Critical Care Nursing Commons^™

Improving Patient Flow Through The Implementation Of A Results Pending Treatment Area, Heather L. Bryant

Nursing Theses and Capstone Projects

Abstract

The purpose of this research study is to retrospectively evaluate whether the implementation of a Results Pending Treatment Area (RPTA) altered patient flow patterns and therefore reduced patient length of stay (LOS) for ambulatory patients in a Level One Trauma Center Emergency Department. The research is justified because a reduction in the length of stay for patients is shown to decrease overcrowding, ED wait times, loss of revenue, and diversion while improving patient safety and patient satisfaction. The Roy Adaptation Model was the overarching theoretical conceptual framework utilized to support the research, with a more detailed emphasis on Swanson's …

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.

Nurse's Perception Of Factors Associated With Family Satisfaction In The Intensive Care, Phyllis K. Buie

Nursing Theses and Capstone Projects

In health care, family satisfaction has become one of the most important and challenging competitive elements of the industry. The purpose of this study is to determine the factors associated with the Registered Nurse's perception of family satisfaction with services provided during a patient's hospitalization in the intensive care unit (ICU). Registered Nurses, with critical care experience within the past five years, were asked to rate factors that influenced family satisfaction in the intensive care using the Critical Care Family Satisfaction Survey (CCFSS) developed by Thomas Wasser (2001). Watson's Theory of Human Caring was used as the theoretical framework for …

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 …

Job Satisfaction Among A Multigenerational, Critical Care, Nursing Workforce, Sara Clay

Nursing Theses and Capstone Projects

Despite the slight ease of the nursing shortage due to the current recession, the United States is expected to still have a shortage of approximately 260,000 registered nurses by the year 2025 (American Association of Colleges of Nursing, 2011). Healthcare is an ever changing profession where nurses, no matter their generation, must learn to adapt to their constantly changing environment and expectations. Job satisfaction is a strong and constant predictor of retention and can vary greatly across generations. The purpose of this study was to get insight into generational differences related to job satisfaction and to use these data to …

Medication Errors: It's A Matter Of Time, Thomas D. Smith Jr.

Nursing Theses and Capstone Projects

A retrospective review of medication errors is presented as a measurement tool. Times of medication errors are separated into categories. The numbers of errors are associated with the numbers of medication administrations. The first data set contains errors that occurred within the first 8 hours of a 12-hour shift and the second data set contains errors that occurred during the last 4 hours of a 12-hour shift.

Data was obtained from a 108 bed critical care hospital in the southeastern United States. A time period will be reviewed between the months of September 2010 until August 2011. All reports of …

A Study Of Emergency Room Utilization Related To Poorly Controlled Asthma In Pediatrics, Leistey T. Wortman

Nursing Theses and Capstone Projects

Asthma is a disease of the respiratory system, which causes swelling and narrowing of the airways. Asthma is commonly seen in children. It is the leading cause of hospital stays and school absences. Hospitalization accounts for the single largest portion of the direct health care costs for asthma, estimated at nearly $18 billion a year (Everage, et al, 2010). Children with asthma may be able to breathe normally most of the time but when they encounter a substance that can cause problems (a "trigger"); an asthma attack (exacerbation) can occur (PubMed Health, 2011). The purpose of this study is to …

Neurological Outcomes In Induced Hypothermic States (Post Cardiac Arrest Resuscitation), Shonna Lee Bible

Nursing Theses and Capstone Projects

International studies indicate that induced hypothermia in successful Post Cardiac Arrest Resuscitation improves cerebral perfusion resulting in improved neurological function. Patients undergoing a neurological exam prior to induction of hypothermia may indicate potential mortality prognosis in this population. Literature Review indicated the use of the Glasgow-Pittsburg Cerebral Performance Categories for evaluation of neurological status in this population, but most institutions seem to utilize Glasgow Coma Scoring (GCS) in all patient populations for neurological examination. The purpose of this study was to determine if a neurological evaluation prior to and during the Induced Hypothermia state would affect the mortality outcomes in …

Emergency Departments And Stemi Care, Are The Guidelines Being Followed?, Dawn W. Hendren

Nursing Theses and Capstone Projects

The purpose of this study examined if an Emergency Department (ED) in a small rural hospital in western North Carolina is compliant with the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for obtaining Electrocardiogram's (ECG's), administering fibrinolytics, and performing Primary Percutaneous Coronary Intervention (PCI) on patients with chest pain diagnosed with ST-Elevation Myocardial Infarction (STEMI). The national standards for ECGs is less than 10 minutes from arrival to first medical contact (FMC) with triage nurse; for fibrinolytics, less than 30 minutes from arrival to FMC; and for FMC to PCI, less than 90 minutes. The …

Critical Care Nursing Interventions And Incidence Of Ventilator Associated Pneumonia In The Trauma Population, Kelli R. Moore

