Critical Care Nursing Commons^™

The Effect Of Escape Room Simulation On The Self-Efficacy And Communication Levels Of Novice Critical Care Nurses, Lauren A. Femino, Kim Chapman, Julie A. Marshall, Shelby A. Trull, Jennifer A. Dibenedetto

The Lahey Journal

Abstract 

Introduction: Novice critical care nurses often report having low self-confidence and effective communication skills when transitioning to the ICU practice, often due to stress, limited experience, and unfamiliarity with critical care environments. These challenges can not only affect their job satisfaction and retention rates, but also pose serious risks to patient safety and outcomes. The purpose of this evidence-based practice (EBP) project was to assess the impact of an escape room simulation on the self-efficacy and communication skills of novice critical care nurses.

Methods: An evidence-based practice (EBP) project with pre-test and post-test design was conducted to …

Early Sepsis-Recognition Simulation Training: An Evidence-Based Initiative, Blanca A. Zavala

SACAD: Scholarly Activities

Sepsis is a life-threatening condition that requires rapid recognition and intervention to prevent poor patient outcomes. Delays in identification remain a significant concern for patient safety, particularly among nurses and nursing students who may lack confidence and clinical judgment in early sepsis recognition (Marsack et al., 2022). This evidence-based practice project aimed to examine the existing evidence on sepsis education and evaluate the effectiveness of simulation-based learning in improving clinical judgment and sepsis recognition, with the goal of informing a potential sepsis training initiative for nursing students.

A literature review of six peer-reviewed studies (2022–2026) was conducted using the PubMed …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

Enteral Nutrition Guidelines Improve Critically Ill Patients’ Outcomes: A Quasiexperimental Study, Marwa Abdo, Sara Elsayed Hegazy

Nursing

Background: Optimal nutritional support is a fundamental element of treatment for critically ill patients. Adherence to evidence-based enteral nutrition guidelines is essential to promote patient care and prevent potential complications. Objectives: To assess the effectiveness of enteral nutrition guidelines in improving critically ill patients’ outcomes. Method: A quasiexperimental study evaluated 68 critically ill patients divided into 2 groups. The intervention group received their nutrition based on the evidence-based enteral nutrition guidelines, while the control group received their nutrition based on the unit’s routine care. The study was conducted in the surgical intensive care units of Mansoura Emergency Hospital in Egypt. …

Empowering Excellence: Nurse-Educator Led Ccrn Study Group, Mary Judson Msn, Rn, Ccrn, Cnl

Posters

Key Takeaway:

Implementation of a nurse-educator led study group for specialty certification exams can potentially increase the number of certified nurses in a unit.

Optimizing Pediatric Peri-Anesthesia Care: A Donna Wright Nursing Competency Framework, Marisa Elise Gauna

Master's Projects and Capstones

Problem: Preventable hospital errors are often associated with inconsistent nursing competency, especially in high-acuity areas such as pediatric peri-anesthesia units. Traditional evaluation tools like checklists have limited effectiveness, as they frequently fail to engage staff or adapt to changing clinical demands (Wright, 2005). Context: At a Bay Area children’s hospital, baseline data from August 2024 revealed that only 65% of peri-anesthesia nurses reported feeling “very” or “somewhat” comfortable with key clinical skills. To address this, a quality improvement project was launched with the goal of increasing comfort levels by 15% using the Donna Wright Competency Model, which emphasizes staff engagement, …

The Wright Way: Advancing Pediatric Perianesthetia Nursing Competencies, Marisela E. Acevedo-Padilla

Master's Projects and Capstones

Objective Implementing the Donna Wright Competency Model at a Bay Area Children’s Hospital in its peri-anesthesia units. Throughout available literature it was possible to observe the positive effects of implementing a competency model such as the DWCM has on the confidence of nursing staff and patient outcomes. An important point shown by literature was addressing more than technical skills and incorporating critical thinking and ethical considerations regarding patient care. Aim We aim to improve nurse competency in pediatric peri-anesthesia units at a Bay Area Children's Hospital by implementing Donna Wright’s Competency Model. Data obtained in August 2024 from a series …

Impact Of Sepsis Education For Emergency Department Staff: A Quality Improvement Project, Shayna E. Thoene, Shannon Mills

Doctor of Nursing Practice Projects: College of Nursing

Background: Sepsis continues to be a critical issue worldwide. New sepsis guidelines instituted by the Centers of Medicare and Medicaid Services (CMS) list evidence-based standards to comply with regarding care for sepsis patients. To help a new acute care facility meet compliance, a sepsis educational program has been developed to assess staff knowledge and confidence in caring for these patients.

