Critical Care Nursing Commons^™

Managing Severe Tbi In The Icu Setting Using A Three Tier Approach, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Assess the effects of injury to the brain in the neurologic injured patient and implement a tiered approach to manage severe TBI
• Evaluate TBI patients using multimodality monitoring
• Apply interventions to manage brain injury & integrate the complex multi-system issues and manage these patients using an actual case study.

Temperature Management: All Shook Up! Managing Shivering In Normothermia, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify key factors related to maintaining normothermia
• Describe the use of the Bedside Shivering Assessment Scale
• Provide interventions to manage shivering in the Neuro patient population

Practice With Purpose & Passion, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Integrate the components of clinical practice in an ICU environment including elements of team membership/performance, teamwork, shared decision making, communication and collaboration
• Demonstrate passion in delivering care in the ICU environment by reflecting on the meaning of nursing care and generating fuel to inspire the clinical team in the work environment

Technology: Inside The Black Box -- Managing Neuro Patients, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify the pathophysiology and cellular processes related to brain injury responses
• Describe the indications, functions, data analysis, and suggested interventions with various monitors of the brain
• Apply this technology to the care of the critically injured neuro patient using evidenced based protocols

Improving Inpatient Pediatric End Of Life Care Education For Bedside Nurses, Grace Wolcott

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose:45,000 infants, children and adolescents die in the US annually. Bedside nurses in inpatient pediatric units receive minimal education on the topic of pediatric end of life care. The purpose of this project was to assess the needs of pediatric inpatient nurses and trial an online educational module for effectiveness in teaching nurses about pediatric end of life care

Methods. This was a quality improvement project aimed at inpatient nurses on 4 different units. Electronic 7 question pre-surveys were sent via email, followed by an educational module accompanied by a 3 question post-survey.

Results. Of 78 participants, 51% reported …

Investigating Compassion Fatigue In Medical-Surgical Nurses, Tammy Darlene Shepherd

Nursing Theses and Capstone Projects

Medical-surgical nurses are consumed by providing care to patients and families and often forget to care for themselves. Compassion fatigue can lead to lack of caring for one’s self in the nurse’s life. The purpose of this thesis was to examine the existence of compassion fatigue among medical-surgical nurses and determine the correlation between the range of years of nursing experience and range of age in years. A review of the literature has identified that nurses should practice self-care to combat compassion fatigue. The theoretical framework was based on Jean Watson’s Theory of Transpersonal Caring. The Professional Quality of Life …

Neurochemical Factors Associated With The Initial Pathophysiological Reaction To Large Vessel Occlusion Stroke, Sarah R. Martha

Theses and Dissertations--Nursing

Ischemic stroke is the leading cause of disability world-wide and affects over 800,000 people per year in the United States. The majority of these strokes are ischemic due to a blockage of blood flow to the brain. Damage to the brain occurs at the onset of stroke, neuronal cell death is irreversible and therefore, quick treatment to remove blockage is critical factor in the recovery from stroke. Mechanical thrombectomy as a treatment for ischemic stroke provides an ideal opportunity to collect blood distal and proximal to the cerebral thrombus to examine neurochemical changes occurring during stroke.

The purpose of this …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Improvement Of Chf Patients’ Fluid Restriction Education Through Self-Efficacy, Johanna Ruckey, William Fyler

Interprofessional Research and Innovations Council

Improvement of CHF patients’ fluid restriction education through self-efficacy

Johanna Ruckey RN and William Fyler BSN

Background: Dietary discretion through limited salt and fluid intake is an important aspect of heart failure (HF) management. Keeping accurate account of fluid intake has shown itself to be a difficult task, as both staff and patients often fail to do so on a fairly regular basis. Although staff are aware of a patient's fluid restrictions, there is a deficit in the patient's role in tracking their own intake. Patients often express confusion and frustration regarding their daily fluid intake, but also lack …

The Effect Of A Simulation-Based Education Program On Nihss Accuracy And Inter-Rater Reliability Among Nursing Staff In The Neurological/Neurosurgical Intensive Care Unit, Amanda Novak

DNP Projects

PURPOSE: The purpose of this Quasi-experimental study was to examine the effect of a simulation-based educational NIHSS workshop on nursing accuracy and inter-rater reliability upon use of the National Institutes of Health Stroke Scale (NIHSS).

