Digital Commons Network^™

What’S Your Q? Empowering Nurses To Answer Clinical Questions Through The Evidence-Based Practice Process, Jodie Pufundt

Nursing Research & Professional Development Conference

Background/Rationale

The research-to-practice gap of approximately 15 years is due to many factors, one lacking clinician’s evidence-based practice (EBP) knowledge, skills, and competency. Evidence-Based Practice is a problem-solving process incorporating external evidence, clinical expertise, and patient preferences, guiding clinicians to integrate evidence into practice. Fostering a spirit of inquiry empowers nurses to engage in the EBP process to solve clinical practice problems and improve patient outcomes. A system-wide practice change for filtering IV fluids led to a wondering question about the best practice for filtering intravenous parenteral nutrition in the neonatal population.

Purpose

To engage clinical nurses in the EBP …

Health & Wellbeing Of The Nurse, Erin E. Bichler, Regina Michler

Nursing Research & Professional Development Conference

Background and/or Rationale:

Central Shared Governance focused on the strategic goal of promoting nurse health and well-being. A survey found interrupted or skipped meal breaks were common on inpatient units. We reviewed the literature and found that the majority of nurses experience workplace stress and that adequate breaks and break areas can decrease stress. Central Shared Governance identified this common occurrence as being misaligned with our nurse health and well-being goals.

Aim or Purpose:

We decided to promote and support uninterrupted, restorative breaks and provide high quality break areas to reduce stress based on the evidence we found.

Implementation Plan: …

Ready, Set, Go! Implementing An Electronic Handoff Tool To Decrease Emergency Department Length Of Stay, Jennifer Peterburs

Nursing Research & Professional Development Conference

Background:

According to the CDC’s (2019) review of health care data in 2019, over 150 million patients were seen in Emergency Departments across the United States. Of these patients, more than 20 million were admitted to the hospital. Longer Emergency Department wait times equate to worse patient outcomes, including higher in-hospital mortality rates and increased occurrence of in-hospital cardiac arrest.

Handoff is considered a high-risk activity (Freel & Flaherty, 2021). Studies have shown most effective handoff tools include the use of mnemonics or tools to aid in the organization of critical information (Kear, 2016).

Aim or purpose of the initiative: …

The Beat Goes On: Resuscitate Your Ecg Program, Tammy Lis, Frances Majca, Patti Stockhausen

Nursing Research & Professional Development Conference

Background/Introduction:

In response to the pandemic, electrocardiogram (ECG) rhythm interpretation education transitioned to an online, self-paced course with optional instructor-led virtual labs. Challenges included technology issues, limited learner engagement, inefficient use of instructor time, and low pass rates. Lab capacity was 30, but average attendance was 5.5. Prescheduled tutoring required instructor availability with only 25% of offerings attended. Legacy learning management system permitted multiple test attempts leading to competency concerns and inaccurate passing rate data.

Purpose or Objective:

Create an innovative hybrid ECG program engaging learners, increasing learner confidence and competence, while improving valuable human resource allocation.

Method or Evaluation: …

Nurse Driven Intervention To Improve Acute Kidney Injury (Aki), Theresa Briggs

Nursing Research & Professional Development Conference

Background and/or rationale

Acute kidney injury (AKI) following the use of contrast agents is a known complication of coronary angiography. The National Cardiovascular Data Registry (NCDR) defines AKI as an acute increase of > 0.3mg/dl or a 50% or greater increase in the serum level of creatinine from baseline and cardiac patients are at high risk for AKI. At a Midwest quaternary medical center, the risk adjusted AKI rate was 8.63% (Q3, 2021) which is above the national average of 3.46% (NCDR).

Aim or purpose of the initiative

The purpose of this project was twofold: 1) Increase nurse’s knowledge about oral …

Implementation Of A Pediatric Intensive Care Unit Diary, Linda Esposito

Nursing Research & Professional Development Conference

Background: Critical illness and the PICU environment may contribute to the development of Post Intensive Care Syndrome (PICS) in children, their parents, or their siblings. PICS has a negative impact on quality of life, including development of PTSD, reduced school performance, or delay in meeting developmental milestones. Diaries have been used to create context and memory after discharge, extending cognitive and emotional support beyond the PICU stay. Entries are staff-written in letter format, including details about the patient’s day, events, or feelings. The diaries become a supportive tool for the patient and family on their journey post critical illness.

