Nursing Commons^™

Can Standardizing Cabg Care With Clinical Pathways Reduce Length Of Stay And Hospital Acquired Infections?, Seana Friedman

Seton Hall University DNP Final Projects

Clinical pathways are a common component in the quest to improve the quality of health. Clinical pathways are used to reduce variation, improve quality of care and maximize the outcomes for specific groups of patients (Lawal, et al., 2016). The purpose of this project is to develop and initiate a Coronary Artery Bypass Grafting (CABG) clinical pathway to reduce variation in care as a way to improve quality of care and patient outcomes for CABG patients CABG surgery is considered a high risk, high cost, yet highly profitable surgery with considerable post-operative complications that affect numerous quality metrics including Length …

A Correlation Between Parental Visitation Neglect And Pediatric Intensive Care Unit Psychosis: An Integrative Literature Review, Alia Mohammad

Grace Peterson Nursing Research Colloquium

Abstract

Background: Pediatric intensive care unit psychosis is a serious disorder where patients experience anxiety, hallucinations, delirium, and other symptoms, setting them back in their recovery process during their hospital stay.

Purpose: This study is an integrative literature review aimed at the use of evidence based practices to establish the most effective solution in preventing ICU psychosis in pediatric patients, and discovering if parental presence is a factor to successful recovery.

Methods: WorldCat.org, MEDLINE, ABI/INFORM Complete, Academic Search Complete, OAlster, PsycARTICLES, ERIC, Business Source Complete, and Computers & Applied Sciences Complete were searched using the keywords pediatric, intensive care unit, …

Organizational Behaviour During Instability: A Critical Discourse Analysis Of Shared Mental Model Through Various Forms Of Acute Care Learning Using Mixed Methods, Adam Morse, Ryan Chan

Western Research Forum

Background: The purpose of this study is to better understand nurses' performance based on training processes. This will determine if group training will increase performance compared to independent training through a shared mental model in a contextual setting of unpredictability mediated by the effects of nurses’ perceptions of patient safety climate. A mixed methods study is conducted using critical discourse analysis of organizational documentation and semi-structured interviews to determine measures of contextual setting when identifying and treating sex trade workers.

Methods: Pragmatic study will analyze two groups of 125 nurses each determining the impact of group and individual …

What’S In A Name: Performance Improvement, Evidence-Based Practice, And Research?, Andrea Prentiss, Eve Butler

Nursing & Health Sciences Research Journal

No abstract provided.

The Impact Of Schizophrenia On Copd Readmission Rate Among Hospitalized South Carolinians, Emilienne Y. Watonsi

DNP Research Projects

Due to elevated readmission costs, the Affordable Care Act established the Hospital Readmission Reduction Program in 2012 to curb the 30-day readmission rates. COPD and schizophrenia are two very expensive diseases, COPD national medical costs is projected to be $49.0 billion in 2020; the cost of schizophrenia was 155.7 billion in 2013. The main objective of this study was to determine if schizophrenia is a significant predictor of 30-day readmission following hospitalization for acute exacerbation of COPD after adjusting for age, gender, anxiety, smoking status, T2DM, chronic ischemic heart disease, and GERD. Methods: A retrospective cohort design was used to …

The Effect Of Individualized Nurse Report Cards And Unit Case Reports On The Awareness And Attitudes Of Nurses Towards Clabsi Contributing Factors, Shannon K. Hawkins

Nursing Theses and Capstone Projects

This DNP project examined the effect of unit case reports and individualized nurse report cards on nurses’ awareness of and attitudes toward central line-associated bloodstream infection (CLABSI) contributing factors. This project also sought to determine whether CLABSI incidences differed across units and if that was affected by nurses’ awareness of and attitudes toward CLABSI contributing factors. A convenience sample of registered nurses (RNs) across four medical units was included in this project. Of the 79 RNs who participated in providing feedback on this project, 48 RNs completed pre-implementation surveys, resulting in a response rate of 61%, and 53 completed post-implementation …

Outcomes Of Family Presence During Resuscitation (Fpdr) In The Acute Care Setting: A Review Of The Literature, Audra M. Corn

Honors Undergraduate Theses

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the …

Prone Positioning In Acute Respiratory Distress Syndrome Patients, Sarah Rose H. Thornton

Honors Undergraduate Theses

Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient’s oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients.

Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms …

Critical Care Nurses’ Qualitative Reports Of Experiences With Family Behaviors As Obstacles In End-Of-Life Care, Renea L. Beckstrand, Caitlin Mallory, Janelle L. B. Macintosh, Karlen E. Luthy

Faculty Publications

Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs …

Evaluation Of Self-Efficacy And Confidence Levels Among Newly Graduated Nurses Exposed To An End-Of-Life Simulation: A Comparison Study, Catherine Edwards

DNP Projects

Purpose: The purpose of this project is to compare self-efficacy and confidence levels among a cohort of newly graduated nurses (defined as nurses who have had no nursing experience and are participating in a new graduate nursing residency) who will participate in an EOL simulation with another cohort of nurses who have been practicing for a year or more, but have not participated in an end-of-life simulation.

Methods: The study included two parts. The first portion included a pre and post-test evaluation of an end-of-life (EOL) simulation intervention with newly graduated nurses (Group One, n= 22), as part of their …

Preventing Emergency Department Overutilization For Florida’S Seasonal Resident Population, Amanda Garcia

DNP Scholarly Projects

Background/Local Problem: Seasonal migration of elderly patients to Lee County, Florida result in overcrowding and prolonged wait times in emergency departments. Many of these seasonal residents dissociate the management of their chronic health conditions with a local provider, therefore utilizing the emergency department for non-urgent needs. Purpose: The Seasonal Resident Navigator Program was intended to enhance the coordination of primary care services for elderly seasonal residents by establishing appointments with local primary care providers (PCP) in order to reduce the overutilization of emergency services and improve patient throughput. Methods: A residency and provider assessment tool was incorporated into the Healthpark …

Social Support, Relationship Quality, And Self-Care Behaviors In Patients With Heart Failure, Majdi Mohammad Rababa

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine the associations among social support, gender, relationship quality, and self-care behaviors in patients with heart failure (HF). Specific aims were to: 1) compare the psychometric properties of the 12-item and the 9-item European Heart Failure Self-Care Behavior Scale (EHFScBS) when used to measure self-care behaviors in patients with HF in the United States; 2) determine whether gender moderated the association between perceived social support and daily sodium intake in patients with HF; and 3) determine whether a patient’s gender and relationship with the primary family caregiver (spousal or non-spousal) moderated the association …

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Peer Accountability Improves Performance For Daily Chg Bathing To Reduce Clabsis, Sara Crawford, Stacy Pennington, Jeremy Affolter, Kathlyn Baharaeen, Paul N. Bauer, Tara Benton, Shekinah Hensley, Tiffany Mullen, Michelle Waddell

Posters

No abstract provided.

The Lifecycle Of A K-Card: Improving Data Collection While Improving Bundle Reliability, Tara Benton, Barb Haney, Lacey Bergerhofer, Susan Burns, Yolanda Ballam, Kaitlyn Hoch

Posters

No abstract provided.

Evaluation Of A Critical-Care Pain Observation Tool Quality Initiative, Caissy A. Goe

DNP Projects

Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes.

Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management.

Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, …

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

Implementation Of The Stop Bang Screening Instrument For Obstructive Sleep Apnea Within The Intensive Care Unit And 5 East Cardiac Unit, Michael T. Lush

DNP Projects

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% …

Assessment Of Alcohol Withdrawal Syndrome Incidence And Identification Of Other Correlating Risk Factors In Patients Admitted Through The Emergency Department, Hannah Young

DNP Projects

PURPOSE: The purpose of this project was to measure adherence rates to the current alcohol use screening process, and identification of correlations of alcohol use and outcomes in patients admitted to Norton Hospital, via the emergency department.

METHODS: The study design is a retrospective descriptive evaluation, of adherence to the current alcohol use screening process, and associations among age, gender, ethnicity, length of stay, number of ICU days, restraint use days, level of care at admission (ICU, TCU, LLM/tele, MS), incidence of AWS/DTs, and activation of the CIWA protocol among the adult inpatient population of Norton Hospital’s downtown campus, admitted …

Intensive Care Admissions: Predicting Palliative Care Needs In The First 24 Hours, Ashton R. Miller

DNP Projects

PURPOSE: The purpose of this retrospective analysis was to determine the proportion of intensive care admissions that required palliative care services during the same admission assessed by an investigator-developed palliative care screening tool. This study also analyzed the screening tool for the number of criteria producing the highest sensitivity and specificity for a palliative care consult occurring during the same hospital stay.

METHODS: Retrospective data collection and analysis were performed by randomly selecting 110 patients records from a report obtained through the electronic health record, Epic. The sample was drawn from patients admitted to a medicine intensive care unit (2A) …

Evaluation Of A Staff Resilience Program In A Pediatric Intensive Care Unit, Stacy Flanders

DNP Projects

Background: Compassion fatigue (CF) and secondary traumatic stress (STS) is prevalent in intensive care nurses, especially in pediatric intensive care nurses (PICU). CF/STS leads to burnout, reduced employee engagement, and nursing turnover.

