Nursing Commons^™

1600 Rn, Jonathan Archibald, Natasha Stankiewicz, Mark Parker, Elizabeth Ridel-Dermanelian, Sandy Ridel-Dermanelian, Amy Stafford, Shawn Taylor, Deb Jackson, Alana Trottier, Roger Maynard, Bonnie Boivin

MaineHealth Maine Medical Center

Due to a changing employment arena, healthcare organizations are hiring more new graduate RNs into acute care units. MMC’s usual process is to put new hires into night shift. Historically, night shifts have less resource availability. These combined factors left staff feeling unsupported; patient care could be compromised when less support is available to those in the beginning of their careers.

The Effects Of Depression On Medication Compliance And Patient Outcome In Heart Failure, Jordan Rogers

Grace Peterson Nursing Research Colloquium

Abstract

Background: Heart failure affects 6.5 million people in the United States and depression occurs in approximately 20-50% of heart failure patients. Depression can lead to complications and increased mortality, so it is necessary to examine the effect of depression on heart failure patients.

Objective: To investigate how depression in heart failure patients affects medication adherence and patient outcomes.

Methods: An integrative literature review was completed by searching databases: CINAHL, PubMed, and PsycInfo. Search terms included: heart failure, depression, medication adherence or compliance, anxiety, and outcomes. Studies included had to be published between 2012 and 2018 and available in …

Educational Prevention Program Of Surgical Site Infections (Ssi) At A Metropolitan Pediatric, Daniel Chavez

Master's Theses

Surgical Site Infections are a common hospital acquired disease. The prevention of Surgical Site Infection at a metropolitan pediatric hospital was lacking thorough education on how to prevent Surgical Site Infections. Literature was used to support this educational program with evidence based practices. To further reduce Surgical Site Infections education played a key role. Most importantly the distribution of education is what this educational program aimed toward supporting. In order to optimize patient outcomes through the use of our educational program literacy requirements must be me. Using this information our team constructed educational pamphlets that would help empower patients so …

Advance Alert Monitor, Liesel Buchner

Master's Projects and Capstones

Problem: The acute deterioration of patients outside the Intensive Care Unit (ICU) are safety and quality concerns. Studies have shown that these deteriorations are associated with increased morbidity and mortality. This study aims to standardize the Rapid Response Team (RRT) nurse documentation in response to an Advanced Alert Monitor (AAM) alert, as at baseline no such alert nor standardized response and documentation exist.

Context: Hospitals are continually challenged to innovate and create systems that can track multiple parameters and identify at-risk patients earlier on. An Early Warning System (EWS) in combination with a RRT significantly reduces patients’ potential for clinical …

Amiodarone-Induced Peripheral Phlebitis:Implementation Of Practice Guideline To Decrease Incidence, Elaine Mindo

Master's Projects and Capstones

Abstract

Amiodarone is used in the management of ventricular and atrial arrhythmias, and the drug of choice among many cardiothoracic surgeons to manage post-operative arrhythmias. Atrial fibrillation with rapid ventricular response, is the most common arrhythmia treated with amiodarone in a telemetry unit in one medical center located in northern California. Nurses have noted a high incidence rate of phlebitis related to amiodarone infusion even when the current hospital guidelines are being followed. Data were collected over six months and included 35 patients, each infusion via a different intravenous site was considered another occurrence, for a total of 40 infusions. …

Reducing Patient Harm From Catheter Associated Urinary Tract Infections: A Quality Improvement Project, Grace Cooper

Master's Projects and Capstones

Abstract

Problem: The Institute of Medicine’s seminal report on patient safety, To Err Is Human led to widespread effort to improve the safety of patients. Healthcare-associated safety problems, which include healthcare-associated infection (HAI), account for far more considerable morbidity and mortality than “never events”. The first harm to be addressed as part of the “No Preventable Harms” campaign was catheter-associated urinary tract infection (CAUTI).

Context: The microsystem is a 20-bed mixed medical surgical intensive care unit. Unit assessment at the beginning of the quality project indicated that there were 2 CAUTIs attributed to the unit in a span of 6 …

Improving The Care For Acute Ischemic Stroke Patients, Hermelinda Gonzalez Rivero

Master's Projects and Capstones

Abstract

Problem: Decreasing the time to assess acute ischemic stroke patients impacts the patients’ well-being. The clinical benefit of intravenous Alteplase for ischemic stroke patients results in better outcomes. Intravenous thrombolysis success is dependent on narrowing time to treat (Fonarow et al., 2014). Decreasing the time to intravenous thrombolysis for acute ischemic stroke patients augments the ability of patients to improve the quality of life by minimizing disability and improving health outcomes (Speirs & Mitchell, 2015).

