Critical Care Nursing Commons^™

Communication Is Key, Stephanie Munsch, Bailey Ellingsworth

Scholars Week

Abstract

This paper is an evidence based look at the efficacy of ventilation communication in the intensive care unit (ICU) and the resources that we found to be useful in expanding said communication. This topic has become more prevalent today due to COVID-19 and the rising numbers of ICU admissions and ventilator use. We looked at various studies that found that patients on ventilators who lacked good communication with their nurses had negative mental and physical effects. Examples of this include increased rates of anxiety, depression, and post traumatic stress disorder among ICU survivors. The evidence also found that effective …

Decreasing Alarm Fatigue Through Alarm Management Training, Leah Davis, Brittany Fleming

Scholars Week

Alarm fatigue is a notable problem in the hospital setting. Alarm fatigue can decrease nurse response time and desensitize nurses to alarms. When this occurs, patient outcomes begin to be negatively affected. To combat this, we researched multiple articles on alarm fatigue and alarm management programs. These programs would be implemented and nurses would learn how to troubleshoot alarm equipment, how to recognize alarm fatigue, how to prevent alarm fatigue, and many more. Based on research articles, alarm management programs decrease alarm fatigue in nurses and the amount of alarms.

Too Loud: A Project For Sound Reduction In The Neonatal Intensive Care Unit, Peyton Cadwell, Amy Krazl

Scholars Week

Sound levels in any intensive care unit environment are significantly higher than the recommended volume. The neonatal intensive care unit (NICU) is included in this aggregate that frequently exceeds advised levels. There are consequences associated with increased sound, such as slower language development and behavior issues. Not only are babies subjected to physiological effects, but there is potential for psychological detriment as well, such as behavioral issues (Bremmer, 2003). Many solutions for this issue have been proposed, including lowering phone volumes, putting rubber shoes on furniture and switching audio alarms to visual alarms. One specific intervention that may reduce the …

Iv Infection Control, Coleman White, Hannah Oswalt

Scholars Week

Infection is one of the most discussed topics in the nursing world, and one topic that is commonly overlooked is IV tubing related to infection. The current rules on CCU/PCU include labeling the tubing, changing the tubing every 72 hours, and cleaning the site with an alcohol swab before injecting medications. While these rules in place are evidenced based, and work properly, there is more research that has been conducted stating better practice to control infection related to IV tubing. Through utilization of theoretical framework along with several quasi-experimental research, we have evaluated infection control effectiveness through “Scrub the Hub” …

How To Control Healthcare Associated Infection, Yeojin Son, Jungyoon Hur

Scholars Week

Healthcare-Associated Infections (HAI) are infections patients acquire while receiving care in hospital. The main reasons of occurring the infections are insufficient knowledge about infection control and decreased compliance with rules by hospital protocol. The purpose of this evidence-based presentation is to exemplify how to control HAI via motivating healthcare workers to comply with infection control policy.

The Anxiolytic Effects Of Aromatherapy On Preprocedural Anxiety: An Integrated Review, Rebekah Smith

Senior Honors Theses

Anxiety before procedures can negatively impact patients by increasing cortisol levels which delays wound healing and increases infection risk, increasing pain and sedation medication needs, and increasing hospitalization time. This review was conducted to find how inhaled essential oils affect pre-procedural anxiety of adults in acute care settings. Nine databases and some gray literature were searched within the past ten years, and documented using the PRISMA flow chart. Ten articles fitting the inclusion criteria were retrieved. Nine of the articles found a significant difference between the aromatherapy group and control group and pre- and post- intervention anxiety scores, and none …

Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport

Senior Honors Theses

The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …

Perception Is Everything: Implementation Of A Peer Evaluation Program For Nurse Leaders In A Hospital Setting, Teruko Williams

Student Scholarly Projects

Practice Problem: A hospital in the Sacramento County area seeking the ANCC Pathway to Excellence Program^® designation determined upon performing a gap analysis that Element of Performance 2.8, a peer evaluation program, was absent, thus creating a deficiency in the fulfillment of the requirements for the designation.

