Nursing Commons^™

Popliteal Blocks For The Treatment Of Distal Injuries In The Lower Extremity In The Emergency Department, Jacob Turner

Doctor of Nursing Practice Projects

Opioid addiction in the United States has increased, and interventions needs to be put into place to manage pain with fewer opioids. Alternatives like peripheral nerve blocks can be used to aid in pain management for acute injuries like ankle and wrist fractures. The purpose of this project is to develop and create a regional anesthesia protocol for acute upper and lower extremity fractures in the emergency department (ED) at Passavant Hospital in Jacksonville, Illinois, with the long-term goal of a reduction in opioid administration. An educational Power Point presentation was provided for the ED and the anesthesia personnel on …

Hand-Off Tool Implementation In Post-Anesthesia Care, Benjamin Nash

Doctor of Nursing Practice Projects

The issues surrounding the safety of patients and improving patient care outcomes in the pre-operative and post-operative environment, is one of ongoing focus and development. Post-operative, hand-off report is one aspect in the continuity of patient care that has affected patient outcomes. Clear, concise, and accurate communication concerning patients and their postoperative status is one way that providers and caregivers may ensure patient safety. There are many various organizations that emphasize the importance of clear, effective communication, in the form of a standardized hand-off tool to maximize patient safety. The purpose of the project was to standardize clear, concise, effective …

Implementing An Enhanced Recovery After Surgery Protocol In A Critical Access Hospital, Joseph Grazaitis

Doctor of Nursing Practice Projects

Enhanced recovery after surgery (ERAS) protocols provide numerous benefits for patients undergoing colorectal surgery. The goal of the protocol is to decrease surgical complications, patient’s length of hospital stay, recovery time, and increase patient satisfaction. The purpose of this doctoral project was to create and implement an ERAS protocol for a 25-bed critical access hospital. The findings obtained from the literature review were presented to the multi-disciplinary team. The specific needs of the surgical team were identified, and the ERAS protocol was created. Lastly, the ERAS protocol was finalized and implemented in the institution. The outcome measures examined were the …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Improving Allergy Immunotherapy Adherence, Amy Branham

Doctor of Nursing Practice Projects

Allergen Immunotherapy (AIT) is an effective treatment for allergic rhinitis. However, at a Midwest teaching clinic, patients tend to not complete the entire course of immunotherapy. AIT adherence is suboptimal due to a multitude of reasons. The purpose of this project is to increase adherence to AIT by implementing the following evidence based interventions; a text message reminder, a communication/education template, and through increasing clinic accessibility. Initial implementation involved working with clinic personnel to develop the content of the reminder texts and of additional educational materials. Subsequently, the changes were executed at the beginning of fall. Over the following three …

Adequate Pain Control With Ofirmev To Minimize Narcotics Consumption And Its Side Effects, Gideon Nkrumah

Doctor of Nursing Practice Projects

Typically, perioperative pain has been managed with opioids, however, the extreme use of opioids has been associated with respiratory depression, excessive sedation, drowsiness, nausea, vomiting, ileus, severe constipation, prolonged hospital stay, addiction, and dependence. The American Society of Anesthesiologists Task Force on Acute Pain Management recommends that patients should always receive non-opioid analgesics like Acetaminophen and NSAIDs as first-line agents so that opioids can be used as adjunctive agents to minimize opioid-related side effects, addiction, and dependence (The American Society of Anesthesiologists, 2011).

A protocol was developed to help providers use Ofirmev effectively and efficiently. The goals of this project …

Implementation Of Crisis Checklists In The Operating Room, Gregory S. Feilner

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Perceptions And Experiences Of Skilled Birth Attendants On Using A Newly Developed Strap-On Electronic Fetal Heart Rate Monitor In Tanzania, Sara Rivenes Lafontan, Hussein Kidanto, Hege L. Ersdal, Columba Mbekenga, Johanne Sundby

School of Nursing & Midwifery, East Africa

Background: Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania.

