An Interprofessional Collaboration To Increase Total Enteral Nutrition In Critically Ill Patients On Vasopressor Agents In Cvicu, Priyanka Shah

DNP Projects

Background: Delayed enteral nutrition (EN) in critically ill patients increases the risk of complications and poor outcomes. The 2016 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (S.C.C.M.) evidence-based guideline recommends initiating EN within 24-48 hours of Intensive Care Unit (ICU) admission once resuscitation and hemodynamically stability have been achieved. The evidence-based guideline notes that critically ill patients on low-dose vasopressors can be started on EN with close monitoring.

Purpose: This interprofessional project aims to increase the amount of EN delivered to all qualifying Cardiovascular Intensive Care Unit (CVICU) patients who are at risk …

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 …

Improving Nursing Comfort In Relation To Difficult Conversations, Sarah Clifton

DNP Projects

Abstract

Background/Purpose

Conversations between care providers and patients are integral to medicine and are the most performed “procedure” (Luff et al., 2016). In Pediatric Intensive Care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs), children of all ages with diverse diagnoses and needs are treated for critical illnesses and traumatic events. Therefore, providers frequently have difficult conversations with patients and their families. Pediatric critical care nurses are often invited to participate in these discussions. However, their role during, and after, these conversations is not always clear. The goal of this project was to evaluate the impact of an educational …

Effectiveness Of A Multimodal Educational Program In Increasing Understanding And Utilization Of Tele-Icu Resources By Critical Care Nurses: A Pilot Study, Olga Vulakh

DNP Projects

Background. Integration of tele-intensive care units (tele-ICUs) into healthcare systems is associated with improved patient outcomes and organizational performance. Inadequate bedside nurses’ knowledge about tele-ICU is associated with poor communication and lack of trust between bedside and tele-ICU teams. These problems might diminish tele-ICU’s ability to maximally impact patient outcomes.

Purpose. The purpose of this project was to create a multimodal educational program with the goal of improving knowledge, attitudes, and skills related to tele-ICU among critical care nurses and to assess the effect of the educational intervention on tele-ICU utilization among bedside nurses as evidenced by the number of …

Relationship Between Number Of Mechanical Ventilation Days Prior To Ecmo Initiation And Outcomes In Covid-19 Patients, Brittany Bergman

DNP Projects

Background: Since the start of the pandemic, there has been over 16,000 COVID-19 positive patients placed on Extracorporeal Membrane Oxygenation (ECMO). Little is known about the effect of long mechanical ventilation prior to ECMO initiation. Purpose: The first purpose of this project is to evaluate whether a longer mechanical ventilator time (ten or more days) prior to ECMO initiation is associated with increased mortality and longer total lengths of time on ECMO in patients with COVID-19, as opposed to being on a ventilator for under ten days prior to being placed on ECMO. The second purpose is to increase provider …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Nursing Students' Competence With Anesthesia, Mallory Groover

Honors College Theses

Anesthesia management is diverse and complex. As a Registered Nurse (RN), it is imperative that the basic pathophysiology of anesthesia complications is understood in order to provide competent care. The effects of anesthesia can vary greatly depending on factors such as age, sex, health status, and lifestyle. Since there are several variables, it takes years of experience working with a diverse population to anticipate adverse effects and patient outcomes. Preparedness for anesthesia management could be improved through the use of simulations during nursing school relating to post-anesthesia care, as well as more in-depth lectures over the potential complications and pharmacodynamics …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le

Master's Projects and Capstones

Problem: The USP General Chapter <800> guidelines protect healthcare workers from hazardous drugs (HD) and are enforceable by hospital regulatory organizations. Hospitals should increase their safe handling and administration of these drugs to be compliant and protect their workers. This quality improvement project aimed to improve nurse compliance with the safe handling of USP <800> drugs on the medical-surgical microsystem within 16 weeks.

Context: This clinical nurse leader (CNL) quality improvement project was implemented on two medical-surgical microsystems in a San Francisco Bay Area hospital system.