PICOT: The PICOT question that guided this project was: In nurse leaders (P) how does the development of a formal peer evaluation process (I) compared to no formal process (C), influence the performance outcome score of self-efficacy (O) over 8 weeks (T)?

Evidence: The evidence demonstrated that if a …

Prevention Of Central Line-Associated Blood Stream Infection (Clabsi) In Adult Icu Patients, Salima Allahbachayo

Student Scholarly Projects

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of a multifaceted approach including evidence-based CLABSI bundle care has shown to prevent this infection in patients with a central line.

PICOT: The PICOT question that guided this project was that in adult intensive care unit (ICU) patients, how does the use of central line bundle care compared to central line care without bundle decrease central line-associated bloodstream infections within eight weeks?

Evidence: The evidence from a rigorous literature review showed that using a central line bundle …

The Lived Experience Of Intensive Care Unit Nurses During The Covid-19 Pandemic, Jessica Rong

Graduate Student Research Symposium

Title: The Lived Experience of Intensive Care Unit Nurses During the COVID-19 Pandemic: A Mini-Phenomenology

Purpose: The purpose of this study is to understand the experiences of ICU nurses working at the bedside during the COVID-19 pandemic that provided care.

Research Questions: The research question for this study is, what was the lived experience of the ICU nurse working at the bedside during the COVID-19 pandemic.

Background: There is a gap in the literature regarding the experience of the ICU nurse providing care during the pandemic. Many nurses are leaving the bedside now and more must be understood about …

The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari

Doctor of Nursing Practice Scholarly Projects

Sepsis is a medical emergency that is prevalent throughout hospitals everywhere. Due to the growing crisis, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Surviving Sepsis Campaign (SSC) adopted core measures for sepsis (SEP-1) which aim at improving overall compliance of evidence-based treatment standards for sepsis. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if incorporating early goal directed sepsis bundles in a rural Midwestern ED was effective in increasing compliance with SEP-1 rates. The secondary purpose evaluated how nursing knowledge, awareness, and compliance with sepsis bundles affects SEP-1 compliance rates. …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

Doctor of Nursing Practice Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Pulmonary Post-Acute Sequelae Of Covid-19, Usman Akbar, Shivam Gulati, Johnny Zakhour Md, Alex Glynn, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: Persistent symptoms have been observed in a substantial proportion of survivors of COVID-19 since relatively early in the pandemic. Among these post-acute sequelae of COVID-19 (PASC), respiratory symptoms appear to be the most prevalent.

Methods: We conducted a literature review of peer-reviewed publications in English on the clinical and epidemiological features of respiratory PASC in cohorts of 100 or more patients with a follow-up of four weeks or more after acute infection. Included studies reported the prevalence of persistent respiratory symptoms and/or the results of follow-up pulmonary function tests.

Results: On our review included 14 studies across eight countries …

Using Complex Medical Devices: Icu Nurses' Safety Perceptions, Violet Rhagnanan-Kramer

NSU REACH and IPE Day

Purpose: The purpose of this study was to gain insight into ICU nurses’ safety perceptions and explore continuing educational strategies for improving nurses’ technological competence. Background: Medical errors are the third leading cause of death in America. Over 10,000 medical errors occur daily, with an estimated financial impact of preventable mistakes is 20 billion dollars annually. Increasing the use of multifarious sophisticated medical technologies in the Intensive Care Unit (ICU) poses a risk of medical errors and unintentional harm to patients. However, limited empirical evidence exists regarding ICU nurses’ perspectives. Methods: This research featured an online mixed methods descriptive exploratory …

Promoting Patient Outcomes: Clabsi Prevention, Woon Paek

Nursing Posters

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:

• Perform hand hygiene
• Don proper PPE
• Sterile/aseptic technique during insertion
• Prioritize for cares related to central line first
• Daily assessment for need of central line
• Daily chlorhexidine gluconate bathing
• Remove catheters that are unnecessary
• "Scrub the hub" BEFORE EVERY access
• Change dressings every 7 days or as needed
• Assessment of site/dressing condition
• Change purple Ultrasite caps with dressings
• Tubing changes per CentraCare policy
• Discard …

Neurointerventional Post-Procedure Assessment And Documentation Compliance, Chandra Brower

Nursing Posters

Per stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.

