Nursing Commons^™

Fall Prevention Through Proactive Toileting, Kristin Smith

Master's Projects and Capstones

This paper will summarize the quality improvement falls prevention project conducted by a University of San Francisco Clinical Nurse Leader student. Falls in the hospital setting are an ongoing problem in our healthcare system as they have great physical and financial impacts (Salamon, Victory, & Bobay, 2012). Hospital A, an urban teaching hospital, uses the Schmid scale for determining if a patient is a fall risk which includes the assessment of need for ambulatory aids, history of falls, and impaired cognition among other criteria (Schmid,1990). Fall rates are climbing in the United States and the trend is similar on Hospital …

Emergency Preparedness On An Inpatient Hospital Unit, Hailee Marie Barnes

Master's Projects and Capstones

This paper will discuss the implementation of an emergency preparedness quality improvement project conducted by a University of San Francisco Clinical Nurse Leader (CNL) student on an inpatient cardiac unit, Unit H, at an urban teaching hospital in Northern California, Hospital B. An assessment of the current state of emergency preparedness, a diagnosis of Unit H’s area of greatest needs, the details of planning and implementing the quality improvement as well as the final evaluation will be discussed. The nursing process will be used for the structure of this paper as it was used as the structure of this project. …

Patient Satisfaction Related To Noise In The Coronary Care Unit, Anjanette S. Dominguez

Master's Projects and Capstones

Background The CCU staff recognized a department trend for low patient-satisfaction score related to environmental noise levels. Based on the Press Ganey score, the patient-satisfaction score plummeted in relation to noise level beginning in March 2014.

Purpose To improve patient satisfaction regarding noise level in the CCU to 100% by November 21, 2014.

Methods Senior & Fleming’s Hard System Model of Change guided this literature search of CINAHL and Fusion for articles published from 2009 to 2014. Specific terms used were noise, critical care, and sleep promotion. From September to November 2014, earplugs were offered to all alert/oriented patients entering …

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

With no designated cardiovascular step-down unit at Phoenix Children’s Hospital, patient transitions to acute care are inconsistent following admission to the Cardiovascular Intensive Care Unit (CVICU). We aim to improve CVICU patient continuum of care through transferring patients to a step-down telemetry unit starting October 13^th, 2014 exemplified by a 95% patient satisfaction of care provided by January 1^st, 2015. The progression of the project was influenced by Lippitt’s theory, which includes seven phases in the change process. To accommodate post CVICU patients, the acute care unit was transformed to include cardiac monitors, telepacks, a central …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

The Significance Of Timing Of Patient Daily Weights And The Barriers, Ann Pan

Master's Projects and Capstones

Background. Current unit practice is that patient daily weights are obtained in the afternoon or evenings. However, patient weights in the afternoon and evenings are not accurate dry weights. According to evidenced based research, to obtain an accurate patient daily weight, patients should be weighed every morning, after their first void and before they eat breakfast.

Purpose. The focus of the study was to compare the current practices of obtaining daily weights in the afternoon and evenings, compared to the evidenced based practice recommended in the literature.

Method. Through interviews and surveys with staff, the barriers to obtaining patient weights …

Improving Patient Outcomes Through Use Of The Teach-Back Method In The Post Anesthesia Care Unit, Kathleen Osullivan

Master's Projects and Capstones

The setting for this Clinical Nurse Leader (CNL) project was the Post Anesthesia Care Unit (PACU) at a level I trauma center in the Bay Area. The goal was to improve the discharge education performed by the PACU nurses to improve patient safety and decrease the chance of complications or readmissions to this hospital. With no clear instructions for how discharge teaching should be done, the nurses have many differing styles which leaves room for gaps in discharge planning. This influenced the implementation of the teach-back method during discharge planning in order to ensure proper education and increased patient understanding. …

Needs Of Patient’S Families In The Hospital Tele-Intensive Care Unit, Mary L. Jahrsdoerfer

Doctoral Dissertations

Purpose: To explore, identify and describe the perceptions of family members of a patient admitted to a telemedicine intensive care unit (tele-ICU); and to determine if these needs differ from those established by the Critical Care Family Needs Inventory (CCFNI) in the traditional ICU setting. Background: The tele-ICU is a new care modality in which offsite nurses provide consultation to bedside clinical staff at geographically-dispersed ICUs. The last decade demonstrates a growing existence of tele-ICU’s in our healthcare culture. ’Information’, ‘close proximity’, ‘assurance’, ‘support’ and ‘comfort’ have been identified as the top five needs of family members in the traditional …

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Palliative Care's Sacramental And Liturgical Foundations: Healthcare Formed By Faith, Hope, And Love, Darren M. Henson

Dissertations (1934 -)

