In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, 2016 University of Southern Mississippi
In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel
Doctoral Nursing Capstone Projects
Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus ...
Improving Compliance In The Use Of Catheter Kit Supplied Hand Sanitizer Prior To The Insertion Of An Indwelling Urinary Catheter, 2016 University of San Francisco
Improving Compliance In The Use Of Catheter Kit Supplied Hand Sanitizer Prior To The Insertion Of An Indwelling Urinary Catheter, Antonette B. Prado
More than half of the staff nurses (65% through direct observation and 60% through interview) in the operating room (OR) department do not perform hand hygiene prior to insertion of an indwelling urinary catheter. This performance improvement project aims to educate all OR staff nurses on the practice of hand hygiene prior to the insertion of an indwelling urinary catheter by using the hand sanitizer included in the sterile catheter insertion kit. Two forms of interventions were provided in order to promote this process change. The first one being an education session with a power point presentation and the ...
Standardized Blood Transfusion Documentation, 2016 University of San Francisco
Standardized Blood Transfusion Documentation, Kelly A. Hill
The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses ...
Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, 2016 Valparaiso University
Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga
Evidence-Based Practice Project Reports
Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU ...
The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, 2016 University of San Francisco
The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West
On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.
The current process was determined using a fishbone diagram, a SWOT analysis was ...
Improving Patients' Pain Management Through Proper Documentation, 2016 University of San Francisco
Improving Patients' Pain Management Through Proper Documentation, Virzen Merina
The aim of this project was to improve pain documentation on the Surgical Unit as a means to enhance caregiver communication on finding the best methods to manage patients’ pain. Effectively managing patients’ pain leads to better patient outcomes, increased patient and nurse satisfaction, and decreased length of hospitalization. The setting is a not-for-profit hospital in Southern California. The microsystem selected is the 32-bed capacity Surgical Unit that mainly admits pre- and post-surgical patients, but also accommodates non-surgical, telemetry, and trauma cases.
To improve pain assessment documentation, collaboration was sought with the multidisciplinary team (IT department, clinical nurse specialists, and ...
Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, 2016 University of San Francisco
Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, Vicki F. Rocconi
Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines
Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors.
Goals & Objectives
Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. Documentation ...
Preventing Hapus In High-Risk Cardiac Cath Patients Using Foam Dressing Protocol, 2016 University of San Francisco
Preventing Hapus In High-Risk Cardiac Cath Patients Using Foam Dressing Protocol, Charles Jasper
The purpose of this project is to implement an evidence-based change in practice resulting safer procedures as evidenced by zero hospital acquired pressure ulcers (HAPUs). It is relevant to nursing as it provides an ethical perspective regarding patient safety and contributes to our present understanding of HAPU prevention. In spite of having already decreased the total number of HAPUs by 50% in 2015, the cardiac catheterization lab (CCL) was implicated in 30% of those reported. My objective is to improve patient safety by reducing the number of HAPUs acquired in the CCL to 0% by three months using a prophylactic ...
Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, 2016 Valparaiso University
Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long
Evidence-Based Practice Project Reports
The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and ...
Barriers To Preoperative Teaching In A Culturally Diverse Healthcare Environment, 2016 California State University, Northern California Consortium Doctor of Nursing Practice
Barriers To Preoperative Teaching In A Culturally Diverse Healthcare Environment, Rancelle Ablan
The role of the professional nurse is integral in educating and ensuring that patients understand essential components of their plan of care. This is especially true for patients who are to undergo surgical interventions; evidence has demonstrated that preoperative education provided to patients is linked with positive patient outcomes and a decrease in post-operative complications (Blackstone, Garrett, & Hasselkus, 2011). This qualitative study investigated the barriers that nurses experience in providing preoperative education to diverse patients in a multicultural healthcare environment. Ten registered nurses at a private community hospital in the San Francisco Bay Area participated in an hour long one-on-one ...
Implementation Of An Educational Session To Improve Compliance Of Reporting Medication Errors And Near Misses Among Anesthesia Providers, Kacy C. Ballard 3679424
There is currently no emphasis being placed on the significance of reporting medication errors, including near misses, for the anesthesia department in a Midwestern hospital system. Efforts to ensure patient safety depend upon collecting data related to actual medication errors, including near misses, so that educational or process improvement opportunities can be identified and implemented. The focus of this quality improvement project was to educate anesthesia providers about the importance of properly reporting all medication errors and near misses. The pre and post survey helped to provide data to determine whether anesthesia providers believe they are more apt to report ...
Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, 2016 University of Kentucky
Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale
DNP Practice Inquiry Projects
Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m2) seen by one surgical service over a two and a half-year ...
Retention Of Cardiopulmonary Resuscitation Knowledge And Psychomotor Skill Among Undergraduate Nursing Students: An Integrative Review Of Literature, Fernanda Tirado
Honors in the Major Theses
Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search ...
Behavioral Interventions Versus Pharmaceutical Interventions To Reduce Preoperative Anxiety In School Aged Children, 2016 University of Central Florida
Behavioral Interventions Versus Pharmaceutical Interventions To Reduce Preoperative Anxiety In School Aged Children, Jennifer J. Cline
Honors in the Major Theses
Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and ...
Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, 2015 University of San Francisco
Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle
The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to ...
Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, 2015 University of San Francisco
Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias
Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.
Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.
Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and ...
Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, 2015 University of San Francisco
Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, Jini K. Paek
The Clinical Nurse Leader project took place at a 106-bed community hospital in Washington. The microsystem has five operating rooms where they provide outpatient, and inpatient surgical procedures. The goal of this project is to reduce and sustain a near zero number of surgical site infections by implementing the use of a no rinse 2% CHG cloth in the surgical patient. The specific aim of the project is to reduce the rate of SSIs by 80% by December 31st, 2015. Due to a lack of a standardized care, specifically designed for the prevention of SSIs, the microsystem is ...
In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, 2015 University of Southern Mississippi
In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, Martha Claudine Boos
Doctoral Nursing Capstone Projects
It is estimated that up to 45% of surgical patients will have postoperative residual neuromuscular blockade (NMB) upon arrival to the postanesthesia care unit (PACU), and incomplete recovery can impair upper airway function and contribute to adverse respiratory events (Nagelhout & Plaus, 2014). This retrospective cohort study examined whether there was an increased incidence of postoperative adverse respiratory events with the neuromuscular blocking agents Rocuronium or Vecuronium. Inclusion criteria included any surgical patient ages 18-65 receiving NMB agents Rocuronium or Vecuronium during the procedure. Exclusion criteria included any surgical patient ages 18-65 with ASA classification > 4, any emergent cases, any patient ...
A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, 2015 University of Southern Mississippi
A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister
Doctoral Nursing Capstone Projects
The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.
PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties ...
Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, 2015 University of Southern Mississippi
Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy
Doctoral Nursing Capstone Projects
The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to ...