Medicine and Health Sciences Commons^™

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather M. Tatusko Phiri

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Development Of A Rotem-Guided Transfusion Algorithm In Cardiothoracic Surgery Patients, Kourtney Jane Snyder

Doctor of Nursing Practice Scholarly Projects

Abstract

Cardiothoracic surgical patients are at an increased risk for bleeding complications for various reasons, including induction of hypothermia, initiation of the coagulation cascade, degradation of the coagulation factors, mechanical destruction of platelets, and a systemic inflammatory response due to cardiopulmonary bypass (CPB). The American Society of Anesthesiologists recommends rotational thromboelastometry (ROTEM)-guided transfusion algorithms for perioperative blood management; however, there remains a heavy reliance on conventional coagulation laboratory values. Utilization of the following PICOT question will guide this project: In cardiothoracic surgical patients, how does the use of ROTEM versus traditional coagulation laboratory tests (PT, INR, aPTT, ACT, platelet count, …

Development Of Evidence-Based Practice Anesthesia Guidelines For Brain-Dead Organ Donors, Kelly Dzialowski

Doctor of Nursing Practice Scholarly Projects

Organ donation is a gift of life for both donors and recipients that can come from living donors, donors after cardiac death, or brain-dead donors (BDDs). Treating the donors with optimal care throughout the entire donation process is crucial due to organ supply shortages. Organs from BDDs are a large contributor to the number of organs donated each year and require critical care from the time of admission, declaration of brain death, and throughout the organ procurement surgery. Although each BDD requires meticulous care for successful retrieval and donation, there is a lack of evidence-based practice (EBP) guidelines for anesthesia …

Preprocedural Ultrasound For Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations, Nicholas Anderson

Doctor of Nursing Practice Scholarly Projects

Central neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Final Scholarly Project: Optimal Perioperative Analgesic Management Guidelines For Elective Hip Arthroplasty In Adults, Makyah Dittoe

Doctor of Nursing Practice Scholarly Projects

Hip arthroplasty, a frequently performed orthopedic surgery, is gaining popularity. However, postoperative pain, opioid utilization, nausea, and vomiting are common side effects associated with this procedure. Perioperative analgesic management for hip arthroplasty varies among providers, leading to possible inadequate pain management. The goal of this scholarly project is to provide an optimal perioperative analgesic guideline to decrease postoperative pain, opioid consumption, nausea, and vomiting in adults undergoing elective hip arthroplasty utilizing evidence-based practice. The evidence suggests that a multimodal analgesic approach incorporating multiple drug classes and types of anesthesia is most effective in reducing adverse postoperative outcomes. Using the Johns …

Evidence-Based Practice Recommendations For The Use Of A Cardiac Optimization Algorithm In Patients Undergoing A Whipple Procedure, Jarrod Genther

Doctor of Nursing Practice Scholarly Projects

A fundamental responsibility of a certified registered nurse anesthetist includes intraoperative fluid and hemodynamic management. While Enhanced Recovery After Surgery protocols advocate goal-directed fluid therapy, the methodology remains controversial. An algorithmic approach systematically optimizes cardiac function and fluid volume status based on stroke volume variation, cardiac index, and mean arterial pressure. This project aims to evaluate the effects of placing intraoperative guidelines for patients undergoing a Whipple procedure when using a cardiac optimization algorithm to guide fluid and vasopressor management. The outcomes evaluated included the amount of fluids delivered intraoperatively, vasoactive medication administration, urine output, amount of blood transfusions, cardiac …

Development Of Evidence-Based Practice Guidelines For Perioperative Multimodal Analgesia During Spine Surgery, Jonathan Wagner

Doctor of Nursing Practice Scholarly Projects

The most common cause of adult disability is chronic back pain. As medication maintenance therapy becomes ineffective, surgical intervention is the last resort for treatment. Patients with chronic pain often rely on pain medication such as opioids for relief. The exposure and dependency of opioids can create unique challenges for anesthesia providers to deliver safe and adequate anesthesia for surgery. Patient’s dependent on chronic opioids develops many adverse effects including sleep disordered breathing, suppression of the immune system, and higher risk of developing cardiovascular events under stress. There is a lack of consistent perioperative guidelines for patients undergoing spinal surgery …

Evidence-Based Recommendations For The Use Of Neostigmine Versus Sugammadex In Patients Undergoing Thoracic Surgery, Ostap Dvorakevych

Doctor of Nursing Practice Scholarly Projects

Neuromuscular blocking agents play a vital role in the safe delivery of modern anesthetic practice. These medications provide patient paralysis for anesthesia staff to perform tracheal intubation and for surgeons to have a motionless surgical field. At the end of surgery, the effects of these paralytic agents must be fully reversed by reversal agents. Incomplete reversal impairs the patient’s ability to maintain an airway, which can lead to various postoperative pulmonary complications such as respiratory failure, pneumonia, and atelectasis. Patients undergoing thoracic surgery are at high risk for this incomplete reversal due to deep levels of paralysis required to keep …

Evidence-Based Recommendations For The Use Of Neostigmine Versus Sugammadex In Patients Undergoing Thoracic Surgery, Ostap Dvorakevych

Doctor of Nursing Practice Scholarly Projects

Neuromuscular blocking agents play a vital role in the safe delivery of modern anesthetic practice. These medications provide patient paralysis for anesthesia staff to perform tracheal intubation and for surgeons to have a motionless surgical field. At the end of surgery, the effects of these paralytic agents must be fully reversed by reversal agents. Incomplete reversal impairs the patient’s ability to maintain an airway, which can lead to various postoperative pulmonary complications such as respiratory failure, pneumonia, and atelectasis. Patients undergoing thoracic surgery are at high risk for this incomplete reversal due to deep levels of paralysis required to keep …

Final Scholarly Project: Clinical Guidelines For The Perioperative Management Of Patients With Opioid Use Disorder Requiring Anesthesia, Jessica Kayla Joos

Doctor of Nursing Practice Scholarly Projects

Opioids have highly addictive properties that allow for high levels of misuse. Since the early 1990s, the misuse and deaths rates related to narcotics have steadily risen in the United States. Efforts to identify individuals using opioids prior to surgery have proven difficult. The number of patients misusing opioids and reporting for surgery can only be estimated due to under-reporting related to fear and self-stigma. With 50 million surgeries in the U.S. annually and 3.32 million people misusing opioids monthly, the chances of a patient with Opioid Use Disorder (OUD) presenting for anesthesia are exceptionally high. Moreover, patients who rate …

Final Scholarly Project: Implementation Guidelines Of Ultrasound-Guided Regional Anesthesia In Pediatric Cardiac Surgical Patients, Matthew Hall

Doctor of Nursing Practice Scholarly Projects

In the United States, around 40,000 surgeries are conducted on pediatric patients yearly to address congenital heart disease. These surgeries involve a variety of complications beyond cardiovascular problems, including pain management. Traditional pain management involving intravenous opioids has drawbacks such as sedation, respiratory depression, and prolonged recovery times. As the healthcare industry moves away from opioid-centric pain management, the use of multimodal analgesia, including ultrasound-guided regional anesthesia, is being utilized. Regional anesthesia techniques, such as the transversus thoracis muscle plane block and the thoracic erector spinae block, are being considered for the ability to provide adequate pain relief while reducing …

Music For Anxiolysis In Primigravida Undergoing Cesarean Delivery Under Neuraxial Anesthesia, Jonathan Garcia

Doctor of Nursing Practice Scholarly Projects

Primigravida women undergoing cesarean section under neuraxial anesthesia frequently suffer from anxiety in the perioperative period. Literature suggests this population suffers disproportionately due to gender, surgical naiveness, lack of birthing experience, fear of complications, and exposure to the operating theatre’s noxious environment. Despite the high anxiety prevalence and numerous negative consequences, safe treatment options are lacking. Unfortunately, contemporary pharmacologic therapy to treat anxiety threatens the parturient and the fetus. However, the field of medicine has long appreciated music’s physiologically calming effects on the body. This project details a literature search, review, synthesis, and analysis of the available literature supporting and …

