Critical Care Nursing Commons^™

Evaluation Of Spontaneous Awakening And Breathing Trials Prior To Mechanical Ventilator Extubation To Enhance Intensive Care Unit Liberation, Shelby Taranto

Doctoral Projects

Spontaneous Awakening and Breathing Trials (SAT/SBT) might be central to early extubation by decreasing total ventilator time and reducing the intensive care unit (ICU) length of stay (LOS). Unfortunately, these trials often have not been conducted consistently in the ICU. The purpose of this research was to evaluate the frequency of SAT/SBT performed prior to mechanical ventilator extubation on total ventilator time in hours and LOS. Quality improvement aims were: (1) to ascertain if an extubation readiness tool could be easily followed and documented, and (2) to evaluate if an extubation readiness tool would add value in clinical practice. A …

Headset To Reset: Virtual Reality Therapy In Postoperative Heart And Lung Transplant Patients, Michaela Sanchez

Doctoral Projects

Postoperative heart, lung, and heart-lung transplant recipients are at increased risk for anxiety and depression, both of which have been associated with increased risk of complications and higher mortality rates. The purpose of this quality improvement project was to implement a mindfulness-based virtual reality (VR) therapy intervention for postoperative transplant recipients at a Northern California academic medical center and to evaluate its feasibility, tolerability, and acceptability during the index hospitalization. Over a 15-week period, five participants completed a total of eight VR sessions. Participants selected from immersive mindfulness-based environments, including guided meditation and other relaxation experiences. Anxiety and depression were …

Increasing Near-Miss Reporting: An Evidence-Based Approach, Rosalud H. Sanchez-Lozada

Doctoral Projects

Near-miss events, defined as errors intercepted before reaching the patient, offer valuable opportunities for learning and prevention, particularly in high-acuity intensive care units (ICUs). Despite the availability of electronic reporting systems and national emphasis on patient safety, near-miss reporting remains inconsistent in many critical care settings. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the impact of a structured educational intervention on near-miss reporting within a cardiovascular intensive care unit (CVICU) at a large academic medical center. A single-group pre–post design was used to examine changes in reporting trends following a three-week intervention that included staff education, leadership …

Implementation Of A Nurse-Driven Early Mobility Algorithm In Critically Ill Adults, Andrea Saito

Doctoral Projects

Background: Early mobilization of critically ill patients is recommended in clinical practice guidelines to mitigate ICU-acquired weakness, delirium, and improve recovery. This intervention is inconsistently implemented in many health systems due to a variety of barriers. One frequent barrier is uncertainty regarding whether patients meet safety criteria for mobilization. Purpose: The purpose of this quality improvement project was to implement a nurse-driven early-mobility algorithm with a clinical safety screen in an adult medical-surgical ICU and evaluate its impact on patient mobility scores, delirium rates, and ICU length of stay.​ Methods: The intervention was evaluated using a quasi-experimental before and after …

Weighted Blankets: Implementation Of A Quality Improvement Pilot Project In The Neurosciences Intensive Care Unit, Anita Musafar

Doctoral Projects

The weighted blanket quality improvement pilot project was implemented at Stanford Healthcare (SHC) to address the limited number of nonpharmacological interventions available for agitation management in the critical care setting. Patients within the Neurosciences ICU (NSICU) at SHC are clinically complex and uniquely vulnerable to experiencing agitation. The objectives of this initiative were to understand nurses' perceptions surrounding weighted blanket use in the critical care setting and assess whether there was a decrease in Richmond Agitation-Sedation Scale (RASS) scores with this intervention. From September 2025 to December 2025, the nurses within the NSICU implemented the use of weighted blankets for …

Implementing A Buddy System To Enhance Float Pool Nurses’ Experience And Unit Integration, Nancy Kairia

Doctoral Projects

Float pool nurses play a vital role in maintaining hospital operations; however, they often experience role ambiguity, inconsistent integration, and reduced psychosocial empowerment, which may negatively influence engagement and retention. This Doctor of Nursing Practice project implemented and evaluated a structured buddy program designed to enhance psychological empowerment among float pool nurses in a large academic medical center. Guided by Gretchen Spreitzer’s Psychological Empowerment Framework, the project examined changes across four domains: meaning, competence, self-determination, and impact. A pre-post design was used to assess outcomes before and after implementation. Five nurses completed the preintervention survey; of these, four completed the …

A Pilot Project On Improving Icu Nurses’ Confidence In Early Defibrillation, Adetutu Obadina

Doctoral Projects

Early recognition of shockable cardiac rhythms and timely defibrillation are critical components of effective resuscitation during in-hospital cardiac arrest. Despite established guidelines from the American Heart Association (AHA), nurses may experience uncertainty or reduced confidence when identifying shockable rhythms and delivering timely defibrillation during cardiac arrest events. The purpose of this project was to examine whether a structured educational intervention incorporating simulation-based training could improve intensive care unit (ICU) nurses’ confidence and knowledge in recognizing shockable rhythms and performing timely defibrillation. A pre-and post-intervention design was implemented among ICU nurses at a large academic medical center between September and October …

