Critical Care Nursing Commons^™

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

Nicu Nurse Burnout: The Influence Of Moral Distress, Compassion Fatigue, And Spirituality On Burnout In Neonatal Intensive Care Unit Nurses, Lucia D'Andrea

Undergraduate Theses

Nurses face a multitude of interpersonal and individual expectations, challenges, and hardships every day of their profession. These experiences accumulate and can lead to burnout. This is especially true for nurses in Neonatal Intensive Care Units (NICUs) who care for infants struggling with prematurity, congenital diseases, withdrawal, and more, all while working closely with grieving parents. This thesis specifically focuses on research discussing moral distress, compassion fatigue, and spirituality as variables associated with the experience of burnout. A critical review of current literature revealed patterns and inconsistencies in the relationships between these factors. Workplace Stressors and moral distress were found …

Respite For Acute Care Nurses With The Use Of A Resilience Room, Marisella Perales

Doctor of Nursing Practice

Background and Significance of the Problem. Nurses are exposed to higher levels of occupational stress in acute care units when compared to other departments within the hospital (Faraji et al., 2019). A qualitative assessment identified a need for resources to be provided for acute care nurses experiencing occupational stress. Purpose. To establish an area for respite and increase nurses’ knowledge about a Resilience Room and a support system to manage occupational stress. Objectives. To educate 75% of acute care nurse on respite care, have 50% of the nurses report utilization of Resilience Room, and increase the nurses use of a …

Post-Operative Nursing Care Of The Renal Transplant Patient, Emily Smith

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Kidneys are the most commonly transplanted organ in the United States. All patients who receive a renal transplant must be on lifelong immunosuppressants to prevent rejection of the donor organ. The majority of patients do not take their immunosuppressant medications as instructed, making noncompliance a huge issue for medical professionals. The purpose of this literature review is to explore what evidence-based techniques nurses should employ to increase the long-term compliance of immunosuppressants in renal transplant patients. A literature review was performed of fifteen studies to identify interventions that nurses can employ to increase immunosuppressant compliance. CINAL and Medline were …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

The Efficacy Of A Communication Guide On Stress Experienced By Family Members Of Patients Admitted In The Intensive Care Unit With Covid-19, Kandace Williams

The Eleanor Mann School of Nursing DNP Capstone Projects

Coronavirus disease (COVID-19), first introduced in the United States on January 20, 2020, has created worldwide panic due insufficient research and understanding of the nature of this new disease. Patients suffering from COVID-19 often require intensive care unit (ICU) admissions, resulting in stress and confusion amongst patients and their families. The high transmissibility of the disease has caused hospitals to adopt firm visitor restrictions to protect the public from exposure and spread. Families experience increased anxiety and stress due to ineffective communication with staff and restricted access to their hospitalized loved ones. A needs assessment revealed a gap in care …

The Lost “Doe”: A Quality Improvement Project For Unidentified Patients, Brendi Gale

The Eleanor Mann School of Nursing DNP Capstone Projects

A Mass Casualty Incident (MCI) describes any natural or manmade disaster that stresses a community beyond their normal resources (CMS, 2019). Across the globe, populations have grappled with an increased frequency of natural disasters and a surge of critically ill secondary to pandemic SARs-CoV-2 (Cavallo, Donoho, & Forman, 2020; Smith, 2020; US Global Change Research Program, 2018). In addition, the incidence and severity of mass shootings has risen in the United States with a reported 277 active shooter events between the years of 2000-2018 (Federal Bureau of Investigation, 2018; Smith et al., 2019). An Emergency Department (ED) in Northwest Arkansas …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

The Impact Of A Digital Intervention On Perceived Stress, Resiliency, Social Support, And Intention To Leave Among Newly Licensed Nurses: A Randomized Controlled Trial, Lisa Concilio

Electronic Theses and Dissertations

The nursing shortage has been deemed a public health crisis with the turnover rate of newly licensed nurses (NLNs) growing (Robert Wood Johnson Foundation, 2014). One out of five NLNs are leaving the profession due to work dissatisfaction and feelings of inadequacy (National Academy of Medicine, 2017). NLN attrition during the first year of hire has been associated with feelings of overwhelming stress and decreased sense of support which negatively impact patient safety (Spence Laschinger et al., 2016). As seasoned nurses are attempting to retire amidst a nursing shortage (American Association of Colleges of Nursing, 2018), NLNs require more support …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Gratitude Journaling As Intervention To Combat Nurse Burnout In Cardiac Surgery Intensive Care Nurses, Melinda Simpson

Master of Science in Nursing Theses and Projects

As a practicing registered nurse in the intensive care setting, this researcher witnessed an episode of burnout characterized by a public meltdown, crying, and yelling. This sparked an interest in an intervention to combat nurse burnout. Literature was found on gratitude which has been found to increase resiliency. An increase in resiliency, in various populations, has been found to decrease perceived stress and feelings of burnout. This researcher investigated the use of gratitude journaling for 21 days as means to decrease perceived stress and feelings of burnout while increasing gratitude and resiliency. The PSS, GQ, BRS, & BBI tools were …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Reducing Re-Hospitalizations Of Patients With Heart Failure At A Skilled Nursing Facility, Louis D'Onofrio Jr.

