Doctor of Nursing Practice Projects

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https://ir.ua.edu/handle/123456789/7250

The DNP is a practice doctorate in nursing which prepares graduates to function at the highest level of nursing practice. The DNP curriculum includes development of a clinical practice project. This “DNP project” is designed to synthesize scholarship in an advanced nursing practice specialty or an area of health care leadership. Practice immersion experiences provide the context within which the project is completed. Students develop the project under the direction of a team, including program faculty, the student, the clinical advisor, the faculty advisor, and alumni mentors.

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Integrating Ultrasound-Guided Peripheral Intravenous Access to Improve First-Time Attempt Success: Quality Improvement Initiative
(2025) Fowler, Krista Klemm; Welch, Teresa
Background: Peripheral intravenous (PIV) access is a critical intervention in healthcare, yet traditional methods often result in multiple attempts, increasing risks of infection, patient discomfort, and healthcare costs, especially in patients with difficult IV access (DIVA). Findings consistently demonstrate that ultrasound guided peripheral intravenous access (USGPIV) improves first-attempt success rates, ranging from 55% to 90%, while reducing complications, patient discomfort, and procedural delays. Studies also highlight increased patient satisfaction and fewer insertion attempts with ultrasound guidance. Implementation challenges, such as training and resource allocation, are emphasized, particularly in high-demand settings like emergency departments and intensive care units. Successful integration of USGPIV access requires structured training programs and adequate resources in order to improve patient care quality and outcomes, optimize procedural efficiency, and enhance healthcare cost-effectiveness. Methods: A pre- and post-intervention design was used to evaluate the impact of standardized USGPIV training among ICU charge nurses at two hospitals within a regional health system. The two-week intervention included didactic instruction, hands-on simulation, and competency validation led by the Vascular Access Team (VAT) and the facility’s ultrasound education coordinator. Data collection included pre/post Learning Self-Efficacy Scale (L-SES) surveys, direct observation, and organizational quality improvement (QI) metrics of first-attempt success rates. Descriptive and comparative analyses were performed. Results: Post-intervention findings demonstrated significant improvements in nurse confidence, knowledge, and procedural skill. Mean post-test scores on key L-SES items increased by up to 2.5 points, with p-values ranging from 0.017 to 0.045 across multiple domains. Average first-attempt PIV success improved from 2–3 attempts using traditional methods to one attempt following USGPIV training, indicating both statistical and clinical significance. Discussion: Implementation of a structured USGPIV training program enhanced nurse competency, increased first-attempt success rates, and optimized patient outcomes, aligning with national infusion therapy standards. These results validate ultrasound guidance as an effective, evidence-based approach for vascular access in critical care settings. Sustainability is supported through integration of USGPIV competency into ongoing training, policy revision, and mentorship by VAT educators.
Implementing an Educational Training Program for Advanced Practice Providers on Ultrasound-Guidance for Vascular Access to Achieve Improved Clinical Outcomes
(2025) Baumer, Corrie L.; Welch, Teresa
Background: The integration of advanced practice providers (APPs) into critical care medicine (CCM) has increased in recent years, requiring APPs to perform more invasive procedures. Currently, there is a lack of standardized education for APPs on these invasive procedures including central venous catheter (CVC) and arterial catheter placement without formal education, specifically the use of ultrasound-guidance. Many professional organizations, including the Society for Critical Care Medicine (SCCM), asserts that clinicians should be properly educated on and use real-time ultrasound when performing all vascular access procedures. With advances in technology, simulation-based methods have been integrated into medical education, These methods have been shown to create better outcomes when the goal relates to the acquisition of a new technical skill. A quality improvement (QI) project was developed and implemented, over a ten-week period, to establish an evidence-based standardized simulation-based medical education (SBME) program on ultrasound-guidance for vascular access (UGVA) for pediatric cardiac intensive care unit (CICU) APPs. The focus was to improve APP perceived self-confidence using ultrasound technology and increase UGVA attempts and first attempt success rates. Methods: This was a quality improvement project designed to provide standardization of UGVA training based on the Society of Critical Care Medicine’s guidelines for best practice. Results: Eleven CICU APPs participated in the SBME program. Participants (n=11) mean scores pre-intervention ranged from 1.91 to 3.27 (SD ± 0.54 – 1.43) and the post-intervention scores ranged from 3.73 to 4.45 (SD ± 0.5 – 0.98). All post-intervention mean scores were consistently higher than the pre-intervention scores, (p < 0.05). The paired-sample T-test showed t-values that ranged from -2.665 to -6.829, p values ranged from 0.00 – 0.024. The differences in mean scores pre- to post-intervention, were statistically significant, p < 0.05. While all UGVA competencies showed increase, seven of the ten UGVA competencies showed a statistically significant increase above the predicted threshold of 20% and 25% (p <0.05). Discussion: SBME has been proven successful for procedural training and should be applied to APP training. This quality improvement initiative successfully developed and implemented a standardized evidence-based SBME intervention that significantly improved UGVA competency among pediatric CICU APPs. For APPs to proficiently use UGVA, educational curricula included formalized instruction with simulation-based training. After the development and implementation of the program APPs were afforded the proper technical training necessary to build CCM competencies. Limitations included this was a single center project with a small sample of APPs. Future efforts should be focused on the application of this project to other critical care areas, providers and other centers.
