Critical Care Nursing Commons^™

Barriers To Advance Directives, Anna Malia Connor Ticknor

Grace Peterson Nursing Research Colloquium

Abstract

Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of ...

Higher Medication Administration Errors Associated With Automated Dispensing System Usage, Jillian Cramer

Grace Peterson Nursing Research Colloquium

According to a report by The Institute of Medicine, medical errors were associated with up to 98,000 deaths and more than 1 million injuries each year in the United States. These errors can result in poor outcomes, which increase harm or death. According to the Pennsylvania Patient Safety Reporting System, up to 15% of errors reported cite automated dispensing cabinets as the source of the drug involved in the error.Nearly 58% to 70% of hospitals nationwide use automated dispensing cabinets. Nurses play a critical role in promoting patient safety by surveilling and intercepting any possible errors that could ...

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education ...

Adverse Psychological Effects Of Patients In Medical Isolation Due To Healthcare-Associated Infections, Kristin Brill

Grace Peterson Nursing Research Colloquium

Background: Patients placed in medical isolation due to healthcare-associated infections experience adverse psychological effects that can impact their quality of life.

Objectives: The purpose of this integrative literature review was to identify the adverse effects of patients in medical isolation as well as explore coping strategies that can be used to decrease these adverse effects.

Method: An integrative literature review was conducted using the databases of CINAHL, PsychInfo, PubMed, and PsychArticles. Search terms included adverse effects, negative effects, effects, adverse outcomes, negative outcomes, isolation precautions, contact isolation, droplet isolation, airborne isolation, isolation, coping and psychology.

Results: Five common adverse psychological ...

Programs That Can Support Nurses To Reduce Compassion Fatigue And Secondary Traumatic Stress: An Integrative Literature Review, Molly Gruettner

Grace Peterson Nursing Research Colloquium

Compassion allows a nurse to empathize with their patient and their family, but it does not prepare the nurse to cope with stressful events. Repeatedly being exposed to traumatizing events, pain, distress, and suffering can lead to nurse burn-out and fatigue. Compassion fatigue is a unique form of burnout and secondary traumatic stress (STS) encompasses ideas of compassion fatigue and the two terms are often used interchangeably. Objective: The goal of this systematic integrated literature review is to discover interventions to reduce compassion fatigue and STS in trauma nurses Methods: A systematic integrated literature review study was conducted using Ebscohost ...

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor ...

Chest Pain Protocol Order Set, Andrey Kulikov

Master's Projects and Capstones

The goal of this project is to implement a chest pain protocol order set in order to increase the nurse-initiated chest pain protocol by 50%. The project was implemented in a Emergency Department (ED) that has problems with understaffing and patient crowding. RN-initiated chest pain orders are implemented 11% of the time and 89% by physicians. RNs initiated orders in less than 10 minutes while 50% of physician orders are initiated over 30 minutes. This results in delayed care and decreases patient flow. A chest pain protocol order set was designed based on the approved nursing protocol policy. 90% of ...

The Clinical Nurse Leader As Risk Anticipator: Optimizing The Completion And Accuracy Of The Code Blue Recorder Sheet, Catherine Morano

Master's Projects and Capstones

Abstract

• A small community hospital in northern California implemented a practice improvement project in critical care units to optimize best practices surrounding a “code blue” event. In-Hospital Cardiac Arrest (IHCA) is a high-risk process of care that requires tremendous resources to deliver an efficient, safe, and cost-effective service. The code blue recorder sheet summarizes the whole patient care event; this necessitates careful documentation. As a risk anticipator, the unit clinical nurse leader identified suboptimal variation in documentation after a microsystem assessment. This led to a practice change project and targeted educational intervention for code blue recorders. Fifteen staff members were ...

Pulmonary Embolism, Tonya Day

Master of Science in Nursing (MSN) Student Scholarship

The pathophysiological topic of acute pulmonary embolism was chosen to increase the knowledge base and provide additional information to assist with moving forward from a registered nurse to an Advance Practicing Nurse. Working as a full-time registered nurse in the emergency department, the working diagnosis of acute pulmonary embolism is something that is ruled out on many patients with complaints of shortness of breath, chest pain, or decrease in pulse oximetry. Since a patient with an acute pulmonary embolism can have both typical and atypical symptoms, the death rate can be very high, if not caught earlier enough. An acute ...

Sepsis, Sarah Jones

Master of Science in Nursing (MSN) Student Scholarship

Sepsis is a dysregulation of the inflammatory response, termed systemic inflammatory response syndrome or SIRS, caused by stimulation of an infectious process. Sepsis often leads to organ dysfunction and increased morbidity, mortality and financial burdens. The goal of treatment is to initiate appropriate antimicrobial therapies, target the underlying infection, optimize intravascular volume, provide fluid resuscitation and maintain adequate perfusion and stroke volume (Taeb, Hooper & Marik, 2017).

Timing of treatment and early detection of sepsis is critical to patients with early warning signs. Sharing this information and potentially making a difference in the outcomes of patients presenting with early signs of ...

Acute Bronchospasm Under General Anesthesia, Cody Rasmussen

Master of Science in Nursing (MSN) Student Scholarship

An acute bronchospasm during general anesthesia can become a life-threatening intraoperative condition for any patient. Bronchospasm occurs when the bronchial smooth muscle constricts which makes ventilating the patient difficult, and can ultimately lead to hypoventilation, hypoxemia, and metabolic acidosis. It’s imperative for any anesthesia provider to understand what a bronchospasm is, its pathophysiology, differential diagnosis, and algorithm of treatments. This poster presentation provides a summary based discussion of acute bronchospasm under general anesthesia.

