Medicine and Health Sciences Commons^™

Evidence-Based Decision Making At The Bedside Process, Roy E. Brown

VCU Libraries Faculty and Staff Publications

Evidence-based practice (EBP) is crucial in healthcare for improving care and organizational outcomes. However, there is a lack of consensus among various health professions regarding the definition and implementation of evidence-based practice in the clinical environment. This lack of consensus centers on whether EBP is project-based or if it occurs primarily at the bedside. This diagram illustrates how evidence is utilized to inform bedside decision-making. It demonstrates that the process is iterative and the intervention or decision made is contingent upon the evidence, one’s clinical experience, and the patient/situation.

The purpose of the diagram is to help those involved in …

The Clinical Inquiry Process Diagram Question Development Checklist, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated handout, previously published in 2023, serves as a reference for those who are either in an EBP course or are practicing healthcare providers involved in questioning practices to improve patient care. The handout guides the user from identifying and developing a question to determining whether the clinical question, based on evidence, will be an evidence-based practice project/initiative, a performance improvement project, or a research project. It aligns with the fifth version of the Clinical Inquiry Process Diagram and now includes several different formats that can be used when trying to create a focused clinical question.

• Update of The …

The Clinical Inquiry Process Diagram (V. 5), Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated edition of The Clinical Inquiry Process Diagram improves on the 2023 version. It provides a depiction of the steps involved in the clinical inquiry process, covering research, performance improvement, and evidence-based practice. The revisions in this version emphasize the importance of alerting users to the iterative nature of clinical inquiry and the ongoing need to assess the situation or patient based on evolving evidence. It's crucial to recognize that the clinical inquiry process does not follow a linear, sequential progression. Instead, individuals may find themselves concurrently addressing different aspects of the process or revisiting prior steps as they …

A Multifaceted Approach Using Implementation Science Methods To Increase Chg Bathing Compliance And Reduce Central Line Associated Blood Stream Infections On A Non-Icu Unit, Emily E. Warwick

VCU Health Nursing

BACKGROUND or RATIONALE:

The Acute Care Surgery unit (ACS) is a General and Progressive level of care post-operative unit at VCU Health system. Between quarter four 2021 and quarter one of 2023, five Central line associated blood stream infections (CLABSIs) occurred. NDNQI data revealed ACS had a higher CLABSI rate per 1,000 patient days than the national average of other similar type units in other magnet hospitals.

STATEMENT OF THE PROBLEM:

A GAP analysis revealed ACS did not achieve the 80% CHG compliance goal set by VCU Health’s Infection Prevention Department in all six quarters that these five CLABSIs occurred. …

Ur-Ine Good Hands In The Neuroscience Intensive Care Unit, Molly Lehatto, Courtney Hastings, Monika Mehlbrech, Christina Szabo

VCU Health Nursing

Purpose:

The purpose of this performance improvement project was to decrease the harm to patients related to catheter associated urinary tract infections (CAUTIs) in the Neuroscience Intensive Care Unit (NSICU). Historically, the NSICU had the highest CAUTI rates in our organization with as many as 6 CAUTIs per calendar year quarter. A core group of nurses partnered with providers, hospital infection preventionists and nursing leaders to improve practices for placing, removing, and managing urinary catheters and to implement guidelines for urine testing stewardship.

Description:

Significance: In 2020, the NSICU had 12 CAUTIs, the highest number of CAUTIs in the entire …

Pmh Connect, English (Greyscale For Printing), Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, EspañOl_Full Color, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, EspañOl_Greyscale For Printing, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

Pmh Connect, English, Full Color, Sara W. Moyer, Patricia Kinser

School of Nursing Publications

Mental health related symptoms and associated experiences in the perinatal period present challenges, particularly regarding identification and appropriate management. Perinatal Mental Health (PMH) screening occurs in clinical settings on a more regular basis than ever before thanks to validated screening measures used at perinatal visits; however, pregnant and parenting individuals report several concerns when completing these screeners and providers report barriers in addressing resultant findings. To address barriers and enhance the PMH screening experience, this team of clinicians and researchers propose a tool – the PMH Connect: a Perinatal Mental Health Screening Connection, Education, and Decision Aid – to be …

The Clinical Inquiry Process Diagram (Version 4), Roy E. Brown

VCU Libraries Faculty and Staff Publications

The purpose of the diagram is to provide a clear understanding of the clinical inquiry process and to highlight the similarities and differences between research, performance improvement, and evidence-based practice. While it is not meant to be comprehensive, it serves as a tool to facilitate a shared understanding of when a particular question may lead to one of these three areas of clinical inquiry.

