Nursing Commons^™

Improving Triage Accuracy In The Emergency Department, Joselyn Silverman

Master's Projects and Capstones

Problem: High rates of patients being mis-triaged was occurring at Hospital X leading to poor patient outcomes and incorrect staffing levels.

Context: This quality improvement project took place at Hospital X’s emergency department. A stakeholder analysis and a microsystem assessment along with a staff survey was created in order to determine areas of improvement and staff responsiveness.

Interventions: Eight educational seminars were conducted along with Hospital X leadership and students created supplemental materials for the staff to use on a daily basis.

Measures: Two data pulls were conducted over the course of the quality improvement project; one prior to the …

Implementation Of Coping Strategies For Compassion Fatigue Through Counseling, Caleb R. Turner

MSN Capstone Projects

Many healthcare organizations are struggling to retain nurses due to the recent COVID-19 pandemic. Understanding common reasons for decreased retention in nursing begins with evaluating job satisfaction and how it can be affected (Cuartero-Castañer, 2021). Compassion Fatigue (CF) and Burnout (BO) are two leading causes of decreased job satisfaction (Compassion Satisfaction (CS)). The Professional Quality of Life Scale (PROQoL) (see Appendix C) is designed to identify individuals at higher risk of CF and BO. Using this scale in conjunction with the Peer-Support coaches in the hospital setting allows nurses to have conversations and communicate effectively with coaches trained to have …

Increasing Sepsis Bundle Compliance Through Nurse Education, Parth S. Papaiya

Master's Projects and Capstones

There exists opportunities for improvement in regards to sepsis management and compliance rates in efforts to reduce sepsis-related complications and incidents in the ED. SEP-1 fallouts and requirements linked to education gaps about sepsis bundle protocols, nurses’ attitudes about implementation of the protocols, and differences in nurse/physician order sets present as deterrents for timely sepsis management and improvements in the rates of compliance/adherence. Denouncing the usage of standardized protocols/use of order sets have been identified as a process gap and a much needed opportunity for improvement. It is presumed that the failure to implement, in addition to improper documentation of …

Effect Of Covid-19 On Icu Nurse Burnout, Kayce Sheppard

Honors College Theses

Burnout is becoming increasingly worse for those in the nursing field after the height of the COVID-19 pandemic. While all nurses are at risk, ICU nurses are seen as at a higher risk for this increased burnout due to the already high stress environment they are subjected to in their unit. Without proper intervention of this issue, the levels of burnout are expected to continue to remain high, leading to job dissatisfaction, short staffing, and reduced patient satisfaction. The objective of this study is to review the level of burnout among ICU nurses. A burnout study was conducted on ICU …

The Effect Of Mentorship And Social Events On Job Embeddedness And Intent To Stay In Emergency Department Nurses, Kacie L. Albertsen

DNP Projects

Background and Purpose: The COVID-19 pandemic has drastically impacted nurse retention. According to the Kentucky Nurses Association, 57% of surveyed Kentucky nurses are considering leaving their jobs. Best retention strategies are unclear. Job embeddedness (JE) and Intent to stay (ITS) are factors that influence retention. The purpose of this project is to increase JE and ITS at a level one emergency department (ED) by implementing evidence-based mentorship and social event interventions.

Methods: This study utilized a mixed-methods, one group pretest-posttest design. Mentorship pairs were matched by personality type using the Big Five Personality Test. Four mentorship discussion meetings and two …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Exploring Moral Permissibility Of Nurse Participation In Limited Resuscitation, Felicia Stokes

Electronic Theses and Dissertations

This dissertation offers a novel approach to support nurses when they face conflict between clinicians and families or alternate decision-makers over potentially inappropriate end-of-life goals of care. This dissertation will provide a normative analysis of the moral permissibility of limited resuscitation, with arguments supported by analyses of families’ and nurses’ perspectives and actions in the EoL decision-making process. Limited resuscitation is a cardiopulmonary resuscitation effort where full pharmacologic and mechanical intervention is not used, or the length of the resuscitative effort is shortened. It is typically associated with deception because it is performed without the knowledge of patients and families. …

Nursing Management To Reduce Hospital Readmissions After Percutaneous Coronary Interventions- Integrative Review, Jeena S. Daniel, Doreen Wagner