Nursing Theses and Capstone Projects

Ventilator Associated Pneumonia (VAP) in the Trauma Intensive Care Unit is the most commonly encountered infection in the intensive care unit and can be linked to increased morbidity, increased mortality, increased mechanical ventilation days, increased hospital length of stay, and increased cost. A retrospective, correlational study examined the effect of compliance with a ventilator bundle protocol in the Neuro-Trauma Intensive Care Unit on aggregate VAP rates. The study's primary focus was to determine if interventions performed by critical care nurses reduced the incidence of Ventilator Associated Pneumonia (VAP) in the Trauma Intensive Care Unit. The study utilized the retrospective collection …

Open Visitation Effects On The Critically Ill Individual, Melissa Mcneilly

Nursing Theses and Capstone Projects

The Intensive Care Unit has been known to be fast paced, stressful, and at times a loud atmosphere. Being a nurse in the ICU can be intimidating and being a patient can be frightening. Critically ill patients require close monitoring and supervision by the nursing staff. Many different aspects of care are crucial to the patients' recovery. Family members are an important part of a critically ill individual's recuperation. Different factors have an effect on the level of stress that a patient may experience while in the hospital. Critical Care Nurses were given a questionnaire to determine the beliefs and …

Protocol Adherence During Inter-Facility Transfer Of Acute Ischemic Stroke Patients Treated With Iv Rtpa, Robin Reed Jones

Nursing Theses and Capstone Projects

Stroke is a common and serious health disorder, affecting approximately 795,000 people in the United States every year. Intravenous recombinant tissue plasminogen activator (IV rtPA) is the only FDA approved thrombolytic for treating acute ischemic stroke within 3 hours of symptom onset. Patients treated at rural health centers are often transported within hours to the closest primary stroke center. The purpose of this study was to evaluate the structure, process and outcomes related to the inter-facility transport of ischemic stroke patients treated with intravenous rtPA. The Quality-Caring Model© was the guiding framework.

A quantitative, retrospective, non-experimental analysis of inter-facility transport …

Diabetes Understanding Among Staff Nurses: Examining The Actual Versus Perceived Knowledge In The Acute Care Setting, Rebecca B. Ledbetter

Nursing Theses and Capstone Projects

Diabetes is the fourth leading cause of death world-wide claiming a staggering 3.8 million lives globally each year to related complications (World Health Organization, 2011). Diabetes complications account for 20% of all acute care admissions or 1 in every 5 patients have a diabetes-related condition (American Diabetes Association, 2011). Patient education in the areas of lifestyle modification, healthy eating habits, and proper medication administration is research-supported to clinically decrease the likelihood of acute complications. Bedside, acute care nurses are at the front line of patient education delivery and have the opportunity to determine behavioral stages related to a patient's readiness …

Monitoring Congestive Heart Failure Across The Healthcare Continuum, Katrina E. Walker

Nursing Theses and Capstone Projects

Congestive heart failure is a chronic condition where the heart no longer pumps adequate blood and oxygen to bodily organs. CHF is a chronic condition that affects millions of people on a yearly basis. Common diseases that cause CHF are coronary artery disease, high blood pressure, and diabetes. CHF patients face many compilations that affect their daily activities. Along with morbidity CHF has major financial implications because much of the cost associated with CHF healthcare is avoidable. The purpose of this study is to evaluate the effects of monitoring congestive heart failure across the healthcare continuum with application to the …

Effects Of Early Initiation Of Induced Therapeutic Hypothermia, Frank Castelblanco

Nursing Theses and Capstone Projects

Cardiac arrests are responsible for about 325,000 deaths annually in the United States (Heart Rhythm Foundation, 2010). The majority of these cardiac arrests occur outside the hospital setting, with a dismal national survival rate of 8% (American Heart Association, 2010). The Bernard (2002) and HACA (2002) studies demonstrated that by initiating therapeutic hypothermia as a treatment modality for cardiac arrests the survival rate could be as high as 49% and 55% respectively. Therapeutic hypothermia can be initiated in many different settings. The question remains, does the setting of the initiation of therapeutic hypothermia effect patient outcomes? The purpose of this …

Preparing The New Graduate Nurse Entering Critical Or Progressive Care Practice Areas: What Is The Effect Of Blended Orientation Approaches On Their Level Of Self-Confidence And Satisfaction With Current Orientation Methods?, Jennifer L. Forbes

Nursing Theses and Capstone Projects

The transition from student nurse to professional nurse is often difficult for the new graduate especially if transitioning into critical or progressive care areas of practice. It is imperative for new graduates to receive a clinical orientation that meets their educational and transitional needs. The orientation process should provide them with a strong foundation in critical or progressive care practices. Educators are challenged to provide educational opportunities while accommodating diverse learning needs and continuing to maintain competency that ensures the highest quality of patient care and improved patient care outcomes.

