Nursing Commons^™

Implementation Of Positive Reinforcement To Promote Staff Adherence To Bowel And Bladder Plans At A Long-Term Care Facility, Alfonso Segura Sanchez

Celebrating Scholarship and Creativity Day (2018-)

Background: Bowel and bladder plans (BBPs), also known as toileting programs, are individualized restorative nursing programs that have strategies to promote continence in residents and reduce the negative consequences of incontinence (Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual Version 1.20.1, 2025). Purpose: Senior nursing students implemented positive reinforcement in a quality improvement (QI) project to reduce rates of incontinence and inconsistent adherence to BBPs at Elim Wellspring, a skilled nursing facility for long-term care in Princeton, MN. According to the Minnesota Department of Human Services and Minnesota Department of Health, the most recent report on quality indicators for …

Optimizing The Charge Nurse Role To Improve Workflow And Communication In A Community Living Center, Ndidi Kalu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of optimizing the charge nurse role on workflow efficiency and communication within a Community Living Center. Identified practice gaps included role ambiguity, inconsistent delegation, and communication breakdowns, which contributed to delays in care and decreased staff satisfaction. An evidence-based approach was used to standardize charge nurse responsibilities, strengthen leadership practices, and introduce structured communication processes. The project demonstrated that improving role clarity and leadership consistency supports more effective delegation, enhances team communication, and improves care coordination. Outcome included increased staff engagement, improved workflow efficiency, and enhanced patient safety. This initiative …

Telehealth Workflow Optimization, Taku Ajongakoh Stella

Walden Dissertations and Doctoral Studies

This evidence-based quality improvement (EBQI) project addresses the 36% telehealth no-show rate at an outpatient behavioral health clinic in Maryland. High attrition rates currently compromise continuity of care and result in a projected annual revenue loss of $124,000. The present project proposed a standardized workflow redesign in the current Integrated Care Approach (ICA) notes Electronic Health Record (EHR) system to address the manual outreach inconsistency. Significant interventions involved the activation of automated multimodal reminders at 72-hour, 24-hour, and 1-hour intervals, and the obligatory 24-hour technical pre-verification connection. Moreover, the project introduced a systematic 48-hour follow-up procedure of missed visits to …

Evaluating The Impact Of Evidence-Based Education On The Utilization Of Preoperative Gastric Ultrasound For Patients On Glp-1 Agonists, Rachel K. Gibbons, Wesley Johnson, Rachel Cartillar

Create@State

Abstract

Patients taking glucagon-like peptide-1 (GLP-1) receptor agonists have a 30.5% higher prevalence of retained gastric contents at the time of surgery despite being held according to ASA and AANA recommendations, highlighting the need for enhanced preoperative assessment to reduce aspiration risk (Sen et al., 2024; Willson et al., 2024). Although an effective, noninvasive tool for assessing gastric contents and reducing the risk of pulmonary aspiration, gastric ultrasound remains underutilized in anesthesia practice (Pan et al., 2024). This evidence-based project evaluated whether an educational intervention could improve anesthesia providers’ knowledge, attitudes, and readiness to adopt point-of-care gastric ultrasound (POC-GUS) into …

Improving Post-Hospital Medication Reconciliation In A Rural Primary Care Clinic Through An Rn-Led Workflow, Jack Kennady

Books, Presentations, Posters, Etc.

Context/background: Adverse events after hospital discharge are common and represent a major patient safety concern. Approximately 1 in 5 patients experience a safety event after discharge, and 39% of these events are adverse drug events (ADEs), with 26% considered preventable. Medication discrepancies during transitions of care contribute significantly to these events, with an estimated 40% of medication errors resulting from inadequate medication reconciliation. Rural primary care clinics face additional challenges, including limited communication between inpatient and outpatient systems and inconsistent reconciliation workflows. Improving medication reconciliation during the transition from hospital discharge to outpatient follow-up represents an important opportunity for family …

The Effect Of A Mass Casualty Incident Adult Hyper-Realistic Simulation On Nurse Confidence Levels And Satisfaction Of Nurses: A Quasi-Experimental Study, Melodie Ann Nutter

Doctoral Dissertations and Projects

The purpose of this quantitative quasi-experimental study was to examine registered nurses (RNs) satisfaction and confidence levels after experiencing hyper-realistic simulations using a mass casualty incident (MCI) simulation method. With the world seeing a rise in MCI events, nurses often become one of the first professional medical providers to interact with the affected individuals. To fill this gap in education, the introduction of intensive hyper-realistic simulation training plays a vital role and provides an advanced perspective on the ever-increasing MCIs in today’s healthcare environment. This quasi-experimental study, using the Wilcoxon rank test and paired, assessed the satisfaction and confidence levels …

Improving Inr Monitoring In Outpatient Cardiology: A Quality Improvement Initiative To Enhance Anticoagulation Safety, Antonette Atori

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to reduce uncaptured INR results by 5% over 12 weeks in an outpatient cardiovascular clinic by implementing a standardized tracking workflow.