Point-Of-Care Gastric Ultrasound For Preoperative Assessment Of Gastric Contents: An Objective Structured Clinical Examination, Joshua Mann, Michael Sykes

Doctoral Projects

Pulmonary aspiration remains a leading cause of anesthesia-related mortality. The current nil per os (NPO) guidelines are proving unreliable in the presence of delayed gastric emptying due to comorbidities and the increasing use of glucagon-like peptide-1 (GLP-1) agonists. Gastric point-of-care ultrasound (POCUS) use provides a non-invasive, evidence-based, and cost-effective approach to assess gastric content and volume directly. However, limited formal training exists for advanced practice registered nurses (APRNs), and this lack of training contributes to the lack of its utilization. This doctoral project evaluated the effectiveness of an educational intervention that incorporated a didactic lecture as well as a hands-on …

A Four-Year Longitudinal Study Of Effectiveness Of Evidence-Based Bundle Practices For Preventing Catheter-Associated Urinary Tract Infections In An Academic Health Care Center, May Mei-Sheng Riley

Doctoral Projects

Catheter-associated urinary tract infections (CAUTIs) significantly contribute to morbidity, prolonged hospitalization, and elevated healthcare costs, underscoring the crucial need for prevention to ensure patient safety. Despite ongoing mitigation efforts, CAUTI prevalence remained a concern in our facility at the time of this study. Catheter insertion and maintenance bundles, a recognized framework utilizing teamwork, collaboration, and focused interventions, were implemented to reduce CAUTIs and improve patient safety. This study evaluated the effectiveness of these bundles in reducing CAUTIs and catheter utilization to identify best practices for enhanced catheter management and care quality.

Improving Communication And Job Satisfaction: Utilizing Team Strategies And Tools To Enhance Performance And Patient Safety (Teamstepps) For Interventional Service Areas, Sukhbinder Kaur Sangha

Doctoral Projects

Purpose: Improved communication and job satisfaction among staff are essential for those working in high-stress critical care environments like the cardiac catheterization laboratory (Cath Lab). The purpose of this investigation was to utilize the quality improvement initiative Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to improve attitudes and job satisfaction in the Cath Lab. Method: A total of 30 subjects participated in a TeamSTEPPS educational intervention. After obtaining informed consent, a demographic survey, a pre- and post-test TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Job Satisfaction Survey (JSS) were administered. The post-test included open-ended questions for feedback …

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 …

The Effect Of A Neonatal Palliative Care Education Program In Increasing Knowledge And Communication Self-Efficacy Among Nicu Nurses, Shiou-Huei Joy Wang

Doctoral Projects

Background: Neonatal palliative care is crucial to providing comprehensive, high-quality care to neonates with life-limiting or life-threatening health conditions and their families. One significant barrier to the inconsistent provision of neonatal palliative care is the lack of education. This project aimed to deliver an education training program to increase neonatal palliative care knowledge and self-efficacy in NICU nurses. Method: A pre-post-test study design was used to examine the efficacy of an educational training program on NICU nurses’ knowledge and communication self-efficacy in neonatal palliative care. A post-test was administered immediately after the training and again four weeks later to evaluate …

Quality Improvement For Patients With Alcohol Withdrawal Syndrome Starts With An Evaluation Tool, Jessica Bass

Doctoral Projects

Patients with alcohol withdrawal syndrome (AWS) have adverse outcomes to the traditional methods of assessing for and treating withdrawal within the intensive care unit (ICU), which includes a standardized treatment plan. Some negative outcomes include acquiring costly and dangerous hospital-acquired infections, safety concerns, and traumatic experiences that deter further treatment. More individualized assessments and treatments are needed to prevent or decrease the severity of AWS from occurring in critical care settings, which will facilitate more positive outcomes and experiences for the staff and patients. The Minnesota detoxification scale has been shown to be a more appropriate tool for the critical …

Objective Structured Clinical Examination For Arterial Line Placement, Delorean Calloway

Doctoral Projects

The University of Southern Mississippi (USM) is lacking a uniform guideline for arterial line placement. This DNP project promotes the addition of an objective clinical structured examination into the nurse anesthesia curriculum for future student registered nurse anesthetists (SRNAs) to gain comprehension and clinical experience in a simulation lab prior to practicing on real patients. Peer-reviewed literature and evidence-based practices have been researched and organized into a learning tool and checklist to be used as a step-by-step guideline. Having a guideline such as an OSCE in place can increase student competency and foster a culture of safety leading to better …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Impact Of Mindfulness Practice On Compassion Fatigue In Pediatric Cardiovascular Critical Care Nurses: A Quality Improvement Project, Kendy Luu