Master of Science in Nursing Final Projects

Abstract

Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses' …

Implementing Mindfulness Meditation To Reduce Nurse Burnout, Jannelle V. Sanchez

Electronic Theses and Dissertations

Abstract

There will be an estimated shortage of 100,000 nurses by the year 2022, with 500,000 seasoned nurses retiring. The nursing profession has recently experienced a devastating pandemic that left no time to combat the detrimental effects of burnout, specifically for intensive care nurses, who are the frontline workers of a physically and psychologically draining working environment conducive to burnout. Nurses experience burnout for a mixture of reasons, but mainly it is due to the lack of interventions to help them combat the disease. Mindfulness meditation represents an interventional tool that has been shown to reduce the negative stressors associated …

Coronavirus Disease 2019 (Covid-19): A Literature Review From A Nursing Perspective, Amir Emami Zeydi, Mohammad Javad Ghazanfari, Farzam Shaikhi Sanandaj, Reza Panahi, Hamed Mortazavi, Keyvan Karimifar, Samad Karkhah, Joseph Osuji

BioMedicine

Introduction: As the COVID-19 pandemic ravages the world, nursing resources, and capacities play an essential role in disease management. This literature review focuses on the central issues related to the nursing care of patients affected by COVID-19.

Material and Methods: This literature review was conducted with an extensive search of databases, including PubMed, Web of Science (WOS), and Scopus, using the keywords "COVID19", "2019-nCoV disease", "2019 novel coronavirus infection", "Nurse", "Nursing Care", and "Nursing management." The span of the literature search was between December 01, 2020, and January 12, 2021. A total of 28 original and English-language articles …

Addressing Critical Care Nurse Burnout, Julie Suarez

Master's Projects and Capstones

Problem: Critical care nurses are at higher risk for developing burnout than nurses from other areas of clinical practice. If not addressed promptly, the problem of burnout can worsen, negatively affecting the healthcare provider, organization, and patient outcomes.

Context: Increased stress and burnout observed in the microsystem with the onset of the COVID-19 pandemic prompted consideration of ways to address the well-being of critical care nursing staff with targeted interventions that could be implemented quickly with readily available resources.

Interventions: The project aim was to reduce critical care nurse burnout scores through implementation of evidence-based strategies addressing participative management, camaraderie …

The Impact Of Mindfulness-Based Stress Reduction Techniques On Nurse Burnout In An Icu, Heather L. Vincent

Student Scholarly Projects

Practice Problem: Burnout among nurses has been linked to turnover, negative patient safety and quality outcomes, and higher costs for institutions.

PICOT: The PICOT question that guided this project was, in ICU nurses (P), what was the impact of the use of MBSR techniques (I), versus the current state in which no MBSR techniques are practiced (C), on self-reported BO (O), over the course of eight weeks (T).

Evidence: A total of 14 studies were identified in the literature that directly support the implementation of this project. Themes from the literature show that mindfulness-based stress reduction techniques such as meditation, …

Nurses' Perspectives On Pain Management In The Emergency Department, Elizabeth Fitzgerald

Seton Hall University Dissertations and Theses (ETDs)

Over 130 million people seek care in emergency departments (ED) in the United States annually. Most patients who seek treatment in emergency departments are experiencing a painful condition, and as such, ED nurses should have a deep understanding of pain management in the ED. There is limited qualitative research which explores pain management from the nurses’ perspective. The purpose of this study is to describe pain management from the nurse’s perspective. Thorne’s (2005) method of Interpretive Description guided this qualitative inquiry. New knowledge describing the nature of pain management in the ED provides insight into elements which support and impede …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Gratitude Journaling As Intervention To Combat Nurse Burnout In Cardiac Surgery Intensive Care Nurses, Melinda Simpson

Master of Science in Nursing Theses and Projects

As a practicing registered nurse in the intensive care setting, this researcher witnessed an episode of burnout characterized by a public meltdown, crying, and yelling. This sparked an interest in an intervention to combat nurse burnout. Literature was found on gratitude which has been found to increase resiliency. An increase in resiliency, in various populations, has been found to decrease perceived stress and feelings of burnout. This researcher investigated the use of gratitude journaling for 21 days as means to decrease perceived stress and feelings of burnout while increasing gratitude and resiliency. The PSS, GQ, BRS, & BBI tools were …

Implementation Of A Mentor Program To Support Nurse Retention: A Pilot Project, Lucy Camarena

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Primary factors affecting nurses’ decisions to stay at an organization include nurse self-concept, job satisfaction, and professional growth. A high turnover rate of nurses poses a risk to patients’ safety and healthcare outcomes. The implementation of mentor programs in institutions that employ new nurses has been shown to reduce turnover rates, increase the quality of patient care, and empower nurses in professional development. The existing literature supports the use of mentor programs and encourages their implementation in healthcare institutions.

