Nursing Commons^™

Reducing Blood Pressure Through Education On Lifestyle Interventions, Charlotte M. Fuller, Shannon Harris, Mohammad A. Naeem

Virtual Presentations

This is the virtual presentation on a quality improvement study conducted in fulfillment of the Doctor of Nursing Practice degree requirements. The purpose of this study was to develop an educational plan for patients with elevated blood pressure to increase their knowledge and self-efficacy of lifestyle interventions proven to help lower blood pressure rates.

Plethysmography Variation Index (Pvi) Utility In Guiding Goal-Directed Fluid Therapy During Major Abdominal Surgery, Ricky Malo

Nurse Anesthesia Student Capstones

When considering intra-operative MAP maintenance, preload is a significant driving factor of stroke volume and therefore cardiac output. In major abdominal surgeries, large fluid shifts are common and accurate fluid resuscitation is extremely important to maintain hemodynamic stability and promote optimal patient outcomes. Invasive methods of measuring fluid status range from esophageal doppler derived flow time (FTc) and arterial line-derived metrics such as stroke volume variation (SVV) and pulse pressure variation (PPV). However, invasive means are not always warranted for every surgical procedure or patient and there is a higher potential risk for complication. Plethysmography Variation Index (PVI) has been …

Neurotoxic Effects Of General Anesthesia On The Developing Brain And The Use Of Spinal Anesthesia As An Alternative Approach For The Neonate And Infant Undergoing Genitourinary Surgery, Makaela E. Delucca

Nurse Anesthesia Student Capstones

Spinal anesthesia (SA) in the child under two years old is an excellent option when undergoing short genitourinary procedures. The use of SA in this patient population can avoid the potential deleterious neurocognitive effects on the developing brain that general anesthesia (GA) poses. A comprehensive literature review was conducted via retrospective case study, case control study, integrated review, and prospective study. The objective of this literature review is to examine the potential long-term neurotoxic effects of GA in the infant, as well as the benefits of SA. GA in the younger population has been shown to produce lower gray matter …

The Effects Of Mindfulness On Stress Reduction And Academic Performance In Students Studying Health Sciences, Julia Montalto

Nurse Anesthesia Student Capstones

Students studying health sciences are often consumed by rigorous curricula and demanding clinical schedules. The extensive concentration and commitment required of these students can be exhausting. This can lead to stress, poor academic performance, substance use and a decreased quality of life (Fauzi et al., 2021, Flowers & Bernard, 2020, Gao et al., 2022, & Melaku et al., 2015). Recent trends in academia have led to an integration of mindfulness-based stress reduction (MBSR) programs into the curriculum of graduate and undergraduate schools. Studies have shown that a consistent practice of some form of mindfulness is associated with a decrease in …

Perioperative Pain Management In Morbidly Obese Patients Undergoing Bariatric Surgery, Jean-Louis Luther

Nurse Anesthesia Student Capstones

Patients with morbid obesity are a growing patient population. These patients present a unique set of challenges in healthcare management. These unique challenges have been a long-standing concern to anesthesia providers in appropriately managing postoperative pain with opioids. Multimodal analgesia strategies have been adopted by many providers to minimize opioid-related side effects that are highly desirable in bariatric surgical procedures. The literature reviewed for this manuscript highlights the challenges this population presents to anesthesia providers, as well as conclusively supports alternative approaches utilizing multimodal pain management.

Impact Of Intrathecal Morphine On Patient Outcomes In Major Abdominal Surgery, Tori E. Howe

Nurse Anesthesia Student Capstones

Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring …

Perioperative Methadone Use And Postoperative Pain Control In Adult Patients Undergoing Elective Spinal Fusion Surgery, Amelia Haney

Nurse Anesthesia Student Capstones

Patients undergoing elective spinal fusion surgeries often experience moderate to severe postoperative pain (Murphy et al., 2017). The use of perioperative methadone has been suggested as an effective adjunct for patients to reduce postoperative pain, decrease opioid use, and improve patient satisfaction (Murphy et al., 2017). Traditional opioid management of orthopedic spine surgeries include intermittent injections or patient-controlled analgesia devices. These approaches may cause fluctuating levels of opioids or require patient education and cooperation to be effective (Murphy & Szokol, 2019). Methadone has a much longer elimination half-life when compared to other opioids, and therefore may provide patients with a …