Use Of Point-Of-Care Ultrasound For Lung Assessment: A Practice Change Educational Program For Advanced Practice Providers And Students, Mark W. Owen

DNP Research Projects

Abstract Background: With over 130 million emergency room (ER) visits per year in the United States, many emergency departments (ED) are struggling with overcrowded conditions. Contributing to overcrowded conditions are those presenting with dyspnea, who are nearly 4 million in number. ED crowding has serious implications. Exploring and implementing evidence-based methods to alleviate congestion is critical. Problem: One method being explored is the integration of point-of-care ultrasound (POCUS) into the stretcher side assessment of dyspneic patients. Multiple pathologies can cause dyspnea and rapidly isolating the underlying etiology is critical. Various studies have demonstrated the efficiency of POCUS at identifying lung …

Reducing Observation Unit Length Of Stay Hours: A Quality Improvement Project, Rena D. Cantrell

Master of Science in Nursing Theses and Projects

An acute care observation unit provides care for patients admitted via Emergency Center (EC) or direct admission from a healthcare provider’s office who do not yet require inpatient status. The goal length of stay (LOS) for these patients should be less than or equal to 24-48 hours. This project is being developed for a 22-bed observation unit in the Southeastern United States to decrease current LOS hours. Currently, the goal LOS for this unit is 24 hours, not to exceed 48 hours, and for patients admitted with a chest pain diagnosis, no longer than 19 hours. A plan to expand …

Increasing Knowledge And Comfort Levels Of Icu Nurses In Goals Of Care Discussions Through Palliative Care Education, Stephanie Harrison

Doctor of Nursing Practice Projects

Critical care nurses are tasked with treating patients during the most complex times, typically beginning with aggressive treatment measures and in many cases, transitioning to end-of-life care. According to the literature review, critical care nurses report they frequently provide care that they feel is futile and palliative care resources are underutilized in the intensive care unit. They also report limited education/training and comfort in understanding their role in goals of care conversations and end-of-life care despite their vital role in providing direct patient care. The goal of this project was to implement an education program using the IMPACT-ICU toolkit to …

How Efficient Is Telemedicine At Qi In The Critical Care Setting?, Christopher Sedeski

Student Research Poster Presentations 2022

No abstract provided.

Implementation Of An Icu Surge Capacity Response Protocol, Patrick Simon Soria

Regis University Student Publications (comprehensive collection)

Implementation of an ICU Surge Capacity Response Protocol

Patrick Simon S. Soria

Abstract

High consequence infectious diseases (HCID) threaten healthcare systems because of their high transmissibility, resulting in massive infections within hours. In the initial stages of an HCID outbreak in developing countries, there are no definite treatment pathways and guidelines to manage patients who become critically ill. The prolonged surge of critically ill patients affects the physical and mental well-being of intensive care unit (ICU) nurses due to many factors. An ICU surge capacity response protocol was implemented in four intensive care units for four months at one government …

Improving Antibiotic Administration Timing In Neonatal Early-Onset Sepsis, Donia B. Bass

Regis University Student Publications (comprehensive collection)

Abstract

Neonatal early onset sepsis (EOS) remains one of the most common causes of neonatal morbidity and mortality. Neonates requiring evaluation and treatment for suspected EOS inconsistently receive antibiotics within one hour of decision to treat as recommended in the 2012 neonatal sepsis guidelines by the National Institutes for Health and Care Excellence (NICE). A mixed method quality improvement initiative was employed in a level three NICU, applying a standardized admission process to mitigate systems flaws impacting delay of first dose antibiotic. A nursing sepsis education module was provided, and the novel SAM admission prioritization tool was developed to guide …

Reduction Of Order-To-Scan Times To Increase Patient Throughput And Improve Patient Outcomes: A Quality Improvement Project, Jason Harrington

Master's Theses and Capstones

Background: Throughput is a key metric for both the emergency department and the hospital system. Diagnostic tests, such as CT scans, can lead to a large delay in patient throughput which can negatively impact patient satisfaction and patient outcomes. Finding ways to reduce delays in CT scan acquisition can positively impact patient satisfaction and patient outcomes.

