21368 research outputs found
Sort by
Executive Summary: Clinical Practice Guideline Guideline for Identifying Patients at Risk for Posttraumatic Stress Disorder (PTSD)
Get PDFIn this Doctor of Nursing Practice (DNP) project, I developed a clinical practice guideline to address the absence of a standardized process for identifying adult outpatients at risk for posttraumatic stress disorder (PTSD) in a community-based mental health clinic. Without such a process, delays in trauma-focused care and inconsistent referrals may occur. The evidence base supports the use of brief, validated screening tools, such as the Primary Care PTSD Screen for DSM-5, for accurate risk identification in routine practice. The practice-focused question that I used to guide this project was: Will an evidence-based guideline for PTSD risk identification be approved by subject matter experts using the AGREE II evaluation tool? The purpose of the project was to develop, assess, and enhance a clinical practice guideline for implementation within the organization. The analytical strategy included a critical appraisal and synthesis of current evidence, structured guideline development across the six AGREE II domains, expert review using the 23-item AGREE II instrument, descriptive analysis of item and domain ratings, and an end-user review to assess overall quality and recommendation status. Key deliverables from the project included the finalized clinical guideline and the development of a stepwise screening and referral workflow by the organization. Implications for nursing practice include enhanced assessment competencies, improved communication strategies that foster patient disclosure, and the development of equitable care pathways that reduce disparities among both civilian and military-affiliated individuals across community-based settings. This initiative promotes positive social change by facilitating earlier access to effective treatments and incorporating equity-focused design elements
Staff Education to Improve Provider Knowledge on Antibiotic Prescribing
Get PDFSummary This Doctor of Nursing Practice (DNP) staff education project addressed a gap in guideline-based antibiotic prescribing among advanced practice registered nurses (APRNs) in an urgent care setting. The practice problem identified at the local project site was inconsistent adherence to Centers of Disease Control and Prevention (CDC) outpatient stewardship expectations, resulting in unnecessary antibiotic use for viral conditions and contributing to antimicrobial resistance. The practice-focused question for this project was as follows: In urgent care APRNs, does implementing a staff education program on guideline-based antibiotic prescribing improve provider-reported knowledge on antibiotic prescribing use? The purpose of this doctoral project was to design, implement, and evaluate an educational intervention to improve APRN knowledge and adherence to evidence-based antibiotic prescribing guidelines. The results of this project demonstrated significant improvement in provider knowledge, with maximum assessment scores increasing from 33% pre-intervention to 83% post-intervention. Implications include improved provider confidence, documentation accuracy, and consistency in antibiotic prescribing practices. Targeted education supported by decision-support tools will improve APRN stewardship performance in urgent care. Recommendations for future practice include embedding stewardship education into provider onboarding, annual competencies, and ongoing audit-feedback cycles to sustain improvement and advance APRN leadership in antibiotic stewardship and strengthening patient safety outcomes. This project supports positive social change by reducing inappropriate antibiotic use, mitigating antimicrobial resistance, and promoting equitable, high-quality care for all populations
Staff Education to Enhance Nurse Practitioner Competency in the Identification and Management of Generalized Anxiety Disorder in an Outpatient Clinic
Get PDFThis Doctor of Nursing Practice (DNP) staff education project was a quality improvement initiative focused on enhancing nurse practitioners’ (NPs’) competency in the identification and management of generalized anxiety disorder (GAD). The practice problem identified at the local project site through organizational feedback and observation was the inconsistent use of the Generalized Anxiety Disorder-7 (GAD-7) screening tool across NP encounters. The practice-focused question for this project was: In NPs in an outpatient clinic setting, how does staff education on GAD-7 and clinical guidelines influence their knowledge, confidence, and consistent use of anxiety screening practices? The purpose of this doctoral project was to improve NP knowledge, confidence, and adherence to guideline-based GAD screening. Review of the data confirmed that screening was performed in less than half of the eligible visits, revealing a critical practice gap. Supporting evidence from the literature confirmed the validity of the GAD-7 tool. The results of this project demonstrated measurable improvement in NP performance. The implications for the staff and organization included enhanced clinical consistency and improved patient follow-up. Based on the results of this project, I concluded that structured, evidence-based education can effectively improve NP competency and promote sustainability. My recommendations for future practice include extending the education to additional staff and evaluating long-term outcomes. The potential implications of this project on nursing practice are substantial, including increased clinical competency. This project also has the potential to positively impact social change by advancing equitable, accessible mental health screening for all patients and reducing disparities in anxiety detection and treatment
Strategies to Reduce Emergency Department Overcrowding at Hospitals in Puerto Rico
