Nursing Commons^™

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Opioid Use In The Cesarean Section Patient With The Preoperative Administration Of Intravenous Acetaminophen, Dana Edwards Bernardo

Doctoral Projects

Cesarean sections are one of the most common surgical procedures and there are no current guidelines for the management of postoperative pain control (Darvish, Ardestani, Shali, & Tajik, 2013). Unresolved pain in this population can lead to long lasting problems, such as chronic pain and depression (Booth, Harris, Eisenach, & Pan, 2015). The goal of multimodal therapy with IV acetaminophen for CS mothers was to ensure a rapid and safe recovery process with reduced adverse complications and shortened hospital length of stay. The independent t-test was used to compare the mean time for length of stay, first request of pain …

Effects Of Electronic Health Record Use On The Ambulatory Surgical Services Nurse's Time, Heather D. Taylor

Master of Science in Nursing Final Projects

ABSTRACT

Purpose: The purpose of this study was to determine the length of time the ambulatory surgical services nurse spends on the EHR compared to performing hands-on patient care.

Design: The research design used in this study was a non-experimental descriptive design.

Methods: Twenty-two surgical services nurses at a small not-for-profit hospital located in the southeastern United States were invited to participate in the study. Out of the 16 ambulatory surgical services nurses that completed the study, one participant was omitted due to incompleteness resulting in a total of 15 time-studies that were used for the data analysis, resulting in …

Improving Compliance In The Use Of Catheter Kit Supplied Hand Sanitizer Prior To The Insertion Of An Indwelling Urinary Catheter, Antonette B. Prado

Master's Projects and Capstones

Abstract

More than half of the staff nurses (65% through direct observation and 60% through interview) in the operating room (OR) department do not perform hand hygiene prior to insertion of an indwelling urinary catheter. This performance improvement project aims to educate all OR staff nurses on the practice of hand hygiene prior to the insertion of an indwelling urinary catheter by using the hand sanitizer included in the sterile catheter insertion kit. Two forms of interventions were provided in order to promote this process change. The first one being an education session with a power point presentation and the …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …

Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga

Evidence-Based Practice Project Reports

Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU …

Knowledge, Perceptions, And Attitudes Of Certified Registered Nurse Anesthetists Regarding The Use Of Desflurane With A Laryngeal Mask Airway, Rachel Davidson

Doctoral Projects

Abstract

The purpose of this capstone project is to evaluate the knowledge, perceptions, and attitudes of currently practicing, nationally board certified, registered nurse anesthetists regarding the use of desflurane with laryngeal mask airways. This research was conducted by developing a questionnaire and administering it to current nurse anesthetists. A literature review was completed to establish a theoretical framework, summarize and describe the current state of science, and determine the nature and design of this study. Although there are studies regarding desflurane use during the maintenance of general anesthesia using a laryngeal mask airway, there is no current perception-based research regarding …

The Structure Of Multidisciplinary Rounds And The Effects On Patient Perceptions, Frank Alagna

Nursing Theses and Capstone Projects

Daily rounds is one strategy to improve communication between caregivers and engage patients and families in care decisions. The purpose of this study was to determine if the structure of multidisciplinary rounds affected the patient's perception of care. King's Theory of Goal Attainment guided this study related to the relationship of interaction and outcomes three medical surgical units were identified as using different structures for patient rounding: tabletop rounds, nurse-led rounds, and team-based rounds. Patient perceptions were collected from the Professional Research Consultants (PRC) database, a nationally recognized patient satisfaction survey. Over a six month period, survey data was analyzed …

Implementing Prophylactic Amiodarone In Heart Surgery To Reduce Post -Operative Atrial Fibrillation, John M. Russell Msn, Apn, Fnp-Bc, Denise Wilson Phd, Apn, Fnp, Cde

Theses and Dissertations

Purpose: The purpose of this project is to evaluate a practice change of implementing peri-operative amiodarone infusion for cardiac surgical patients at a large northern Illinois hospital to reduce the incidence of post-operative atrial fibrillation. Evidence supports use of prophylactic amiodarone as a strategy to reduce its incidence. The sequelae of untreated post-op atrial fibrillation include increased risk of embolic stroke, extended hospitalization, and increased healthcare costs.

Data Sources: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgical Database is a validated research tool used to collect comprehensive data on its member surgeons. A pre/post intervention case-controlled retrospective study design …

Obstructive Sleep Apnea: Emphasis On Discharge Education After Surgery, Arbert Almoite Nazareno, Cresilda Newsom, Esther Lee, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to evaluate the effectiveness of discharge education (DCE) on obstructive sleep apnea (OSA) for increasing continuous positive airway pressure (CPAP) compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Background & Evidence for Problem: In the United States, the prevalence of OSA in the adult population is approximately 20%. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. …

The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West

Master's Projects and Capstones

On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.

The current process was determined using a fishbone diagram, a SWOT analysis was …

Improving Patients' Pain Management Through Proper Documentation, Virzen Merina

Master's Projects and Capstones

The aim of this project was to improve pain documentation on the Surgical Unit as a means to enhance caregiver communication on finding the best methods to manage patients’ pain. Effectively managing patients’ pain leads to better patient outcomes, increased patient and nurse satisfaction, and decreased length of hospitalization. The setting is a not-for-profit hospital in Southern California. The microsystem selected is the 32-bed capacity Surgical Unit that mainly admits pre- and post-surgical patients, but also accommodates non-surgical, telemetry, and trauma cases.

To improve pain assessment documentation, collaboration was sought with the multidisciplinary team (IT department, clinical nurse specialists, and …

Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, Vicki F. Rocconi

Master's Projects and Capstones

Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines

Background

Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors.