Implementation of a Standardized Urine Collection Protocol: Reducing Specimen Contamination
(2025) Drury, Anna; Hobbs, Jill R.
Introduction: Antimicrobial resistance poses a significant threat to global healthcare systems, as it undermines the effectiveness of treatments for infections, leading to prolonged illnesses, higher medical costs, and increased mortality rates. Overprescribing antibiotics, often before urine cultures are performed, contributes significantly to this issue. Over half of the urine cultures collected in primary care clinics are contaminated. Implementation of a standardized urine collection protocol could potentially reduce the number of contaminated urine samples, increase the accuracy of the specimen results, and help mitigate overprescribing of antibiotics. Methods: Using the IOWA model as a framework, a standardized urine collection protocol was implemented based on current evidence-based criteria for obtaining a midstream clean-catch urinalysis. Data was collected on the number of patients presenting with UTI symptoms who had cultures sent out that were contaminated. A Chi-square for equal proportions was performed comparing the mean of contaminated cultures 6 weeks before implementation to the mean of contaminated cultures 6 weeks after implementation. Results: A total of 85 cultures were collected over two 6-week periods. Results indicated that 30.4% of cultures were contaminated before implementation, while 28.2% were contaminated after implementation. Discussion: Implementing a standardized protocol can reduce the incidence of contaminated urine cultures and improve patient care by ensuring that the correct antibiotic is prescribed when necessary. While the results of this initiative were not statistically significant, analysis of the data revealed room for improvement in culture ordering among providers.
The OAS-M Tool: Reducing Seclusion and Restraint Use
(2025) Ponce de Leon, John P.; Lee, Amy
Introduction/Purpose: The Modified Overt Aggression Scale (OAS-M) is a validated state-based aggression assessment tool used on an adolescent in-patient psychiatric unit in Cincinnati, OH. The tool allows for objective documentation of aggressive behaviors on a shift-by-shift basis. According to the Six Core Strategies (6CS) method of restraint reduction, the appropriate use of an aggression assessment tool is a pillar of its strategies. This project aimed to decrease seclusion and restraint (S/R) use by reinforcing education regarding the proper implementation and documentation of the OAS-M amongst unit staff. Methods: Over an eight-week period, unit staff were provided with presentations at the start of their shifts five days a week along with educational flyers/ handouts regarding guidelines to proper OAS-M documentation. Results: After the eight-week period seclusions, restraints, OAS-M scores, and staff injuries all rose when compared to data collected over the immediate eight weeks prior to implementation. However, compared to pre-implementation, statistical analysis of seclusion and restraint use rates demonstrated to not be statistically significant (p= 0.4538). Discussion: Education on an assessment tool alone did not prove effective enough to decrease S/R rates. Future quality improvement projects aimed at decreasing S/R rates may benefit from a more encompassing approach such as the full spectrum of the 6CS to create significant results. Although all metrics demonstrated an increase overall, an increase in average daily OAS-M scores may be interpreted as being due to admitted higher acuity patients or better adherence to documentation guidelines.
