Nursing Commons^™

Implementing A Standardized Counting Process, Paula M. Mbye

Master's Projects and Capstones

Abstract

Background: In a Northern California medical center with 11 operating rooms, two retained foreign object (RFO) events occurred following surgical procedures in 2025.

Problem: Surgical teams rely on manual counting processes to prevent retained foreign objects. Variability in counting practices among registered nurses and surgical technologists, combined with workflow interruptions and environmental distractions, can increase the risk of counting discrepancies and missed items. Standardizing the counting process may improve count accuracy and reduce the risk of RFOs.

Interventions: This quality improvement project implemented a standardized surgical counting process based on Association of periOperative Registered Nurses (AORN) guidelines within …

Staff Education To Enhance Phq-9 Depression Screening Compliance, Chibugo Chukwu

Walden Dissertations and Doctoral Studies

This staff education quality improvement project at Clinic P targeted the clinical problem of depression under-diagnosis, evidenced by less than 60% of patients completing the patient health questionnaire (PHQ-9) before the initiative. Depression under-diagnosis, significantly caused by provider PHQ-9 screening competency deficits that need to be addressed through staff education, is associated with adverse patient health outcomes, in turn generating negative implications for providers and wider society. The problem compromises the quality of nursing care because it limits nurses' ability to intervene and deliver timely and effective care to patients with depression. Thus, at Clinic P, this initiative asked how …

Staff Education To Address Verbal De-Escalation Skills In Correctional Mental Healthcare, Mary L. Goodman

Walden Dissertations and Doctoral Studies

This staff education project evaluated the effects of a structured verbal de-escalation training program on self-efficacy among staff in a federal correctional mental health unit. Staff at the site often reported uncertainty managing escalating behaviors, leading to frequent use of restrictive interventions like restraints and seclusion—practices that can compromise safety, quality of care, and raise ethical concerns. To address this gap, an evidence-based curriculum was implemented for 41 multidisciplinary staff, including nurses, certified nursing assistants, and correctional officers. The curriculum included a PowerPoint presentation, role play, and group discussion. A pre–post design measured changes in staff confidence using a modified …

A Program Proposal For An Evidence-Based Dietary Program To Support Spanish Speaking Diabetic Patients, Shaquetta Ann Mccloud-Petion

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) executive leadership system improvement project addresses provider-identified gaps in dietary education for Spanish-speaking patients with diabetes, which may contribute to suboptimal glycemic control and diabetes self-management. A comprehensive review of evidence from CINAHL Complete, PubMed/MEDLINE, and Cochrane supports the use of culturally tailored, evidence-based dietary education to improve diabetes knowledge, self-management behaviors, and health outcomes. The project proposes the development and implementation of a standardized dietary education program using culturally appropriate dietary exchange tools within an outpatient clinic. The initiative aims to improve staff confidence, adoption, and consistency in delivering culturally responsive diabetes education …

Staff Education To Improve Knowledge On Accurate Administration Of Medication, Deepu Pudasaini

Walden Dissertations and Doctoral Studies

Medication errors have been a significant problem, primarily due to a lack of continuous monitoring and inadequate training for personnel involved in managing or administering medications in non-healthcare settings. These errors often go undetected or unreported. This Doctor of Nursing Practice (DNP) project was a staff education project to improve staff knowledge of accurate medication administration of medication in a group home. The practice-focused question was: Will a staff education program on the accurate administration of medication improve certified medication technicians’ (CMTs) knowledge about the association between the medication administration process and medication error? The purpose of this DNP staff …

Staff Education To Reduce Foley Catheter Utilization In Patients With Acute Urinary Retention, Dennis Ulep

Walden Dissertations and Doctoral Studies

Acute urinary retention (AUR) is a common inpatient condition associated with complications such as urinary tract infections, prolonged hospitalization, and impaired mobility when not managed appropriately. Despite evidence supporting intermittent catheterization as a preferred first-line intervention for many patients with AUR, indwelling Foley catheters continue to be overused in acute care settings. Purpose: This Doctor of Nursing Practice (DNP) project evaluated whether staff education on a standardized AUR algorithm would improve evidence-based urinary retention management and reduce unnecessary Foley catheter utilization among nurses caring for adult hospitalized patients on a hematology and oncology unit in a Southern California acute care …

Standardizing Interfacility Transfer In And Out Processes Across The Local Va Setting, Petrice Robinson Brown

Walden Dissertations and Doctoral Studies

The quality improvement project focused on the inconsistent documentation and communication of the transfer of veterans in and out of a Veterans Affairs Medical Center. Lack of transparency in handoff knowledge and ineffective documents posed a risk of delayed care and patient injuries. The staff provided an audit tool with staff education to monitor completion of mandatory transfer steps, such as special mode travel approval, equipment needs, nurse-to-nurse handoff, transfer notes, consent, and physician correspondence. This method was based on the evidence found in literature indicating that structured checklists and handoff tools minimize missed information and facilitate safer care transitions …

Improving Documentation Of Skin Assessment In The Med-Surg Overflow Microsystem, Min Kim, Mikeal A. Swift

Master's Projects and Capstones

Abstract

Problem

Hospital-acquired pressure injuries (HAPIs) remain a costly patient safety concern with increased morbidity and prolonged hospitalization. Inconsistent admission skin assessment documentation in a 24-bed overflow medical–surgical microsystem led to delayed wound identification and misclassification.