METHODS: This study was conducted in the Neurological/Neurosurgical Intensive Care Unit (ICU) at Baptist Health, a comprehensive stroke center located in Lexington, KY. The sample included 26 eligible nurses employed in the aforesaid unit. Nurses completed the NIHSS on a patient actor in a simulated scenario (this session was videotaped), a one-on-one debriefing with review of the videotape was conducted afterward, and then the nurse …

Burnout Syndrome In Critical Care Nurses, Katie Burke, Kelly Claridge, Mallory Bidlen

Williams Honors College, Honors Research Projects

Burnout syndrome among nurses, especially within the critical care setting, has been a persistent and increasingly prevalent problem in the healthcare field. This systematic review aims to explore the common causes of burnout among nurses associated with working in a critical care setting. Twenty-five peer-reviewed articles, published between the years of 2000 and 2018, were selected for analysis and synthesis using the databases PubMed and CINAHL. The group included research studies conducted in the United States, Spain, France, China and Iran with sample sizes ranging from 42 to 2,392 intensive care unit (ICU) nurses. The articles included in this review …

The Effect Of Computed Tomography Perfusion (Ctp) Scans On Acute Ischemic Stroke Patients At A Comprehensive Stroke Center, Sarah Holloway, Sarah Elizabeth Holloway

DNP Projects

Objective: The DEFUSE 3 and DAWN trials have revealed that stroke patients may be eligible for mechanical thrombectomy up to 24 hours from symptom onset with appropriate perfusion imaging. The purpose of the study is to evaluate the impact CTP imaging will have patient selection and outcomes at a Comprehensive Stroke Center.

Methods: This study is a retrospective and prospective chart review comparing acute ischemic stroke patients evaluated for mechanical thrombectomy utilizing CT angiogram verses CT perfusion imaging from January 1, 2018- June 30^th 2019 at a Comprehensive Stroke Center.

Results: Of the 129 patients who received CTAs, 36 …

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

Improving The Delivery Of Enteral Nutrition In The Neurocritical Care Unit Through The Implementation Of A Volume-Base Feeding Protocol, Joan M. Walsh

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Neurocritical care patients receiving rate-based enteral nutrition (RBEN) consistently received less than their full prescription of enteral nutrition (EN) volume due to interruptions in feeding. This study investigated the impact of the implementation of a volume-based feeding protocol (VBEN) on the percentage of prescribed volume of EN delivered over the course of patients’ neurocritical care unit (NCCU) length of stay. Aim: The aim of this study was to better meet the nutritional needs of adult neurocritical care patients receiving nutrition through the enteral route. Methods: A retrospective pre and postimplementation chart review was conducted on adult patients with age 18 …

Nurses' Perceptions Of Open Visiting Policy In The Adult Intensive Care Unit: An Integrative Review, Susan P. Mckenna

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The Intensive care unit (ICU) can undoubtedly be overwhelming and stressful at times. Open visitation has many demonstrated benefits for the patient and the family but can also have disadvantages. Nurses, who are a central element in the care of the critical patient, can be greatly affected by visitation. This integrative review explored nurses' perceptions of open visitation as well as visitation policies of ICUs across the nation. Beneficial effects of open visitation include enhanced teaching, improved communication, reduced anxiety, and physiologic benefits. Barriers of open visitation include hindrance in the delivery of care, physiological concerns, creating additional workload, and …

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

An Evaluation Of A Pilot Inpatient Hospice Unit And The Impact It Has On End-Of-Life Care At An Academic Medical Center, Cynthia Minetree

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.

Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact …

Patient Outcomes Associated With Delayed Rapid Response System Activation: A Retrospective Comparative Study, Ricardo Padilla

Dissertations

Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, …

The Use Of Behavioral Pain Assessment Tools And Pain Outcomes In Nonverbal Patients, Patrick A. Healy

Honors Undergraduate Theses

Acute and critical care patients experience significantly more pain than those patients on a general nursing unit. Due to the severity of their condition, acute care patients may be nonverbal and unable to self-report their pain. Behavioral pain assessment tools are a method of objectively measuring pain in patients who are unable to communicate. While the use of these tools has been shown to improve short- and long-term outcome for patients, there is a paucity of evidence as to nurses' perceptions related to their use. The purpose of this study is to investigate acute care nurses' perceptions of the relationship …

Stroke Clinical Order Pathway Education (Scope) For Apns, Varsha Singh

Seton Hall University DNP Final Projects

More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across New Jersey (NJ) …