Nursing Commons^™

Improving Advanced Care Planning Conversations And Documentation Through App Education And Standardized Epic Workflow: A Quality Improvement Initiative, Michelle N. Rutter, Emily Goldstein

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Advance care planning (ACP) is essential for ensuring (GOC), particularly in acute care settings, defined in this paper as inpatient hospital environments, including critical and intensive care units (ICU), where a patient’s decision-making capacity could become impaired. ICU patients are often critically ill and may lose the ability to make health care decisions. Family uncertainty regarding patient preferences frequently exacerbates psychological distress regarding GOC. Restricted access to ACP may result in non-concordant medical care, as well as elevated healthcare expenditures driven by the underutilization or inappropriate allocation of critical resources. Despite the recognized importance of ACP and …

Staff Education To Improve Consistent Phq-9 Administration In An Outpatient Psychiatric Practice, Ngozi Eboru

Walden Dissertations and Doctoral Studies

Depression is a leading cause of disability and is associated with functional impairment, reduced quality of life, and increased healthcare utilization. Consistent administration of the Patient Health Questionnaire-9 (PHQ-9) is an essential component of measurement-based care, supporting the identification, monitoring, and treatment of depressive symptoms. A retrospective chart review at a private outpatient psychiatric practice identified inconsistent PHQ-9 administration and documentation, with a baseline completion rate of 62%. The purpose of this Doctor of Nursing Practice staff education project was to evaluate the impact of a structured educational intervention on the consistency of PHQ-9 administration among staff involved in the …

Staff Education To Improve Knowledge Of Standardized Scheduling In A Certified Home Health Agency, Roger Nounamo Kamkoumeu

Walden Dissertations and Doctoral Studies

In this staff education project, I addressed the concerning rate of missed patient visits in home healthcare settings. At the practicum site, there has been no education program addressing scheduling and communication best practices for staff. The practice-focused question guiding this project was: Among nursing staff in a home health agency, does implementation of a staff education program on a standardized scheduling and reminder protocol, improve staff knowledge of missed visit reduction practices? The purpose of the project was to evaluate the effectiveness of the staff training on staff knowledge of scheduling, communication, and reminder protocols for the reduction of …

Sbirt Staff Education To Registered Nurses In The Emergency Department, Rosemary Thuet

Walden Dissertations and Doctoral Studies

Summary The project hospitals have, on average, 2,400 emergency department (ED) visits a month. Although patients receive a social screening, there are no specific assessments to determine if the person is at risk for alcohol use disorder (AUD). The lack of screening is a missed opportunity to provide a Screening, Brief Intervention and Referral to Treatment (SBIRT) assessment of over 2,400 patients a month or 48,000 people annually. Although several screening tools could be used for an SBIRT assessment, the recommendation of ED nursing leadership is to implement the tool known as the CAGE Questionnaire (Cut down, Annoyed, Guilty, and …

Staff Education To Improve Behavioral Health Integration In Primary Care, Nelly Endah Atu

Walden Dissertations and Doctoral Studies

This staff education project addressed a persistent gap in the delivery of integrated physical and mental healthcare for patients with co-occurring conditions. Fragmented care in primary care contributes to untreated mental health needs, increased patient distress, higher costs, and poor outcomes. The aim of this project was to develop, deliver, and evaluate a staff education program equipping nurses, nurse practitioners, and interdisciplinary team members with the knowledge, skills, and practical strategies needed to improve behavioral health integration in primary care. The practice question was, among interdisciplinary staff in a community health setting, did the implementation of an evidence-based, ADDIE-designed staff …

Relationship Between Hospital Case Management Leadership Style And Employee Engagement, Malinda Ellis

Walden Dissertations and Doctoral Studies

Employee engagement among hospital-based nurse case managers is important because these nurses support discharge planning, utilization management, care coordination, and safe patient transitions. Although leadership style has been studied in nursing, limited research has examined its relationship to engagement among nurse case managers. The purpose of this quantitative, nonexperimental, correlational study, using House’s path-goal theory, was to examine the relationship between transformational, transactional, and laissez-faire leadership styles and employee engagement among hospital-based nurse case managers. Data were collected from 89 registered nurse case managers in acute care settings in the United States, who completed the Multifactor Leadership Questionnaire, Short Form, …

Frailty And Activities Of Daily Living In Older Adults In Primary Care: A Cross-Sectional Study, Öznur Adadıoğlu, Ahmet Seven, Esin Danç

Makara Journal of Health Research

Background: This study aimed to examine frailty status and activities of daily living among older adults.