Context

A baseline needs assessment (n = 15) identified key barriers, including low nurse confidence utilizing Rover (mobile software application) and linking photos to the LDA (lines-drains-airway) in the electronic health record.

Intervention

A bundle of 6 components was tested over 12 weeks: standardization of the two-RN skin assessments within 8 hours of admission or transfer; optimization of Rover photo capture and LDA linkage; …

Implementation Of A Structured Safety Planning Intervention In An Outpatient Psychiatric Setting, Ellen Riccio

Walden Dissertations and Doctoral Studies

This organization change process evaluation addressed continued reliance on outdated no-suicide and no-harm contracts in an outpatient psychiatric setting, despite evidence that such contracts do not reduce suicide risk and may create a false sense of security. Adult outpatients with mood or psychotic disorders who express safety concerns represent a population for whom structured, collaborative safety planning is the accepted standard of care. Addressing this gap is central to patient safety and quality nursing care. The practice-focused question asked whether replacing no-suicide contracts with a structured, six-step Safety Planning Intervention would influence safety events, self-harm behaviors, and psychiatric hospitalizations among …

Staff Education To Reduce Stress In Assisted Living Nursing Staff, Cherechi Onyenso

Walden Dissertations and Doctoral Studies

In this staff education doctor of nursing practice (DNP) project, I addressed a practice gap associated with inadequate staff knowledge of workplace stress-management strategies in an assisted living facility. Workplace stress in nursing practice is a contributing factor to burnout, reduced job satisfaction, poor teamwork, and a decline in the quality of resident care. The practice-focused question for this project was about whether staff knowledge would be enhanced over an 8-week period in comparison to baseline knowledge as a result of their participation in a structured staff education program on workplace stress management. The purpose of the project was to …

Staff Education To Improve Staff Knowledge, Confidence, And Intent To Consistently Implement Medication-Assisted Treatment, Matilda Boachie

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice staff education project addressed inconsistent medication-assisted treatment (MAT) implementation in a masked crisis stabilization unit. MAT was available, but staff education was informal and inconsistent, contributing to variation in knowledge, confidence, patient education, documentation, and discharge planning. The practice-focused question that was answered through this project was whether structured staff education would improve knowledge, confidence, and intent to consistently implement MAT. The purpose was to develop, implement, and evaluate structured education for interdisciplinary staff. De-identified pre- and post-education surveys were analyzed with descriptive statistics, and aggregate averages were compared because individual surveys were not matched. …

Staff Education To Improve C-Ssrs Suicide Risk Screening Competency, Pearl Binka

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed inconsistent administration and documentation of the Columbia-Suicide Severity Rating Scale (C-SSRS) in an acute care mental health setting. The practice problem was important because inconsistent standardized screening could delay identification of patients who required timely safety interventions. The practice-focused question examined whether structured C-SSRS education improved nursing staff competency, screening consistency, and documentation compliance. The project was developed and implemented to strengthen nurses’ knowledge, confidence, and skill in applying the C-SSRS as part of routine suicide risk screening. Evaluation strategies included comparisons of pre- and posteducation knowledge scores, competency checklist completion, chart audit findings, …

Implementation Of An Evidence-Based, Standardized Hypertension Follow-Up Protocol To Improve Quality And Outcomes Among African American Females In A Primary Care Setting, Fausat Oluremi Ojo

Walden Dissertations and Doctoral Studies

Hypertension is a major modifiable risk factor for cardiovascular disease, stroke, kidney disease, and premature mortality. African American women experience a disproportionate burden of hypertension and hypertension-related complications, making timely follow-up and treatment intensification essential quality and equity priorities. This evidence-based practice project implemented a standardized hypertension follow-up protocol in a primary care setting to improve blood pressure (BP) control and follow-up reliability among African American females ages 18 to 65 with a hypertension diagnosis. The project population included 67 patients, numbered 1 to 67. Baseline BP report data showed that 47 patients had BP less than 140/90 mm Hg, …

Staff Education Project To Increase Nursing Staff Knowledge Of Falls Prevention In Long-Term Care Facility, Oludele Olagoke