Background

Suboptimal anticoagulation management in outpatient settings can lead to uncaptured International Normalized Ratio (INR) results, delayed therapy adjustments, and increased risk of bleeding or thromboembolic events.

Methodology

Guided by the Plan-Do-Study-Act (PDSA) framework, a pre–post intervention design was used. Interventions included an electronic medical record (EMR)-based tracking system using a reminders inbox for overdue results and nurse-led follow-up phone calls. Data was collected from the EMR and analyzed using descriptive statistics, …

Evaluating The Screening And Referral Process For The Use Of Phq-9 Screening Tool In Middle-School Aged Students: A Scoping Review, Kaythi Soe, Msn, Pmhnp-Bc, Fnp-Bc, Margaret Harvey Phd, Acnp-Bc, Fhrs, Sharon Little Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

No abstract provided.

Optimizing Glycemic Control In Type Ii Diabetes: Continuous Glucose Monitoring : A Scoping Review, Sarah Poe, Bsn, Rn, Bailey Li, Bsn, Rn, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Individuals with Type II diabetes mellitus (T2DM) experience increased risk of cardiovascular disease and higher mortality rates relative to non-diabetic populations. Continuous glucose monitoring (CGM) enables more precise analysis of glucose patterns and trends compared to conventional self-monitoring of blood glucose (SMBG). CGM provides frequent measurements and generate meaningful metrics, such as time in range (TIR), time above range (TAR), and time below range (TBR), allowing evaluation of glucose stability and variability. Despite these advantages, evidence comparing CGM and SMBG remains inconsistent. This scoping review aims to evaluate how CGM compares with SMBG across reported outcomes, including TIR, TAR, …

Associate Degree Program Administrator Perceptions Of Clinical Dishonesty, Cynthia Moore Swineford

Doctoral Dissertations and Projects

The purpose of this hermeneutic phenomenological study was to explore the perceptions of associate degree nursing program administrators regarding faculty reporting of dishonest clinical behaviors by pre-licensure nursing students. Aristotle’s theory of virtue ethics guided this examination of how administrators interpret ethical responsibility, leadership influence, and professional accountability related to clinical dishonesty. The central research question asked, “What are the perceptions of associate degree program administrators regarding faculty reporting of dishonest student behaviors in clinical settings?” The sample included 11 associate degree nursing program administrators from programmatically accredited nursing programs in three mid-Atlantic states. Data were collected through semi-structured interviews, …

Use Of The Casper Test As An Admissions Test For Predicting Academic And Clinical Performance In Student Registered Nurse Anesthetists: A Predictive Correlational Study, Barbara A. Acord

Doctoral Dissertations and Projects

This quantitative, non-experimental, predictive correlational study examined the extent to which CASPer test scores predict academic and clinical performance among student registered nurse anesthetists (SRNAs). Certified registered nurse anesthetists (CRNAs) provide over 80% of anesthesia services in the United States, showing the importance of effective admissions processes to identify candidates most likely to succeed academically and clinically. Traditional admissions criteria in nurse anesthesia programs largely prioritize grades and may underrepresent non-cognitive attributes associated with student success. A convenience sample used a medium effect size, power of .8, and alpha level of .05, with G*Power calculated to be 85 participants 2nd …

Riding The End-Tidal Wave: Enhancing Nurse Confidence And Clinical Competence On Capnography Waveform Interpretation, Megan Monda, Kirk Wallis, Rachel Zehner

Doctor of Nursing Practice (DNP) Student Projects

This quality improvement project addressed inconsistent use of end-tidal carbon dioxide (ETCO2) monitoring among nurses in the Cardiac Procedure Center (CPC) at Barnes-Jewish Hospital. Although capnography detects respiratory compromise earlier than pulse oximetry, limited staff education contributed to variability in waveform interpretation and clinical response. Guided by Kurt Lewin’s Change Model and the Plan-Do-Study-Act cycle, four structured one-hour educational sessions were delivered to CPC nurses and supplemented with hands-on practice and visual cognitive aids. Pre-, immediate post-, and two-week post-education surveys evaluated changes in knowledge, confidence, and clinical skill. Mean knowledge scores improved from 65% at baseline to 75% immediately …

Quality Improvement Project: Evaluating The Effectiveness Of Chlorhexidine Gluconate Bathing Education On Staff Perceived Knowledge, Kaonta Spencer

Doctor of Nursing Practice Projects

A community hospital set strategic goals to achieve Vizient top-decile performance and drive continuous improvement by reducing surgical site infection (SSI) rates. The purpose of this quality improvement project was to support this goal by implementing an evidence-based educational intervention to improve nurses' perceived knowledge and self-reported ability with the chlorhexidine gluconate (CHG) bathing protocol for hysterectomy patients. Guided by Lewin's Change Theory, the Iowa Model Revised, and the Iowa Implementation Framework, the educational intervention applied a structured approach to address behavioral and organizational barriers contributing to protocol noncompliance. A quantitative, quasi-experimental pre- and post-intervention design was used to evaluate …

Quality Improvement Project: Improving Interdisciplinary Care In Nursing Education Through Simulation, Anna Williams