Methods: This descriptive and cross-sectional study was conducted with 306 voluntary participants aged 65 years and older who were registered at a primary healthcare center in a city in Türkiye. Data were collected using the Participant Information Form, the FRAIL Scale, and the Katz Index of Activities of Daily Living.

Results: Among the participants, 36.9% were non-frail, 42.2% were pre-frail, and 20.9% were frail. The mean Katz Index score was 5.42 ± 1.35. The mean scores of activities of daily living …

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …

Validity And Reliability Of The Turkish Nursing Students’ Self-Perceptions About Safe Medication Management, Derya Şimşekli, Bedriye Cansu Koyunoğlu, Elanur Yilmaz Karabulutlu

Makara Journal of Health Research

Background: Safe medication management is central to nursing education and patient safety. To the best of our knowledge, there is currently no validated Turkish instrument specifically designed to assess nursing students’ self-perceptions regarding safe medication management. This study aimed to evaluate the validity and reliability of the Turkish version of the Nursing Students’ Self-Perceptions about Safe Medication Management (NURSPeM).

Methods: This methodological study was conducted at a single university using convenience sampling. Data were collected from a sample of 400 nursing students using the NURSPeM. Construct validity was examined with confirmatory factor analysis (CFA). Internal consistency was evaluated …

Needlestick Injury Risk And Preventive Behaviors Among Nursing Students, Angga Wilandika, Riandi Alfin, Rosa Intan Khoerunnisa

Makara Journal of Health Research

Background: Needlestick injury (NSI) remains a persistent occupational safety risk for nursing students during clinical practice, with implications for worker safety, patient care, and healthcare safety systems. Understanding preventive safety behavior within clinical training environments is essential for improving workplace safety in healthcare settings.

Methods: A cross-sectional study was conducted among nursing students undertaking hospital-based clinical placements. Using a purposive sampling, participants completed a structured self-administered questionnaire assessing NSI exposure, preventive safety behaviors, clinical supervision, safety training, and perceived safety within the clinical learning environment. Data was analyzed to identify patterns of NSI risk and associated preventive behaviors. …

Staff Education On Frailty And Senior Surgical Safety, Kimberly Buhay Gibu

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed a practice gap involving limited education on frailty assessment and senior surgical safety within the general surgery department of a large, integrated healthcare system. Frailty is associated with increased postoperative complications, hospitalizations, readmissions, and mortality among older adults, making early recognition essential to improving surgical outcomes. The practice-focused question project was: Does education on frailty screening and senior surgical safety improve the knowledge, confidence, and intent of general surgery staff in a large, integrated health system? The purpose was to develop, implement, and evaluate an evidence-based educational intervention. The project was guided by the …

Staff Education To Improve Blood Pressure Reassessment And Referral Practices In An Urgent Care Setting, Carolyn Denise Kluttz

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education and quality improvement initiative designed to improve blood pressure (BP) reassessment and referral compliance among adult patients presenting with elevated BP readings in an urgent care setting. Elevated blood pressure is frequently identified during urgent care visits; however, provider responses and follow-up recommendations are often inconsistent, creating missed opportunities for early identification and intervention. The practice-focused question guiding this project was: In adult patients presenting to urgent care settings, how does implementing a standardized nurse-led hypertension screening and referral protocol, compared with usual care, affect the identification and follow-up …

Staff Education On Improving Medication Adherence, Oneil Dobgima Galega

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed a practice gap in an outpatient behavioral health setting involving inconsistent use of structured communication strategies to support medication adherence among psychiatric patients. Although nurses routinely provided medication instructions, approaches such as motivational interviewing and psychoeducation were underutilized, limiting patient engagement, understanding, and adherence, and ultimately affecting care continuity and outcomes. The purpose of the project was to improve psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation to enhance medication adherence. The guiding practice-focused question examined whether a structured educational intervention could strengthen nurses’ competencies in these communication strategies. …