Guidelines For Non-Anesthesia Providers Performing Point Of Care Ultrasound (Pocus) For Airway Assessment In The Emergency Room, Shannen Steinbrunner

Doctor of Nursing Practice Scholarly Projects

Effective airway management is critical for nurse anesthetists, encompassing tasks such as anesthesia administration, airway establishment, and patient safety, particularly in challenging cases where airway difficulties may arise. The subjectivity in airway assessments poses challenges for clinicians when accurately predicting difficult cases. Point-of-care ultrasound (POCUS) has emerged as a valuable tool for quantifying airway parameters, providing objective data to guide decision-making. This project aims to establish evidence-based guidelines for managing the airway in unconscious trauma patients requiring intubation using POCUS. By quantifying parameters such as PEP/E-VC ratios, hyomental distance, thyrohyoid membrane thickness, and anterior neck thickness, healthcare providers can make …

Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Patients At Risk Of Emergence Delirium, Christina Bensley

Doctor of Nursing Practice Scholarly Projects

Postoperative emergence agitation or emergence delirium (ED) is a phenomenon that can occur in patients who have undergone surgery requiring the administration of inhaled anesthetics. ED is a postoperative side effect of general anesthesia commonly experienced by pediatric patients that negatively impacts a patient’s overall postoperative experience. There is a lack of consistent standardized clinical practice guidelines for general anesthesia in pediatric or adult populations. The primary goal of this scholarly project is to develop and implement clinical practice guidelines focusing on the occurrence of postoperative ED and select adverse clinical outcomes in pediatric patients undergoing general anesthesia. The project …

Enhancing Srna Confidence: Integrating Simulation-Based Crm Training With Didactic Education To Improve Intraoperative Recognition, Communication, And Management Of Intraoperative Cardiac Arrest, Melissa Lee

Doctor of Nursing Practice Scholarly Projects

Within the operating room (OR), the ability to identify deteriorating patient conditions and effectively communicate, is essential to delivering safe and efficient care. Although rare, the critical nature of emergent events necessitates early recognition and prompt intervention by an experienced anesthesia provider. The complexity of emergency management is often related to diagnostic ambiguity, individual provider experience, and disruptions of the fast-paced OR environment, requiring appropriate training methods for proficient execution. However, student registered nurse anesthetists (SRNAs) often lack sufficient exposure to emergent clinical scenarios, leading to delayed intervention and diminished confidence during crisis management. An evidence-based simulation education guideline for …

Enhancing Srna Confidence: Simulation-Based Crm Training For The Management Of Intraoperative Cardiac Arrest, Melissa Lee

Doctor of Nursing Practice Scholarly Projects

Intraoperative emergencies in the operating room (OR) are rare but necessitate early recognition and intervention.

Evidence-Based Strategy To Improve Delirium Detection In Elderly Postsurgical Patients, Aimee Baker

Doctor of Nursing Practice Scholarly Projects

Postoperative delirium (POD) is a serious adverse outcome that frequently affects older adults. Patients experiencing POD are at greater risk for postoperative mortality, increased length of hospital stay, functional decline, and increased cost of care. Current global population trends indicate that the population of adults over the age of 60 years old will double over the next thirty years. Recent guidelines call for hospitals to implement routine delirium assessment to improve early intervention. Nursing delirium assessment tools are a critical resource for early delirium identification. Nursing delirium assessment tools are often highly sensitive and specific for delirium when used in …

Implementation And Evaluation Of A Structured Mentorship Program, Cary Bedinghaus, Caroline Hillman

