Nursing Commons^™

The Role Of Intraoperative Esmolol Vs Ketamine In Laparoscopic Cholecystectomy, Rebekah Bitar

Nurse Anesthesia MSNA Student Capstones

As the understanding of opioid dependence mechanisms and origins in the adult population continues to evolve in the United States, so does the pursuit of alternative avenues for analgesia. Many opioid substance-use disorder patients can trace the origins of their dependence to routine prescription and administration of opioids during surgical procedures (Bohringer et al., 2020). One such procedure where opioids are frequently utilized for intraoperative and postoperative analgesia is laparoscopic cholecystectomy. Incidence of gall bladder disease is closely related to obesity (Hines & Marschall, 2018). Gallstone disease continues to be a common and costly health problem affecting 10 to 20% …

Perioperative Pain Management In Morbidly Obese Patients Undergoing Bariatric Surgery, Jean-Louis Luther

Nurse Anesthesia MSNA Student Capstones

Patients with morbid obesity are a growing patient population. These patients present a unique set of challenges in healthcare management. These unique challenges have been a long-standing concern to anesthesia providers in appropriately managing postoperative pain with opioids. Multimodal analgesia strategies have been adopted by many providers to minimize opioid-related side effects that are highly desirable in bariatric surgical procedures. The literature reviewed for this manuscript highlights the challenges this population presents to anesthesia providers, as well as conclusively supports alternative approaches utilizing multimodal pain management.

Impact Of Intrathecal Morphine On Patient Outcomes In Major Abdominal Surgery, Tori E. Howe

Nurse Anesthesia MSNA Student Capstones

Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring …

Perioperative Methadone Use And Postoperative Pain Control In Adult Patients Undergoing Elective Spinal Fusion Surgery, Amelia Haney

Nurse Anesthesia MSNA Student Capstones

Patients undergoing elective spinal fusion surgeries often experience moderate to severe postoperative pain (Murphy et al., 2017). The use of perioperative methadone has been suggested as an effective adjunct for patients to reduce postoperative pain, decrease opioid use, and improve patient satisfaction (Murphy et al., 2017). Traditional opioid management of orthopedic spine surgeries include intermittent injections or patient-controlled analgesia devices. These approaches may cause fluctuating levels of opioids or require patient education and cooperation to be effective (Murphy & Szokol, 2019). Methadone has a much longer elimination half-life when compared to other opioids, and therefore may provide patients with a …

Neurotoxic Effects Of General Anesthesia On The Developing Brain And The Use Of Spinal Anesthesia As An Alternative Approach For The Neonate And Infant Undergoing Genitourinary Surgery, Makaela E. Delucca

Nurse Anesthesia MSNA Student Capstones

Spinal anesthesia (SA) in the child under two years old is an excellent option when undergoing short genitourinary procedures. The use of SA in this patient population can avoid the potential deleterious neurocognitive effects on the developing brain that general anesthesia (GA) poses. A comprehensive literature review was conducted via retrospective case study, case control study, integrated review, and prospective study. The objective of this literature review is to examine the potential long-term neurotoxic effects of GA in the infant, as well as the benefits of SA. GA in the younger population has been shown to produce lower gray matter …

Ketorolac: To Bleed Or Not To Bleed? That Is The Question, Elisabeth E. Stewart

Nurse Anesthesia MSNA Student Capstones

Ketorolac is a readily available, inexpensive, moderate to severe pain management adjunct. As opioids lost favor, ketorolac gained popularity, as an opioid-sparing alternative (Corsini et al., 2021). Anecdotally, surgeons have been resistant to intra-operative intravenous ketorolac due to perceived bleeding risks. As such, this review seeks to evaluate the literature to determine whether ketorolac administration is associated with clinically significant bleeding in adult breast surgery patients. The results demonstrated conflicting evidence for ketorolac use. No literature has established a causal relationship between ketorolac and clinically significant bleeding. Future research avenues include geriatric, pediatric, labor and delivery, dosing, and randomized control …

The Effects Of Mindfulness On Stress Reduction And Academic Performance In Students Studying Health Sciences, Julia Montalto

Nurse Anesthesia MSNA Student Capstones

Students studying health sciences are often consumed by rigorous curricula and demanding clinical schedules. The extensive concentration and commitment required of these students can be exhausting. This can lead to stress, poor academic performance, substance use and a decreased quality of life (Fauzi et al., 2021, Flowers & Bernard, 2020, Gao et al., 2022, & Melaku et al., 2015). Recent trends in academia have led to an integration of mindfulness-based stress reduction (MBSR) programs into the curriculum of graduate and undergraduate schools. Studies have shown that a consistent practice of some form of mindfulness is associated with a decrease in …