Methods: A qualitative design was used to collect …

Development Of A Guideline To Reduce Spinal Induced Hypotension And Related Nausea And Vomiting In Patients Undergoing Scheduled Cesarean Section, Peter Gillen

Doctor of Nursing Practice Projects

Cesarean sections performed under spinal anesthesia frequently involve spinal-induced hypotension and can result in intraoperative nausea and vomiting for the patient. This project involved the development of a guideline to combat this problem using lower sequential devices, co-loading of crystalloid fluids, and prophylactic administration of intravenous ondansetron. The guideline was presented to anesthesia providers at a tertiary care facility in Southwestern Illinois. Evaluation of the project included pre and post-tests as well as post-implementation surveys of the providers. The pre-test results indicated a need for further education among providers to address the problem. The post-test scores achieved the goal of …

Differences In Plasma Levels Of Long Chain And Very Long Chain Ceramides Between African Americans And Whites: An Observational Study, Joy N. Buie, Samar M. Hammad, Paul J. Nietert, Gayenell S. Magwood Phd, Rn, Faha, Faan, Robert J. Adams, Leonardo Bonilha, Catrina Sims-Robinson

Publications

BACKGROUND: Population-wide reductions in cardiovascular disease (CVD) have not been equally shared in the African American community due to a higher burden of CVD risk factors such as metabolic disorders and obesity. Differential concentrations of sphingolipids such as ceramide, sphingosine, and sphingosine 1-phosphate (S1P) has been associated with the development of CVD, metabolic disorders (MetD), and obesity. Whether African Americans have disparate expression levels of sphingolipids that explain higher burdens of CVD remains unknown. METHODS: A cross sectional analysis of plasma concentrations of ceramides, sphingosine, and S1P were measured from 8 whites and 7 African Americans without metabolic disorders and …

Emergency Nurse Perceptions Of Disaster Preparedness After The Implementation Of A Department Emergency Operations Plan, Angela R. Gentry

Theses and Dissertations from 2019

Emergency departments (ED) are the entryway into the healthcare system during a disaster event and patients often arrive in the first thirty minutes after an event has occurred. This creates unique challenges for ED nurses. The purpose of the Quality Improvement (QI) project was to measure the impact of a Department Emergency Operations Plan (DEOP) on the ED nurse’s perception of disaster preparedness. This study included a convenience sample of 126 full time and part time registered nurses working in the ED at a Level 1 Trauma hospital. Institutional Review Board (IRB) approval was obtained by both Arkansas Tech University …

The Impact Of Bedside Reporting On Patient Safety Events, Patient Satisfaction, And Nurse Accountability In A Pediatric Unit, Ginger Mcearl

Theses and Dissertations from 2019

One of the fundamental elements of nursing practice is the transfer of patient information from one provider to another known as a bedside report. However, an unstructured bedside report that occurs away from the bedside, places patient safety, quality of patient care, and patient satisfaction in jeopardy. The purpose of this quality improvement (QI) project is to determine if the implementation of bedside reporting in an acute care pediatric unit will: decrease preventable errors reported through an event reporting system known as Safety Tracker, increase patient satisfaction in provider communication, and improve nurse accountability. The study included a convenience sample …

Spiritual Care In Nursing Practice In Veteran Healthcare, Elizabeth Burkhart, Anna Bretschneider, Sharon Gerc, Mary E. Desmond

Nursing: School of Nursing Faculty Publications and Other Works

Spiritual care is important in nursing practice, and spiritual well-being and spiritual care are associated with better health. Military veterans, a unique patient population, want spiritual care to cope with chronic conditions. It is unclear whether spiritual care is provided in veteran health care in the United States. This study used a qualitative descriptive method, guided by the Spiritual Care in Nursing Practice (SCNiP) theory, to describe spiritual care in nursing practice and facilitators/barriers in veteran health care. Individual interviews were conducted with 39 registered nurses (RNs) at a U.S. veteran health system. Findings were consistent with the SCNiP theory …

Factors That Influence Transition To Advanced Roles By Rn To Bsn Nurses, In Three Selected Hospitals Of Central-Uganda, John Baptist Asiimwe, Mercy Muwema, Karen B. Drake

School of Nursing & Midwifery, East Africa

Background

Despite the global rise in the number of nurses upgrading from Registered Nursing (RN) to a Bachelor of Science in Nursing (BSN), studies have indicated that successful role transition is difficult once the nurses return to their previous workplaces. Guided by the Transitional Theory, this study investigates the factors that influence the transition from basic to advanced roles among RN to BSN nurses in Uganda, Africa.

