Nursing Commons^™

Family Members’ Experiences Of Post-Cardiac Surgery Delirium In The Intensive Care Unit: A Narrative Inquiry, Amber Coral Mclean

Theses: Doctorates and Masters

Aim: This study explores delirium in the intensive care unit (ICU) following cardiac surgery from the perspective of family members.

Background: Delirium is a common complication affecting 28-52% of people following cardiac surgery in the ICU, which can lead to distress for both the person and their family members. While research has been conducted on clinical outcomes of family involvement in delirium care, there is a lack of understanding of how delirium impacts the family members themselves. This study seeks to provide detailed narrative accounts of families’ experience of witnessing delirium in their loved one following cardiac surgery in the …

Implementation Of The Novel Nurse Intuition Patient Deterioration Scale To Assess For A Correlation Among Nurse Intuition And Patients Returning To The Intensive Care Unit, Janie L. Walsh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Adult hospitalized medical and surgical patients at an academic medical center are being transferred out of the Intensive Care Unit (ICU) to the step-down floor and having rapid response calls in less than 48 hours after the transfer. Nurse intuition is not a consideration in the decision to transfer a patient. Physiological variables such as Modified Early Warning Scores (MEWS) and vital signs are relied on heavily as indicators for escalation or de-escalation of care. There is evidence supporting the use of acknowledging nurse intuition to better predict a patient’s readiness for transitions of care.

Purpose: To evaluate the …

A Quality Improvement Project To Assess The Impact Of A Patient Acuity Tool On Nurse Satisfaction In Equitable Patient Assignments In Nurse Workload And Perceived Quality Care Provided, Claire Alexandra Rodgers

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Traditional nursing staffing models used to create patient-care assignments do not account for patient acuity. As patient acuity increases, nurse workload increases. When patient-care assignments do not account for acuity, nurses are unable to provide quality care to patients. Utilizing a patient acuity tool (PAT) has been shown to improve nurse satisfaction and equity in assignments while also enhancing the ability for nurses to provide quality care.

Purpose: The project aims to assess the impact of a PAT to improve nurse satisfaction in equitable patient assignments based on nurse workload and perception of quality of care provided to patients …

Implementation Of An Evidenced Based Enteral Nutrition Protocol For Mechanically Ventilated Patients: A Quality Improvement Initiative, Hannah R. Nuzum

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Implementation of an Evidenced Based Enteral Nutrition Protocol for Mechanically Ventilated Patients: A Quality Improvement Initiative.

Hannah Nuzum

Background: Mechanically ventilated patients require supplemental nutrition as an important factor for their overall recovery. Malnutrition in hospitalized patients is reported as high as 35% (Ikram et al., 2022).

Purpose: Lack of an enteral nutrition (EN) protocol has contributed to variability in initiation of EN for post-intubated mechanically ventilated patients.

Intervention: The project interventions are threefold: the development of an EN protocol, EN initiated within 24 to 28 hours for post-intubation patients, and staff understands that EN should be initiated within …

Implementing Noninvasive Capnography Monitoring To Enhance Early Recognition Of Postoperative Respiratory Decline In High-Risk Patients: A Quality Improvement Project, Trevor A. Messenger

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Implementing Noninvasive Capnography Monitoring to Enhance Early Recognition of Postoperative Respiratory Decline in High-Risk Patients: A Quality Improvement Initiative

Trevor Messenger

Background: Those suffering from chronic respiratory disease, obstructive sleep apnea (OSA), obesity, and other serious comorbidities are at an increased risk of respiratory decline after receiving general anesthesia. Respiratory decline leads to adverse outcomes, including increased hospital length of stay, intensive care unit (ICU) admissions, morbidity, and mortality.

Purpose: To improve the safety of postoperative patients at risk for OSA, and to reduce adverse events and airway interventions by enhancing the monitoring capabilities of bedside clinicians with waveform …

Keep It Quiet: A Quality Improvement Initiative To Reduce Noise In The Operating Room During Anesthesia Induction, Ghislaine Fasseu Kameni

Graduate Theses, Dissertations, and Problem Reports (ETD)

Problem: Excessive noise during the critical phase of anesthesia induction in operating rooms (OR) can significantly impact anesthesia providers' ability to focus, potentially compromising patient safety and quality of care.