Improving HPV Vaccination Rates Among Underserved, Uninsured Women Aged 19-26 in a Federally Qualified Health Center
(2025) Christensen, Stephanie; Lee, Amy
Introduction/Purpose: Despite the proven efficacy of the HPV vaccine in reducing cervical cancer and other HPV-related conditions, vaccination rates in this population remain critically low due to vaccine hesitancy, misinformation, cultural beliefs, and limited access to care. This project aimed to address these barriers through an evidence-based educational intervention designed to increase awareness, improve health literacy, and promote vaccination uptake among uninsured and underserved women aged 19-26 in a Federally Qualified Health Center (FQHC) in south Alabama. Methods: The project utilized a quantitative approach to evaluate the impact of an educational intervention on HPV vaccination rates. Educational sessions were conducted in clinical and community settings, tailored to address specific concerns and knowledge gaps within the target population. Pre- and post-intervention surveys, including the adapted Vaccine Hesitancy Scale (VHS), measured changes in attitudes, beliefs, and willingness to vaccinate. The adapted VHS instrument, in both English and Spanish, is included in Appendix D. Vaccination rates were tracked through electronic health records (EHR). Demographic data, including age, ethnicity, and insurance status, were analyzed to identify subgroup differences. Statistical analyses included paired t-tests with Wilcoxon signed-rank confirmation for VHS changes and logistic regression for predictors of vaccination; chi-square tests were used for selected cross-tabulations. Results: Eighty-seven women participated (mean age 23.4 years, SD 2.2; 74% Hispanic, 18% African American, 8% Caucasian). Vaccination initiation was 86.2% after the intervention (75/87). Mean VHS decreased from 38.7 (SD 6.1) to 27.9 (SD 7.2) (paired t ≈ 16, p < .001; Wilcoxon p < .001). Older age (OR 0.40, 95% CI 0.20–0.81, p = .01) and Caucasian ethnicity vs African American (OR 0.015, 95% CI 0.0005–0.42, p = .014) were associated with lower odds of vaccination; baseline hesitancy was not predictive. Discussion: The intervention significantly reduced hesitancy and increased uptake in an underserved population. Findings support integrating provider counseling and bilingual education into routine care and suggest targeted strategies for older and Caucasian subgroups. This initiative aligns with broader public health goals of reducing HPV-related health disparities and improving population health outcomes.
Optimizing Patient Outcomes: Implementing a Tobacco and Nicotine Cessation Program Protocol in Ambulatory Care Clinic
(2025) Bass, Casey P.; Scott, Letisha
Introduction: Tobacco and nicotine use is a silent epidemic plaguing our country. These substances, heavily marketed and widely accessible, have led millions into addiction with devastating health consequences. The allure of smoking and vaping is often glamorized, covering the harsh reality of lung cancer, heart disease, and respiratory issues that come with prolonged use. Health care providers play a pivotal role in cessation practices by offering various interventions including screening, brief advice, counseling, and pharmacotherapy. Nicotine cessation counseling is considered a standard of care in the United States, but this often gets omitted in the ambulatory care setting, which means patients may not receive the support and resources needed to quit. This lack of regular assessment and counseling is compounded by the absence of standardized protocols and procedures for cessation interventions, resulting in inconsistent care. The aim of this quality improvement project is to educate the physicians and advanced practice providers on the importance of identifying, documenting, and implementing a plan to address tobacco and nicotine use during all patient interactions in ambulatory care settings. Also, this project addresses the knowledge deficit among health care providers regarding evidence-based cessation strategies, which contributes to the underutilization of nicotine counseling in routine clinical practice. Methods: Using the RE-AIM model as a framework, the valid and effective 5A’s protocol was implemented based on current evidence-based practice for providing nicotine cessation services. To evaluate the effectiveness of health care provider understanding regarding the 5A’s protocol, a t-test was used to compare clinicians' knowledge and implementation skills 6 weeks before training sessions and 6 weeks after training sessions. By analyzing the average success rates of nicotine cessation during these periods, the t-test helped determine if there was a statistically significant improvement in outcomes due to the new protocol. ICD-10 and CPT codes related to nicotine cessation/nicotine use were extracted from the EHR for pre- and post-intervention periods. Frequencies and percentages were calculated and compared descriptively to identify changes. Results: In the 6-week post-intervention period, 2,347 patients were seen. Of those, 138 were identified as tobacco users, 768 as non-users, and 1,407 lacked documentation, highlighting persistent assessment gaps. Provider surveys (N = 10) showed significant improvements across all 5A’s domains: Ask/Assess (p = 0.009), Advise (p = 0.003), Assist (p < 0.001), and Arrange (p = 0.014), indicating increased knowledge and confidence. Tobacco-related ICD coding rose slightly from 18 (0.8%) to 21 (0.9%) charts, with 11 charts coded for counseling (Z71.6) and one CPT code (99406) documented, reflecting modest gains in cessation service documentation. Discussion: Well-defined guidelines enabled providers to deliver counseling more effectively during patient visits. Findings highlight the protocol’s effectiveness in improving provider engagement but also emphasize the need for standardized screening, reliable documentation, and better coder training to optimize tobacco cessation practices.
Implementation of a Standardized Shift Handoff Method on an Inpatient Psychiatry Unit
(2025) Ponce de Leon, Ashley; Simmons, Staci A.
