Nursing Commons^™

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

Management Of Sepsis With The Quick Sequential Organ Failure Assessment, Jeanna Adams

Providence Nursing Research Conference 2023 – Present

Abstract

Background:

Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely …

Fall Prevention Quality Initiative: Implementation Of Fall Ambassador Safety Team (Fast), Jerome Codilla, Joanna Arraiza

Providence Nursing Research Conference 2023 – Present

Background

Patient falls are the most common adverse events reported in hospitals and represent a persistent patient safety issue. Annually, roughly 700,000 to 1 million patient falls occur in United States hospitals, resulting in around 250,000 injuries and up to 11,000 deaths (LeLaurin et al., 2019). Nurses are responsible for the identification of high fall risk patients and development of a plan of care to minimize risk. Multifactorial strategies have been shown to reduce falls, but evidence of a sustainability team (fall champions) is lacking. Review of the National Database of Nursing Quality Indicators (NDNQI) data on a 33-bed progressive …

A Quality Improvement Project To Decrease New Or Worsening Pressure Ulcers In A Skilled Nursing Facility (D-Pus Snf), Shaune Mattsson

Providence Nursing Research Conference 2023 – Present

Background:

Pressure ulcers (PU) are a "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or shear/friction". PU are an urgent problem in the United States (U.S.). Residents in skilled nursing facilities (SNF) are disproportionately affected, with 9.2% of residents estimated to suffer a PU nationally. The Braden Scale is gold standard for identifying individuals at risk for PU in healthcare settings across the continuum and grades PU risk in 6 categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. To protect against PU, a Braden Scale must be documented on …

A Quality Improvement Project To Reduce Hospital Acquired Pressure Injuries In Patients With Darker Pigmented Skin, Ma Fe Chase, Travis Scott, Renee Hoeskel, Yolanda Rodriquez

Providence Nursing Research Conference 2023 – Present

Purpose: This quality improvement (QI) project aims to improve the accuracy and effectiveness of skin assessments for patients with darker skin tones in preventing hospital-acquired pressure injuries (HAPIs) by implementing an evidence-based, standardized skin assessment protocol and training program.

Background: Nursing staff play a vital role in preventing HAPIs. Nearly 2.5 million patients develop HAPIs annually in the United States increasing their risk of prolonged hospitalization, increased readmission, infections, and severe pain. Preventing HAPIs continues to be top priority in acute care facilities. Recent audits at a large urban Pacific Northwest hospital revealed high HAPI rates with a staff …

An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo

Providence Nursing Research Conference 2023 – Present

Background:

Pressure injuries have detrimental effects on patients healing and outcomes and are costly to organizations due to payment programs. Pressure injuries are largely preventable if appropriate interventions are implemented early. In our ICU, post-pandemic monitoring showed increases in hospital-acquired pressure injuries (HAPIs) and consults for medical device HAPIs were increasing. Rounds with wound care department indicated lack of staff compliance with recommended preventive practices. Some issues reported were the use of diapers and excessive linens, failure to use scheduled turning for patients, lack of prevention related to medical devices

Purpose:

The goal of this skin-care management project is …

Characteristics Of Nursing Professional Identity Survey Completers, Teresa Rangel, Crystal Billings, Rose Timmerman, Tulla Landis

Providence Nursing Research Conference 2023 – Present

Background: Magnet and Pathways to Excellence (PTE) designations through the American Nurses Credentialing Center (ANCC) publicly recognize hospitals achieving outstanding nursing excellence. An issue of special interest to clinical nurses working in Magnet/PTE facilities is the professional identity of nurses, which is hypothesized to positively correlate to nursing satisfaction and delivery of high-quality patient care. A valid and reliable survey tool, called Professional Identity in Nursing Scale (PINS), is a low-cost and low-burden strategy for nurses to measure professional identity in nursing. However, survey attrition rate is a significant barrier to collecting robust and representative data. Little is published …

Going Beyond The Pronouns: Caring Well For Lgbtq+ People, Tobias Johnson

Providence Nursing Research Conference 2023 – Present

No abstract provided.