Purpose: The purpose of this project was to evaluate the impact of a staff resilience program on nursing turnover, employee engagement and improved compassion satisfaction/ resilience among nurses in a PICU.

Methods: A retrospective pre-test and post-test design was used to evaluate the impact on turnover and engagement after implementation of the staff resilience program. Comparison of RN turnover and engagement results pre-implementation were compared to RN turnover …

The Effect Of An American Heart Association Telephone Follow-Up Intervention On Knowledge And Self-Efficacy In Rural Heart Failure Patients, Haley Fuller

DNP Projects

Background: An increased national and local prevalence of heart failure fostered a review of the evidence to identify best practice interventions focusing on improving self-care and knowledge. Heart failure remains a leading cause of 30-day readmission in the United States and in Madisonville, Kentucky, the site of study. A review of the literature emphasized improving transitions from hospital to home with a multi-dimensional approach. Self-care and knowledge were identified as major determinants to adequately prepare a patient to manage this chronic disease. A pre- and post quasi experimental study was performed at a rural hospital in Kentucky. Objective: The goal …

Identifying Nurse’S Perspectives And Practices About Clinical Monitor Alarm Burden And Alarm Fatigue., Doreen M. Legere

DNP Projects

PURPOSE: To obtain insight into the nursing culture of the University of Kentucky Medical Center (UKMC) regarding alarm fatigue, measure nuisance alarm events, and identify the practices nurses at UKMC engage in to manage alarm pollution and mitigate alarm burden. Moreover, this practice improvement project identified how innovations like the introduction of a monitor watcher has impacted the rates of nuisance alarms and influenced nursing culture.

METHODS: A online survey based on the 2011 Healthcare Technology Foundation Alarms Survey (HTF) was sent to nurses in two intensive care units at UK Healthcare (UKHC). The results of the 2017 UKHC Alarm …

Evaluation Of Risk Factors And Postoperative Outcomes In Surgical Laryngectomies With Intraoperative Hypothermia, Kristen V. Carter

DNP Projects

PURPOSE: The purpose of this study is to determine whether intraoperative hypothermia exposure would be identified as an independent risk factor for surgical laryngectomy patients’ rate of postoperative complications within their surgical admission. The findings would help to justify the institution of “pre-warming” laryngectomy patients to prevent detrimental effects postoperatively.

METHODS: Retrospective chart review of 245 patients who had laryngectomies at the University of Kentucky from 2010-2017. Rate of complication and variables predictability of postoperative complications was evaluated.

RESULTS: In the sample, 157 patients developed complications. Complications included 35 transpharyngeal fistulas, 29 free flap failures, 43 hematomas, 50 wound infections/ …

Impact Of A Nurse-Physician Communication Intervention On Psychological Empowerment And Effectiveness Of Collaboration Between Medical Staff And Critical Care Nurses, Kristen Wieder

DNP Projects

Background: Nurse-physician communication is an essential element of safe, effective patient care, nurse engagement and job satisfaction. Communication breakdowns can lead to poor patient outcomes and disengagement among nurses.

Purpose: The purpose of this project was to determine the impact of a nurse-physician communication intervention on psychological empowerment of critical care nurses. A second purpose of the study was to evaluate the effectiveness of communication between critical care nurses and members or the cardiothoracic surgery team and understand barriers and communication challenges.

Methods: A quasi-experimental pre-test/post-test design was utilized to evaluate the impact of a nurse-physician communication intervention …

Does A Nonstandardized Lactulose Administration Practice Affect Hepatic Encephalopathy In Patients With Liver Disease In The Acute Care Setting?, Mary Broadbent

DNP Projects

PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease …

Appreciating The Golden Hour: A Comparative Interdisciplinary Study, Taylor Tachon

Honors Undergraduate Theses

Within the health care, many medical professionals know about the critical time restraints for provisions of care within their discipline, but do not know the term "The Golden Hour". The Golden Hour is a term indicating the universal time restraint found within every area of health care and more specifically, every area of nursing. The term and concept represented by it should be recognized to better the outcomes of our patients. Although the Golden Hour typically indicates a 60-minute period of time, various settings recognize shorter and longer periods during which specific actions must be taken to assure positive patient …

Influence Of Muscle Strength On Mobility In Critically Ill Adult Patients On Mechanical Ventilation, Audrey R. Roberson

Theses and Dissertations

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …