Medicine and Health Sciences Commons^™

Relationships Between Cortisol, Sleep, Stress, And Mood Among Night Shift Nurses, Teresa Bigand, Panshak P. Dakup, Devon Hansen, Marian Wilson, Benjamin Thomas, Steven James, Lois James, Shobhan Gaddameedhi

2021 Providence Nurse Research Conference

Background: Working night shift is a physical and emotional stressor related to negative health outcomes. Cortisol is a biomarker that has been related to an increased risk for metabolic syndrome among adults. Cortisol levels follow a circadian rhythm in humans; levels reach a peak in the early morning and drop to the lowest level in the late evening. Changes in cortisol levels have been related to changes in mood or sleep and to exposure to stressful situations. In a group of Registered Nurses, the impact of consecutive 12-hour night shifts on relationships between cortisol levels, sleep, stress, and mood, was …

Team Up Against Sepsis: Six Tasks In Sixty Minutes, Karin Kloppel, Barbara Richards

2021 Providence Nurse Research Conference

Background: Sepsis is the number one cause of mortality in hospitals nationwide. Our hospital system has identified sepsis mortality reduction as a top priority. Early recognition and treatment through improving sepsis bundle compliance was the selected focus in a 40-bed Emergency Department (ED) a community-based hospital.

Purpose: To evaluate the impact of a team response to sepsis alerts on sepsis outcomes in the ED in an acute care hospital.

Methods: Prior to implementing a team approach to sepsis alerts, ED staff were surveyed to describe awareness of SIRS and sepsis criteria and of sepsis bundle intervention metrics. Challenges identified …

Reducing Hospital Acquired Pressure Injuries On An Advanced Care Unit, Dawn Doud, Lynn Stapleton

2021 Providence Nurse Research Conference

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) are increasing nationwide. HAPIs are a negative outcome of hospitalization and these conditions are not eligible for reimbursement, resulting in billions of dollars of healthcare costs to hospitals. HAPI rates were noted to climb on an advanced care unit in a community-based hospital in the Pacific Northwest. In order to reduce this patient harm event, the nurse manager partnered with the nursing professional development specialist to lead a HAPI prevention quality improvement plan.

PURPOSE: To decrease HAPI rates on the Advanced Care Unit.

METHODS: The nurse manager conducted a deep dive on all HAPI events …

Inpatient Registered Nursing Use Of Evidence-Based Practice Tools To Manage Withdrawal Symptoms Among Adults Hospitalized With Acute Alcohol Or Opioid Withdrawal: A Needs Assessment, Julie Baker, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Patients who suffer from alcohol or opioid use disorder face unpleasant and potentially life-threatening complications related to substance withdrawal when hospitalized. Evidence suggests that the use of a standardized tool to rate withdrawal severity and direct treatment, including score-driven medication dosing to alleviate withdrawal, leads to improved clinical outcomes. However, clinical nurses working in the inpatient medical-surgical specialty in a large medical center questioned whether all nurses were effectively using evidence-based practice (EBP) tools to assess and treat alcohol or opiate withdrawal severity.

Purpose/Aims: To understand nursing practice at one hospital regarding use of ministry-specific evidence-based practice tools …

Break Habits Of Registered Nurses Working In The Acute Care Setting During The Covid-19 Pandemic, Michelle Bradberry, Gisele Nicole Bazan, Sahar Mihandoust, Jamie Roney, Marian Wilson, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Nurses report high levels of burnout and stress while working in the acute care setting, especially during the current COVID-19 outbreak. Evidence suggests that taking a restorative break during an extended, 12-hour shift may help mitigate stress and translate to better patient and caregiver outcomes. Yet, little is known about how Registered Nurses report taking breaks in the context of the pandemic.

Purpose/Aims: The purpose of this project was to describe the frequency of breaks reported by nurses working 12-hour shifts during the COVID-19 pandemic, and to test for demographic differences between nurses reporting fewer compared to more breaks …

Increasing Nursing Leaderships’ Knowledge And Support Of Nursing Research, Marietta Sperry

2021 Providence Nurse Research Conference

Background: The lack of leadership support and research knowledge are reported barriers nurses experience in conducting hospital-based research.

