Critical Care Nursing Commons^™

Implementing An Icu-Specific Pressure Injury Prevention Bundle (Skin Safe)To Reduce The Incidence Of Hospital-Acquired Pressure Injuries In Adult Surgical Intensive Care Unit., Komal Ali

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The purpose of this project was to evaluate the effectiveness of implementing an ICU-specific pressure injury prevention bundle (SKIN SAFE) Sto reduce hospital-acquired pressure injuries (HAPIs) in an adult Surgical ICU.

BACKGROUND

HAPIs remain a major safety concern in critically ill patients. Standardized prevention bundles improve adherence and reduce incidence.

METHODOLOGY

This QI project in a 20-bed Surgical ICU used the PDSA framework to implement the eight-component SKINSAFE bundle. Strategies included staff education, champions, and weekly audits. Data were collected through EMR review, monthly PIP audits for HAPI incidence, and weekly compliance audits.

RESULTS

Pre-intervention data showed two HAPIs …

Promoting Sleep Hygiene In The Intensive Care Unit- Implementation Of A Sleep Bundle, Emma J. Harris

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement (QI) project’s purpose was implementation of a sleep bundle for at least 25% of an 18-bed cardiac intensive care unit (ICU) and reduce noise level by 20% (decibels) through education of at least 75% of the patient-care staff 3 months post-implementation.

Background: This quality improvement (QI) project’s purpose was implementation of a sleep bundle for at least 25% of an 18-bed cardiac intensive care unit (ICU) and reduce noise level by 20% (decibels) through education of at least 75% of the patient-care staff 3 months post-implementation.

Methodology: Patients were assessed using the Richard Campbell Sleep Questionnaire …

Improving Cpr Quality In The Emergency Department By Implementing Data Driven Debriefs, Alyssa M. Hughes

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of the quality improvement project was to evaluate the effectiveness of implementing a data driven debrief tool to improve the average compressions in target in adult cardio-pulmonary resuscitation (CPR) events.

Results

In FY23 prior to implementation the average compressions in target was only 1.65%. During the implementation phase of the project the average compressions in target reached 41% (n=3). In addition, the staff provided positive feedback regarding the tool and the integration in the workflow.

Background

The project was completed in a tertiary academic medical center emergency room. All adult CPR events within the emergency department utilizing …

Nurse Manager Perceptions Of Strategies To Overcome The Underutilization Of Nonpharmacological Pain Control Methods In Adult Acute Care, Landen M. Bonnell

Undergraduate Honors Theses

A basic patient right is to have pain adequately managed. However, research consistently indicates that many adult patients in acute care experience inadequately managed pain, which may contribute to adverse patient outcomes. Studies have shown that nonpharmacological pain management can lead to increased patient satisfaction, shorter hospital stays, and better patient outcomes. However, many barriers exist to nurses providing effective nonpharmacological pain control therapy, primarily including heavy workload and a lack of education and support. Currently, there is insufficient research on how to overcome these barriers. Four nurse managers with experience in nursing leadership were interviewed using a qualitative descriptive …

Implementation Of Phq-9 To Improve Depression Identification In Icu, Jenny C. Manoly Bsn, Rn

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement project aimed to improve depression identification by screening 80% of eligible adults admitted to two heart failure intensive care units (ICU) using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS Screening compliance increased from 42.1% to 85% by Week 13, exceeding the project goal. Of 101 patients screened, 16.8% screened positive for depression. Workflow changes, leadership support, and peer engagement improved compliance, though psychiatric referrals remained inconsistent.

BACKGROUND Depression is common among critically ill patients but is frequently underrecognized because ICU care primarily focuses on physiologic stabilization. Existing admission screening was limited to suicide risk assessment, delaying identification …

Enhancing Heart Failure Transitional Care To Reduce 30-Day Readmission Rate, Thuy Nhu Uyen Tran

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project is to reduce 30-day readmissions for adult patients with heart failure (HF) by implementing a standardized HF pathway beginning in the intensive care unit (ICU) and continuing through discharge.

Background: The project was implemented within a large healthcare organization in Northwest Houston, Texas.

