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Articles 1 - 30 of 65
Full-Text Articles in Critical Care
Massive Transfusion And Shock Index, Kasey House
Massive Transfusion And Shock Index, Kasey House
MSN Capstone Projects
Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.
While initiating an MTP …
Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Faust
Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Faust
Electronic Theses and Dissertations
This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …
Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske
Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske
Graduate Medical Education Research Journal
Background: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes.
Purpose: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR).
Method: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. …
Sustaining Care Team Engagement Using A Hierarchy Of Needs Framework, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Natalia Johnson, Rebecca A. Brookes
Sustaining Care Team Engagement Using A Hierarchy Of Needs Framework, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Natalia Johnson, Rebecca A. Brookes
Operational Transformation
Cardiology Intensive Care & Cardiovascular Interventional (CICU & R9 West) teams provide superb care to critically ill cardiac patients at Maine Medical Center. Covid Pandemic revealed the importance of physical and mental health wellbeing, as well as care team engagement in order to continue to provide outstanding care to patients. CICU/R9 West Leadership looked for ways to improve team engagement and ensure that care team members’ needs are met and sustained.
Acute Care Staff Interactions With Chaplains To Discuss Personal, Non-Work-Related Stressors, Gary Weisbrich, Teresa Rangel
Acute Care Staff Interactions With Chaplains To Discuss Personal, Non-Work-Related Stressors, Gary Weisbrich, Teresa Rangel
Central Division Nurse Clinical Inquiry Conference
No abstract provided.
Moral Injury, Moral Resilience, And The Healthy Work Environment Among Icu Nurses: A Secondary Analysis, Angie Shemwell, Sarah Sumner
Moral Injury, Moral Resilience, And The Healthy Work Environment Among Icu Nurses: A Secondary Analysis, Angie Shemwell, Sarah Sumner
Central Division Nurse Clinical Inquiry Conference
No abstract provided.
A Team Mentor Project To Reduce Turnover On A Cicu, Sarah Evans
A Team Mentor Project To Reduce Turnover On A Cicu, Sarah Evans
Central Division Nurse Clinical Inquiry Conference
Abstract:
Background
From 2022-2023, a 28-bed cardiac care intensive unit (CICU) employing 120 Registered Nurses (RNs) hired 63 RNs, including 3 new graduates and 32 new-to-specialty, following significant turnover. Nurses in the CICU frequently face complex situations, leading to emotional distress and potential turnover if coping resources are not provided. Research suggests that pairing a new CICU nurse with an experienced mentor to help cope with complex situations can significantly increase confidence and resiliency and reduce emotional distress and turnover. On our CICU, nurses are assigned a preceptor for 12-20 weeks to orient to CICU-specific competencies without an emphasis on …
Poster: Clinical Practice Panel: Don't Skip A Beat, Follow The Sheet! Designing A Clinical Care Map For Open Heart Patients In The Icu, Danielle Fogel, Nico Vargas
Poster: Clinical Practice Panel: Don't Skip A Beat, Follow The Sheet! Designing A Clinical Care Map For Open Heart Patients In The Icu, Danielle Fogel, Nico Vargas
2023 South Division Nursing Research Conference
No abstract provided.
Poster: Eliminating Hospital Acquired Pressure Injuries (Hapis) In The Intensive Care Unit, Luzbel Diaz
Poster: Eliminating Hospital Acquired Pressure Injuries (Hapis) In The Intensive Care Unit, Luzbel Diaz
2023 South Division Nursing Research Conference
No abstract provided.
Poster: Moral Injury & Nurse Work Performance Following The Covid-19 Surges, Annette Callis, Trisha Saul, Ross Bindler
Poster: Moral Injury & Nurse Work Performance Following The Covid-19 Surges, Annette Callis, Trisha Saul, Ross Bindler
2023 South Division Nursing Research Conference
No abstract provided.
About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski
About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski
Electronic Thesis and Dissertation Repository
This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …
Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs
Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs
Dissertations
Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …
Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke
Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke
Dissertations
Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit
Abstract
Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.
Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …
Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah
DNP Projects
Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).
Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …
Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry
Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry
Providence Nursing Research Conference 2023 – Present
Development of a RN Clinical Coach program to improve retention of ICU residents and fellows
Background:
The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.
Purpose:
The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.
Methods:
In September 2021 the ICU manager at Providence Saint …
Recognition Of Nonconclusive Seizures In Patients After Cardiac Arrest Using, Teresa Jahn, Elizabeth Plante
Recognition Of Nonconclusive Seizures In Patients After Cardiac Arrest Using, Teresa Jahn, Elizabeth Plante
Nursing Posters
Background:
Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest.
Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring …
Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church
DNP Projects
Abstract
Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.
Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …
Nursing Considerations For Post-Traumatic Amnesia After A Traumatic Brain Injury, Hannah Grant
Nursing Considerations For Post-Traumatic Amnesia After A Traumatic Brain Injury, Hannah Grant
Senior Honors Theses
A period known as post-traumatic amnesia (PTA) often follows a traumatic brain injury (TBI). PTA is characterized by anterograde and retrograde amnesia, confusion, disorientation, and agitation. The duration and severity of PTA is a key indicator of the long-term prognosis after a TBI, so proper assessment and nursing care of a PTA patient is crucial. TBIs range from mild to severe, but primarily affect the fronto-temporal lobes. In PTA, both neural lesions and white matter damage within the parahippocampal region can cause PTA. A nurse must perform a thorough assessment of a TBI patient, but, since PTA is a key …
Early And Progressive Mobility: A Program Implementation Strategy For High Acuity Patient Care Locations, Stefani Poland
Early And Progressive Mobility: A Program Implementation Strategy For High Acuity Patient Care Locations, Stefani Poland
Student Scholarly Projects
Despite an increase in the promotion of early progressive mobility, its decrease in hospital-acquired complications and improvement of patient outcomes, there remains a reluctance in staff commitment to daily evaluation and implementation. This is largely due to the fact nurses or other interprofessional staff are the primary individuals responsible for this change in process. A lack of confidence in staff to correctly identify patients that meet criteria and anxiety regarding the safe transfer or mobilization of patients, particularly in high acuity settings have been identified as major barriers. The PICOT question that guided this program development of a CBO toolkit …
Quality Improvement For Patients With Alcohol Withdrawal Syndrome Starts With An Evaluation Tool, Jessica Bass
Quality Improvement For Patients With Alcohol Withdrawal Syndrome Starts With An Evaluation Tool, Jessica Bass
Doctoral Projects
Patients with alcohol withdrawal syndrome (AWS) have adverse outcomes to the traditional methods of assessing for and treating withdrawal within the intensive care unit (ICU), which includes a standardized treatment plan. Some negative outcomes include acquiring costly and dangerous hospital-acquired infections, safety concerns, and traumatic experiences that deter further treatment. More individualized assessments and treatments are needed to prevent or decrease the severity of AWS from occurring in critical care settings, which will facilitate more positive outcomes and experiences for the staff and patients. The Minnesota detoxification scale has been shown to be a more appropriate tool for the critical …
The Effects Of Bundle Adherence On Ventilator-Associated Pneumonia: A Quality Improvement Project, Sara Borges, Tracy L. Brewer, Donita Beard
The Effects Of Bundle Adherence On Ventilator-Associated Pneumonia: A Quality Improvement Project, Sara Borges, Tracy L. Brewer, Donita Beard
Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)
Abstract
Ventilator-associated pneumonia (VAP) is a hospital-acquired infection that affects intubated patients on a ventilator. The risk of acquiring the infection increases the longer a patient stays on the ventilator. Complications from ventilator-associated pneumonia can impact the patient physically, financially, or emotionally. Evidence-based recommendations collectively implemented to prevent VAP are referred to as a care bundle. Despite rising VAP cases in a local hospital, adherence to all elements of the VAP prevention bundle remained low. Our quality improvement project aimed to provide training to staff to increase awareness and adherence to the VAP bundle and decrease the number of VAP …
Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary
Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary
Journal of Patient-Centered Research and Reviews
Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.
Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …
Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone
Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone
Journal of Patient-Centered Research and Reviews
Delirium, a common and serious disorder in older hospitalized patients, remains underrecognized. While several delirium predictive models have been developed, only a handful have focused on electronic health record (EHR) data. This prospective cohort study of older inpatients (≥ 65 years old) aimed to determine if variables within our health system’s EHR could be used to identify delirium among hospitalized patients at the bedside. Trained researchers screened daily for delirium using the 3-minute diagnostic Confusion Assessment Method (3D-CAM). Patient demographic and clinical variables were extracted from the EHR. Among 408 participants, mean age was 75 years, 60.8% were female, and …
Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach
Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach
Dissertations
Abstract
Problem: Patients admitted to the pediatric intensive care unit (PICU) are at increased risk for the development of ocular surface disease (OSD) due to impaired ocular mechanisms while intubated, sedated, and on continuous neuromuscular blockade. The purpose of this project is to prevent OSD and vision impairments by increasing the frequency of eye care in accordance with a PICU eye care protocol.
Methods: An observational descriptive study was conducted utilizing retrospective and prospective chart review. Comparisons were drawn between the 2021 pre intervention group and the 2022 post intervention group regarding the impact of linking lubricating eye ointment orders …
Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen
Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen
Dissertations
Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost
Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …
An Exploration Of Covid-19 Impact On Healthcare Workers’ Mental Health In China, Jenny Yang
An Exploration Of Covid-19 Impact On Healthcare Workers’ Mental Health In China, Jenny Yang
Nursing | Senior Theses
Background
In December 2019, the first confirmed human case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 occurred in Wuhan, China. By March 2020, the World Health Organization (WHO) had classified the COVID-19 outbreak as a pandemic due to the rapid spread of the virus to other countries. Many people have been affected by the COVID-19 pandemic in various aspects, especially front-line healthcare workers. Hospital working conditions are constantly changing to cope with the problems that arise from the pandemic. These problems can result in an unsafe patient-to-nurse ratio, understaffed healthcare workers in hospitals, equipment shortage, and increased …
A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan
A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan
Symposium of Student Scholars
Abstract
A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU
Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs?
Literature Review: HAIs during CPR can be acquired through …
Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport
Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport
Senior Honors Theses
The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …
The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari
The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari
DNP Scholarly Projects
Sepsis is a medical emergency that is prevalent throughout hospitals everywhere. Due to the growing crisis, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Surviving Sepsis Campaign (SSC) adopted core measures for sepsis (SEP-1) which aim at improving overall compliance of evidence-based treatment standards for sepsis. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if incorporating early goal directed sepsis bundles in a rural Midwestern ED was effective in increasing compliance with SEP-1 rates. The secondary purpose evaluated how nursing knowledge, awareness, and compliance with sepsis bundles affects SEP-1 compliance rates. …
Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn
Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn
Doctor of Nursing Practice Projects
Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.
Methods A literature review was …