The author would like to acknowledge the following for their ideas and willingness to provide feedback to improve this latest version of the diagram.

• Kady Martini, DNP, RN, EBP-CH, NEA-BC (The Ohio State University School of …

Cauti: Are We Testing Appropriately?, Christoph Lecznar

VCU Health Nursing

Purpose: The purpose of this evidence-based quality improvement project was to decrease catheter associated urinary tract infections in a 28 bed Surgical Trauma Intensive Care Unit in a Level One Trauma Academic Medical Center.

Background: Catheter Associated Urinary Tract Infections (CAUTI) are deemed never events by the Centers for Medicare & Medicaid Services. Centers for Disease Control and Prevention estimates 17-69% of CAUTIs are preventable. Current recommendations for CAUTI reduction include: Education strategies, chlorhexidine gluconate bathing and catheter care, catheter avoidance, policies for insertion, and urine culture testing stewardship. Our unit experienced an increase in CAUTI incidence in May and …

Violence Prevention Task Force: A Health System’S Journey Towards Zero, Lisa Davis, Denise Holyoak

VCU Health Nursing

VCU Health's mission is to be the safest most caring hospital with zero events of preventable harm to patients, team members, and visitors. Our goal cannot be achieved if our staff suffer from workplace violence injuries thus, our executive leaders sponsored a Violence Task Force in 2017 comprised of leaders and bedside staff from all disciplines to implement evidence-informed strategies to aid in the prevention, response or recovery to a violent event. Review of data and measures of our outcomes are based on our worker's compensation, behavioral rapid response, and safety culture surveys. Event drill-downs are achieved by our post-assault …

Climate Change And Mental Health: What Can We Do?, Ann N. Welch

VCU Health Nursing

Climate change has been described as the defining health issue of this century. Many aspects of mental health are affected by the events related to the earth's warming climate. This poster presentation will identify ways in which climate change affects mental health and suggest concrete actions that can be taken to help to mitigate these effects.

Using Silicone Mesh To Mitigate Risk Of Forehead Pulse Ox Pressure Injuries, Patrick Alridge

VCU Health Nursing

Introduction

In the intensive care unit (ICU) setting, patients may require the use of a pulse ox probe on the forehead to obtain an appropriate oxygenation saturation reading. The pulse ox probe has two clear plastic sensors, through which the infrared light travels to measure oxygenation. Despite applying the sensor per manufacturer’s instructions and rotating the device location on the forehead more frequently than manufacturer recommendations, the sensor can still cause a medical device-related pressure injury.

Methods

Silicone mesh dressing is commonly used under wet to dry dressings or under negative pressure wound therapy dressings to prevent adherence of the …

Black Hearts Matter: A Comparative Study Of Sociodemographic, Clinical, And Psychosocial Characteristics In Black And White Persons With Heart Failure, Hannah M Anderson Hughes

Theses and Dissertations

Heart failure (HF) is a chronic, progressive, debilitating illness that disproportionately affects Black individuals, often leading to poor quality of life (QOL). Various sociodemographic, clinical, and psychological characteristics are related to QOL in patients with HF. Because most studies do not include representative Black samples or report findings from racial subgroup analyses, these relationships and any existing racial differences are not well understood. The purpose of this descriptive, comparative study was to explore the relationships among sociodemographic, clinical, and psychological characteristics and QOL in patients with HF and to determine if there were racial differences between Black and White individuals. …

Family History Of Substance Problems Among African Americans: Associations With Drug Use, Drug Use Disorder, And Prescription Drug Misuse, Rebecca Mahrs-Gould

Theses and Dissertations

Background: Understanding individual risk for substance use and substance use disorders is important in the efforts of reducing risk and prevention of these problems. A family history of alcohol and/or drug problems often increases the risk for these problems, however the majority of research in this area is conducted in samples that are predominantly White. African Americans face disparate outcomes from substance use and substance use disorders, and the risks for substance problems may not be the same as for Whites. A systematic review of the literature identified nine studies that examined a family history of either substance problems or …

Splanchnic Oxygenation And Feeding Intolerance In The Very Low Birthweight Infant, Melissa C. Dollings

Theses and Dissertations

SPLANCHNIC OXYGENATION AND FEEDING INTOLERANCE IN THE VERY LOW BIRTHWEIGHT INFANT

By Melissa C. Dollings, Ph.D.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2022