Methodology: This project utilized a pre- and post-implementation design guided by the Plan-Do-Study-Act (PDSA) model. Eligible adult patients (≥18 years) with a primary or secondary HF diagnosis were identified during March 2026. The My Pathway to Wellness HF education pathway was initiated at the time of ICU downgrade …

The Comfort Cart Initiative: A Quality Improvement Intervention To Improve Patient Satisfaction In The Emergency Department, Heidy Cladimir Ayala

Doctor of Nursing Practice Final Project Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory …

Nurses’ Knowledge And Practices Regarding Infection Prevention Measures In Cardiac Intensive Care Unit, Marwa G. Abouheiba, Maha Adel Salem, Jean Bertin Mudenge

Nursing

Abstract: Background: Healthcare-associated infections (HAIs) remain a major global patient safety challenge, contributing substantially to morbidity, mortality, prolonged hospitalization, antimicrobial resistance, and increased healthcare costs. Patients admitted to cardiac intensive care units (ICUs) are particularly vulnerable because of their critical illness, frequent exposure to invasive devices, and complex cardiovascular interventions. Nurses play a pivotal role in preventing HAIs through the consistent implementation of evidence-based infection prevention and control (IPC) measures. Therefore, assessing both nurses' knowledge and their observed clinical practices is essential for identifying strengths, potential gaps, and opportunities for quality improvement. Aim: To assess nurses' knowledge and observed practices …

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle In Adult Cardiac Care Units, Marwa Abdo

Nursing

Ventilator-associated pneumonia (VAP) is among the most common ICU infections for ventilated patients, associated with increased mortality (20-50%), morbidity, and health care costs. Nurses' knowledge of VAP prevention bundles is vital to reducing its incidence in critical care areas. Aim: To assess Nurses’ knowledge regarding the ventilator-associated pneumonia prevention bundle in Adult Cardiac Care Units. Study design: A cross-sectional study design was used. Setting: This study was conducted in both the adult cardiac intensive care unit and the cardiac care unit at Aswan Heart Centre–Magdy Yacoub Foundation, Egypt. Subject: A convenience sample of 67 nurses was selected. Data collection tool: …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Posters and Presentations

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Improving Nursing Compliance With Pressure Injury Prevention In Postoperative Patients In The Cardiovascular Intensive Care Unit, Chingyi Lam

Doctor of Nursing Practice Final Project Abstract

Pressure injuries acquired in the hospital continue to be a major concern in patient safety among critically ill populations. The purpose of the quality improvement project was to improve nursing compliance with pressure injury prevention strategies among postoperative patients in a cardiovascular intensive care unit (CVICU). Patients who undergo cardiovascular surgery are at a high risk of developing pressure injuries due to immobility, sedation, vasopressors, and prolonged positioning on their backs. The quality improvement project was carried out in a 37-bed CVICU using the Institute for Healthcare Improvement (IHI) Model for Improvement and Plan–Do–Study–Act (PDSA) cycles. Data on nursing repositioning …

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 …

Improving Postoperative Handoff For Placenta Accreta: Implementing A Structured Handoff Communication Tool, Isabelle L. Gerrard

Doctor of Nursing Practice Final Project Abstract

Purpose Implement a standardized postoperative handoff tool to improve interdisciplinary communication during transfer of placenta accreta spectrum (PAS) patients from the operating room to an obstetric intensive care unit at an academic women's hospital.

Background Placenta accreta spectrum (PAS) is a high-risk obstetric condition requiring coordinated multidisciplinary care. At the project site, operating room (OR)-to-obstetric intensive care unit (OB ICU) handoffs lacked a standardized process. This resulted in inconsistent communication and omission of critical information. Nurses reported reduced confidence. Standardized handoff tools can improve communication and promote safer transitions of care.

Methodology This 10-week quality improvement project used Plan-Do-Study-Act methodology …

Nurse-Driven Infusion Protocols In Diabetic Ketoacidosis: A Scoping Review, Nicholas Morrell Pierce Msn, Rn, Cen, Ccrn, Mary Cassandra Scott Bsn, Rn, Ccrn, Cen, Alvertis Demetreis Warren Bsn, Rn, Ccrn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, …

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

2025

No abstract provided.

The Impact Of Structured Family Meetings In The Intensive Care Unit, Loyce T. Mofor

Doctor of Nursing Practice Final Project Abstract

The Impact of Structured Family Meetings in the Intensive Care Unit (ICU)

Purpose

Train providers at an academic institution in a large metropolitan area to conduct family meetings using a structured approach and evaluate this intervention's impact on family satisfaction with communication in the ICU.