Walden Dissertations and Doctoral Studies

Falls among residents in long-term care facilities are a concern for families and facility management. Falls inflict pain, discomfort, and head trauma, causing fractures. In nursing practice, falls are nursing-sensitive indicators that reflect the quality of nursing care and patient safety. There is a need to bridge the gap and increase staff knowledge on how to prevent falls in the facility. The Doctor of Nursing Practice (DNP) project focused on increased nursing staff knowledge through an evidence-based education program and the implementation of an evidence-based practice education program. The DNP project practice question was about nursing staff in long-term care …

Organization Change Process Evaluation Improving Phq-9 Completion Following Positive Phq-2 Screenings In An Outpatient Behavioral Health Setting, Diana Pieterson

Walden Dissertations and Doctoral Studies

Depression is a leading cause of disability worldwide and is associated with significant impairment, delayed treatment, and increased suicide risk when not appropriately identified and managed. In an outpatient behavioral health setting, review of de-identified electronic health record (EHR) data identified inconsistent completion of the Patient Health Questionnaire-9 (PHQ-9) following positive Patient Health Questionnaire-2 (PHQ-2) screenings, resulting in incomplete depression assessment and missed opportunities for timely intervention. This Doctor of Nursing Practice (DNP) project evaluated whether implementation of a standardized PHQ-2 to PHQ-9 workflow improved PHQ-9 completion rates among adult outpatients with positive PHQ-2 screenings. The organization change process included …

Staff Education On Psychoeducation Delivery To Enhance Medication-Adherence Education For Adults With Bipolar Disorder In An Outpatient Psychiatric Mental Health Facility, Bibiana Chinwe Ndula

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project addressed inconsistent delivery of evidence-based medication-adherence psychoeducation for adults with bipolar disorder (BD) in an outpatient psychiatric mental health facility. The project question was whether an 8-week structured module, in relation to existing staff education practices, would increase staff knowledge and confidence. The intervention was guided by the Johns Hopkins evidence-based practice (JHEBP) model and comprised a PowerPoint presentation, a facilitator guide, a handout, a checklist, a toolkit, and anonymous pre- and post-training assessments. Eight out of ten invited staff completed the project. The mean knowledge rose from 6.1 to 8.9 …

Staff Education To Standardize Chronic Pain Patient Education In Primary Care, Jessica Okpara

Walden Dissertations and Doctoral Studies

Inconsistent delivery and documentation of chronic pain patient education may contribute to variations in patient knowledge, treatment expectations, and engagement in self-management. This Doctor of Nursing Practice staff education and quality improvement project was designed to standardize chronic pain patient education in a primary care setting. The practice-focused question examined whether implementing standardized chronic pain education, compared with non-standardized education, would improve patient knowledge and use of self-management strategies over 10 weeks. Guided by the Johns Hopkins Evidence-Based Practice Model, the project included development of evidence-based education materials, staff preparation, workflow integration, and a standardized documentation process. Clinic staff identified …

Reducing Medication Administration Errors Through Implementation Of An Electronic Medication Administration Safety Dashboard, Myrlande Daguindeau

Walden Dissertations and Doctoral Studies

The DNP project was a quality improvement (QI) initiative designed to reduce medication administration errors by integrating an electronic medication administration safety dashboard (BCMA) at Sheppard Pratt Hospital in Elkridge, Maryland. The purpose of the project was to evaluate the effectiveness of a medication safety dashboard in providing automated clinical alerts to improve real-time monitoring and support safer medication administration practices. The project was informed by the prevalence of medication administration errors in the psychiatric unit attributed to factors such as frequent adjustments of medication and interruptions during the medication administration process. Data were collected from the hospital’s records and …

Improving Glycemic Control And Self-Care Among Adult Patients With Type 2 Diabetes Mellitus At A Community Health Center, Lydia Asabea Lartey

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a significant practice concern in community health settings, where adults often encounter barriers to effective self-management, including low health literacy, socioeconomic challenges, and limited access to Diabetes Self-Management Education and Support (DSMES). At the project site, inconsistent staff preparation, high patient volume, and limited standardized teaching resources contributed to gaps between evidence-based standards and routine diabetes education. To address these gaps, the project implemented a standardized, culturally responsive diabetes-education workflow to strengthen care quality, patient safety, and responsible resource use. The practice question guiding the project was: How does implementing a standardized, culturally responsive …

Staff Education To Improve Knowledge And Confidence In A1c Screening For Adults With Serious Mental Illness, Veronica Akweley Odoi

Walden Dissertations and Doctoral Studies

This project was conducted to observe the effects of staff education on staff knowledge and confidence regarding metabolic risk and hemoglobin A1c (A1C) monitoring for adults with serious mental illness in a crisis response unit. The lack of a streamlined system in metabolic testing in recent times has led to nuances in metabolic testing for patients with serious mental illness. The practice-focused question asked whether evidence-based staff education on A1C monitoring, and provider roles would improve staff knowledge and confidence. The purpose of the education is to strengthen knowledge of metabolic risk, A1C screening expectations, role clarity, workflow, and staff …