Nursing Commons^™

Minimizing Unplanned Extubations In The Intensive Care Nursery, Lindsay Barrosse, Blaire Collins, Cassidy Horton, Jodie Seitzer, Brittney Hunter, Jenny Mckee

Nurse Presentations

Describes a project to ensure compliance with a standardized process for endotracheal tube management in the intensive care nursery in order to reduce the number of unplanned extubations and their consequent adverse effects.

Timely Interventions In Patients Developing Sepsis Within The Picu, Lindsey Bloom, Ashley Bramel, Kelsey Cumpton, Christopher Damrat, Emily Lingo, Grace Sexton, Breton Struble

Nurse Presentations

Describes a project to increase the number of sepsis interventions completed within one hour in the pediatric intensive care unit, and to improve the documentation (COW Cards) of rapid interventions.

Engaging Student Nurses In A Professional Association, Nicholas Craig

Student Engagement Posters

Nicholas Craig discusses student engagement at Linfield College with regard to his involement with the Critical Care Nurses' Club.

Sepsis: Triage Triggers, Outcomes Quicker, Rylee Ainge, Mackenzie Flaws, Natalie Heim, Emily Herndon, Hayley Norris, Amy L. Scott

Posters

No abstract provided.

Managing Severe Tbi In The Icu Setting Using A Three Tier Approach, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Assess the effects of injury to the brain in the neurologic injured patient and implement a tiered approach to manage severe TBI
• Evaluate TBI patients using multimodality monitoring
• Apply interventions to manage brain injury & integrate the complex multi-system issues and manage these patients using an actual case study.

Temperature Management: All Shook Up! Managing Shivering In Normothermia, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify key factors related to maintaining normothermia
• Describe the use of the Bedside Shivering Assessment Scale
• Provide interventions to manage shivering in the Neuro patient population

Technology: Inside The Black Box -- Managing Neuro Patients, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify the pathophysiology and cellular processes related to brain injury responses
• Describe the indications, functions, data analysis, and suggested interventions with various monitors of the brain
• Apply this technology to the care of the critically injured neuro patient using evidenced based protocols

Practice With Purpose & Passion, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Integrate the components of clinical practice in an ICU environment including elements of team membership/performance, teamwork, shared decision making, communication and collaboration
• Demonstrate passion in delivering care in the ICU environment by reflecting on the meaning of nursing care and generating fuel to inspire the clinical team in the work environment

Investigating Compassion Fatigue In Medical-Surgical Nurses, Tammy Darlene Shepherd

Nursing Theses and Capstone Projects

Medical-surgical nurses are consumed by providing care to patients and families and often forget to care for themselves. Compassion fatigue can lead to lack of caring for one’s self in the nurse’s life. The purpose of this thesis was to examine the existence of compassion fatigue among medical-surgical nurses and determine the correlation between the range of years of nursing experience and range of age in years. A review of the literature has identified that nurses should practice self-care to combat compassion fatigue. The theoretical framework was based on Jean Watson’s Theory of Transpersonal Caring. The Professional Quality of Life …

An Evaluation Of A Pilot Inpatient Hospice Unit And The Impact It Has On End-Of-Life Care At An Academic Medical Center, Cynthia Minetree

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.

Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact …

The Use Of Behavioral Pain Assessment Tools And Pain Outcomes In Nonverbal Patients, Patrick A. Healy

Honors Undergraduate Theses

Acute and critical care patients experience significantly more pain than those patients on a general nursing unit. Due to the severity of their condition, acute care patients may be nonverbal and unable to self-report their pain. Behavioral pain assessment tools are a method of objectively measuring pain in patients who are unable to communicate. While the use of these tools has been shown to improve short- and long-term outcome for patients, there is a paucity of evidence as to nurses' perceptions related to their use. The purpose of this study is to investigate acute care nurses' perceptions of the relationship …

Burnout Syndrome In Critical Care Nurses, Katie Burke, Kelly Claridge, Mallory Bidlen

Williams Honors College, Honors Research Projects

Burnout syndrome among nurses, especially within the critical care setting, has been a persistent and increasingly prevalent problem in the healthcare field. This systematic review aims to explore the common causes of burnout among nurses associated with working in a critical care setting. Twenty-five peer-reviewed articles, published between the years of 2000 and 2018, were selected for analysis and synthesis using the databases PubMed and CINAHL. The group included research studies conducted in the United States, Spain, France, China and Iran with sample sizes ranging from 42 to 2,392 intensive care unit (ICU) nurses. The articles included in this review …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

Neurochemical Factors Associated With The Initial Pathophysiological Reaction To Large Vessel Occlusion Stroke, Sarah R. Martha

Theses and Dissertations--Nursing

Ischemic stroke is the leading cause of disability world-wide and affects over 800,000 people per year in the United States. The majority of these strokes are ischemic due to a blockage of blood flow to the brain. Damage to the brain occurs at the onset of stroke, neuronal cell death is irreversible and therefore, quick treatment to remove blockage is critical factor in the recovery from stroke. Mechanical thrombectomy as a treatment for ischemic stroke provides an ideal opportunity to collect blood distal and proximal to the cerebral thrombus to examine neurochemical changes occurring during stroke.

The purpose of this …

Patient Outcomes Associated With Delayed Rapid Response System Activation: A Retrospective Comparative Study, Ricardo Padilla

Dissertations

Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, …

The Effect Of A Simulation-Based Education Program On Nihss Accuracy And Inter-Rater Reliability Among Nursing Staff In The Neurological/Neurosurgical Intensive Care Unit, Amanda Novak

DNP Projects

PURPOSE: The purpose of this Quasi-experimental study was to examine the effect of a simulation-based educational NIHSS workshop on nursing accuracy and inter-rater reliability upon use of the National Institutes of Health Stroke Scale (NIHSS).

METHODS: This study was conducted in the Neurological/Neurosurgical Intensive Care Unit (ICU) at Baptist Health, a comprehensive stroke center located in Lexington, KY. The sample included 26 eligible nurses employed in the aforesaid unit. Nurses completed the NIHSS on a patient actor in a simulated scenario (this session was videotaped), a one-on-one debriefing with review of the videotape was conducted afterward, and then the nurse …

The Effect Of Computed Tomography Perfusion (Ctp) Scans On Acute Ischemic Stroke Patients At A Comprehensive Stroke Center, Sarah Holloway, Sarah Elizabeth Holloway

DNP Projects

Objective: The DEFUSE 3 and DAWN trials have revealed that stroke patients may be eligible for mechanical thrombectomy up to 24 hours from symptom onset with appropriate perfusion imaging. The purpose of the study is to evaluate the impact CTP imaging will have patient selection and outcomes at a Comprehensive Stroke Center.

Methods: This study is a retrospective and prospective chart review comparing acute ischemic stroke patients evaluated for mechanical thrombectomy utilizing CT angiogram verses CT perfusion imaging from January 1, 2018- June 30^th 2019 at a Comprehensive Stroke Center.

Results: Of the 129 patients who received CTAs, 36 …

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

Stroke Clinical Order Pathway Education (Scope) For Apns, Varsha Singh

Seton Hall University DNP Final Projects

More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across New Jersey (NJ) …

An Interdisciplinary Code Sepsis Team To Improve Sepsis Bundle Compliance In The Emergency Department, Jill M. Delawder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: Sepsis is one of the leading causes of mortality with over 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis including electronic alert systems, standardized order sets, nurse-initiated protocols and specialty trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.

Methods: The aims of this rapid cycle quality improvement project were 1) to develop and implement an interdisciplinary team to address early implementation of evidence-based sepsis bundles in the emergency department and 2) to compare sepsis bundle compliance three months pre-and three …

Transitioning With Grace: Improving Quality Of Life For Comfort Care Patients In The Intensive Care Unit, Melissa Ashley

Doctor of Nursing Practice Projects

The primary aim of this project was to develop and execute a standard protocol of interventions for comfort care patients on a medical intensive care unit. Staff at a 15 bed MICU at a Midwest urban teaching hospital from June 1 until August 11, 2018 were trained to execute a standardized protocol of interventions for comfort care patients. Seventeen MICU patients who transitioned to comfort care were offered a standardized set of evidence-based interventions, after staff attended educational in-services on providing high quality end of life (EOL) care. Checklists were used to determine intervention compliance. Pre-project and post-project surveys were …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Strategies To Improve Resource Availability For New Graduate Nurses In A Critical Care Setting, Natasha Stankiewicz, Jonathan Archibald, Shawn Taylor, Deborah Jackson, Bonnie Boivin, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE RESOURCE AVAILABILITY FOR NEW GRADUATE NURSES

Due to changes in the employment arena, health care organizations are hiring new graduate RNs into acute care. At an academic tertiary medical center, new hires typically are assigned into a night shift, which traditionally has less resource availability.

The results of a recent AHRQ hospital survey on patient culture safety demonstrated that new graduates were feeling unsupported and that patient safety could be potentially compromised. A team of caregivers developed several goals to provide increased support, encouragement and education to night shift new hires. Improvement in overall patient care and …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Improving Revenue Capture And Patient Safety In An Icu Setting, Natasha Stankiewicz, Laura Lewis, Jonathan Archibald, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

IMPROVING REVENUE CAPTURE AND PATIENT SAEFTY IN AN INTENSIVE CARE SETTING

Materials management department is responsible for restocking chargeable supplies in an intensive care unit (ICU) at an academic tertiary medical center. Staff confusion as to what items were considered chargeable often led to low supply par levels resulting in delays of critical patient care.

Using baseline metrics, a team of caregivers created several performance improvement goals to increase nursing compliance with appropriate supply charging. The results of a root cause analysis spearheaded the development of a KPI that encompassed staff education, lost charge tracking and charge supply labeling.

Post …

Improving The Practice Model In A Military Clinic, Kristina Marie Zuccarelli

Doctoral Dissertations and Projects

Military members and their families face numerous stressors due to the unique lifestyle of this career (Lester, 2011). The occupational impact on these members creates a highly stressful and physically demanding environment with low morale, chronic medical complaints, and poor mental health for these individuals. This project incorporated the current patient-centered medical home (PCMH) model and fused it with the operational medical model for all the active duty members in this unit. The combination of models allowed the provider to have a better understanding of the population’s needs. By embedding in the units, the provider developed a team approach to …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Improving Analgesia Administration For Pediatric Patients In A Rural Emergency Department, Alvin R. Walters

DNP Qualifying Manuscripts

When a child is in pain, parents often seek out treatment at an emergency department. After a detailed chart review it was determined that only 32.53% of the pediatric patients who present to a rural, northern California, ED in pain receive any documented form of analgesia during their time in the ED. A review of the literature revealed that triage nurse-initiated protocols can successfully manage to provide consistent and efficient analgesia to patients who present to an ED with pain. Therefore, a practice improvement project was undertaken to increase of the consistency and efficiency of analgesia administration for pediatric patients …

Nicu Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Renea L. Beckstrand, Rebecca F. Isaacson, Janelle L. B. Macintosh, Karlen E. Luthy, Lacey Eden

Faculty Publications

Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles.

Objective: The objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs.

Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.

Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between …