Increasing Pulmonary Artery Catheter Education Among Ccu Nurses: A Quality Improvement Project, Kayla Marie Fisher Rn, Bsn

Doctor of Nursing Practice (DNP) Scholarly Projects

Executive Summary

Title: Increasing Pulmonary Artery Catheter Education Among CCU Nurses: A Quality Improvement Project

Background and Significance: Among the patient population in the Cardiac Care Unit (CCU) at a large academic medical center in Seattle, pulmonary artery (PA) catheters are commonplace. PA catheters are invasive central venous access devices with the ability to measure hemodynamic parameters that reveal information about the functionality and cardiac output of the heart. Should values obtained from PA catheters be incorrectly measured, serious complications could arise. Appropriate management of this device requires specialized expertise which is usually limited to cardiac critical care and surgical …

Relationship Between Treatment Comorbidities And Hiv Viral Suppression Among People Who Live With Aidsi N Johannesburg., Nwogo Immaculata Ekeji, Tolulope A. Osoba, Hebatullah Tawfik, Mehdi Agha

Journal of Social, Behavioral, and Health Sciences

HIV has globally infected over 37.9 million people, of which 28.2 million (73%) are on antiretroviral treatment, and 66% of those on treatment are virally suppressed. In South Africa, however, low rate of viral suppression (47%) among people living with HIV is a major health problem that has continued to fuel HIV prevalence. A cross-sectional quantitative research design was used to investigate the relationship between treatment comorbidities and viral suppression among HIV-infected adults aged 18–49 who were diabetic, had cancer, or tuberculosis in Johannesburg. HIV Care Continuum formed the theoretical framework for this research. An existing HIV-infected patient de-identifiable dataset …

Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry

Providence Nursing Research Conference 2023 – Present

Development of a RN Clinical Coach program to improve retention of ICU residents and fellows

Background:
The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.

Purpose:
The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.

Methods:
In September 2021 the ICU manager at Providence Saint …

Performance Of A Sars-Cov-2 Rt-Pcr Assay With Non-Traditional Specimen Types, Subathra Marimuthu, Holly Aliesky, Heather Ness, Daniya Sheikh, Sathya Rashmit, Dawn Balcom, Leslie A. Wolf

The University of Louisville Journal of Respiratory Infections

During the first two years of the coronavirus disease 2019 (COVID-19) pandemic, nasopharyngeal (NP) specimens were the gold standard for clinical diagnostic testing. As information about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic continued to be shared, it was clear that the virus could be detected in other specimen types during an active infection. The University of Louisville Infectious Diseases Laboratory accepted non-traditional specimen types, most without a paired, positive NP result, for research purposes only to support local epidemiology efforts. A real-time reverse transcription-polymerase chain reaction (RT-PCR) assay originally validated for NP specimens was used …

What? Now A Respiratory Syncytial Virus Epidemic, Aya Allam, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Coronary Care Unit Nurses’ Experiences Of Care Management Self-Efficacy: A Qualitative Content Analysis, Fatemeh Mansouri, Parand Pourghane, Maryam Rajab Pour Nikfam, James C. Oleson

The Qualitative Report

Recognizing various aspects of the self-efficacy concept in specialized medical units such as intensive care units (ICUs) and coronary care units (CCUs) has the potential to help nurses improve their quality of care. Therefore, we conducted a qualitative content analysis study in 2018 in hospitals of the Guilan Province, northern Iran, to help explain nurses’ perceptions of self-efficacy in care management within CCU wards. Thirty-four semi-structured interviews were conducted with nurses from CCUs. Using Graneheim and Lundman’s (2004) analytical techniques, we extracted three main themes and nine sub-themes from the data: decline in self-efficacy (e.g., time constraint, high work pressure, …

Parental Contextual Factors And Decision-Making Related To Periviable Birth: An Integrative Review, Amy L. Wright, Elizabeth Mens, Gausiha Rathitharan