Context: The microsystem chosen for this evidence-based change of practice project change takes place in the Northern California emergency department (ED). The ED provides …

Improve Effectiveness In Trauma Teamwork, Ginger Miramontes

Master's Projects and Capstones

On average, each Ventilator-Associated Event (VAE) is anticipated to increase the length of stay in the Intensive Care Unit (ICU), resulting in potential adverse events and cost to the organization. The Center for Disease Control (CDC) defines VAE as the increase of daily minimum positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) values, after a baseline period of patient stability or improvement on the ventilator (CDC, 2018). Standard endotracheal tube designs have led to the incidence of VAE because of the accumulation of subglottic secretions in the trachea. Untreated VAE can later result in Ventilator Associated Pneumonia (VAP). …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Validation Of The Registered Nurse Assessment Of Readiness For Hospital Discharge Scale, Kathleen L. Bobay, Marianne E. Weiss, Debra Oswald, Olga Yakusheva

Nursing: School of Nursing Faculty Publications and Other Works

Background Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models.

Objectives The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity.

Methods Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency …

Leadership Rounding In The Intensive Care Unit To Improve Satisfaction, Stephanie Laborde

Master's Projects and Capstones

A mid-sized hospital in Alameda County would like to increase its Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores by improving the patient care experience. The specific aim for this project is that by August 2018, the implementation of daily leadership rounding in the ICU will result in an increase of patient satisfaction HCAHPS scores by 5%. The project team used the Plan-Do-Study-Act cycle to guide the implementation of leadership rounding. Leadership rounding was conducted daily over a 10-week period by the project team, which consisted of the floor manager and clinical nurse leader (CNL) student. The project …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

Current Evidence For Pediatric Triage Pain Protocols In The Emergency Department, Alvin R. Walters

DNP Qualifying Manuscripts

Only 50% of pediatric patients presenting with significant pain receive any form of analgesia while in the emergency department (ED). The American College of Emergency Physicians endorses the use of triage protocols to improve the speed and consistency of analgesia in the ED. However, given the unique needs of the pediatric population insufficient evidence exists, if any, to support the use of triage protocols for their treatment in the ED. After a review of the literature it is concluded that triage pain protocols are a safe and effective method for providing pediatric analgesia in the ED. However, the variability in …

Sepsis, John Bell

Nursing Student Class Projects (Formerly MSN)

The pathophysiology of sepsis is related to the patient’s immune response. It involves an imbalance between pro-inflammatory and antiinflammatory responses, causing damage by a variety of mechanisms (Keegan & Wira, 2014).

Emergency Nurses’ Department Design Recommendations For Improved End-Of-Life Care, Renea L. Beckstrand, Elise M. Corbett, Janelle L. B. Macintosh, Karlen E. (Beth) Luthy, Ryan J. Rasmussen

Faculty Publications

Introduction: Although death is common in emergency departments, there is limited research regarding ED design as an obstacle to end-of-life care. This study identifies emergency nurses’ recommendations regarding ways designs have negative or positive impact on care for dying patients and their families.

Methods: A 25-item questionnaire was sent to a national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in emergency departments, and had cared for at least 1 patient at the end of life (EOL). Responses were individually reviewed and coded.

Results: Major obstacles included (1) issues related to limited space, …

Assessment Of Nursing Knowledge Before And After Implementation Of Educational Intervention On Heart Failure, Sarah Scott

Dissertations

Purpose: The purpose of this study was to assess the knowledge of nursing staff on a cardiology unit before and after the implementation of heart failure specific education. Methods: Forty staff nurses on a cardiology unit at a single institution were given The Nurses Knowledge of Heart Failure Education Principles Survey (NKHFEP), a validated tool to assess nursing knowledge of heart failure. A series of four educational sessions were given to the same forty nurses. They were then given the NKHFEP survey a second time to assess change in knowledge post educational intervention. Results: The mean of Pre-education (M = …

The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde

Dissertations

Purpose:To examine the association of kangaroo mother care (KMC) on energy utilization and bonding as evidenced by reduced biochemical markers of adenosine triphosphate (ATP) degradation, hypoxanthine (Hx), xanthine (Xa), and uric acid (UA), and (allantoin), a measure of oxidative stress in preterm infants 24-36 weeks gestation. A secondary objective was to compare specific physiological parameters using bedside monitoring and perfusion and oxygenation of the gut using near-infrared spectroscopy (NIRS) during 1 hour of KMC compared to incubator care.

Study design: A randomized controlled trial (RCT) examining the effects of 1-hour of KMC or 1-hour incubator care on urinary markers …

Hospital Acquired Pressure Injury Prevention On An Inpatient Unit, Cherilyn Schumacher

Master's Projects and Capstones

Abstract

The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the …

Oxygen Consumption In Sepsis, Julie Graham

Dissertations

Background: Sepsis is a life-threatening condition that can lead to septic shock and death. With over 300,000 annual cases (AHRQ, 2011) costing a staggering $1.5 billion (Health Care Utilization Project Brief #185), the importance of sepsis is becoming clear. However, some basic biological mechanisms are poorly understood. Study Purpose: This study investigated the relationships between select demographics, resting energy expenditure (REE), serum lactate, SOFA score mortality index, oxygen consumption [by way of measuring net oxygen consumed, (V02) and net carbon dioxide produced (VC02)], and sepsis. Specific Aims: Aims were to describe 1) patient demographics, serum lactate, SOFA score mortality index, …