Purpose …

Do Your New Nurses Have What It Takes To “Escape”?, Kathleen Kingman, Megan Kirchen, Mary Mcmanus

Nursing Research & Professional Development Conference

Background: The Nursing Education Professional Development Team were challenged to limit new hire orientation to one in-person learning day and transition all essential content to self-paced computer-based modules. The Nursing Education Professional Development Team are accountable for supporting new hires to achieve established goals in the clinical setting with less time.

Aim: New tools were needed to support new hires to validate the uptake of the essential content. The Nursing Education Professional Development Team reviewed innovative best practices to reinforce organizational education and orientation needs.

Implementation Plan: The Nursing Education Professional Development Team redesigned the curriculum and created …

Keep Calm And Labor On! Use Of Aromatherapy In Labor And Delivery, Erica Biancalana, Tricia Green

Nursing Research & Professional Development Conference

Background and/or rationale

Labor pain is unavoidable and can be the biggest determining factor of the labor experience. In labor, a patient’s anxiety stimulates the sympathetic nervous system and releases stress related hormones, which increases the severity of pain. Nonpharmacologic interventions can decrease anxiety and the perception of pain. Benefits to nonpharmacologic strategies include sense of control when patients actively manage their pain, lack of serious side effects, minimal expense, and ease of use. Lavender aromatherapy can decrease labor anxiety while also decreasing pain perception.

Aim or purpose of the initiative

This EBP project purpose: Does utilizing aromatherapy with birthing …

"Coast"Ing Through Bedside Shift Report, Kristi Webster

Nursing Research & Professional Development Conference

Background: Multiple types of shift report exist, a “blended” bedside shift report incorporates verbal face to face between staff with a bedside component. Baseline audits in March 2023 showed during bedside report only 3% addressed codes status, 3% oxygen, 6% access, 3% safety, and 12% tubes and drains. Additional baseline data from March 2023 showed 71% compliance with No CPR band application and one fall. This prompted the PICO question: Does the use of a blended bedside report compared to traditional verbal report increase communication between staff?

Aim/Purpose: To implement blended shift report in one ICU at a quaternary medical …

Patient Experience Best Practices: An Exemplar Of Advanced Practice Registered Nurse Ebp Mentor Team Led Inquiry, Jodie Pufundt, Kelly Perez, Megan Morgan

Nursing Research & Professional Development Conference

Background/Rationale

Patient experience is one of the five tenets of the Quintuple Aim- population health, cost of care, clinician wellbeing, and health equity. The Aim is a model for achieving high quality, safe, and cost-effective care. Engagement is an important strategy for reaching an optimal state of the patient and family care experience. At our organization, the patient experience scores have been static and under target for a while, despite implementation of many interventions. A team of APRN evidence-based practice (EBP) Mentors (Clinical Nurse Specialists and a Nurse Practitioner) engaged in the EBP process identified practices that impact the patient …

Keep Calm And Screen For Sepsis, Nicole Hamilton

Nursing Research & Professional Development Conference

Background:

Pediatric emergencies have been found to be challenging for emergency professional teams. Sepsis is one of the leading causes of mortality in children in the US with 1.2 million pediatric patients are diagnosed with sepsis annually.

PICO statement: Nurses and patient care technicians in the Emergency Department caring for a pediatric patient aged 5 years or younger presenting with symptoms of sepsis will have improved outcomes when comparing current practice after a skill-based program that will improve knowledge, skill, and confidence of Nurses and Patient Care.

AIM: Focus of the initiative:

• Improved outcomes for included pediatric sepsis positive screened …

Shared Governance Led Pilot To Implement A Multidisciplinary Case Review Process, Amanda Smith, Katalin Stanaszak, Venus Grice

Nursing Research & Professional Development Conference

Background:

Enterprise Population Health Ambulatory Care Management established Nursing Shared Governance Practice Council in 2022, aimed at identifying opportunities for process improvement to promote application of evidence-based best practice. Practice Council was tasked with developing a clinical case review process to implement within Ambulatory Care Management Midwest region.

Purpose of the initiative:

Evaluate current literature, and reflect on historic departmental practices, to create a Multidisciplinary Case Review process for use in Ambulatory Care Management.

Implementation Plan:

Practice Council conducted current/previous state analysis of case review processes across Ambulatory Care Management. Information was obtained on the purpose, frequency, duration, case identification …

Perfecting The Poke, Alyssa Krueger, Morgan Brill

Nursing Research & Professional Development Conference

Background/Introduction:

Aurora Medical Center Grafton Resource Nurses noted high volumes of requests to assist with peripheral intravenous catheter placements. Between January - October 2021, 868 requests were made for intravenous catheters to be placed by other resources. This data was brought to the nursing professional development team for evaluation. A significant need for directed efforts to grow nurse competency was identified. This included increased confidence in basic insertion skills and training nurses for complex placements utilizing ultrasound guidance.