The Eleanor Mann School of Nursing DNP Capstone Projects

The purpose of this project was to introduce the quality improvement (QI) process to reduce re-hospitalization rates in a skilled nursing facility (SNF) in Stratford, Connecticut for patients having a diagnosis of heart failure (HF). After reviewing the data from the nursing facility for re-hospitalization rates over a three-month period, it was discovered that 22% of patients at the SNF were re-hospitalized within 30 days. Of this population of patients, 22.9% had a diagnosis or complication of HF, which is associated with the highest re-hospitalization rates. This QI project focused on HF education customized towards nursing and nursing assistant staff …

Musculoskeletal Disorders In Healthcare Workers, Josephine Lauer

Master's Projects and Capstones

Musculoskeletal Disorders (MSD) are one of the leading causes of disability in hospital nurses and nursing aids and is a high cost problem in the healthcare industry. Working in a complex environment of an acute medical floor where repetitive nature of patient handling, can lead to musculoskeletal injuries for healthcare workers. This is evidenced by work-related injuries in hospitals nearly doubling compared to private industry and hospitals are one of the most hazardous work environments in the country. Musculoskeletal injuries of healthcare workers are an ongoing problem which requires investigation due to high risk of reoccurrence. This is especially true …

Impressions Of Participants In A Chemical Mass Casualty Exercise, Ethan J. Start, Joan M. Culley, Abbas Tavakoli

Senior Theses

A mass casualty exercise was performed to investigate triage and decontamination of patients exposed to an irritant gas. Nursing students participated in two groups: emergency department triage (ED) and decontamination (DECON). While participants felt overall that the experience was valuable, DECON participants had a greater interest in emergency response and were more likely to volunteer again.

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Reducing Annual Emergency Department Visits Through Improved Asthma Discharge Teaching, Alvin R. Walters

Master's Projects and Capstones

Asthma is the most common pediatric condition in the United States, and a child's home environment plays an impactful role in the triggering of asthma exacerbations (Harper et al., 2015). Current emergency department (ED) ideology focuses on symptoms management, with little time spent on education, and virtually no attention paid to the home environment. Evidence shows that programs which incorporate home environmental assessments into asthma patient education produce a reduction in annual ED visits, fewer missed school days, decreased use of rescue medications, and improvements in quality of life (Gruber K.J., et al, 2016, Hollenbach J.P. & Cloutier M.M., 2015, …

Retention Of Cardiopulmonary Resuscitation Knowledge And Psychomotor Skill Among Undergraduate Nursing Students: An Integrative Review Of Literature, Fernanda Tirado

Honors Undergraduate Theses

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: …

The Impact Of Self-Care Education On Heart Failure Patients With A High Risk For Readmission, Neil Williams Ii

Nursing Theses and Capstone Projects

The purpose of this Capstone Project study was to answer the question: Does self-care education improve knowledge and decrease 30 day readmission rates in a class of heart failure patients that are at high risk for exacerbation? The study used a randomized control design with a pre-test/post-test. A convenience sample of 50 African Americans diagnosed with heart failure were entered; control group (n=25) and experimental group (n=25). Both groups received the Heart failure Pre/Post Test developed by the researcher during the initial interview and four weeks post discharge. The experimental group received a phone call weekly over the four weeks …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

Staff Perception Related To Family Presence During Resuscitation, Stephanie L. Herron

Nursing Theses and Capstone Projects

The purpose of this study was to examine the perception of health care professionals (staff nurses) regarding family presence during resuscitation. The sample consisted of 59 nurses of different ages and working in different departments. The Staff Perceptions of Family-Witnessed Resuscitation questionnaire was used to collect data. The relationships between participants' demographic data and perceived attitudes and beliefs were also analyzed. Many of the healthcare professionals felt that it was acceptable to have family members present during resuscitation if the patient makes clear decisions prior to the incident or if the physician makes the decision for the patient. Almost half …

Discharge Education In The Emergency Department: Are We Effectively Teaching Chest Pain Patients?, Emily Edwards Nishiyama

