Nursing Commons^™

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus …

Incidence Of Student Registered Nurse Anesthetists In The United States Who Own And Use Smartphone As Supplemental Learning Tools, Ruoyu Zhao

Doctoral Projects

Background: Smartphones have a great potential for students to learn more efficiently. Students now have the ability to download applications with pertinent information in the palm of their hand for both educational and clinical duties. This descriptive correlational quantitative research examines whether student registered nurse anesthetists own and use smartphones as supplementary learning tools.

Methods: An online survey was sent through AANA to Masters and DNP student registered nurse anesthetists (SRNAs) in the United States. Respondents were asked if they owned smartphones and how often they used smartphones for educational and clinical duties. Data Analysis was conducted using a Chi-square …

Parturient Safety: Proper Positioning Education Prior To Neuraxial Anesthesia, Christina Joy Young

Doctoral Projects

In the United States, 61% of parturient patients elect neuraxial anesthesia for labor pain (Koyyalamudi et al., 2016). The incidence of postdural puncture headache is estimated up to 81% following accidental dural puncture-especially in pregnant women receiving elective epidurals (Ragab & Facharzt, 2014). Although the combined rates of complications for spinal and epidural anesthesia are low (2.78%) (American Society Anesthesiologists, 2014), patient safety is extremely important and should be addressed by the overall healthcare system. The purpose of this project assessed a willingness to change which focused on the CRNAs incorporation of proper positioning education prior to neuraxial anesthesia into …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Electronic Communication Among Anesthesia Providers, Joseph K. Wells

Doctoral Projects

Facilities in the United States are utilizing electronic communication devices (ECDs) for their nursing staff on intensive care units, general medical-surgical floors, and chemotherapy floors, but it is underutilized in the operating room where seconds truly matter (Wu et al., 2012). Situations arise daily within operating rooms that require quick and decisive communication to avoid poor patient outcomes. The ultimate goal is to prevent poor patient outcomes by enhancing communication among anesthesia providers.

This doctoral project evaluated an anesthesia group in southeast Mississippi regarding their satisfaction with current devices used for communication. This anesthesia group utilized smart phones and public …

The Effects Of Tranexamic Acid On Mortality Rate In Trauma Patients Compared To Trauma Patients With No Tranexamic Acid Treatment, Bradley Earl Tolar

Doctoral Projects

Traumatic injury is the leading cause of death for many age groups. Traumatic accidents caused over 130,000 deaths in the United States in 2014. This DNP project studied the effects of Tranexamic acid on mortality rate in trauma patients. After the completion of a needs assessment at a local level II trauma center, a literature review was performed. The literature showed a decrease in mortality rate when patients were administered Tranexamic acid within 3 hours of injury with statistically significant statistics. Also, the data from the literature showed no correlation between vascular occlusive events and Tranexamic acid use in trauma …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo

Doctoral Projects

Laparoscopic capability provides numerous benefits to patients requiring abdominal surgical procedures. However, the use of these techniques has presented the anesthesia provider with a unique set of challenges in terms of perioperative management and postoperative pain reduction. No standardized method has existed to reduce postoperative pain and improve recovery following these procedures. There were three primary goals of this project. The first goal was to conduct a meta-analysis of randomized controlled trials to determine the benefit of the use of intravenous lidocaine infusions to reduce postoperative pain in laparoscopic abdominal surgery. Twelve articles were included in the meta-analysis that pertained …

Utilizing Culturally Congruent Educational Interventions To Improve Native American Diabetic Outcomes, Laurie Ann Hamilton

Doctoral Projects

Native Americans suffer from diabetes type II at a proportionately higher rate than other populations. Management of diabetes in this population is problematic and compounded by multiple influences such as socioeconomic, cultural and linguistic variables. The purpose of this DNP project was to investigate cultural influences on Native American diabetic outcomes.

Do cultural influences act as barriers to diabetic medication, diet and education understanding? Would a Native American nurse applied education on medication, diet and exercise improve diabetic outcomes in a 3 month period?