Doctor of Nursing Practice Scholarly Projects

The project addresses mentorship in a graduate nursing anesthesia program. The goal is to improve the existing mentorship program and to implement a durable and consistent system that gathers and responds to feedback from the students. Two literature reviews form the underpinnings of the structure and evaluation components of the project. Three structural components were identified in the review as highly effective in multiple studies of diverse mentorship programs. The first component is establishing an effective dyad matching scheme. The second component is establishing clear goals. The third component is maintaining the relationship and achieving goals through frequent and consistent …

Use And Evaluation Of A New Nurse Practitioner Fellowship Program, Brandi Herman

Doctor of Nursing Practice Scholarly Projects

The project addresses fellowship programs for new graduate nurse practitioners. The goal is to determine if a nurse residency or fellowship program is beneficial in role transition as a new graduate nurse practitioner. Nurse practitioner residency or fellowship programs are typically 12 months in duration, have small cohort sizes of two to four trainees, and are composed of a combination of didactic educational content, clinical supervision, peer support and debriefing, and self-reflection The study utilizes a survey design to measure the impact of a nurse practitioner fellowship program versus a standard orientation period. The article concludes with barriers and recommendations …

Implementation Of Evidence Based Practices To Reduce Postoperative Sore Throat, Anthony Brusadin

Doctor of Nursing Practice Scholarly Projects

An estimated 15 million endotracheal tube (ETT) intubations occur annually in the United States. In addition to pain and nausea, one of the leading complaints by patients after intubation is a sore throat. Postoperative sore throat (POST) is caused by increased pressure on the trachea from the ETT during intubation and after the ETT cuff has been inflated. To prevent the occurrences of POST many options were explored, including cuff material, shape, filling media, and ETT tube size. Through research one of the ways to reduce POST is by monitoring the cuff pressure of the ETT against the tracheal. Typically, …

Implementation Of Evidence Based Practices To Reduce Postoperative Sore Throat, Anthony Brusadin

Doctor of Nursing Practice Scholarly Projects

An estimated 15 million endotracheal tube (ETT) intubations occur annually in the United States. In addition to pain and nausea, one of the leading complaints by patients after intubation is a sore throat. Postoperative sore throat (POST) is caused by increased pressure on the trachea from the ETT during intubation and after the ETT cuff has been inflated. To prevent the occurrences of POST many options were explored, including cuff material, shape, filling media, and ETT tube size. Through research one of the ways to reduce POST is by monitoring the cuff pressure of the ETT against the tracheal. Typically, …

Implementation Of A Diabetes Education Program In The Correctional Setting: A Project Proposal, Raymond Lengel

Doctor of Nursing Practice Scholarly Projects

Diabetes is a chronic disease requiring patient responsibility to ensure good control and reduced morbidity and mortality. Incarcerated diabetic adults suffer from poor control and complications associated with their disease partly due to their limited health literacy. Arming diabetics with knowledge related to diabetes improves disease control and healthcare outcomes. The proposed final scholarly project involves the implementation of a diabetic education initiative to assess the effects of diabetic-specific education on self-care activities. The proposed quality improvement project will be framed with the Plan-Do-Study-Act and Nola Pender's Health Promotion Model. The proposed final scholarly project involves obtaining a baseline assessment, …

Inadequacies In Nutritional Counseling In The Perinatal Population, Tiffany Fry

Doctor of Nursing Practice Scholarly Projects

Abstract

Obesity continues to increase at unprecedented levels and warrants immediate provider attention at the perinatal level to improve the health of the present and future generations. Reduction of this condition can reduce risk factors leading to morbidity and mortality. Guidelines exist for the prevention and management of obesity, yet little focus is placed on prevention in the perinatal population. Lack of consistent and healthy lifestyle in the perinatal population has the potential to not only place the mother at risk for obesity but also her unborn child. The overall purpose of the scholarly project is to identify any potential …

