Critical Care Nursing Commons^™

The Effect Of Medication Reconciliation Timeout On Patient Safety: An Evidence-Based Project, Renante Dizon

Student Scholarly Projects

Practice Problem:There was a report of a high rate of medication errors from inaccurate medication reconciliation during admission to a local hospital in South Texas. The medication error rate was 14.88% on 20 reviewed charts, and 85% of all evaluated charts contained at least one medication discrepancy.

PICOT: This evidence-based, system-change project was guided by the following PICOT question: For nurses administering medication in a long-term acute care hospital, does the implementation of Medication Reconciliation Timeout Process (MRTP) decrease the medication errors, compared to the usual medication practice, in one month?

Evidence: Thirteen pertinent studies recommended the use of …

New Graduate Nurses Experiences During Their Transition From Novice To Competent And How Mentorship Post Residency Affect Their Experiences, Kelsey N. Murphy

MSN Capstone Projects

Staffing competent nurses in specialized areas poses a unique challenge to hospitals across the country. Competent and experienced RNs are leaving the bedside for a multitude of reasons including dissatisfaction in workplace environment, retirement, and hospitals are facing a shortage of skilled nurses in acute care (Valdez, 2008). To address this growing concern and meet increasingly complex health care demands, hospitals are relying on nursing schools to produce competent graduate nurses (GNs) (Valdez, 2008). Hospitals recruit and hire GNs for highly specialized roles in acute care areas despite the stressors accompanied with these roles. Clinical educators have the opportunity to …

Tele Critical Care Implementation And Education Project, Jeffrey Dover

Master's Projects and Capstones

Abstract

Problem: The intensive care unit has the highest rate of mortality and patient care costs in the hospital. There are significant challenges in improving care and controlling costs. One solution adopted by many healthcare organizations is intensive care telemedicine. Commonly known as eICUs or Tele Critical Care (TCC). These specialty units provide access to intensivists and nurses 24-hours a day and has shown success in reducing mortality and length of stay while providing cost savings.

Challenges exist in introducing telemedicine to a new setting. Barriers identified are high initial cost of equipment, competing priorities for resources, and nurse acceptance. …

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …

Keeping Patients Vertical In The Intensive Care Unit, Melanie Smith

Master's Projects and Capstones

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem’s current …

Is This Really Happening? Family-Centered Care During Covid-19: People Before Policy, Terri Savino, Karri Crispino

Patient Experience Journal

In the middle of a global pandemic, hospitals created policies for visitor restrictions to reduce the transmission of coronavirus to protect patients and staff and developed protocols allowing only one support person to call the critical care unit for patient updates. Late on a Tuesday afternoon, the Manager of Patient Experience received a phone call asking her to call Karri, the wife of one of our patients who was on a ventilator. Karri was struggling with updating her mother-in-law because she was very upset with the news she received, making it difficult to call her husband’s mom. Karri asked the …

Sepsis Pathophysiology, Samantha Kingsley

Nursing Student Class Projects (Formerly MSN)

Sepsis is one of the most common diagnoses in medical intensive care units (MICUs) worldwide. Sepsis is a medical emergency where prompt intervention is vital to promoting positive patient outcomes. Septic shock develops when sepsis has progressed to the point of persistent hypotension despite appropriate fluid resuscitation. It is important to recognize the early signs of sepsis and intervene to prevent further progression. As the understanding of the pathophysiology has developed further over the years, the treatments and outcomes associated with sepsis have also improved. However, prompt recognition and intervention have always been at the forefront of management and should …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …

Malignant Hyperthermia, Kathryn Hernandez

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia (MH) is a condition in which the body goes into a hypermetabolic state affecting skeletal muscle in response to receiving inhaled anesthetics or the neuromuscular blocking agent, succinylcholine. MH is an autosomal dominant disorder that is most closely related to a defect in the ryanodine receptor. The defective receptor causes a rapid increase of intracellular calcium causing hyperthermia, tachycardia, tachypnea, hypercapnia, increased oxygen consumption, acidosis, hyperkalemia, muscle rigidity, and rhabdomyolysis. With the complexity of this disorder and its unique pathophysiological process it is crucial that all parts of the surgical team, especially anesthesia providers, understand how to treat …

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Aortic Stenosis, Christina Lower

Nursing Student Class Projects (Formerly MSN)

