Critical Care Nursing Commons^™

Noise In The Acute Care Patient Setting, Taylor A. Cota, Brynn Roberts

Honors Theses and Capstones

Noise levels in hospital environments can negatively impact patient satisfaction and recovery, particularly in high-acuity units such as Progressive Care Units (PCUs) (Choiniere, D. B., 2010). Patient satisfaction surveys at the PCU at Exeter Hospital have consistently identified noise as a concern, highlighting the need for rigorous quality improvement (QI) planning phase to determine whether a structured intervention, such as white noise implementation, is indicated.

This project focuses on the initial planning phase of the Plan-Do-Study-Act (PDSA) cycle (Institute for Healthcare Improvement, n.d.) to assess the feasibility and necessity of introducing white noise machines to enhance patient experience on the …

Implementing Safe Nurse-To-Patient Ratios, Susan Clark, Molly Peasley, Tessa Pemantell, Grace Fritch

SPARK Symposium Presentations

Our project advocates for state mandated nurse-to-patient ratios in Tennessee critical care units to enhance patient safety, reduce nurse burnout, and improve overall healthcare quality. Research shows that inadequate staffing leads to higher mortality rates, complications, and longer hospital stays, while hospitals with mandated ratios report better patient outcomes and nurse retention. California’s model demonstrates the effectiveness of such policies, highlighting the need for nationwide implementation. The project follows an SBAR approach, outlining the situation of unsafe staffing, the background of financial-driven disparities, and the need for policy change. The plan includes stakeholder engagement, legislative advocacy, and public awareness campaigns. …

Enhancing Resilience In Oncology Nurses Through The Implementation Of A Peer Support Program, Denise M. Robinson-Smith

DNP Scholarly Projects

ABSTRACT

Background: Oncology nurses face high rates of burnout and compassion fatigue, contributing to significant turnover and threatening the stability of the oncology nursing workforce. The projected increase in cancer incidence and the resulting demand for oncology services underscore the urgent need for interventions that enhance nurse resilience. Local Problem: At a major hospital in Jacksonville, Florida, it was found that oncology nurses face a significant gap in emotional support, especially during critical incidents such as patient deaths or traumatic events. Existing resources were insufficient to address the unique stressors faced by this team. Methods: A quality …

Design And Implementation Of A Nursing Peer Practice Case Review Program In An Academic Surgical/Trauma Icu, Natalie Tredway

DNP Scholarly Projects

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on …

Implementation And Evaluation Of A Competency-Based Phased Orientation Program For Nurse Practitioners In The Intensive Care Unit Setting, Meredith Sherer

DNP Projects

Background: Research has demonstrated that structured orientation helps to integrate new nurse practitioners (NPs) into practice, ease role transition, decrease NP turnover, and lead to better patient care. However, at University of Kentucky HealthCare (UKHC) clinical orientation programs for NPs are not standardized.

Purpose: The purpose of this project was to implement and evaluate a competency-based phased orientation program for NPs in the intensive care unit (ICU) setting at UKHC.

Methods: This project utilized a prospective, single group, presurvey-postsurvey design to examine the effect of a three-phased competency-based orientation program on the outcome variables of NP confidence, autonomy, proficiency of …

Implementation Of An Advanced Practice Provider Into The Outpatient Neurology Clinic To Improve Access To Care And Medication Compliance, Sean O'Laughlin

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The American Association of Neurology (AAN) recommended that post-stroke and TIA patients receive follow-up care within 2–4 weeks of discharge to reduce complications, improve medication adherence, and decrease readmission rates (2023). However, in 2022, a Central Virginia neurology practice reported an average wait time of 98.66 days for outpatient follow-up appointments, significantly exceeding the AAN recommendation, while medication adherence was only 72.23%, compared to the national average of 80%. Research by the American Academy of Neurology Workforce Task Force (2013) and Woo et al. (2017) highlighted that incorporating advanced practice nurses into outpatient settings could enhance access to care and …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In Adult Oncology Patients Through Improved Compliance With Oral Hygiene Protocols, Rickey Maung

Master's Projects and Capstones

Objective: Oncology patients undergoing chemotherapy are at increased risk of mucosal barrier injuries and aspiration pneumonia, with current aspiration pneumonia rates exceeding target levels. Enhanced oral hygiene protocols and improved compliance have been shown to reduce these complications in this vulnerable population.

