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Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Reducing Observation Unit Length Of Stay Hours: A Quality Improvement Project, Rena D. Cantrell

Master of Science in Nursing Theses and Projects

An acute care observation unit provides care for patients admitted via Emergency Center (EC) or direct admission from a healthcare provider’s office who do not yet require inpatient status. The goal length of stay (LOS) for these patients should be less than or equal to 24-48 hours. This project is being developed for a 22-bed observation unit in the Southeastern United States to decrease current LOS hours. Currently, the goal LOS for this unit is 24 hours, not to exceed 48 hours, and for patients admitted with a chest pain diagnosis, no longer than 19 hours. A plan to expand …

Increasing Knowledge And Comfort Levels Of Icu Nurses In Goals Of Care Discussions Through Palliative Care Education, Stephanie Harrison

Doctor of Nursing Practice Projects

Critical care nurses are tasked with treating patients during the most complex times, typically beginning with aggressive treatment measures and in many cases, transitioning to end-of-life care. According to the literature review, critical care nurses report they frequently provide care that they feel is futile and palliative care resources are underutilized in the intensive care unit. They also report limited education/training and comfort in understanding their role in goals of care conversations and end-of-life care despite their vital role in providing direct patient care. The goal of this project was to implement an education program using the IMPACT-ICU toolkit to …

Debriefing Emergency Department Nurses During The Covid-19 Pandemic, Jessica Hailstock

Master of Science in Nursing Theses and Projects

This study examined the consequences of increased stress experienced by emergency department nurses related to the COVID-19 pandemic. The goal was to acknowledge that this particular population of nurses already experience high levels of stress and that being on the frontlines of healthcare during a pandemic exacerbates the issue. Nursing leaders within the emergency department must acknowledge and monitor the nurses’ stress. Findings suggest that debriefing led by qualified individuals is a powerful intervention to combat the negative effects of stress.

Gratitude Journaling As Intervention To Combat Nurse Burnout In Cardiac Surgery Intensive Care Nurses, Melinda Simpson

Master of Science in Nursing Theses and Projects

As a practicing registered nurse in the intensive care setting, this researcher witnessed an episode of burnout characterized by a public meltdown, crying, and yelling. This sparked an interest in an intervention to combat nurse burnout. Literature was found on gratitude which has been found to increase resiliency. An increase in resiliency, in various populations, has been found to decrease perceived stress and feelings of burnout. This researcher investigated the use of gratitude journaling for 21 days as means to decrease perceived stress and feelings of burnout while increasing gratitude and resiliency. The PSS, GQ, BRS, & BBI tools were …

Assessment Of Intensive Care Family Satisfaction, Jami Burnette

Doctor of Nursing Practice Projects

There continues to be an unknown factor in knowing true patient and family satisfaction within the intensive care unit (ICU) setting. Current literature reveals surveys used to measure patient satisfaction do not pertain to the ICU setting. Patients often do not remember the ICU stay due to critical illness and are unable to actively participate with care. Families act as surrogates, are included in patient care, and collaborate with nursing and medical teams to help make care decisions. Families are integral in the patient care process and are vital members of the health care team. Even though families are included …

Investigating Compassion Fatigue In Medical-Surgical Nurses, Tammy Darlene Shepherd

Nursing Theses and Capstone Projects

Medical-surgical nurses are consumed by providing care to patients and families and often forget to care for themselves. Compassion fatigue can lead to lack of caring for one’s self in the nurse’s life. The purpose of this thesis was to examine the existence of compassion fatigue among medical-surgical nurses and determine the correlation between the range of years of nursing experience and range of age in years. A review of the literature has identified that nurses should practice self-care to combat compassion fatigue. The theoretical framework was based on Jean Watson’s Theory of Transpersonal Caring. The Professional Quality of Life …

The Effect Of Individualized Nurse Report Cards And Unit Case Reports On The Awareness And Attitudes Of Nurses Towards Clabsi Contributing Factors, Shannon K. Hawkins

Nursing Theses and Capstone Projects

This DNP project examined the effect of unit case reports and individualized nurse report cards on nurses’ awareness of and attitudes toward central line-associated bloodstream infection (CLABSI) contributing factors. This project also sought to determine whether CLABSI incidences differed across units and if that was affected by nurses’ awareness of and attitudes toward CLABSI contributing factors. A convenience sample of registered nurses (RNs) across four medical units was included in this project. Of the 79 RNs who participated in providing feedback on this project, 48 RNs completed pre-implementation surveys, resulting in a response rate of 61%, and 53 completed post-implementation …

