Critical Care Nursing Commons^™

Integrating Evidence-Based Practice Into Post-Code Blue Debriefings To Enhance Clinical Practice And Staff Well-Being In The Micu - A Quality Improvement Project, Jeffrey Schall

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction/Background:

Intensive care (ICU) nurses are routinely exposed to traumatic events, such as code blue resuscitations, which contribute to increased stress, burnout, and lower perceived quality of care. A gap analysis of MICU charge nurses and team leaders found that 87% reported that post-code debriefing did not occur and that 40% experienced emotional distress, indicating a need for a brief, structured, emotionally safe reflection process.

Methodology: Using a pre-post design, the CARE tool, adapted from the DISCERN and Post-Code Pause frameworks and validated by three institutional experts, was introduced into practice over six weeks. Nurse champions completed pre-surveys …

Implementing A Noise Reduction Protocol To Reduce Perceived Noise In The Icu – An Evidence-Based Practice Project, Soh Jeon

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims:

This project aims to reduce perceived noise in the ICU and promote a healing environment through a multi-interventional noise-reduction protocol and nursing staff education.

Rationale/Background:

The World Health Organization (WHO) recommends that hospital noise levels remain below 35 decibels during the day and 30 decibels at night. However, ICU noise often exceeds 50-70 decibels. Increased noise levels are primarily caused by conversations, monitoring alarms, and routine care activities, such as cleaning and procedures. These high noise levels directly affect patients’ sleep, which is essential to recovery. Insufficient rest can lead to immunosuppression, prolonged mechanical ventilation, and elevated stress …

Scrub Up For Success: Transforming Infection Control In Transplant Patients Through Microlearning Video And Poster – A Quality Improvement Project, Wendy Dio

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Background

Healthcare-associated infections (HAIs) threaten patient safety, affecting about 1 in 25 hospitalized patients. Clostridium difficile infection (CDI) is a significant contributor, impacting both high-risk groups and the general population. Proper hand hygiene is crucial for preventing CDI transmission. In the U.S., hospital-acquired CDI costs over $1.5 billion annually and causes nearly 500,000 cases and I15,000 deaths each year. California reported 3,526 CDI cases in acute care hospitals, with Loma Linda University hospitals accounting for 16 cases, or 23% of their health system's infection rate.

Methodology

Nurses in the 6A West-Transplant Unit received a PowerPoint presentation on when …

Optimizing Tbi Care: Brain Oxygen Monitoring In Nursing - An Evidence-Based Practice, Alyssa Grisham

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims

This DNP project aims to enhance the care of patients with traumatic brain injury (TBI) by improving nurses’ knowledge, clinical decision-making, and early intervention strategies through the integration of brain oxygenation data into routine neurocritical care assessments. This project seeks to promote personalized patient care, reduce secondary brain injury, and improve neurological outcomes for critically ill adults with TBI by implementing an educational protocol designed to deepen understanding of brain oxygen monitoring.

Background of Problem & Description of Current Practice

TBI remains a leading cause of death and disability worldwide and continues to pose a significant public health burden. …

An Examination Of The Moderating Effect Of Proactive Coping In Nicu Nurses, Britan M. Moore

Loma Linda University Electronic Theses, Dissertations & Projects

The NICU environment is unique in that the patient population consists of critically ill neonates. Research has revealed that there are increased levels of depression, secondary traumatic stress, and burnout in nurses. Problem solving and support seeking coping strategies have been shown to be associated with lower levels of burnout and increased patient and job satisfaction in general staff nurses. Multiple linear regression and a hierarchical stepwise technique was used to conduct moderator analyses assessing whether the use of problem solving or support seeking strategies moderated the relationship between secondary traumatic stress levels and burnout as well as between depressive …

Hospice Care In Malaysia: Knowledge, Attitude And Time Of Discussion, Shanthi Ellen Solomon