Doctor of Nursing Practice Projects

Interprofessional education (IPE) is essential in preparing nursing students for effective teamwork and communication in clinical practice and is supported by the literature as improving these outcomes. However, limited faculty training in interprofessional simulation design contributes to reduced IPE opportunities within nursing curricula. A needs assessment at the project site identified a lack of structured, hands-on training for simulation faculty, resulting in decreased faculty confidence and limited implementation of IPE simulations. The purpose of this quality improvement project was to evaluate whether a structured training intervention improved simulation faculty self-efficacy in developing and implementing IPE simulations. Bandura’s Self-Efficacy Theory guided …

Implementation Of A Nurse-Led Discharge Protocol To Impact Nurse Confidence And Optimize Transitional Care Management, Jessi-Ann Elrod

Doctor of Nursing Practice Projects

Heart failure (HF) remains a leading cause of hospitalization and readmission, with the transition from hospital to home representing a vulnerable period for patients. Variability in discharge education and follow-up scheduling contributes to poor self-management and adverse outcomes. This quality improvement (QI) project evaluated whether implementing a standardized nurse-led HF discharge protocol impacted nurses' confidence and the rate of 7–14-day transitional care management (TCM) follow-up appointments. Guided by Meleis’ Transitions Theory and Lewin’s Change Theory, a one–group pretest–posttest QI design was implemented on a cardiac step-down unit. Twelve discharge nurses participated. The intervention included a structured education session and the …

Quality Improvement Project Reducing Attrition Rates In Nursing Students: Evaluating The Enhanced Student Success Program, Jason Grigg

Doctor of Nursing Practice Projects

The high attrition rate in the Associate of Applied Science in Nursing (AASN) program created an opportunity to develop the enhanced Student Success Program (eSSP). This is a faculty-based quality improvement project designed to increase support for students at risk of withdrawal from the AASN program. The aim of eSSP is to reduce attrition rates, however, this project evaluated only short-term changes in faculty confidence. Using Lewin's Change Model and the Theory of Planned Behavior as a guide, this QI implemented a one-group pre-post experimental design to determine whether a short eSSP training program, combined with a 5-week implementation period, …

Quality Improvement Project : Educating Critical Care Nurses On Braden Scale And Sskin Care Bundle To Impact Pressure Injuries, Andrea Garrett

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) increase patients' risk of infection, prolonged hospitalization, death, and healthcare costs. The Agency for Health Research and Quality (AHRQ) has shown that implementing a standardized skin assessment process and a care bundle helps prevent skin injuries. A critical care unit (CCU) at an acute care 339-bed hospital in Southaven, MS, has seen an increase in HAPIs. This quality improvement project aimed to educate CCU nurses about the Braden Scale and the SSKIN care bundle to impact pressure injuries in the CCU within 8 weeks. Education on the Braden Scale and the Skin, Sensory, Keep Moving, Incontinence, …

Quality Improvement Project: Faculty Development For Understanding And Utilization Of Exam Data, Deanne Hutchens

Doctor of Nursing Practice Projects

This quality improvement project focused on inconsistent use and understanding of exam data among Associate Degree in Nursing (ADN) faculty, which can influence teaching decisions and student success. Many nursing faculty enter education with strong clinical backgrounds but limited experience working with exam statistics such as item difficulty, discrimination values, and Kuder-Richardson 20 (KR-20) reliability. Without a consistent approach, exam results may not be fully used to guide remediation or adjust instruction. This Doctor of Nursing Practice (DNP) project examined whether a structured faculty development session could improve faculty confidence and ability to interpret and apply exam data. A pre- …

Quality Improvement Project: Evaluating The Impact Of Provider Education On Sbirt On Screening For Suds, Faith Ogala

Doctor of Nursing Practice Projects

Substance use disorder (SUD) is a serious public health issue in people with psychiatric disorders. However, diagnosis and treatment are often delayed, leading to poor treatment outcomes and increased social and economic costs. The purpose and aim of this Doctor of Nursing Practice (DNP) project was to educate providers on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model to facilitate the timely diagnosis of SUDs in patients with dual diagnoses. The key outcomes were provider knowledge and SBIRT implementation rates. The Donabedian Model of Healthcare Quality assessed the outcomes, whereas Lewin’s Change Model guided implementation. The project employed …

Establishing A Standardized Suicide Risk Screening Policy For Psychiatric Providers: Closing Gaps In Provider Accountability And Clinical Documentation, Fadekemi Olude

Doctor of Nursing Practice Projects

Psychiatric providers in outpatient settings often experience inconsistent confidence and incomplete documentation when conducting suicide risk screening, contributing to missed opportunities for early identification of at-risk patients. This quality improvement project addressed the need for standardized suicide risk screening at an urban outpatient psychiatric clinic. The purpose was to evaluate documentation using the Columbia-Suicide Severity Rating Scale (C-SSRS). Using a pre-post intervention design guided by Lewin's Change Theory and the Donabedian Model of Quality Improvement, a 60-minute training session was delivered to 31 psychiatric providers. Participants completed pre- and post-intervention General Self-Efficacy Scale (GSES) surveys. Chart audits (N = 1,970) …