College of Nursing

Permanent URI for this collectionhttp://hdl.handle.net/10342/117

Browse

Now showing 1 - 20 of 778

Open Access
DNP Scholarly Project: Increasing Screening Rates for Social Needs in an Adult Behavioral Health Unit
(2025-07-25) Holland, Brandi
Abstract: This quality improvement (QI) project was centered on increasing the screening rate for social drivers of health (SDOH) within a 24-bed Adult Behavioral Health Unit (ABHU) located in an academic medical center (AMC). The SDOH screening encompassed five domains: food insecurity, housing instability, interpersonal safety, transportation needs, and utility difficulties. By implementing systematic strategies to enhance the capture of SDOH data, the project aimed to improve the identification and documentation of social factors impacting patient health. SDOH screenings were tracked for completeness over 18 weeks. Of the 311 patients who were eligible for the SDOH screening, 303 were screened across all domains, resulting in an overall screening rate of 97.43%. SDOH needs were identified in the five domains:(1) 25% screened positive for food insecurity; (2) 24% screened positive for housing instability; (3) 24% screened positive for interpersonal safety; (4) 21% screened positive for transportation needs; and (5) 16% screened positive for utility difficulties. These findings underscore the high prevalence of unmet social needs in the ABHU. Patients identified with positive screenings were provided with information on community resources. Future efforts should focus on measuring the impact of connecting patients to resources that address unmet social needs.
Open Access
Executive Summary: Evidence-Based Practice in Diagnostic Radiology
(2025-07-22) Williams, Deneeka
Background: Evidence-based practice is used in variable amounts in the radiology setting. Clinical practice in radiology is influenced by tradition, organizational culture, and outdated resources. Resources in practice should be supported by evidence. Study Purpose: To improve the use and knowledge of evidence-based practice in diagnostic radiology by creating an evidence-based procedural manual. The manual will provide clinical practice guidelines that can be utilized across multiple sites and improve the quality of care. Methodology: Quality Improvement (QI) initiative in the outpatient radiology setting using the Six Sigma Framework and DMAIC process. Implementation: Physical and electronic version of a diagnostic procedural manual and education huddles/presentations implemented in the clinic setting for 12 weeks. Post-intervention survey during the last four weeks of implementation. Results: 19 study participants, which included diagnostic radiographers, registered nurses, advanced practice providers, and physicians (18 participants completed the entire study). Overall, the survey revealed a positive response to the procedural manual and educational component of the study. Conclusion: Consistent use of EBP is needed in the radiology setting. Although research in radiology is limited, studies that use evidence to create clinical tools and implement practice guidelines can be completed, and these studies should be accompanied by an education component.
Open Access
Executive Summary: Improving Contraceptive Access in a Pediatric Primary Care Practice
(2025-07-11) Shelly D. Lynch, BSN, RN, FNP-BC
Adolescent pregnancies are a public health emergency. Many are unintended. Knowledge and access to contraceptives can reduce unintended pregnancies and adverse outcomes. Long-acting reversible contraceptives (LARCs) are considered first-line for adolescents. These devices are safe and effective. Pediatricians play a pivotal role in contraceptive access. Pediatricians untrained in LARC insertion can provide access through referrals. Referrals to Title X facilities can increase access and education.
Open Access
Suicide Awareness and Prevention Training for Healthcare Workers
(2025-07-15) Dent, Alisa W.
Suicide prevention training is critical in healthcare environments, where high levels of stress, emotional exhaustion, and burnout can contribute to mental health challenges among staff. Following the tragic suicide of a Neonatal Intensive Care Unit (NICU) team member in 2022, this project introduced the Question, Persuade, Refer (QPR) suicide prevention training within the NICU. The initiative aimed to equip staff with the knowledge and skills necessary to recognize and respond to individuals at risk for suicide, while also enhancing perceptions of organizational support for staff well-being. Over a two-month period (1/2/2025 to 2/21/2025), 62 NICU staff members completed the training, with pre- and post-assessments measuring changes in suicide prevention knowledge and in intervention confidence or self-efficacy. Results demonstrated significant increases in staff knowledge, and a willingness to engage in suicide prevention conversations, while also improving the perception of organizational support. In light of these outcomes, the hospital has committed to integrating QPR into new employee orientation to promote long-term sustainability. Future recommendations include expanding the training to additional units, leveraging technology to offer virtual training options, and conducting long-term follow-up studies to assess the ongoing impact of QPR. This project highlights the value of embedding suicide prevention training into healthcare settings and offers a scalable approach to strengthening mental health support for frontline healthcare workers.
