Critical Care Nursing Commons^™

Reducing The Incidence Of Pressure Injuries In Adult Icu Patients At Mcallen Medical Center With The Implementation Of A Pressure Injury Preventive Bundle: A Quality Improvement Project, Cheryl Cruz

Student Scholarly Projects

Practice Problem: Pressure injuries (PIs) are a significant healthcare problem globally. Adult patients in the intensive care setting are especially vulnerable to the development of PIs given the acuity of their diagnoses requiring extensive treatments, procedures and the use of multiple medical devices.

PICOT: The PICOT question that guided this project was, “In adult intensive care unit (ICU) patients, how does the effect of implementing a pressure injury prevention bundle compare in patients who received the bundle, and patients receiving standard pressure injury prevention in reducing the incidence of pressure injuries after two months?”

Evidence: Evidence exist that bundle implementation ...

The Effect Of Medication Reconciliation Timeout On Patient Safety: An Evidence-Based Project, Renante Dizon

Student Scholarly Projects

Practice Problem:There was a report of a high rate of medication errors from inaccurate medication reconciliation during admission to a local hospital in South Texas. The medication error rate was 14.88% on 20 reviewed charts, and 85% of all evaluated charts contained at least one medication discrepancy.

PICOT: This evidence-based, system-change project was guided by the following PICOT question: For nurses administering medication in a long-term acute care hospital, does the implementation of Medication Reconciliation Timeout Process (MRTP) decrease the medication errors, compared to the usual medication practice, in one month?

Evidence: Thirteen pertinent studies recommended the use ...

New Graduate Nurses Experiences During Their Transition From Novice To Competent And How Mentorship Post Residency Affect Their Experiences, Kelsey N. Murphy

MSN Capstone Projects

Staffing competent nurses in specialized areas poses a unique challenge to hospitals across the country. Competent and experienced RNs are leaving the bedside for a multitude of reasons including dissatisfaction in workplace environment, retirement, and hospitals are facing a shortage of skilled nurses in acute care (Valdez, 2008). To address this growing concern and meet increasingly complex health care demands, hospitals are relying on nursing schools to produce competent graduate nurses (GNs) (Valdez, 2008). Hospitals recruit and hire GNs for highly specialized roles in acute care areas despite the stressors accompanied with these roles. Clinical educators have the opportunity to ...

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent ...

Keeping Patients Vertical In The Intensive Care Unit, Melanie Smith

Master's Projects and Capstones

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem ...

Tele Critical Care Implementation And Education Project, Jeffrey Dover

Master's Projects and Capstones

Abstract

Problem: The intensive care unit has the highest rate of mortality and patient care costs in the hospital. There are significant challenges in improving care and controlling costs. One solution adopted by many healthcare organizations is intensive care telemedicine. Commonly known as eICUs or Tele Critical Care (TCC). These specialty units provide access to intensivists and nurses 24-hours a day and has shown success in reducing mortality and length of stay while providing cost savings.

Challenges exist in introducing telemedicine to a new setting. Barriers identified are high initial cost of equipment, competing priorities for resources, and nurse acceptance ...

Is This Really Happening? Family-Centered Care During Covid-19: People Before Policy, Terri Savino, Karri Crispino

Patient Experience Journal

In the middle of a global pandemic, hospitals created policies for visitor restrictions to reduce the transmission of coronavirus to protect patients and staff and developed protocols allowing only one support person to call the critical care unit for patient updates. Late on a Tuesday afternoon, the Manager of Patient Experience received a phone call asking her to call Karri, the wife of one of our patients who was on a ventilator. Karri was struggling with updating her mother-in-law because she was very upset with the news she received, making it difficult to call her husband’s mom. Karri asked ...

Pre-Discharge Bnp: A Policy Change To Reduce Hospital Readmission, Melissa Duckett

Doctor of Nursing Practice Projects

Heart Failure (HF) is the leading cause of hospital readmission for patients 65 years of age and older. A pre-discharge B-type natriuretic peptide is a strong predictor of hospital readmission and mortality. The annual cost for admission of patients with HF is greater than $17 billion. Diagnosed heart failure patients continue to be discharged without the physician knowing their current BNP levels. The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) requiring the Center for Medicare and Medicaid Services (CMS) to reduce reimbursement to hospitals with high readmission rates. A change in policy should be initiated to include ...

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing ...

Sepsis Pathophysiology, Samantha Kingsley

Nursing Student Class Projects (Formerly MSN)

Sepsis is one of the most common diagnoses in medical intensive care units (MICUs) worldwide. Sepsis is a medical emergency where prompt intervention is vital to promoting positive patient outcomes. Septic shock develops when sepsis has progressed to the point of persistent hypotension despite appropriate fluid resuscitation. It is important to recognize the early signs of sepsis and intervene to prevent further progression. As the understanding of the pathophysiology has developed further over the years, the treatments and outcomes associated with sepsis have also improved. However, prompt recognition and intervention have always been at the forefront of management and should ...

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire ...

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of Life Scale ...