Benefits Of Ketamine Versus Propofol In Acute Traumatic Brain Injuries With Elevated Intracranial Pressure, Marissa Diloreto

Nurse Anesthesia Student Capstones

Ketamine is a widely used medication that can be administered for the delivery of anesthesia as well as analgesia while supporting hemodynamics. A commonly taught concept based on early research is that ketamine should not be administered to those with acute brain injuries. Early research had stated that ketamine can cause a dangerous increase in intracranial pressure (ICP) and thus a decrease in cerebral perfusion and oxygenation in those with traumatic brain injuries (TBI) (Takeshita et al., 1972). More recent research has shown that ketamine may be efficacious for patients with TBIs and can decrease ICP (Dengler et al., 2022). …

The Role Of Intraoperative Esmolol Vs Ketamine In Laparoscopic Cholecystectomy, Rebekah Bitar

Nurse Anesthesia Student Capstones

As the understanding of opioid dependence mechanisms and origins in the adult population continues to evolve in the United States, so does the pursuit of alternative avenues for analgesia. Many opioid substance-use disorder patients can trace the origins of their dependence to routine prescription and administration of opioids during surgical procedures (Bohringer et al., 2020). One such procedure where opioids are frequently utilized for intraoperative and postoperative analgesia is laparoscopic cholecystectomy. Incidence of gall bladder disease is closely related to obesity (Hines & Marschall, 2018). Gallstone disease continues to be a common and costly health problem affecting 10 to 20% …

Lessons From A Natural-Born Teacher: Reflections On Mentorship And Kindness In Medical Education, Chloe Hille, Brianna Wetmore

be Still

The transition from preclinical education to medical clerkships is an important period of medical school that challenges students to advance their clinical knowledge. The help of strong and inspirational mentors is crucial for students to not only gain proficiency in their clinical skills, but to also develop into confident and compassionate future physicians.

Adult Post-Cardiac Surgery Deep Sternal Wound Infections, Samantha Porcher, Cole Gatzke

Nursing DNP Projects

ABSTRACT

Purpose and rationale: Deep Sternal Wound Infections (DSWI) are associated with morbidity rates and mortality rates as high as 10% -15% as well as significantly increased hospital costs. The purpose of this project is to decrease current rates of DSWIs in adults undergoing cardiac surgery at a large medical institution.

Synthesis of evidence: The literature shows a strong relationship between elevated HbA1C and DSWI. All articles reviewed for this proposal which implement a sternal vest intervention support its use to prevent DSWI.

Practice change and implementation strategies: The strategy used to implement these evidence-based practice interventions includes …

College Of Nursing, Spring 2023, Jill Fier, Micayla Standish, Dave Graves, Addison Dehaven, Emily Weber

College of Nursing Magazine

College News
2 Nursing research continues growth
6 Marge and Ron Hegge Endowment
7 Leadership Challenge Opportunity
8 American Academy of Nursing Fellows
11 New faculty
12 Scholarly outcomes

Student News
14 A semester on the Emerald Isle
18 Madison Fitch: Future nurse

Alumni News
20 Corps of Jackrabbits excels in small-town Minnesota
23 Speaker promotes nursing-engineering collaboration

SDSU Foundation
24 Commitment to our people
25 Scholarships at SDSU

Implementing Best Practices To Improve Nurse-Patient Communication And The Ed Experience In A Small Suburban Hospital In The Northwestern U.S.: A Pilot Project, Kimberli Munn

Doctor of Nursing Practice Projects

As one measure of quality of care and patient satisfaction, healthcare systems now routinely evaluate the patient experience. Nurses at every level of care, especially those in the hospital, can directly impact the outcome of that experience (American Association of Colleges of Nursing [AACN], 2011; Natsui et al., 2018). Communication with the health care team during patient visits enhances overall patient satisfaction, and research has established a clear correlation between the patient experience and improved patient outcomes and quality of care (Hermann et al., 2019, Sonis et al., 2017; Tan et al., 2013). Quality care, a high standard, reflects the …

Improving Pediatric Medical Nurses’ Confidence In Caring For Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System In The Pacific Northwest, Lauren Kalember

Doctor of Nursing Practice Projects

Problem Description

Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the …

A Pilot Program To Address Nurse Leader Moral Distress Secondary To The Performance Evaluation Of Underperforming Personnel, Lisa Krening