Context: The microsystem under review comprises six oncology units within Hospital A, a major medical center in California. Aspiration pneumonia, frequently linked to mucosal barrier injuries, poses a significant threat to patient safety and increases treatment costs and complications in oncology care. Recognizing the critical need to address this issue, an aspiration pneumonia task force has prioritized efforts …

Impact Of Training For Nursing Staff In The Prevention Of Hapis, Onyinye E. Ohia, Colleen A. Anthony

Master's Projects

Abstract

Background: The incidence of Hospital acquired pressure injuries (HAPIs) have remained a problem in healthcare despite concerted efforts by hospitals and other governmental agencies to eliminate the problem via policy and emphasis on safety. There is support in literature for the training of healthcare professionals as an important tool in the prevention and management of HAPIs. Despite the existence of studies that link training of nurses to a reduction in rates of HAPIs, evidence in support of that is still piecemeal; with poorly defined outcomes.

Aims and objectives: The aim of this integrative review is to identify …

Emergency Room Nurses' Perceptions Of Medication Errors In The Emergency Department, Yasmeen Mustafa

Undergraduate Honors Theses

Medication errors (MEs) remain a pervasive issue in United States emergency departments, where emergency room (ER) nurses play a central role in the medication process. The medication process involves transcribing, prescribing, dispensing, administering, and monitoring. Proper adherence to the process ensures that the right medication is given to the right patient in the correct dose, route, and time. It also allows consideration of potential interactions and side effects, with the goal of achieving safe and efficacious therapeutic outcomes. Given the potential life-altering consequences of MEs, it is imperative to harness the unique insights and experiences of ER nurses who are …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Unlocking Icu Barriers: Investigating The Challenges Of Early Progressive Mobility, Leslie S. Bigler

Doctoral Projects

Approximately 800,000 patients in the United States annually are admitted to the Intensive Care Unit (ICU) due to critical illnesses and prolonged immobility contributes to poor patient outcomes. While existing data demonstrates early and progressive mobility helps improve outcomes, adherence remains inconsistent for a variety of reasons such as safety concerns, staffing, and lack of knowledge and confidence of mobilization techniques. This quality improvement project, conducted in a 20-bed Medical Intensive Care Unit, asked staff to identify barriers to adherence to mobility protocols. Nurse managers and clinical educators play a crucial role in addressing these issues using strategies such as …

Implementation Of An Evidence-Based Hospital Acquired Pressure Injury Strategy In The Intensive Care Unit, Tonya C.W. Brigman

Student Scholarly Projects

Practice Problem: Hospital-acquired pressure injuries (HAPI) are a significant concern in healthcare with the most vulnerable group being the adult patients in ICUs leading to increased morbidity, longer hospital stays, and higher healthcare costs.

PICOT: In adult ICU patients (P) does the implementation of daily chlorhexidine gluconate (CHG) baths with post bath barrier cream combined with intentional turning every 2-hours (I) compared to standard skin care practices and nonintentional turning (C) reduce the incidence of hospital-acquired pressure injuries (HAPI) (O) within 10-weeks (T)?

Evidence: The project was based on the analysis of the literature published in the …

Ultrasound Guided Piv Insertion Implementation, Blake Hotchkiss, Beth O'Donnell, Miles Merwin, Billie Jo Senecal, Ronica Smith, Eric Alan, Bryan Tavary, Chelsea Harkins, Taylor Archard, Leslie Geissinger, Lauren Remington

Operations Transformation

Observed high number of unsuccessful peripheral IV insertion attempts. This increases waste (cost and time) and decreases patient satisfaction.

Dnp Final Report: Central Line Dressing Change Regimen To Decrease Central Line-Associated Bloodstream Infections, Ann Campbell

DNP Final Reports

Central line associated bloodstream infections (CLABSI) are dangerous and costly occurrences in healthcare facilities. This evidence-based project's purpose is to implement interventions to reduce CLABSIs in a healthcare facility that has higher than the national average of reported cases. The practice problem PICOT question is: In inpatients with indwelling central venous access devices at the facility, (P) how does implementation of evidence-based guidelines for central line dressing changes every seven days and as needed (I) compared to the current practice of dressing changes on Fridays (C) affect CLABSI rates over a three-month period (O). The body of evidence obtained in …

Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

The Lived Experience Of Nurses In Caring For Patients With Covid-19, Jessica Barre

Electronic Theses and Dissertations

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …

Research Makes A Difference: Changing Post Surgical Vital Signs, Elizabeth Plante, Sadie Seezs, Jennifer Burris, Tiffany Omann-Bidinger

Nursing Posters

Research Question:

Are reduced frequency of vital signs as effective in identifying patient deterioration in postoperative adult orthopedic and spine patients after a post anesthesia care unit stay with transfer to orthopedic and neuroscience spine units when compared to current practice?