Introduction/Purpose: Shift handoff is the transfer of patient information and provider responsibility at the beginning of each shift. Incomplete patient handoffs result in increased risk of provider errors and poor nurse satisfaction. Standardized communication formats allow for more complete and concise delivery of patient information, leading to improved staff satisfaction with the handoff process. This quality improvement (QI) project aimed to educate nurses and behavioral health specialists (BHS) on the use of a standardized shift handoff tool within an inpatient pediatric psychiatry unit and to measure its impacts on staff satisfaction. Methods: Prior to the intervention, staff completed the Handover Evaluation Scale (HES) to gauge satisfaction with current shift handoff practices. All staff received in-person education about the use of the handoff tool created by hospital leadership. Staff exclusively utilized the new tool for four weeks. They were then asked to complete the HES again to evaluate their satisfaction with the adopted handoff tool. Results: Staff completed 26 pre-intervention and 10 post-intervention surveys. Aggregated survey scores were analyzed using an unpaired t-test with a resultant P value of 0.9485. Staff valued the handoff tool’s clear and organized structure, noting its potential to improve the thoroughness and efficiency of shift handoff. Discussion: Standardized handoff offers a structured and organized method of gathering and communicating patient information. Shift handoffs guided by a standardized handoff template produce high quality, complete delivery of patient information and may improve staff satisfaction with the shift handoff process.
Effects of Lavender Aromatherapy on Oncology Patients’ Perceptions of Comfort and Wellbeing
(2025) Cros, Carolyn; Simmons, Staci A.
Purpose: Oncological patient hospitalizations often exacerbate stressors, which affect the ability to cope while negatively impacting wellbeing and health outcomes. Addressing these stressors is important to ensure a comprehensive care approach. Use of lavender aromatherapy, as a nurse driven multimodal holistic intervention enhances comfort and wellbeing in conjunction with traditional pharmacological treatment of illness. Lavender aromatherapy has been studied in healthcare, showing benefits of comfort, wellbeing, and satisfaction of care. This study aims to explore the effects of lavender aromatherapy on hospitalized oncology patients’ perception of comfort and wellbeing. Methods: All patients within the oncology units of 5 Hope, 6 Hope and 5 Clarke at Baptist Hospital Miami were screened by staff, and those who meet inclusion criteria for the study received an invitation. Enrolled patients were provided with details of the study, provided with informed consent, and were asked to complete the pre-intervention survey. The patient then received the lavender aromatherapy intervention as a one-time individual use Elequil® Aromatabs® that adheres to the hospital gown, lasting up to 24 hours. Post-intervention surveys were collected at the four-hour mark and prior to discharge. Pre- and post- intervention surveys consisted of the Aromatherapy Comfort questionnaire, WHO-5 wellbeing, and visual analog scale to determine effectiveness of aromatherapy on the perception of wellbeing and comfort. Results: Participants (n=62) were aged 28-82 years (M=64.9, SD=14.9), gender (56% male, 44% female), 72% Hispanic. The number of aromatherapy sessions ranged from 1-8 days (M=3.5, SD=1.9). There was a reduction in self-reported pain (3.5 + 3,2 vs. 2.1+ 2.5, p < 0.05) and anxiety level (2.9 + 3.2 vs. 1.7 + 2.3, p < 0.05) from admission to discharge, and these were significant. There were significant differences between admission and discharge results for the WHO-5 Well-Being Index and Visual Analog Scale (p<0.05). There were significant statistical and clinical differences between the pre-intervention and post intervention results for the Aromatherapy Comfort Questionnaire. These findings suggest that the implementation of lavender aromatherapy sessions may contribute to improved perception of comfort and well-being in patients with cancer. Discussion: Incorporating a nurse driven protocol by using lavender aromatherapy launches the holistic dynamic of the healing environment. Lavender aromatherapy improves mood, reduces sleeplessness, restlessness, and discomfort, and elicits the sensation of relaxation. Utilizing lavender aromatherapy in conjunction with traditional medicine can be an effective tool for improving patient comfort and wellbeing.
Implementation of an Educational Intervention to Improve Screening for Obesity During Well-Child Checks
(2025) Morris. Zhinga A.; Simmons, Staci A.
Early identification of childhood obesity has been shown to decrease the risks of prediabetes and the progression to chronic illnesses like diabetes and cardiovascular disease. This project was conducted to determine if educational intervention improved screening for pediatric obesity during Well Child Checks (WCCs). A privately owned family practice staffed by five Advanced Practice Providers (APPs) and a Pediatrician in South Florida served as the clinical site where inadequate screening for obesity created a gap between healthy and at-risk obese patients. The APPs at the clinic site supported an educational intervention to increase obesity screenings. A review of literature supported an educational intervention to improve screening and clinical outcomes for childhood obesity. This quality improvement (QI) project involved chart reviews over 12 weeks to identify obesity screenings in a pre- and post-interventional period. In the preinterventional period, APPs were educated on the need for consistency of obesity screening and reminded to evaluate body mass index (BMI) calculations in the Electronic Medical Record (EMR) during each WCC. The outcome of this project was consistent with findings that screening for childhood obesity during each WCC identified more at-risk pediatric patients in need of early intervention to prevent chronic disease. This clinical project demonstrated that a simple educational intervention can significantly improve screening for pediatric obesity and support chronic disease prevention.