Loma Linda University Electronic Theses, Dissertations & Projects

Despite available and adequate hospice care resources, fewer terminally ill patients in Malaysia use hospice care services than one might reasonably expect. It is reported that only around 10% of patients who die of terminal illness in Malaysia, die in hospice care (Devaraj, 2003). The projected number of individuals that should receive palliative care in Malaysia is 17 to 27% (Connor & Sepulveda Bermedo, 2014). In order to study why hospice care is not accessed as expected, nurses and doctors in Penang and Sabah completed a survey measuring knowledge of current hospice practices, attitude toward caring for the dying, personal …

Breathlessness Descriptors In Patients With Chronic Obstructive Pulmonary Disease Versus Congestive Heart Failure, Adelaide De Souza Caroci

Loma Linda University Electronic Theses, Dissertations & Projects

This cross-sectional descriptive study investigated breathlessness (dyspnea) in stable patients with Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). The purpose of this study was (a) to characterize the most common terms COPD and CHF patients use to describe their breathing, (b) to identify the frequency of dyspnea in patients with COPD and CHF, and (c) to determine the intensity of dyspnea in these populations.

A purposive sample of 60 patients, 30 with moderate to severe COPD and 30 patients with moderate to severe CHF, met the inclusion criteria and were enrolled in this study. The participants provided …

The Effect Of Lateral Body Positions Upon Pulmonary Artery And Pulmonary Wedge Pressures In Critically Ill Patients, Sharon Greer Millard

Loma Linda University Electronic Theses, Dissertations & Projects

The effect of lateral body positions on pulmonary artery pressures and pulmonary capillary wedge pressure was studied in a clinical comparative study using eight critically ill patients. Pulmonary artery pressures (systolic, diastolic, and mean) and pulmonary capillary wedge pressure measurements were taken with the patients in three different positions, i.e., supine flat, right lateral, left lateral. Comparison was made between the control data (pressure measurements in the supine flat position) and the pressure measurements in each lateral body position. Mean pressures were lower in the lateral body positions than those in the supine flat position, ranging from 0.1 mm Hg …

The Effect Of Lateral Body Positions Upon Pulmonary Artery And Pulmonary Wedge Pressures In Critically Ill Patients, Sharon Greer Millard

Loma Linda University Electronic Theses, Dissertations & Projects

The effect of lateral body positions on pulmonary artery pressures and pulmonary capillary wedge pressure was studied in a clinical comparative study using eight critically ill patients. Pulmonary artery pressures (systolic, diastolic, and mean) and pulmonary capillary wedge pressure measurements were taken with the patients in three different positions, i.e., supine flat, right lateral, left lateral. Comparison was made between the control data (pressure measurements in the supine flat position) and the pressure measurements in each lateral body position. Mean pressures were lower in the lateral body positions than those in the supine flat position, ranging from 0.1 mm Hg …

The Cardiovascular Effects Of Human Contact With Coronary Artery Disease Patients In The Coronary Care Unit, Margaret A. Palmour

Loma Linda University Electronic Theses, Dissertations & Projects

Ten coronary artery disease patients were selected using purposive method of sampling and observed for six hours. It was postulated that 1) Human contact with coronary artery disease patients in the coronary intensive care unit would be associated with significant (p = 0.05) changes in the electrocardiogram such as: (a) increased heart rate more than 10 per cent, (b) changed atrio-ventricular conduction more than 10 per cent, (c) changed ST segment one millimeter or more and (d) increased frequency of ectopic beats more than 10 per cent. 2) The degree of stress and cardiac response was related to a number …

Relationship Of Ventilation Ability And Positioning In Left-Sided Congestive Heart Failure Patients, Nancy E. Carson

Loma Linda University Electronic Theses, Dissertations & Projects

Proper positioning is used to relieve dyspnea, edema, and fatigue in congestive heart failure patients. According to the review of literature, improved ventilation as measured by specific lung volumes and lung mechanics occurred with upright positioning in normal persons. The effects of specific changes in lung volumes related to position change in congestive heart failure patients has not been documented in literature, although various recommendations related to positioning are made. This exploratory study was undertaken with nine congestive heart failure patients to see if a relationship existed between degree of head elevation and lung ventilation ability as measured by water-bell …