Open Access
Executive Summary: PRESS ON Hands-Only CPR: A Community Education Project
(2025-07-23) Racheal E Shaddeau
PRESS ON Hands-Only CPR: A Community Education Project There were 139,822 out-of-hospital cardiac arrests (OHCA) captured in the 2023 Cardiac Arrest Registry to Enhance Survival (CARES) report, and sadly, only 10.2% of those people survived to hospital discharge. The CARES registry collects data from 37 states and 11 additional community-based sites, which represent approximately 56% of the United States population. Overall, approximately 350,000 OHCA cases occur annually in the United States (Blewer et al., 2024). Poor survival rates for OHCA can be attributed to several factors, including pre-existing health conditions, the time of first chest compressions, whether an automatic external defibrillator (AED) is used, emergency medical response times, and the availability of a receiving hospital to provide evidence-based care. There are opportunities to improve outcomes along the spectrum of care; however, the most important factors are the early activation of 911, the rapid initiation of chest compressions, and the use of an AED if available. Studies have shown that bystander CPR can double the odds of surviving OHCA (Cheng et al., 2020; Dainty et al., 2022). Currently, only 40% of adult victims of OHCA receive cardiopulmonary resuscitation (CPR), and 29% had an AED applied before paramedics arrived (RACE CARS Trial, n.d.). Those rates are lower in rural areas, low-income neighborhoods, and minority populations (Ashburn et al.,2021; Pu et al., 2023). Despite extensive funding and education initiatives, the United States is still falling short of the Healthy People 2030 (Office of Disease Prevention and Promotion, n.d.) goal that 45.1% of all OHCA victims receive bystander CPR. We must continue to create opportunities to empower bystanders with the skills and confidence to act when cardiac arrest occurs, thereby improving this measure and its related outcomes.
Open Access
Addressing Opioid Overdose in Wake County Through Collaboration of EMS and Peer Support Professionals: Executive Summary
(2025-07-23) Juan J Powe
The opioid epidemic continues to be a significant public health crisis in North Carolina (NC), with more than 37,000 opioid-related deaths between 2000 and 2022. In response, Wake County established the Drug Overdose Prevention Coalition and launched the Post-Overdose Response Team (PORT) initiative to decrease opioid overdoses and improve outcomes for people with substance use disorder (SUD). This doctoral project aimed to improve post-overdose care by utilizing certified peer support professionals in the PORT program to conduct a brief, three-question assessment during follow-up visits. From January to April 2025, Emergency Medical Services (EMS) reported 269 opioid overdose incidents in Wake County. The PORT attempted outreach to 115 individuals (43%) and successfully contacted 36 (31%). Naloxone was the most common resource distributed, and one individual was connected to medication for opioid use disorder (MOUD). Barriers such as housing instability and safety concerns prevented outreach to the remaining 57% of overdose survivors. The project demonstrated the value of peer support professionals in building trust and engaging overdose survivors, especially when traditional systems often fail to reach this group. However, logistical and engagement challenges limited its overall effect. This community-based, collaborative approach highlights the potential for peer-led interventions to lower overdose deaths and enhance the quality of life for individuals with SUD in Wake County.
Open Access
Executive Summary: Nurse Practitioner Clinical Engagement Pathway
(2025-07-24) Sarah Finnerty
Open Access
Implementing a Clinical Instructor Orientation Program to Improve Instructor Self-Efficacy, Satisfaction, and Retention
(2025-07-23) Murray, Mary
BACKGROUND: This study aimed to improve nursing clinical faculty’s knowledge, support, and comfort level in facilitating pre-licensure students in the clinical setting by evaluating fac-ulty’s knowledge gaps and developing educational modules to improve their expertise, satisfac-tion, and retention. METHOD: A clinical faculty orientation was designed and implemented, and pre- and post-surveys were used to compare faculty satisfaction, efficacy, and retention. Both quantitative and qualitative data were collected via the Qualtrics platform. RESULTS: Eight successful clinical faculty members completed the modules, both pre- and post-surveys. CONCLUSION: Through innovative assessment, planning, implementation, and evaluation, academic recruitment and retention of clinical faculty can improve. This will help address clin-ical faculty shortages and increase clinical faculty quality and student and patient outcomes.