Benefits Of Ketamine Versus Propofol In Acute Traumatic Brain Injuries With Elevated Intracranial Pressure, Marissa Diloreto

Nurse Anesthesia MSNA Student Capstones

Ketamine is a widely used medication that can be administered for the delivery of anesthesia as well as analgesia while supporting hemodynamics. A commonly taught concept based on early research is that ketamine should not be administered to those with acute brain injuries. Early research had stated that ketamine can cause a dangerous increase in intracranial pressure (ICP) and thus a decrease in cerebral perfusion and oxygenation in those with traumatic brain injuries (TBI) (Takeshita et al., 1972). More recent research has shown that ketamine may be efficacious for patients with TBIs and can decrease ICP (Dengler et al., 2022). …

Trauma And Resiliency, Madelyn Ferguson

Honors Projects

Life is a series of events, some overwhelmingly positive and others devastatingly negative. Because of the inevitability of adversity, one must learn to adapt to negative circumstances. However, people react to trauma in different ways with some seeking to take their own lives and others finding a healthy outlet. What causes such a difference in our reactions to trauma? Is it simply the power of thought or is there a genetic component? What can I do to build my own resilience and promote the resilience of others around me? The purpose of this paper is to explore the relationship between …

The Jackson/Cubbin Skin Risk Assessment Tool: Implementing An Evidence-Based Practice Change Initiative In The Intensive Care Unit, Andrew Riddle Msn, Rn, Npd-Bc, Ccrn-K

Doctor of Nursing Practice Projects

Background: Pressure injuries in acute care patients cause thousands of deaths and billions of losses annually. The Braden Scale has been an American standard of pressure injury risk assessment yet demonstrates poor predictability in the Intensive Care Unit (ICU) population. Recent evidence indicates that the Jackson/Cubbin Scale performs similarly or superiorly to the standard.

Purpose: To compare the Jackson/Cubbin Scale to the Braden Scale in assessing ICU patients’ risk for pressure injuries and resulting nursing interventions. Methods: Using a pretest-posttest and comparative design, trained nurses in two ICUs applied both Jackson/Cubbin Scale and Braden Scale to assess patients’ risks twice …

Impact Of An Automated Text And Phone Call Post-Discharge Follow-Up Program On Patient Satisfaction Scores And 30-Day Hospital Readmission Among Adult Patients, Michael Clarke

Doctor of Nursing Practice Projects

Background: The Center for Medicare & Medicare (CMS) withholds reimbursement from hospitals that fail to meet established benchmarks for the rate of 30-day hospital readmission and patient satisfaction.

Objective: This project aimed to improve patient satisfaction scores and decrease 30-day hospital readmissions among adult patients at the project hospital by implementing an automated phone call and text message post-discharge follow-up program.

Methods: This quality improvement project utilized a Plan-Do-Study-Act (PDSA) method. Program participants’ 30-day readmission data and patient satisfaction scores were collected and analyzed throughout the 90-day project and up to 30 days after the project ended. Program participants received …

Roadmap To Reduce Barriers To Medical Aid In Dying For Rural Coloradans: A Health Policy Analysis And Advocacy Campaign, Ashley D. Fry Msn, Apn, Agacnp-Bc, Achpn

Doctor of Nursing Practice Projects

Background: Medical aid in dying (MAID) is a process by which a terminally ill adult with a prognosis of six months or less can request prescription medications to end their life. Colorado’s End-of-Life Options Act requires that two physicians participate in the process to certify terminal illness and prescribe medications. Nearly all rural and frontier counties face shortages of medical professionals. These conditions challenge rural residents who want to access MAID. Advanced practice registered nurses and physician assistants can address gaps in rural and frontier counties; on average, they outnumber physicians in these communities.

Aims: The aims of this health …

Cultivating Unit-Based Leaders Through A Tiered, Structured Mentorship Program, Brittney Daley Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Succession planning and mentorship is an essential need in developing future nursing leaders. The IOM and published literature strongly support the importance of mentorship programs in nursing (IOM, 2021). The current succession plan and mentorship program is not sufficient.

Purpose: The purpose of this project was to create and implement an evidence-based, 3-tiered unit-based leadership mentorship program (LMP) for bedside registered nurses to support growth and professional development between tiers over a 4-month period.

Aims/Objectives: Using the completion of a pre and post survey the mentee was assigned a tier from novice to experienced leaders. Through the program, the …

Impacts Of Emotional Intelligence Skill Development Training On Nurse Leaders, Denise A. Holyoak Dnp, Rn, Ccrn-K, Nea-Bc

Doctor of Nursing Practice Projects

Background: Emotional intelligence (EI) skills are recognized as an essential tool for leaders’ success in their organization. Research shows that an EI skill development training program is effective at improving this skill set of nurse leaders and thus positively influence individual and organizational outcomes.

