Critical Care Nursing Commons^™

Implementation Of A Planned Extubation Nurse-Led Safety Bundle In A Pediatric Cardiac Intensive Care Unit, Broderick Sutton

Doctor of Nursing Practice Final Project Abstract

Purpose: To implement and evaluate a nurse-led planned extubation safety bundle designed to improve nurse preparedness, interdisciplinary communication, workflow consistency, and confidence during planned extubation events in a pediatric Cardiac Intensive Care Unit (CICU).

Background: Planned extubation in critically ill pediatric cardiac patients requires effective interdisciplinary coordination. Variability in nurse preparation, communication, and knowledge of sedation pharmacokinetics contributed to workflow inefficiencies and patient safety concerns. Evidence supports standardized nurse-led protocols to improve extubation readiness and reduce practice variability.

Methodology: A prospective pre-post quality improvement project was conducted over eight weeks in a pediatric CICU. The intervention included a nurse-led planned …

2025 Nursing Annual Report, Children's Health System Of Texas

2025

No abstract provided.

Enhancing Healthcare Communication With Artificial Intelligence Translation Methods For Improved Patient Healthcare Satisfaction, Mireille Signe

Doctor of Nursing Practice Final Project Abstract

Purpose:

To evaluate whether artificial intelligence (AI) verbal translation improved communication-related satisfaction during routine nurse–patient interactions.

Background:

In the ICU, brief, frequent conversations with patients with Limited English Proficiency (LEP) often occur without timely access to professional interpreters, contributing to delays, improvised communication, and lower satisfaction. AI tools offer immediate access for low‑complexity exchanges but require evaluation for feasibility and effectiveness as a supplement to certified interpreter services.

Methodology:

Twelve nurse-LEP proxy patient dyads were evaluated using a mixed-methods design (8/2025-12/2025) in a 16-bed ICU during QI PDSA cycles. Standardized care communication scenarios were completed using the AI tool. Process …

Improving Bedside Nurse Central Line Policy Compliance And Combating Clabsis, Keyshawna N. Chambers

Doctor of Nursing Practice Final Project Abstract

Central line-associated bloodstream infections (CLABSIs) are a problem, both globally and locally at this 20-bed pediatric cardiovascular ICU in Houston, TX. Bedside nursing staff had gaps in knowledge of central line policies and were often unaware of when dressings needed to be changed. This posed a significant concern, as this nosocomial infection is among the most life-threatening and costly complications in healthcare. Leadership attempted to correct this issue with weekly multidisciplinary rounds, but with high turnover, this was not a long-term fix. This quality improvement project aimed to increase central line policy compliance among bedside nursing staff to 93%, from …

The Impact Of Night Shift On New Nurses: Effects On Mental Health And Work-Life Balance, Avery Windham, Abby Maruskin, Elizabeth Yoder

Williams Honors College, Honors Research Projects

This research examines the impact of night shift schedules on new nurses' mental health and work-life balance as they transition into professional practice. The transition from nursing school to the workforce presents challenges that are further compounded by shift work, which can disrupt circadian rhythms and contribute to stress, fatigue, and reduced job satisfaction. The purpose of this research is to evaluate how starting on night shift versus day shift influences nurses’ self-evaluation of work-life balance within their first year of practice. This systematic review synthesizes findings from peer-reviewed sources to assess the physical, emotional, and professional consequences of night …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Prevention Of Burnout Among Critical Care Nurses, Jenelle Balaoing, Junela Bautista

Nursing | Student Research Posters

Background: Nursing burnout is a state of mental and physical exhaustion caused by excessive stress among nurses. Critical care nurses face challenges with direct patient care that contribute to emotional and psychological strain that are greatly influenced by workplace adversity and emotional management. Purpose: This research examines the prevalence of burnout among pediatric and adult intensive care unit (ICU) nurses, highlighting particularly high rates of burnout among those with extended years of service. Method: ICU nurses will participate in a qualitative interview that involves open ended questions relevant among burnout and resilience during shifts. Aspects specifically years of critical experience …

Resonant Disruptions: Understanding Canadian Nurses’ Practice With Youth Survivors Of Sexual Exploitation, Danielle E. Giebelhaus, Andrew Estefan Phd, Rpn

Dignity: A Journal of Analysis of Exploitation and Violence

The sexual exploitation of youth is a global concern. Youth survivors of sexual exploitation present to and require healthcare services, but most nurses do not feel effectively equipped to care for this population. There is currently little nursing literature to guide nurses in their practice with youth survivors. In this article, we report on a qualitative, hermeneutic study undertaken to explore nursing practice with youth survivors of sexual exploitation. Hermeneutics is concerned with understanding, and is a helpful way to conduct research when little is known about a topic. In this study, we asked the research question, “How might we …

Bowel Regimen Protocol Implementation For Pediatric Patients Following Cardiac Surgery, Eryn Watson

Dissertations

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients …

2024 Nursing Annual Report, System Of Texas Children's Health

2024

No abstract provided.

