Critical Care Nursing Commons^™

Post-Operative Nursing Care Of The Renal Transplant Patient, Emily Smith

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Kidneys are the most commonly transplanted organ in the United States. All patients who receive a renal transplant must be on lifelong immunosuppressants to prevent rejection of the donor organ. The majority of patients do not take their immunosuppressant medications as instructed, making noncompliance a huge issue for medical professionals. The purpose of this literature review is to explore what evidence-based techniques nurses should employ to increase the long-term compliance of immunosuppressants in renal transplant patients. A literature review was performed of fifteen studies to identify interventions that nurses can employ to increase immunosuppressant compliance. CINAL and Medline were …

The Effects Of Covid-19 On Healthcare Workers: An Exploration Of Burnout, Cherise Fernandez

Nursing | Senior Theses

The healthcare workplace has been challenged with the SARS-CoV-2 corona virus (COVID-19) for majority of the year 2020 and it has posed a number of challenges for healthcare workers (HCWs). Due to the increased workload and demanding work hours, the prevalence of physician burnout has increased amongst this population. The escalation of burnout may lead to negative effects on physical and mental health. This poses a health concern amongst patients because the increase of burnout affects patient care, safety, and quality of care. Various surveys have been sent out to HCWs in order to determine if burnout has increased within …

Altruism And Self-Concept In Pediatric Intensive Care Unit Nurses: Is There A Relationship With Reports Of Workplace Violence?, Minnette Markus-Rodden

Seton Hall University Dissertations and Theses (ETDs)

Incidents of workplace violence (WPV) are pervasive in healthcare settings. WPV in the US occurs four times more frequently in the healthcare sector than in the private sector. However, the true incidence of WPV in healthcare settings is thought to be much higher secondary to significant under-reporting. The American Nurses Association (2019) reports, while one in four nurses are assaulted, only 20-60% of the incidents are reported. This extensive range is due to the lack of an accepted definition of what constitutes WPV, variable reporting mechanisms, and an overall perception by healthcare workers that WPV is “part of the job”. …

The Effects Of Dexmedetomidine On Preventing/Decreasing Severity Of Delirium When Given To Surgical Intensive Care Unit Patients: A Systematic Review Of Randomized Control Trials, Lindsey Hettish

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review was to integrate research evidence from studies published from 2010 to 2020 on the relationship between administration of dexmedetomidine and severity/prevalence of postprocedural delirium in patients in the surgical intensive care unit. In this review, clinical trial studies were recovered by searching the MEDLINE Complete and PubMed databases and utilizing MeSH terminology search. The MeSH terms utilized to search for applicable articles on PubMed included: “intensive care units” or “critical care” or “critical care nursing”, and “delirium”, “dexmedetomidine”, and “surgical procedures, operative”. On MEDLINE Complete, the search terms utilized were “ICU or intensive care …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

Workplace Violence Interventions: A Benchmark Project, Madison Orwosky

MSN Capstone Projects

Workplace violence incidence rates are increasing in the medical field. The staff in the emergency department (ED) is especially prone to these workplace violence events due to patients arriving in such unpredictable states. Alarmingly, most medical staff members report experiencing some type of workplace violence, whether that is verbal, physical, or sexual violence. The former director of the Parkland ED sent out a survey to the ED staff regarding workplace violence. Out of 145 participants that completed this survey, 121 participants reported that they had personally experienced a workplace violence event. This survey data illuminates that a change is warranted …

Effects Of Palliative Care On Nurses’ Knowledge And Attitudes, Daniel Kerr

MSN Capstone Projects

Heart failure (HF) is a chronic, progressive disease that affects 6 million Americans (Ng & Wong, 2017). During the course of the disease, patients have worsening symptoms and need increasing levels of care from both medical staff and home caregivers. Often, these caregivers are family members or friends who spend a significant amount of their free time assisting the patient, leading to significant stress and burden on the caregivers. Recent changes in recommendations from the American Heart Association (AHA) include Palliative Care (PC) consultation for patients diagnosed with advanced stage heart failure, but many physicians have not included a PC …

Exploring The Lived Experience Of Adolescent Caregivers, Abbigale Laurentius

Honors Theses

In today’s society, the population is aging, and any member of the family could find themselves in the role as an informal caregiver. Adolescents between the ages of 12 and 18 years old may have these caregiving responsibilities, and it is imperative that healthcare professionals recognize and support this change of roles. A literature review revealed a general lack of research from within the last five years regarding adolescent caregivers. Those studies that were analyzed in the review presented themes of depression, anxiety, lack of education, and insufficient social supports for the adolescent. An unfolding case study was then designed …

Protecting Sleep To Reduce Delirium In An Adult Intensive Care Unit, Heather Thomas

Student Scholarly Projects

Practice Problem: Delirium is a common, yet often preventable complication in hospitalized patients. It is often caused by fragmented sleep, medications, environmental stimuli, and treatment therapies.