New graduate nurses hired into the critical or progressive care …

The Nurse's Knowledge Of Blood Conservation As A Part Of Blood Management, Lindsey Putnam Austin

Nursing Theses and Capstone Projects

Medicine has historically regarded blood transfusion as an integral component of major surgery or illness. However, clinical studies have shown that allogeneic blood transfusions are associated with increased morbidity and decreased survival. Knowledge of this research and the concepts of blood conservation so as to avoid unnecessary blood transfusions is needed in order to deliver holistic care and serve as patient advocate. This knowledge reaches every specialty of nursing care.

This study of the nurse's knowledge of blood conservation as a part of blood management utilizes The Conservation Model developed by Myra E. Levine in 1973. Levine's work is a …

The Effect Of Emergency Department Length Of Stay On Clinical Outcomes For Critically Ill Or Injured Patients, Sheila Radcliff

Nursing Theses and Capstone Projects

The purpose of the study was to identify the effects of the emergency department length of stay on clinical outcomes for critically ill or injured patients in the regional referral community hospital. Delays in transfer have been associated with increased mortality rates, prolonged length of stays, and poor outcomes. Emergency departments are designed to respond to immediate life or limb threatening emergencies.

A quantitative, descriptive, retrospective design was used in this study. Data was collected from APACHE II, trauma databases, and ED logs. The study was conducted in a 752 bed hospital in the western North Carolina. Data was analyzed …

What Is The Experience Of Emergency Department Nurses With Lateral Verbal Aggression?, Wendi Harper-Lonabaugh

Nursing Theses and Capstone Projects

This descriptive study investigated the incidence of lateral verbal aggression among emergency department nurses. A sample of registered emergency department nurses currently working in western North Carolina with more than one year of full time work experience was surveyed (N=68). Roy's adaptation model was used as a theoretical framework for this qualitative study. A survey was utilized to collect the frequency, source, and incidences of reporting the lateral verbal aggression that occurred. Nurses also reported personal and professional ramifications to the lateral verbal aggression. Aggregate data was examined; no specific individual data was analyzed. The most common perpetrators of lateral …

Copd Care Coordination Program, Glenda Mccall

Nursing Theses and Capstone Projects

COPD is the fourth leading cause of death in the United States. Several studies confirm only 50% of COPD patients receive optimal care. The disease is greatly under-recognized and generally is not diagnosed until it is clinically apparent and moderately advanced. COPD is also a major resource consuming disease. Considering these facts, Mission Hospitals realized the opportunity to improve evidence based quality care for patients diagnosed with COPD as well as the development of a Care Coordinated Program to improve outcomes for the patient as well as the organization. The goal of the program is to provide correct, comprehensive, and …

Development Of An Educational Resource Tool To Improve Hospital Wide Knowledge Of Rehabilitation Care And Services, Vickey R. Allen

Nursing Theses and Capstone Projects

Health Care Organizations (HCO) are businesses. In an effort to be successful and to remain viable, HCOs must provide a myriad of services to meet their customer's needs. Included in these services is competent rehabilitation care that manages patients holistically. Utilizing Orem's theory of self care deficit, this project will demonstrate the growing need for rehabilitation services and the importance of all healthcare providers to understand the profession in general. In addition, this project will provide a resource tool to educate healthcare workers and others; students and non-licensed personnel, on the care and services patients receive during their stay in …

Practices And Perceptions Of Delirium Assessment By Critical Care Nurses, Jacqueline M. Meunier

Nursing Theses and Capstone Projects

Delirium has a tremendous impact on the patient, his family, and the health care system. In particular, the elderly patient in the Intensive Care Unit is the most susceptible to this condition. Delirium often results in longer hospital stays, more Intensive Care days, increased likelihood of being placed in a skilled nursing facility, and increases in mortality. For delirium to be treated properly it must first be identified. Critical care nurses are in the best position to identify these patients and initiate treatment. Past studies have shown that nurses do not identify patients that have delirium, and do not know …

Evaluation Of Purposeful Rounding On Patient Falls, Stephanie Spittle

Nursing Theses and Capstone Projects

The purpose of this study was to evaluate the effectiveness of routine purposeful rounding on the total number of falls on a medical unit in an acute care hospital. The project was prompted by high fall rates within the hospital and the implementation of the purposeful rounding initiative. Staff training was provided in a two hour educational class which covered the purpose for the initiative as well as the specific functions that must be performed with each round. To evaluate the effectiveness of purposeful rounding on patient falls, pre and post rounding fall rates were compared. These initial results were …

The Experienced Critical Care Rn's Perception Of New Graduate Rns Competence In Critical Care Using Benner's Novice To Expert, Denise H. Reid

Nursing Theses and Capstone Projects

The purpose of the study was to describe the experienced critical care RNs' perception of the new graduate RNs' competence in critical care areas. Using the Six-Dimension Scale of Nursing Performance (Six-D Scale) by Patricia Schwirian, experienced nurses from critical care areas with at least three years of experience were asked to rate new graduate RNs in their critical care area on specific nursing activities. Benner's theory of Novice to Expert is used as the theoretical framework. Findings revealed that experienced critical care RNs perception of new graduate RNs is greater than expected. All activities on the Six-D Scale were …