Nursing Commons^™

Fall Prevention Through Proactive Toileting, Kristin Smith

Master's Projects and Capstones

This paper will summarize the quality improvement falls prevention project conducted by a University of San Francisco Clinical Nurse Leader student. Falls in the hospital setting are an ongoing problem in our healthcare system as they have great physical and financial impacts (Salamon, Victory, & Bobay, 2012). Hospital A, an urban teaching hospital, uses the Schmid scale for determining if a patient is a fall risk which includes the assessment of need for ambulatory aids, history of falls, and impaired cognition among other criteria (Schmid,1990). Fall rates are climbing in the United States and the trend is similar on Hospital …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

With no designated cardiovascular step-down unit at Phoenix Children’s Hospital, patient transitions to acute care are inconsistent following admission to the Cardiovascular Intensive Care Unit (CVICU). We aim to improve CVICU patient continuum of care through transferring patients to a step-down telemetry unit starting October 13^th, 2014 exemplified by a 95% patient satisfaction of care provided by January 1^st, 2015. The progression of the project was influenced by Lippitt’s theory, which includes seven phases in the change process. To accommodate post CVICU patients, the acute care unit was transformed to include cardiac monitors, telepacks, a central …

Improving Patient Outcomes Through Use Of The Teach-Back Method In The Post Anesthesia Care Unit, Kathleen Osullivan

Master's Projects and Capstones

The setting for this Clinical Nurse Leader (CNL) project was the Post Anesthesia Care Unit (PACU) at a level I trauma center in the Bay Area. The goal was to improve the discharge education performed by the PACU nurses to improve patient safety and decrease the chance of complications or readmissions to this hospital. With no clear instructions for how discharge teaching should be done, the nurses have many differing styles which leaves room for gaps in discharge planning. This influenced the implementation of the teach-back method during discharge planning in order to ensure proper education and increased patient understanding. …

Patient Satisfaction Related To Noise In The Coronary Care Unit, Anjanette S. Dominguez

Master's Projects and Capstones

Background The CCU staff recognized a department trend for low patient-satisfaction score related to environmental noise levels. Based on the Press Ganey score, the patient-satisfaction score plummeted in relation to noise level beginning in March 2014.

Purpose To improve patient satisfaction regarding noise level in the CCU to 100% by November 21, 2014.

Methods Senior & Fleming’s Hard System Model of Change guided this literature search of CINAHL and Fusion for articles published from 2009 to 2014. Specific terms used were noise, critical care, and sleep promotion. From September to November 2014, earplugs were offered to all alert/oriented patients entering …

The Significance Of Timing Of Patient Daily Weights And The Barriers, Ann Pan

Master's Projects and Capstones

Background. Current unit practice is that patient daily weights are obtained in the afternoon or evenings. However, patient weights in the afternoon and evenings are not accurate dry weights. According to evidenced based research, to obtain an accurate patient daily weight, patients should be weighed every morning, after their first void and before they eat breakfast.

Purpose. The focus of the study was to compare the current practices of obtaining daily weights in the afternoon and evenings, compared to the evidenced based practice recommended in the literature.

Method. Through interviews and surveys with staff, the barriers to obtaining patient weights …

Emergency Preparedness On An Inpatient Hospital Unit, Hailee Marie Barnes

Master's Projects and Capstones

This paper will discuss the implementation of an emergency preparedness quality improvement project conducted by a University of San Francisco Clinical Nurse Leader (CNL) student on an inpatient cardiac unit, Unit H, at an urban teaching hospital in Northern California, Hospital B. An assessment of the current state of emergency preparedness, a diagnosis of Unit H’s area of greatest needs, the details of planning and implementing the quality improvement as well as the final evaluation will be discussed. The nursing process will be used for the structure of this paper as it was used as the structure of this project. …