Doctor of Nursing Practice Projects

Problem Description: First defined in 1984, as a nurse knowing the correct course of action but perceiving barriers that constrain the action, moral distress has evolved to include challenging situations associated with moral uncertainty, moral conflict, and ethical or moral dilemmas (Campbell et al., 2016; Fourie, 2015, 2016; Jameton, 1984). While the bulk of the moral distress literature has highlighted the challenges of direct care nurses, nurse leaders also grapple with ethical dilemmas that often lead to moral distress (Edmonson, 2010; Ganz et al., 2015; Prestia et al., 2017). Additionally, research indicates that nurse leaders lack experience in navigating ethical …

Transformational Leadership And Structural Empowerment For Nurse Managers To Improve Nursing Job Satisfaction, Engagement, And Retention, Leah M. Gehri

Doctor of Nursing Practice Projects

Problem Description

Low nurse job satisfaction and engagement have historically been associated with high attrition. While it is too soon to fully quantify the impact of Covid-19 on nurse satisfaction, engagement, and turnover, evidence is emerging that high chronic fatigue and persistent feelings of being overwhelmed are causing nurses to either leave the bedside or quit nursing altogether, exacerbating existing nurse staffing challenges caused by a decades long nursing shortage that, pre-pandemic, predicted a national deficit of over one-half million nurses by 2030. The financial impact of competing for experienced nurses, and recruiting, hiring, and training new nurses to replace …

An Inpatient Fall Prevention Program Evaluation Using The Context, Input, Process And Product Model, Brittany Harker

Doctor of Nursing Practice Projects

Background/Context: Falls remain a substantial risk for patients and is reported that 1,000,000 patients fall each year and one-third result in injury to the patient.

Problem/Purpose: To evaluate the implementation of a fall prevention toolkit to determine if standards of care were followed and outcomes were met using the Context, Input, Process, and Product model.

Outcomes/Results: Fall risk assessment was occurring on admission (n=33) with opportunity for reassessment throughout stay. Required post-fall documentation was not completed per policy. 26% of staff responded to the feedback survey. The facility’s fall rate target was not met but reducing the …

Implementing Cognitive Behavioral Therapy For Insomnia With Motivational Interviewing In The Mental Health Setting, Kassandra E. Ransom

Doctor of Nursing Practice Projects

Can you imagine not sleeping well for weeks or months at a time? Insomnia impacts approximately one-third of adults and is considered the most prevalent of all sleep disorders. With a lack of consistent, quality sleep, insomnia has significant negative consequences that impact a person’s overall mental well-being, like increased anxiety, depression, chronic pain, and daily coping. Cognitive Behavioral Therapy for Insomnia (CBT-I) allows patients to reduce or eliminate insomnia or related symptoms without needing medication to obtain quality and consistent sleep. CBT-I is difficult, so partnering it with Motivational Interviewing (MI) techniques provides patient engagement and compliance to strike …

Dnp Final Report: Preventing Critical Care Nurse Burnout: An Evidence Based Approach To Raising Awareness, Trendalyn S. King

DNP Final Reports

Burnout has affected nurses nationally and globally for decades. Burnout in nurses is characterized by emotional exhaustion, depersonalization, and lack of feelings of personal accomplishment. Consequences of burnout include physical and emotional suffering in nurses, poorer patient outcomes, and lost revenue and increased cost in healthcare organizations. Burnout is prevalent in many healthcare settings, but 81% of critical care nurses have reported severe symptoms of burnout, Because of the high risk of burnout in critical care nurses, raising awareness about burnout and its prevention in those nurses was imperative. The following PICOT question guided the search for evidence to support …

Dnp Final Report: Conquering Rn Turnover: Implementing Flexible Scheduling To Improve Job Satisfaction, Camille Y. Parsee

DNP Final Reports

Nurse turnover is a complex problem for the nursing profession, especially in the behavioral health setting, where turnover rates are higher than the overall RN national average. The consequences of high nurse turnover include increased health costs, low-quality patient care, and staffing constraints. The association between nurse turnover and job satisfaction is profound because of their reciprocal relationship; therefore, implementing an intervention to help mitigate nurse dissatisfaction is essential to overcoming nurse turnover. Flexible scheduling is an intervention that gives nurses independence with their schedule which improves work-life balance and promotes nurse retention (Wright, 2017). The following PICOT question was …