Interventions: The DNP project’s goal was to identify effective methods of promoting positive nurse self-concept and increasing job satisfaction …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Moral Distress In Critical Care And Emergency Department Nurses, Morgan Timberlake, Nicole Phillips

Senior Honors Projects, 2010-2019

Moral distress is a phenomenon that occurs when a person is unable to carry out what they believe is the ethically appropriate action due to various external constraints. This literature review seeks to explore the interventions that are most effective in reducing moral distress in critical care and emergency department nurses who have experienced moral distress in practice.

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized for …

Study Of Nurses' Attitudes And Practices Towards Pain Evaluation In Nonverbal Patients, Rebekah Lovin

Montview Journal of Research & Scholarship

Pain, and the appropriate treatment of it, has recently come to the forefront of issues addressed with healthcare providers. Since the cornerstone of pain management is an appropriate assessment, methods of accurate pain evaluation are necessary. This need is particularly important in the population of patients who cannot express their pain. While pain assessment tools are available for use with nonverbal patients and hospitals typically mandate the use of one of these tools, actual compliance with such policy may not actually occur. Various barriers, such as education in the use of a tool, time, and the personal views of the …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

The Application Of Grounded Theory: An Example From Nursing Workforce Research, Latoya J. Lewis-Pierre 4572586, Joann Kovacich, Linda Amankwaa

The Qualitative Report

The application of grounded theory was the conduit to theory development in this study. The intent was to explore nurse manager, educator, preceptor, and new graduates’ perceptions of workplace readiness for new graduates entering an Intensive Care Unit. Research participants were drawn from five different ICUs: Medical, Coronary Care, Surgical, Neuroscience, and Trauma. One-on-one interviews were conducted to collect participants’ perspectives on readiness to practice in the ICU. Using grounded theory, four themes emerged giving rise to the novice nurse embracing the ICU theory (NNEIT). Reflections on the type of grounded theory used, reasons for the selection, challenges faced in …

Effective Coping Mechanisms For Nurses Following Patient Death, Tiffany Gagliardo

Senior Honors Projects

The loss of a loved one affects family and friends but also the nurses and health care providers. At the time of death, nurses are at the bedside providing comfort and words of support. But who is there to support the nurses when the patient dies? The objective of this research project is to identify positive coping mechanisms that nurses can use on a daily basis through an extensive analysis of the literature and individual nurse interviews.

Unfortunately, patient death may be more common for nurses who work on Intensive Care Units (ICU) and Hospice agencies. With the daily requirements …

Impact Of Standardized Oral Health Assessment On Preventing Ventilator-Associated Events, Juana Ambriz De Williams

Evidence-Based Practice Project Reports

Ventilator-associated pneumonia (VAP) is a common but preventable health-care associated infection that affects up to 20% of mechanically ventilated adult patients, resulting in estimated mortality rates ranging from 13% to 55% (Chahoud, Semaan, Almoosa, 2015; Melsen et al., 2013). In an effort to reduce morbidity, mortality and related costs, the Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN), proposed ventilator-associated pneumonia prevention as a national patient safety goal. In 2014, amid growing concerns that the subjectivity of existing definitions had led to inconsistent reporting, thereby impeding efforts to reduce VAP, the CDC refocused surveillance …

Empathy Of Nurses And Family Needs In The Intensive Care Unit, Jolene Marie Tietz

All Graduate Theses, Dissertations, and Other Capstone Projects

Introduction: Patients and patients' families are in crisis when the patient is in the Intensive Care Unit. There have been studies demonstrating the importance of recognizing patient and family needs, and meeting those needs. This study explored what needs families rank as important and if the nurse met their needs, and what effect nurse empathy had on meeting family needs. Methods: Families in the Intensive Care Unit were given questionnaires to complete that addressed which needs they felt were important, if their needs were met, and the level of empathy they gauged their nurse to have. The tools utilized in …