Purpose or Objective:

Create a professional development program to increase nurse confidence with basic peripheral intravenous insertion skills and increase nurses trained …

Best Fit For Nurse Advancement: Program Development & Evaluation, Dulce Torres, Sara Marzinski, Jeannie Hlebichuk

Nursing Research & Professional Development Conference

Background: Nurses are provided resources and guidance early in their careers, but they need continued support, opportunities, and assistance to professionally develop and make next steps in their careers. Literature has shown that nurses report professional development as fundamental to the profession of nursing (Mlambo et al., 2021). Moreover, supporting nurses with development and career advancement has been shown to aid in retention (Williamson et al., 2022).

Purpose/Objective: The Best Fit for Nurse Advancement (BFNA) program was developed and implemented in 2022. The program’s purpose is to provide experienced nurses with the opportunity to explore professional development and career …

Utilizing Simulation To Increase Confidence In Onboarding Care Managers & Social Workers, Tara Nixon, Elena Ochakovski, Jenn Mepham, Kari Congenie

Nursing Research & Professional Development Conference

Background

New hire inpatient care managers and social workers are often overwhelmed with the complexity of their new care coordination role. Role-play is a useful experiential strategy connecting theory to practice in a safe space. Use of standardized patients for communication simulation improves patient centeredness versus role playing, justifying organizational investment. Simulation helps learners reflect and analyze practice within a psychologically safe environment. A simulation-based advanced care transition program was adapted to provide onboarding teammates opportunities to experience complex care coordination situations aligning with organizational and regulatory requirements.

Purpose

The purpose of this project is to provide onboarding Inpatient Care …

Coming Out Of Covid: Resuscitating Live Onboarding, Patricia Shafer, Claire Hackelberg

Nursing Research & Professional Development Conference

Background: Effective onboarding and orientation processes are critical for successful new hire engagement and retention. The COVID-19 pandemic caused disruption in the established in-person onboarding process leading to inconsistency and fragmentation. Evidence suggests that structured and supported on-the-job training is the most effective onboarding strategy (Frogeli et al., 2023). A program make-over was needed.

Purpose: To redesign the onboarding and orientation process for new nurses with effective and efficient process to address issues and increase satisfaction.

Method: Nursing Professional Development (NPD) Staff collaborated with the hospital and unit managers to gather input and redesign the on-boarding process for new hires. …

Do Ask Do Tell: Improving Sexual Orientation And Gender Identity Documentation Completion Within Electronic Medical Records, Patrick Griggs

Nursing Research & Professional Development Conference

Background – Lesbian, Gay, Bisexual, Transgender, and other (LGBTQIA+) patients represent a minority group in healthcare settings. This population is underrepresented due to many factors, including lack of sexual orientation and gender identity (SOGI) reporting via electronic medical record (EMR) though it is a federally mandated policy. By not reporting SOGI for patients, underrepresentation of LGBTQIA+ health issues are reported. Increasing documentation of SOGI, patients can have their identities seen and ultimately helps improve health equity for LGBTQIA+ patients.

Purpose – Increase documentation in EMR related to patients’ sexual orientation, gender identity, sex assigned at birth, and pronouns in the …

Using Simulation To Enhance Staff Skills In Massive Transfusion, Jennifer Peterburs, Tara Anderson

Nursing Research & Professional Development Conference

Background:

The Massive Transfusion Protocol refers to the administration of a large number of blood products quickly to an actively bleeding patient. Failure to adhere to the protocol leads to inappropriate patient care and wasted blood products. As many as two to four cases per month may occur at the hospital, a Level 2 Trauma Center. Audits identified care and documentation inconsistent with the protocol and inappropriate protocol activation.

Purpose:

To use a professional development activities to improve nurses and provider knowledge, skills, and documentation of the administration of massive transfusion per protocol.

Method:

A multidisciplinary team met to discuss …

Bonus Time! Using A Rewards Program To Encourage Engagement In A Nurse Residency Program, Michelle Grube, Melissa Oberle, Veronica Bigott

Nursing Research & Professional Development Conference

Background/Information

Within a virtual Nurse Residency Program, the opportunity existed to increase engagement among nurse resident participants. Program facilitators self-reported low level of engagement citing, “difficult to get engaged,” “offer activities for conversation,” and “allow time for engagement activities.” Literature suggests participants may feel uncomfortable engaging in virtual environments. Thus, a Rewards Program was developed to encourage engagement of participants and piloted in ten Nurse Residency cohorts.