Educating Nurses on How to Overcome Compassion Fatigue
(2025) Glass, Tonya; Dayton, Leigh Bray
Introduction: Compassion fatigue is emotional, mental, and physical exhaustion in people who regularly help others. Compassion fatigue, unlike burnout, is caused by the emotional investment required to help others. This may cause helplessness, impatience, and a decreased capacity to empathize and provide care. Understanding compassion fatigue is crucial because it affects caregivers' well-being and may lower their quality of care. Methods: The healthcare workers’ compassion fatigue level was assessed prior to and after the interventions detailed in this proposal. The participant's level of compassion fatigue was evaluated pre- and post-educational intervention via the Secondary Traumatic Stress Scale (STSS). A paired T-test was utilized to compare pre- and post-intervention scores. This instrument comprises seventeen (17) inquiries concerning mental health concerns that have arisen within the previous seven (7) days. A subscale that evaluates intrusion, avoidance, and arousal is utilized to score the scale. After the scores are tabulated, the score interpretation assigns a rating to the score, ranging from no secondary traumatic stress to severe. Results: All six (6) participants experienced an increase in their aggregate scores on the Secondary Stress Trauma Scale. The average decrease in the intrusion questions was 3.8 points. The average arousal score decreased by 3.5 points. On average, the avoidance scores decreased by 7.3 points. The total point decrease was 88 points. Discussion: The findings demonstrate that educating nurses on techniques to overcome compassion fatigue was significantly successful, as reflected by a quantifiable decrease in STSS ratings across all participants. The intervention effectively mitigated secondary traumatic stress, as seen by significant reductions in intrusion, arousal, and avoidance scores. In general, the 88-point total reduction underscores the importance of targeted education in improving the quality of patient care and fostering the well-being of nurses.
Enhancing Critical Care Transport: Development and Implementation of a Debrief
(2025) Turner, Renee Kyle; Wedgeworth, Monika
Introduction: Debriefing in critical care transport is used as a safety communication tool whether that mission was completed by ground, rotor-wing, or fixed-wing transport. This method of communication allows the team members to freely express what went right or wrong with the call to use for quality analysis and to decide what to keep or make changes for future transports. This Doctor of Nursing Practice (DNP) project addresses the quality improvement change from “hot wash” verbal debriefs to a standard written debrief form. The project’s primary aim is to increase the compliance of completed debriefs with the ability to electronically track each debrief completed. Methods: A process improvement project was implemented. This new process changed the debriefing process from “hot wash” verbal debriefs to written debriefs on the online platform called Ninth Brain. Results: The data indicated an increase in the absolute number of completed debriefs; however, the overall percentage declined due to a rise in patient transportation volume. Feedback provided by crew members during these debriefs has proven instrumental in guiding educational initiatives and enhancing safety protocols. Discussion: Without a consistent and comprehensive debriefing mechanism, transport organizations struggle to identify key issues, disseminate after action review, and apply best practices to future occurrences. Consequently, the gap impedes efforts to enhance overall quality and safety in patient care, which is crucial for meeting industry standards and improving clinical outcomes.