Interventions: The team conducted passive observational data collection and active observation in the form of a …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong

Master's Projects and Capstones

The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Improving Safe Handling And Administration Of Usp<800> Hazardous Drugs Within The Medical-Surgical Unit, Pavlo Karaputa

Master's Projects and Capstones

Nurses comprise the largest proportion of healthcare providers who make contact with Hazardous Drugs (HDs) during multiple types of clinical activities and have a risk of exposure. Hazardous drugs (HDs) are a class of pharmaceuticals that pose serious health risks to individuals who handle them, including organ toxicity, reproductive and developmental defects, infertility, miscarriage, genetic toxicity, cancer, and even death. This project was implemented in a hospital system within Northern California, on two units that serve medical-surgical, oncology, geriatric, and transplant patients. The Medical Surgical microsystem at this hospital comprises a small group of professionals such as registered nurses (RNs), …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

Sunsetting Excessive Chest X-Rays In An Intensive Care Unit: A Quality Improvement Project, Cassandra Sweet

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

In the cardiovascular service line at an academic medical center in the southeastern United States, obtaining daily chest x-rays still occurred despite evidence that it is unnecessary and possibly even harmful. This quality improvement project was implemented in a 24-bed Cardiovascular Intensive Care Unit and 20-bed acute care unit, together considered to be the cardiac service line. Using the implementation framework of the Model for Improvement and Plan/Do/Study/Act, a guideline that outlines appropriate times to obtain a chest x-ray based on the American College of Radiology’s appropriateness criteria was created. Daily chest x-rays were eliminated and replaced with an on-demand …

Exploring The Influence Of Contextual Factors And The Caregiving Process On Burden, Quality Of Life, And Outcomes Of Heart Failure (Hf) Dyads After A Hospital Discharge Guided By The Individual And Family Self-Management Theory (Ifsmt): A Mixed Method Study, Tamara Bernard

Theses & Dissertations

ABSTRACT The purpose of this study is to explore the influence of contextual factors and caregiving process characteristics on proximal outcomes of the patient and caregiver after discharge from the hospital. The long-term goal of this research is to reduce caregiver burden and improve patient outcomes. Heart failure (HF) is an increasingly common chronic illness with unique caregiving needs and a high rate of hospital readmissions. Caregiver burden has been researched extensively in other areas of medicine such as oncology and dementia and has been reported for stable chronic HF patients in an outpatient setting. However, there is little research …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

Reducing Readmission (And Mortality) For Older Patients & Survivors Of Life-Threatening Conditions: A Study Using The Staarr Protocol, Akhenaten Amun

Symposium of Student Scholars

Readmission rates for patients admitted for heart failure, pneumonia, chronic obstructive pulmonary disorder, a myocardial infarction, a hip or knee arthroplasty, or coronary artery bypass surgery tend to have high readmission and mortality rates within 30 days of their discharge from a hospital. Starting in October 2012, the Healthcare Reimbursement Reduction Program enforced penalties on Medicare reimbursements for hospitals with readmission rates, for patients with the conditions above, were higher than averages based on facilities with similar characteristics and patient populations. Teach-back and verify (Klingbeil & Gibson, 2018), interdisciplinary teams that engage in patient care and support (Reiter-Palmon et al., …

Interventions To Decrease Readmission Rates In Lvad Patients, Karolina Jackson

Symposium of Student Scholars

Interventions to Decrease Readmission Rates in LVAD Patients

Karolina Jackson

WellStar School of Nursing, Kennesaw State University

NURS 4417: Advanced Clinical Practicum

Lynnda Campbell

October 21, 2022

Abstract

Background: Patients who have undergone implantation of a left ventricular assistive device are at a higher risk for readmission- whether that be due to driveline dressing infections, thrombosis, bleeding at the site of implantation, or electrolyte imbalances. These readmission rates in the LVAD population can be decreased through appropriate intervention methods. Literature Review: This study’s main purpose was to discover interventions healthcare facilities and core LVAD staff can implement in practice to …

Impact Of Alarm Management Classes In Reducing Alarm Fatigue, Elizabeth Laegen

Symposium of Student Scholars

Alarm fatigue is becoming a more and more common problem for nurses working in inpatient hospital units, especially critical care units. Monitoring systems, ventilators, vital signs monitors, and other electronic devices designed to detect critical or pending critical values and alterations in patients have become more of a nuisance than the lifesaving systems they were designed to be. With alarms sounding frequently for what are typically nonactionable alerts, nurses to have developed a decrease in sensitivity to all alarms, regardless of importance. Research of alarm fatigue has shown that while the significance of the problem is clear and studies have …

In Adult Icu Patients With Central Lines, Does Improved Staff Adherence To The Clabsi Prevention Clinical Practice Guidelines Reduce The Incidence Of Clabsis?, Job Waihiga

