Medicine and Health Sciences Commons^™

Painting A Landscape Of Acute Care Nurse Scientist Work, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Hospitals are increasingly hiring nurse scientists, motivated in part by nursing excellence designations such as Magnet. Magnet designation requires at least three, nurse-led, Institutional Review Board-approved research studies to be conducted in the hospital every four years and for nurses to be actively implementing evidence-based practice (EBP) projects using research evidence. However, clinical nurses often lack the specialized knowledge and training necessary to engage in well-designed research or EBP. Nurse scientists are PhD-prepared individuals with expertise to mentor clinical nurses to navigate the rigor and complexity of creating, implementing, analyzing, and disseminating research and EBP projects. Yet, due …

Nurse Engagement In Clinical Scholarship Linked To A Hospital-Based, Virtual Nursing Research Course, Trisha Saul, Frances Chu, Rose Timmerman, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background:

Clinical scholarship is a multifaceted concept in nursing that embodies building and disseminating knowledge within the professional environment. This requires conducting practice-based research, discovering the best available evidence for clinical practice, and translating findings into nurse-led interventions. An environment of clinical scholarship involves creating opportunities for nurse engagement in research, evidence-based practice (EBP) projects, and quality improvement initiatives. This must be supported by education and training centered on the principles of clinical scholarship. A course was developed with the curriculum design focusing on its attributes and application in the clinical setting and cultural milieu.

Purpose:

To examine hospital-based nurses’ …

Acute Care Staff Interactions With Chaplains To Discuss Team Or Personal, Non-Work-Related Stressors, Gary Weisbrich, Sarah Sumner, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Healthcare staff experience stress from the workplace when providing complex patient care and often may lean on specially trained spiritual support caregivers, or chaplains, for support navigating patient-related stressors. Yet, healthcare staff can also suffer from team-related or personal stressors that, if unresolved, could negatively impact care delivery. Little is known about whether, how often, and which staff may interact with chaplains for emotional support when experiencing non-patient-related stressors originating from work or personal lives.

Purpose: To describe the proportion of individuals who report discussing team-related or personal stressors with chaplains in the past 12 months, and to …

Alleviating Health Professionals' Moral Distress Through Hospital-Based Chaplain Care, Karen Colorafi, Sarah Sumner, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Healthcare workers frequently experience occupational stressors that negatively impact their emotional well-being. Recent evidence suggests that healthcare workers’ occupational stressors may translate to moral distress, defined as emotional turmoil occurring over an ethical dilemma secondary to a patient care or team-related issue. Following the COVID-19 pandemic, moral distress and a wide range of psychological and physical issues have been linked to high rates of healthcare worker burnout. Increased occupational stressors significantly augment turnover intentions and behaviors and negatively impact well-being. The resultant turnover rates have reached an all-time high among professional registered nurses. Some evidence suggests that the …

Perceived Moral Distress Among Patient-Facing Healthcare Professionals During The Covid-19 Pandemic, Sarah Sumner, Karen Colorafi, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background:

The most common framework for ethical decision-making in healthcare is principalism which is founded on three ethical traditions: utilitarianism, achieving the most good for the most people; deontology, upholding moral obligations to individuals; and virtue ethics, doing what is virtuous regardless of the consequences. Principalism is further guided by four principles: 1) respect for autonomy; 2) beneficence, the duty to do good; 3) nonmaleficence, the duty to do no harm; and 3) justice, the duty to treat similar cases similarly. Patient-facing healthcare professionals (HCPs) commonly expect all moral values will be considered when decisions are made that impact patients …

Dietary Intake And Continuous Blood Glucose Measurement In Nurses Working Either 12-Hour Day Shifts Or Night Shifts, Rachel Carlson, Teresa Rangel, Lindsey Miller, Sushana Sudhi

Providence Nursing Research Conference 2023 – Present

Background:

Night shift work is essential in the hospital yet shift work among nurses is linked to negative outcomes such as chronic fatigue and cardiometabolic illnesses. Furthermore, nurses working night shift are more likely to have aberrant glucose levels, defined as greater than 140 mg/dl. Currently, it is unclear whether nurses working night shift eat differently than those working day shift which may explain aberrant glucose levels.

Purpose:

To determine whether night shift nurses have altered glucose levels and dietary intake compared to day shift nurses.