A convenience sample of 6 Native American participants obtained at a primary care clinic were given …

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 …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Efficacy Of Intravenous Ondansetron In Relieving Nausea/Vomiting And Pruritus Post Epidural Administered Opioids In The Obstetric Patient, Benjamin Stephen Butler

Doctoral Projects

One prominent side effect in the use of a neuraxial anesthesia is pruritus, with an incidence in the obstetric patient of 60-100% (Kumar & Singh, 2013). Another side effect of an epidural placement is nausea and vomiting. Nausea and vomiting occurs frequently during the progress of labor and is difficult to determine an incidence that is related to epidural opioid administration (Chestnut, Wong, Tsen, Ngan Kee, Beilin, & Mhyre, 2014). A review of literature was performed and established evidence that ondansetron is effective in reducing incidence of pruritus in intrathecal administered opioids for cesarean sections in the obstetric patient. No …

The Use Of Simulation To Decrease Stress In First Year Student Registered Nurse Anesthetists, Jared Scott Seymour

Doctoral Projects

Each year, critical care nurses across the nation make the decision to become anesthesia providers. In order to become a certified anesthesia provider, nurses must meet the high standards required to be considered for entrance into anesthesia school. Once accepted, these students, known as Student Registered Nurse Anesthetists (SRNAs), must successfully complete a rigorous curriculum consisting of both didactic and clinical training. Due in part to the high degree of difficulty of anesthesia programs, SRNAs are at risk for experiencing high levels of stress. Chipas and McKenna (2011) shows SRNAs experience a self-reported average daily stress level of 7.2 on …

Regional Anesthesia Introduced Into An Emergency/Trauma, Jennifer Bryant Covalt

Doctoral Projects

Emergency rooms across the United States have an incredibly large number of shoulder dislocations that need to be manipulated and reset on a daily basis. A cost-benefit analysis in this Doctor of Nursing Practice Project will demonstrate a new form of care for shoulder dislocations in the emergency room with certified registered nurse anesthetists (CRNA) providing regional anesthesia with local lidocaine injections into the shoulder joint. A level II trauma center in Mississippi with many shoulder dislocations was the location that was used to evaluate conscious sedation, length of procedure, and pain scores. A retrospective chart review was performed at …

A Comparison Of The Features And Functions Available In Electronic Health Records, Kathryn Marie Tetreault

Doctoral Projects

The Institute of Medicine (IOM) (2007) estimates that medical errors transpire at a rate of 1.5 million per year. The IOM (2000), approximates 7,000 deaths per year are related to preventable medication errors, which are the leading cause of medical errors. Adverse drug events (ADE) occur due to medication errors, which are 100% preventable. Annually, approximately $21 billion dollars are spent to care for patients’ who experience ADE due to medication errors (IOM, 2007).

This doctoral project evaluates the current features and available functions for pediatric medication administration within the electronic health record (EHR). This comparison explored the EHR functionalities …

Fentanyl Administration On Emergence From Surgery And Post Anesthesia Care Unit Discharge Times And Pain Scores, Andrew Ernst Wetzel

Doctoral Projects

Problem: Pain has been historically mismanaged potentially leading to a host of negative physiological consequences. Today’s dynamic health care reform offers an opportunity to increase satisfaction with care. Utilizing the PICO question, in adults undergoing laparoscopic cholecystectomy over a 12 month period, does medication with fentanyl during emergence versus not medicating during emergence reduce the need for pain medications and discharge times? Evidence/Background: Two national studies surveyed patient perception of pain management following surgery. The first, conducted by Apfelbaum et.al (2003) showed that 80% of patients experienced acute pain after surgery with 86% rating that pain as moderate …

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 …

Oral Carbohydrate Administration Prior To Colorectal Surgery: Practice Change Outcomes And Economic Analysis, Joshua Kendrick Ezelle