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Pulmonary Arterial Hypertension, Gifty Menka

Nursing Student Class Projects (Formerly MSN)

Pulmonary arterial hypertension (PAH), is diagnosed as persistently elevated pressures in the pulmonary arteries. It is a severe disease that requires early diagnosis and treatment as it can be life-threatening if not treated promptly and adequately. The initial presenting signs and symptoms such as lethargy, malaise, and exercise intolerance can be vague, making it difficult to diagnose. Also, doctors at centers that specialize in treating PAH are the only ones who can properly diagnose the condition and initiate disease-targeted therapy. There are different types of PAH; the World Health Organization (WHO) recognizes 5 groups of pulmonary hypertension (PH), and they ...

Malignant Hyperthermia, Kathryn Hernandez

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia (MH) is a condition in which the body goes into a hypermetabolic state affecting skeletal muscle in response to receiving inhaled anesthetics or the neuromuscular blocking agent, succinylcholine. MH is an autosomal dominant disorder that is most closely related to a defect in the ryanodine receptor. The defective receptor causes a rapid increase of intracellular calcium causing hyperthermia, tachycardia, tachypnea, hypercapnia, increased oxygen consumption, acidosis, hyperkalemia, muscle rigidity, and rhabdomyolysis. With the complexity of this disorder and its unique pathophysiological process it is crucial that all parts of the surgical team, especially anesthesia providers, understand how to treat ...

Aortic Stenosis, Christina Lower

Nursing Student Class Projects (Formerly MSN)

Aortic Stenosis is the progressive and permanent narrowing of the aortic valve that is located between the left ventricle and the aorta. The pathophysiology is endothelial damage to the valve resulting in lipid penetration, calcific changesand valve stiffness.Major risk factors for aortic stenosis are natural aging>60 years(atherosclerotic changes in vasculature) and male gender.In the early phases of aortic stenosis, the body compensatesvia hypertrophy of the left ventricle to accommodateforthe increased pressure gradient. Progression is typically over years to decades untildecreased outflow of blood leads toinadequate perfusion to major organsystems including the heart itself. Patientsdo not typically ...

Coarctation Of The Aorta, Megan Berens

Nursing Student Class Projects (Formerly MSN)

Coarctation of the aorta (CoA) is a ductal dependent congenital heart defect that causes decreased blood flow to areas of the body distal to the site of constriction. CoA is one of the most common congenital heart defects, though is often missed in neonatal assessments. Neonatal patients with CoA often present to the hospital in a state of cardiopulmonary collapse. CoA is occasionally diagnosed in older children and adults who have upper extremity hypertension and decreased femoral pulses. CoA repair is performed through surgery or percutaneous catheter interventions. Patients with CoA have an increased likelihood of developing other vascular lesions ...

Hyperosmolar Hyperglycemic State, Justin Momeyer

Nursing Student Class Projects (Formerly MSN)

Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are dangerous complications of diabetes. HHS is examined in this poster and compared to DKA. Even though both have some similarities, they have very different laboratory profiles, patient presentations, treatments, complications, and can require different levels of care. With diabetes becoming more common amongst patients in the hospital, it is imperative that healthcare providers are aware of both of these complications. Nurses who understand both of these complications are able to act pro-actively for their patients, ask questions regarding correct treatments and orders, include the right providers in the care team, and ...

Chronic Thromboembolic Pulmonary Hypertension, Alyssa Curry

Nursing Student Class Projects (Formerly MSN)

Chronic pulmonary hypertension (CTEPH) is a rare and underdiagnosed complication of unresolved acute pulmonary embolism (PE). A chronic fibrotic thrombus replaces the unresolved emboli in the pulmonary vascular bed causing pre-capillary pulmonary hypertension (Mahmud et al., 2018). Symptoms rang from mild nonspecific such as exercise intolerance and dyspnea. As the disease progresses, symptoms present similarly to right ventricular heart failure (Gopalan et al., 2016). Although the pathophysiology and etiology of CTEPH is still not fully understood, risk factors include increased size of the PE, right ventricular strain, chronic inflammation, and defects in fibrinolysis among others (Fernandes et al., 2016). Treatment ...

Analyse Du Contexte Clinique Dans Le Développement Et L’Implantation D’Une Intervention De Soutien Pour Les Familles De Patients Atteints De Lésions Cérébrales Acquises : Une Étude Qualitative, Véronique De Goumoëns, Chantal Grandjean, Daniel Joye, Yann-Olivier Bettex, Philippe Ryvlin, Anne-Sylvie Ramelet

Science of Nursing and Health Practices - Science infirmière et pratiques en santé

Introduction: Acquired brain injuries (ABI) are among the leading causes of disability in adults. Supporting the families of patients with ABI is part of good practice, but this is not systematic in Switzerland. Preceding the implementation of a new intervention, an analysis of the contextual factors was carried out. Objectives: The objectives of this study were to describe the perspectives of interdisciplinary management teams concerning the support of these families and to explore the contextual resources and obstacles of the intervention. Methods: A descriptive qualitative research was conducted in a clinical neurosciences department of a tertiary reference hospital. Semi-structured interviews ...