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 …

Reducing Alarm Fatigue, Christina Smith

2025

Alarm fatigue refers to the phenomenon of excessive alarms in the healthcare system leading to staff ignoring or not hearing alarms that need clinical intervention (Bosma & Christopher, 2023). Healthcare staff experiencing alarm fatigue and desensitization leads to patient harm events up to and including death (Dee et al., 2022). Several interventions have proven effective to reduce non-actionable alarms or alarms that do not require action by the clinician. Combining these evidence based interventions into a bundle of nurse led interventions provides increased effectiveness in reducing alarm fatigue. This evidence-based practice (EBP) project aimed to evaluate the effectiveness of bundle …

Improving Pediatric Delirium Assessment Documentation And Nursing Knowledge In A Pediatric Cardiovascular Intensive Care Unit, Heather E. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Pediatric delirium is prevalent in the Pediatric Cardiovascular Intensive Care Unit (PCICU). It is associated with longer PCICU stays, extended hospital stays, prolonged duration of mechanical ventilation, and higher hospital costs (Mallick et al., 2022). It has also been associated with increased mortality risk and decreased quality of life after hospital discharge (Rohlik et al., 2021). Due to the adverse sequelae associated with pediatric delirium, routine screening with a validated screening tool is recommended (Flagg & Mauney, 2023). Despite consensus guidelines advocating routine screening for pediatric delirium, routine screening is not being completed (Flagg & Mauney, 2023).

Exploring The Barriers To The Implementation Of Acute Care Nurse Practitioner Roles, Madeline Wd Mcnulty

2025 Fall Honors Capstones Projects - Archive

Acute care nurse practitioners (ACNPs) are associated with improved patient outcomes and are among the fastest-growing professions in healthcare. However, this growth is accompanied by barriers to the ACNP role. Despite this expansion, limited research has examined these barriers or identified strategies to reduce them in acute care settings. Therefore, this study aimed to identify the obstacles to ACNP practice and to describe approaches to overcoming them. A qualitative descriptive design was employed. Twenty-one pioneering ACNPs participated in semi-structured interviews. Data were analyzed using the “Sort and Sift, Think and Shift” method. We identified nine themes in the study: four …

Prepared To Protect: Improving Cardiac Emergency Response Through Education And Action Planning In Youth Club Sports, Melissa Garcia

Nursing | Senior Theses

Sudden cardiac arrest (SCA) is the leading cause of death in youth sports, illuminating the essential demand for adequate emergency response, including cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and comprehensive emergency action plans (EAPs). Research shows that despite the importance of prompt intervention, the majority of youth club sports programs outside of the school setting lack the training and resources needed to respond effectively to SCA incidents. This study will evaluate the effectiveness of an educational seminar that includes CPR/AED training and EAP simulation exercises in improving participants’ knowledge, skills, and confidence in managing cardiac emergencies. A quasi-experimental …

The Impact Of Parental Presence On Pediatric Recovery Outcomes Following Invasive Procedures Or Surgery, Jaymie Riza Torres, Franchesca Isabelle Andaya Lazaro

Nursing | Senior Theses

Background: Pediatric patients are severely affected by preoperative anxiety which can lead to postoperative complications and delayed recovery. This could be attributed to their developmental stage which determines their response to stress and fear. Purpose: The purpose of this paper is to evaluate postoperative recovery outcomes in pediatric patients following the implementation of parental presence at the induction of anesthesia and upon first waking up. Method: This proposed research utilizes a mixed-method approach, combining qualitative and quantitative methods through a quasi-experimental study. The target population consists of pediatric patients between the ages of three and eight years …

A Quality Improvement Project: Increasing Pre-Term Infant Safety By Enhancing Skin-To-Skin Time In The Nicu, Maureen A. Cassidy

Master's Theses and Capstones

Background: Skin-to-skin (STS) contact, also known as kangaroo care, is a critical intervention for preterm infants, especially for those in the neonatal intensive care unit (NICU). It promotes neurodevelopmental outcomes, physiological stability, and parental bonding. However, STS often falls below recommended daily levels due to a variety of berries. Exploring aids like belly bands may help address these barriers and promote improved outcomes.