Objectives: This project aimed to reduce anesthesia providers' perception of distraction caused by noise during induction by implementing educational interventions and visual cues. The objectives included educating anesthesia and surgical staff on the impact of noise, introducing visual reminders to minimize distractions, and evaluating the effectiveness of these strategies through survey data collection.

Methods: A quality improvement initiative was conducted in the OR department of a nearby hospital. Certified registered …

Does Education On Aseptic Non-Touch Technique Affect Nurse Knowledge On Aseptic Technique When Placing Ultrasound Guided Peripheral Intravenous Lines? A Quality Improvement Initiative, Hannah G. Keyser

Graduate Theses, Dissertations, and Problem Reports (ETD)

This Doctor of Nursing Practice (DNP) project attempted to increase nurse’s knowledge of aseptic technique when placing USG-PIVs in hospitalized adult patients after educational training on the Aseptic Non-Touch Technique Clinical Practice Framework (ANTT CPF). Implementation of the ANTT CPF in the cardiovascular intensive care unit (CVICU) at Ruby Memorial Hospital, as a didactic educational session for nurses already trained to place ultrasound-guided peripheral intravenous lines, was utilized for this DNP project. Pre- and post-surveys were employed to determine changes in knowledge scores as well as feelings of comfort and knowledge related to the CPF. Results remained stable for survey …

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative, Haley Lynne Johnson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative

Haley Lynne Johnson, BSN, RN

Background: Stroke and brain injuries remain among the leading causes of mortality in the United States, accounting for 162,890 deaths in 2021 (Centers for Disease Control and Prevention [CDC], 2021). Although frequent neurological assessments are essential for monitoring patient status, limited evidence supports the prolonged use of hourly neuro-checks (LaBuzetta et al., 2022). Excessive neuro-check frequency has been linked to sleep deprivation, an increased risk of delirium, and inefficient resource utilization (Kishore et al., 2021).

Purpose: This project aimed to assess the impact of …

Improving Timely Palliative Care Consultation In The Micu: A Nurse-Driven Quality Improvement Initiative, Sandy Louise Gray

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) …

Emotional Safety In Maternity Care: An Evolutionary Concept Analysis, Elliesha O'Reilly, Kate Buchanan, Sara Bayes

Research outputs 2022 to 2026

Background: Safety in maternity care is a priority, and a broadened view of safety (e.g., emotional, psychological, cultural) is evident in scientific literature and in lay discourse. ‘Emotional safety’ is being referred to with increasing frequency in this context; however, there is a lack of clarity in its use and meaning. Aim: The aim of this concept analysis was to examine the concept of emotional safety in maternity care. Methods: The evolutionary approach was used for this concept analysis. Data sources: This concept analysis was literature-based, with a systematic search conducted of CINAHL, MIDIRS, and MEDLINE databases. Ten articles published …

An Evidence-Based Practice Initiative To Improve Blood Pressure Control, Teresa D. Hines

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: High blood pressure (HBP) is a significant public health concern. It affects millions of adults in the United States (US) and half of the adult population in the Appalachia regions. High blood pressure is a known risk factor for cardiovascular disease (CVD), which is the leading cause of morbidity and mortality Appalachia. Complications associated with high blood pressure result in substantial economic burdens for patients and their families, healthcare systems, and national economies. High blood pressure is a significant health issue in West Virginia (WV), with an estimated 602,000 people suffering from HBP.

Purpose: The purpose of this …

A New Electronic Handoff Tool To Facilitate Patient Transfer From The Or To Sicu: A Quality Improvement Initiative, Kaylan Jean Kerrigan

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Transfer of care is a vulnerable time for patients. Continuity of care depends on good communication from the transferring team to the receiving team. Communication failures contribute to frustration among medical staff and poor patient outcomes. Purpose: The purose of this project was to improve handoff communication and satisfaction between the anesthesia team in the operating room (OR) and the receiving surgical intensive care unit (SICU) nurses. Intervention: A new electronic handoff tool was developed for the Epic electronic health record (EHR) to provide SICU nurses with patient information (name, age, allergies), procedure and diagnosis, intubation status, reversal status, …

Fostering A Resilient Healthcare System: Supportive Practice Environment Initiatives To Support Nurse And Midwives A Scoping Review, Gemma Doleman, Dianne Bloxsome, Rong Wang, Lisa Whitehead