The Qualitative Report

Parents facing a periviable birth, or birth before 25 weeks of gestation, commonly engage in antenatal consultation with healthcare providers to determine a plan of care. Parents’ pre-existing contextual factors, beliefs, and values influence their decisions regarding birth and the care of their infant. This study aims to understand the role of parental contextual factors and best-practices to their integration during antenatal consultation The Whittemore and Knafl (2005) approach to conducting an integrative review along with thematic analysis was employed to determine and present the findings. Results describe three themes related to how contextual factors influence parental decision-making: personal values …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong

Master's Projects and Capstones

The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …

Usp<800> Hazardous Drug Safe-Handling In The Medical-Surgical Microsystem: A Cnl Quality Improvement Project, Ananda T. Le

Master's Projects and Capstones

Problem: The USP General Chapter <800> guidelines protect healthcare workers from hazardous drugs (HD) and are enforceable by hospital regulatory organizations. Hospitals should increase their safe handling and administration of these drugs to be compliant and protect their workers. This quality improvement project aimed to improve nurse compliance with the safe handling of USP <800> drugs on the medical-surgical microsystem within 16 weeks.

Context: This clinical nurse leader (CNL) quality improvement project was implemented on two medical-surgical microsystems in a San Francisco Bay Area hospital system.

Interventions: The team conducted passive observational data collection and active observation in the form of a …

Improving Safe Handling And Administration Of Usp<800> Hazardous Drugs Within The Medical-Surgical Unit, Pavlo Karaputa

Master's Projects and Capstones

Nurses comprise the largest proportion of healthcare providers who make contact with Hazardous Drugs (HDs) during multiple types of clinical activities and have a risk of exposure. Hazardous drugs (HDs) are a class of pharmaceuticals that pose serious health risks to individuals who handle them, including organ toxicity, reproductive and developmental defects, infertility, miscarriage, genetic toxicity, cancer, and even death. This project was implemented in a hospital system within Northern California, on two units that serve medical-surgical, oncology, geriatric, and transplant patients. The Medical Surgical microsystem at this hospital comprises a small group of professionals such as registered nurses (RNs), …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

Reducing Readmission (And Mortality) For Older Patients & Survivors Of Life-Threatening Conditions: A Study Using The Staarr Protocol, Akhenaten Amun

Symposium of Student Scholars

Readmission rates for patients admitted for heart failure, pneumonia, chronic obstructive pulmonary disorder, a myocardial infarction, a hip or knee arthroplasty, or coronary artery bypass surgery tend to have high readmission and mortality rates within 30 days of their discharge from a hospital. Starting in October 2012, the Healthcare Reimbursement Reduction Program enforced penalties on Medicare reimbursements for hospitals with readmission rates, for patients with the conditions above, were higher than averages based on facilities with similar characteristics and patient populations. Teach-back and verify (Klingbeil & Gibson, 2018), interdisciplinary teams that engage in patient care and support (Reiter-Palmon et al., …

Interventions To Decrease Readmission Rates In Lvad Patients, Karolina Jackson

Symposium of Student Scholars

Interventions to Decrease Readmission Rates in LVAD Patients

Karolina Jackson

WellStar School of Nursing, Kennesaw State University

NURS 4417: Advanced Clinical Practicum

Lynnda Campbell

October 21, 2022

Abstract

Background: Patients who have undergone implantation of a left ventricular assistive device are at a higher risk for readmission- whether that be due to driveline dressing infections, thrombosis, bleeding at the site of implantation, or electrolyte imbalances. These readmission rates in the LVAD population can be decreased through appropriate intervention methods. Literature Review: This study’s main purpose was to discover interventions healthcare facilities and core LVAD staff can implement in practice to …

