Critical Care Nursing Commons^™

Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

Using The Model For Improvement To Address Invasive Hemodynamic Safety Concerns In Critical Care, Selena Truban

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

The use of invasive catheters to monitor hemodynamic readings is common in the critical care setting and requires the use of specialized equipment. Variation in equipment set-up impacts operational efficiency and creates the potential for improper patient treatment based on inaccurate readings. The methodology of setting up and maintaining hemodynamic pressure lines in the critical care units lacked structural and processional measures, creating the potential for patient harm. Multimodal strategies, guided by the Model for Improvement, were used to increase the use of evidence-based methods for setting up and maintaining invasive hemodynamic lines in the critical care units. A …

Emergency Department Workplace Violence Against Nurses, Adam Johnson

MSN Capstone Projects

Emergency room nurses are often thought of as the adrenaline junkies of the nursing world. Emergency nurses interact with a wide array of patients and visitors and are often the first clinician a patient may see upon arriving at an emergency department. With this wide array of patients and visitors, also comes a volatile environment with the increased risks of violence against nurses. This violence could include verbal, physical, and emotional violence from patients, visitors, and even fellow staff members. As violence increases, nursing longevity decreases and thus further increases the expense of nursing on a facility. Therefore, this has …

Increased Discharge Compliance Through Mental Health Follow-Up, Robert H. Kirby

MSN Capstone Projects

Emergency departments are being strained to their breaking points as a result of the recent COVID pandemic. These departments are in need of programs that can help to reduce stress on not only limited budgets but also reduce the strain on their overwhelmed staff. One such strain on emergency departments and their limited resources is the readmittance of mental health patients as a result of non-compliance of the discharge instructions. The change project looks to address whether following up 10 days post discharge can increase discharge instruction compliance and ultimately reduce readmissions. The aim of the project is through the …

Burnout And Fatigue: A Potential Downside Of The Critical Care Nursing Profession, Samantha L. Ford

MSN Capstone Projects

Studies show that burnout and fatigue increase healthcare cost and decreases organizational profit due to increased rates of employee turnover, decreased employee satisfaction, a decrease in the quality of care provided to patients, and the development of a toxic work environment. The three principal factors of job-related burnout and fatigue will be addressed within the context of this paper including emotional exhaustion, depersonalization, and personal accomplishment.

Critical care nurses suffer from feeling emotionally depleted to the point they feel as though they can no longer give anymore of themselves to the patients they care for, which is a result of …

Effect Of Fluid Resuscitation In Patients With Esrd And Sepsis Or Septic Shock: An Integrative Review, Luke Eady

Master of Science in Nursing Final Projects

In patients with ESRD, clinicians are tentative to initiate fluid resuscitation given the chance of negative outcomes associated with fluid overload. Given this, many ESRD patients with sepsis are severely under-resuscitated with fluids and experience a delay in receiving antibiotics (Abou Dagher et al. 2015). There is also controversy surrounding the type of fluid that should be used with patients with ESRD. The mainstay fluid for treatment is 0.9% sodium chloride solution (normal saline). Patient studies have found that this fluid could be harmful to the kidneys and should not be administered in patients with kidney disease (Rochwerg et al. …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

Critical-Care Pain Observation Tool Benchmark Project, Rachel Lutz

MSN Capstone Projects

Background: Pain in the nonverbal adult patient is often misdiagnosed and undertreated. Patients who are unable to communicate pain does not indicate that pain is not present. With the majority of critical-care patients being hemodynamically unstable leaving pain untreated can have detrimental effects on already unstable hemodynamics thus affecting patient outcomes. Research has indicated that patients who have accurate pain management with appropriate analgesia and minimal sedation can help decrease ventilator days, improve patient’s mobility, and help decrease the rate of delirium and length of stay in the intensive care unit (ICU) (Bourbonnais et al., 2016).

Aim: This benchmark project …

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 …

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 …

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 …

The Impact Of A Digital Intervention On Perceived Stress, Resiliency, Social Support, And Intention To Leave Among Newly Licensed Nurses: A Randomized Controlled Trial, Lisa Concilio

Electronic Theses and Dissertations

The nursing shortage has been deemed a public health crisis with the turnover rate of newly licensed nurses (NLNs) growing (Robert Wood Johnson Foundation, 2014). One out of five NLNs are leaving the profession due to work dissatisfaction and feelings of inadequacy (National Academy of Medicine, 2017). NLN attrition during the first year of hire has been associated with feelings of overwhelming stress and decreased sense of support which negatively impact patient safety (Spence Laschinger et al., 2016). As seasoned nurses are attempting to retire amidst a nursing shortage (American Association of Colleges of Nursing, 2018), NLNs require more support …