Purpose/aims: The purpose was to determine if nursing leadership's knowledge and support of nursing research could be improved through an interactive intervention and to identify their research needs.

Methods/Approach: Design: A translational research study (Doctor of Nursing Practice project) utilizing the Barriers to Nurses' Participation in Research Questionnaire was conducted. Sample: The sample consisted of an even distribution of managers/assistant managers, charge nurses, and directors/chief nursing operating officers. Of the 300 email invitations, 17 nursing leaders completed the pre-test and eight completed …

The Benefits Of Fasting For Patients Who Are Immunocompromised And Undergoing Cancer Treatment: An Integrative Research Review, Lori Burnett

2021 Providence Nurse Research Conference

Background: In the past several decades, remarkable advances in the treatment of cancer have been made. However, a gap remains regarding best practice strategies to reduce the amount of short and long-term side effects and adverse or emergent events related to cancer treatment that may negatively impact patient quality of life. Recent evidence suggests that if patients undergoing cancer treatment fast for a period of time, they may experience reduced chemotherapy-related side effects and enhanced immune potential. Weight loss and malnutrition associated with cancer treatments highlight the importance of evidence appraisal associated with fasting prior to recommending this practice …

Exploring The Relationship Between Covid-19 Unit Designation And Nurse Burnout Syndrome, Gisele Bazan, Tiffany Patterson, Kelsey Sawyer, Jamie Roney, Erin Whitley, Sahar Mihandoust, Joann Long

2021 Providence Nurse Research Conference

Background: The COVID-19 pandemic impacted healthcare due to surges in infected patient and respiratory failure. Nursing burnout syndrome (NBS) results from occupational factors leading to mental health problems. Nurses working in intensive care units (ICUs) dedicated to caring for COVID-19infected individuals may be even more susceptible to NBS due to increased burdens of futile care delivery and high mortality rates within overstretched healthcare systems. Identifying socio-demographic, work-related, and psychological predictors of NBS may help organizations mitigate, or at least minimize, the negative psychological impact on ICU nurses working during future pandemics.

Purpose/Aims: The aim of this study was to compare …

Pediatric Surgery Nurses Lead And Coordinate Covid-19 Recovery Efforts, Shelly Johnson, Alice E. Dupler

2021 Providence Nurse Research Conference

Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide …

Reducing Specimen Labeling Errors To Promote Patient Safety: A Quality Improvement Project At An Inpatient Department In A Regional Acute Care Hospital, Jihye Johnson

2021 Providence Nurse Research Conference

Background: Mislabeled specimen can cause patient harm by delaying treatment or by inappropriately administering treatment based on incorrectly assigned results. National patient safety goals have consistently called for a reduction of these errors in the hospital setting to zero. The specimen labeling errors on one inpatient department (IPD) at an acute care hospital in Eastern Washington were noted to be elevated from 2019 to 2020, potentially threatening patient safety. An evidence-based technique called the Red Rule has been linked to an improvement in lab labeling performance in the hospital setting.

Purpose/aims: The primary purpose of the QI project was to …

Do Compassion Rounds Improve Professional Quality Of Life For Nurses ?, Deepti Bhatnagar, Martha E.F. Highfield

2021 Providence Nurse Research Conference

Background: When RN worklife quality is positive, nurse and patient outcomes are positive (e.g, RN retention and patient satisfaction), and when worklife quality is negative, outcomes are negative (e.g., RN disengagement and errors).Yet professional quality of life(QOL)among RNs in progressive care units (PCUs) is undocumented. Stamm’s framework of compassion satisfaction and fatigue guided this study. Purpose: The purpose was to test the effect of supportive groups on professional quality of life. The hypothesis: Compassion Rounds (CR) will improve compassion satisfaction and reduce compassion fatigue among PCU RNs. Methods/ design: Using a quasi-experimental design we measured RNs’ professional QOL once …

Implementing Ideal Discharge Planning: A Quality Improvement Project On An Inpatient Unit​, Dawn Doud, Brenda Senger, Karen Colorafi, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Effective discharge teaching reduces 30-day hospital readmissions, decreases unnecessary emergency room visits, improves patient satisfaction, and is cost effective for hospitals by improving the Centers for Medicare and Medicaid Services (CMS) measures for reimbursement. Evidence suggests that standardized discharge teaching templates embedded within the electronic health records lack patient engagement and can fail to meet individual patient discharge education needs. A need was identified to improve the discharge planning process on an advanced care unit in a community based hospital.