Doctoral Projects

Difference in recovery times has been an interest of mine for many years. I observed that an open heart surgery routinely recovered and discharged on the third post-op day, while a colorectal patient often required a hospital stay of five to ten days. I began researching recovery methods of colorectal patients. I found enhanced recovery techniques like decreased narcotic, use of NSAID’s, early ambulation, and the use of medications that assist with bowel peristalsis are being employed nationally. Other techniques are now starting to be used with positive results. One of these is Carb-loading. Carb-loading is the oral intake of …

Use Of A Handoff Communication Tool Between Certified Registered Nurse Anesthetists, Anesthesiologists, And Post Anesthesia Care Unit Nurses, Rachel Louise Johnson

Doctoral Projects

Ineffective communication in the post-anesthesia care unit (PACU) is considered to have incidences of increased error, mortality, morbidity, which leads to decrease patient outcomes and quality of care. Therefore, the purpose of this study was to introduce a structured, standardized, and consistent handoff tool to Certified Registered Nurse Anesthetists (CRNA), Anesthesiologists, and Post Anesthesia Care Unit Nurses (PACU) that may result in favorable perception of usage. Without a structured handoff tool, the organization risks the occurrence of increasing errors when the message is not transmitted effectively and efficiently every time. Distractions leave the handoff susceptible to a breakdown during the …

Identification Of Nonalcoholic Fatty Liver Disease In Patients With Hepatitis C: Using Evidence Based Guidelines To Improve Diagnosis And Transition Of Care From Specialty Care Provider To Primary Care Provider, Debra B. Bayus

Doctoral Projects

Chronic liver disease is a process that involves progressive destruction and regeneration of the liver causing fibrosis, cirrhosis and hepatocellular carcinoma, and early death. Persons with chronic liver disease treated for hepatitis C with abnormal radiological imaging consistent with increased fat content in the liver (hepatic steatosis) should be evaluated for nonalcoholic fatty liver disease (NAFLD). However, individuals treated at a community hepatitis C treatment clinic are currently not being evaluated for NAFLD. In addition, if NAFLD is diagnosed, management of these co-occurring conditions is required to delay disease progression. Factors contributing to gaps in NAFLD care include: poor communication, …

Implementing Spirometry-Driven Evidence-Based Asthma Care In A Primary Care Practice, Douglas C. Rau

Doctoral Projects

This project was a quality improvement initiative employing an educational intervention to increase the awareness and stress the importance of utilizing spirometry in the diagnosis, treatment, and management of asthma. Clinical support staff received training on how to perform spirometry and providers received education on the interpretation and utility of spirometry results to drive care to improve outcomes for clients with asthma. Project outcomes examined the self-rated confidence to perform and interpret spirometry before and after the intervention and the subsequent utilization pattern of office-based spirometry at the primary care clinic. For clinical support staff, the self-comfort level at performing …

Population Health Management Risk Assessment Tool Validation: Directing Resource Utilization, Sonya L. Christensen

Doctoral Projects

The Affordable Care Act (ACA) of 2010 is transforming health care across the nation into a value-based system that emphasizes quality and continuity with reimbursement tied to patient outcomes. The shift in emphasis is best realized through the strategy of Population Health Management, a change from traditional episodic treatment of illness to management of the health needs of populations throughout the continuum of health. The goal of care is to ensure that patients, especially the chronically ill, receive effective attention to their health needs in order to improve outcomes, decrease costs, and provide a positive patient experience. An important component …

Implementation Of A Smart Goal Intervention For Diabetic Patients: A Practice Change In Primary Care, Mackenzie Swanson

Doctoral Projects

Self-management techniques have been shown to be useful practice tools for providers managing patients with chronic disease. One valuable aspect of self-management is goal setting, whereby the patient is directed to create highly attainable personal goals to modify a selected behavior. Through the attainment of these goals, the patient begins to experience confidence and improved self-efficacy in managing chronic diseases such as diabetes. This paper provides background on the use of SMART goals for diabetic patients, how this practice change supports Meaningful Use objectives and helps meet the requirements for future reimbursement opportunities. A thorough organizational assessment of a Midwest …

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 …

Health Literacy Assessment And The Meaningful Use Incentive Of Providing Clinical Summaries In An Underserved, Hypertensive Population, Tami Pettenger