Patient Characteristics Associated With False Arrhythmia Alarms In Intensive Care [Abstract 19717], Patricia Harris, Jessica K. Zègre-Hemsey, Tina Mammone, Daniel Schindler, Xiao Hu, Yong Bai, Steven M. Paul, Barbara J. Drew

Patricia Harris

Needs Of Patient’S Families In The Hospital Tele-Intensive Care Unit, Mary L. Jahrsdoerfer

Doctoral Dissertations

Purpose: To explore, identify and describe the perceptions of family members of a patient admitted to a telemedicine intensive care unit (tele-ICU); and to determine if these needs differ from those established by the Critical Care Family Needs Inventory (CCFNI) in the traditional ICU setting. Background: The tele-ICU is a new care modality in which offsite nurses provide consultation to bedside clinical staff at geographically-dispersed ICUs. The last decade demonstrates a growing existence of tele-ICU’s in our healthcare culture. ’Information’, ‘close proximity’, ‘assurance’, ‘support’ and ‘comfort’ have been identified as the top five needs of family members in the traditional …

Hearing The Child's Voice: Their Lived Experience In The Pediatric Intensive Care Unit, Andrea S. Prentiss

FIU Electronic Theses and Dissertations

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce.

Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. …

Effect Of Incentive Spirometry On Preventing Atelectasis: A Review Of The Literature, Caitlin Powers, Caine Teal

Nursing Student Work

No abstract provided.

Respecting Our Elders: Say No To Restraints!, Charity G. Schenk, Stephanie J. Williams

Nursing Student Work

No abstract provided.

When Should Nurses Use Restraints Versus Alternatives To Restraints?, Rosa Garza Moore, Motunrayo Ogunkua

Nursing Student Work

No abstract provided.

Flushing Out The Competition: Normal Saline Vs Heparin Flushes In Peripheral Iv Catheters, Sarah Albrecht, Sarah Williams

Nursing Student Work

No abstract provided.

Effect Of Silver-Alloy Urinary Catheters In Reducing The Rate Of Cauti’S In Patients Requiring Short-Term Catheterization: A Review Of The Literature, Courtney Mckee, Devon Williams

Nursing Student Work

No abstract provided.

False Ventricular Tachycardia Alarm Suppression In The Icu Based On The Discrete Wavelet Transform In The Ecg Signal, Rebeca Salas-Boni, Yong Bai, Patricia Harris, Barbara J. Drew, Xiao Hu

Patricia Harris

Insights Into The Problem Of Alarm Fatigue With Physiologic Monitor Devices: A Comprehensive Observational Study Of Consecutive Intensive Care Unit Patients, Barbara J. Drew, Patricia Harris, Jessica K. Zègre-Hemsey, Tina Mammone, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, Xiao Hu

Collected Faculty and Staff Scholarship

Purpose: Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing ‘‘alarm fatigue’’ which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.

Results: A total of 2,558,760 unique alarms occurred in the …

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Palliative Care's Sacramental And Liturgical Foundations: Healthcare Formed By Faith, Hope, And Love, Darren M. Henson

Dissertations (1934 -)

Medical history identifies Dame Cicely Saunders as the founder of modern hospice and palliative care for the unique care she gave to the incurably and terminally ill. Less known is how her Christian faith, combined with her knowledge of medicine, influenced her vision. This work retrieves the Christian roots of palliative care and asserts that the practice of faith preserves the practice of medicine from succumbing to medicalized dying--a phenomenon that excessively relies on technology with the implied hope that it will ultimately conquer illnesses and even death. Efficiency and effectiveness ground modern medicine's epistemology. These concepts follow the philosophical …

Heart Rate Variability Measured Early In Patients With Evolving Acute Coronary Syndrome And 1-Year Outcomes Of Rehospitalization And Mortality, Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Collected Faculty and Staff Scholarship

Objective: This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS).

Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established.

Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with �18 hours of sinus rhythm were selected for HRV analysis (number [N] �193). Time domain, frequency …

Family Presence During Resuscitation Of Adults: The Impact Of An Online Learning Module On Critical Care Nurses' Perception And Self-Confidence, Kelly Powers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family presence during resuscitation (FPDR) involves offering family members the option to remain with their loved one who is undergoing life-saving measures. FPDR has been shown to enhance comfort and facilitate grieving, and 90% to 100% of patients and family members support it as an option. However, critical care nurses are not fully supportive of FPDR and approximately only one-third implement it in their care of patients. The perceived risks of FPDR are cited as a primary reason for lack of support and implementation. Yet, the perceived risks have not been proven, while the benefits have been established in research. …

Heart Rate Variability Measurement And Clinical Depression In Acute Coronary Syndrome Patients: Narrative Review Of Recent Literature, Patricia R.E. Harris, Claire E. Sommargren, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Collected Faculty and Staff Scholarship

Aim: We aimed to explore links between heart rate variability (HRV) and clinical depression in patients with acute coronary syndrome (ACS), through a review of recent clinical research literature.

Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function.

Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search …

Lessons Learned In Caring For Patients Treated With Therapeutic Hypothermia, Catherine H. Swedberg Rn, Kelly A. Wolfenden Rn, Bsn, Cci, Jeffrey Martin Rn, Carolyn Ordway Msn, Rn, Crnp

Patient Care Services / Nursing

No abstract provided.

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Humor As A Buffer For Stress In Nurse Anesthesia Students, Kayla C. Forbis

Honors Theses

This simple, quantitative study was carried out on 18, first-year, CRNA students to determine if humor could act as a buffer for some of his or her perceived stress. Before an impending final exam, when stress levels would most likely be at their highest, the students were broken into three groups: a control group, a non-humorous group, and a humorous group. The students in the control group ranked their level of stress on a 0-10 scale without any other intervention. The other two groups watched a video clip, either humorous or non-humorous, while ranking their perceived stress on a scale …

The Effect Of Breathable Under Pads To Decrease Hospital Acquired Pressure Ulcers: A Nurse Resident Project, Sara Meshino, Bsn, Rn, Bridget Trefz, Bsn, Rn

Department of Nursing papers and presentations

PURPOSE

To reduce the rate of hospital acquired pressure ulcers (HAPU), in June 2013, a large urban academic medical center switched from non-breathable to breathable under pads for incontinent patients lying on either a standard bed (low risk patients) or low-air-loss mattress (high risk patients). Standard pressure ulcer prevention measures were maintained. Staff on two oncology units sought to determine the effectiveness of breathable vs. non-breathable under pads in reducing the rate of HAPU and UAPU.

Analysis Of Patient Alarms In Adult Intensive Care Units, Patricia Harris

Patricia Harris

Ready-Set-Go! A Clinical Practice Guideline That Promotes Safe Care Of The Sedated Patient Before, During And After Transport, Kimberly A. Martin Rn, Cnrn, Jennifer Houp Rn, Cnrn

Patient Care Services / Nursing

No abstract provided.

Mobilizing Mechanically Ventilated Neuroscience Patients - A Clinical Practice Guideline To ‘Get Up And Go’, Bonnie Wasilowsky Bspa-Hca, Rn, Cnrn

Patient Care Services / Nursing

No abstract provided.

The Effects Of Oral Pain Medication Being Administered In Phase I As Compared To Oral Pain Medications Administered In Phase Ii, Dana Jones

Nursing Theses and Capstone Projects

Healthcare and the provision of care are ever-changing as governing bodies over-see and regulate the way institutions provide care for patients. Pain assessment, reassessment, and pain management are a focus nationally and healthcare providers are held accountable for how pain is managed for patients. One piece to this broad topic is the use of oral pain medications, more specifically in the ambulatory surgical patient. The purpose of this project was to compare the length of stay, reported pain scores, and total amount of IV medications administered between patients who receive the first dose of oral pain medications in Phase I …