Purpose: The purpose of this project was to evaluate and assess the implementation of an evidence based toolkit, IDEAL …

Exploring The Relationship Between Exposure To Nature While At Work And Burnout Among Female Nurses On Day Shift, Jamie Roney, Sahar Mihandoust, Stephanie Dunkle

2021 Providence Nurse Research Conference

Background: Registered Nurses working extended shifts in the hospital setting may report burnout, which reduces caregiver satisfaction, increases turnover, and potentially translates to delivery of suboptimal patient care. To align with the quadruple aim, efforts are needed to reduce nurse burnout. Limited literature suggests that visual access to nature, either via artwork or exterior landscaping, may reduce burnout. However, more research is needed to understand whether visual access to nature influences burnout among Registered Nurses delivering direct patient care.

Purpose/Aims: The purpose of this study was to explore the relationship between visual access to exterior landscaping or nature artwork and …

Covid In Our Backyard: The Lived Experiences Of Rn To Bsn Students Facing A Pandemic, Shelly Johnson, Alice E. Dupler, Deanna J. Koepke

2021 Providence Nurse Research Conference

Background: Relationships exist between improved patient outcomes and Registered Nurse (RN) caregivers with an earned Bachelor’s degree or higher compared to those with an associate’s or diploma in nursing. However, nurses who are working and attending a bridge program to obtain a Bachelor of Science in Nursing (BSN) report high levels of stress which may increase risk for withdrawing from the program or quitting work. Furthermore, providing direct patient care during the COVID-19 pandemic may significantly increase stress among those who are concurrently finishing a nursing advanced degree. Little is known about how front-line caregivers perceive the experience of working …

Utilizing A Social Media Platform To Increase Participation In A Virtual Journal Club, Alex Bubica, Trisha Saul

2021 Providence Nurse Research Conference

Background: A virtual journal club (VJC) is a place where nurses can read, synthesize, and discuss research and evidence-based practice articles. There is a well-known time lag of disseminating this knowledge from bench to bedside. In 2016, a 300-bed community hospital constructed a VJC to educate nurses on the latest studies. In 2016 and 2017, this VJC was used via an intranet-based platform with little success. Main barriers included (1) no access outside of work and (2) difficulty following threads leading to in-cohesive interactions. In 2018, a website was created. This platform had one fatal flaw, a multistep verification process …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Syndey Pham, Teresa Bigand, Brenda Senger, Kenn Daratha, Kris Daratha

2021 Providence Nurse Research Conference

Background: Cellulitis is an infection of the skin causing swelling and acute pain. Two and a half to three and a half million adults seek care in the emergency department annually for this condition. Opioid medications are commonly administered and prescribed for pain, especially following the Joint Commission’s campaign in 2001 characterizing “pain as the 5th vital sign”. An estimated 22% of older adults hospitalized with a painful medical condition receive a new prescription for an opioid medication. Evidence suggests that there is no difference in pain outcomes among adults prescribed opioid versus non-opioid medications for acute pain conditions in …

Differences In Perceived Patient Mobility Barriers Among Nurses From Various Departments And Location Work Sites, Teresa Bigand, Danell Stengem, Crystal Billings, Jennifer Hoople, Tiffanie Rampley, Elena Crooks, Nathaniel Nickerson, Brandon Clem

2021 Providence Nurse Research Conference

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.

Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation of the …

Improving Outcomes For Pregnant Women With Severe Hypertension, Danette Schloeder

2021 Providence Nurse Research Conference

Background: In 2019, a large hospital in Alaska joined the Alaska Perinatal Quality Collaborative (PQC). The first project was the AIM Hypertension Project. The goals of the project were to reduce severe maternal morbidity among preeclampsia cases by 20% and Increase the timely treatment of hypertension to 80%. Other process and structure measures included education, simulation, clinical debriefs, and follow-up visits.