Primary Care "Catches" Up With Behavioral Health, Michael Hannes Thorarinson

Nursing Theses and Capstone Projects

The problems caused by the lack of care coordination between primary care and behavioral health are well documented. Patients with uncontrolled mental health issues along with chronic health problems cost two to three times the health care dollars to manage than patients who have the same chronic health problems but without uncontrolled mental health issues. Despite this, in rural North Carolina, the de facto level of care coordination is none. Mental health and primary care are completely separate, distinct systems that do not routinely communicate. One of the identified barriers to care coordination is the lack of reimbursement for the …

Effects Of Engaging Hospitalized Heart Failure Patients In A Self-Care Management Protocol On Self-Care Self-Confidence Levels, Michele Denise Blakely

Nursing Theses and Capstone Projects

Delivering high quality heart failure (HF) management and education to empower patients to manage successfully in the community is imperative. Common trends observed impacting HF patients and concerning inpatient nurses on a medical cardiology unit were identified and discussed. Understanding accessing and adhering to a low salt diet, fluid restriction, and daily weights were all commonly identified challenges by direct care nurses of HF patients. Nurses reported increased frustration with patients not knowing or possessing little awareness of their fluid restriction or how to manage or articulate restrictions during the inpatient stay. Nurses felt intake and output (I&O) and daily …

Patient Safety In The Ambulatory Oncology Environment: A Teamstepps® Journey, Tammi Phelps Hick

Nursing Theses and Capstone Projects

Problem: Children have reported that pain and anxiety were the most difficult part of hospitalization, and under treatment of pain and anxiety can have short and long term effects on health outcomes. Most healthcare professionals recognize a link between emotional health and physical health, but this may be especially true for pediatric patients who may not be able to marshal adequate coping skills due to their developmental age. Providing age appropriate alternatives, such as distraction therapy, may result in less invasive treatments for pediatric patients. Distraction therapy is an effective non-pharmacological intervention that is often under-utilized in the acute care …

Improving Cardiopulmonary Resuscitation Skills Using Unit Based Simulation, Lesa R. Smith

Nursing Theses and Capstone Projects

The performance and quick interventions by nurses during a code blue event can have significant impact on patient outcomes. Code blue events can be stressful for nurses practicing in the medical surgical environment where, since the implementation of rapid response teams, the number of code blue events has decreased. The traditional basic life support (BLS) offering in the acute care settings offers nurses the opportunity to practice cardiopulmonary resuscitation (CPR) with manikins and automatic external defibrillators (AED). However, the experience is lacking real working environment teams and equipment in which nurses practice every day. It is also well documented in …

Telephone Follow-Up To Reduce The Readmission Rate In Gynecologic Oncology Surgery Patients, Karla Kenyon Fernandez

Nursing Theses and Capstone Projects

Unplanned hospital readmissions are commonly viewed as a marker of poor quality care and result in increased costs for both healthcare institutions and patients. Factors associated with readmission for gynecological oncology patients can be related to the radical surgical interventions required for the management of their disease, as well as complex comorbidity profiles, surgical complexity, cancer stage, and perioperative complications. The purpose of this study was to explore and examine the impact of nursing-led telephone follow up on the reduction of the readmission rate in gynecologic oncology abdominal surgery patients following initial discharge post-operatively. A cross-sectional research study was used …

Utilization Of Emergency Departments: Examining Patient Perception Of Urgency, Susan Dale O'Shields

Nursing Theses and Capstone Projects

Nationwide volumes of those utilizing an emergency department (ED) for care have increased significantly over three decades with health professionals witnessing a significant increase of those triaged as non-urgent. Despite alternative healthcare resources, utilization has continued. Multiple factors are influential in the decision-making process with seriousness of condition having a direct link. However, a gap of knowledge exists between the professionals’ actual measured level of acuity and the patient’s perceived level. The term “urgency” has no standard definition in healthcare. Few studies have examined urgency from the patient’s perspective. The purpose of this study was to identify primary factors influential …

Registered Nurse Satisfaction: The Impact Of Organizational Communication On Satisfaction Among Registered Nurses In The Acute Care/Hospital Setting, Lori Michelle Lovelace

Nursing Theses and Capstone Projects

Organizational communication can impact the satisfaction of registered nurses in the acute care hospital setting. With the projected growth of the nursing profession, recruitment and retention of registered nurses is essential in building a highly engaged workforce. Literature review identified areas that impact nurse satisfaction including salary and benefits, nursing leadership, nursing engagement, and nursing workload and staffing. The researcher recognized a gap in the literature regarding the impact of organizational communication on satisfaction of registered nurses in the acute care hospital setting. This study evaluates the difference in the satisfaction of organizational communication among registered nurses who spend less …