Methods/Approach:

Nurses regularly working full time 12-hour night shifts (n=12) or full time …

Healthcare Staff Awareness Of Climate Health And An Environmental Stewardship Framework, Patricia Joubert, Angie Shemwell, Barb Ngyuen, Rose Timmerman, Teresa Rangel (Pi)

Providence Nursing Research Conference 2023 – Present

Background: Climate change negatively impacts human health and is largely driven by human activities which generate pollutants. In the United States (U.S.), healthcare operations lead to significant pollutants. The workforce supporting healthcare in the U.S. is massive; thus, healthcare HCP can help significantly reduce harmful healthcare emissions. A nurse-authored framework helps contextualize causes of healthcare pollutants as Waste, Energy/water, Agriculture/food, Chemicals, and Transportation (WE ACT). A large health system adopted and disseminated this framework to healthcare professionals (HCP) in 2020 to help achieve a critical objective of becoming carbon-negative by 2030. To date, HCP awareness of climate health and …

Nurse Awareness Of An Environmental Stewardship Framework For Climate Health, Sarah Johnson, Elizabeth Schenk, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: The World Health Organization has recently stated that climate change is the single biggest threat to the health of humanity. Climate change is largely driven by human activity generating pollutants that negatively impact the environment. The healthcare sector’s operations alone account for nearly 8.5% of annual United States (U.S.) greenhouse emissions. Nurses are well-positioned within the healthcare space to take actions to reduce healthcare emissions and promote environmental health. For instance, a nurse-authored framework helps contextualize causes of healthcare pollutants as: Waste, Energy/water, Agriculture/food, Chemicals, and Transportation (WE ACT). A large, 52-hospital health system in the United States …

Health Professional Concern For Environment And Behaviors To Protect Climate Health, Sarah Johnson, Mary Jo Kelly, Gale Springer, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Air pollution, medical waste, and climate change are a threat to our health and environmental sustainability. The World Health Organization (WHO) estimates that annually, 7 million premature deaths are associated with climate change, making climate change this century’s greatest threat to health. The healthcare industry negatively impacts climate change through the production of approximately 5% of all global carbon emissions. However, little is understood about relationships between healthcare professionals' concern for the environment and behaviors at home or work to protect climate health.

Purpose: To test relationships between healthcare professionals' concern for the environment and behaviors at …

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates, Stefanie Lai

Providence Nursing Research Conference 2023 – Present

Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% compliance with this policy.

Purpose: The purpose of this project …

Preventing And Responding To Workplace Violence In The Emergency Department, Stefanie Lai, Alicia Rodriguez

Providence Nursing Research Conference 2023 – Present

Background: Workplace violence (WPV) is defined as physical violence or verbal threats of physical violence, regardless of whether an employee sustains an injury. Emergency department (ED) staff are at high risk of exposure to WPV, which can lead to burnout, job dissatisfaction, and secondary stress. Effective preparation for and response to WPV incidents can help mitigate these negative effects. Multicomponent interventions, including education, safety huddles, behavioral health rapid response teams, and environmental modifications, have been shown to reduce WPV incidents and increase staff perceptions of safety.

Purpose: The purpose of this evidence informed-quality improvement project was to increase knowledge of …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

Management Of Sepsis With The Quick Sequential Organ Failure Assessment, Jeanna Adams

Providence Nursing Research Conference 2023 – Present

Abstract

Background:

Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely …

Fall Prevention Quality Initiative: Implementation Of Fall Ambassador Safety Team (Fast), Jerome Codilla, Joanna Arraiza

Providence Nursing Research Conference 2023 – Present

Background

Patient falls are the most common adverse events reported in hospitals and represent a persistent patient safety issue. Annually, roughly 700,000 to 1 million patient falls occur in United States hospitals, resulting in around 250,000 injuries and up to 11,000 deaths (LeLaurin et al., 2019). Nurses are responsible for the identification of high fall risk patients and development of a plan of care to minimize risk. Multifactorial strategies have been shown to reduce falls, but evidence of a sustainability team (fall champions) is lacking. Review of the National Database of Nursing Quality Indicators (NDNQI) data on a 33-bed progressive …

Characteristics Of Nursing Professional Identity Survey Completers, Teresa Rangel, Crystal Billings, Rose Timmerman, Tulla Landis

Providence Nursing Research Conference 2023 – Present

Background: Magnet and Pathways to Excellence (PTE) designations through the American Nurses Credentialing Center (ANCC) publicly recognize hospitals achieving outstanding nursing excellence. An issue of special interest to clinical nurses working in Magnet/PTE facilities is the professional identity of nurses, which is hypothesized to positively correlate to nursing satisfaction and delivery of high-quality patient care. A valid and reliable survey tool, called Professional Identity in Nursing Scale (PINS), is a low-cost and low-burden strategy for nurses to measure professional identity in nursing. However, survey attrition rate is a significant barrier to collecting robust and representative data. Little is published …

