Date of Graduation

Fall 12-12-2025

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Department/Program

Public Health

Program

MSN project

First Advisor

Mohamad El Najm, PhD, MHCM, MSN-Ed, RN

Second Advisor

Ana Viera-Martinez, DNP, APRN-CNS, CNL, RNC-OB, CLE

Abstract

This quality improvement project addressed the problem of incomplete or unsustained clinical initiatives at a long-term care facility by introducing Kotter’s Change Model, an evidence-based framework designed to support and sustain lasting improvements in clinical practice. Within the context of a religious-based residential community for older adults with complex chronic needs, the objective was to strengthen the facility’s capacity to implement and sustain change more effectively. By using two previously unfinished initiatives, the NaRT triage tool and Polypharmacy management process, the project applied Kotter’s model to evaluate how structured change strategies can improve staff engagement, leadership alignment, and long-term project sustainability. Thus, the central aim was to enhance the sustainability of clinical initiatives by adopting Kotter’s 8-Step Change Model and to complete the two prioritized projects. The methods involved a mixed-methods approach: Kotter’s model was introduced to leadership, the NaRT tool was refined and paired with simulation training for nursing staff, and a Polypharmacy protocol was developed using expert consensus methods. Key measures included leadership validation rates, expert consensus on clinical tools via Delphi methods, and nursing staff competency assessed through simulation checklists. The results demonstrated a 100% leadership validation and adoption of Kotter’s model, a 100% expert validation rate for both the revised NaRT tool and the new Polypharmacy protocol, and a 100% pass rate among trained nurses (16/16) on competency assessments. In conclusion, the application of a structured, evidence-based change management model successfully enabled the completion of previously stalled QI projects. It established a replicable process for achieving sustainable clinical improvements, thereby directly addressing the core problem of initiative failure.

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