Methods: This quality improvement (QI) project was developed using a pre-post study design to assess the impact of implementing a sepsis educational program for emergency department staff at this new acute care institution. A sepsis educational program was derived from …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Enhancing Srna Confidence: Integrating Simulation-Based Crm Training With Didactic Education To Improve Intraoperative Recognition, Communication, And Management Of Intraoperative Cardiac Arrest, Melissa Lee

Doctor of Nursing Practice Scholarly Projects

Within the operating room (OR), the ability to identify deteriorating patient conditions and effectively communicate, is essential to delivering safe and efficient care. Although rare, the critical nature of emergent events necessitates early recognition and prompt intervention by an experienced anesthesia provider. The complexity of emergency management is often related to diagnostic ambiguity, individual provider experience, and disruptions of the fast-paced OR environment, requiring appropriate training methods for proficient execution. However, student registered nurse anesthetists (SRNAs) often lack sufficient exposure to emergent clinical scenarios, leading to delayed intervention and diminished confidence during crisis management. An evidence-based simulation education guideline for …

Nursing Care During Natural Disasters, War Zones, And Mass Casualty Incidents: Implications For An Educational And Professional Overhaul, Erin N. White

Undergraduate Honors Theses

Emergency situations around the world are inevitable. Any nurse who practices for any period of time is sure to encounter situations like these. Their hospital may be flooded with traumatic and severely life-threatening patient cases where supplies can become scarce. In these situations, a nurse and all other healthcare personnel are expected to act effectively, efficiently and in a highly organized way. Despite this need, many hospitals fail to implement effective disaster preparedness programs and plans. This leaves healthcare workers at a loss for how to treat patients, communicate within and outside of the hospital, coordinate transport, and all the …

Impact Of Nursing Education On Kangaroo Mother Care: Neurodevelopment Outcomes In Preterm Infants, Giana Usac

Nursing | Student Research Posters

Preterm birth poses a significant risk to the normal trajectory of brain development, particularly in the cortex, which is responsible for higher cognitive functions, motor control, and socio-emotional processing. However, Kangaroo Mother Care (KMC) has emerged as an important early intervention capable of improving neurodevelopmental outcomes in preterm newborns. This quantitative research proposal aims to assess the influence of nurse education on KMC practices, identifying pivotal periods in infancy when KMC has the most significant impact on neurodevelopment outcomes in preterm infants. The literature critique focuses on the efficacy of nursing education, the optimization of KMC regarding duration and frequency, …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Improving Nutrition Screening Practice In The Hospitalized Heart Failure Patient Population, Amanda J. Bourgeois

DNP Projects

Background: Heart Failure is a disease known to affect nearly 6.5 million adults in the United States. Characterized by recurrent hospitalizations, heart failure significantly contributes to morbidity, mortality, and healthcare costs in the United States and worldwide. Because malnutrition is prevalent in the heart failure population, healthcare providers must perform nutritional assessments on admission to intervene in the case of malnutrition, prevent deterioration, and improve patient prognosis. Without intervention and early identification of malnutrition, heart failure hospitalizations will remain a significant problem.

Purpose: The purpose of this study is to evaluate the effect of an evidence-based educational program for cardiac …

Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Tyler Faust

Electronic Theses and Dissertations

This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …

Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske

Graduate Medical Education Research Journal

Background: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes.

Purpose: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR).

Method: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto

Master's Projects and Capstones

Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.

Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.

Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.

Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …

Implementation Of A Nurse-Led Clinical Algorithm For Pressure Injury Prevention Associated With Non-Invasive Ventilation Medical Device Use, Capri Steinkuhler, Kaitlin Rogge

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Medical device related pressure injuries (PI) account for as much as 61-81% of all hospital reported wound incidents (Gefen et al., 2020) and are frequently caused by respiratory devices such as non-invasive ventilation (NIV). Use of NIV in critically ill patients dramatically increased during the pandemic. PI are one of the leading causes of injury to hospitalized patients and lengthens hospital stays (National Pressure Injury Advisory Panel [NPIAP], 2019). The NPIAP recommends routine skin assessment under devices, proper mask fit, protective barrier, moisture reduction, and interdisciplinary collaboration to prevent PIs from NIV masks. This feasibility study’s purpose …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

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 …

Nursing Students’ Perceptions Of Using Branching Simulation: A Qualitative Descriptive Study, Mohammad Rababa, Dania Bani-Hamad, Shatha Al-Sabbah