Aortic Stenosis is the progressive and permanent narrowing of the aortic valve that is located between the left ventricle and the aorta. The pathophysiology is endothelial damage to the valve resulting in lipid penetration, calcific changesand valve stiffness.Major risk factors for aortic stenosis are natural aging>60 years(atherosclerotic changes in vasculature) and male gender.In the early phases of aortic stenosis, the body compensatesvia hypertrophy of the left ventricle to accommodateforthe increased pressure gradient. Progression is typically over years to decades untildecreased outflow of blood leads toinadequate perfusion to major organsystems including the heart itself. Patientsdo not typically have symptoms until …

Coarctation Of The Aorta, Megan Berens

Nursing Student Class Projects (Formerly MSN)

Coarctation of the aorta (CoA) is a ductal dependent congenital heart defect that causes decreased blood flow to areas of the body distal to the site of constriction. CoA is one of the most common congenital heart defects, though is often missed in neonatal assessments. Neonatal patients with CoA often present to the hospital in a state of cardiopulmonary collapse. CoA is occasionally diagnosed in older children and adults who have upper extremity hypertension and decreased femoral pulses. CoA repair is performed through surgery or percutaneous catheter interventions. Patients with CoA have an increased likelihood of developing other vascular lesions. …

Pulmonary Arterial Hypertension, Gifty Menka

Nursing Student Class Projects (Formerly MSN)

Pulmonary arterial hypertension (PAH), is diagnosed as persistently elevated pressures in the pulmonary arteries. It is a severe disease that requires early diagnosis and treatment as it can be life-threatening if not treated promptly and adequately. The initial presenting signs and symptoms such as lethargy, malaise, and exercise intolerance can be vague, making it difficult to diagnose. Also, doctors at centers that specialize in treating PAH are the only ones who can properly diagnose the condition and initiate disease-targeted therapy. There are different types of PAH; the World Health Organization (WHO) recognizes 5 groups of pulmonary hypertension (PH), and they …

Hyperosmolar Hyperglycemic State, Justin Momeyer

Nursing Student Class Projects (Formerly MSN)

Hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) are dangerous complications of diabetes. HHS is examined in this poster and compared to DKA. Even though both have some similarities, they have very different laboratory profiles, patient presentations, treatments, complications, and can require different levels of care. With diabetes becoming more common amongst patients in the hospital, it is imperative that healthcare providers are aware of both of these complications. Nurses who understand both of these complications are able to act pro-actively for their patients, ask questions regarding correct treatments and orders, include the right providers in the care team, and …

Sepsis Screening Education, Brittany R. Horn

Doctor of Nursing Practice Scholarly Project

Sepsis is a significant burden to the healthcare field with 1.7 million Americans annually diagnosed with this condition. Earlier diagnosis and treatment are the most effective ways of reducing morbidity and mortality related to sepsis. The current sepsis screening tool in place at Stormont-Vail Hospital, in Topeka, Kansas, is the systemic inflammatory response (SIRS) criteria; however, this screening tool has proven to be less effective than other screening tools available. The screening tools proven more effective than the SIRS criteria, are the quick sequential organ failure assessment (qSOFA) and the sequential organ failure assessment (SOFA). For this project, nursing staff …

Chronic Thromboembolic Pulmonary Hypertension, Alyssa Curry

Nursing Student Class Projects (Formerly MSN)

Chronic pulmonary hypertension (CTEPH) is a rare and underdiagnosed complication of unresolved acute pulmonary embolism (PE). A chronic fibrotic thrombus replaces the unresolved emboli in the pulmonary vascular bed causing pre-capillary pulmonary hypertension (Mahmud et al., 2018). Symptoms rang from mild nonspecific such as exercise intolerance and dyspnea. As the disease progresses, symptoms present similarly to right ventricular heart failure (Gopalan et al., 2016). Although the pathophysiology and etiology of CTEPH is still not fully understood, risk factors include increased size of the PE, right ventricular strain, chronic inflammation, and defects in fibrinolysis among others (Fernandes et al., 2016). Treatment …

Family Behaviors As Unchanging Obstacles In End-Of-Life Care: 16-Year Comparative Data, Renea L. Beckstrand, Jasmine B. Jenkins, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined.

Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time.

Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999.

Results Of the 2000 questionnaires …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Dnp Final Report: Sedation Protocol Compliance For Improved Outcomes In Intensive Care, Sonya M. Grigsby

DNP Final Reports

Background: Current evidence-based practice guidelines show that lighter sedation reduces mechanical ventilator days (MVD) and intensive care (ICU) length of stay (LOS). Guidelines (2018) for the management of pain, agitation, delirium, immobility, and sleep were released to direct appropriate high-quality care to achieve positive outcomes. However, studies demonstrated there were barriers to compliance of these guidelines.