PICOT: The PICOT question that guided this evidence-based practice change project was: For patients in an adult Intensive Care Unit (ICU), does using a nurse-initiated, non-pharmacological sleep-enhancement protocol, versus no sleep-enhancement protocol, reduce the incidence of ICU-delirium over a period of 2 months?

Evidence: The reviewed literature supported the evidence for effective use of a nurse-initiated protocol in reducing delirium in the ICU. Sixteen articles met the inclusion criteria for the review of literature …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

The Efficacy Of A Communication Guide On Stress Experienced By Family Members Of Patients Admitted In The Intensive Care Unit With Covid-19, Kandace Williams

The Eleanor Mann School of Nursing DNP Capstone Projects

Coronavirus disease (COVID-19), first introduced in the United States on January 20, 2020, has created worldwide panic due insufficient research and understanding of the nature of this new disease. Patients suffering from COVID-19 often require intensive care unit (ICU) admissions, resulting in stress and confusion amongst patients and their families. The high transmissibility of the disease has caused hospitals to adopt firm visitor restrictions to protect the public from exposure and spread. Families experience increased anxiety and stress due to ineffective communication with staff and restricted access to their hospitalized loved ones. A needs assessment revealed a gap in care …

The Effects Of A Survivorship Care Plan On Hospital Readmission Rates In Allogenic Stem Cell Transplant Patients, Chantaney Williams

The Eleanor Mann School of Nursing DNP Capstone Projects

Stem cell transplants (SCTs) are complicated treatments utilized to treat hematologic malignancies and other disorders, such as multiple myeloma, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, acute myeloid leukemia, neuroblastomas, germ cell tumors, amyloidosis, and autoimmune disorders such as systemic lupus erythematosus and systemic sclerosis. The complex care of patients undergoing SCTs place them at high risk for adverse outcomes, including infection, cytomegalovirus, graft vs host disease, secondary new cancers, infertility, and sexual dysfunction (American Cancer Society, 2020). Survivorship care plans (SCPs) are a vital part of the discharge process to educate allogenic SCT patients about post-transplantation care. SCPs are implemented to reduce …

Improving Sepsis Bundle Compliance In The Emergency Department, Meredith Burkhart

The Eleanor Mann School of Nursing DNP Capstone Projects

Sepsis is one of the leading causes of death in hospitals across the nation. It is also the costliest condition a patient can be admitted to the hospital for. This proposal discussed the significance of sepsis in the local, national, and international level. It also covered the SEP-1 guidelines given by the Centers for Medicare and Medicaid. Prior to project implementation, the clinical site had at least one sepsis bundle fall out every month, meaning that a portion of the SEP-1 guideline was not met. This project introduced an alert system for the emergency department to respond to patients with …

Nursing Fatigue In Intensive Care Units: A Clinical Inquiry, Elizabeth A. Gambill

The Eleanor Mann School of Nursing DNP Capstone Projects

Registered Nurses (RN) working in Intensive Care Units (ICU) report increased physical and emotional fatigue from a combination of various environmental factors. Fatigue is suspected as contributing to low retention rates of ICU RNs. A meeting was arranged with an ICU nursing director in an acute care facility in Northern Arkansas revealing the need for a clinical inquiry into the prevalence of fatigue. A review of literature further analyzed the impact of fatigue, management practices, safety culture in the workplace, the Occupational Fatigue/Exhaustion and Recovery (OFER) scale, the Copenhagen Burnout Inventory (CBI), and the Moral Distress Scale- Revised (MDS-R). The …

Implementation Of A Postdischarge Virtual Visit And Nurse Follow-Up Protocol To Decrease 30-Day Readmission Rates For Patients With Pulmonary Arterial Hypertension, Kimberly Thompson