Aims: The purpose of this evidence-based practice (EBP) project was to design an EI skill development curriculum for frontline inpatient nurse managers and to evaluate its impact on three aims: EI skill scores of nurse managers, patient satisfaction scores related to nurse communication and nurse manager leadership communication scores.

Methods: Eleven inpatient nurse managers from a …

Addressing Verbal Aggression To Reduce Workplace Violence Against Nurses, Rebecca Harris

Doctor of Nursing Practice Projects

Background: Almost three-quarters of non-fatal workplace violence-related injuries requiring time away from the workplace occur in the healthcare and social services sector. More than 90 percent of assaults against nurses are from patients. Verbal aggression was correlated with physical violence and could contribute to nurses’ stress and dissatisfaction and compromise patient care. Policies and guidelines addressing verbal aggression against nurses are often unclear and not well-supported by evidence. This can leave nurses unprepared to recognize and respond to verbal aggression or threats of physical harm without compromising their safety.

Aim: This health policy analysis aimed to explore a range of …

Management Of Stage I And Stage Ii Labor Arrest Disorder To Reduce Primary Cesarean Section Birth Rate For African American Women, Ariam Yitbarek Mha, Bsn, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Background: Cesarean section delivery rate in the United States has reached an alarming rate of over 30%. African American women experience a higher cesarean birth rate compared to Caucasian Women. The repeat c-section rate for all patients is greater than 80%. These findings underscore the need for intervention to reduce primary cesarean section deliveries in African American Women.

Objective: This quality improvement project aimed to implement caregiver education on the ACOG/SMFM definition of the first and second-stage labor arrest disorder to reduce primary cesarean section birth for African American women.

Method: This pre-and post-intervention quality improvement project was conducted on …

The Impact Of Nurse-To-Nurse Change Of Shift Report At The Bedside On Patient Satisfaction Scores And Patient Safety, Tonya Washington

Doctor of Nursing Practice Projects

Background: Nursing shift report is an essential part of the clinical practice. It allows nursing staff to exchange necessary patient information to ensure continuity of care and patient safety. Traditionally, nursing shift report was done at the nurses’ station or behind closed doors and did not involve the patient.

Objective: This project aims to implement an evidenced-based bedside shift report (BSR) on two medical and two surgical inpatient units to improve patient safety and patient satisfaction scores in the Communication with Nurses domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Methods: The project utilized a …

Kangaroo Care Education For Low Socioeconomic Status Families In The Neonatal Care Unit, Joara Peterson

Nursing | Student Research Posters

The early contact between mother and baby is known as skin-to-skin, also referred to as “kangaroo care” (KC). It involves placing the baby on the mother’s chest as soon as it is appropriate (Thompson, 1979). This interaction was primarily for bonding but many researchers have discovered additional benefits. There is significant correlation between kangaroo care and weight gain (especially for low birth weight infants), as well as body temperature and heart rate regulation, which reduces the risk of medical complications. It also decreases levels of stress in mothers and babies by lowering the release of cortisol hormone (Mohammadi et al. …

The Impact Of Remote Video Monitoring On Costs And Patient Outcomes, Karen Wyche Latham Msn, Rn, Nea-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Reducing patient falls remains a challenge for many acute care hospitals. Sitters (1:1 observation) are often utilized as an intervention to mitigate this. This costly intervention has drained both personnel and financial resources, forcing hospitals to find less costly alternatives to achieve the same safety outcomes. Remote video monitoring technology (RVM) is an innovative technology that supports the monitoring of multiple patients by one observer from a remote location and is an effective alternative in reducing patient falls and/or injury and associated costs.

Aim: The goal of this evidence-based practice initiative was to evaluate the effectiveness of RVM compared …

Implementation Of Collaborative Care Intervention Within A Fqhc To Achieve Uniform Data System (Uds) Measure Of Depression Remission, Rasha A. Kafi Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Depression is one of the most common and treatable mental health conditions. Untreated depression causes emotional suffering, reduced productivity, lost wages, increased comorbidity risks, and increased healthcare costs.

Purpose: The purpose of this project was to implement Collaborative Care Interventions (CCI) to achieve the Uniform Data System (UDS) Measure of Depression Remission.

Aims: The AIMS of this project were: (a) Increases the percentage of nursing staff compliance and completion of the educational training; (b) increases nursing staff knowledge of recognition of depression signs and symptoms, early identification of depression, and administration to all adult patients; (c) Increase the percentage …

Improving Mental Wellness In Clinical Staff: Use Of Respite Rooms And Mindfulness Strategies In Ambulatory Care Settings, Whitney Hodges Shanley, Karen Whitt

GW Research Showcase 2021-2026

No abstract provided.