Purpose/Objective

The program's key purpose was to enhance engagement by incentivizing participants to complete activities offered throughout a 6-month Nurse Residency Program. Program activities stimulated communication, fun, and teamwork leading to positive evaluations. …

Strength In Numbers: Achieving Nurse Certifications For Large Groups Using A Three-Pronged Approach, Kristen Livermore

Nursing Research & Professional Development Conference

Background:

Literature suggests professional RN certification contributes to improved outcomes, yet little is known about what motivates nurses to become certified. (Solomon et al, 2016)

Objective:

Increase the percentage of qualified nurses with specialty certification on a single unit quickly.

Method:

The strategy incorporated a three-prong approach. 1) Create Commitment: generated excitement and provided nurses the opportunity to participate as a group with a concrete start and end date. 2) Comprehensive Study Plan: participating nurses were given a comprehensive study plan pathway. This included a weekly schedule of topics with study materials (posters, notes, videos) to keep the program manageable. …

Electronic Orientation Checklist: Click It To Check It!, Rubie Rose Costales, Tonya Pagor, Fran Majca, Candice Spak

Nursing Research & Professional Development Conference

Background/Introduction:

In 2022, approximately 15,000 Registered nurses and 6,000 Nursing assistants were onboarded utilizing paper checklists across 26 hospitals. The 95 identified checklists required printing multiple pages and was cumbersome for leadership to monitor and access.

Purpose or Objective:

Nursing Education and Professional Development launched an electronic orientation checklist initiative. The checklists transitioned to electronic platform delivering an updated, comprehensive, and collaborative approach to system orientation resources. This provides secure access, guarantees timely check off, offers real-time support to teammates, cost savings and fosters ecological consciousness.

Method:

Electronic checklists were piloted at two sites. Feedback from stakeholders, including executive leadership, …

Bridge To Practice: Program Initiation And Evaluation, Seung Kapusta, Dulce Torres, Sara Marzinski, Jeanne Hlebichuk, Jami Tutino

Nursing Research & Professional Development Conference

Background/Introduction: Mentoring is important in preparing nursing students to work in the complex health care work environment. A nurse’s personal and professional development is impacted through mentoring; however, the traditional clinical mentor and environment are not always conducive to the full mentoring relationship capacity.

Objective: The Bridge to Practice program was initiated in Fall 2022 as a partnership between a quaternary medical center site and local university to pair second year nursing students with experienced nurses to explore the reality of work environment, specialty practice settings, and mentorship. Information sessions are held monthly over nine months and lead by mentors …

More Than Numbers – Let’S Talk About Mixed Methods Research, Deborah Gentile

Nursing Research & Professional Development Conference

Introduction: There are multiple approaches to conducting research. Quantitative and qualitative research inform nursing practice, but quantitative research tends to be emphasized. At AAH, most nursing research studies (in excess of 90%) are quantitative in nature even when the research question focuses on the meaning of a phenomenon or experience of a research subject. Meaning and experiences are best elicited using qualitative methods. Using one method to answer a research question is sometimes not enough.

Purpose: This presentation will address the use of mixed methods – involving quantitative and qualitative data – to add value to a study and …

Assessing Internal Travel Nurses Clinical Knowledge: A Modern, Electronic Approach To Staffing Readiness, Nicole Hartmann

Nursing Research & Professional Development Conference

Background/Introduction:

The Advocate Aurora Health Internal Agency needed an efficient way to assess teammates clinical knowledge to rapidly hire nurses into our internal travel pool. Advocate Aurora requires new teammates to complete orientation skills checklists upon hire. These checklists take many hours to complete, and several original checklists could not be retrieved. We also needed a way to assess pre-hire candidates to ensure they were clinically skilled.

Purpose or Objective:

Utilize a validated tool to assess traveler nurse knowledge prior to hire/contract/acceptance to internal agency. The goal of the tool is to efficiently evaluate level of expertise, and immediately transition …

A Nursing Led Initiative In Collaboration With The Performance Of Excellence Center To Change Psychiatric Emergency Department Triage Procedures To Improve Patient Care, Kristen Edmunds, Nicholas Archer, Michell Olshan-Perlmutter, Marquita Boggess

Nursing Research & Professional Development Conference

Background

Psychiatric emergency room visits are often associated with long wait times, leading to agitation and dissatisfaction among patients, delay in care, some patients leaving without receiving care, staff frustration and increased cost. Research indicates that triage guidelines correlate with wait times and patient satisfaction.