Comparison Of Data On Preterm Neonatal Growth Measures In The Neonatal Intensive Care Unit, Madison Baty, Emily Faerber, Cayenne Sirois

Providence Nursing Research Conference 2023 – Present

Background:

Extrauterine Growth Restriction (EUGR) has been defined as infant weight-for-age z-score (WAZ) of less than -1.28 standard deviations (SD), at discharge or 36–40 weeks (about 9 months) postmenstrual age. In 2018, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published indicators of neonatal malnutrition, including a decline in WAZ over time. Mild, moderate, and severe neonatal malnutrition is defined as a WAZ decline of 0.8-1.2 SD; >1.2-2 SD; >2 SD, respectively, and it is unclear how widely revised neonatal malnutrition indicators are being used.

Purpose/aim:

To investigate the sensitivity and specificity …

Triage Re-Education: Impact On Accuracy Of Acuity And Care Provision, Alexandra Rowen

Providence Nursing Research Conference 2023 – Present

Background:

Triage is the process of sorting and prioritizing patients requiring medical treatment. A primary goal is to identify high-risk or life-threatening situations. Emergency Severity Index (ESI) is a validated method to assign an acuity level from Level 1 (emergent) to Level 5 (non-urgent). ESI handbook states competency is vital to the success and accuracy of the ESI tool & requires periodic assessment of RNs participating in triage. The Emergency Nurses Association (ENA) reports only 60% accuracy in assigning acuity.

Aim:

The aim of this evidence-based practice project was to determine compliance with triage standards and provision of initial …

Utilization Of Catheter Calendars For Cauti Reduction, Katie Whitehead

Providence Nursing Research Conference 2023 – Present

Background:

Hospital acquired infections are a nursing sensitive quality indicator used by the public, governmental agencies, and regulatory bodies to determine the caliber of care offered by nursing staff in acute care hospitals. Lower incidences of hospital acquired infections are linked to improved safety and patient outcomes. Historically, a 356-bed community hospital had very low rates of catheter associated urinary tract infections (CAUTIs) prior to 2021, however in the first two quarters of the year, the medical-surgical units saw this number jump from four total in 2020 and 2021 to five in six months.

Purpose:

To reduce the incidence of …

In-Depth Perspectives Of Faith Community Nurses Serving In A Western U.S. State: Findings From A Healthcare-Academic Collaboration, Nathan West, Lauren Kiker (Doctoral Student), Beverly Bateman

Providence Nursing Research Conference 2023 – Present

Background: Faith community nurses (FCNs) implement congregational health programs, address health-related needs, and deliver wholistic care within the faith communities they serve. FCNs have reported certain challenges impacting their ability to deliver care within faith-based settings (e.g., training, funding, resources). Literature, however, documenting the lived experience of FCNs is limited, particularly in (U.S. State blinded for review [i.e., a Western state)]. The ministry’s Faith Community Nurse Resource Center (FCNRC) at a Providence Medical Center supports 150 non-paid professionals by providing: Support (e.g., community-building), Training (e.g., FCN Foundations Course), Continuing education credits, Consulting (e.g., ministry effectiveness), and Resources (e.g., research, …

Prevalence And Characteristics Of On-Shift Napping Among Hospital-Based Nurses, Rachel Carlson, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Building The Future: New Grad Residency As A Response To The Staffing Crisis, Caitlin Silva, Geri Harmon

Providence Nursing Research Conference 2023 – Present

Purpose:

An innovative nursing project was created to evaluate if increasing the total number of nurses entering the Transition into Practice (TIP) program would decrease traveler utilization, resulting in cost savings for the hospital.

Relevance/Significance:

Nursing shortages reached a critical level during the pandemic, and many hospitals throughout the country have not recovered. Many nurses have either left the bedside entirely or moved to the competitive pay of travel nursing requiring hospitals to create competitive hiring practices. The utilization of travel nurses results in increased costs and can have negative patient outcomes.

