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Articles 1 - 30 of 47
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Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt
Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt
Doctor of Nursing Practice Projects
Background
In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.
Purpose
The …
Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest
Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest
Master's Projects and Capstones
Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …
Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey
Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey
Doctoral Projects
Improper positioning of patients in the lateral decubitus or prone positions can lead to significant complications, including but not limited to: airway and invasive line loss, physiologic derangements, soft tissue injury, and peripheral nerve injuries (PNI) (Barash et al., 2017; Butterworth et al., 2018). Chui et al.’s (2018) analysis found that PNIs accounted for 12% of anesthesia malpractice since 1990, making PNIs costly. PNIs effects are not limited to cost and result in increased lengths of stay, increased pain levels, and decreased quality of life (Wojtkiewicz et al., 2015). The massive effect poor positioning can have requires that the anesthesia …
Improving The Perioperative Experience Of Patients And Families In A Pediatric Setting, Anjanette Pong
Improving The Perioperative Experience Of Patients And Families In A Pediatric Setting, Anjanette Pong
Student Scholarly Projects
Practice Problem: The experience of surgery for pediatric patients and their families can be dependent on multiple factors including adequate preparation, English language proficiency and realistic expectations. Anxiety can contribute to a negative experience that may result in poor outcomes and a damaging reflection of the healthcare team and organization.
PICOT: The PICOT question that guided this project was: In preoperative pediatric patients and their families, how do therapeutic communication style and the provision of information about the perioperative experience affect their healthcare experience over eight weeks?
Evidence: A multi-modal approach to providing tailored preoperative education for the child and …
Factors Impacting Organ Transplant Outcomes, Katelyn Grubich
Factors Impacting Organ Transplant Outcomes, Katelyn Grubich
Nursing | Senior Theses
Organ transplants are crucial to the survival of those on the receiving end. With medicine advancing, so has transplantation. Health care providers are becoming more aware of the strategies necessary to prolong the transplanted organ and how to obtain better outcomes. Heart, lungs, kidney, liver, pancreas, and some where more than one organ are involved, are the types of organ transplants performed.
Providing patients information will allow them to be a part of their treatment and can help to ease their anxiety knowing what is being performed and what can be expected. Health care providers must ensure that patients and …
Objective Structured Clinical Evaluation For Volume Control And Pressure Control Ventilator Modes, Brian Bailey, Anthony Newsom
Objective Structured Clinical Evaluation For Volume Control And Pressure Control Ventilator Modes, Brian Bailey, Anthony Newsom
Doctoral Projects
The purpose of this doctoral project was to create a tool to teach student registered nurse anesthetists (SRNAs) in The University of Sothern Mississippi’s (USM’s) anesthesia program about pressure control and volume control ventilator modes, and how to use them. To accomplish this goal an Objective Structured Clinical Examination (OSCE) was developed. The framework used for creating this OSCE was Kolb's Theory. Kolb's Theory uses a four-stage learning cycle in which the learner encounters a new experience, reflects on the observations of said new experience, conceptualizes or modifies a concept based on this experience, and then applies their idea to …
Teaching Time: Postoperative Urinary Catheter Care In The Preoperative Setting Before Surgery, Lynn Utecht
Teaching Time: Postoperative Urinary Catheter Care In The Preoperative Setting Before Surgery, Lynn Utecht
Master's Projects and Capstones
Abstract
Problem: Patients who have same day surgery often have little or no recall of the postoperative home care instructions when delivered in the aftercare area. The number of instructions that are required for home care, combined with medications given for pain and nausea as well as anesthesia, can make recall of these instructions difficult. The purpose of this quality improvement project was to provide the postoperative instructions for post prostatectomy patients discharged with an indwelling urinary catheter in the pre-operative area before the patient underwent surgery to decrease the length of time the patient spent in the recovery unit. …
Utilization Of A Block Excellence Specialty Team Is B.E.S.T, Lauren E. Pittman
Utilization Of A Block Excellence Specialty Team Is B.E.S.T, Lauren E. Pittman
Master's Projects and Capstones
Perioperative registered nurses and anesthesiologists that rely on a process for placing regional anesthesia (R.A.) blocks on the correct side for surgical patients consistently provide high-quality, safe care. Infrequently anesthesiologists place the wrong side peripheral nerve blocks (P.N.B.). Due to the sensitive nature of sentinel events, the frequency of its occurrence at this quality improvement (Q.I.) project site is unavailable. Therefore, a report by Harris et al. (2021) was referenced for the incidence of wrong side blocks (W.S.B.), which were recorded in worldwide, national, and multihospital health care system cohorts as 3.63/10,000, 1.6/10,000, and 1.28/10,000 respectively. The PreOp/PACU nursing staff …
Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone
Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone
Master's Projects and Capstones
Abstract
Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.
Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.
Intervention: A …
Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone
Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone
Master's Projects and Capstones
Problem
One million hospitalized people fall annually in the United States, and up to a third are preventable.
Context
Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.
Interventions
A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.
Measures
Outcome measures observe for total fall count and the …
Cognitive Preference And Skill Acquisition: The Relationship Between Student Nurse Anesthetists And Certified Registered Nurse Anesthetists Thinking Styles, Thomas Diller
Electronic Theses and Dissertations
Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making.
The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher …
Anesthetic Considerations For Patients With Aortic Stenosis, Owen Diehl
Anesthetic Considerations For Patients With Aortic Stenosis, Owen Diehl
Nursing Student Class Projects (Formerly MSN)
Aortic Stenosis places surgical patients at greater risk for adverse events during surgery. Due to the pathological process of Aortic Stenosis, the left ventricle must generate high systolic pressures to ensure adequate cardiac output. These increased pressures result in left ventricular hypertrophy, placing the patient at greater risk for myocardial ischemia. For induction of anesthesia, it is imperative to maintain hemodynamic stability as this is where problems arise. Five research articles were reviewed to determine how to administer anesthesia to these patients safely. Additional sources were gathered for a background on the pathophysiology of aortic stenosis. The research articles reviewed …
Myasthenia Gravis, Rebecca Wheeler
Myasthenia Gravis, Rebecca Wheeler
Nursing Student Class Projects (Formerly MSN)
Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …
Reducing Falls Related To Toileting, Brian Locastro
Reducing Falls Related To Toileting, Brian Locastro
Student Scholarly Projects
Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days.
PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)?
Evidence: Nine high-quality articles supported a toileting …
Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill
Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill
Student Scholarly Projects
Practice Problem: Immobility of patients in the hospital intensive care unit can cause longer stays in the intensive care unit and the hospital. Evidence-based early mobilization of patients helps to reduce length of stay (LOS) and avoid many detrimental sequelae, leading to short and long-term debilitation.
PICOT: The PICOT question that guided this project was: In the adult medical and surgical intensive care units (P), how does implementation of a nurse-driven protocol for early mobility (I), affect the LOS in the intensive care units and the LOS in the hospital (O), as opposed to not using a protocol for early …
Implementation Of A Pre-Anesthesia Questionnaire In The Preoperative Phase Of Care, Katherine Jones
Implementation Of A Pre-Anesthesia Questionnaire In The Preoperative Phase Of Care, Katherine Jones
Dissertations
The preoperative assessment is an integral component in the prevention of perioperative complications and costly procedure cancellations. Efforts to improve the quality and efficiency of the preoperative assessment have included the use of surgical safety checklists in the preoperative and postoperative phases of care. Patient information obtained in the preoperative setting provides the foundational structure for the information relayed down the clinical pathway. Strategies to improve the quality and integrity of the preoperative assessment are needed to ensure the patient’s safety and avoid procedure delays.