Educating Patients with Multiple Sclerosis on Health and Wellness Topics through Shared Medical Appointments
(2025) Wilkinson, Erin; Lucena-Glass, Kayla
Introduction/Purpose: Multiple Sclerosis (MS) is a chronic neurological disease that requires long-term management and wellness-focused interventions. This Doctor of Nursing Practice (DNP) project implemented Shared Medical Appointments (SMAs) to deliver health and wellness education in a patient-centered, group-based format. The aim was to enhance patients’ perceptions of knowledge gained, self-confidence, and self-efficacy while promoting peer support and lifestyle change. This project also sought to address time constraints in traditional visits by providing extended education in a collaborative environment tailored to the needs of individuals living with MS. Methods: The project utilized a descriptive evaluation design to assess the effectiveness of SMAs in delivering health and wellness education to individuals diagnosed with MS. Virtual SMAs were held monthly over a 12-week period. Each 90-minute session included a certified MS nurse practitioner who served as the project lead, a licensed clinical social worker who served as the SMA facilitator, and approximately six patients per session. Educational content covered six domains: nutrition, physical activity, mental health, sleep hygiene and energy conservation, cognitive health, and comorbidity management. Patients completed an anonymous post-session survey using a 4-point Likert scale to assess patients’ perceptions of knowledge gained, their confidence in applying the information, and their intent to implement wellness-behavior changes. Descriptive statistical analysis was conducted using JASP (version 0.95.2). For clarity in reporting, survey items were grouped by domain and aligned with the three overarching constructs: (1) knowledge gained, (2) self-confidence in applying the knowledge, and (3) self-efficacy or intent to implement health-related behavior changes. Qualitative feedback from open-ended questions and provider observations were also reviewed to capture patient perceptions and peer interaction dynamics. Results: Thirteen participants completed the post SMA session survey. Across all domains, responses were consistently positive, with no participants selecting “Disagree” or “Strongly Disagree.” Most reported increased knowledge, greater confidence in applying what they learned, and motivation to adopt wellness strategies. The domain of comorbidity management received the highest rating across all three areas. Open-ended responses revealed themes of empowerment, reduced isolation, and appreciation for peer support within the SMA setting. Conclusion: SMAs are an effective, feasible approach for educating MS patients on wellness topics, fostering peer engagement, and promoting motivation and intent toward behavior change. This model may also enhance provider satisfaction, reduce burnout, and improve clinic efficiency. The positive outcomes observed in this project support the integration of SMAs as a sustainable, nurse practitioner-led model of care in neurology-focused settings. Nurse practitioners are uniquely positioned to lead SMA implementation in chronic disease care.
Educating Providers on Monitoring and Managing Antipsychotic-Induced Weight Gain in Adults
(2025) Palmer, Krystal; Horton, Abby
Aim: To evaluate the effects of a provider education program and standardized metabolic monitoring protocol on improving antipsychotic-induced weight management in adults at a rural community mental health center. Design: A 12-week pre–post quality improvement project guided by the Iowa Model. Methods: Five psychiatric prescribers were invited to complete an evidence-based metabolic training module; four (80%) completed it. A standardized monitoring protocol and electronic documentation template were implemented. Ten adult patients receiving antipsychotic medications participated. Outcomes included provider adherence to weight/BMI and metabolic-laboratory monitoring, patient BMI, knowledge (WMNKQ), and satisfaction. Results: Weight/BMI documentation rose from 40% to 90%, metabolic lab completion from 30% to 80%, and full metabolic panels from 10% to 50%. Mean BMI decreased from 34.1 to 33.8 kg. WMNKQ scores improved from 5.2 to 8.4. Satisfaction ranged from 4.3–4.8/5. Conclusion: A structured provider education intervention combined with standardized monitoring tools improved adherence to guideline-recommended monitoring and supported early weight stabilization.
Implementation of an Evidence-Based Prevention Bundle to Reduce Central Line-Associated Bloodstream Infections
(2025) Minton, Heather; Acker, Kristi
Central line-associated infections (CLABSIs) continue to be a challenge in healthcare settings and can result in higher patient morbidity and mortality. Patients in settings, such as intensive care units, are especially vulnerable to CLABSIs. Through a multiple-step implementation plan, a quality improvement initiative was implemented over 8 weeks. The Doctor of Nursing (DNP) project integrated a CLABSIs Prevention Bundle which included hand hygiene and antisepsis processes, staff adherence audits, an electronic checklist integration, and staff education. The DNP Project aimed to reduce CLABSI rates within a single-site ICU setting. At project completion, CLABSI rates decreased by 71 percent. Infection control staff compliance measures increased significantly. Project evaluation yielded that 96% of the respondents reported a greater understanding of CLABSI prevention strategies and indicated a strong interest in additional prevention training. The DNP Project outcomes lend support that integrating evidence-based practice strategies, through intentional processes, can result in a reduction in CLABSIs within a high-risk health care environment. Findings further highlight the importance of long-term monitoring, lifelong learning, and the importance of utilizing clinician reminders for reducing CLABSI. Project limitations included, but were not limited to, a single setting, small sample population, and low staff evaluative response rates. Findings from the project align with the current science regarding CLABSIs and provide organizational synergy for adopting like-strategies, including infection control processes and procedures for managing central lines in other high-risk settings.