Major Director: Lisa F. Brown, Ph.D., RN, School of Nursing

Background. Feeding intolerance is common in preterm infants but can be an ominous precursor of necrotizing enterocolitis, a life-threatening gastrointestinal disease. The definition and management of feeding intolerance vary widely. This research examined the relationship

between feeding intolerance, intrauterine factors, extrauterine factors, and intestinal immaturity and circulatory immaturity in the …

Cervical Collar Clearance: Using Ebp To Decrease Pressure Injuries, Christoph Lecznar

VCU Health Nursing

Purpose: The purpose of this evidence-based practice (EBP) project was to decrease medical device pressure injury (MDPI) related to Cervical Collar (C-collar) clearance in adult blunt trauma patients. PICO: In the adult obtunded blunt trauma patient, should a c-collar be cleared with a negative CT, compared to a negative CT with adjunct imaging to reduce adverse events such as MDRPI?

Background: Our unit observed an incidence in C-collar MDRPI of 3 in 2019 and 3 in 2020 based on the date of the survey. C-collar clearance in the blunt trauma patient is a crucial step to avoid MDRPI. There are …

Cauti: What Are We Testing?, Christoph Lecznar

VCU Health Nursing

Purpose: The purpose of this evidence-based practice (EBP) project was to identify and implement evidence-based practice to reduce Catheter-Associated Urinary Tract Infections (CAUTI).

Background: CAUTIs are deemed never events by Centers for Medicaid and Medicare and are tied to financial reimbursements. CDC states 17-69% of CAUTIs are preventable with recommended infection control measures. UTIs are the most common type of Hospital-acquired infection, with an estimated of occurrence of 9.5% reported by acute care hospitals. Every day a catheter is in place, the risk of CAUTI increases by 3-7%. Current recommendations for reduction in CAUTI rates include educational strategies, catheter avoidance, …

Literature Review: Covid-19'S Impact On Violence, Jean Cheek, Laura Ashworth

VCU Health Nursing

Violence has been exacerbated by the pandemic, resulting in a plethora of research that can be complementary and contradictory. A preliminary thematic literature search was performed using keywords such as human trafficking, IPV, sexual assault, pandemic, covid, and child abuse. This resulted in over 100 articles between 2019 and 2021. The literature review revealed common themes such as pandemics and natural disasters increase the risk for violence in women, children, and marginalized populations. Stay-at-home orders put vulnerable populations in closer proximity to the abuser. A low socioeconomic standing increases the propensity to abuse and be abused. Calls to human trafficking …

Sleep-Related Problems, Sleep-Related Distress, And Sleep-Related Functional Status Among Adult Inpatients Receiving Palliative Care, Lisa C. Sievers

Theses and Dissertations

Palliative care patients may be at a higher risk for sleep-related problems and their negative effects compared to the general population, yet limited sleep research has been done with this population. The purpose of this dissertation was to determine prevalence rates for excessive sleepiness, insomnia, restless legs syndrome (RLS), and high risk for sleep apnea (HRSA); examine relationships between the aforementioned sleep-related problems, sleep-related distress (SD), and sleep-related functional status (SFS); and to determine which sleep-related problem measures along with age and gender predicted SD and SFS among a sample of adult palliative care inpatients. Secondary aims were to understand …

Evaluating The Clinical Utility Of A Novel Electroencephalography System For Assessing Perioperative Neurocognition In Older Surgical Patients, Lloyd H. Barnwell Iii

Theses and Dissertations

Postoperative delirium (POD) is a public health and research priority (American Society of Anesthesiologists, 2019). POD is a risk factor for long-term neurocognitive decline, and the rate of decline is directly proportional to the severity of POD (Vasunilashorn et al., 2018). Baseline cognitive function is a strong, independent predictor for POD (Culley et al., 2017). The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anesthesia (Berger, et al., 2018). Perioperative cognitive screening tools trialed in anesthesia are not routinely incorporated into clinical practice related to validity, reliability, or practicality problems …

The Basic Rules Of Doing A Good Search And Search Tips - Revised, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This is a handout that is used as a reference for those who are learning to more effectively search databases for assignments and evidence-based practice projects. The revised handout contains information related to the databases that may be searched as well as about Google Scholar.

Please contact the author for a version that can be reused and rebranded.