In-Depth Perspectives Of Faith Community Nurses Serving In A Western U.S. State: Findings From A Healthcare-Academic Collaboration, Nathan West, Lauren Kiker (Doctoral Student), Beverly Bateman

Providence Nursing Research Conference 2023 – Present

Background: Faith community nurses (FCNs) implement congregational health programs, address health-related needs, and deliver wholistic care within the faith communities they serve. FCNs have reported certain challenges impacting their ability to deliver care within faith-based settings (e.g., training, funding, resources). Literature, however, documenting the lived experience of FCNs is limited, particularly in (U.S. State blinded for review [i.e., a Western state)]. The ministry’s Faith Community Nurse Resource Center (FCNRC) at a Providence Medical Center supports 150 non-paid professionals by providing: Support (e.g., community-building), Training (e.g., FCN Foundations Course), Continuing education credits, Consulting (e.g., ministry effectiveness), and Resources (e.g., research, …

Triage Re-Education: Impact On Accuracy Of Acuity And Care Provision, Alexandra Rowen

Providence Nursing Research Conference 2023 – Present

Background:

Triage is the process of sorting and prioritizing patients requiring medical treatment. A primary goal is to identify high-risk or life-threatening situations. Emergency Severity Index (ESI) is a validated method to assign an acuity level from Level 1 (emergent) to Level 5 (non-urgent). ESI handbook states competency is vital to the success and accuracy of the ESI tool & requires periodic assessment of RNs participating in triage. The Emergency Nurses Association (ENA) reports only 60% accuracy in assigning acuity.

Aim:

The aim of this evidence-based practice project was to determine compliance with triage standards and provision of initial …

Using A Virtual, Case-Based Approach To Developing Clinical Competency In Hospice, Melissa Robinson, Sasha Holden, Tara Poulsen

Providence Nursing Research Conference 2023 – Present

Background:

There has been a shift in nursing education away from a teacher-centered approach that is focused on requiring learners to memorize large amounts of content to a concept-based approach that is learner-centered and focuses on the development of critical thinking, clinical judgment, and problem-solving skills (Giddens et al., 2020). Conceptual learning requires learners to connect facts and exemplars to concepts through active learning experiences such as completing case studies or problem-solving activities (Baron, 2017). This allows learners to ‘practice’ thinking and apply new knowledge to clinical practice.

The clinical education team is applying this knowledge to the current competency-based …

Effective Non-Pharmacological Pain Relief Interventions Among Neonates: An Integrative Research Review, Staci Shaw

Providence Nursing Research Conference 2023 – Present

Background:

Newborns encounter many painful events, including heel sticks, venous blood sampling, peripheral intravenous insertions, and more. Newborns cannot verbally express pain, and caregivers rely on changes in vital signs (increased heart rate, decreased oxygen saturations) behavior (long periods of inconsolable crying), and facial expressions to grade newborn pain. Pain management in neonates is critical to preserve neurodevelopment. Due to adverse effects of pharmacological pain management interventions in neonatal populations, non-pharmacological pain management interventions are often utilized in newborns, such as swaddling, non-nutritive sucking, kangaroo care, oral sucrose, holding, touching, music, and breastfeeding. However, the most effective pain management intervention, …

A Better Tool For Ed Fall Risk Assessments: The Monego-Barra Ed Fall Risk Assessment Tool (Moba), Roxanne Barra, Mary Waldo, Angela Graves, Jessica Monego

Providence Nursing Research Conference 2023 – Present

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment …

Utilization Of Catheter Calendars For Cauti Reduction, Katie Whitehead

Providence Nursing Research Conference 2023 – Present

Background:

Hospital acquired infections are a nursing sensitive quality indicator used by the public, governmental agencies, and regulatory bodies to determine the caliber of care offered by nursing staff in acute care hospitals. Lower incidences of hospital acquired infections are linked to improved safety and patient outcomes. Historically, a 356-bed community hospital had very low rates of catheter associated urinary tract infections (CAUTIs) prior to 2021, however in the first two quarters of the year, the medical-surgical units saw this number jump from four total in 2020 and 2021 to five in six months.

