Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Tracie Gadler, DNP, APRN, ACHPN, RNFA, FNP-C

Abstract

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, which provided a systematic approach to identifying clinical problems, appraising evidence, implementing practice changes, and evaluating outcomes.
Methods: Following identification of a gap in GI symptom management workflow, three evidence-based standing order sets for constipation, nausea/vomiting, and diarrhea were developed, refined through interdisciplinary team review, and implemented into clinic triage workflow. Baseline data were collected via a six-month retrospective chart review of triage nurse-patient encounters, with prospective data collected similarly over three months post- implementation to evaluate impact on workflow consistency, timeliness, and quality. Additionally, clinician satisfaction was assessed through post-implementation surveys.
Results: The standing order sets were found to be effective in resolving GI symptoms, demonstrated high adherence rates, increased consistency with evidence-based practice, improved follow-up timeframes, and eliminated provider workflow interruptions for routine symptom management. Additionally, post-intervention surveys showed positive impressions of the practice change, and overall support of nursing staff’s expanded professional role.

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