Goals & Objectives

Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. …

Preventing Hapus In High-Risk Cardiac Cath Patients Using Foam Dressing Protocol, Charles Jasper

Master's Projects and Capstones

The purpose of this project is to implement an evidence-based change in practice resulting safer procedures as evidenced by zero hospital acquired pressure ulcers (HAPUs). It is relevant to nursing as it provides an ethical perspective regarding patient safety and contributes to our present understanding of HAPU prevention. In spite of having already decreased the total number of HAPUs by 50% in 2015, the cardiac catheterization lab (CCL) was implicated in 30% of those reported. My objective is to improve patient safety by reducing the number of HAPUs acquired in the CCL to 0% by three months using a prophylactic …

Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long

Evidence-Based Practice Project Reports

The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and PACU …

Preprocedure Warming To Prevent Intraoperative Hypothermia, Kathy C. Anders

Nursing Theses and Capstone Projects

Maintaining homeostasis during surgery is vital to preserving health and preventing postoperative complications. Research supports the benefits of preprocedure warming in preventing or reducing intraoperative hypothermia. Better postoperative outcomes are linked to intraop normothermia such as a reduction in the occurrence of surgical site wound infection, reduced bleeding, and faster recovery from anesthetics. However there were barriers to prewarming at the researcher’s institution such as cost, convenience, and compliance. The purpose of this research project was to study the impact of prewarming in the high risk population of surgical spine fusion patients. The researcher also hoped to examine and raise …

Barriers To Preoperative Teaching In A Culturally Diverse Healthcare Environment, Rancelle Ablan

Doctoral Projects

The role of the professional nurse is integral in educating and ensuring that patients understand essential components of their plan of care. This is especially true for patients who are to undergo surgical interventions; evidence has demonstrated that preoperative education provided to patients is linked with positive patient outcomes and a decrease in post-operative complications (Blackstone, Garrett, & Hasselkus, 2011). This qualitative study investigated the barriers that nurses experience in providing preoperative education to diverse patients in a multicultural healthcare environment. Ten registered nurses at a private community hospital in the San Francisco Bay Area participated in an hour long …

Preoperative Assessment Clinic Reduces Total Joint Arthroplasty Case Cancellations, Angelica Adriano

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to reduce the rate of elective total joint arthroplasty case cancellations by implementing a nurse practitioner-led Preoperative Assessment Clinic (POAC), in the orthopedic department of a major southern California Veterans Affairs (VA) hospital. Retrospective data collected in a 12-month time period showed a surgical cancellation rate of 22%. Reasons for delays or cancellations included: medical instability, abnormal labs and/or studies, patients requiring referral to specialists, dental clearance, patient-initiated cancellations, and active infections. The POAC reduced the rate of case cancellations at 1 year to 17% and at 2 years to 9%. Lost revenue …

Implementation Of An Educational Session To Improve Compliance Of Reporting Medication Errors And Near Misses Among Anesthesia Providers, Kacy C. Ballard 3679424

Doctor of Nursing Practice Scholarly Projects

There is currently no emphasis being placed on the significance of reporting medication errors, including near misses, for the anesthesia department in a Midwestern hospital system. Efforts to ensure patient safety depend upon collecting data related to actual medication errors, including near misses, so that educational or process improvement opportunities can be identified and implemented. The focus of this quality improvement project was to educate anesthesia providers about the importance of properly reporting all medication errors and near misses. The pre and post survey helped to provide data to determine whether anesthesia providers believe they are more apt to report …

Assessing Potential Relationship Between Medical/Surgical Nurse’S Certification Rate To Patient Outcome In A Newly Designated Magnet Hospital, Eva Mitra, Rosalina Butao, Julie Lamoureux

All Publications

No abstract provided.

Retention Of Cardiopulmonary Resuscitation Knowledge And Psychomotor Skill Among Undergraduate Nursing Students: An Integrative Review Of Literature, Fernanda Tirado

Honors Undergraduate Theses

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: …

Behavioral Interventions Versus Pharmaceutical Interventions To Reduce Preoperative Anxiety In School Aged Children, Jennifer J. Cline

Honors Undergraduate Theses

Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and …

Psychological Distress And Cardiac Disease, Tracey Vitori

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications …

Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale

DNP Projects

Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m²) seen by one surgical service over a two and …

Recognizing Pain Using Novel Simulation Technology, Justin C. Grace

Honors Undergraduate Theses

Effective pain management and time to treatment is essential in patient care. Despite scientific evidence supporting the need to treat pain and an emphasis on addressing pain as a priority, pain management continues to be an unresolved issue. As a member of the health care team, nurses are integral to optimal pain management. Currently, nursing schools have limited innovative or alternative methods for teaching pain assessment and management. Simulation in nursing education provides a unique opportunity to expose students to realistic patient situations and allow them to learn and make mistakes without causing harm. However, modern low- and high-fidelity simulation …

Preoperative Education: A Patient-Centered Care Approach, Gia L. Wendt

Master's Projects and Capstones

Abstract

This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education …

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Is Dexamethasone 4mg A More Effective Anti-Emetic Than Dexamethasone 8mg For The Prevention Of Early Post-Operative Nausea And Vomiting In Women Undergoing Laparoscopic Gynecological Surgery?, Steven B. Doyle

Doctoral Projects

Postoperative nausea and vomiting (PONV) is a common problem in the surgical setting. It affects as much as 20 to 80 percent of patients undergoing surgery (D'souza, Swami, & Bhagwat, 2011). PONV can lead to increased patient costs and recovery time by causing the patient to stay in the healthcare facility for a longer period of time. A retrospective cohort study was completed to examine whether or not there was a significant difference between patients who received 4mg and 8mg of dexamethasone in the incidence of PONV. All patients studied received ondansetron intraoperatively as their primary anti-emetic. English speaking patients …