Musculoskeletal Disorders In Healthcare Workers, Josephine Lauer

Master's Projects and Capstones

Musculoskeletal Disorders (MSD) are one of the leading causes of disability in hospital nurses and nursing aids and is a high cost problem in the healthcare industry. Working in a complex environment of an acute medical floor where repetitive nature of patient handling, can lead to musculoskeletal injuries for healthcare workers. This is evidenced by work-related injuries in hospitals nearly doubling compared to private industry and hospitals are one of the most hazardous work environments in the country. Musculoskeletal injuries of healthcare workers are an ongoing problem which requires investigation due to high risk of reoccurrence. This is especially true …

Increasing Early Mobility Of Patients In The Intensive Care Unit, Wendie Gilliam

Master's Projects and Capstones

Abstract

This project occurred in a 35-bed intensive care unit at a level II trauma center in central California. The purpose of this project was to strengthen the implementation of evidence-based initiatives promoted by the Society of Critical Care Medicine. The Society of Critical Care Medicine has a set of initiatives for the intensive care units nationwide to improve the outcomes for patients. One of the initiatives is the ICU Liberation, which includes six different bundles labeled: A, B, C, D, E, & F (Society of Critical Care Medicine ,2013). Their studies showed a significant improvement in the outcomes for …

Comparison Of Two Methods Of Pediatric Triage Education, Catherine Recznik

Electronic Theses and Dissertations

Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was …

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 …

Establishing A Hybrid Wound And Ostomy Continuing Education Program, Vivian K. Wong

Faculty Publications

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive.

The Impact Of Diabetes Mellitus On Burns And Standard Burn Treatments, Emma Shepard

Senior Honors Theses

Burns are complex injuries that trigger the stress response and result in increased blood glucose. Diabetes mellitus, an endocrine disorder with abnormal glucose regulation, can significantly alter the risk for burns and the treatment of burns. Pre-existing diabetes mellitus complicates burn treatments and healing ability. Diabetes mellitus may also develop directly from an unregulated stress response to the burn. The consideration of diabetes mellitus affects wound care, medications, and nutrition for burn patients. As patient advocates, nurses are responsible for caring for burn patients with awareness of endocrine complications. This paper provides a detailed overview of the pathophysiology, complications, and …

Nursing Compliance With Vap Bundle, Taylor Meadows

Scholars Week

It has been proposed that by initiating the highest percentages of nursing compliance, overall patient outcomes will improve along with a decrease in the number of ventilator-associated events (VAEs). The aim of the study is to appraise the association between nursing compliance with a ventilator bundle and a successful decline in the number of events of ventilator-associated pneumonia (VAP) in the intensive care unit (ICU). The study also provides evidence-based direction on the best nursing practices essential to reducing the rates of VAP. Objectives include expanding the awareness of critical care staff on prevention and compliance and to improve teamwork …

Transitioning Experienced General Care Float Pool Nurses To A Critical Care Float Pool, Troy T. Betts, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: A nationwide nursing shortage has resulted in a significant reduction in the number of qualified nurse applicants for critical care positions. Additional recruitment solutions for critical care staffing needed to be explored.

Purpose: The purpose of this project was to evaluate the effectiveness of an orientation program designed to transition experienced general care trained float pool nurses to a critical care float pool.

Methods: This descriptive study measured participants’ pre and post critical care orientation knowledge, and completion of core computerized competencies. Critical thinking questions, unit-based competencies, and measurement of participants’ individual perception of competence were also completed. Pre …

Impressions Of Participants In A Chemical Mass Casualty Exercise, Ethan J. Start, Joan M. Culley, Abbas Tavakoli

Senior Theses

A mass casualty exercise was performed to investigate triage and decontamination of patients exposed to an irritant gas. Nursing students participated in two groups: emergency department triage (ED) and decontamination (DECON). While participants felt overall that the experience was valuable, DECON participants had a greater interest in emergency response and were more likely to volunteer again.

A Pediatric Respiratory Care Curriculum For Emergency Department Nurses, Luzmaria Alcala-Van Houten

Doctoral Projects

As pediatric visits to community hospitals increase, the Institute of Medicine (IOM) and the Pediatric Emergency Care Network (PECARN) recommend that staff be provided improved education, protocols, and resources to improve patient outcomes (Emergency Medical Services for Children, n.d.). Acute respiratory disorders are the most commonly seen complaints in children aged 0–24 months, with an average of 2–4 visits a year. The purpose of this Doctor of Nursing Practice (DNP) project is to create a pediatric respiratory care curriculum for emergency department nurses in the Kaiser Permanente Central Valley Area (CVA) and to have it evaluated by a group of …

The Impact Of Advance Directives On The Intensity Of Care Received In The Acute Care Setting In Older Adults, Marsha Helen Tyacke

Dissertations (1934 -)

The proportion of older adults in the U.S. is rapidly increasing. One-third of Medicare expenditures occur in the final year of life, with nearly half resulting from acute exacerbations of chronic, progressive diseases(Riley & Lubitz, 2010). Older adults prefer comfort over life-sustaining care, and decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Advance directives (ADs) have been proposed as mechanisms to improve congruence between patient wishes and EOL care; however, the impact of ADs on care delivered in the acute care setting at the EOL for this population is unclear. A retrospective, correlation …