Purpose:

To reduce the incidence of …

Prevalence And Characteristics Of On-Shift Napping Among Hospital-Based Nurses, Rachel Carlson, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Comparison Of Data On Preterm Neonatal Growth Measures In The Neonatal Intensive Care Unit, Madison Baty, Emily Faerber, Cayenne Sirois

Providence Nursing Research Conference 2023 – Present

Background:

Extrauterine Growth Restriction (EUGR) has been defined as infant weight-for-age z-score (WAZ) of less than -1.28 standard deviations (SD), at discharge or 36–40 weeks (about 9 months) postmenstrual age. In 2018, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published indicators of neonatal malnutrition, including a decline in WAZ over time. Mild, moderate, and severe neonatal malnutrition is defined as a WAZ decline of 0.8-1.2 SD; >1.2-2 SD; >2 SD, respectively, and it is unclear how widely revised neonatal malnutrition indicators are being used.

Purpose/aim:

To investigate the sensitivity and specificity …

Adherence To Sb5195 Naloxone Distribution Requirements At Discharge From The Emergency Department, E Stewart, J Delfeld, J Mckay, J Corhei, Kailyn Elliot

Providence Nursing Research Conference 2023 – Present

Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has …

Building The Future: New Grad Residency As A Response To The Staffing Crisis, Caitlin Silva, Geri Harmon

Providence Nursing Research Conference 2023 – Present

Purpose:

An innovative nursing project was created to evaluate if increasing the total number of nurses entering the Transition into Practice (TIP) program would decrease traveler utilization, resulting in cost savings for the hospital.

Relevance/Significance:

Nursing shortages reached a critical level during the pandemic, and many hospitals throughout the country have not recovered. Many nurses have either left the bedside entirely or moved to the competitive pay of travel nursing requiring hospitals to create competitive hiring practices. The utilization of travel nurses results in increased costs and can have negative patient outcomes.

Strategy/Implementation/Methods:

The clinical education team collaborated with leadership …

Sepsis 5 Rights Round (S5rr), William Lim, Bilma Pellissery, Jenny Carrillo

Providence Nursing Research Conference 2023 – Present

Background. Sepsis-related hospitalizations with prolonged length of stay (LOS) are rising in the US. Likewise in our setting, sepsis is the #1 diagnosis-related group (DRG). Moreover, our sepsis patient outcomes for DRG-related LOS, timely discharge, readmission rates, and observed/expected (O/E) mortality did not meet our healthcare system’s regional goals. Thus, because evidence suggests that interprofessional rounds may improve those outcomes among non-sepsis patients, we decided to add afternoon interprofessional rounds to existing morning rounds. Those Sepsis 5 Rights Rounds (S5RR) would focus on the right patient, place, time, level of care, and plan of care.

Purpose.The purpose of this …

Impact Of Visitation On The Mental Health Outcomes Of Patients In The Icu Environment, Nicole Conte

Nursing Undergraduate

Intensive Care Units (ICUs) are hospital units designed to help care for patients who are critically ill. The ICU provides these patients with specialized medical and nursing care, enhanced monitoring, and multiple approaches to help physiologic organ support. These units handle severe, life-threatening medical cases (Marshal et al., 2017). Patients in these intensive care units experience a wide variety of changes which can contribute to their mental health. According to the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, …

The Complexity Of Prn Psychotropic Medications In The Acute Care Setting, Morgan Pasquali Bsc Rn

Nurse Residency

PICOT Question: In the geriatric population who have PRN medication for agitation compared with those without PRN medication for agitation, are at risk for adverse events during their hospital stay?

The Use Of Nitrous Oxide In Adult Inpatient Populations For Analgesic And Anxiety Management During Bedside Procedures, Avery Low Rn, Frances Brown Rn, Hannah Lewis Rn

Nurse Residency

PICOT question: In adult medical-surgical inpatient populations, how does nitrous oxide compared to commonly used pain medications, affect patient procedure compliance and/or experience, within the length of their hospital visit?