The Eleanor Mann School of Nursing DNP Capstone Projects

Pulmonary arterial hypertension (PAH) is a rare, chronic disease with no cure. Patients with this disease have high mortality and morbidity, experience frequent hospitalizations, readmissions, and psychosocial burdens, and require a high degree of self-care management skills (Doyle-Cox et al., 2016; Lattimer et al., 2016; McDevitt & Walter, 2019). More than half of PAH patients are hospitalized within the first year following diagnosis, and about 20% are readmitted to the hospital within thirty days of discharge (Bhattacharya et al., 2019: Tonelli, 2020). These patients also have a high symptom burden, and these symptoms significantly affect their physical and mental quality …

Implementation Of Same Day Discharge Following Elective Percutaneous Coronary Intervention, Kaitlyn Miller Jeffcoat

The Eleanor Mann School of Nursing DNP Capstone Projects

High rates of Cardiovascular disease (CVD) and ischemic heart disease (IHD) have led to ever-increasing numbers of percutaneous coronary interventions (PCI) performed. The prevalence of IHD and subsequent PCI has been found to limit bed availability and access to cardiovascular care. Historically, the standard of care following elective PCI has included overnight observation (OO) though clinical advances to PCI procedures have made it possible for same day discharge (SDD) following elective PCI. There are many benefits of SDD following elective PCI that include increased access to cardiovascular care, hospital cost savings, and patient satisfaction without compromising patient safety. The DNP …

The Lost “Doe”: A Quality Improvement Project For Unidentified Patients, Brendi Gale

The Eleanor Mann School of Nursing DNP Capstone Projects

A Mass Casualty Incident (MCI) describes any natural or manmade disaster that stresses a community beyond their normal resources (CMS, 2019). Across the globe, populations have grappled with an increased frequency of natural disasters and a surge of critically ill secondary to pandemic SARs-CoV-2 (Cavallo, Donoho, & Forman, 2020; Smith, 2020; US Global Change Research Program, 2018). In addition, the incidence and severity of mass shootings has risen in the United States with a reported 277 active shooter events between the years of 2000-2018 (Federal Bureau of Investigation, 2018; Smith et al., 2019). An Emergency Department (ED) in Northwest Arkansas …

2021 Nursing Annual Report, System Of Texas Children's Health

2021

No abstract provided.

Implementing Interdisciplinary Team Rounding To Reduce External Ventricular Drain-Associated Infections, Laura Reiter

Student Scholarly Projects

External ventricular drains (EVD) are a common intervention in critical care areas for the management of hydrocephalus. The most common complication of this life-saving intervention is infection, which negatively impacts patient outcomes and overall healthcare costs. Current evidence shows that interdisciplinary team rounding improves compliance with evidence-based practice and reduces hospital-associated infection rates. The PICOT question that guided this project is: For patients with an external ventricular drain (EVD), what is the effect of interdisciplinary team rounding compared with the current practice of informal rounding, on compliance with an EVD care bundle and EVD-associated cerebrospinal fluid infections over two months? …

Preventing Insulin Storage And Administration Errors, Makena Reddick

Scholars Week

■The research problem was discovered when nurses were observed storing and administering insulin improperly. The objectives of this project were to find the correct policies for these procedures, obtain research that backed these policies, and present this information to nurses to create a safer habit. In researching, it was found that reducing the physical distance between a person completing work and the materials required to do so increased compliance (Gibbs & McLernon, 2017). In a second study, the delivery of safe, effective and high-quality care for patients with diabetes in the community is dependent upon (district) nurses having appropriate knowledge …

Exploring Saudi Emergency Room Nurses’ Perceptions About Their Disaster Preparedness, Fadiyah Alshahrani

Seton Hall University Dissertations and Theses (ETDs)

Background: Disasters can overwhelm the capacities of health care facilities quickly. In recent years, the world has been affected by an increasing number of significant disasters. These include natural disasters such as earthquakes, hurricanes, floods, tornados, storms, fires, and epidemic outbreaks. There are man-made disasters such as terrorist attacks, transportation accidents, and stampedes at mass gatherings. The resulting deaths and property damages have enormously affected countries’ economies, particularly on a health care system’s preparedness. In a major disaster, health care professionals must respond, manage, and prevent additional harm to victims. Nurses are the largest group of health care professionals …

