Critical Care Nursing Commons^™

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated by …

Improving Trauma Activation Guideline Adherence In A Level Iii Emergency Department, Jesus Valdez

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase appropriate use of trauma activation guidelines by nurses in a level III emergency department. Care provided by a multidisciplinary trauma team is paramount for the severely injured patient, as this may facilitate rapid diagnosis and treatment. Trauma related mortality can be significantly decreased through the care provided. Trauma patients require specialized care at a precise time often called the “golden hour” to help prevent death or disability. Almost 30 Texans die every day from trauma related injuries, which averages to 10,000 people each year. Trauma is the leading cause of …

Stem Cell Therapy As An Effective Treatment Method For Traumatic Burn Injuries, Axita Patel

Grace Peterson Nursing Research Colloquium

Effectiveness of Stem Cell Treatment for

Burn Patients: An Integrative Literature Review

Axita Patel

Faculty Sponsor: Elizabeth Moxley

Abstract

Background: Current literature suggests that packing burn wounds with antimicrobial solutions and skin barrier creams are no longer considered to be effective in the patient’s recovery process. Stem cell therapy has been introduced as an alternative treatment strategy that aims to yield reliable and improved patient outcomes.

Objectives: To explore what research has been conducted regarding stem cell therapy as a treatment option for burn patients and to explore the benefits of using the suggested newly proposed method as opposed to …

Sensitivity Of Pain Assessment For Critically Ill, Nonverbal Adults, Ruta Jarmontaviciute

Grace Peterson Nursing Research Colloquium

Abstract

Background: Patient’s self-report is a “gold standard” in assessing pain, yet it is not always possible in critically ill, nonverbal adults. In such cases, the use of reliable behavioral pain assessment tools is paramount to patient outcomes. However, the literature presented conflicting information regarding behavioral pain assessment tools and their sensitivity in assessing pain in critically ill, nonverbal adults.

Objective: This integrative research aimed to explore the effectiveness and barriers in the clinical guidelines of the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) assessment tools for the detection of pain in critically ill, nonverbal adults. …

Nurses Can Do Better At Recognizing And Treating Sepsis, Stefan Lindsay

Grace Peterson Nursing Research Colloquium

No abstract provided.

Patient Experiences In Intensive Care Units: A Systematic Review, Serpil Topçu, Şule Ecevit Alpar, Bilgi Gülseven, Ayda Kebapçı

Patient Experience Journal

The aim of this systematic review is to analyze the data gathered from studies conducted to determine patient experiences in intensive care and levels of the recollection of the intensive care period that were published between December, 1998 – April, 2013. The systematic review was carried out screening of the related publications. The findings of the systematic review were studied under the following two titles: “remembering the intensive care period” and “recalled experiences” of patients. Studying 15 papers which were found suitable to the inclusion criteria of the review indicated that majority of the patients had recollection of the intensive …

Comparison Of The Behavioral Pain Scale And The Critical-Care Pain Observation Tool In Assessing Pain In Ventilated Critical Care Patients, John Weldon

Master of Science in Nursing Final Projects

Purpose: The study aimed to compare the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) in their effectiveness to identify the presence of pain in nonverbal mechanically ventilated critically ill patients. Nurses’ evaluation with the feasibility, clinical relevance, and satisfaction of the tools were also gathered and compared.

Design: This study followed a non-experimental, correlational, comparative design.

Methods: Nurses were recruited from the surgical intensive care unit in a midsized community hospital in the Southeastern United States. After training, nurse participants obtained pain assessments on ventilated critically ill patients at rest, following a normal blood pressure …

Knowledge And Attitudes Of Orthopedic Nurses Regarding Pain Management, Matthew Neumann

Doctoral Dissertations and Scholarly Projects

Nurses are at the forefront in the care of patient pain management; however, many nurses do not possess the knowledge, skills, and attitudes required for best pain management outcomes. Adequate pain management education is often infrequent in academic settings and in post-graduate health care environments. That shortcoming suggests a need to improve pain management education as advocated by The Joint Commission and U.S. Department of Health and Human Services. The purpose of this study is to measure 20 nurses’ knowledge and attitudes regarding pain and pain management while working in an orthopedic setting. It was an evidence-based practice project utilizing …

Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance

Doctoral Dissertations and Projects

Providers of healthcare have continued to focus on addressing patients’ chronic health outcomes. When understanding how to manage chronic disease, there remains many opportunities in facilitation of better management. With such a wide range of individuals who suffer with a chronic condition, better management to address this population is essential. Palliative care aids in accomplishing this task. It was seen that there was a lack of education in relation to palliative care, with perceptions that continued to be a barrier to the utilization of the service. Due to the lack in education, the strongest barrier to palliative care service utilization …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Adverse Psychological Effects Of Patients In Medical Isolation Due To Healthcare-Associated Infections, Kristin Brill

Grace Peterson Nursing Research Colloquium

Background: Patients placed in medical isolation due to healthcare-associated infections experience adverse psychological effects that can impact their quality of life.