Medical history identifies Dame Cicely Saunders as the founder of modern hospice and palliative care for the unique care she gave to the incurably and terminally ill. Less known is how her Christian faith, combined with her knowledge of medicine, influenced her vision. This work retrieves the Christian roots of palliative care and asserts that the practice of faith preserves the practice of medicine from succumbing to medicalized dying--a phenomenon that excessively relies on technology with the implied hope that it will ultimately conquer illnesses and even death. Efficiency and effectiveness ground modern medicine's epistemology. These concepts follow the philosophical …

Family Presence During Resuscitation Of Adults: The Impact Of An Online Learning Module On Critical Care Nurses' Perception And Self-Confidence, Kelly Powers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family presence during resuscitation (FPDR) involves offering family members the option to remain with their loved one who is undergoing life-saving measures. FPDR has been shown to enhance comfort and facilitate grieving, and 90% to 100% of patients and family members support it as an option. However, critical care nurses are not fully supportive of FPDR and approximately only one-third implement it in their care of patients. The perceived risks of FPDR are cited as a primary reason for lack of support and implementation. Yet, the perceived risks have not been proven, while the benefits have been established in research. …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Humor As A Buffer For Stress In Nurse Anesthesia Students, Kayla C. Forbis

Honors Theses

This simple, quantitative study was carried out on 18, first-year, CRNA students to determine if humor could act as a buffer for some of his or her perceived stress. Before an impending final exam, when stress levels would most likely be at their highest, the students were broken into three groups: a control group, a non-humorous group, and a humorous group. The students in the control group ranked their level of stress on a 0-10 scale without any other intervention. The other two groups watched a video clip, either humorous or non-humorous, while ranking their perceived stress on a scale …

Staff Perception Related To Family Presence During Resuscitation, Stephanie L. Herron

Nursing Theses and Capstone Projects

The purpose of this study was to examine the perception of health care professionals (staff nurses) regarding family presence during resuscitation. The sample consisted of 59 nurses of different ages and working in different departments. The Staff Perceptions of Family-Witnessed Resuscitation questionnaire was used to collect data. The relationships between participants' demographic data and perceived attitudes and beliefs were also analyzed. Many of the healthcare professionals felt that it was acceptable to have family members present during resuscitation if the patient makes clear decisions prior to the incident or if the physician makes the decision for the patient. Almost half …

Discharge Education In The Emergency Department: Are We Effectively Teaching Chest Pain Patients?, Emily Edwards Nishiyama

Nursing Theses and Capstone Projects

Millions of individuals visit the emergency department (ED) each year with complaints of chest pain. Many chest pain patients do not have an underlying condition of Acute Coronary Syndrome (ACS) but the health and well-being of these patients is indispensable. Research has indicated soaring costs, an increased demand in medical resources, and an increasingly poor quality of life for these patients after discharge. Although research encourages quality education at discharge, very few studies have been conducted on ED discharge education for non-ACS chest pain patients. Using a cross-sectional descriptive research design, this quantitative study discovered the frequency of education provided …

Novel Oral Anticoagulants: Bedrest And Bleeding In Patients Undergoing Atrial Fibrillation Catheter Ablation, Lynn Mcwhirter

UNF Graduate Theses and Dissertations

Atrial fibrillation (AF), the most common cardiac arrhythmia in persons over age 65, is associated with an increased stroke risk necessitating the need for long-term oral anticoagulation for risk reduction. With the introduction of direct thrombin and factor Xa inhibitors in the US since 2010, these novel oral anticoagulants (NOACs) are increasingly being prescribed, replacing the use of warfarin, a vitamin K antagonist. AF catheter ablation (CA), an elective procedure requiring femoral vascular access is a treatment for drug refractory and persistent AF. Bedrest, limb immobilization, and limited head of bed elevation are nursing measures utilized following femoral venous, and …

Nursing Retention In Critical Care, Jeannine A. Eckman

Nursing Theses and Capstone Projects

The purpose of the study was to examine anticipated turnover in critical care nurses and if having previous nursing experience prior to working in critical care affects that turnover. Using the Anticipated Turnover Scale (ATS) by Hinson and Atwood, nurses that had been employed in the critical care areas five years or less were asked to participate. They were asked to complete the ATS and answer the question relating to previous nursing experience. Findings of the study indicated that the nurses with previous nursing experience before working in critical care had a higher ATS score than the nurses with no …

Patient Education In The Emergency Department, Bryan K. Devinney

Nursing Theses and Capstone Projects

Patient education is a core component to the practice of nursing in many countries, including the United States. Emergency department nurses are often overwhelmed with the number of patients they must care for in short amounts of time. The patients are often in varying stages of evaluation and treatment, and the nurse may be involved in one-on-one interventions with these patients. This can leave little time for patient education, especially if the nurse does not feel like the patient education is meaningful or useful. Various factors can influence the ability and desire of the emergency department nurse to provide proper …