Get PDFEmergency department (ED) overcrowding has become an increasingly critical issue for the healthcare system of Puerto Rico, resulting in delayed care and increased patient morbidity, among other challenges faced by hospital leaders and administrators. This paper explores evidence-based strategies tailored to the Puerto Rican healthcare context to alleviate ED overcrowding. An integrative review of literature published between 2020 and 2025 was conducted. For this review, 15 articles were selected and appraised using the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. The strategies gleaned from the literature comprised six themes and 21 subthemes, centered on two major outcomes: reducing wait times and reducing ED overcrowding. These strategies include patient education to redirect patients with non-emergent cases to alternate urgent care locations, building and establishing a specialized team to address overcrowding, and optimizing the hospital’s operations, such as improving patient flow. The results show that the efficiency and sustainability of the ED depends on a system-wide integration (i.e., triage redesign, diagnostic acceleration, capacity optimization, and data-driven management). Recommendations for professional practice focus on the implementation of a collaborative triage redesign, integrate point-of-care testing (POCT), adopt predictive data tools, and set quality and safety mechanisms into routine ED operations. The implications for social change include promoting equitable access to care, enhancing workforce resilience, and fostering the public’s trust through transparency and adaptability. Despite limitations, the review proposes transforming the EDs in Puerto Rico into responsive, data-driven ecosystems to reduce wait times and overcrowding
Staff Education to Impact Staff Knowledge of Depression Screening in Primary Care
Get PDFSummary This doctoral project was a staff education program designed to improve depression screening among patients in an adult primary care setting. The practice problem addressed was the lack of standardized depression screening that led to inconsistent detection, delayed diagnosis, and fragmented mental health care. A move to address the issue is critical in nursing practice since nurses play a central role in early identification, patient advocacy, and integration of behavioral health into primary care. The practice-focused question guiding the project was, Will implementing a nursing staff education program impact their knowledge of Clinical Practice Guideline (CPG) for depression screening and willingness to use /adopt PHQ-9 as a standard routine for monitoring and managing depression among adult patients? The project’s purpose was to educate nurses on standardizing depression screening through the adoption of the PHQ-9 tool and to strengthen staff confidence in its use. The analytical strategies used in the project included pre-and post-training questionnaires, with quantitative data analyzed using descriptive statistics and normalized learning gain calculations in Excel, and qualitative responses coded for emergent themes. The findings showed significant improvements in knowledge (average scores increased from 57% to 90%), substantial normalized gains (average of 34%), and enhanced staff confidence. The qualitative results highlighted leadership support, improved recognition of mental health parity, and the need for clear referral pathways. Overall, the project produced a structured depression screening guideline using PHQ-9. Its implications include strengthening nursing practice through consistent, evidence-based screening and promoting positive social change by advancing equity, inclusion, and access to mental health care in diverse populations
Exploring Counselor Perspectives on the Role of Ecotherapy in Mental Health Treatment: A Qualitative Study
Get PDFThis grounded qualitative study explored the common themes of ecotherapy in practice. The research problem was the limited understanding of how counselors implement ecotherapy in clinical practice, hindering the field’s ability to fully integrate nature-based approaches into mental health treatment. The purpose of this grounded theory study was to explore counselor perspectives on ecotherapy using the biophilia hypothesis and Swarbrick’s wellness model. The research questions focused on how licensed mental health counselors understood, implemented, and evaluated the impact of ecotherapy. Qualitative data were collected through an online survey with open-ended questions from 15 licensed counselors across the United States who use ecotherapy. Inclusion criteria included counseling licensure and at least six months of experience using nature-based interventions. Data were analyzed using axial coding to identify themes and subthemes related to research questions exploring counselor understanding, implementation, and evaluation. Findings suggested counselors’ understanding of ecotherapy is rooted in the healing connection between humans and nature, mindfulness, grounding, and somatic awareness. For implementation, practices were used to promote emotional regulation and self-awareness. Evaluation themes varied. Recommendations include developing counselor-specific competencies and expanding research of its practical foundation in alignment with traditional therapeutic functions (e.g., assessment). Implications for positive social change include identifying the foundation for systemic competencies that can span organizational layers, thus promoting equitable care for individuals whose insurance company may not otherwise support
Impact of Staff Education to Clinical Documentation Integrity Team