Traumatic Induced Coagulopathy, Paul Devore

Master of Science in Nursing (MSN) Student Scholarship

Trauma is a leading cause of mortality and morbidity in the United States. For years patients have been resuscitated in a similar method without improvement in survival of the most severely injured cohort. While acidemia, hypoxia, and hypothermia have long been recognized as complicating factors in the care of trauma patients, it is only recently that research has led to a greater understanding of the pathophysiology of this deadly trio. Coagulopathy of trauma is a multi factorial process which is now being recognized as the proximate cause of death in many patients. This poster examines the pathophysiology and nursing interventions ...

Local Anesthesia Toxicity, Nicole Mccleery

Master of Science in Nursing (MSN) Student Scholarship

Local anesthesia (LA) provides a way to relieve temporary pain in a small part of the body and has been used for over 100 years (Fencl, 2015). LA also prevents the passage of surgical stimuli into the central nervous system (CNS) making a surgical procedure less painful for the patient (Noble, 2015). According to Noble, “altering the passage of stimuli from smaller diameter neurons in a confined area with lower drug dosages is called LA, such as the injection of LA around a surgical incision” (Noble, 2015, p.325). LA can be used in a variety of settings, such as ...

Sepsis To Septic Shock, Seth Whitlow

Master of Science in Nursing (MSN) Student Scholarship

Abstract

The diagnosis of sepsis has long been part of medicine, however ambiguous definitions, treatment modalities, and research criteria have not provided a unified understanding of the disease. In 2016, international healthcare practitioners convened a panel of experts and developed criteria that defined sepsis as ‘life-threatening organ dysfunction caused by dysregulated host response to infection’. The pathogenesis of sepsis and septic shock is complex and make understanding physiological host response to infection difficult. Evidence shows that with each passing hour patient mortality is increased when treatment is withheld. Sepsis has proven an elusive diagnosis where one size does not fit ...

Angioedema: Ace-Inhibitors Adverse Reaction, Jesse Vandyne

Master of Science in Nursing (MSN) Student Scholarship

This is a poster presentation about angioedema caused by Angiotensin-converting enzyme (ACEI or ACE Inhibitors). Angiotensin-converting enzyme inhibitor (ACEI) medications are one of the leading causes of angioedema in the United States, also known as ACEI-RA (Chan & Soliman, 2015, p. 207). ACE inhibitors are among the most commonly prescribed medications worldwide because they are indicated for the management of hypertension, congestive heart failure, myocardial infarction, diabetic nephropathy, and chronic kidney disease (Chan & Soliman, 2015, p. 207).

Critical Illness Myopathy, Salima Moez Meherali, Yasmin Parpio, Tazeen Ali

Tazeen Ali

Critical illness myopathy (CIM) is a syndrome of widespread muscle weakness and neurological dysfunction which can develop in critically ill patients receiving intensive care. CIM are often distinguished largely on the basis of specialized electrophysiologic testing or muscle and nerve biopsy and its causes are unknown, though they are thought to be a possible neurological manifestation of systemic inflammatory response syndrome usually developing in patients after a brief period of stay in the Intensive Care Unit (ICU). This case report aims to analyze the Clinical feature, diagnosis and treatment of CIM of 60 years old male case with Chronic Obstructive ...

Malignant Hyperthermia, Garrett Erickson

Master of Science in Nursing (MSN) Student Scholarship

Malignant hyperthermia is known as a pharmacogenetic disorder which manifests itself in the skeletal muscle (Heytens, Forget, Scholtès, & Veyckemans, 2015). When a susceptible patient, who carries the autosomal dominant trait, is exposed to volatile anesthetics and/or the neuromuscular blocker succinylcholine, a detrimental response can occur. This response is a hypermetabolic state with hypercapnia, hemodynamic instability, rigidity, hyperthermia, and signs of rhabdomyolysis (Heytens et al., 2015). MH is a rare condition with incidences between 1/5,000 and 1/50,000 (Nagelhout and Plaus, 2014, p. 829), and often occurs during the induction of anesthesia but can also occur intraoperatively ...

Study Of Nurses' Attitudes And Practices Towards Pain Evaluation In Nonverbal Patients, Rebekah Lovin

Montview Liberty University Journal of Undergraduate Research

Pain, and the appropriate treatment of it, has recently come to the forefront of issues addressed with healthcare providers. Since the cornerstone of pain management is an appropriate assessment, methods of accurate pain evaluation are necessary. This need is particularly important in the population of patients who cannot express their pain. While pain assessment tools are available for use with nonverbal patients and hospitals typically mandate the use of one of these tools, actual compliance with such policy may not actually occur. Various barriers, such as education in the use of a tool, time, and the personal views of the ...

Gadgets And Grieving: A Chronological Analysis On The Ways In Which Advancements In Medical Technologies Have Altered The Grieving Process, Grace Mcnair

Dialogue & Nexus

Since the 1940s, both end-of-life care and advancements in medical technologies have expanded exponentially. This article explores the advancements in medical technologies and how these have altered the way that Western society grieves death. With the capabilities to prolong life, the family, the patient, and the medical team, all grieve the end of life in different ways. This article provides a chronological analysis of palliative care, hospice care, and various medical advancements. These changes in medicine are then paralleled with alterations in the bereavement process. This article explores historical narratives of Western society’s transformation of grief through the lens ...

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that ...