Critical Care Nursing Commons^™

Reducing Cautis In A Neurological Icu, Claire Mckee

Dissertations

Catheter-associated urinary tract infections (CAUTIs) are the primary source of infection in patients with urinary catheters and are the fourth leading cause of healthcare-associated infection. Because indwelling urinary catheters are not completely avoidable in hospitalized patients, it is crucial to utilize evidence-based research to prevent CAUTIs. A urinary catheter maintenance bundle is one way to reduce CAUTI rates in hospitalized patients. This quality improvement project utilizes a catheter maintenance bundle with seven elements with the aim of reducing CAUTI rates. The project takes place in a 20-bed neurological intensive care unit (ICU) in a larger tertiary care medical center. Prior …

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 …

Does Preoperative Ostomy Education Decrease Anxiety In The New Ostomy Patient?, Michelle Suzann Harris

Doctoral Projects

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. …

An Interdisciplinary Code Sepsis Team To Improve Sepsis Bundle Compliance In The Emergency Department, Jill M. Delawder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: Sepsis is one of the leading causes of mortality with over 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis including electronic alert systems, standardized order sets, nurse-initiated protocols and specialty trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.

Methods: The aims of this rapid cycle quality improvement project were 1) to develop and implement an interdisciplinary team to address early implementation of evidence-based sepsis bundles in the emergency department and 2) to compare sepsis bundle compliance three months pre-and three …

Nicu Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Renea L. Beckstrand, Rebecca F. Isaacson, Janelle L. B. Macintosh, Karlen E. Luthy, Lacey Eden

Faculty Publications

Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles.

Objective: The objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs.

Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.

Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Leadership Rounding In The Intensive Care Unit To Improve Satisfaction, Stephanie Laborde

Master's Projects and Capstones

A mid-sized hospital in Alameda County would like to increase its Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores by improving the patient care experience. The specific aim for this project is that by August 2018, the implementation of daily leadership rounding in the ICU will result in an increase of patient satisfaction HCAHPS scores by 5%. The project team used the Plan-Do-Study-Act cycle to guide the implementation of leadership rounding. Leadership rounding was conducted daily over a 10-week period by the project team, which consisted of the floor manager and clinical nurse leader (CNL) student. The project …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

Emergency Nurses’ Department Design Recommendations For Improved End-Of-Life Care, Renea L. Beckstrand, Elise M. Corbett, Janelle L. B. Macintosh, Karlen E. (Beth) Luthy, Ryan J. Rasmussen

Faculty Publications

Introduction: Although death is common in emergency departments, there is limited research regarding ED design as an obstacle to end-of-life care. This study identifies emergency nurses’ recommendations regarding ways designs have negative or positive impact on care for dying patients and their families.

Methods: A 25-item questionnaire was sent to a national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in emergency departments, and had cared for at least 1 patient at the end of life (EOL). Responses were individually reviewed and coded.

Results: Major obstacles included (1) issues related to limited space, …

Assessment Of Nursing Knowledge Before And After Implementation Of Educational Intervention On Heart Failure, Sarah Scott

Dissertations

Purpose: The purpose of this study was to assess the knowledge of nursing staff on a cardiology unit before and after the implementation of heart failure specific education. Methods: Forty staff nurses on a cardiology unit at a single institution were given The Nurses Knowledge of Heart Failure Education Principles Survey (NKHFEP), a validated tool to assess nursing knowledge of heart failure. A series of four educational sessions were given to the same forty nurses. They were then given the NKHFEP survey a second time to assess change in knowledge post educational intervention. Results: The mean of Pre-education (M = …

Hospital Acquired Pressure Injury Prevention On An Inpatient Unit, Cherilyn Schumacher

Master's Projects and Capstones

Abstract

The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the …

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 …

Establishing A Hybrid Wound And Ostomy Continuing Education Program, Vivian K. Wong

Faculty Publications

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive.

A Pediatric Respiratory Care Curriculum For Emergency Department Nurses, Luzmaria Alcala-Van Houten

Doctoral Projects

As pediatric visits to community hospitals increase, the Institute of Medicine (IOM) and the Pediatric Emergency Care Network (PECARN) recommend that staff be provided improved education, protocols, and resources to improve patient outcomes (Emergency Medical Services for Children, n.d.). Acute respiratory disorders are the most commonly seen complaints in children aged 0–24 months, with an average of 2–4 visits a year. The purpose of this Doctor of Nursing Practice (DNP) project is to create a pediatric respiratory care curriculum for emergency department nurses in the Kaiser Permanente Central Valley Area (CVA) and to have it evaluated by a group of …

Prone Positioning In Acute Respiratory Distress Syndrome Patients, Sarah Rose H. Thornton

Honors Undergraduate Theses

Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient’s oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients.

Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms …

Critical Care Nurses’ Qualitative Reports Of Experiences With Family Behaviors As Obstacles In End-Of-Life Care, Renea L. Beckstrand, Caitlin Mallory, Janelle L. B. Macintosh, Karlen E. Luthy

Faculty Publications

Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs …

Evaluation Of Self-Efficacy And Confidence Levels Among Newly Graduated Nurses Exposed To An End-Of-Life Simulation: A Comparison Study, Catherine Edwards

DNP Projects

Purpose: The purpose of this project is to compare self-efficacy and confidence levels among a cohort of newly graduated nurses (defined as nurses who have had no nursing experience and are participating in a new graduate nursing residency) who will participate in an EOL simulation with another cohort of nurses who have been practicing for a year or more, but have not participated in an end-of-life simulation.

Methods: The study included two parts. The first portion included a pre and post-test evaluation of an end-of-life (EOL) simulation intervention with newly graduated nurses (Group One, n= 22), as part of their …

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Knowledge And Attitudes Of Orthopedic Nurses Regarding Pain Management, Matthew Neumann

Doctoral Dissertations and Scholarly Projects

Nurses are at the forefront in the care of patient pain management; however, many nurses do not possess the knowledge, skills, and attitudes required for best pain management outcomes. Adequate pain management education is often infrequent in academic settings and in post-graduate health care environments. That shortcoming suggests a need to improve pain management education as advocated by The Joint Commission and U.S. Department of Health and Human Services. The purpose of this study is to measure 20 nurses’ knowledge and attitudes regarding pain and pain management while working in an orthopedic setting. It was an evidence-based practice project utilizing …

Programs That Can Support Nurses To Reduce Compassion Fatigue And Secondary Traumatic Stress: An Integrative Literature Review, Molly Gruettner

Grace Peterson Nursing Research Colloquium

Compassion allows a nurse to empathize with their patient and their family, but it does not prepare the nurse to cope with stressful events. Repeatedly being exposed to traumatizing events, pain, distress, and suffering can lead to nurse burn-out and fatigue. Compassion fatigue is a unique form of burnout and secondary traumatic stress (STS) encompasses ideas of compassion fatigue and the two terms are often used interchangeably. Objective: The goal of this systematic integrated literature review is to discover interventions to reduce compassion fatigue and STS in trauma nurses Methods: A systematic integrated literature review study was conducted using Ebscohost …

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education …

Barriers To Advance Directives, Anna Malia Connor Ticknor

Grace Peterson Nursing Research Colloquium

Abstract

Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of …

Cnl As Educator In The Emergency Department: Improving Hand Hygiene Outcomes, Michelle Batz

Master's Projects and Capstones

Prevention of hospital acquired infections (HAI) is a National Patient Safety Goal. Proper and frequent hand hygiene (HH) prevents HAI and various cross-infections in any setting. Audits of visual adherence for HH generates low compliance scores. During a yearlong improvement project, low monthly compliance scores of 52% in the Emergency Department (ED) of a community hospital, were reported by hospital auditors and found to be inaccurate by ED staff due to lack of visibility of HH actions because they occurred behind curtains or closed doors. Low scores and challenges were associated with behavioral change among ED team members, requiring multiple …

Acute Bronchospasm Under General Anesthesia, Cody Rasmussen

Nursing Student Class Projects (Formerly MSN)

An acute bronchospasm during general anesthesia can become a life-threatening intraoperative condition for any patient. Bronchospasm occurs when the bronchial smooth muscle constricts which makes ventilating the patient difficult, and can ultimately lead to hypoventilation, hypoxemia, and metabolic acidosis. It’s imperative for any anesthesia provider to understand what a bronchospasm is, its pathophysiology, differential diagnosis, and algorithm of treatments. This poster presentation provides a summary based discussion of acute bronchospasm under general anesthesia.

Critical Care Nurses’ Suggestions To Improve End-Of-Life Care Obstacles: Minimal Change Over 17 Years, Renea L. Beckstrand, Kacie Hart Hadley, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background: Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients.

Objectives: The purposes of this study were to collect CCNs’ current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions …

Copd Management And Role Of The Nurse Coach: Increasing Referrals And Participation In Pulmonary Rehabilitation, Carol Upcraft, C. Hoover, Joy Plamann, Jessica Oman

Articles

Chronic obstructive pulmonary disease (COPD) remains a significant cause for hospitalization and with complex management issues upon discharge a significant portion are being re-admitted within 30-days of first hospitalization. The beneficial effects of pulmonary rehabilitation (PR) in the management of COPD is well documented but continues to be underutilized as an important management strategy to reduce hospital readmissions. Transitional care programs which include nurse coaches, have immerged to empower patients to manage their disease and facilitate transitions through multiple care environments. Little is known about the efficacy of such programs on referral and participation in PR and subsequent reductions in …

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 …