Purpose: To improve the preoperative assessment by decreasing the occurrence of incomplete or inaccurate information …
Standardizing Discharge Practices For Pediatric Urology Outpatient Procedures: A Quality Improvement Project, Megan Bush
Standardizing Discharge Practices For Pediatric Urology Outpatient Procedures: A Quality Improvement Project, Megan Bush
Dissertations
Background: Standard discharge instructions of verbal and written methods are only understood by about 45-50% of caregivers. Video discharge instructions (VDIs) in addition to standard methods of verbal and written instructions can be very effective for caregiver comprehension (CC), retaining discharge education information and improving patient outcomes. Problem: In an outpatient surgery department in a Midwestern Children’s hospital, 100% of the discharge instructions for pediatric urology outpatient procedures are different than the instructions given to caregivers by the surgeon. Methods: The study utilizes a descriptive evaluation of change in how discharge instructions were written and provided. Interventions …
Perioperative Risks Of The Patient With Heart Failure, Gabrielle Metoyer
Perioperative Risks Of The Patient With Heart Failure, Gabrielle Metoyer
Nursing Student Class Projects (Formerly MSN)
Perioperative Risks of the Patient with Heart Failure
Gabrielle Metoyer
Department of Nursing, Otterbein University
NURS 6810 – Advanced Pathophysiology
Dr. Deanna Batross and Dr. Shivani Bhatnagar
August 5, 2022
Abstract
According to the CDC (2020), heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in your body. Heart failure is an epidemic disease affecting 1-2% of the population worldwide (Schwinger, 2020). It is one of the leading causes of morbidity and mortality worldwide with an estimated 6.5 million adults with heart failure in the United States (Lo et al., 2021). Medical advances …
Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher
Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher
Doctor of Nursing Practice Final Manuscripts
Pancreatic cancer remains one of the most complex and lethal diseases worldwide with surgical resection as a major treatment choice. Although surgery may be one of the only options for advanced pancreatic cancer, it is not without a lengthy hospital stay, a long list of possible postoperative complications, and an increased risk for readmission after discharge. Enhanced recovery after surgery (ERAS) programs have been implemented for years in other surgical services for cancer care. These programs have now been extended and researched to include patients undergoing surgery for pancreatic cancer. These programs are designed to assist patients and their families …
Surgical Site Infections: Reducing Excessive Foot Traffic In The Surgical Room To Minimize The Risk Of Surgical Site Infections, Christopher D. Pobre
Surgical Site Infections: Reducing Excessive Foot Traffic In The Surgical Room To Minimize The Risk Of Surgical Site Infections, Christopher D. Pobre
Master's Projects and Capstones
Problem: In 2021, a perioperative unit experienced 21 different surgical site infections (SSIs). SSIs are associated with increased medical complications and financial costs. One risk factor for SSIs is the increased or excessive operating room (OR) foot traffic, which increases airborne contaminants within the OR.
Context: A seven-room operating department performing 5,800 surgical procedures annually. The unit specializes in general, elective, and emergent procedures for the adult population predominately in the East Bay Area. A diverse mix of surgical procedures was observed throughout this project.
Assessment: A microsystem assessment was conducted to determine the causes and patterns that lead to …
Implementation Of Aidet And Commit To Sit In Pediatric Outpatient Setting, Shibani Dhir
Implementation Of Aidet And Commit To Sit In Pediatric Outpatient Setting, Shibani Dhir
Master's Projects and Capstones
Problem: This quality improvement project implements AIDET (Acknowledge, Introduce, Duration, Explain, and Thank You), Commit to Sit, and cultural-competent care to improve patient satisfaction and communication between multidisciplinary health care team members and patients in a microsystem of a pediatric outpatient setting. The National Research Company (NRC) scores from the microsystem are below the 85th percentile, and this microsystem strives for excellence in the care provided to patients. The detractors from the patient satisfaction scores include patients scoring low on staff needing to work together, care providers not taking enough time to explain and listen, wanting to trust providers with …
Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance
Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance
Master's Projects and Capstones
Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …
Implementation Of Aidet, Commit To Sit, And Culturally-Competent Care In Pediatric Outpatient Setting, Melanie T. Wine
Implementation Of Aidet, Commit To Sit, And Culturally-Competent Care In Pediatric Outpatient Setting, Melanie T. Wine
Master's Projects and Capstones
Problem: This quality improvement project implements AIDET, Commit to Sit, and culturally-competent care to improve patient satisfaction and communication between providers and patients in a diverse pediatric outpatient surgery microsystem setting. The microsystem’s NRC patient satisfaction scores from September to September is below the 85th percentile, and there is an immense desire to improve the overall scores by the staff. The detractors of the overall performance derived from the patients feeling that the staff needs to work together to meet patients’ needs, care providers not taking enough time to explain and listen, wanting to trust providers with care, procedures …
Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad
Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad
Master's Projects and Capstones
Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …
Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland
Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland
Doctor of Nursing Practice (DNP) Projects
BACKGROUND: Millions of nurse practitioners (NP), physician assistants (PA), and registered nurses (RN) are optimistic that their current employers will help them reach their full potential. One area that can add value to the hospital and empower employees to work to the full scope of their practice, and utilize the skillsets like that of an NP, is to train these providers to support medical device equipment in the operating room instead of relying on medical device representatives (MDRs) of medical device companies.