Local Problem: STS time in this NICU microsystem falls significantly below nationally recommended levels, with most preterm infants receiving less than one to two hours daily compared to the World Health Organization’s recommendation of 8-24 hours per …

Post-Incident Debriefings For Pediatric Intensive Care Nurse Burnout A Scoping Review, Sulah Emilie Monize

Honors Undergraduate Theses

Burnout is prevalent among pediatric intensive care unit (PICU) nurses, impacting between 42-77% of them. High emotional burden, physical demand, and cognitive overload contribute to significant PICU nurse burnout prevalence. Burnout is linked to increased job turnover, compromised patient care, and decreased staff mental well-being. Addressing burnout is crucial to ensure patient safety and maintain care quality. Burnout in adult ICU nurses is well documented but less so with PICU nurses, and they face stressors unique to their setting, such as a vulnerable patient population and unique dynamics with families and providers. This scoping review includes 9 articles examining the …

Facilitating Caregiver Involvement In Reducing Delirium Among Critically Ill Children In The Pediatric Intensive Care Unit, Emma R. Bilberry

DNP Projects

Background: The pediatric intensive care unit (PICU) is a dynamic, fast-paced, and high-acuity unit where children are prone to the development of pediatric delirium (PD). PD is a condition of neurologic dysfunction increasing risk of morbidity and mortality among patients. Literature on PD is rapidly expanding, providing an opportunity for increased research on how to manage PD. Caregivers know their children, are often readily available at the bedside, and invested in being included in care. Additionally, literature shows that caregiver presence at the bedside is one non- pharmacological intervention that can aid in reducing PD. The development and implementation of …

Relationship Between Nursing Care Provided For Children On Mechanical Ventilation And Their Clinical Outcomes, Marwa G. Abouheiba, Nehad S. Basiouny

Nursing

Background: Indication of mechanical ventilation are variable and diverse. It is required whenever the child is unable to maintain adequate alveolar oxygenation or ventilation. Objective: To assess the relationship between provided nursing care for children on mechanical ventilation and their clinical outcomes. Setting: The Pediatric Intensive Care Unit (PICU) of Alexandria University Children’s Hospital (AUCH)at El-Shatby. Subjects: Study subjects were included both nurses and children. The first part of the study are all nurses (30) worked at the previously mentioned setting were included this inclusion was regardless of their level of education and years of experience. The second part is …

Implementation Of Chlorhexidine Gluconate Dressings And The Effect On Bloodstream Infections In Extracorporeal Membrane Oxygenation Patients At A Pediatric Hospital, Kaitlin Vernier

Dissertations

Extracorporeal membrane oxygenation (ECMO) is an advanced lifesaving therapy used for patients with significant cardiorespiratory failure not responding to conventional therapies. The most common and life-threatening complications associated with ECMO are blood stream infections (BSIs). In addition to increased mortality, BSI's increase patient length of stay and cost. Chlorhexidine Gluconate (CHG) is known to be a significant factor in BSI reduction. The purpose of this quality improvement project is to assess the utilization of CHG-impregnated dressings on the incidence of BSI rates in pediatric ECMO patients. The setting was a 40-bed pediatric intensive care unit (PICU) and a 30-bed cardiac …

Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces In The Picu, Emily Heth

Dissertations

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the …

Implementation Of A Standardized Nursing Handoff In A Pediatric Intensive Care Unit, Tori Keeven

Dissertations

Handoff communication is critical in healthcare and is associated with patient safety outcomes. Various tools and interventions are available to improve handoff communication as inadequate communication contributes to medical errors, patient adverse events, and increased mortality. The implementation of a standardized handoff tool has been shown to be effective. Findings revealed a significant 60% reduction in reported patient harm events, despite the study's limited sample size and lack of statistical significance (p = .614). Challenges such as low utilization (18.62%) were attributed to concerns about tool organization, spatial constraints, and staff resistance to change. Recommendations include refining the tool to …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

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 …

2023 Nursing Annual Report, Children's Health System Of Texas

2023

No abstract provided.

A Pulse For Progress – Examining The Efficacy Of Best Nursing Developmental Care Practices For Children With Congenital Heart Disease At Risk For Developmental Delay In The Pcicu: A Prospective Quasi-Experimental Cohort Study, Jasmyn Jansen

Nursing | Senior Theses

Emerging advances in pediatric cardiovascular surgery have significantly decreased the mortality rates in infants born with critical congenital heart disease (CHD), in turn, leading to increasing prevalence in adolescence and adulthood. At the same time, developmental delays (DD) are on the rise among children with CHD. Recent research suggests that prolonged exposure to the pediatric cardiac intensive care unit (PCICU), with its environmental stressors, negatively implicates neurodevelopment raising the question, and risk, of DD. In January 2023, the American Heart Association (AHA) issued a scientific advisory calling hospitals to implement developmental care practices for hospitalized infants and young children with …