Research outputs 2022 to 2026

Aim: This scoping review aimed to explore supportive practice environment initiatives that support novice and expert nurses and midwives. Design: Scoping review. Methods: Studies were identified through the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsychInfo, Scopus, and Web of Science. Grey literature was searched using GreyNet, National Grey Literature Collection, ProQuest Dissertation and Theses, and Google Scholar. Results: Thirty-one papers met the criteria for inclusion and data extraction. The key concepts identified were the need for adequate staffing and resources, clear and regular communication, managerial presence and engagement in committees and relationship building, celebration …

Health Professional Perceptions Of Delivering Hospital Falls Prevention Education—A Qualitative Study, Anne Marie Hill, Cheng Yen Loo, Steffanie Coulter, Carol Watson, Sharmila Vaz, Meg E. Morris, Leon Flicker, Tammy Weselman

Research outputs 2022 to 2026

Background: Providing patient falls prevention education can help reduce falls in hospitals, yet research exploring staff perceptions about providing falls education in hospitals is limited. Objective: We sought to determine enablers and barriers to implementing a hospital falls prevention education program (the Safe Recovery Program) from the clinical staff perspective. Methods: Purposive sampling was used to recruit health professionals (N = 40) from 12 acute medical and surgical wards at a 450-bed hospital in Perth, Western Australia. Participants were given the option to take part in a focus group or semi-structured interview. Data were analyzed via directed content analysis. Results: …

Aboriginal, Torres Strait Islander And Māori Nursing And Midwifery Academic Workforce Across Australia And Aotearoa New Zealand, Ann Bonner, Linda Deravin, Jan Dewar, Moira Williamson, Kerri Gillespie, Cheryl Atherfold, Karen Nightingale, Caryn West, Karen Strickland

Research outputs 2022 to 2026

Background: Promoting a representative and supportive industry for Aboriginal, Torres Strait Islander and Māori nursing and midwifery academic staff is a key tenet of Australian and Aotearoa New Zealand universities, and fundamental to strengthening the health workforce. Surprisingly, information about this workforce is unknown. Aim: The aim of the study was to gain an understanding of the Aboriginal, Torres Strait Islander and Māori nursing and midwifery academic workforce. Methods: A cross-sectional study was conducted using an online survey of organisations that provide accredited nursing and midwifery education within Australia and Aotearoa New Zealand. Demographic, academic and employment information relating to …

Observing Nursing Assistant Companions Supporting Older Adults In Hospital: A Cross-Sectional Study, Rosemary Saunders, Kate Crookes, Tania Leach, Seng Giap Marcus Ang, Caroline Bulsara, Beverly Ewens, Michelle Gay, Karla Seaman, Paige Watkins, Christopher Etherton-Beer, Olivia Gallagher

Research outputs 2022 to 2026

Background: Hospital environments may cause or exacerbate behavioural and psychological symptoms of older adults with cognitive impairment. Many hospitals in Australia employ staff as companions to provide constant observation and additional support for those with cognitive impairment and/or at risk of falls; however, little is known about the activities of this role. Aim: To examine the activities of assistant in nursing companions allocated to older patients in hospital. Methods: A cross-sectional study design using an observation tool was conducted at an acute metropolitan hospital in Western Australia. A nonparticipant nurse conducted the observations. Descriptive statistical analysis explored the data and …

Nursing Assessment Of Mental Health Issues In The General Clinical Environment: A Descriptive Study, Irene Ngune, Beverley Ewens, Sharlene Bell, Brendon Burns, Claire Sutton, Craig Creswell, Yvonne Middlewick

Research outputs 2022 to 2026

Aims: To evaluate the effectiveness of a mental health screening form for early identification and care escalation of mental health issues in general settings. A secondary aim was to explore general nurses' use of the form and their confidence to discuss mental health issues with patients. Methods: A cross-sectional design comprising a review of clinical records to determine use of the form, instances of missed care and escalation to the mental health team. The survey focused on nurses' confidence in general settings to engage in discussions with patients about mental health. Data were collected from April to December 2022. The …

Nurse By Numbers: The Impact Of Early Warning Systems On Nurses' Higher-Order Thinking, A Quantitative Study, Marie Danielle Le Lagadec, Deb Massey, Amy Louise Byrne, Justine Connor, Tracy Flenady