Get PDFThe doctoral project investigates the impact of education on Clinical Documentation Integrity (CDI) nurses in enhancing the accuracy and quality of clinical documentation within healthcare organizations. Clinical documentation plays a crucial role in accurately reflecting patient care and is essential for capturing proper diagnoses, coding, and reimbursement. In contrast, inaccurate or incomplete documentation can lead to misdiagnoses, poor patient outcomes, and financial deficits. Due to frequent updates in clinical guidelines and coding standards, CDI professionals require continuous, specialized training to stay informed with ever-changing medical terminology, disease processes, and coding regulations. By enhancing the CDI education, the aim is to improve the quality of clinical documentation, reduce diagnostic errors, and facilitate accurate coding practices. Through pre- and post-education reviews of claim-based data (CBD), the project assesses the effectiveness of enhanced training on diagnosis accuracy, query writing, and overall documentation quality. The goal is to measure how improved education affects the quality of queries, leading to more accurate diagnosis capture and optimal patient care quality. The project’s findings include a post-education increase in clinician agreement rates and in the accuracy of diagnostic documentation through effective query writing. Through CDI education, query writing becomes more effective in providing documentation integrity and coding of valid diagnoses. Ongoing education for CDI professionals is essential to maintaining high-quality, accurate clinical documentation, reducing misdiagnosis rates, improving patient safety, and optimizing the healthcare system performance, ultimately supporting better health outcomes
Impact of Staff Education on Cultural Competency Knowledge and Skills
Get PDFSummary The Doctor of Nursing Practice (DNP) project involved implementing a cultural competency staff education program at an outpatient mental health clinic. The identified practice problem was poor cultural competence practices knowledge among staff, resulting in poor patient engagement and a low patient satisfaction rate. Improving cultural competency in nursing practice was necessary to facilitate therapeutic trust, increase patient treatment adherence, and enhance staff compliance with Culturally and Linguistically Appropriate Services (CLAS). The practice-focused question guiding the DNP project was: Does implementing staff education impact their knowledge of cultural competence and confidence in adhering to CLAS? Data were collected through pre- and post-training surveys to measure staff knowledge and confidence. Learning gain was calculated using Brigham and Women’s Hospital Center for Nursing Excellence Pre- and Post-Test Guidelines. The findings demonstrated increased staff knowledge of CLAS and confidence in culturally competent care. The major products of this project included training modules, assessment tools, and a framework for ongoing cultural education. The project concluded that structured training is effective in improving staff knowledge and confidence in integrating culturally competent care in healthcare facilities. In this regard, the nursing practice should deliver better-quality care, allow for better collaboration, and improve positive organizational culture. The initiative helps bring about social change by working to mitigate health disparities and ensuring diversity, equity, and inclusion are at the center of care
The Lived Experiences of Imposter Syndrome Among Women of Color Professors in Higher Education
Get PDFThis qualitative phenomenological study explored the unique challenges faced by women of color professors in higher education, who often experience imposter syndrome due to systemic barriers and underrepresentation. The purpose of this study was to gain an in-depth understanding of how these professors experienced and made meaning of imposter syndrome in academic settings. The central research question examined the meaning of imposter syndrome among women of color professors in higher education. This study was grounded in intersectionality and self-determination theory, which provided frameworks for understanding how multiple identities influenced feelings of inadequacy and professional identity. Participants included 12 women of color who had taught for at least 1 year in higher education. Data were collected through semistructured interviews and analyzed using Giorgi’s descriptive phenomenological method, which involved identifying and transforming meaning units to derive an overarching structure of the experience. Findings revealed that participants experienced compounded discrimination, invisibility, and perfectionistic pressures that intensified imposter feelings despite high levels of achievement. The results highlight the need for institutional support systems that recognize and address these challenges. Ultimately, the study contributes to positive social change by informing policies and practices that foster inclusive academic environments, improve faculty retention, and empower marginalized voices within higher education
Staff Education for the Management of Cooccurring Mental Health and Substance Disorders
Get PDFThis Doctor of Nursing Practice (DNP) project was the development and evaluation of a staff education initiative aimed at improving nurses’ knowledge and confidence in managing patients with co-occurring mental health and substance use disorders. The practice problem was the lack of structured training, which left nurses underprepared and contributed to inconsistent care and poorer outcomes. Addressing this gap is essential in nursing practice to ensure safe, equitable, and patient-centered care. The practice-focused question for this project was: Does staff education in a behavioral health setting improve nurses’ knowledge and confidence in managing cooccurring mental health and substance use disorders, as measured pre- and post-education? The purpose was to implement and evaluate an evidence-based education program that prepared nurses to provide integrated, patient-centered care. Fourteen registered nurses participated in the project. Pre- and post-surveys were used to measure self-reported knowledge and confidence, and descriptive analysis was applied. Results showed improvements, with no participants in the lowest categories after training and more advancing to higher levels of competence and confidence. Findings confirmed that structured education can close practice gaps, strengthen confidence, and enhance care delivery. Key recommendations include integrating the program into staff orientation and offering refresher sessions. The project has important implications for nursing practice, including building workforce readiness, improving patient outcomes, and supporting vulnerable populations. Beyond the local site, it contributes to positive social change by reducing stigma and advancing diversity, equity, and inclusion in behavioral healthcare