Impact Of Alarm Management Classes In Reducing Alarm Fatigue, Elizabeth Laegen

Symposium of Student Scholars

Alarm fatigue is becoming a more and more common problem for nurses working in inpatient hospital units, especially critical care units. Monitoring systems, ventilators, vital signs monitors, and other electronic devices designed to detect critical or pending critical values and alterations in patients have become more of a nuisance than the lifesaving systems they were designed to be. With alarms sounding frequently for what are typically nonactionable alerts, nurses to have developed a decrease in sensitivity to all alarms, regardless of importance. Research of alarm fatigue has shown that while the significance of the problem is clear and studies have …

In Adult Icu Patients With Central Lines, Does Improved Staff Adherence To The Clabsi Prevention Clinical Practice Guidelines Reduce The Incidence Of Clabsis?, Job Waihiga

Symposium of Student Scholars

A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when bacteria or viruses enter the bloodstream through the central line. Background: This project is important because central line-associated bloodstream infections increase hospital mortality rates, lengths of stay, and 30-day readmission rates. They also impose heavy financial burdens on hospital systems. Furthermore, out of all the nosocomial infections, central line-associated bloodstream infections have the highest and most recent incidence rates in this adult ICU unit. Purpose: This project aims to identify an intervention to improve staff adherence to the CLABSI prevention bundle and decrease the rate of …

Reducing Noise Levels In Intensive Care Units Using Noise Monitoring Technology, Kayla Kloes

Symposium of Student Scholars

Intensive care units require many medical procedures, activities, machines, and staff that contribute to high levels of noise. These high noise levels have been found to cause adverse psychological and/or physiological health effects related to sleep disturbances, increased anxiety, and increased stress. These health effects may lead to decreased patient satisfaction. The purpose of this proposal is to explore the effectiveness of the SoundEar 3-300 device in decreasing levels of noise and as a result, increasing patient satisfaction. The current research indicates that the SoundEar 3-300 device is successful at reducing hospital noise levels. This device allows for the measurement …

Impact Of Alarm Fatigue In Critical Care Nurses On Patient Outcomes, Addie Mctyre

Symposium of Student Scholars

Background

Critical care units are equipped with extensive amounts of patient monitoring equipment that sound alarms to alert nursing staff to changes in the patient’s condition. The constant beeping of alarms can result in a phenomenon known as alarm fatigue, when nursing staff becomes accustomed to the continuous sound of alarms and either tune it out or ignore it completely. This can result in poor patient outcomes. The purpose of this project is to propose techniques to decrease false alarms to reduce the overall number of alarms during a shift. This will lead to a reduction in the occurrence of …

Does The Use Of Machine Learning Algorithms Help Reduce Mortality Rates In Patients With Sepsis, Jacqueline Easter

Symposium of Student Scholars

Abstract

Background: Sepsis is the result of the body’s dysregulated response to an infection. The response can cause an inflammatory chain reaction which can lead to multiple organ dysfunction septic shock, and death. Early recognition and treatment of risk of sepsis is essential to control the disease. Each hour of delay treatment is associated with 3%-9% increase in mortality rate (Kuo et al., 2021). The current methods for prediction of sepsis such as SOFA have prediction rates low as 61% (van Doorn et al., 2021). Research using Machine Learning Algorithm has demonstrated prediction rates of 95% within an hour (Singh …

Intensive Care Unit (Icu) Delirium, Mckenna Redmond

Symposium of Student Scholars

The purpose of this evidence-based practice project is to implement and evaluate an effective way to prevent intensive care unit (ICU) delirium. My research question is asking whether nonpharmacological or pharmacological therapies are effective for preventing intensive care unit delirium acquired during stay. Delirium is a mental state that occurs from a variety of reasons that creates changes in arousal, cognition, and in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. Delirium during acute settings, such as the ICU, can cause an increased risk for mortality. Thorough evaluation of multiple studies exemplified that …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Effects Of Oral Care And Positioning On The Incidence Of Ventilator-Associated Pneumonia, Nneka Uwaekwe