The Impact of Follow-up Calls on Patient Satisfaction Scores in an Urgent Care Setting
(2025) Franklin, Karlisa; Brown, Janet
Introduction/Purpose: Patient satisfaction plays a vital role in urgent care, significantly impacting health outcomes and patient retention. Urgent care clinics experience high patient volumes and operate under fast-paced workflows, often prioritizing immediate treatment and neglecting structured follow-up after visits. This approach can leave underlying issues unresolved, potentially resulting in lower satisfaction scores. This DNP project aims to evaluate whether conducting follow-up calls within 48 hours after a visit can improve patient satisfaction ratings. Methods: A quality improvement (QI) initiative was implemented over a 6-week period, including pre- and post-intervention assessments. Brief but targeted staff training sessions were conducted to ensure consistency and enhance communication standards. Follow-up calls were made within 24 to 48 hours after each visit to address any concerns and were documented in the electronic health record (EHR). Patient satisfaction was evaluated using Press-Ganey survey items that focused on communication effectiveness, the likelihood of recommending the services, and overall experience during the visit. Results: The introduction of follow-up calls led to a significant increase in patient satisfaction scores, improved communication between patients and their providers, and encouraged better adherence to post-visit care instructions. After implementing the intervention, overall patient satisfaction scores rose notably from 74% to 82%. Importantly, the areas of “care provider communication” and “navigating your visit” showed the greatest improvements. These findings are essential for developing evidence-based recommendations for adding follow-up calls into urgent care workflows, ultimately enhancing patient-centered care and the overall patient experience. Discussion/Conclusion: The results underscore the value of incorporating follow-up calls as a patient-centered approach to boost satisfaction in urgent care environments. This project offers valuable insights for healthcare leaders aiming to enhance patient experience and improve quality metrics in busy, fast-paced environments such as urgent care. These findings substantiate the incorporation of post-visit follow-up calls as a sustainable strategy for enhancing quality improvement efforts aimed at improving patient-centered care and organizational performance.
Implementation of a Social Determinants of Health Screening Tool in a Primary Care Clinic
(2025) Mims, Miesha; Prevost, Suzanne
Background: Social determinants of health (SDOH) influence 30–55% of health outcomes, yet standardized screening is inconsistent in many primary care settings despite evidence supporting its importance. Objective: To evaluate the impact of integrating the Accountable Health Communities–Health-Related Social Needs (AHC-HRSN) screening tool into a primary care clinic to improve screening completion and referral rates. Methods: An eight-week quality improvement project was implemented using a Plan-Do-Study-Act model. The AHC-HRSN screening tool was added to the electronic health record (EHR), staff received training, and SDOH screening was conducted at all adult visits. Pre- and post-intervention screening and referral rates were compared using chi-square analysis. Results: Screening completion increased from 11% pre-intervention to 97.5% post-intervention. Among 471 completed screenings, 11.8% identified at least one unmet social need. All patients who screened positive received a referral to community resources. The increase in screening rates was statistically significant (χ² = 695.13, p < .001). Conclusions: Standardized integration of the AHC-HRSN tool significantly improved SDOH screening and referral practices. Implications for Nursing: Routine SDOH screening promotes equitable patient care, enhances care coordination, and aligns with the Centers for Medicare and Medicaid Services (CMS) and Healthy People 2030 priorities.
Utilizing Point of Care Hemoglobin A1c Testing to Improve Adherence to Testing Frequency Guidelines
(2025) Yeager, Laura; Bratcher, Lee
Introduction/Purpose: Diabetes mellitus (DM) is a major public health challenge. Poor glycemic control in type 2 diabetes (T2DM) can lead to micro and macrovascular complications like cardiovascular disease and events, nephropathy, retinopathy, and neuropathy. Uncontrolled diabetes is the leading cause of kidney failure, blindness, lower limb amputations, and heart attack. Despite standard of care guidelines (SOCG), diabetes continues to be a concern in the United States. The use of point of care (POC) hemoglobin A1c (HbA1c) testing by the primary care practitioner can improve glycemic control and improve patient outcomes. Real-time feedback on HbA1c numbers may strengthen patient-provider relationships and help overcome clinical inertia present in diabetes care Methods: The purpose of the project is to provide education regarding SOCG on testing frequency in T2DM and utilize POC HbA1c testing. The Plan-Do-Study-Act (PDSA) method will be used to implement this quality improvement project. A retrospective chart review will be completed to determine current baseline practice, then educational intervention will be provided to each provider, and the final phase will take place over a four-week timeframe. Results: This project showed improvements in ordering POC HbA1c test and adherence to standard of care guidelines on testing frequencies, but these results were not statistically significant. Though not statistically significant, it can be concluded that provider education can improve adherence to SOCGs for testing frequencies and increase the use of POC testing for T2DM patients. Discussion: The project was clinically significant in improving adherence to SOCGs for testing frequency and increased use of POC HbA1c testing. Uncontrolled diabetes can result in substantial direct and indirect costs along with an increase in micro and macrovascular complications. Adherence to testing frequency of HbA1c along with utilizing POC testing can improve patient-provider relationships, decrease therapeutic inertia and improve diabetes care in the primary care setting.