Doctoral Projects

Background: A considerable proportion of the extant literature on healthcare has documented compassion fatigue (CF) as a major factor that contributes to poor job performance, satisfaction, and negative patient outcomes (Figley, 2002). CF is well known to negatively impact patient care and outcome, relationships, and job satisfaction among pediatric cardiovascular intensive care (CVICU) nurses. Developing interventions to reduce burnout and CF bear the potential to reduce costs and improve quality care; one particularly promising approach in this regard is the practice of mindfulness-based stress reduction (MBSR). Purpose: This quality improvement project aimed to determine the impact of an abbreviated MBSR …

Improving Door To Transfer Times For St Segment Elevation Myocardial Infarction In Small Emergency Departments: A Quality Performance Improvement Project, Amber Ryals

Doctoral Projects

Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often …

Educating Student Registered Nurse Anesthetist On Malignant Hyperthermia Using An Objective Structured Clinical Examination, Ednita Street Fountain, Faith Sherman

Doctoral Projects

Malignant hyperthermia (MH) is a low-frequency, high-impact event that many student registered nurse anesthetists (SRNA) may be unprepared to manage due to limited exposure in clinical practice (Hackl et al., 1990). Lack of preparation for dealing with such low frequency, high impact events can lead to unfortunate adverse events resulting in death (Hackl et al., 1990). Thus, students should be are prepared to handle these situations if an event should occur.

An objective structured clinical examination (OSCE) is a structured method used to assess certain skills and underpinning knowledge required for practice (Harden & Gleeson, 1979). Students are allowed to …

Developing An Interdisciplinary Team Checklist To Assess Readiness For Appropriate Medical Removal Of Central Venous Catheter (Cvc), Miranda Harper

Doctoral Projects

Healthcare-associated infections are not a new concept in health care. Many different health-care-associated infections have been established over the years including but not limited to healthcare-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bacterial infection. While these infections are common in healthcare facilities, the rates of these infections are still prevalent in hospitals across the United States. This DNP project focused on central line-associated bacterial infections.

An interdisciplinary team checklist to assess readiness for appropriate medical removal of central venous catheter (CVC) was developed to assess intensive care unit patients for early appropriate medical CVC removal. The interdisciplinary team …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Honoring Patient Do Not Resuscitate Wishes And Reducing Harm During Transitions Of Care: A Quality Improvement Project, Emily L. Kraus

Doctoral Projects

Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.

Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.

Results: Patient charts were audited (N=261 [pre=124; …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Opioid Abuse Among Student Registered Nurse Anesthetists In The United States: A Policy Change Proposal, Ifeoma P. Anakor

Doctoral Projects

Opioid abuse among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) is an epidemic that is growing in numbers yearly. The number of deaths from opioid abuse is also increasing. The specialty of anesthesia primarily has increased instances of opioid abuse cases (Wright et al., 2012). The reason for the increase in opioid abuse occurrences is because anesthesia providers regularly administer opioids in patient care. Opioid abuse commonly results in injury or death. While abusing, anesthesia providers are not only putting their lives in jeopardy but also the lives of their patients.

The project observed the opioid …

Comparing Two Surgical Outcomes: Minithoracotomy Or Full Sternotomy In Coronary Artery Bypass Grafting Surgery, Shirin Badrkhani

Doctoral Projects

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG).

Specifically, there is inadequate data to compare these …

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. …

Addressing Disparities In Nurses’ Understanding Of Congestive Heart Failure, David Tomas Palecek

Doctoral Projects

Congestive heart failure (CHF) continues to affect millions of people a year and remains one of the leading causes of re-hospitalization in the US. Within the Central San Joaquin Valley (CSJV) the incidence of CHF remains significantly higher than the rest of California. In order to ensure appropriate patient care and outcomes registered nurses (RNs) must have a thorough and full understanding of the disease process and its associated symptomatology. This study aimed to find if the implementation of an interactive multimedia educational program focusing on all aspects of CHF could improve RNs education and understanding of CHF. It is …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Implementation Strategies To Increase Uptake Of Hester Davis Tool Tailoring Of Fall Prevention Interventions, Beena Philip

Doctoral Projects

Introduction. Falls are the most common cause of injury to patients in acute care hospitals globally and higher incidences of falls with injury are reported in the hospitalized elderly. Falls can result in physical and emotional injury, long-term pain, functional impairment, disability, loss of income, increased hospital stay and mortality. Research demonstrates individualized, multifactorial fall prevention interventions are most beneficial in preventing falls and related injuries. This paper reports whether accurate fall risk assessment using the Hester Davis, proactive use of 5T’s (toileting, tolerating pain, tidy, turn, technology), appropriate gait belt use, individualized interventions and intentional toileting for patients with …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

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 …