Open Access
Integrating Trauma-Informed Care Post-ACE Screening in School Settings
(2025-07-12) McNeely, Tonya
Exposure to Adverse Childhood Experiences (ACEs) is strongly associated with negative academic, behavioral, and health outcomes in school-aged children. This quality improvement project assessed the feasibility of integrating ACE screening into a school-based support model by training student support staff from a nonprofit organization in trauma-informed care.
Open Access
Administrative Changes to Improve Appointment Adherence: A Quality Improvement Project
(2025-07-22) Robinson, Victoria M
Open Access
Executive Summary–Intern to Impact: Cultivating a Clinical Nurse Specialist Team
(2025-07-22) Clark, Nikki
The practice of the clinical nurse specialist (CNS) spans direct patient care, nursing practice, and healthcare systems improvement; however, the role remains largely misunderstood and underutilized in clinical practice settings. The following manuscript details a quality improvement project in which a proposal for a CNS Intern role was developed to mitigate both issues simultaneously. Surveys were conducted to determine stakeholders’ understanding of CNS practice. This information was utilized to outline a CNS Intern role to be presented to nurse executives at the project site. Finally, a post-survey was conducted to collect feedback on the resulting clarity surrounding the understanding of CNS practice and the viability of the CNS Intern role. Survey results indicated that the proposal improved stakeholders’ understanding of the CNS scope of practice. Respondents also agreed that the CNS Intern role is a viable method for facilitating the timely growth of an effective CNS team, which will be instrumental in achieving strategic initiatives to realize the organization’s mission and vision.
Open Access
Evaluation of Patient Engagement on Driveline Infection Rates in LVAD Patients through Digital Education
(2025-07-22) Heather Pena
Mechanical circulatory support in the form of a left ventricular assist device (LVAD) can support patients with advanced Heart Failure (HF). The most common complication following LVAD implantation is driveline infection (DLI) leading to increased morbidity, mortality, and costs. Management of the driveline insertion site by the patient at home after discharge is critical in prevention of DLI. A quality improvement project utilizing the FADE model was conducted by leveraging video-based education delivered via an electronic health portal and evaluated the impact on infection rates, 30-day readmission rates in LVAD patients, and patient engagement. Post-implementation, the DLI rates remained unchanged, 30-day readmission rates improved slightly, and patient engagement was low with newly implanted patients although higher in prior implants. Limitations included types of delivery mechanisms within the electronic health portal and overall engagement and activation of the electronic health portal. The use of video-based education allowed for consistent delivery of educational material and has the ability to impact morbidity, mortality, and costs. A multi-modal approach to LVAD education supports enhanced patient education and earlier engagement may be more beneficial to enhance utilization. Future recommendations include evaluation of timing of delivery and other delivery methodologies such as QR codes.
Open Access
Executive Summary: A Quality Initiative to Improve Transitional Care for Patients with Opioid Use Disorder in Rural North Carolina
(2025-07-22) Kenneth N. Gregory
The opioid epidemic is a significant health issue in the United States, affecting about 3 million people. Over the past 15 years, opioid-related deaths have continued to rise due to the widespread availability of heroin and synthetic opioids like fentanyl. Effective medications such as buprenorphine, methadone, and naltrexone are available to treat opioid use disorder (OUD). However, despite the high death toll and associated health problems like HIV, hepatitis C, and infective endocarditis, only around 20% of individuals with OUD receive treatment. This is mainly due to social stigma, costs, transportation barriers, and health disparities. Communities in North Carolina are also impacted, with opioid-related deaths increasing by 72% from 2019 to 2022 across all races in the state. This Doctor of Nursing Practice project aimed to develop a sustainable transitional care process that facilitates referrals to community resources for these patients at the time of discharge from the emergency department. The project successfully aligned care delivery with the goals of Healthy People 2030 for patients with OUD.