Objectives: The purpose of this integrative literature review was to identify the adverse effects of patients in medical isolation as well as explore coping strategies that can be used to decrease these adverse effects.

Method: An integrative literature review was conducted using the databases of CINAHL, PsychInfo, PubMed, and PsychArticles. Search terms included adverse effects, negative effects, effects, adverse outcomes, negative outcomes, isolation precautions, contact isolation, droplet isolation, airborne isolation, isolation, coping and psychology.

Results: Five common adverse psychological …

Programs That Can Support Nurses To Reduce Compassion Fatigue And Secondary Traumatic Stress: An Integrative Literature Review, Molly Gruettner

Grace Peterson Nursing Research Colloquium

Compassion allows a nurse to empathize with their patient and their family, but it does not prepare the nurse to cope with stressful events. Repeatedly being exposed to traumatizing events, pain, distress, and suffering can lead to nurse burn-out and fatigue. Compassion fatigue is a unique form of burnout and secondary traumatic stress (STS) encompasses ideas of compassion fatigue and the two terms are often used interchangeably. Objective: The goal of this systematic integrated literature review is to discover interventions to reduce compassion fatigue and STS in trauma nurses Methods: A systematic integrated literature review study was conducted using Ebscohost …

Higher Medication Administration Errors Associated With Automated Dispensing System Usage, Jillian Cramer

Grace Peterson Nursing Research Colloquium

According to a report by The Institute of Medicine, medical errors were associated with up to 98,000 deaths and more than 1 million injuries each year in the United States. These errors can result in poor outcomes, which increase harm or death. According to the Pennsylvania Patient Safety Reporting System, up to 15% of errors reported cite automated dispensing cabinets as the source of the drug involved in the error.Nearly 58% to 70% of hospitals nationwide use automated dispensing cabinets. Nurses play a critical role in promoting patient safety by surveilling and intercepting any possible errors that could occur during …

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education …

Barriers To Advance Directives, Anna Malia Connor Ticknor

Grace Peterson Nursing Research Colloquium

Abstract

Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of …

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor …

Meta-Regression: Prognostic Models As Objective Predictors Of Mortality Among Icu Cancer Patients, Sheila Donnell

Nursing Theses and Dissertations

Cancer patients admitted to the intensive care unit (ICU) may be experiencing complications of disease or treatment-related effects. While acute complications related to disease and/or its therapeutic management vary in severity, the approach to ICU-centered care is complicated by actual versus perceived risks of poor outcomes. Prognostic models that inform clinical judgment of nurses and physicians may prove helpful in this population. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) are ICU-based models predicting 30-day mortality among the general ICU population. Although studies have been …

Chest Pain Protocol Order Set, Andrey Kulikov

Master's Projects and Capstones

The goal of this project is to implement a chest pain protocol order set in order to increase the nurse-initiated chest pain protocol by 50%. The project was implemented in a Emergency Department (ED) that has problems with understaffing and patient crowding. RN-initiated chest pain orders are implemented 11% of the time and 89% by physicians. RNs initiated orders in less than 10 minutes while 50% of physician orders are initiated over 30 minutes. This results in delayed care and decreases patient flow. A chest pain protocol order set was designed based on the approved nursing protocol policy. 90% of …

The Clinical Nurse Leader As Risk Anticipator: Optimizing The Completion And Accuracy Of The Code Blue Recorder Sheet, Catherine Morano

Master's Projects and Capstones

Abstract

• A small community hospital in northern California implemented a practice improvement project in critical care units to optimize best practices surrounding a “code blue” event. In-Hospital Cardiac Arrest (IHCA) is a high-risk process of care that requires tremendous resources to deliver an efficient, safe, and cost-effective service. The code blue recorder sheet summarizes the whole patient care event; this necessitates careful documentation. As a risk anticipator, the unit clinical nurse leader identified suboptimal variation in documentation after a microsystem assessment. This led to a practice change project and targeted educational intervention for code blue recorders. Fifteen staff members were …

