing Practice Projects

Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on …

Hypothermia Management In Adult Trauma Patients: Enhancing Nursing Knowledge And Self-Efficacy In The Emergency Department, Shannon M. Rapert

Doctor of Nursing Practice Projects

Trauma-induced hypothermia is a significant, preventable condition that contributes to increased mortality. Evidence suggests that inconsistent recognition and management of hypothermia persist in the emergency department (ED), highlighting the need to strengthen ED nurses’ knowledge and self-efficacy in evidence-based warming strategies. The purpose of this quality improvement project was to evaluate the impact of an educational intervention on ED nurses’ knowledge and self-efficacy in managing trauma-induced hypothermia. Guided by the Iowa Model of Evidence-Based Practice, the ADKAR Change Model, and the Plan-Do-Study-Act framework, this quantitative, quasi-experimental, pretest–posttest project evaluated the effect of an instructor-led educational intervention in ED nurses at …

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 …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Telling Their Intensive Stories: Black/African American Intensive Care Unit Nurses And Their Perceived Encounters With Icu Workplace Racism, Sharon M. Butler

Theses & Dissertations

The 2022 American Nurses Association (ANA) study on racism and racial inequality within the nursing profession both acknowledges the presence of racism in nursing and provides evidence of the diverse negative social and psychological effects of racism on minority nurses. Although the 2022 ANA study sets a precedent and shows evidence of racism’s effects across the broader professional nursing workforce, there is limited nursing research literature that offers a focused presentation and understanding of the lived experiences of minority nurses and their personal perceptions of workplace racism. There is also limited nursing research on how workplace racism impacts cultural and …

Nurse Manager Perceptions Of Strategies To Overcome The Underutilization Of Nonpharmacological Pain Control Methods In Adult Acute Care, Landen M. Bonnell

Undergraduate Honors Theses

A basic patient right is to have pain adequately managed. However, research consistently indicates that many adult patients in acute care experience inadequately managed pain, which may contribute to adverse patient outcomes. Studies have shown that nonpharmacological pain management can lead to increased patient satisfaction, shorter hospital stays, and better patient outcomes. However, many barriers exist to nurses providing effective nonpharmacological pain control therapy, primarily including heavy workload and a lack of education and support. Currently, there is insufficient research on how to overcome these barriers. Four nurse managers with experience in nursing leadership were interviewed using a qualitative descriptive …

Online Group Neurobehavioral Therapy (Nbt) For Veterans With Epilepsy And Major Depressive Disorder (Mdd), Melissa F. Fadipe

Dissertations and Theses (Open Access)

Background: Veterans with epilepsy experience high rates of psychiatric comorbidity, most commonly major depressive disorder (MDD). Barriers to accessing mental health care—including geographic distance, transportation limitations related to seizure-related driving restrictions, and fragmented care between neurology and psychiatry, contribute to the underdiagnosis and undertreatment of MDD in this population. Neurobehavioral Therapy (NBT), a Cognitive Behavioral Therapy (CBT)-informed psychotherapy developed for individuals with seizures, has demonstrated benefits for psychological distress and quality of life. Internet-based interventions and short message service (SMS) text messaging offer promising strategies to address access barriers; however, limited research has examined the feasibility and acceptability of delivering …

From Birth To Better Health: Educating Mothers With Gestational Diabetes On Breastfeeding Benefits And Glucose Management, Jesse A. Soria Jr, Sarah Smith, Audrey Nolan Smith, Keeley Kosier

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Gestational diabetes mellitus (GDM) increases a mother's risk of developing type 2 diabetes mellitus (T2DM) later in life and can affect an infant's future health. Breastfeeding can help improve a mother's blood sugar control and may lower her future risk of diabetes, but many mothers with GDM do not know about these benefits. This quality improvement (QI) project evaluated a standardized education program on breastfeeding and diabetes prevention for postpartum mothers with GDM at the Family Birthing Center at St. Joseph's Medical Center (SJMC) in Stockton, California. The intervention included a 10- to 15-minute education session and an evidence-based educational …

Improving Mobility Awareness And Jh-Amp Tool Utilization On A Cardiac Care Unit, Courtney Joe, Clarissa Chaires, Jocelyn Martin, Eunice Sanchez

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

The quality improvement project evaluated the impact of staff education and a unit-wide mobility awareness campaign on the use of the Johns Hopkins Activity and Mobility Promotion tools and patient mobilization in a 48-bed Cardiac Care Unit (CCU). The project involved registered nurses, nursing assistants, unit leaders, and adult cardiac patients represented by aggregate mobility data. A preliminary survey completed by 42 CCU staff members, CCU Partnership Council focus group, meetings with clinical nurse specialists, and a baseline unit audit identified inconsistent mobility practices, uncertainty regarding Johns Hopkins Highest Level of Mobility tool, and limited completion of in-room mobility signs. …

Mind Over Scrubs – A Peer-Led Anxiety Reduction Program, Nhi T. Tran, Angelica Dirige, Adeleke Fashola

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Nursing students experience elevated anxiety during the transition into accelerated programs, which can negatively affect academic performance, well-being, and retention. This quality improvement project evaluated Mind Over Scrubs, a peer-led anxiety reduction program for incoming Entry-Level Master of Science in Nursing students at the University of the Pacific, consisting of four 45-minute sessions on evidence-based coping strategies. Generalized Anxiety Disorder-7 surveys were administered at baseline, before and after each session, and at two- and four-week follow-ups; Wilcoxon signed-rank tests evaluated matched changes. Thirty-one of 62 enrolled students (50%) attended at least one session. Post-session scores fell below individual baselines for …

Know Your Birth, Jasmine Mckelvey, Reagan L. Hunt, Michaela M. David

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Maternal mortality remains a significant public health concern in rural Kenya because of limited healthcare resources, inadequate emergency obstetric training, and barriers to accessing timely, high-quality maternal care. This quality improvement project evaluated the implementation of the Know Your Birth educational intervention, a culturally responsive, simulation-based training program designed to improve healthcare providers' knowledge, confidence, and competency in evidence-based maternal and newborn care. The project was conducted at Sega Dispensary in Sega, Siaya County, Kenya, and included 26 healthcare staff members. Guided by the Plan-Do-Study-Act framework, participants completed a brief educational presentation followed by three interactive skills stations focused on …

Attrition Of The Midwifery Workforce: Understanding Factors Associated With Leaving The Profession, E. Brie Thumm, Amy H. Goh, Elizabeth G. Phillips, Zachary Giano

College of Health Professions Faculty Papers

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who …

The Effects Of An Educational Intervention To Enhance Knowledge And Awareness Of The Prevention Of Sexually Transmitted Infections Among College Students, Darcy Yates

Doctor of Nursing Practice Projects

Purpose

The DNP student implemented a single group pretest-postest design underpinned by the Health Belief Model to address the PICOT question: Among a purposive sample of college students at a mid-west college (Population) to what degree does participation in an evidence-based intervention providing information about STIs (Intervention), compared with before that intervention (Comparison), result in to an increase in knowledge and awareness regarding STI infections and associated risks and treatment options (Outcomes) over a six-week period (Time)?

Methods

The pretest and postest scores of 15 students for the 27 items in the Sexually Transmitted Diseases Knowledge Questionnaire (STD-KQ) were evaluated. …

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 Heart Failure Transitional Care To Reduce 30-Day Readmission Rate, Thuy Nhu Uyen Tran

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project is to reduce 30-day readmissions for adult patients with heart failure (HF) by implementing a standardized HF pathway beginning in the intensive care unit (ICU) and continuing through discharge.

Background: The project was implemented within a large healthcare organization in Northwest Houston, Texas.

Methodology: This project utilized a pre- and post-implementation design guided by the Plan-Do-Study-Act (PDSA) model. Eligible adult patients (≥18 years) with a primary or secondary HF diagnosis were identified during March 2026. The My Pathway to Wellness HF education pathway was initiated at the time of ICU downgrade …

Recover Well: Reducing Readmissions Through Nurse-Led Follow-Up After Urologic Surgery – A Quality Improvement Project, Candace Brigette Mike

Doctor of Nursing Practice Projects

Hospital readmissions within 30 days following urologic surgeries are often associated with catheter complications, infections, poor pain management, and limited patient understanding of discharge instructions and therefore represent a significant quality and safety concern for patients and institutions alike. The purpose of this quality improvement project was to evaluate whether implementing structured, nurse-led telephone follow-up in conjunction with standard discharge education reduced unplanned 30-day hospital readmissions among adult patients undergoing urologic surgery. Guided by the Logic Model framework, this project used a quasi-experimental, two-group pre- and post-intervention design to compare outcomes at a high-volume outpatient urology clinic in Houston, Texas. …

Utilization Of An On-Site Primary Care Clinic – An Evaluation, Joulvous Jarvis Drake

Doctor of Nursing Practice Projects

Background: Employers incorporate on-site primary care clinics into their workplace health strategies to improve employees’ access to timely care and chronic disease management and reduce absenteeism and healthcare-related costs. Yet despite the demonstrated organizational and health benefits, many worksite clinics experience lower-than-expected utilization. Purpose: This evaluation project aimed to identify the behavioral and structural factors that influenced employee utilization of a corporate on-site primary care clinic. Method: A quantitative, cross-sectional design was used to evaluate the factors contributing to employees’ low utilization of the on-site primary care clinic. Approximately 1,000 eligible full-time employees at a large corporate campus in Texas …

Quality Improvement Initiative To Improve Adherence To Ob Hemorrhage Policy And Standardize Pitocin Administration During Cesarean Sections To Reduce Postpartum Hemorrhage Risk, Lauren R. Litz, Monica Blauser

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, and Pitocin administration is an important component of hemorrhage prevention and management during cesarean delivery. Variation in Pitocin timing, dosing, method of administration, and adherence to evidence-based recommendations may compromise patient safety and create barriers to standardized obstetric anesthesia care. The purpose of this Doctorate of Nurse Anesthesia Practice quality improvement project was to evaluate current anesthesia provider practices for Pitocin administration during cesarean delivery, compare observed practices with the California Maternal Quality Care Collaborative hemorrhage toolkit and Society for Obstetric Anesthesia and Perinatology Enhanced Recovery After Cesarean recommendations, …

Enhancing Patient Outcomes In Obstetric Neuraxial Anesthesia: Evaluation Of A Structured Documentation Tool For Post-Dural Puncture Headache Tracking (Pdph), Jacqueline Saldana Tovar, Ahmad Hasaan

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

The purpose of this Doctor of Nursing Practice (DNP) project is to evaluate the incidence, management, and practice variation of post-dural puncture headache (PDPH) in an obstetric population using retrospective data from standardized follow-up tools. The project aims to identify inconsistencies in procedural techniques, documentation practices, and adherence to evidence-based guidelines across anesthesia provider levels. By analyzing key clinical variables and patient outcomes, this project seeks to identify gaps in current practice, improve data reliability, and support the development of standardized protocols for PDPH assessment and management. Ultimately, the goal is to enhance quality of care, promote evidence-based decision-making, and …