Open Access
Use of Quality by Design in Clinical Trial Implementation Planning
(2025-07-22) Stanton, Douglas
International Council on Harmonisation (ICH) E8(R1) guidance recommends proactive clinical trial planning to ensure participant safety and study integrity (ICH, 2021). By applying these concepts during trial implementation planning, investigative sites can have a more robust approach to detecting, remediating, and preventing errors. Following a literature review, FOCUS-PDSA was utilized by a quality improvement team (QIT) in developing a tool to introduce Quality by Design (QbD) concepts for study plan development. A narrated slide presentation was provided to orient staff. The project was implemented from January 13, 2025, through April 25, 2025, over four clinical trial studies. An anonymous survey was conducted among the eight research coordinators participating in the pilot, assessing the use of the tool in terms of clarity, ease of use, impact on time management, and knowledge gained in QbD concepts. Four surveys were returned, with respondents indicating an increased knowledge of QbD post-pilot, openness to further QbD education, general satisfaction with the tool, and content relevant to their role. However, responses indicated some were open to future use of QbD in study planning, while others were unsure. Comments suggested more guidance on identifying critical factors and developing comprehensive study plans. Clinical trial research is essential to advancing medical knowledge as a critical arm of translational science. Safeguarding participant safety and trial integrity through protocol development and study implementation planning is paramount. Although demonstrated through a small sample of survey returns, utilizing QbD methodologies shows potential benefits during trial implementation planning at the investigative site level.
Open Access
No Crumbs in Bed: A Nurse-Led Initiative for Mealtime Mobility
(2025-07-21) Marianna L Hoffmann
Introduction: Low physical activity among hospitalized patients significantly contributes to poor health outcomes, such as physical deconditioning, pressure ulcers, pneumonia, and increased mortality. This issue is especially concerning for older adults, who often spend over 90% of their hospital stays in sedentary states, frequently taking fewer than 1,000 steps daily. Design: This project utilized a quality improvement design, employing an iterative approach to implement and evaluate a nurse-led initiative aimed at increasing patient mobilization during mealtimes. Methods: The "No Crumbs in Bed" initiative was carried out in a specialized medical-surgical progressive care unit at a large regional medical center. The project aimed to implement a mealtime mobilization protocol, encouraging eligible patients to move from bed to a chair for all meals. The Institute for Healthcare Improvement (IHI) Model for Improvement, specifically its Plan-Do-Study-Act (PDSA) cycles, guided the implementation. Data on the documented times and frequency of patients moving from bed to a chair, along with daily Johns Hopkins Highest Level of Mobility (JH-HLM) goals and scores, were systematically collected from Epic electronic health record reports. Staff perception surveys were administered using REDCap for data collection and analysis. Results: The initiative successfully increased documented patient mobility from a 2024 baseline of 21% to 33% by April 2025, surpassing the project's target of 31%. While a high percentage of patients (ranging from 79% to 84%) consistently had a JH-HLM goal assessed at four or greater (indicating a goal of out-of-bed to chair or higher), the proportion of patients meeting this assessed goal remained between 45% and 50% throughout the project period. Pre-intervention surveys revealed a strong staff perception of the severity and likelihood of complications from immobility, while also highlighting significant barriers related to time constraints, patient factors, and staffing issues. Conclusion: This nurse-led initiative demonstrated that structured interventions can significantly improve patient mobility documentation within an acute care setting. Despite the identified barriers to consistently achieving assessed mobility goals, including inconsistent meal delivery, limited seating, and established cultural norms that favor bed rest, the project provides a practical framework for fostering a culture of mobility. This approach promises to improve long-term patient outcomes by reducing complications associated with immobility, aligning with the IHI’s Triple Aim framework and Healthy People 2030 goals. Clinical Relevance: This nurse-led initiative offers a practical framework for enhancing patient mobility during hospitalization, thereby reducing complications and promoting patient recovery through structured mealtime interventions. Keywords: mobility, hospitalization, nurse-led initiative, deconditioning, patient outcomes, Triple Aim, mealtime
Open Access
Cardiac Connection: Virtual Nurse Utilization for Heart Failure Readmission Reduction
(2025) Williams, Kate S
Heart failure (HF) is a leading cause of hospital readmissions, resulting in increased patient morbidity and financial strain on healthcare systems. This quality improvement project aimed to reduce 30-day readmissions for HF patients by integrating virtual nurses (VNs) into the discharge process to provide standardized education and schedule timely follow-up appointments. Conducted in a progressive care unit of a community hospital in central North Carolina, the intervention employed the Plan-Do-Study-Act (PDSA) framework to implement and evaluate the new process. Pre- and post-intervention data were collected and analyzed to assess utilization of VN services, appointment scheduling, and readmission rates. During the four-month implementation period, readmission rates declined from 20% to 16.7% overall, and to 18.2% when excluding patients discharged to skilled nursing facilities, those leaving against medical advice, or those who expired during the admission. Despite lower-than-expected VN utilization (19.4%), findings support that VN led discharge education and timely follow-up appointments can positively influence readmission rates. This project demonstrates the feasibility and impact of VN integration as a scalable and sustainable strategy for improving care coordination among HF patients.