Cnl As Educator In The Emergency Department: Improving Hand Hygiene Outcomes, Michelle Batz

Master's Projects and Capstones

Prevention of hospital acquired infections (HAI) is a National Patient Safety Goal. Proper and frequent hand hygiene (HH) prevents HAI and various cross-infections in any setting. Audits of visual adherence for HH generates low compliance scores. During a yearlong improvement project, low monthly compliance scores of 52% in the Emergency Department (ED) of a community hospital, were reported by hospital auditors and found to be inaccurate by ED staff due to lack of visibility of HH actions because they occurred behind curtains or closed doors. Low scores and challenges were associated with behavioral change among ED team members, requiring multiple …

Pulmonary Embolism, Tonya Day

Nursing Student Class Projects (Formerly MSN)

The pathophysiological topic of acute pulmonary embolism was chosen to increase the knowledge base and provide additional information to assist with moving forward from a registered nurse to an Advance Practicing Nurse. Working as a full-time registered nurse in the emergency department, the working diagnosis of acute pulmonary embolism is something that is ruled out on many patients with complaints of shortness of breath, chest pain, or decrease in pulse oximetry. Since a patient with an acute pulmonary embolism can have both typical and atypical symptoms, the death rate can be very high, if not caught earlier enough. An acute …

Implementation Of An Innovative Early Warning System: Evidenced-Based Strategies For Ensuring System-Wide Nursing Adoption, Shirley S. Paulson

Doctor of Nursing Practice (DNP) Projects

Early deterioration in adult medical-surgical patients is associated with increased intensive care unit and hospital mortality (Goldhill, 2001). Failure to recognize deterioration is a preventable patient safety and quality issue. To address this problem, since 2013, Kaiser Permanente Northern California (KP NCAL) has piloted Advance Alert Monitor (AAM) at two hospitals. This early warning system employs a set of predictive models developed by the KP NCAL Division of Research, which automatically predicts patient deterioration within the next 12 hours based on a complex algorithm of laboratory and clinical data points. Improvements in mortality and length of stay have been realized …

Acute Bronchospasm Under General Anesthesia, Cody Rasmussen

Nursing Student Class Projects (Formerly MSN)

An acute bronchospasm during general anesthesia can become a life-threatening intraoperative condition for any patient. Bronchospasm occurs when the bronchial smooth muscle constricts which makes ventilating the patient difficult, and can ultimately lead to hypoventilation, hypoxemia, and metabolic acidosis. It’s imperative for any anesthesia provider to understand what a bronchospasm is, its pathophysiology, differential diagnosis, and algorithm of treatments. This poster presentation provides a summary based discussion of acute bronchospasm under general anesthesia.

Sepsis, Sarah Jones

Nursing Student Class Projects (Formerly MSN)

Sepsis is a dysregulation of the inflammatory response, termed systemic inflammatory response syndrome or SIRS, caused by stimulation of an infectious process. Sepsis often leads to organ dysfunction and increased morbidity, mortality and financial burdens. The goal of treatment is to initiate appropriate antimicrobial therapies, target the underlying infection, optimize intravascular volume, provide fluid resuscitation and maintain adequate perfusion and stroke volume (Taeb, Hooper & Marik, 2017).

Timing of treatment and early detection of sepsis is critical to patients with early warning signs. Sharing this information and potentially making a difference in the outcomes of patients presenting with early signs …

2017-2018 Graduate Studies In Nursing Handbook, Otterbein Office Of Graduate Programs

Graduate School

A graduate handbook for the Graduate Studies in Nursing programs at Otterbein University.

Traumatic Induced Coagulopathy, Paul Devore

Nursing Student Class Projects (Formerly MSN)

Trauma is a leading cause of mortality and morbidity in the United States. For years patients have been resuscitated in a similar method without improvement in survival of the most severely injured cohort. While acidemia, hypoxia, and hypothermia have long been recognized as complicating factors in the care of trauma patients, it is only recently that research has led to a greater understanding of the pathophysiology of this deadly trio. Coagulopathy of trauma is a multi factorial process which is now being recognized as the proximate cause of death in many patients. This poster examines the pathophysiology and nursing interventions …