Nurse Manager Role Perception In An Acute Care Facility, H. Gale Waters

Nursing Theses and Capstone Projects

The Nurse Manager role is a crucial part of the healthcare delivery system in an acute care facility, particularly in the current wave of healthcare reform. These are unprecedented times for nursing leadership as they develop and move in a new direction. The role of Nurse Manager is complex with numerous studies including: past roles, characteristics, innovation, outcome, education, and advancement. This study observed the role through the point of view of the Nurse Manager. The Nurse Managers participated in a survey in which they ranked themselves on a one to five scale, with one being a novice in the …

Evidence-Based Blood Conservation Education For Icu Nurses: A Pre And Post-Test Evaluation Of Nursing Knowledge, Stefanie M. Bull

DNP Projects

Purpose: The purpose of this evidence-based education project was (i) to evaluate baseline nursing knowledge of anemia, blood conservation and transfusion medicine, (ii) to identify current blood conservation practice and the nurse’s prior exposure to blood conservation education (iii) to determine the potential impact of evidence-based education on nursing knowledge, and (iv) to determine the impact of education on the nurse’s attitudes towards future implementation of blood conservation practices based on the nurse’s self report.

Setting: The project was implemented in the Cardiovascular and Thoracic ICU (CVICU) at an 875-bed level-1 Trauma and Multi-Organ Transplant Center located in central Kentucky. …

The Effects Of Oral Pain Medication Being Administered In Phase I As Compared To Oral Pain Medications Administered In Phase Ii, Dana Jones

Nursing Theses and Capstone Projects

Healthcare and the provision of care are ever-changing as governing bodies over-see and regulate the way institutions provide care for patients. Pain assessment, reassessment, and pain management are a focus nationally and healthcare providers are held accountable for how pain is managed for patients. One piece to this broad topic is the use of oral pain medications, more specifically in the ambulatory surgical patient. The purpose of this project was to compare the length of stay, reported pain scores, and total amount of IV medications administered between patients who receive the first dose of oral pain medications in Phase I …

Trauma Resource Nurse: A Leadership Role In A Pediatric Level 1 Trauma Center, Claudia Hines

Theses and Graduate Projects

Nurses in a pediatric emergency department are accustomed to caring for critically ill and injured children. Pediatric trauma requires nurses to have a high level of expertise. However, along with this expertise, nurses need to demonstrate strong leadership skills to be an effective partner in the trauma team. Attaining a pediatric level I trauma designation by the American College of Surgeons generated uncertainty in emergency nurses' perceptions of their ability to care for trauma patients. Emergency departments within trauma centers have recognized the need for specialized nursing programs or nursing roles in the care of trauma. Nursing leadership competencies, interprofessional …

Nurses Perceptions Of Family Presence During Resuscitation In The Emergency Department, Jennifer L. Jennings

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Family presence during resuscitation has been a controversial and much debated topic for many years. In the past decade, the movement toward family presence has steadily grown. The Emergency Nurses Association (ENA) and the American Heart Association (AHA) have endorsed family presence and incorporated guidelines for its implementation. Although becoming more accepted in practice, there are still many hospitals without family presence policies, and some nurses and other health care providers continue to identify concerns about its’ use. The purpose of this project was to survey nurses’ perceptions of family presence during resuscitation in the Emergency Department. A researcher developed …

Assessment Of Mild Traumatic Brain Injury By Advanced Practice Registered Nurses, Mary Lou Garey

Doctor of Nursing Practice Scholarly Projects

The purpose of this project was to evaluate the knowledge about assessing mild traumatic brain injured patient by the advanced practice registered nurse (APRN) as reflected in the Centers for Disease Control (CDC) Acute Concussion Evaluation (ACE) Tool Kit. A descriptive cross-sectional survey research design was used to assess knowledge about the evidenced based assessment of APRNs practicing in an urgent care setting as established by the CDC for the evaluation of acute concussion. Specifically the history and physical assessment practices of the APRNs for the mild traumatic brain injured patient (MTBI) were evaluated in relationship to the CDC / …

Augmentative And Alternative Communication In The Intensive Care Unit, Jonathan Todd Sizemore

Online Theses and Dissertations

Current research is lacking on the frequency of augmentative and alternative communication (AAC) system use in intensive care units (ICU) and clinical decision making patterns. AAC is use of any alternative method of communication when oral communication cannot be achieved (ASHA, 2013). Patients in the ICU may become nonverbal for many reasons including tracheostomy, mechanical ventilation (McKinley, Pooke, & White, 2010) and intubation (Radtke, Bauman, Garrett, & Happ, 2011). Being nonverbal in the ICU may lead to poorer health outcomes (Patak, Wilson-Stronks, & Costello, 2009). AAC systems may improve outcomes by allowing patients to communicate more clearly with family, friends, …