Nursing Theses and Capstone Projects

Millions of individuals visit the emergency department (ED) each year with complaints of chest pain. Many chest pain patients do not have an underlying condition of Acute Coronary Syndrome (ACS) but the health and well-being of these patients is indispensable. Research has indicated soaring costs, an increased demand in medical resources, and an increasingly poor quality of life for these patients after discharge. Although research encourages quality education at discharge, very few studies have been conducted on ED discharge education for non-ACS chest pain patients. Using a cross-sectional descriptive research design, this quantitative study discovered the frequency of education provided …

Nursing Retention In Critical Care, Jeannine A. Eckman

Nursing Theses and Capstone Projects

The purpose of the study was to examine anticipated turnover in critical care nurses and if having previous nursing experience prior to working in critical care affects that turnover. Using the Anticipated Turnover Scale (ATS) by Hinson and Atwood, nurses that had been employed in the critical care areas five years or less were asked to participate. They were asked to complete the ATS and answer the question relating to previous nursing experience. Findings of the study indicated that the nurses with previous nursing experience before working in critical care had a higher ATS score than the nurses with no …

Nurse Manager Role Perception In An Acute Care Facility, H. Gale Waters

Nursing Theses and Capstone Projects

The Nurse Manager role is a crucial part of the healthcare delivery system in an acute care facility, particularly in the current wave of healthcare reform. These are unprecedented times for nursing leadership as they develop and move in a new direction. The role of Nurse Manager is complex with numerous studies including: past roles, characteristics, innovation, outcome, education, and advancement. This study observed the role through the point of view of the Nurse Manager. The Nurse Managers participated in a survey in which they ranked themselves on a one to five scale, with one being a novice in the …

The Effects Of Oral Pain Medication Being Administered In Phase I As Compared To Oral Pain Medications Administered In Phase Ii, Dana Jones

Nursing Theses and Capstone Projects

Healthcare and the provision of care are ever-changing as governing bodies over-see and regulate the way institutions provide care for patients. Pain assessment, reassessment, and pain management are a focus nationally and healthcare providers are held accountable for how pain is managed for patients. One piece to this broad topic is the use of oral pain medications, more specifically in the ambulatory surgical patient. The purpose of this project was to compare the length of stay, reported pain scores, and total amount of IV medications administered between patients who receive the first dose of oral pain medications in Phase I …

Evidence Based Practice: Patient Discharge Education Barriers To Patient Education, Catherine Lyerly Lingle

Nursing Theses and Capstone Projects

Evidence-based guidelines for discharge instructions, when successfully administered, reduce readmission rates in patients, leading to improved quality of life and economic savings. Unfortunately, effective delivery is complex and time consuming, placing a high demand on already overworked bedside nurses. Failure to provide complete discharge instructions can result in non adherence to patient treatment regimens and lack of essential follow-up, the most commonly identified reasons for readmissions. To improve quality of care, hospitals need to adopt a new model that incorporates delivery of intensive, one on one education to patients during the hospital stay with continuing support, guidance, and education throughout …

Floating Nurses To Specialty Areas, Deborah S. Hickman

Nursing Theses and Capstone Projects

As the largest group of health care providers, nurses play a vital role in the safety and satisfaction of patients. Despite this vital role, the nursing shortage continues to grow. As a result of this shortage and to fix staffing insufficiencies, nurses are frequently assigned to work in an area that they are not familiar with. This reassignment of a nurse to a different unit from their normally assigned unit is referred to as "floating." Nurses that are reassigned to a different unit from their normally assigned unit are referred to as "float nurses." Some healthcare professionals believe the use …

Workplace Violence: Emergency Department Versus Medical Surgical Nurses, Dakeita K. Roakes

Nursing Theses and Capstone Projects

The purpose of this study is to answer the following question: Does a registered nurses department, medical-surgical versus emergency department, change the amount of workplace violence they may experience? To accomplish this, a cross sectional descriptive study using an anonymous web-based Workplace Violence questionnaire survey by Wolters Kluwer Health was used to collect data from nurses working on medical-surgical units and in the emergency department at the facility. The findings indicate more physical violence with more frequent or occasional occurrences in emergency departments. The medical-surgical nurses reported more intimidation or emotional violence and never experience workplace violence.

The Effect Of Education On Healthcare Personnel's Knowledge Of Lymphedema Detection And Prevention, Dolly Wilson

Nursing Theses and Capstone Projects

Secondary lymphedema (SLE) is a serious problem for many of the 2.6 million breast cancer survivors in the United States. It is estimated that 28 - 38% of breast cancer survivors develop lymphedema. The five-year incidence ranges from 43% to 94% (Armer, 2010). The purpose of this study was to evaluate the effectiveness of an education program on healthcare personnel's knowledge of the risk of and preventive measures for upper limb lymphedema in breast cancer patients. A sample of healthcare personnel (N = 32) included both trained healthcare personnel and ancillary staff who are employed in a single oncology center …