An Extensive Literature Review On Neonatal Pain Assessment & Management, Bailey Bishop

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Neonatal pain assessment and management is a field requiring much more research. This literature review outlines the current climate of neonatal pain assessment, compares a variety of neonatal pain scales on validity and clinical utility, and implications for how neonatal pain management can be improved. Neonates experience pain to the same degree, if not more, than everyone else. Unmanaged pain during the neonatal period leads to adverse health outcomes. In order to prevent these atrocities from this vulnerable population, NICU pain assessing needs to become the standard of care.

The Exploration Of The Long-Term Effects Of Stroke Patients In The Icu, Hannah Smith

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Hospitalization in the Intensive Care Unit (ICU) has been shown to have poorer long-term effects in stroke patients from the time of admission up to one year of discharge. Throughout the world, people suffer from the complications of having a stroke and being in the ICU. Increased mortality rate, dysphagia, poor speech, loss of mental status, and decreased muscle movement are found in stroke patients who received treatment in the ICU. The poorer long-term effects in stroke patients receiving treatment in the ICU may be caused by the type of stroke, comorbidities, or mental status at admission. The long-term effects …

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

How Does The 2020 Revised Definition Of Pain Impact Nursing Practice?, Olivia Sonneborn, Annie Williams

Journal of Perioperative Nursing

The widely used and acknowledged universal definition of pain developed by the International Association for the Study of Pain (IASP) in 1979 has been revised in 2020. The 2020 IASP definition states pain is ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’. The 2020 IASP definition of pain reinforces the importance for nurses to have an understanding of the pathophysiology of pain and highlights the crucial role pain assessment plays in overall pain management, which nurses are pivotal in driving and delivering.

The Effect Of Opium Addiction On Short-Term Postoperative Outcomes After Coronary Artery Bypass Graft Surgery: A Prospective Observational Cohort Study, Mohammad Reza Habibi, Abbas Alipour, Aria Soleimani, Farshad Hasanzadeh Kiabi, Ali Habibi, Amir Emami Zeydi

BioMedicine

Introduction: Opium addiction has been recently suggested as a potential risk factor for the occurrence of perioperative complications in patients undergoing coronary artery bypass graft (CABG) surgery. The aim of this study was to evaluate whether opium addiction can potentially affect patients' short-term postoperative outcomes after CABG surgery.

Material and Methods: In a prospective observational cohort study, all consecutive patients who were scheduled for first-time isolated elective on pump CABG surgery were screened during the study period for opium addiction. The study was carried out between September 2015 and November 2016 at Mazandaran Heart Center, Sari, Iran. A total …

Tailoring Violence Prevention Programming To A Critical Care Area, Jaime Campbell

Dissertations

Abstract

Problem: Rising rates of violence in health care environments signal a need for health care workers, specifically frontline nurses, to be trained in effective de-escalation management skills. Since January 2017, there has been an increase in the number of patients categorized as aggressive with more violent patient events taking place at a selected midwestern hospital facility in the critical care department, particularly the intensive care and transitional care units.

Methods: Using a pre-post design, this project compared nurses’ verbal de-escalation skills using the English Modified De-escalating Aggressive Behaviour Scale (EMDABS) to determine effectiveness of de-escalation strategies in simulated scenarios …

Nurse-Initiated Protocols For Chest Pain In The Emergency Department, Matthew Hodges

Student Scholarly Projects

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes.

PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks?

Evidence: The reviewed literature supported the evidence of …

Bedside Shift Report: A Way To Improve Patient And Family Satisfaction With Nursing Care, Audriana Pevec

Student Scholarly Projects

Poor communication during the handoff process contributes to approximately 30% of malpractice claims costing up to $1.3 billion annually (Fenner, 2017), which demonstrates the importance of evaluating the quality of information exchange between nurses, patients, and families when associating quality of care to patient satisfaction (Kullberg et al.,2017).

The following question guided this Evidence-Based Project (EBP) project. In adult, progressive care unit patients (P), does the implementation of a nursing bedside handoff (I) compared to current handoff practices (C) improve patient/family satisfaction with nursing care (O) over eight weeks (T)?

The literature revealed evidence from 10 studies answering …

Music Therapy As A Means Of Pain Reduction And Decreased Opioid Use In The Icu Setting, Dakota Shemwell

Scholars Week

Abstract

Being in the ICU as a patient is not a pleasant experience by any stretch of the imagination. Patients in the ICU have recently had major surgery, are ventilated, or are critically ill in other ways. On top of this are the painful procedures that take place in the ICU; repositioning the patient and endotracheal suctioning are just two such procedures that take place in the ICU. Music therapy has been proven effective in reducing a patient’s pain thus, leading to fewer needed doses of PRN opioid pain medications. With our nation in the midst of an opioid epidemic, …

Family Presence During Resuscitation, Brittany Whistle

Scholars Week

Background:

Families want more involvement in their loved one’s care than they did just twenty years ago. Especially, in the matter of resuscitation efforts, this involvement remains controversial.

Evidence and Findings:

Based on research, theories, and multiple educated opinions, family presence during resuscitation (FPDR) needs to be implemented in hospitals. Theories by Kolcaba and Helvie demonstrate a need for comfort and positive energy around patients to enhance the healing process. Evidence has shown multiple benefits of FPDR. The patient receives a holistic approach of care, the family gains closure and feeling of participation of care, and provides a plan for …

Implementation Of Music Therapy To Reduce Anxiety In Icu Patients, Calley Womack

Scholars Week

Current practice in intensive care units regarding anxiety commonly results in administration of an anxiolytic, which can potentially increase patient’s time admitted, increase costs due to adverse effects, and decrease patient involvement in care. An analysis of multiple research studies was conducted to explore the best practice for management of anxiety, particularly the implementation of music therapy. Studies have been conducted on the implementation of music therapy to reduce levels of anxiety in patients on intensive care floors. Specifically, extensive research with music therapy has been conducted on patients receiving ventilation in the ICU. Consequentially, these studies have shown that …

Peripheral Iv Bundle, Alicia Hanna

Graduate Theses, Dissertations, and Capstones

Abstract

It is estimated that over 90% of hospitalized patients require IV access during their hospitalization. Peripheral IVs (PIVs), while less risky than central lines, are not without risk to the patients. Intravenous (IV) infiltration in pediatric patients is a very common complication associated with IV access, accounting for about 67% of IV catheter removals; a less common complication, but much more serious complication of a PIV can be a blood stream infection (BSI) which can account for up to 35% of BSIs seen in patients. BSIs are associated with increased length of stay, increased morbidity and can result in …

What Are The Nurse’S Perception Of The Effectiveness Of The Electronic Go-Jo Monitoring System On Hand Hygiene Compliance And Hospital Acquired Infection’S?, Patricia James

Seton Hall University DNP Final Projects

Background: The importance of hand hygiene compliance in preventing hospital acquired infections is well known. Yet national averages for compliance rates with hand hygiene among healthcare workers remains unsatisfactory. Noncompliance with hand hygiene practices can contribute to increased patient mortality, prolonged length of hospitalization, increase healthcare costs and decreased reimbursement for hospitals from the Centers for Medicare and Medicaid. Project Aim: The purpose of this quality improvement project was to explore the nurses’ perceptions of the effectiveness of the electronic Go-Jo monitoring system on hand hygiene compliance and hospital acquired infections. Methods: This was a performance …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Cardiac Resuscitation Training: An Integrative Literature Review, Dominick Pahl

Nursing Masters Papers

Despite highly trained healthcare professionals being readily available to respond to In-Hospital Cardiac Arrest (IHCA), a patient experiencing an IHCA often remains a devastating event for the patient. Each year in America, 13.5% of all deaths result from sudden cardiac arrest. Even with healthcare professionals certified in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS), the survival rates following an IHCA are not inspiring. The median survival rate to hospital discharge of an adult experiencing IHCA is 26.4% and 49.5% for the pediatric population. Despite a continued focus on improving CPR quality from the American Heart Association (AHA), …

Exploring The Mental Health Needs Of Intensive Care Unit Nurses Facing The Pandemic Of Covid-19, Bushra Salamah

The Eleanor Mann School of Nursing Student Works

Coronavirus disease (COVID-19) has spread domestically and internationally, with approximately 134 billion confirmed cases worldwide and over 2 million deaths attributed to the virus. Frontline healthcare workers are at a substantially higher risk of infection and death due to excessive COVID-19 exposure while also facing mental health challenges. Epidemiological data on the mental health statuses of frontline nurses is still limited. The aim of this study was to examine mental health (burnout, stress, emotional exhaustion, disengagement) and associated factors among Intensive Care Unit (ICU) Nurses who are caring for COVID-19 patients to support and maintain their psychological well-being.