Research outputs 2022 to 2026

Aim: To evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher-order thinking skills. Design: A concurrent mixed methods study design. Method: Using an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher-order thinking. Likert-type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers. Results: Most of the 305 (91%) participants …

Effects Of Pregnancy And Lactation Prebiotics Supplementation On Infant Allergic Disease: A Randomized Controlled Trial, Debra J. Palmer, Alana R. Cuthbert, Thomas R. Sullivan, Rachelle A. Pretorius, Johan Garssen, Kristina Rueter, Maria C. Jenmalm, Jeffrey A. Keelan, Desiree Silva, Susan L. Prescott

Research outputs 2022 to 2026

Background: Ingestion of prebiotics during pregnancy and lactation may have immunomodulatory benefits for the developing fetal and infant immune system and provide a potential dietary strategy to reduce the risk of allergic diseases. Objective: We sought to determine whether maternal supplementation with dietary prebiotics reduces the risk of allergic outcomes in infants with hereditary risk. Methods: We undertook a double-blind randomized controlled trial in which pregnant women were allocated to consume prebiotics (14.2 g daily of galacto-oligosaccharides and fructo-oligosaccharides in the ratio 9:1) or placebo (8.7 g daily of maltodextrin) powder from less than 21 weeks’ gestation until 6 months …

Patient Perception Of Involvement In Nursing Bedside Handover: A Cross-Sectional Study, Manonita Ghosh, Kaoru Nosaka, Rosemary Saunders, Olivia Gallagher, Amanda Towell-Barnard, Debannita Ghosh, Lucy Gent, Linda Coventry

Research outputs 2022 to 2026

Background: In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered. Aim: To explore patient perceptions of their involvement in nursing bedside handovers. Methods: A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and …

The Impact Of A Planned Change To Nurse Staffing Levels In Emergency Departments: A Pre-Test, Post-Test Design, Vera J.C. Mc Carthy, Noeleen Brady, Ashling Murphy, Aileen Murphy, Jane Ball, Robert Crouch, Christine Duffield, Peter Griffiths, Anne Scott, Jonathan Drennan

Research outputs 2022 to 2026

Aim: To examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels. Design: A pre-post observational design. Methods: A systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing. Results: An adjustment …

Implementing A Gerontological Nursing Competencies Programme In Aged Care: Participant Experiences, Victoria Traynor, Nicole Britten, Diane Gibson, Stephanie Munk, Lynn Chenoweth, Jolan Stokes, Tracey Moroney, Karen Strickland, Toni Donaghy, Kasia Bail

Research outputs 2022 to 2026

Aims: To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development. Background: The global population is ageing and needs a reliable aged-care nursing workforce. Introduction: Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation. Methods: Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria. Results: …

Physiological Plateaus During Normal Labor And Birth: A Novel Definition, Marina Weckend, Kylie Mccullough, Christine Duffield, Sara Bayes, Clare Davison

Research outputs 2022 to 2026

Background: Diagnoses of labor dystocia, and subsequent labor augmentation, make one of the biggest contributions to childbirth medicalization, which remains a key challenge in contemporary maternity care. However, labor dystocia is poorly defined, and the antithetical concept of physiological plateaus remains insufficiently explored. Aim: To generate a definition of physiological plateaus as a basis for further research. Methods: This qualitative study applied grounded theory methods and comprised interviews with 20 midwives across Australia, conducted between September 2020 and February 2022. Data were coded in a three-phase approach, starting with inductive line-by-line coding, which generated themes and subthemes, and finally, through …

Clinical Is The Pinnacle: Nurse Academics' Perspectives And Opinions Of Their Students Undertaking Mental Health Clinical Placements, Lorna Moxham, Kim Foster, Brenda Happell, Richard Lakeman, Michael Hazelton, John Hurley

Research outputs 2022 to 2026

Clinical placements form an integral and important part of preregistration nursing student learning. The theory–practice gap has been identified as problematic, with clinical experience being a key strategy to address this. Despite this, the perceptions of nurse academics teaching preregistration mental health nursing regarding clinical placements have not been widely explored. To garner perspectives and experiences of mental health clinical placements from nurse academics teaching mental health nursing to preregistration nursing students. A descriptive qualitative study involving 19 nurse academics from 13 metropolitan and regional Australian universities, who were involved in the design and delivery of preregistration mental health nursing …