Decreasing Antibiotic Misuse through Antibiotic Stewardship
(2025) Witherspoon, Valencia; Owings, Clara; Worthy, Emily
Introduction/Purpose: Antibiotic misuse and overuse have grown to be the key underlying factors in antibiotic resistance. At least 30-50% of antibiotic prescriptions have been deemed unnecessary, especially in patients diagnosed with viral upper respiratory symptoms in urgent care settings. A lack of patient education may play a role in the increasing rates of unnecessary antibiotic prescribing. Methods: Patients received an initial and post-survey to test their knowledge about bacterial versus viral infections. CDC handouts were given in between surveys to educate patients on the appropriate symptoms and treatment. Evaluation of initial surveys and post-surveys were analyzed to determine a link between unnecessary antibiotic use and lack of patient education. Experity records were also analyzed to see if the educational intervention had any impact on the pre- and post-antibiotic prescribing rate. Results: The results from this analysis indicated that patients do need more appropriate education about their diagnosis during their initial visit. At least 58% of the participants answered the pre-surveys incorrectly, but post-surveys indicated that at least 66% answered correctly, proving that educational handouts did increase knowledge. The pre-intervention prescribing rate for upper respiratory infections was 62.7%, while the post-intervention prescribing rate was 59.2%. Conclusion: Pre- and post-intervention rates showed increased patient knowledge after implementing the CDC handout. Although this project did not reach the goal of a 5% decrease in the antibiotic prescribing rate, it did show a 3.5% decrease, which suggested that education can play a role in decreasing the rate of unnecessary antibiotic prescriptions.
Managing Chronic Obstructive Pulmonary Disease in Outpatient Settings with Soft Belly Breathing Exercises to Reduce Hospital Readmissions
(2025) Simon-Eveillard
Introduction/Purpose: Chronic Obstructive Pulmonary Disease (COPD) poses significant challenges in healthcare due to its readmission rates and associated costs. The purpose of this study is to investigate the efficacy of implementing soft belly breathing exercises as a non-pharmacological intervention for managing COPD in an outpatient setting. The goal is to enhance pulmonary function, reduce dyspnea, and minimize hospital readmissions among COPD patients. Methods: The project was conducted over 12 weeks in an outpatient clinic in urban Florida. The data was collected from the electronic medical records of the patients and the Strategic Analytics for Improvement and Learning (SAIL) report. The study compared 30-day hospital readmission rates between two groups of patients: the group before the implementation of belly breathing exercises and the group after the exercises. The team access information from the Corporate Data Warehouse (CDW). 30-day readmission (yes or no) data was collected for a comparison group of patients for 30 days before the implementation. The data was analyzed using a chi-square analysis. A pre/post survey was also conducted to assess changes in pulmonary function and dyspnea. Results: The chi-square test showed a statically significant/insignificant difference [ X2 (1, N = X, XXX) = X. XX, p =.XXX] between the 30-day hospital readmission rates of comparative and implementation patients. Discussion: Clinical significance is shown by the increase or decrease in 30-day hospital admission rates. Based on the project findings, the implementation of soft belly breathing exercises improved the quality of life for COPD patients.
Implementation of a Nurse Mentor Program to Increase New Operating Room Nurses' Support, Intent to Stay, and Retention Rates
(2025) Shine, Tammy L.; Welch, Susan; Zelko-Bennick, Christina
Introduction/Purpose: Retaining nursing staff is essential for nurses' well-being and reducing burnout, positively correlating with patient outcomes. National statistics indicate that, on average, 13% of nurses leave their positions within the first year. Key factors contributing to this attrition include inadequate support during their transition to independent practice. This project aimed to implement a mentoring program for newly hired nurses in the operating room to enhance their feelings of support, increase retention rates, and improve patient outcomes. Methods: A Nurse Mentor program was established based on the American Medical Surgical Nurse Mentoring Program guidelines. Six nurses undergoing orientation in the operating room were paired with mentors. Pairs met biweekly, and Nurse Mentor Agendas were provided to facilitate their discussions. Mentees completed the Intent to Stay, Relationship with Mentor, and Job Satisfaction Scale surveys monthly. Additionally, surgical site infection rates were monitored for assessment purposes. Results: New nurses reported high levels of job satisfaction, strong intent to stay, and positive feedback regarding their relationships with mentors. Remarkably, new nurse retention reached 100% at the six-month mark. Additionally, as vacancies decreased, the surgical site infection ratio improved incrementally from 1.806 to 0.602 over three months. Discussion: The outcomes of the Nurse Mentor Program are highly encouraging. Future longitudinal studies of the program will be critical to evaluating its long-term effects on job satisfaction, intent to remain in their position, and surgical site infection rates.

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