Assessing Psychometric Predictors Of Academic And Life Success For High School Students In A Stem-Based Program In Rural Alabama, Robin Bartlett, Alan Mckendall, Sherron Mckendall, Paige Johnson, Ann Chester

Faculty & Staff Scholarship

The Health Sciences and Technology Academy of Alabama (HSTA-AL) is an academic program focused on health sciences enrichment offered through the College of Nursing at the University of Alabama to address the state’s nursing and biomedical professionals shortage (i.e., a 10:1,000 nursing to population ratio). This paper examines outcomes addressing social, academic, and life success from the participants’ perspective. The one-sample-pretest-posttest designed study evaluated whether there was a difference between baseline and year 1 levels of community engagement and academic intentions for the 23 students for which paired data were obtained. Analyses show promising outcomes from baseline to year one …

Q2 Turns And Air Fluidized Therapy Beds, Fartun Hirsi Rn, Audrey Iradukunda Rn, Krissia Walker Rn

Nurse Residency

PICOT Question: How does repositioning patients every 2 hours compared to Air Fluidized therapy beds reduce the incidence of pressure injuries in critically immobile ill older adults?

The Benefits Of Heat Application And Range Of Motion Vs. Ice Therapy, Jared Proulx Rn Bsn, Alejandro Canales Rn

Nurse Residency

PICOT Question: In patients with musculoskeletal injuries, is heat application and gentle range of motion more or less effective than standard icing and immobilization methods in regard to the healing process, prognosis and positive patient outcomes?

Betamethasone And The Effects On Newborns Of Various Gestations, Julie Allen, Hanna Freeman, Kristina Smith

Nurse Residency

PICOT Question: In newborns of various gestational ages, how does administering betamethasone affect newborn outcomes within the first 72 hours of life?

Handoff Report & Standardizing Report Sheets, Isabella Santeramo Rn Adn, Caitlin Salas Rn Adn, Samantha Neilhart Rn Adn, Debra Harmon Rn Adn

Nurse Residency

PICOT Question: In nursing, how does a standardized report compared to a non-standardized report affect efficiency in continuity of care in a 12-hour shift?

The Need And Impact Of Child Life Interventions And Support On Night Shift, Meranda Martin Rn, Elise Moloney Rn Bsn, Natani Condo Rn Bsn

Nurse Residency

PICOT Question: For pediatric patients (P), how would having a Child Life resource available on night shift (I) improve (C) overall patient experience (O) during hospital stays (T)?

Ensuring Intervention Fidelity Of An Attention Control Arm In A Multisite Randomized Controlled Trial, Amy R. Newman, Karen M. Moody, Kerri Becktell, Erin Connelly, Cynthia Holladay, Katie Parisio, Jonathan L. Powell, Verna L. Hendricks-Ferguson

College of Nursing Faculty Research and Publications

Background

Intervention fidelity is a critical element of randomized controlled trials, yet reporting of intervention fidelity among attention control arms is limited. Lack of fidelity to attention control procedures can affect study outcomes by either overestimating or underestimating the efficacy of the intervention under examination.

Objectives

This brief report describes the approach researchers took to promote fidelity to the attention control arm of a pediatric palliative care randomized controlled trial funded by the National Institutes of Health.

Methods

The Informational Meetings for Planning and Coordinating Treatment trial aims to determine the efficacy of a communication intervention that uses care team …

Scopes Of Practice For Advanced Practice Nursing And Advanced Practice Midwifery In Kenya: A Gap Analysis, Eunice Ndirangu, Rachel Kimani, Catherine Onyancha, Bernard Mutwiri, Beatrice May, Isabel Kambo, Nicholas Koech, Ann Mukuna, Colette Henderson, Constance Shumba

School of Nursing & Midwifery, East Africa

Background: There is increasing global evidence on the impact of advanced nursing andmidwifery practitioners, and Kenya’s healthcare system has an excellent opportunity todevelop scopes of practice and other regulatory frameworks for the integration of theseroles.

Objective: The primary purpose of this gap analysis was to explore the existing evidenceon opportunities and threats toward the integration of the advanced practice nursing(APN) and advanced practice midwifery (APM) roles in Kenya’s healthcare system.

Methods: The study team conducted a structured electronic database search of PubMed,CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrievearticles and credible websites for reports highlighting the opportunities …