The Qualitative Report

Previous intervention studies have shown that branching simulation (BS) unfolds the complex multidimensional aspects of challenging health problems. The present study aimed to examine graduate nursing students’ perceptions of using BS in professional training. This study used a qualitative descriptive design with semi-structured interviews with a sample of 20 graduate nursing students. Four main themes emerged from the results: (a) BS as a support to students’ professional training, (b) BS leads to changes in clinical practice, (c) whether BS is a stressful learning experience, and (d) BS versus traditional lecturing. The participating students perceived BS as a valid learning tool …

A Competence-Based Online Learning Video And In-Situ Simulation To Improve Perioperative Anesthesia Nurse Practitioner Self-Efficacy In Responding To Anesthesia Emergencies, Sara Durgerian

Doctor of Nursing Practice Scholarly Projects

Background: Nurse Practitioners (NPs) are broadly educated to the population-based role in which they practice. Further education in subspecialties is essential as more NPs are working autonomously in highly specialized care areas.

Problem: In the Department of Anesthesia at a large urban hospital, perioperative anesthesia NPs lack formal training in the subspecialty of anesthesia, which contributed to a lack of self-efficacy when responding to anesthesia emergencies.

Methods: An asynchronous multimodal brief instructional video accompanied by an in-situ simulation of an anesthesia emergency was developed to increase knowledge and confidence in perioperative anesthesia nurse practitioner response to anesthesia emergencies.

Results: A …

Everyday Ethics And Equity At The Bedside, Shika Kalevor, Angie Knackstedt

Research Days

Background: Traditional bioethics training, although important, may not be completely suited to the nursing role. In contrast to traditional clinical ethics, which focuses on healthcare dilemmas, everyday ethics focuses on routine clinical encounters between clinicians, patients, and families and may be better suited to help nurses address issues such as bias and racism at the bedside.

Objectives/Goal: This study aims to provide a data-backed approach to ethics education for nurses as it pertains to improvements in the understanding of Diversity, Equity, & Inclusion (DEI) efforts in healthcare. This study also provides an opportunity for the field of bioethics to provide …

Using Complex Medical Devices: Icu Nurses' Safety Perceptions, Violet Rhagnanan-Kramer

NSU REACH and IPE Day

Purpose: The purpose of this study was to gain insight into ICU nurses’ safety perceptions and explore continuing educational strategies for improving nurses’ technological competence. Background: Medical errors are the third leading cause of death in America. Over 10,000 medical errors occur daily, with an estimated financial impact of preventable mistakes is 20 billion dollars annually. Increasing the use of multifarious sophisticated medical technologies in the Intensive Care Unit (ICU) poses a risk of medical errors and unintentional harm to patients. However, limited empirical evidence exists regarding ICU nurses’ perspectives. Methods: This research featured an online mixed methods descriptive exploratory …

Exploring Saudi Emergency Room Nurses’ Perceptions About Their Disaster Preparedness, Fadiyah Alshahrani

Seton Hall University Dissertations and Theses (ETDs)

Background: Disasters can overwhelm the capacities of health care facilities quickly. In recent years, the world has been affected by an increasing number of significant disasters. These include natural disasters such as earthquakes, hurricanes, floods, tornados, storms, fires, and epidemic outbreaks. There are man-made disasters such as terrorist attacks, transportation accidents, and stampedes at mass gatherings. The resulting deaths and property damages have enormously affected countries’ economies, particularly on a health care system’s preparedness. In a major disaster, health care professionals must respond, manage, and prevent additional harm to victims. Nurses are the largest group of health care professionals …

Reducing The Incidence Of Pressure Injuries In Adult Icu Patients At Mcallen Medical Center With The Implementation Of A Pressure Injury Preventive Bundle: A Quality Improvement Project, Cheryl Cruz

Student Scholarly Projects

Practice Problem: Pressure injuries (PIs) are a significant healthcare problem globally. Adult patients in the intensive care setting are especially vulnerable to the development of PIs given the acuity of their diagnoses requiring extensive treatments, procedures and the use of multiple medical devices.

PICOT: The PICOT question that guided this project was, “In adult intensive care unit (ICU) patients, how does the effect of implementing a pressure injury prevention bundle compare in patients who received the bundle, and patients receiving standard pressure injury prevention in reducing the incidence of pressure injuries after two months?”

Evidence: Evidence exist that bundle implementation …

Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable

Master's Projects and Capstones

The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …

A Compilation Of Written Instructional Practice Reflections On The Acue (Association Of College And University Educators) Course In Effective Teaching Practices, Sheryll Go

Q2S Enhancing Pedagogy

This is a compilation of written instructional practice reflections on The ACUE (Association of College and University Educators) Course in Effective Teaching Practices, from January – April 2020. This online course has prepared Nurse Educators like me in gaining a foundation in evidence-based teaching practices that increase student motivation, engagement, and learning. The attached assignment include reflections from completed modules.