Defense Date

7-20-2026

Graduation Date

Summer 8-7-2026

Submission Type

Dissertation/Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Doctor of Nursing Practice (DNP) Program

School

School of Nursing

Faculty Mentor

Frank Kosnosky

Committee Member

Gwendolyn Lane

Keywords

loneliness, home-health aides, older adults, quality improvement, behavioral activation, empathy-focused communication

Abstract

Loneliness is a significant public health concern that adversely affects mental, cognitive, and physical health, with consequences comparable to smoking 15 cigarettes per day. Home care recipients experience loneliness at rates of 15.9% to 24.2%, yet home-health aides (HHAs), who often have the most consistent contact with homebound clients, lack structured tools for recognizing and responding to loneliness. This gap highlights the need for practical, evidence-based strategies that can be integrated into routine home care practice. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the feasibility, acceptability, and appropriateness of a home-health aide–delivered loneliness reduction program within a small, privately owned home care agency in the northeastern United States. Guided by Jean Watson’s Theory of Human Caring, the Johns Hopkins Evidence-Based Practice Model, and the Institute for Healthcare Improvement’s Model for Improvement with Plan-Do-Study-Act cycles, HHAs completed a 30-minute interactive online training module followed by a four-week pilot. They screened clients using the UCLA Three-Item Loneliness Scale and implemented Behavioral Activation activities and Empathy-Focused Communication techniques during routine visits. Pre-learning, post-learning, and post-pilot surveys were administered using the Adapted Perceived Competence Scale, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Data was analyzed descriptively and thematically. Findings demonstrated increased HHA perceived competence after training, with PCS means rising from 6.20 pre-learning to 6.70 post-learning and remaining high at 6.63 post-pilot. AIM, IAM, and FIM scores exceeded the ≥ 4.0 benchmark, supporting acceptability, appropriateness, and feasibility. HHAs used strategies on 87 of 111 reported care days, and limited client feedback suggested supportive, meaningful engagement. These results support Caring Connections as a sustainable, low-cost framework for home care and reinforce frontline caregivers’ role in addressing loneliness and social connection needs in practice.

Language

English

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