Background

Inadequate communication between families and healthcare teams leads to lower family satisfaction, heightened feelings of guilt, and diminished capacity for making clinical decisions.

Methodology

VitalTalk training was utilized to improve providers’ communication skills. Structured family meetings were conducted for Surgical and Thoracic ICU patients with an ICU length of stay of > 5 days or …

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 …

The Effect Of Fall Prevention Programs With Hourly Rounding On Fall Rates Among Adults Patients In Neurological Unit, Oyinlola A. Ogundeji

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this QI project was to evaluate the effect of a structured hourly rounding program on patient fall rates in an adult neurological inpatient unit.

Background

Patient falls remain a major safety concern in acute care, particularly among hospitalized neurological patients with impairments in mobility, cognition, and balance. In an adult neurological unit within a Magnet-designated hospital, fall rates exceeded national benchmarks, underscoring the need for a targeted quality-improvement

Methodology

A pre–post QI design, guided by the Plan-Do-Study-Act framework, was implemented over 12 weeks in a 28-bed neurological unit. This intervention featured structured hourly rounding using the …

Improving New Graduate Nurse Clinical Readiness Through Interprofessional Collaboration And High-Fidelity Simulation, Alyssa M. Starkey

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement (QI) project was to enhance new graduate nurse (NGN) clinical readiness through an interprofessional high-fidelity simulation focused on recognizing and responding to patient deterioration during nurse residency onboarding.

Background

New graduate nurses often feel uncertain about recognizing clinical deterioration and communicating. Research shows that simulation-based and interprofessional training improve judgment, teamwork, and communication. This project aims to achieve at least a 10% increase in NGN clinical readiness following the implementation of a high-fidelity simulation program.

Methodology

A pre–post QI study based on Kolb’s Theory and PDSA principles was conducted in a nurse residency …

Health Is Where The Huddle Is, Lyndsey Anthony, Anna E. Komistek, Philip C. Pritchett, Emma K. Swanson

SPARK Symposium Presentations

“Health is Where the Huddle Is”

Huddles are an evidence-based strategy to facilitate a culture of safety within nursing teams. A review of 158 huddle studies found that 44.3% reported improved clinical outcomes and 24.3% showed fewer medical errors when huddles were implemented (Pimentel et al., 2021). Currently, a local hospital’s 13-bed ICU lacks an effective system for nursing staff to huddle due to staffing constraints and the absence of monitor technicians, creating safety concerns when nurses leave monitors unattended. This project aims to implement an effective, nurse-led shift huddle that maintains continuous patient monitoring while also strengthening patient safety …

Optimizing Central Line Discontinuation In The Surgical Intensive Care Unit: A Quality Improvement Initiative Using A Visual Aid To Reduce The Risk Of Central Line-Associated Bloodstream Infections, John Quyen D. Van

Doctor of Nursing Practice Final Project Abstract

PURPOSE 

The aim of this quality improvement (QI) project was to reduce unnecessary central line dwell time by 20% in a surgical intensive care unit (SICU) in Central Texas.

BACKGROUND 

Central line–associated bloodstream infections (CLABSIs) contribute to patient harm and increased healthcare costs. The literature strongly supports the timely removal of central venous catheters (CVCs) to reduce this risk; however, delays often occur due to workflow demands, communication gaps, and inconsistent daily necessity assessments.

METHODOLOGY 

Guided by the Health Belief Model (HBM) and the Institute for Healthcare Improvement (IHI) Model for Improvement, the QI project consisted of an 8-week baseline …

Improving Patient Satisfaction In The Emergency Department Waiting Room Through Enhanced Communication Strategies: A Quality Improvement Initiative, Wael P. Karaki

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project aimed to improve ED waiting room experience by standardizing communication to increase transparency and expectation management, targeting an increase in Net Promoter Score (NPS) from 33.5 to ≥35.4 within three months.

Background: ED waiting room dissatisfaction is driven by uncertainty (unclear wait times, inconsistent updates, and limited understanding of triage and ED flow), supporting structured communication over individual clinician delivery.