The Careful Project: Evaluating The Acceptability Of Local Virtual Reality Experiences As A Leisure Activity For Residents In Aged Care, Davina Porock, Patricia Cain, Christopher Young, Julieanne Hilbers, Maria Bomm, Manonita Ghosh, Mandy Stanley

Research outputs 2022 to 2026

Objectives: The aim of this project was to evaluate the feasibility and acceptability of virtual reality (VR) as a leisure activity for people living in residential aged care. Virtual reality experiences may offer alternatives for residents with limited mobility, or during times when older people are unable to leave residential care. Methods: The intervention used VR videos delivered via a head-mounted device. Video content was created by a local artist specifically for use with older Western Australian adults and used local content. VR sessions were videotaped for analysis. The evaluation included structured observation of video content to assess mood and …

The Impact Of The Covid-19 Pandemic On Nurses' And Junior Doctors' Workloads, Gemma Doleman, Annemarie De Leo, Dianne Bloxsome

Research outputs 2022 to 2026

Aims: To explore the impact of the COVID-19 pandemic on nurses' and junior doctors' workload, changes to direct care and the impact of workload on resource allocation. Design: Mixed-method design was used. Methods: Data were collected from direct observation, hospital administrative database and a survey. Nurses and junior doctors were observed on two COVID-19 wards and one non-COVID-19 ward using a semi-structured observation schedule. Survey data were collected from nurses and junior doctors that had worked on the COVID-19 ward during the pandemic. Patient data were collected from Web Patient Administration System during the period of March–August 2021 and compared …

A Brief History Of Antenatal Colostrum Expression, And Where To From Here, Therese A. O’Sullivan, Connie N. Ihlein

Research outputs 2022 to 2026

The practice of antenatal colostrum expression (ACE), or the extraction of colostrum from the breasts during pregnancy, has an interesting history and continues to evolve. This narrative review aims to describe how perception and practices of ACE have changed over time, summarise the evidence on ACE in maternal and infant care, and highlight areas for future research. The literature demonstrates that ACE is safe for low-risk women when done from around 36 weeks’ gestation. Women should be reassured that the skill of hand expressing is a valuable tool post-birth, regardless of whether they are able to collect colostrum antenatally or …

Quality Over Quantity: Doula Perspectives On Equity, Access, And Quality Of Care In Black Maternal Health Outcomes, Terry-Ann E. Lynch

West Chester University Graduate Theses, Dissertations, and Final Projects

Black maternal mortality in the United States is a public health crisis. There are a plethora of reasons as to why maternal and fetal deaths disproportionately impact Black women. From a public health perspective, health disparities are an area of concern in marginalized communities, with Black maternal mortality being a risk factor. “According to the Centers for Disease Control and Prevention (CDC), in 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6)” Maternal Mortality Rates in the United States, 2021” …

An Integrative Review Of Specialised Nursing Career Frameworks To Develop A Nursing Career Framework For Registered Nurses Working In Aged Care, Sachini Thennakoon, Seng Giap Marcus Ang, Victoria Traynor, Karen Strickland

Research outputs 2022 to 2026

Aim: The aim of this study is to synthesise literature on specialised nursing career frameworks to inform the development of an aged care nursing career framework. Design: An integrative review was conducted. Method: The review followed Whittemore and Knafl's five-step integrative review method. To appraise the quality of the studies, the Quality Appraisal for Diverse Studies tool for peer-reviewed articles and the ACCODS (Authority, Accuracy, Coverage, Objectivity, Date, and Significance) checklist for grey literature were used. Data were extracted and synthesised using the constant comparison method. Data Source: The electronic databases of CINAHL, Medline, PsycINFO and Google Scholar were searched …

Through The Looking Glass; Midwifery Students' Experience Of Ethical Issues: A Feminist Explanatory Case Study, D. Bygraves, K. Wissemann, K. Buchanan

Research outputs 2022 to 2026

Background: The ethical component in midwifery education is governed by international professional values, codes, and ethical principles. The aim of midwifery education is to encourage students to develop a lifelong commitment to ethical practice within their midwifery role and scope. However, little evidence is available on the experiences of midwifery students and how they navigate ethical issues in maternity systems. Aim: To present a case study from a midwifery students' perspective that demonstrates observed ethical issues and to provide analysis of the ethical issues identified. Design: A Single explanatory case study design with a feminist lens applied. Explanatory case studies …