Local Problem

Atrium Health Charlotte is a dedicated psychiatric emergency room that has consistently seen an increase in yearly patient visits. Overcrowding and long wait times are commonplace. Last year almost 10,000 patients were seen, and 839 left without being seen. The average time for patients’ length of stay from door to discharge was 245 …

Tele-Critical Care Nurse Initiative Drives Central Line Stewardship To Improve Quality Of Care, Noelle M. Hartley, Lynn Thompson

Nursing Research & Professional Development Conference

Background

Central line-associated bloodstream infections (CLABSIs) lead to increased hospital length of stay, cost, morbidity, and mortality, and negatively impact patient experience with an average inpatient cost of $48,108 (AHRQ, n.d.). Critically ill patients are at increased risk for CLABSI.

Local Problem

Atrium Health’s Virtual Critical Care (VCC) standardizes and delivers care at 14 ICUs across the Advocate Health Southeast region utilizing evidence-based practice, Intensivist-managed care, and multidisciplinary teamwork. VCC nurses also collaborate to support the units’ clinical quality goals. Atrium Health Union’s Critical Care Unit (CCU) experienced 8 CLABSIs in the first 3 quarters of 2022, and CL utilization …

Living Up To The Challenge: Preventing Unplanned Extubations In The Nicu, Yorleni Ambrosio, Julie Lombardo, Christina Bourque

Nursing Research & Professional Development Conference

Background

An unplanned extubation is a common adverse event for an intubated neonate that can lead to negative outcomes such as hypoxia, ventilator-associated pneumonia, extended hospital stays, and risk of injury. Prevention is a unique challenge in the NICU population due to small facial anatomy, increased ventilation days, and environmental factors.

Local Problem

A level 3 NICU experienced a total of five UEs in 2022 which equates to a rate of 3.59 per 100 ventilator days compared to a rate of 0 to 1 in previous years.

Method

A team consisting of the NICU APRN, Respiratory Educator and Neonatologists, performed …

High Risk For Readmission Criteria For Wound Care Patients, Carolyn Jacobson

Nursing Research & Professional Development Conference

Background: The most common reported complication of diabetes mellitus is diabetic foot ulcers. Outpatients with diabetic foot wounds are at an increased risk for all cause hospitalization. Moreover, diabetics socioeconomic status has been shown to influence health outcomes associated with disease management.

Local Problem: At a Midwest quaternary medical center, within the outpatient wound clinic and Aurora Limb Preservation Program (ALPP), the 30-day hospital admission percentage for patients with diabetic foot ulcers was elevated in January 2022 (16%) and February 2022 (19%).

Method: A quality improvement project, utilizing A3 methodology, was initiated to proactively address patients’ social determinants …

Implementing Clinical Event Debriefing To Improve Patient Care, Colleen Butler

Nursing Research & Professional Development Conference

Background

The Advocate Children’s Hospital Neonatal/Pediatric Transport Team (ACHTT) transports approximately 2,000 neonatal/pediatric patients each year within the Advocate Children’s Hospital and Northshore system. Opportunities have been identified to improve feedback on transports completed. Debriefing is associated with improved outcomes, improved team performance, and provides the opportunity to discuss gaps in clinical knowledge, performance, and behaviors. Debriefing also provides the opportunity for group reflection and examination of teamwork.

Local Problem

No process existed to formally debrief after a transport completed by the ACHTT. The need to create a multidisciplinary clinical debriefing program was identified.

Method

A review of literature was …

Malignant Hyperthermia Simulation And Competency, Nicholas Nowak, Anna Auger

Nursing Research & Professional Development Conference

Background

Malignant hyperthermia (MH) is a potentially fatal reaction to a volatile anesthetic or succinylcholine producing a hypermetabolic state. Prompt recognition and treatment of MH are essential for survival.

Local Problem

Rapid Response Team (RRT) leaders identified a nursing knowledge gap about the process for treating MH for patients outside high-risk areas at a level 1 trauma center.

Method

A new process, workflow, and medication box were created for obtaining the necessary supplies to treat MH patients. RRT nursing leaders developed a simulation education program with the goals to improve overall MH knowledge and to develop RRT nurses’ response skills …