Symposium of Student Scholars

A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when bacteria or viruses enter the bloodstream through the central line. Background: This project is important because central line-associated bloodstream infections increase hospital mortality rates, lengths of stay, and 30-day readmission rates. They also impose heavy financial burdens on hospital systems. Furthermore, out of all the nosocomial infections, central line-associated bloodstream infections have the highest and most recent incidence rates in this adult ICU unit. Purpose: This project aims to identify an intervention to improve staff adherence to the CLABSI prevention bundle and decrease the rate of …

Reducing Noise Levels In Intensive Care Units Using Noise Monitoring Technology, Kayla Kloes

Symposium of Student Scholars

Intensive care units require many medical procedures, activities, machines, and staff that contribute to high levels of noise. These high noise levels have been found to cause adverse psychological and/or physiological health effects related to sleep disturbances, increased anxiety, and increased stress. These health effects may lead to decreased patient satisfaction. The purpose of this proposal is to explore the effectiveness of the SoundEar 3-300 device in decreasing levels of noise and as a result, increasing patient satisfaction. The current research indicates that the SoundEar 3-300 device is successful at reducing hospital noise levels. This device allows for the measurement …

Impact Of Alarm Fatigue In Critical Care Nurses On Patient Outcomes, Addie Mctyre

Symposium of Student Scholars

Background

Critical care units are equipped with extensive amounts of patient monitoring equipment that sound alarms to alert nursing staff to changes in the patient’s condition. The constant beeping of alarms can result in a phenomenon known as alarm fatigue, when nursing staff becomes accustomed to the continuous sound of alarms and either tune it out or ignore it completely. This can result in poor patient outcomes. The purpose of this project is to propose techniques to decrease false alarms to reduce the overall number of alarms during a shift. This will lead to a reduction in the occurrence of …

Does The Use Of Machine Learning Algorithms Help Reduce Mortality Rates In Patients With Sepsis, Jacqueline Easter

Symposium of Student Scholars

Abstract

Background: Sepsis is the result of the body’s dysregulated response to an infection. The response can cause an inflammatory chain reaction which can lead to multiple organ dysfunction septic shock, and death. Early recognition and treatment of risk of sepsis is essential to control the disease. Each hour of delay treatment is associated with 3%-9% increase in mortality rate (Kuo et al., 2021). The current methods for prediction of sepsis such as SOFA have prediction rates low as 61% (van Doorn et al., 2021). Research using Machine Learning Algorithm has demonstrated prediction rates of 95% within an hour (Singh …

Intensive Care Unit (Icu) Delirium, Mckenna Redmond

Symposium of Student Scholars

The purpose of this evidence-based practice project is to implement and evaluate an effective way to prevent intensive care unit (ICU) delirium. My research question is asking whether nonpharmacological or pharmacological therapies are effective for preventing intensive care unit delirium acquired during stay. Delirium is a mental state that occurs from a variety of reasons that creates changes in arousal, cognition, and in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. Delirium during acute settings, such as the ICU, can cause an increased risk for mortality. Thorough evaluation of multiple studies exemplified that …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Effects Of Oral Care And Positioning On The Incidence Of Ventilator-Associated Pneumonia, Nneka Uwaekwe

Symposium of Student Scholars

Abstract

Background: Ventilator-associated pneumonia (VAP) is a lung infection that is acquired after endotracheal intubation. It is associated with increased length of hospital stays, costs, and rate of mortality for mechanically ventilated patients in the intensive care unit. The role of oral care with chlorhexidine and patient positioning are being considered as interventions for VAP prevention, however, uncertainties remain regarding the benefits and harms of chlorhexidine and positioning for preventing VAP. Purpose: The purpose of this study is to determine the effect of positioning and the use of chlorhexidine for mechanically ventilated patients, on the incidence of ventilator-associated pneumonia …

Unmasking The Leading Injuries In Hospitals And A Promising Change, Taylor Karisny

Symposium of Student Scholars

Abstract

The problem that will be studied is the increased development of pressure ulcers among hospitalized intensive care unit patients. The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately and effectively is increasingly important for all professionals in wound care. The review of the literature shows, hospital-acquired pressure ulcers are expensive to treat with the U.S. median cost at $39,000 per patient stay and costing U.S. health care system $3.6 billion per year. Several interventions and preventive measures are current used …