Methodology: A 3-month, single-site QI project in an urban ED used iterative PDSA cycles and included all ED encounters (n=17,444). The bilingual intervention included orientation pamphlets (print/QR-based), standardized triage verbalization of …

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 Use Of A Safety Screening Tool To Improve Sedation Holiday Compliance And Nurse Confidence, Shelby Marchisio

Doctor of Nursing Practice Final Project Abstract

Purpose

This project sought to evaluate the impact of a safety screening tool on sedation holiday compliance and nurse confidence.

Background

This project was conducted within a 42-bed intensive care unit at a large academic hospital in Houston, Texas. Despite having a nurse-led sedation holiday protocol, compliance averages varied from 50-85%. In alignment with evidence-based practice, it was determined that integrating a safety screening tool into the sedation holiday process may improve compliance.

Methodology

The FADE Model for Quality Improvement guided project development. An anonymous survey was conducted using Likert-scale ratings to assess nursing perceptions and confidence related to sedation …

Implementation Of A Turn Team To Reduce Hospital-Acquired Pressure Injuries In A Medical Intensive Care Unit, Heather A, Adair

Doctor of Nursing Practice Final Project Abstract

Implementation of a Turn Team to Reduce Hospital-Acquired Pressure Injuries in a Medical Intensive Care Unit

PURPOSE

The project aimed to reduce hospital-acquired pressure injury (HAPI) rates in a Medical Intensive Care Unit (MICU) by improving nurses' knowledge of the Braden Scale and implementing a structured two-nurse turn team workflow to reposition high-risk patients every two hours.

RESULTS

Repositioning compliance improved substantially and consistently exceeded the project goal of 90% after implementing a pod-based workflow. The HAPI prevalence rate decreased from a baseline of 8% to below the project goal of ≤5% during implementation but was not sustained in the …

Acuity-Based Staffing Tool: Improving Patient Outcomes And Nurse Wellbeing In A Local Critical Care Unit, Grace Watson, Rachel Nazha, Madeline Ruffin, Evvy Lewis

SPARK Symposium Presentations

This change project proposes implementation of the CAMEO (Complexity Assessment and Monitoring to Ensure Optimal Outcomes) acuity-based staffing tool in a local critical care unit to improve patient safety, nurse wellbeing, and organizational outcomes (Hurtig et al., 2021). Current staffing practices rely on floating nurses from other units during census fluctuations, creating skill mismatches, increased burnout, and risk for adverse events. Evidence links inadequate staffing with increased mortality, infections, length of stay, and nurse turnover, revealing the need for a more systematic approach (Elmdni, 2025). The CAMEO tool quantifies cognitive workload across 18 domains of care and aligns nurse expertise …

Slow Your Pace; Do I-Trace!, Meghan Delaney, Mckenna Geary, Kacie Knary, Chloe Minnich

SPARK Symposium Presentations

SPARK Final Summary

Slow your pace; do I-TRACE! The purpose of this project is the addition of the I-TRACE method to strengthen the current strategies and practices with a long-term goal of reducing central line associated bloodstream infections (CLABSI) events. CLABSI remains an ICU concern, with an estimated 15,000 cases annually in the U.S. (NHSN, 2026). In 2025, a local ICU reported seven CLABSI events, an unusually high number for one hospital (LeapFrog, 2016). To combat CLABSIs, we will implement the I-TRACE method during every hand-off. The oncoming nurse will assess all central lines and dressings, and both nurses will …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

The Murdock Daily Reilly (M.D.R.) Scale: A Pressure Injury Risk Assessment Scale For Critical Care, Ann Murdock, Andrea Daily, Deby Reilly, Shih-Ting Chiu, Melissa Robinson

Publications 2026-present

No abstract provided.

Enteral Nutrition Guidelines Improve Critically Ill Patients’ Outcomes: A Quasiexperimental Study, Marwa Abdo, Sara Elsayed Hegazy

Nursing

Background: Optimal nutritional support is a fundamental element of treatment for critically ill patients. Adherence to evidence-based enteral nutrition guidelines is essential to promote patient care and prevent potential complications. Objectives: To assess the effectiveness of enteral nutrition guidelines in improving critically ill patients’ outcomes. Method: A quasiexperimental study evaluated 68 critically ill patients divided into 2 groups. The intervention group received their nutrition based on the evidence-based enteral nutrition guidelines, while the control group received their nutrition based on the unit’s routine care. The study was conducted in the surgical intensive care units of Mansoura Emergency Hospital in Egypt. …