Open Access
Improving SDOH Screening in an Inpatient Setting
(2025-06-04) Barrett Odom
Abstract Aim: This study aimed to determine if the implementation of an educational toolkit for nurses improved social determinants of health (SDOH) screening compliance on an inpatient unit. The overarching goal was to increase identification of those with SDOH needs and to address those needs. Design: A quantitative design was used. Methods: A toolkit was developed to educate nurses on a 24-bed unit on SDOH and screening for SDOH. A total of 323 patients were admitted to the study unit, where 49 nurses are employed. The study evaluated the number of patients who were screened for SDOH needs upon admission to the unit, as well as nursing perception of SDOH and SDOH screening with two surveys. The goal was to improve SDOH screening by 10%. Results: Survey results indicate nurses thought the toolkit was helpful; however, SDOH screening rates increased by only 1.8%. Conclusion: Although the educational toolkit was well-received, other methods are needed to improve SDOH screening rates in an inpatient setting. Implications: Further studies are necessary to address SDOH screening compliance. Possible realms of improvement include streamlined screening forms and several on-site nurse champions. Impact: SDOH plays a large role in people’s health and well-being. Addressing SDOH needs can improve patient outcomes and the health of the community. Even a small increase in screening rates is impactful, although further studies are needed to make a lasting impact on SDOH screening. Contribution: There were no patient or public contributions. Contribution to the Clinical Community: This study ameliorates a paucity in research surrounding SDOH screening and improving SDOH screening compliance.
Open Access
Implementing an Opioid Overdose Toolkit for Lay Persons in Eastern North Carolina: A Pilot
(N/A, 2025-07-17) Thomas Shannon Jennings
This executive summary outlines a Doctor of Nursing Practice (DNP) project creating and disseminating a validated opioid overdose toolkit based on national models.
Open Access
Executive Summary: Optimizing Breastfeeding in a Family Practice Office, A Quality Improvement Initiative to Promote Breastfeeding Support
(2025-07-19) Padgett, Roslyn C.
Background: Breastfeeding offers benefits for the child, mother, society, and the environment. However, breastfeeding rates still fall short of targets. Factors influencing these rates include maternal and clinician lactation support, education, and self-efficacy. Aim Statement: A family practice clinic aims to enhance its breastfeeding support by providing an evidence-based, online lactation education and support program for clinicians and families. Methods: Quality improvement methodologies utilizing the Iowa Model of Evidence-Based Practice Intervention: Online implementation of HUG Your Baby, the Roadmap to Breastfeeding Success, in a primary care office Results: The program increased clinicians' knowledge and confidence to teach families about breastfeeding, and confirmed that it was convenient, easy to use, and evidence-based. Conclusions: This project supports the use of an online breastfeeding education and support program in the primary care setting.
Open Access
An Executive Summary Highlighting a Doctor of Nursing Practice Project - "Empowering Families Through Online Access: A Digital Toolkit for Adolescent Substance Use Support"
(2025-07-15) Woodlief, Ashlie Kennedy
Adolescent substance use disorder (SUD) is a critical public health concern, often resulting in long-term cognitive, emotional, and social consequences. Families navigating adolescent SUD face significant barriers, including limited access to comprehensive, accessible, and stigma-free resources. This Doctor of Nursing Practice (DNP) project aimed to address this gap by designing and implementing a community-specific, evidence-informed website toolkit for families in Carteret County, North Carolina. Guided by the PRECEDE-PROCEED model and King’s Theory of Goal Attainment, the project engaged interdisciplinary partners to develop a digital platform offering crisis intervention contacts, legal and therapeutic support links, educational materials, and peer-guided strategies. Outcome measures included quantitative engagement tracked via Google Analytics and qualitative feedback collected through online surveys. Although engagement rates partially met initial targets, analytics revealed sustained user interest, high interaction with critical resource pages, and positive qualitative feedback. Identified barriers included limited survey participation and initial site visibility, informing future enhancements. This project demonstrates how nurse-led digital interventions can bridge service gaps, align with national health objectives, and offer scalable models adaptable to other rural and underserved communities. By leveraging technology and interdisciplinary collaboration, the resource toolkit empowered families with accessible tools to support adolescent recovery and familial resilience.

Browse

Recent Submissions