Conclusions/Implications:

• Changing the frequency of post operative vital signs provides the same quality, not directly affecting an increased risk of death.
• Reduction in number of times vital signs needed completion, saving time for nurses to complete other duties.
• System wide change to routine post operative vital signs for floor level patients was implemented.
• Recommend future research for obstetric and …

Code Blue Debriefing, Micaela Herbst-Bialke

Nursing Posters

Situation and Assessment:

Opportunities to improve code blue events have been identified by comments received on code blue critiques and results from a survey completed by 120 code blue team members.

Background:

As referenced by the American Heart Association along with Get with the Guidelines, post code debriefing is a key element to promote continuous quality improvement in patient care. Post-event debriefings are a foundational behavior of high performing teams in improving individual and team performance.

Standardizing The Discharge Process To Reduce Copd Readmission Rates, Kristine Doligosa

Doctor of Nursing Practice Scholarly Projects

Background: Frequent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can lead to unfavorable patient outcomes and costly readmissions. Inadequate patient support during discharge and an inconsistent discharge process are factors contributing to high readmissions in this population.

Purpose: This quality improvement project aimed to reduce COPD-related hospital readmissions by standardizing the discharge process for patients admitted with AECOPD and identify patient risk factors for readmission.

Methods: Following a quantitative and quasi-experimental design, this project standardized the discharge process for patients admitted with AECOPD using the Re-Engineered Discharge Toolkit components and a discharge care bundle. The project was …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Student Research Posters

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Bundle For Left Ventricular Assist Device (Lvad) In The Ed, Tina Morris

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose

Left Ventricular Assist Device (LVAD) is a high-risk, low-volume patient population with admission rates of up to 72%. The purpose of this study was to provide a care bundle to increase the knowledge of the emergency department (ED) staff and decrease the door to consult times to the advanced heart failure (AHF) team for LVAD patients presenting to the ED at a level I trauma center in Texas.

Methods

In collaboration with emergency clinical staff, the project team implemented a bundle that included a pathway for the LVAD patients upon presentation to the ED, targeted education for clinical staff …

A Quality Improvement Initiative To Reduce Preanalytical Blood Gas Errors, Layla Haver Newbrough

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Introduction: Laboratory testing is one of the most commonly performed procedures in healthcare and resulting data are paramount to clinical decision making. Background: Preanalytical blood gas laboratory errors often stem from the incorrect recording of a patient’s fraction of inspired oxygen (FiO2) within the laboratory collection application. Incorrect FiO2 may cause erroneous results or delays in reporting results that have the potential to negatively impact patient safety and medical management.

Purpose: The purpose of this quality improvement initiative was to reduce the occurrence of preanalytical blood gas laboratory errors. Methods/Interventions: This initiative combined modification of the laboratory collection application …

Implementing A Nurse-Driven Clostridium Difficile Screening Protocol, Sandrela Magnuson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: Clostridium difficile infection (CDI) is a prevalent infection often contracted in hospitals. CDI is also increasingly originating from community settings. In addition to the health risks associated with CDI, diagnosis of a hospital-acquired CDI can have a significant financial impact on hospital systems. When hospital acquired, hospital systems are no longer reimbursed by payers. Secondary to the increasing prevalence of community-acquired CDI, mechanisms for early detection and isolation are warranted.

Local Problem: J.W. Ruby Memorial Hospital has an integrated Clostridium difficile (C. difficile) electronic health record (EHR) screening questionnaire that requires updating to align with current guidelines.

Purpose: …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Benefits Of Bedside Report, Konner Spalding, Hannah Mattingly

Scholars Week

No abstract provided.

Enhancing A Pressure Injury Prevention Bundle In A Skilled Nursing Facility, Lorillie Soleta

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and …