The Jackson/Cubbin Skin Risk Assessment Tool: Implementing An Evidence-Based Practice Change Initiative In The Intensive Care Unit, Stephan Andrew Riddle, Qiuping Zhou, Patricia Mccabe

GW Research Showcase 2021-2026

No abstract provided.

Benchmark: Impact Of Weight Loss Education On Obese Patients, Tabitha A. Moorehead

MSN Capstone Projects

Objective: With an epidemic as severe as obesity, it is paramount that healthcare professionals be aware of the overarching negative effects the disease can contribute to the human body. If constructive dialogue can be achieved between patient and provider without suspicion of bias or judgment, we would potentially experience an elevated willingness of patients to follow treatment steps.

Background: According to the World Health Organization (WHO), worldwide obesity has nearly tripled since 1975. “Most of the world's population live in countries where overweight and obesity kills more people than underweight” (WHO, 2021). “More than 4 in 10 Americans are …

Covid-19 Lockdown: Impact On College Students’ Lives, Wendy C. Birmingham, Lori L. Wadsworth, Jane H. Lassetter

Faculty Publications

Objective: In light of COVID-19, leaders issued stay-at-home orders, including closure of higher-education schools. Most students left campus, likely impacting their employment and social network. Leaders are making decisions about opening universities and modality of instruction. Understanding students' psychological, physiological, academic, and financial responses to the shut-down and reopening of campuses can help leaders make informed decisions. Participants: 654 students from a large western university enrolled during the pandemic shutdown. Methods: Students were invited via email to complete an online survey. Results: Students reported stress, depression, loneliness, lack of motivation, difficulty focusing on schoolwork, restless sleep, appetite changes, job loss …

Nursing Care Of Family Caregivers: Interventions And Considerations Regarding Current Issues Facing Family Caregivers Of Persons With Dementia Relevant To Nursing Practice, Alayna Kent

Senior Honors Theses

There are an estimated 6.5 million Americans age 65 and older who are currently living with Alzheimer’s dementia. A large majority of these individuals receive care from a nonprofessional family caregiver, typically in the home setting. It is well documented that family caregivers of dementia patients experience many unique challenges. These challenges provide valuable opportunities for nurses to provide helpful interventions to aid this vulnerable population. An integrated review of the recent literature was conducted, and articles were chosen by a method modeled after the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowsheet. The research was then analyzed …

A Metabolic, Mechanical, Multi-Organ Masterpiece: Dural Device Support Bridge To En-Bloc Heart-Liver Transplantation In Propionic Acidemia, Rebecca Juhl, Brian Birnbaum, Aliessa P. Barnes, William Gibson, Bhargava Mullapudi, Beth Lang, Megan Faseler, Daniel E. Heble, Victoria Urban, Ryan T. Fischer, Jennifer L. Gannon, David Sutcliffe

Posters

Introduction: Propionic Acidemia (PA) is a disorder related to abnormal protein and lipid metabolism resulting in progressive neurological injury and dilated cardiomyopathy (DCM). Interventions for PA and secondary disease manifestations can require multi-organ transplantation. Herein we report the case of a child with PA and end-stage DCM requiring left ventricular assist device (LVAD) support with eventual heart-liver transplant. Case Report: A 17 year old male diagnosed in childhood with PA developed chronically progressive DCM culminating in end stage heart failure with acute decompensations. In a recurrent admission, he progressed to require dual inotropic support and systemic anticoagulation for new LV …

Lessons From A Natural-Born Teacher: Reflections On Mentorship And Kindness In Medical Education, Chloe Hille, Brianna Wetmore

be Still

The transition from preclinical education to medical clerkships is an important period of medical school that challenges students to advance their clinical knowledge. The help of strong and inspirational mentors is crucial for students to not only gain proficiency in their clinical skills, but to also develop into confident and compassionate future physicians.

2023 Research Day Program, Lincoln Memorial University

Research Day

This program contains abstracts and presentation summaries from LMU's 2023 Annual Research Day conference.

Iv Dexamethasone To Assist With Post Operative Pain And Nausea, Tasha Coumbs

Articles, Abstracts, and Reports

No abstract provided.

Caring For Children With Mental Health Concerns: The Experience Of Being A School Nurse, Jeannine Kaskoun

Dissertations, Theses, and Capstone Projects

Mental health issues have for years been on the rise among our nation’s schoolchildren, and the COVID-19 pandemic has only served to aggravate what can now be called a crisis. Researchers agree that timely assessment, diagnosis, and treatment of mental health concerns in children are critical to maintaining their growth and development and could potentially aid in decreasing serious mental health events as they move into adulthood. While in an ideal world, each child would have a family medical provider, the fact is that for many children, the school nurse is the child’s sole provider of health care. Many times, …