Standardized Handoffs For Anesthesia Students, Shawn Barkalow, Noah Prebish

Doctor of Nursing Practice Scholarly Projects

Communication between healthcare providers is an essential aspect of caring for patients. Effective communication is vital during the patient handoff process. The patient handoff process involves exchanging patient’s medical information between a provider currently caring for the patient and the provider assuming care of the patient. If the information exchanged during the handoff process is inaccurate or essential information is omitted, that could potentially lead to harmful consequences for the patient. Currently, no standardized handoff tool exists for student registered nurse anesthesia students (SRNAs) in clinical practicum at the local level one trauma center. The lack of a standardized handoff …

The Effectiveness Of Targeted Education On Improving Nurses’ Self-Efficacy In Caring For Psychiatric Patients On Medical Surgical Units, Rachel Shirey

Doctor of Nursing Practice Scholarly Projects

Individuals with mental illness are occasionally hospitalized on medical units, specifically medical-surgical units. Nurses working on medical-surgical units may find patients with mental illness more challenging due to the complexity of care they sometimes require. Nurses’ perceived ability to provide quality care for these patients is reduced in comparison to their perceived ability to care for patients without mental illness. Consequently, low self-efficacy can result in the provision of a lower quality of care for this population. The purpose of this quality improvement project was to improve the care that patients with mental illness receive while hospitalized on medical-surgical units. …

Ohio Forensic Nurse Examiners: Readiness To Care For Victims Of Sexual Assault With Disability, Deanna Nicole Smith

Doctor of Nursing Practice Scholarly Projects

Forensic nurse examiners (FNEs) care for crime victims in acute care settings. These nurses are specifically trained in trauma-informed care and evidence collection in cases of sexual assault, domestic violence, abuse, and human trafficking (RAINN, 2022). The scholarly project focuses on the care of victims of sexual assault living with disability, as this population is three times more likely to be victimized than any other population (NSVRC, 2022). The project literature review reveals a lack of data on preparation standards for FNEs on caring for victims with disability and providing accommodations during forensic examination. Currently, it is unknown if FNEs …

Early Vs Late Referrals To Nephrology And Its Effect On Patient Outcomes In End-Stage Renal Disease (Esrd) Patients Who Are On Renal Replacement Therapy (Rrt) A Retrospective Chart Review, Tricia Brown

Doctor of Nursing Practice Scholarly Projects

End-stage renal disease may greatly affect a patient’s overall health and outcomes. This project aimed to look at early versus late nephrology referrals. A retrospective chart review of patient’s demographic and health outcome data was reviewed through a patient’s electronic health record. The patient data from the chart review, along with the evidence obtained from the review of the literature has been utilized to describe findings and develop evidence-based practice-guided recommendations for nephrology referrals in clinical practice. This project has been completed at a dialysis center in rural Ohio. The patient population included around 60 patients who had dialysis at …

Development And Implementation Of An Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Program For Student Registered Nurse Anesthetists, Nicholas Colangelo, Zachary Wise

Doctor of Nursing Practice Scholarly Projects

The American Association of Nurse Anesthetists (AANA) has defined the scope of nurse anesthesia practice to include services in acute, chronic, and interventional pain management, as well as the use of ultrasound (U/S) and other diagnostic technologies. However, there are no standard curriculum requirements in place that mandate graduate programs to educate student nurse anesthetists in U/S-related modalities. In addition to the AANA, the use of U/S in nurse anesthesia practice has recently been adopted by The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), which characterizes U/S use by its clinical impact on the reduction in complications, increased …

Analysis Of Current Practices In Prehospital Congestive Heart Failure Care And Protocol Development To Prevent Readmission., Ayushma Neupane

Doctor of Nursing Practice Scholarly Projects

Congestive Heart failure patients have the highest readmission rate within 30 days of discharge placing a significant burden on healthcare costs and quality of life for the patient and families. Community Emergency Medical Services are the first to respond to moderate to severe exacerbation of Congestive Heart Failure (CHF) patients’ calls. Involving Emergency Medical Services in a preventive approach rather than just responding to exacerbation calls has proven to be effective in pilot studies to prevent heart failure readmissions. The purpose of this Scholarly project was to develop evidence-based recommendations for community Emergency Medical Services’ involvement in the management of …