Implementation Of Telephone-Based Medication Adherence Conferences To Improve Health Outcomes Of Heart Failure Patients, Diana Marie Broadway

The Eleanor Mann School of Nursing DNP Capstone Projects

Cardiovascular disease (CVD) has been a significant health problem worldwide and is the leading cause of death globally. Heart failure (HF) is a chronic progressive form of CVD that affects millions of adults in the United States. The treatment for heart failure is very complex and requires an ongoing regimen of medications. In heart failure, many patients report nonadherence to their medication regimens, which leads to a magnitude of preventable deaths annually. With frequent medication nonadherence of the HF patients, there must be an intervention used to combat this problem. The use of telephone-based interventions (TBI) can modify nonadherent medication-taking …

A Systematic Review Of Acuity-Based Staffing In Acute Healthcare Environments, Demitria Idella Stafford

Electronic Theses and Dissertations

Nursing leadership is responsible for considering the equity of patient care assignments when providing nursing care. Nursing leadership is responsible for assuring the delivery of patient care assignments with the intent to offer nurses an unbiased, evenly distributed patient load. Effective distribution of patient care assignments ensures patients receive the safest, most efficient, and highest quality of care. The purpose of this project was to provide nursing leadership with an executive summary of a systematic review of evidence-based research on the structure and process of making patient care assignments, and it provided evidence on how those patient care assignments affect …

Improve The Risk Of Central Line-Associated Bloodstream Infections With Central Line Dressing Changes Through A Team Approach, Jessica Comstock

Student Scholarly Projects

Practice Problem: Central Line Associated Bloodstream Infections (CLABSI) are a preventable hospital acquired infection which contributes to patient morbidity, mortality and rising healthcare costs.

PICOT: The PICOT question that guided this project was: In adult inpatients with central venous catheters, does the use of a two-person dressing change team, compared to a single person procedure, decrease the rate of central line associated bloodstream infections over the course of 8 weeks?

Evidence: The prevention of CLABSI is most effective when multifaceted line maintenance bundles are implemented and adherence to these bundles nears 100% (Schreiber et al. 2018).

Intervention: A two-person, …

Generating Evidence Of Critical Care Nurses' Perceptions, Knowledge, Beliefs, And Use Of Music Therapy, Aromatherapy, And Guided Imagery, Annie Heiderscheit, Shawna Vernisie, Wendy L. Magee, Helen Shoemark

Faculty Authored Articles

No abstract provided.

Atrial Fibrillation In Covid-19: A Descriptive Study Of Incidence, Mortality And Related Factors, Diana L. Taylor

DNP Research Projects

Abstract

This scholarly project determined the relationship of atrial fibrillation (AF) occurrences in COVID-19, as it is the most frequent arrhythmia in the U.S. and is driven by inflammatory pathology. In COVID-19 positive patients with AF occurrences understanding the relationship between these conditions could help identify patients with poor prognosis, higher morality, and other factors earlier in the hospital course.

This single-center scholarly project was a retrospective descriptive chart review to determine the relationship between AF and COVID-19 over a 6-month timeline in Chattanooga, TN. Of the 565 hospitalized COVID-19 positive patients included, 82 (14.5%) had AF occurrences. A higher …

Lyme Disease Essentials For Healthcare Workers, Donita Blanken-Little

DNP Research Projects

No abstract provided.

Statins And Women, Debra Schulte

Rural Health Professions Projects

Low-density lipoprotein (LDL) elevation is a primary risk factor for atherosclerotic cardiovascular problems such as heart disease and stroke. Heart disease is the leading cause of death in the United States and stroke is the fifth leading. Earlier LDL reduction improves morbidity and mortality. Literature indicates fewer women start statin medications compared to men.

Effect Of Emergency Severity Index (Esi) Annual Competency Assessment On Mistriage Rates, Stefanie Hoffman

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: In order to accurately assign an Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage area, it is essential triage nurses remain competent in the ESI triage tool. In addition, effective use of the ESI triage tool is critical in preventing patients from being mistriaged.
Objective: The purpose of this quality improvement project was to determine the effect of an ESI annual competency assessment in an ED for triage trained registered nurses (RNs).
Methods: Triage trained RNs completed an ESI competency assessment composed of 25 patient scenarios in competency assessment A, and …

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …