Critical Care Nursing Commons^™

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Reduction Of Hospital-Acquired Pressure Injuries In The Acute Care Setting, Bailey Rasmussen, Taylor Bacon, Andrew Gross

Doctor of Nursing Practice Projects: College of Nursing

Background: Hospital-acquired pressure injuries (HAPIs) have been a longstanding problem in hospitals nationwide. HAPIs cause significant financial strain to a healthcare system and complications can be devastating to the patient.

Purpose: The purpose of this project was to implement the Standard Pressure Injury Prevention Protocol (SPIPP) 2.0 Checklist for patients in the Intensive Care Unit (ICU). The primary aim of this study was to determine if implementing the checklist would reduce the number of HAPIs.

Methods: This project took place over a four-week period at a Midwest hospital in the ICU. Data were collected via patient chart …

A Benchmark Project On Early Mobility In The Intensive Care Unit, Millicent Odhiambo

MSN Capstone Projects

Introducing early mobility interventions in the Intensive Care Unit (ICU) is a crucial measure to improve patient outcomes and optimize care delivery in the critical care setting. The objective of this project is to tackle the difficulties caused by extended periods of immobility in the Intensive Care Unit (ICU), with the aim of diminishing complications, shortening the duration of ICU stays, and enhancing the functional recovery of patients.

The Effect Of Continuous Glucose Monitoring On Glucose Control And Re-Hospitalizations In Type Ii Diabetes Mellitus Patients, Susan Ferguson

The Eleanor Mann School of Nursing Student Works

Purpose: This Program Development and Evaluation project was designed to improve the management of patients with type II diabetes mellitus through the implementation of a combined in-patient discharge protocol and outpatient continuous glucose monitoring protocol follow-up plan in a diabetes clinic following discharge from a rural-based acute facility hospitalization.

Method: This quasi-experimental project was based on Rosswurm and Larrabee's Model for Change framework. Outcome measures analyzed type II diabetes mellitus patients to assess the effects of a continuous glucose monitoring discharge protocol on pre- and post-glycemic levels, rehospitalizations, and patient (n=2) and provider knowledge (n=4) obtainment.

Results: In a comparison …

Optimizing A Clostridium Difficile Screen For Intensive Care Unit Admissions, Mary Katherine V. Natour, Jennifer Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Clostridium difficile infection is one of the most common healthcare-associated infections. Careful screening upon hospital admission enables clinicians to mitigate the spread and sequelae of this illness through early intervention and isolation but this screening must be accurate and highly sensitive to maximize benefit.

Local problem: The site for this project, an ICU in Tennessee, currently employs a highly sensitive but nonspecific tool to detect CDI. This has resulted in low accuracy, low staff compliance, low patient morale, and unnecessarily high personal protective equipment (PPE) costs.

Methods: Levin’s evidence-based practice improvement model was chosen to guide this project from …

Emphasizing The Importance Of Clustering Care For Newborns In The Nicu Setting, Callie Hines Sn, Alyssa Howell Sn, Elizabeth Crews Sn

Scholars Week

For our Evidence-Based Project, we have chosen to cover the topic concerning clustering care for premature infants in the neonatal intensive care unit. In many NICU's across the country preterm infants are taken care of on an as needed basis. Research and Swanson’s theory of caring supports that clustering care has a positive correlation with the improvement of vital signs, physical and intellectual development, and infection control.

Improving Anesthesia Handoff: Implementing Standardized Handoff Tool For Post-Open-Heart Surgery In Critical Care Settings, Kelly Doyle

Scholars Week

The purpose of this project was to create a handoff tool implemented post-operatively by anesthesia providers during every transfer of care with patients undergoing open heart surgery and transitioning to the intensive care unit. Communication errors have been identified as a primary cause of anesthesia-related sentinel events, particularly during patient handoff, which can lead to negative patient outcomes due to incomplete relay of information. This Quality Improvement Project was conducted at a single facility where Certified Registered Nurse Anesthetists, (CRNAs) incorporated a handoff tool into their anesthesia handoff following coronary artery bypass graft surgery over a six-week period. Both pre- …

Education Of Ventilator-Associated Pneumonia Prevention In Adult Intensive Care Patients, Carlin Morgan

Scholars Week

The purpose of this project was to improve knowledge related to evidence-based ventilator-associated pneumonia (VAP) preventative measures that decrease the prevalence of VAP in adult patients in the intensive care unit (ICU). An educational presentation was provided to twelve critical care nurses at a 349-bed hospital in western Kentucky. A pretest was obtained to measure the nurse’s knowledge prior to the presentation. A PowerPoint and pamphlet containing VAP prevention techniques were presented to the twelve critical care nurses during each meeting. A posttest was then administered after the presentation to measure the efficacy of the educational presentation. The mean of …

The Impact Of Telecritical Care On Length Of Stay In A Critical Care Setting, Mallory Oberts

Student Scholarly Projects

Practice Problem: At a major metropolitan VA hospital, there was a lack of adherence by the nursing staff to the TeleCritical Care program for adult patients in the critical care setting.

PICOT: The PICOT question guiding this project was: In adult patients admitted to critical care (P), does the implementation of TeleCritical Care (I) compared to standard critical care without telemedicine (C) decrease length of stay (O) within 8 weeks (T)?

Evidence: The literature review identified improved quality of care delivery, decreased length of stay, and reduced mortality rates as key benefits of implementing TeleCritical Care in …

Assessing Nursing Deployment Readiness-A Literature Review, George Mcenroe

DNP Qualifying Manuscripts

Air Force nurses must be prepared for deployment to support military missions on short notice. During deployments, they may be asked to practice in demanding and austere wartime environments. The required competencies for deployment include the care of multi-trauma patients, military vehicles and aircraft, mass casualty care, and military-specific skills. Many Air Force nurses work in low acuity roles and do not maintain the clinical competency and skills necessary if called upon to deploy. A deployment notification may happen with little notification, limiting the opportunity for a quick “ramp-up” of critical skills. Maintaining deployment and clinical readiness is an ongoing …

Enhancing The Safety Of Medication Administration: The Synergistic Role Of Closed Loop Electronic Medication Management And Iv Medication Administration, Kelly Goetz, Angela Schoenung, Lauren Daugherty, Kaitlyn Hornsby

Posters-at-the-Capitol

The high acuity of patients in the ICU results in numerous medications being administered, increasing the risk of medication errors. The purpose of this project is to investigate the impact of integrating consistent closed loop electronic medication management (CLEMM) to decrease medication errors in the ICU for bedside nurses who use electronic health records (EHRs). The project type is a comprehensive literature review, with studies that included a single prospective cohort study, case report, single non-randomized trial, quasi experimental study, single cross-sectional studies, and systematic reviews. The importance of this project is to address the break in the loop of …

Improving Knowledge, Confidence, And Competency Among Icu Nurses Concerning The Benefits Of Using The Uk Ventilator Separation Protocol, Brittany Monroe

DNP Projects

Background: The trauma intensive care unit (ICU) at University of Kentucky (UK) Healthcare uses a ventilator separation protocol which provides specific guidelines on the successful weaning of patients from mechanical ventilation. However, many of the nurses are not aware of this protocol as formal education is not included in their orientation or training. This lack of knowledge can lead to risks such as increased patient morbidity, mortality, ICU length of stay, and healthcare-related costs. Research shows that using structured mechanical ventilator weaning tools in the ICU can shorten the duration of mechanical ventilation, which in turn, lowers these associated risks. …

A Pulse For Progress – Examining The Efficacy Of Best Nursing Developmental Care Practices For Children With Congenital Heart Disease At Risk For Developmental Delay In The Pcicu: A Prospective Quasi-Experimental Cohort Study, Jasmyn Jansen

Nursing | Senior Theses

Emerging advances in pediatric cardiovascular surgery have significantly decreased the mortality rates in infants born with critical congenital heart disease (CHD), in turn, leading to increasing prevalence in adolescence and adulthood. At the same time, developmental delays (DD) are on the rise among children with CHD. Recent research suggests that prolonged exposure to the pediatric cardiac intensive care unit (PCICU), with its environmental stressors, negatively implicates neurodevelopment raising the question, and risk, of DD. In January 2023, the American Heart Association (AHA) issued a scientific advisory calling hospitals to implement developmental care practices for hospitalized infants and young children with …

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Senior Theses

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the …

Mindfulness Based Interventions To Reduce Burnout And Ptsd Symptoms In Critical Care Nursing, Kelly A. Pellegrino, Libby M. Colley, Carly R. Fazendin, Emma R. Parrotta, Mollie Johnson