Methods/Approach: The PQC used monthly educational sessions, data collection and review of every case with severe hypertension, and Plan-Do-Study-Act cycles. Data collection occurred over an 18-month period. Cases were identified by the Washington State Hospital Association database and reviewed …

Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Taste & Smell), Marietta Sperry, Kimberly Kohlieber

2021 Providence Nurse Research Conference

Background: Anosmia, or the loss of taste and smell, is an important symptom for nurses to screen for among patients, as this can result in a poor appetite which impairs healing. In the early stages of the COVID19 pandemic, anosmia was not a known symptom indicative of infection with the virus. Yet, one Registered Nurse who was working in an Emergency Room received a positive COVID test following a workplace exposure to the virus while wearing personal protective equipment, and began to complain of anosmia shortly thereafter. Because the anosmia persisted, his spouse conducted blind taste test on him …

Providence Nurses: Supporting Health For A Better World, Sylvain Trepanier

2021 Providence Nurse Research Conference

Keynote speech.

Improving Discharge Times And Patient Flow, Robyn Song, Miguel Ros, August Maggio, Kim Nicole Rossillo, Jason Caberto, Soudi Bogert, Stephanie Floriano, Caroline Brandenburger, Darleen Nguyen, Jacoba Walsh, Richard Urgel, Tanya Lenhardt, Joan Aquino

2021 Providence Nurse Research Conference

Background: Delays in discharging patients can impact hospital and emergency department (ED) throughput. The complex discharge process makes it difficult to ensure that patients are set up for successful post-hospital care regimens. The focus of this project was to improve discharge times and flow throughout the hospital to align with national standards of providing the right care, in the right place, at the right time. To improve access to beds, The Joint Commission stipulates that hospitals have processes in place to support patient flow throughout the hospital and to use data to drive improvements in patient flow. Failure to regulate …

Improving Primary Care Screening For Familial Hypercholesterolemia, Mary Nametka, Brenda Senger

2021 Providence Nurse Research Conference

Background: Familial Hypercholesterolemia (FH) is the most common genetic condition resulting in cardiovascular disease, a leading cause of death in the United States. FH is estimated to affect 1 in 250 individuals with elevated lipid levels present from birth. An estimated 90% of individuals with FH remain undiagnosed. '

Purpose: The purpose of this quality improvement project was to increase provider awareness and promote screening for FH among adults ages 20 years and older. '

Methods: This quality improvement project consisted of an online educational intervention for providers working at an outpatient clinic regarding FH. Outcomes included: 1) pre-intervention …

Pain Management Trends Among Adults Hospitalized With Cellulitis: An Evidence-Based Practice Project, Nonna Dobyns, Teresa Bigand, Kristopher Darath, Denise Ogorek

2021 Providence Nurse Research Conference

Background: Cellulitis is an acute infection of the skin resulting in acute pain and often requires pharmacological analgesics. Past studies revealed that more than half of patients receiving inpatient medical care in the United States received opioid analgesics for pain management during the hospital stay. While opioids are regarded as the strongest analgesic available to ease physical pain, these are habit-forming drugs that contribute to negative outcomes such as opioid use disorder and increased risk for accidental overdose and death. Recommendations for acute pain management in the hospital setting include prescribing less than 50 morphine milligram equivalents (MME's) per day …

Postpartum Depression Screening To Improve Maternal Outcomes, Jill Goebel, Jeff Ramirez

2021 Providence Nurse Research Conference

Background: Postpartum depression (PPD) is correlated with worsened maternal and infant health outcomes, and an estimated10-20% of women experience this condition after giving birth. Universal depression screening for PPD in maternity and well-child appointments is the standard of care. However, PPD screening is not well-integrated into outpatient lactation visits which assist new moms with difficulties breastfeeding. To address this gap, routine PPD screening and education was implemented in an outpatient lactation clinic servicing postpartum women in Eastern Washington. Purpose: The purpose of this quality improvement project was to implement the use of PPD screening in a lactation clinic to …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act In Two Northwestern U.S. Hospitals, Rebecca Penders

