Date of Conferral

8-26-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Joan Hahn

Abstract

This quality improvement staff education project addressed the inconsistent use of the Clinical Institute Withdrawal Assessment (CIWA) and Clinical Opiate Withdrawal Scale (COWS) assessment tools among nursing staff in an adult psychiatric and addictions unit located in the Mid-Atlantic region of the United States. Inconsistent use of the CIWA and COWS tools may lead to unfavorable patient outcomes. The goal of this project was to enhance nursing familiarity, confidence, and sense of importance in using CIWA and COWS tools for assessing and managing withdrawal symptoms in patients with co-occurring depression and substance use disorders. A pre- and posteducation survey design was used to evaluate the impact of an evidence-based training session using a five-item survey. Data from three items, rated using a Likert scale (1 = low to 5 = high), demonstrated sizeable improvements in participants’ self-reported familiarity and confidence from means 2.25 to 4.0, a 77.8 normalized learning gain, while sense of importance showed a lower gain (14.3) due to higher scores prior to education (M = 3.5). Qualitative responses from two open-ended items revealed posteducation themes, such as improved symptom recognition, appreciation for standardized tools, and increased accuracy in applying CIWA/COWS protocols. Staff expressed greater clarity in how to score and reassess symptoms, along with a commitment to integrating the tools into routine care. The results support the effectiveness of education in closing practice gaps and underscore the importance of structured assessment tools in ensuring consistent and safe withdrawal management. This initiative met its original objectives and lays the groundwork for sustainable improvements in clinical practice across psychiatric settings for patients experiencing withdrawal symptoms from substance use disorder.

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