METHODS: Training NPs, PAs, or RNs how to support neurological medical device equipment will better utilize the skillset …
The Lived Experience Of Second Victim Crnas, Michael Neft
The Lived Experience Of Second Victim Crnas, Michael Neft
Electronic Theses and Dissertations
A second victim is a health care provider who has been involved in a critical event. A
critical event is a clinical situation in which an unforeseen clinical outcome occurs, or
the clinical deterioration of the patient takes place for many different reasons. The
patient and his/her family are the first victims. The health care provider(s) involved in
the event are second victims. After such an event, the healthcare provider may
experience a constellation of negative emotions, such as guilt, sadness, depression,
somatic symptoms, hypervigilance, and fear. Most second victims require support to
cope with the adverse clinical situation. Second …
A Quality Improvement Project: Streamlining The Post-Surgical Process In Total Knee And Hip Replacements With An Evidence-Based Guidance And Practice Protocol, Bianca Bullie
Doctoral Projects
ABSTRACT
The rates of total joint replacements, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA), are on the rise in the United States and are expected to rise further in the next 20 years (Singh et al., 2019). Implementing an ERAS protocol coupled with current orthopedic practices will decrease a vast number of postoperative issues such as length of hospital stays, the financial burden on the facility, and overall patient satisfaction. The DNP project proposed a multidisciplinary protocol to standardize the care of patients undergoing THA or TKA and identified if this surgical process would be adopted …
Evaluating Pre-Anesthesia Telehealth Visit Outcomes In Cardiac Surgery Patients At A Tertiary-Level, Private, Academic Hospital, Ann Pan
Doctoral Projects
Telehealth is a dynamic, growing field in healthcare. Research has alluded to the potential of telemedicine in the pre-anesthesia area. With infection risk concerns brought to the forefront of healthcare due to the COVID pandemic, telemedicine offers an alternative evaluation method. Telehealth extends care to patients who otherwise would not have access to more comprehensive pre-anesthetic care and surveillance. Although studies show telemedicine's potential and positive effects, institutions have not extended virtual visits for all cardiac surgery pre-anesthesia patients. This retrospective evaluation study aimed to assess the impacts of telehealth on cardiac surgery pre-anesthesia assessments in a tertiary-level, private, academic …
Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon
Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon
Dissertations
Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.
Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …
The Impact Of Psychological Interventions Given To Icu Patients To Help With Pain Management, Kelly Liu
The Impact Of Psychological Interventions Given To Icu Patients To Help With Pain Management, Kelly Liu
Nursing | Senior Theses
Pain management among the critically ill population is a significant issue in the intensive care setting. Whether the pain is acute or chronic, nurses tend to be the first-hand responders to help with pain management in the intensive care unit (ICU). With barriers ranging from patients’ inability to verbalize pain to nurses’ experience with obstacles to assessment such as sedation, confusion, or other concerns, pain management is a serious issue. Although pharmacological interventions such as opioids and analgesics help with pain control, in this thesis, we will focus on the impact of nonpharmacological and psychological nursing interventions and how it …