Methods

This study employed a descriptive correlational design. Using convenience sampling, fifty-one (51) RN to BSN nurses completed the semi-structured questionnaires.

Results

All the study participants (100%) described themselves as having transitioned from …

Implementing Routine Hiv Testing And Prevention In A Primary Care Setting, Michelle Bassett

Doctor of Nursing Practice Projects

Evidenced-based research has identified that routine HIV testing and education is pivotal in identifying new infections, providing access to treatment, and decreasing the rates of transmission. In 2006, the CDC implemented new guidelines recommending that all persons aged 13-64 years be tested yearly for HIV regardless of risk factors. Despite these recommendations, the CDC estimated that less than 37% of people were tested in 2017 and in the years prior. In this project, a protocol for routine testing and education was developed and implemented in a private Southern Illinois primary care practice. Providers and staff were educated on HIV and …

A Qualitative Study Into The Communication Surrounding The Initiation And Withdrawal Of Non-Invasive Ventilation (Niv) In People With Motor Neurone Disease, Charlotte Chapman

Theses: Doctorates and Masters

Introduction

Motor neurone disease (MND) is a degenerative disease that adversely affects the nervous system and muscular control. Eventually respiratory muscles weaken, causing breathing, communication and swallowing difficulties, and ultimately, respiratory failure and death. Improved quality of life and potentially a short extension of life can be provided with non-invasive ventilation (NIV), which is offered to people with MND when symptoms of respiratory distress become evident.

It is recommended that end-of-life communication, encompassing the benefits and burdens of symptom-relieving interventions (NIV and percutaneous gastrostomy tube to assist with nutrition), NIV withdrawal (proposed when continued use is considered futile) and other …

Moral Distress In Critical Care And Emergency Department Nurses, Morgan Timberlake, Nicole Phillips

Senior Honors Projects, 2010-2019

Moral distress is a phenomenon that occurs when a person is unable to carry out what they believe is the ethically appropriate action due to various external constraints. This literature review seeks to explore the interventions that are most effective in reducing moral distress in critical care and emergency department nurses who have experienced moral distress in practice.

Exploring The Relationships Between Moral Distress, Moral Courage, And Moral Resilience In Undergraduate Nursing Students, Erin Gibson

Nursing Theses and Dissertations

The pervasiveness of moral distress in nursing can no longer be ignored. Moral distress can have devastating effects on a nurse and lead to burnout and/or cause the nurse to leave the profession. To mitigate these effects, strategies to decrease moral distress should be implemented as early as nursing school. Related concepts such as moral courage and moral resilience show favorable effects as strategies to combat moral distress. However, little evidence is known as to how these three moral concepts are related with one another.

Chapter 2, “Student Courage: An Essential for Today’s Health Education” provides a concept analysis of …

Improving Patient Education On Spinal Anesthesia: An Assessment Of A Patient Educational Program, Nicholas Raburn

Doctor of Nursing Practice Projects

Abstract

Spinal Anesthesia (SA) is a common type of anesthesia that is frequently used for surgeries of the lower abdomen, lower extremities, and perineal area. Spinal anesthesia offers fewer side effects and risks than General Anesthesia (GA). Patients usually recover their senses much faster with SA (MedlinePlus, 2017). Some patients often refuse SA due to fears and misconceptions. These misconceptions are related to a lack of education and resources available to patients. It is crucial that anesthesia providers learn to adequately educate patients preoperatively on the use of SA. Anesthesia providers in a community hospital in southern Illinois educated patients …

Recent Veterans’ Self-Management Of Health During Military To Civilian Life Transition: A Grounded Theory Study, Narda A. Ligotti

Theses & Dissertations

United States Veterans of combat within Iraq and/or Afghanistan return home to face an array of somatic and psychological health concerns. Little was known about how they manage their health after military discharge. The research question for this study was “how do OIF/OEF/OND combat Veterans and their primary support persons manage Veterans’ health at home?” There is little information about these Veterans’ perspective of self-management of health in the home. This study was designed to provide a theoretical understanding of self-management and family support in this population. The Family Management Style Framework (Knafl, Deatrick & Havill, 2012) was used as …

Examining Depressive Symptoms Over Time In Women With Coronary Heart Disease, Sydney A. Buckland

Theses & Dissertations

Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported.

Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores.

This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on …

Effect Of An Intervention To Improve Smoking Cessation Treatment In A Federally Qualified Healthcare Clinic, Shirley Camp

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Abstract

Significant progress has been made in the reduction of tobacco use in the United States, but the smoking prevalence among the socially and economically disadvantaged populations (i.e. individuals who are homeless, uninsured, LGBT, and living with HIV) is significantly higher than the general population (CDC, 2018b). As a result, these vulnerable populations carry a disproportionate burden of tobacco-related mortality and morbidity (CDC, 2018b). There is a cost-effective and evidence-based treatment for tobacco use dependence (Fiore et al, 2008), but the delivery by primary care providers to this population is inconsistent (Tyman, Bonevski, Paul, & Bryant, 2014). This study focused …

School Of Nursing News, Georgia Southern University

Nursing: News & Publications (2013-2023)

• 50 Savannah area high school students representing seven different schools in the Medical Explorers program were provided the opportunity to experience a day in the life of a nurse.

A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough

Evidence-Based Practice Project Reports

As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …

Enhancing Iana Member Communication & Engagement, Bart Bowers

Doctor of Nursing Practice Projects

The National Provider Identifier (NPI) Registry data identifies CRNAs as the sole providers of anesthesia for 29% of counties in the state of Illinois (“Illinois CRNA Map,” n.d.). These CRNAs, therefore, should play an important role in advocating for access to high quality care. While IANA is a vigorous advocate with regards to patient access to high quality, affordable health care (Bickel, 2017), the long-term patient advocacy capabilities of IANA are at risk due to a declining trend in membership numbers (Farina et al., 2016; Flores, 2014; “Keeping Pace,” n.d.; Yohn, 2016). Traditional forms of communication utilized by IANA, such …

Improving Perioperative Pain Management: Development Of An Adult Lidocaine Infusion Protocol, Kelsey Wallace

Doctor of Nursing Practice Projects

Abstract

Postoperative pain is a challenge in healthcare, with more than 50% of patients reporting inadequate pain control (Zengin, Saracoglu, Eti, Umuroglu, & Gogus, 2015). Inadequately controlled pain can negatively impact a patient’s quality of life, recovery, and cause postsurgical complications (Chou et al., 2016). Aims for acute pain management focus on reducing the incidence and severity of pain in order to improve patient function, minimize side effects, and prevent further complications (Gordon et al, 2016). Implementing a multimodal approach to pain control that includes a lidocaine bolus followed by continuous infusion has resulted in reduced opioid consumption, fewer adverse …

Update Of Blood Transfusion Protocols At A Regional Hospital In Rural Illinois, Kendra Tracy

Doctor of Nursing Practice Projects

The chief nursing officer (CNO) at a small regional hospital in rural Illinois requested an update to their blood transfusion policy and protocol based on current evidence-based information. These documents were updated with current information on safe assembly and delivery, identification of transfusion reactions, and appropriate responses to these reactions. In collaboration with the CNO and Quality Improvement Committee (QIC), drafts of a new policy and protocol and a Blood Transfusion Skills Checklist were developed. These documents were presented at a hospital-wide Skills Lab Day to registered nurses employed at the facility. A Likert Scale evaluation survey was presented to …

Treating Acute Bronchitis In Primary Care, Haylie Patterson, Stacy Wieland

Doctor of Nursing Practice Projects

There has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A …

Feasibility Of Electronic Stethoscope For En Route And Combat Casualty Care, Melissa A. Wilson, Brittany L. Fouts, Charles J. Harding, . Us Air Force School Of Aerospace Medicine, Aeromedical Research Department, Wright-Patterson Afb, Oh.

Nursing Faculty Publications

In the En Route and Combat Casualty Care environments, occupational stressors can complicate the ability to perform medical interventions which are often used in civilian ground healthcare facilities. Conventional stethoscopes are the primary diagnostic tool for patient assessment and triage, but during aeromedical transport, high noise limits the ability to auscultate patients to assess cardiovascular, respiratory, and gastrointestinal systems for clinically relevant abnormalities. The ability to accurately identify these abnormalities using an essential diagnostic tool and medically intervene when necessary may reduce the number of preventable deaths from the battlefield and ultimately, improve patient outcomes. To address this gap, this …