Non-Thesis Student Work

Within the medical field, nursing is a career that can be very taxing on both one’s physical and mental wellbeing, especially in regards to critical care. The life-threatening situations and strenuous work that critical care nurses are met with everyday make them especially susceptible to struggling with burnout, compassion fatigue, and PTSD-like symptoms. This not only puts their own safety at risk, but the safety of their patients as well. This raises the question: In critical care nursing, does the utilization of mindfulness based interventions, compared to no intervention, aid in the reduction of nursing burnout and PTSD symptoms? In …

Improving Nutrition Screening Practice In The Hospitalized Heart Failure Patient Population, Amanda J. Bourgeois

DNP Projects

Background: Heart Failure is a disease known to affect nearly 6.5 million adults in the United States. Characterized by recurrent hospitalizations, heart failure significantly contributes to morbidity, mortality, and healthcare costs in the United States and worldwide. Because malnutrition is prevalent in the heart failure population, healthcare providers must perform nutritional assessments on admission to intervene in the case of malnutrition, prevent deterioration, and improve patient prognosis. Without intervention and early identification of malnutrition, heart failure hospitalizations will remain a significant problem.

Purpose: The purpose of this study is to evaluate the effect of an evidence-based educational program for cardiac …

Say No To Drugs: Nonpharmacologic Interventions For Preventing Delirium In Critically Ill Patients Intubated & Sedated In A Pediatric Icu, Jessica C. Ellzey

DNP Projects

Background. Delirium is an acute clinical syndrome that is characterized by features of disrupted arousal, attention, cognition, sleep, and perception. Delirium is a well-documented phenomenon in critical care settings in both adult and pediatric populations, particularly among patients with length of stay greater than or equal to 48 hours. Delirium has multiple adverse effects, including increased mortality rate, prolonged duration of mechanical ventilation, higher reintubation rates, prolonged intensive care unit (ICU) admission, prolonged hospital admission, short- and long-term cognitive impairment, and posttraumatic stress disorder. There are currently no accepted guidelines or FDA approved medications to treat ICU delirium in the …

Implementation Of Unit-Based Preceptor Orientation: The Effects On Perceived Orientee Competence And Self-Confidence Of The Precepting Cvicu Nurse, Laura K. Marcum

DNP Projects

Purpose: The purpose of this study was to assess how unit-specific preceptor training impacted the perceived readiness of new graduate nurses, self-confidence of preceptors, and the correlated job satisfaction.

Background: The nurse attrition rate is resulting in inexperience at the bedside. Nursing inexperience leads to lower quality patient care. If improving the efficiency of training and education can improve perceived readiness, then in turn we can increase the longevity of our new nurses. Improving the longevity of nurses has significant implications on the budget of each hospital, the patient outcomes, and the staff’s resulting job satisfaction.

Methods: New graduate nurse …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Oscar J. Castillo

Master's Projects and Capstones

Problem: The Quality Improvement (QI) Project focused on improving early sepsis management and sepsis bundle adherence among Emergency Department (ED) nurses to decrease sepsis mortality rates and avoidable length of hospital stays (LOS).

Context: A group of Clinical Nurse Leaders (CNL) students evaluated sepsis protocol compliance at Hospital A's ED, which provides critical care for patients with various medical conditions. The CNL students concentrated on patients identified with sepsis for the QI Project.

Interventions: Limitations and time did not allow for the implementation of interventions. Recommendations offered to management included increasing sepsis training biannually and intravenous placement skills, offering sepsis …

Improving Early Sepsis Recognition: Resocializing Intensive Care Unit Nurses In A Large Hospital On The Inpatient Sepsis Bundle Checklist, Elizabeth Rose Maykel

Master's Projects and Capstones

Problem: In order to lower sepsis morbidity and mortality rates through early recognition and treatment, this quality improvement project sought to raise sepsis awareness and bundle compliance within the Intensive Care Unit.

Context: Clinical Nurse Leader (CNL) students completed a microsystem assessment of the Intensive Care Unit at Hospital X in Northern California. This unit cares for patients with sepsis, organ failure, respiratory failure, different types of shock, acute kidney injury, and traumatic brain injury.

Interventions: The implemented intervention included a refresher huddle on sepsis bundle awareness. Though the intervention was ineffective, the students did offer recommendations …