Compassion Fatigue And Burnout Of Critical Care Nurses, Lyndsey Brooke Couch

Nursing Theses and Capstone Projects

The purpose of this study was to explore levels of compassion satisfaction, compassion fatigue, burnout, and secondary post-traumatic stress of critical care nurses. Compassion fatigue is a combination of physical, emotional, and spiritual depletion that caregivers experience when they care for patients who are in physical or emotional distress. Compassion fatigue has affected many nurses and has a direct effect on patients' satisfactions. Jean Watson's Theory of Human Caring served as the theoretical framework for this study. The literature shows that there is a prevalence of compassion fatigue of acute care nurses. A quantitative study was performed using the ProQOL …

Compassion Fatigue: Exploring The Impact On Emergency Department Nurses, Lauren E. Pittman

Nursing Theses and Capstone Projects

The purpose of this thesis project was to explore levels of compassion fatigue in emergency department nurses. Compassion fatigue has directly affected many nurses’ lives as well as impacting the field of nursing in various ways. Jean Watson’s Theory of Human Caring served as the theoretical framework for the study. The literature maintains that the prevalence of compassion fatigue has been established, yet severity varies among institutions and specialties. A quantitative study to determine the level of compassion fatigue in ED nurses was conducted by utilizing a group on the social media site Facebook that is specific to travel nurses …

Stemi Gender Differences, Rhonda Anderson

Nursing Theses and Capstone Projects

The purpose of this study was to look at gender differences in a ST elevation myocardial infarction (STEMI), in a population from a large tertiary hospital over one year and three months period to see if there were differences in female and male population. Looking at the time of onset of symptoms to time in seeking treatment and to see if this had an impact on morbidity, treatment modalities, and length of stay in the hospital. The time of onset of symptoms to time of treatment is important because of the time-dependent nature of reperfusion strategies. This can minimize myocardial …

Bedside Nurses' Perceptions Of Intensive Care Unit Telemedicine In A Rural Setting, Susan Parker

Nursing Theses and Capstone Projects

Healthcare is a rapidly changing and continuously advancing field. Currently, virtual care technology (e-ICU) is moving into many rural healthcare facilities in an effort to improve patient care outcomes and bridge physician and nursing shortages. The purpose of this Masters of Science thesis is to determine the impact that electronic telemedicine has on the quality of nursing care at the bedside. The study done by Mullen-Fortino et al. (2012) in an urban academic center was replicated to compare the bedside nurses’ perception of ICU telemedicine in a rural hospital setting. Thirty-eight rural ICU nurses working with ICU telemedicine responded to …

The Impact Of Self-Care Education On Heart Failure Patients With A High Risk For Readmission, Neil Williams Ii

Nursing Theses and Capstone Projects

The purpose of this Capstone Project study was to answer the question: Does self-care education improve knowledge and decrease 30 day readmission rates in a class of heart failure patients that are at high risk for exacerbation? The study used a randomized control design with a pre-test/post-test. A convenience sample of 50 African Americans diagnosed with heart failure were entered; control group (n=25) and experimental group (n=25). Both groups received the Heart failure Pre/Post Test developed by the researcher during the initial interview and four weeks post discharge. The experimental group received a phone call weekly over the four weeks …

Incorporating Simulation Into Advanced Cardiac Life Support, Lorraine Calwile

Nursing Theses and Capstone Projects

The knowledge and practical skills of the Basic Life Support (BLS) and the Advanced Cardiac Life Support (ACLS) are among the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. Every year there are millions of healthcare workers that dread coming to ACLS class for fear of failure of the written exam or the mega code. Many of these participants haven’t participated in a code situation since they left class the previous two years. Participants sit in class for two days listening to lectures and going through practice mega codes to prepare them for the final mega code. …

Staff Perception Related To Family Presence During Resuscitation, Stephanie L. Herron

Nursing Theses and Capstone Projects

The purpose of this study was to examine the perception of health care professionals (staff nurses) regarding family presence during resuscitation. The sample consisted of 59 nurses of different ages and working in different departments. The Staff Perceptions of Family-Witnessed Resuscitation questionnaire was used to collect data. The relationships between participants' demographic data and perceived attitudes and beliefs were also analyzed. Many of the healthcare professionals felt that it was acceptable to have family members present during resuscitation if the patient makes clear decisions prior to the incident or if the physician makes the decision for the patient. Almost half …

Discharge Education In The Emergency Department: Are We Effectively Teaching Chest Pain Patients?, Emily Edwards Nishiyama