The Evidence Based Practice Question Development & Search Tips Checklist (Revised), Roy E. Brown

VCU Libraries Faculty and Staff Publications

The Evidence Based Practice Question Development and Search Tips Checklist is a tool that is used in instructional sessions with nurses in reference to evidence-based practice and literature searching. It is intended as a reference handout. The revised handout contains information related to the databases that may be searched as well as about Google Scholar.

It is under a creative commons license. If you would like a version that can be rebranded for your organization to use, please contact the author for an editable version.

Post Procedural Care Of Patients Receiving Percutaneous Transhepatic Biliary Drainage Catheter Placement, Erin Pacelli, Jennifer Almeda, Christina Graham, Malcolm Sydnor, Kunal Patel

VCU Health Nursing

A recent review of patients undergoing transhepatic biliary drainage catheter placement showed a 30-day readmission rate of 28%. New post-procedural processes were created to standardize the care of this patient population to decrease readmission rates and improve patient satisfaction.

Deleting A Sacred Cow From The Emr: Removing Gastric Residual Volume Assessments, Christoph Lecznar

VCU Health Nursing

Purpose: The purpose of this Evidence-based practice (EBP) project was to implement current guidelines related to gastric residual volume (GRV) assessments for monitoring of feeding intolerance.

Background: Metabolic support of patients is critical for the survival of critical illness and optimal recovery. Enteral nutrition is the preferred method of delivery, but its success is dependent upon the bedside clinician₂. Current clinical practice guidelines do not support the practice of monitoring GRVs however₂; greater than 98% of critical care nurses utilize GRV monitoring to assess for feeding intolerance₁. In our urban Academic Level I Trauma …

Successful Mentorship In Perioperative Surgical Services Can Happen! Developing The M.A.P.P. (Mentorship Amongst Peers Program), Natalie Sorensen, Diane Hanson-Johnson

VCU Health Nursing

Description of Team: Multidisciplinary team consisting of Nurse Educators, Registered Nurses, Certified Surgical Technologist, Administrative Staff, and a Health Care Partner. This team came together with a common goal of improving morale, breaking out of silos, and ultimately increasing retention throughout Perioperative Surgical Services.

Preparation and Planning: Research was performed previously on retention by Clinical IV Registered Nurse as part of her Master’s in Nursing program thesis. She presented the research to department leaders as a method to improve satisfaction and in turn, increase retention. In April 2018 a mentoring planning workshop was held with team members from each unit …

Infection Prevention In Patients Receiving Continuous Renal Replacement Therapy Through Proper Hemodialysis Line Care, Nicole Ingram, Susan Mckenna

VCU Health Nursing

The goal was to reduce Continuous Renal Replacement Therapy (CRRT)-related Central Line-Associated Bloodstream Infection (CLABSI) rates by introducing a just-in-time re-education toolkit for proper hemodialysis (HD) line care in adult Intensive Care Units (ICU).

CRRT requires specialized expertise delivered in the ICU setting with the support of HD nurses. Problem-solving when cartridges clot or clog requires ICU nurses to return the blood and notify HD to restart therapy. Current evidence supports the use of white Curos^TM caps and Tego^TM connectors when deaccessing lines in order to prevent CLABSIs, air emboli, and bleeding. A learning needs assessment revealed inconsistent …

Improving Access To Care In Virginia: Reaching Nurse Practitioner Training Capacity Through Preceptor Incentives, Debra Barksdale, Christine Kennedy, Shelly Smith

Translational Research Fellows Policy Briefs

Workforce data reinforces the notion that educating nurse practitioners in Virginia is critical in helping to improve access to care in the Commonwealth, particularly in underserved communities. Six of Virginia’s thirty-nine state funded colleges and universities offer nurse practitioner programs. All of these universities report their capacity to train nurse practitioners is not limited by qualified applicants but rather by a shortage of clinical preceptors. This paper provides a summary of public policy initiatives that support preceptors as an example for Virginia to consider.

Examining Body Mass Index And Sepsis Mortality At One Year After Sepsis, Jamie D. Robinson

Theses and Dissertations

Introduction: Sepsis is a serious and life-threatening syndrome affecting 1.7 million Americans annually and resulting in approximately 270,000 deaths. An “obesity paradox” where obese individuals have lower sepsis mortality than their non-obese counterparts has been described. The problem is that the longevity of the effect is unknown, and few studies have examined the obesity paradox after 1-2 months post-diagnosis.

Methods: This retrospective cohort study examined clinical, demographic, and biomarker variables thought to affect sepsis mortality at three-time points: 30 days, 180 days, and at one year post-sepsis diagnosis in order to shed light on specific factors that might define …