Symposium of Student Scholars

Abstract

Background: Ventilator-associated pneumonia (VAP) is a lung infection that is acquired after endotracheal intubation. It is associated with increased length of hospital stays, costs, and rate of mortality for mechanically ventilated patients in the intensive care unit. The role of oral care with chlorhexidine and patient positioning are being considered as interventions for VAP prevention, however, uncertainties remain regarding the benefits and harms of chlorhexidine and positioning for preventing VAP. Purpose: The purpose of this study is to determine the effect of positioning and the use of chlorhexidine for mechanically ventilated patients, on the incidence of ventilator-associated pneumonia …

Unmasking The Leading Injuries In Hospitals And A Promising Change, Taylor Karisny

Symposium of Student Scholars

Abstract

The problem that will be studied is the increased development of pressure ulcers among hospitalized intensive care unit patients. The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately and effectively is increasingly important for all professionals in wound care. The review of the literature shows, hospital-acquired pressure ulcers are expensive to treat with the U.S. median cost at $39,000 per patient stay and costing U.S. health care system $3.6 billion per year. Several interventions and preventive measures are current used …

Interventions To Combat Burnout In Intensive Care Unit Nurses, Emily C. Randall, Amber T. Mcclarty, Omotoyosi Ogedengbe

Symposium of Student Scholars

Background: This literature review summarizes the knowledge, causative factors, associations/relationships, and interventions of burnout, positive work environments, and sleep quality in intensive care unit (ICU) nurses.

Objectives: To answer the question, how effective is a positive work environment compared to psychological interventions, specifically improved sleep habits, in reducing burnout in ICU nurses?

Methods: A literature search was conducted using combined keywords in 4 databases of 10 peer reviewed publications from 2016 to 2022. Information related to burnout, positive work environments, and sleep quality in intensive care unit (ICU) nurses was compared and summarized.

Results: There is sufficient evidence that positive …

Interventions To Prevent Hospital Acquired Pressure Injuries, Astrid Geronimo

Symposium of Student Scholars

Background: Hospital acquired pressure injuries (HAPIs) are the most common preventable complication among critical care patients. This project is conducted to compare the effectiveness between the current implemented preventative measure versus the new measures that have data supporting their effectiveness. Brief Significance: Five articles were chosen that outlined the prevalence of hospital acquired pressure injuries in critical care patients and alternative interventions that have been effective in the prevention of HAPIs. These evidence-based interventions include: The application of multilayered foam dressing with hypo oxygenated fatty oils which would reduce sheer and provide support from the pressure of laying in the …

Cauti Prevention In The Icu, Kai Zheng, Christie Emerson, Nerma Redcross

Symposium of Student Scholars

Project Proposal Abstract

Background: ICU patients are often bedbound for extended periods. Routine insertion of a urinary catheter, lack of proper Foley care techniques, and reluctance to remove the urinary catheter increase the risk of CAUTI. Each day a catheter is left in place, the patient's risk for CAUTI increases by 5%.

Brief Literature review: The incorporation of the Plan-Do-Study-Act approach helped to reduce CAUTI by deliberately layering single interventions over an extended period of time, it allowed the nurses to fully adopt each intervention before moving on to the next.

Methods: Interventions included considering alternatives to indwelling urinary catheters, …

Prevention Of Pressure Ulcers Interventions, Halle Borgel

Symposium of Student Scholars

Pressure injuries continue to be a rising problem in hospitalized patients, specifically non-ambulatory patients. Without frequent turning and pressure relieving surfaces, patients may develop a pressure injury that costs them more and lengthens their hospital stay. By comparing frequent turning schedules and pressure relieving foam mattresses in the prevention of pressure injuries, thousands will be prevented. After a thorough search review on articles, five articles were selected in determining which prevention method happens to be the best. Although no articles researched the clinical prevention in foam mattresses and frequent turning, conducting a proposed project is effective. The proposed project consists …