Objective: To improve compliance with an existing evidence-based sedation protocol in an intensive care, and, thereby, improve patient outcomes (MVD and ICU LOS).

Methods: The three-month quality improvement (QI) project evaluated processes leading to compliance with the guideline. First, nurses were surveyed to determine …

Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable

Master's Projects and Capstones

The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …

Risk Factors Associated With Pressure Injury In Pediatric Congenital Heart Disease Patients, Ashlee Shields

Electronic Theses and Dissertations

Pediatric congenital heart disease (CHD) patients have unique risk factors associated with the pathophysiology of abnormal heart function. This vulnerable population is likely at an increased risk of acquiring a pressure injury during hospitalization. There are limited studies that include congenital heart disease patients and more specifically, factors unique to these patients. The purpose of this study was to identify risk factors associated with development of pressure injury in pediatric CHD patients. This retrospective study used a convenience sample from hospital-acquired data including subjects with congenital heart disease. The results demonstrated an association between pressure injury development and variables both …

The Watson Room: Mitigating Compassion Fatigue In Oncology Nurses, Patricia A. Viscardi

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

Aim: The aim of this project was to plan, develop, and implement “The Watson Room” or “Quiet Room” in an inpatient oncology nursing population and evaluate changes in Professional Quality of Life (ProQOL).

Background: Oncology Nurses are at high risk for compassion fatigue (CF), burn-out (BO), and secondary traumatic stress (STS) related to the effects of living the traumas of oncology patients and their families through their cancer journey and the innate stress in a complex and intense workplace. High levels of compassion fatigue, burn-out, and secondary traumatic stress that are poorly managed reduces the nurse’s ability to self-regulate their …

Oral Care And Ventilator Associated Pneumonia Prevention, Rachel Baber

MSN Capstone Projects

With rising healthcare costs and increasing demands placed on healthcare workers, it is no wonder that decreasing hospital length of stay for patients is high priority for hospitals today. Hospital acquired infections are one of the culprits keeping so many patients hospitalized. Specifically, in intensive care units (ICU) and intermediate care (IMC) units that care for mechanically ventilated patients, ventilator associated pneumonia secondary to intubation is a complication and cost that is being sought to be avoided. Hospitals have been pro-active to prevent ventilator associated pneumonia from occurring by placing oral care bundles or protocols in place to care for …

Report: The Beat Stops Here: A Nurse-Driven Protocol To Manage Telemetry Orders, Holly Dripps, Kirk Hummer

Doctor of Nursing Practice Scholarly Projects

At a large midwestem healthcare organization, cardiac telemetry monitoring orders are not aligned with clinical guidelines developed by the American Heart Association (AHA). A nurse-driven protocol, based on AHA guidelines, to manage cardiac telemetry orders may reduce telemetry usage. Donabedian' s quality improvement framework of strnch1re-process-outcomes was utilized as the theoretical framework for this project, with the purpose to reduce telemetry days within 30 days on a selected acute care unit utilizing AHA guidelines. Project objectives included developing an assessment tool based on AHA guidelines, educating pe1iinent stakeholders on the nurse assessment tool, and implementation of the tool on the …

A Compilation Of Written Instructional Practice Reflections On The Acue (Association Of College And University Educators) Course In Effective Teaching Practices, Sheryll Go

Q2S Enhancing Pedagogy

This is a compilation of written instructional practice reflections on The ACUE (Association of College and University Educators) Course in Effective Teaching Practices, from January – April 2020. This online course has prepared Nurse Educators like me in gaining a foundation in evidence-based teaching practices that increase student motivation, engagement, and learning. The attached assignment include reflections from completed modules.

Eliminating Routine Gastric Residual Volume Assessments In The Intensive Care Setting, John Marshall Smith

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

This evidence-based project sought to evaluate the practice change of routine GRV elimination within a 14 bed adult intensive care unit (ICU) at a large teaching hospital in the southeastern United States. For decades, the gold standard to determine tolerance to enteral nutrition (EN) has been routine GRV assessments via aspiration. However, recent studies have concluded the practice ineffective. Critical Care guidelines published in 2016 now recommend cessation of routine GRV assessments (Ozen, et. al, 2018). In-servicing, education, and implementation of a validated protocol from the University of Virginia Medical Center was used to enact the practice change. A 30-day …