Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Adriane Stasurak
Abstract
Problem: The outpatient urology practice encountered challenges with adherence to Clinical Practice Guidelines (CPGs), primarily due to unfamiliarity and lack of operational accountability. This led to a low adherence rate of only 40% among patients with bladder cancer. Key issues included inadequate training and knowledge gaps regarding CPGs.
Aim of the Project: The project aimed to improve patient care and outcomes in bladder cancer treatment by enhancing patient retention and adherence to treatment protocols. Evidence-based interventions were implemented to optimize care delivery and support adherence to prescribed treatments.
Review of Evidence: A literature review highlights the effectiveness of nurse navigator interventions in improving patient compliance by addressing barriers, including coordinating follow-up appointments and serving as a primary point of contact. This evidence emphasizes the value of proactive, patient-centered approaches in enhancing care coordination and practice efficiency.
Project Design: The project utilized the Plan-Do-Study-Act (PDSA) cycle with the OhioHealth Change Management model to engage stakeholders and gather feedback. Tools such as Electronic Health Records (EHRs) and Excel spreadsheets facilitated regular communication and enabled real-time problem resolution through targeted interventions.
Intervention: The intervention aimed to monitor positive pathologic biopsies following Transurethral Resection of Bladder Tumor (TURBT) to ensure adherence to the National Comprehensive Cancer Network (NCCN) clinical guidelines for the management of bladder cancer. Patients not adhering to these guidelines were referred to the Physician Champion for review, followed by discussions to align patient follow-up with the appropriate clinical practices.
Significant Findings/Outcomes: The percentage of patients receiving timely follow-up appointments improved from 36% in December 2025 to 82% by January and February 2026, following the establishment of a standard operating procedure for automatic follow-up appointments two weeks post-Transurethral Resection of Bladder Tumor (TURBT). Additionally, adherence to Clinical Practice Guidelines (CPGs) increased from 38% to 59% in the same period.
Implications for Nursing: This initiative highlighted nursing's role in ensuring continuity of patient care. By focusing on patient-centered care, it improved retention, reduced the risk of non-compliance, and enhanced the quality of care. Ongoing nursing leadership monitoring of key performance indicators (KPIs) is crucial for long-term impact and cost savings.
Recommended Citation
Boren, Melanie, "Poor Adherence to Established Clinical Guidelines in Outpatient Bladder Cancer Management" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 64.
https://fuse.franklin.edu/dnp-project/64
Rights
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