Nursing Theses and Capstone Projects

Millions of individuals visit the emergency department (ED) each year with complaints of chest pain. Many chest pain patients do not have an underlying condition of Acute Coronary Syndrome (ACS) but the health and well-being of these patients is indispensable. Research has indicated soaring costs, an increased demand in medical resources, and an increasingly poor quality of life for these patients after discharge. Although research encourages quality education at discharge, very few studies have been conducted on ED discharge education for non-ACS chest pain patients. Using a cross-sectional descriptive research design, this quantitative study discovered the frequency of education provided …

The Effects Of Oral Pain Medication Being Administered In Phase I As Compared To Oral Pain Medications Administered In Phase Ii, Dana Jones

Nursing Theses and Capstone Projects

Healthcare and the provision of care are ever-changing as governing bodies over-see and regulate the way institutions provide care for patients. Pain assessment, reassessment, and pain management are a focus nationally and healthcare providers are held accountable for how pain is managed for patients. One piece to this broad topic is the use of oral pain medications, more specifically in the ambulatory surgical patient. The purpose of this project was to compare the length of stay, reported pain scores, and total amount of IV medications administered between patients who receive the first dose of oral pain medications in Phase I …

Nursing Retention In Critical Care, Jeannine A. Eckman

Nursing Theses and Capstone Projects

The purpose of the study was to examine anticipated turnover in critical care nurses and if having previous nursing experience prior to working in critical care affects that turnover. Using the Anticipated Turnover Scale (ATS) by Hinson and Atwood, nurses that had been employed in the critical care areas five years or less were asked to participate. They were asked to complete the ATS and answer the question relating to previous nursing experience. Findings of the study indicated that the nurses with previous nursing experience before working in critical care had a higher ATS score than the nurses with no …

Patient Education In The Emergency Department, Bryan K. Devinney

Nursing Theses and Capstone Projects

Patient education is a core component to the practice of nursing in many countries, including the United States. Emergency department nurses are often overwhelmed with the number of patients they must care for in short amounts of time. The patients are often in varying stages of evaluation and treatment, and the nurse may be involved in one-on-one interventions with these patients. This can leave little time for patient education, especially if the nurse does not feel like the patient education is meaningful or useful. Various factors can influence the ability and desire of the emergency department nurse to provide proper …

Nurse Manager Role Perception In An Acute Care Facility, H. Gale Waters

Nursing Theses and Capstone Projects

The Nurse Manager role is a crucial part of the healthcare delivery system in an acute care facility, particularly in the current wave of healthcare reform. These are unprecedented times for nursing leadership as they develop and move in a new direction. The role of Nurse Manager is complex with numerous studies including: past roles, characteristics, innovation, outcome, education, and advancement. This study observed the role through the point of view of the Nurse Manager. The Nurse Managers participated in a survey in which they ranked themselves on a one to five scale, with one being a novice in the …

Early Home Visits By A Registered Nurse Care Manager With Heart Failure Patients, Dana Davis Blake

Nursing Theses and Capstone Projects

Strategies focused on 30 days in the life of a patient with heart failure will have limited impact on the burden that heart failure will have nationally or individually. The broader landscape of readmission risk underscores the need for a more comprehensive approach to heart failure management. Care management with a registered nurse demonstrated efficiently coordinate care. Home visits address the peaks of risk in the post-discharge transition and palliative phase while providing longitudinal support. The purpose of this study is to substantiate that early home visits and telephone followup with a registered nurse after discharge from the hospital will …

Improving Patient Flow Through The Implementation Of A Results Pending Treatment Area, Heather L. Bryant

Nursing Theses and Capstone Projects

Abstract

The purpose of this research study is to retrospectively evaluate whether the implementation of a Results Pending Treatment Area (RPTA) altered patient flow patterns and therefore reduced patient length of stay (LOS) for ambulatory patients in a Level One Trauma Center Emergency Department. The research is justified because a reduction in the length of stay for patients is shown to decrease overcrowding, ED wait times, loss of revenue, and diversion while improving patient safety and patient satisfaction. The Roy Adaptation Model was the overarching theoretical conceptual framework utilized to support the research, with a more detailed emphasis on Swanson's …

Evidence Based Practice: Patient Discharge Education Barriers To Patient Education, Catherine Lyerly Lingle

Nursing Theses and Capstone Projects

Evidence-based guidelines for discharge instructions, when successfully administered, reduce readmission rates in patients, leading to improved quality of life and economic savings. Unfortunately, effective delivery is complex and time consuming, placing a high demand on already overworked bedside nurses. Failure to provide complete discharge instructions can result in non adherence to patient treatment regimens and lack of essential follow-up, the most commonly identified reasons for readmissions. To improve quality of care, hospitals need to adopt a new model that incorporates delivery of intensive, one on one education to patients during the hospital stay with continuing support, guidance, and education throughout …