Strategy/Implementation/Methods:

The clinical education team collaborated with leadership …

A Better Tool For Ed Fall Risk Assessments: The Monego-Barra Ed Fall Risk Assessment Tool (Moba), Roxanne Barra, Mary Waldo, Angela Graves, Jessica Monego

Providence Nursing Research Conference 2023 – Present

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment …

Adherence To Sb5195 Naloxone Distribution Requirements At Discharge From The Emergency Department, E Stewart, J Delfeld, J Mckay, J Corhei, Kailyn Elliot

Providence Nursing Research Conference 2023 – Present

Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has …

A Quality Improvement Project To Decrease New Or Worsening Pressure Ulcers In A Skilled Nursing Facility (D-Pus Snf), Shaune Mattsson

Providence Nursing Research Conference 2023 – Present

Background:

Pressure ulcers (PU) are a "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or shear/friction". PU are an urgent problem in the United States (U.S.). Residents in skilled nursing facilities (SNF) are disproportionately affected, with 9.2% of residents estimated to suffer a PU nationally. The Braden Scale is gold standard for identifying individuals at risk for PU in healthcare settings across the continuum and grades PU risk in 6 categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. To protect against PU, a Braden Scale must be documented on …

An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo

Providence Nursing Research Conference 2023 – Present

Background:

Pressure injuries have detrimental effects on patients healing and outcomes and are costly to organizations due to payment programs. Pressure injuries are largely preventable if appropriate interventions are implemented early. In our ICU, post-pandemic monitoring showed increases in hospital-acquired pressure injuries (HAPIs) and consults for medical device HAPIs were increasing. Rounds with wound care department indicated lack of staff compliance with recommended preventive practices. Some issues reported were the use of diapers and excessive linens, failure to use scheduled turning for patients, lack of prevention related to medical devices

Purpose:

The goal of this skin-care management project is …

Going Beyond The Pronouns: Caring Well For Lgbtq+ People, Tobias Johnson

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Sepsis 5 Rights Round (S5rr), William Lim, Bilma Pellissery, Jenny Carrillo

Providence Nursing Research Conference 2023 – Present

Background. Sepsis-related hospitalizations with prolonged length of stay (LOS) are rising in the US. Likewise in our setting, sepsis is the #1 diagnosis-related group (DRG). Moreover, our sepsis patient outcomes for DRG-related LOS, timely discharge, readmission rates, and observed/expected (O/E) mortality did not meet our healthcare system’s regional goals. Thus, because evidence suggests that interprofessional rounds may improve those outcomes among non-sepsis patients, we decided to add afternoon interprofessional rounds to existing morning rounds. Those Sepsis 5 Rights Rounds (S5RR) would focus on the right patient, place, time, level of care, and plan of care.

Purpose.The purpose of this …

Using A Virtual, Case-Based Approach To Developing Clinical Competency In Hospice, Melissa Robinson, Sasha Holden, Tara Poulsen

Providence Nursing Research Conference 2023 – Present

Background:

There has been a shift in nursing education away from a teacher-centered approach that is focused on requiring learners to memorize large amounts of content to a concept-based approach that is learner-centered and focuses on the development of critical thinking, clinical judgment, and problem-solving skills (Giddens et al., 2020). Conceptual learning requires learners to connect facts and exemplars to concepts through active learning experiences such as completing case studies or problem-solving activities (Baron, 2017). This allows learners to ‘practice’ thinking and apply new knowledge to clinical practice.

The clinical education team is applying this knowledge to the current competency-based …

Effective Non-Pharmacological Pain Relief Interventions Among Neonates: An Integrative Research Review, Staci Shaw

Providence Nursing Research Conference 2023 – Present

Background:

Newborns encounter many painful events, including heel sticks, venous blood sampling, peripheral intravenous insertions, and more. Newborns cannot verbally express pain, and caregivers rely on changes in vital signs (increased heart rate, decreased oxygen saturations) behavior (long periods of inconsolable crying), and facial expressions to grade newborn pain. Pain management in neonates is critical to preserve neurodevelopment. Due to adverse effects of pharmacological pain management interventions in neonatal populations, non-pharmacological pain management interventions are often utilized in newborns, such as swaddling, non-nutritive sucking, kangaroo care, oral sucrose, holding, touching, music, and breastfeeding. However, the most effective pain management intervention, …

A Quality Improvement Project To Reduce Hospital Acquired Pressure Injuries In Patients With Darker Pigmented Skin, Ma Fe Chase, Travis Scott, Renee Hoeskel, Yolanda Rodriquez

Providence Nursing Research Conference 2023 – Present

Purpose: This quality improvement (QI) project aims to improve the accuracy and effectiveness of skin assessments for patients with darker skin tones in preventing hospital-acquired pressure injuries (HAPIs) by implementing an evidence-based, standardized skin assessment protocol and training program.

Background: Nursing staff play a vital role in preventing HAPIs. Nearly 2.5 million patients develop HAPIs annually in the United States increasing their risk of prolonged hospitalization, increased readmission, infections, and severe pain. Preventing HAPIs continues to be top priority in acute care facilities. Recent audits at a large urban Pacific Northwest hospital revealed high HAPI rates with a staff …