Date of Conferral

8-11-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Betsy Rodgers

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and hospital readmissions, with rural critical access hospitals (CAHs) facing unique challenges in delivering consistent, evidence-based care. At the pilot CAH medical–surgical unit, local chart review and practice observation revealed an approximately 18% 30-day COPD readmission rate and significant variation in discharge education, written action plans, inhaler technique assessment, and structured post‑discharge follow‑up. The purpose of this Doctor of Nursing Practice project was to develop and appraise an evidence‑based, Appraisal of Guidelines Research and Evaluation II (AGREE II) and Institute of Medicine–compliant COPD clinical practice guideline (CPG) to address these practice gaps and support future standardization of inpatient and transitional COPD care in a rural setting. Using the Johns Hopkins Evidence‑Based Practice Model, a systematic literature review was conducted across CINAHL, PubMed, and the Cochrane Database of Systematic Reviews, yielding 11 appraised sources that included Level I and II studies, expert consensus, and local organizational data. Key evidence supported self‑management interventions with written exacerbation action plans, nurse‑led transitional care, standardized COPD bundles, and teach‑back‑based education to reduce hospital admissions, 30‑day readmissions, and emergency department revisits. The COPD CPG was drafted to address diagnostic confirmation and classification, standardized admission and discharge processes, guideline‑concordant pharmacotherapy, inhaler technique assessment, patient self‑management education, individualized written action planning, and early post‑discharge follow‑up. Guideline quality was evaluated using the 23‑item AGREE II instrument by a five‑member multidisciplinary content expert panel representing nursing, medicine, respiratory therapy, and quality. Scaled domain scores exceeded the commonly accepted 60% quality threshold across all six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, Editorial Independence), and the mean overall quality rating was 6.4 on a 7‑point scale. Narrative feedback highlighted the clarity of pharmacologic recommendations, usability of scoring tools (CAT, GOLD group, mMRC), and bedside readiness of the discharge checklist and written action plan; suggestions led to clarifications of stakeholder credentials, rural resource barriers, and antibiotic stewardship pathways, which were incorporated into the final CPG. The AGREE II Overall Guideline Assessment completed by the same panel resulted in unanimous recommendation for use (Yes/Yes with modifications). Although clinical implementation and outcome measurement were beyond the scope of this project, adoption of the CPG is anticipated to standardize COPD admission and discharge workflows, improve inhaler technique assessment and patient education, optimize pharmacotherapy in alignment with GOLD and COPD‑X guidance, and support evidence‑based self‑management and transitional care in an underserved rural population. This project demonstrates how the DNP role can bridge the gap between research evidence and clinical practice through locally relevant, rigorously appraised guideline development, with potential to reduce health disparities and promote positive social change by embedding health‑literacy‑sensitive, person‑centered COPD care in rural CAHs.

Download

Share

 
COinS