Doctoral Projects

Hypertension is a common diagnosis in the United States and can lead to health complications if not well managed. However, this condition often has few to no symptoms which may lead patients to modify, disregard, or otherwise be non-adherent to treatment plans. Also a patient’s health literacy level may directly affect his or her ability to understand and act on health information. This may be especially true in vulnerable populations such as older adults and underserved communities. In addition, the education material provided to patients, such as clinical summaries following a health visit, may not be consistent or understandable or …

Quality Improvement Initiative In Transplant Diabetes Care: Needs Assessment And Protocol Development, Dawn Korson

Doctoral Projects

Over 30,000 people receive a solid organ transplant each year, with 5-30% developing post-transplant diabetes mellitus (PTDM) (United Networking for Organ Sharing, 2015). At a Midwestern transplantation center, over 22% of patients with a history of diabetes were not consulted to endocrinology after kidney and liver transplantation. With poor glycemic control, there is an increased risk of developing PTDM leading to poor outcomes. Utilizing the Donabedian model and the Six Sigma’s Define, Measure, Analyze, Improve, and Control (DMAIC) as guides for implementation, the purpose of this project was to address the process measures of increasing appropriate consultations for evaluation and …

The Effect Of Music Intervention On Cam Scores Of Hospitalized Older Adults Experiencing Delirium, Mae Lavente Dizon

Doctoral Projects

Older adults are vulnerable to developing while hospitalized is delirium. Research has shown that non-pharmacological interventions are effective in managing delirium and should be the first-line of treatment; however despite this, nurses fmd it difficult to address delirium. The purpose of this research study is to examine the effectiveness of classical music intervention in hospitalized older adults experiencing delirium by evaluating their Confusion Assessment Method (CAM) scores. A pre-and-post study design to compare the CAM scores of patients before and after music intervention was implemented. Study participants were patients 65 years and older identified to be experiencing delirium by a …

A Comparison Of Educational Approaches To The End-Of-Life-Nursing Education Consortium (Elnec) Course, Jennifer L. Bodine

Doctoral Projects

Purpose: The purpose of this project was to compare the effectiveness of two different educational approaches to teaching the End of Life Nursing Education Consortium course.

Background: Terminally ill patients frequently visit the emergency department for palliative care. However, various references show that staff does not have the knowledge base necessary to provide quality end-of-life care in the emergency setting.

Method: Participants from the emergency department at a Level I Trauma Center were recruited. A quantitative, cross-sectional pilot study was conducted to investigate whether lecture or lecture with simulation was more effective in increasing the knowledge base of participants regarding …

Assessing Readiness For Interprofessional Learning About Sepsis Among Registered Nurses, Physicians, And Respiratory Therapists In A Community Hospital, Katie Choy

Doctoral Projects

Interprofessional teamwork and education have been advanced as methods to address the complexities of patient care (National Academy of Medicine [NAM], 2011-2013). One area needing further exploration is health care professionals' readiness to learn together in the acute care setting. The application of interprofessionalleaming (IPL) focused on sepsis education and improvement in sepsis outcomes in a community hospital has not been fully assessed. This descriptive, quantitative study explored interprofessional readiness to learn, perceptions of professional identity, and understanding of roles and responsibilities, by examining three subgroups. Registered nurses (n = 52), physicians (n = 29), and respiratory therapists (n = …

The Impact Of Intensive Case Management On Hospice Utilization, Debra Lowry Hummel

Doctoral Projects

Objective: The purpose of this study is to examine if patients enrolled in multi-disciplinary intensive case management program (ImPACT) alter the patient’s end-of-life path or setting of death.

Methods: The quality improvement project is a quantitative retrospective study that compared patients receiving standard primary care vs intensive case management (ImPACT) during 2/2013-1/2014. It is a secondary analysis of a larger study of a quality improvement evaluation that took place at the Veterans Administration facility in Palo Alto, Ca.

Results: Among the 82 patients who died, 19 were enrolled in ImPACT for approximately 249 days compared to 63 who received standard …