Staff Education To Improve Nursing Knowledge On Pressure Injury Prevention, Kheeda Kimberly Gopaul

Walden Dissertations and Doctoral Studies

Staff education in this project was focused on improving nursing staff’s knowledge on pressure injury prevention, inspired by the persistent care quality gap. The gap in practice as of 2024 related to hospital-acquired pressure injury (HAPI) at the host health organization was reported to be approximately 0.2 per 1,000 discharges. It was apparent that education could benefit the nursing staff to improve their knowledge in pressure injury prevention. The education in service focused on continuous nursing skin assessments, to ensure over prolonged hospitalization, patients’ skin does not deteriorate with the development of pressure injuries or advancing of pre-existing pressure ulcers. …

Addressing Implicit Bias Toward Patients With Substance Use Disorders Through A Staff Education Quality Improvement Initiative, Jeanne Baleng Okuwobi

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education quality improvement (QI) initiative designed to reduce implicit bias among healthcare providers toward patients with substance use disorder (SUD) at a community mental health center. Provider implicit bias toward patients with SUD contributes to stigma, inequitable care, reduced treatment engagement, and poorer health outcomes; addressing this bias is essential to advancing patient safety, health equity, and quality nursing care. The practice-focused question guiding this project asked whether a 9-week evidence-based staff education program incorporating didactic instruction and reflective practice would reduce provider implicit bias toward patients with SUD compared with current practice, which …

Staff Education For Medication Adherence Among Adults With Major Depressive Disorder In A Private Outpatient Psychiatric And Mental Health Practice, Judith Timbui Eta

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project implemented a staff education initiative to improve medication adherence among adults with major depressive disorder (MDD) in a private outpatient psychiatric and mental health practice. Medication nonadherence remains a significant barrier to effective depression treatment and is associated with symptom relapse, increased healthcare utilization, and poorer patient outcomes. Evidence supports provider education as an effective strategy for improving adherence-related practices. The project examined whether a targeted educational intervention could improve staff knowledge and confidence in promoting medication adherence over a 12-week implementation period. Guided by the Johns Hopkins Evidence-Based Practice Model and the …

Registered Nurses’ Knowledge, Self-Efficacy, And Willingness To Assess Near-Fatal Strangulation: Development Of The Near-Fatal Strangulation Self-Efficacy Scale, Morgan Kenady Mcmahon

Walden Dissertations and Doctoral Studies

Near-fatal strangulation (NFS) is a time-critical clinical presentation associated with elevated risk of stroke, delayed airway compromise, and future intimate partner homicide, yet no validated instrument existed to assess nurses' NFS-specific knowledge or self-efficacy. The purpose of this cross-sectional study, guided by Bandura's social cognitive theory and Benner's novice to expert theory, was to develop and pilot test the Nurses' Near-Fatal Strangulation Self-Efficacy Scale (NFS-SES) and to examine whether knowledge and self-efficacy predicted nurses' willingness to conduct an NFS assessment. A convenience sample of 150 registered nurses in emergency, labor and delivery, and obstetric emergency departments completed the NFS-SES, a …

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

Fireready Oc: Developing A Public Health Protocol For Wildland-Urban Interface (Wui) Fire Events In Orange County, Christian Andre O. Gequillo, Allyson Hayakawa, Selin Erdogan, Natalie Albarran

Master's Projects and Capstones

Objective/Problem: Wildland-Urban Interface (WUI) fires expose communities to a greater number of hazardous pollutants than traditional wildfires and can pose significant health risks; however, Orange County does not have a standardized public health protocol to address WUI fires. A review of the literature identified the need for standardized WUI fire guidance that is focused on improved preparedness and response. Aim: The FireReady OC quality improvement project aimed to develop an evidence-based public health protocol to improve Orange County’s public health preparedness and response for WUI fire events from 0% to 10% during the 12-week period from May 27, 2026, to …