2021 Providence Nurse Research Conference

Background: Breastfeeding is the gold standard for infant nutrition. Many workplace barriers to lactation exist for mothers returning to work after the birth of an infant. In 2010 the Breastfeeding Provisions in the Patient Protection and Affordable Care Act (BP-PPACA) was enacted as the first federal breastfeeding law which outlined specifically break time and a place to pump for businesses with over 50 employees who employed hourly wage workers. There is little known about the satisfaction of hospital employees pumping/lactation experience after the BP-PPACA.

Purpose/Aims: The purpose of this study was to determine the extent to which employed mothers' …

How Much Is Too Much: Examining Fluid Responsiveness In Septic Patients, Natalie Kitago, Lak Tuong, Sarah Rosenberg

2021 Providence Nurse Research Conference

Background & Significance: The leading cause of death of critically ill patients is sepsis. The CDC reports that sepsis is estimated to be responsible for 1 of every 3-hospital deaths. Furthermore, in hospitals located in California for one large hospital system, a reported30.74% patients admitted to the ICU with sepsis died in the year 2017.

Purpose: The purpose of the study was to determine if utilizing non-invasive pulse contour technology (PCT) is a feasible intervention to manage fluid responsiveness and resuscitation specifically with septic patients in a community Intensive Care Unit in California. A secondary aim was to determine …

Feasibility Of Launching A Multi-State Nursing Health Study In The Midst Of The Covid-19 Pandemic, Ross Bindler, Shaekira Niehuser, Trisha Saul, Teresa Bigand

2021 Providence Nurse Research Conference

Background: The Quadruple Aim recommends that healthcare institutions support clinician well-being as a strategy to improve patient and caregiver outcomes. During the COVID-19 global pandemic, Registered Nurses (RNs) working full-time, 12-hour shifts have reported increasing health concerns. Therefore, research documenting objective information on preventive health habits of RN’s is needed to support nursing well-being. Yet, conducting bio-behavioral research in this population, especially during the pandemic, presents with unique challenges. Purpose: The purpose of this pilot study to assess the feasibility of collecting and evaluating health data from RNs working full-time, 12-hour shifts across the United States during the COVID-19 pandemic. …

The Impact Of The Implementation Of Code-Blue Nurse Champions For Cardiac Arrest, Beverly Holland, Sherri Mendelson

2021 Providence Nurse Research Conference

Background: Delayed recognition of in-hospital cardiac arrest (IHCA) events can affect survival rates. At the project site, there was a failure to rescue in the medical-surgical population. Key elements of success include staff identifying at-risk patients combined with early interventions to prevent deterioration of cardiac arrest. Survival and favorable outcomes for IHCA (i.e., neurological sequelae) were shown to be highly dependent on several factors, such as a skilled resuscitation team, prompt initiation of cardiopulmonary resuscitation and defibrillation, and organizational structures to support resuscitation care; therefore, nurses are an integral part of an IHCA response.

Purpose / Aims: The purpose of …

Promoting Mobility In Post-Surgical Patients: A Quality Improvement Project, Abel Sawa, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.

Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation …

The Effect Of Covid-Related Changes In Diet, Exercise, Sleep Patterns, And Mood On Stress Levels Of Rns Who Work 12-Hour Shifts During The Pandemic, Amber Norman, Trisha Saul, Ross Bindler, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Registered Nurses (RNs) working 12-hour shifts are regularly exposed to high stress situations which has intensified during the COVID-19 pandemic. Chronic stress exposure may lead to changes in health habits and impact sleep, exercise or diet, augmenting risk for adverse health outcomes and taking a negative emotional toll. While nursing staff educate patients on reducing stress and engaging in health promotion behaviors, there is little research on perceived stress and relationships to COVID-related changes in sleep, diet, exercise, and mood of nurses working full-time, 12-hour shifts during the pandemic.

Purpose: The purpose of this pilot study was to gain …