Date of Award


Degree Type


Degree Name

Doctor of Education (EdD)

First Advisor

Melvin Welch

Second Advisor

Paul Koch

Third Advisor

Houston Thompson

Scholarship Domain(s)

Scholarship of Discovery


A clinical quality review (CQR) assessing high-risk areas as staffing, change in condition, and pressure ulcers (PU) was completed in 31 nursing homes. Scores between the assigned clinician and the researcher were analyzed using paired t-tests and Pearson r correlations. Average scores for staffing were reliable, while the PU and change in condition scores were significantly different. Individual staffing, 6 of 9 change in condition, and 9 of 18 PU questions were reliable and consistent. Multiple regressions compared relationships between performance improvement (PI), internal risk, and CQR scores with various results. The internal risk and PI scores were inversely related. Future focus should be on PI, and review of policies and instructions for change in condition and PU areas.


Ed.D. dissertation completed in 2010 for Olivet Nazarene University.