Aim: The specific aim of this quality improvement project was to decrease the amount of time it takes to complete abdominal CT scans with IV contrast once ordered from 61 minutes to below 35 minutes by July 1^st, 2022

Methods: Plan was …

Enhancing Peripheral Intravenous Line Maintenance Practices Among Nurses In A Critical Care Setting: A Quality Improvement Project, Jaylene Velasquez

Honors Theses and Capstones

Abstract

Background: One of the major risks of infection lies in a patient’s intravenous (IV) access. On a cardiac intensive unit, a Levell II trauma center, preventing adverse events (i.e. infections, sepsis, etc.) is essential within this unit due to the nature of these health conditions. To ensure patient safety, nurses must abide by evidence-based practices and facility guidelines regarding intravenous line management. This quality improvement (QI) project implemented interventions to enhance nursing practices for peripheral intravenous therapy.

Methods: This project included statistical analysis and audits to measure the impact of the interventions. The variables being observed in this project …

Development And Psychometric Testing Of An Instrument To Identify Factors That Predict Intentions Related To Post-Mortem Organ Donation Among Saudi Arabian Nurses, Salman Alreshidi

Theses and Dissertations--Nursing

Organ donation shortage is a major international concern. Global data on organ donation and transplantation activities from the World Health Organization indicate that in 2019 organs were available for less than 10% of transplantations needed. In Saudi Arabia alone, the organ donation shortage accounts for 28.8% of deaths annually. Nearly 31% of donated organs are from donors outside of the country because many eligible donors in Saudi Arabia do not donate.

While post-mortem organ donation has the potential to increase available organs for transplantation, in many countries, including Saudi Arabia, hesitancy among candidate donors and their family members can present …

Impact Of Mindfulness Practice On Compassion Fatigue In Pediatric Cardiovascular Critical Care Nurses: A Quality Improvement Project, Kendy Luu

Doctoral Projects

Background: A considerable proportion of the extant literature on healthcare has documented compassion fatigue (CF) as a major factor that contributes to poor job performance, satisfaction, and negative patient outcomes (Figley, 2002). CF is well known to negatively impact patient care and outcome, relationships, and job satisfaction among pediatric cardiovascular intensive care (CVICU) nurses. Developing interventions to reduce burnout and CF bear the potential to reduce costs and improve quality care; one particularly promising approach in this regard is the practice of mindfulness-based stress reduction (MBSR). Purpose: This quality improvement project aimed to determine the impact of an abbreviated MBSR …

Implementation Of Stress Management And Resiliency Training To Address Nursing Burnout In A Neuroscience Critical Care Unit, Jessica May Marie Hughes

Graduate Theses, Dissertations, and Problem Reports (ETD)

In the United States, over one-third of nurses experience symptoms of burnout (Reith, 2018). If left unchecked, poor stress management and resiliency skills can contribute to nursing burnout, leading to costly employee turnover. Stress management and resiliency training (SMART) provides the tools necessary to develop resiliency, improve stress management and decrease burnout (Resilient Option, 2020). Nursing staff under the age of 36, who work in a Neurosciences Critical Care Unit (NCCU) demonstrate lower resiliency scores and a higher risk of burnout. This project aimed to evaluate: (a) the effects of a SMART program on the wellbeing of nursing staff in …

Reducing Patient Handoff Inadequacies Using An Electronic Medical Record Based Standardized Handoff Tool In The Critical Care Unit, Mariah E. Needham

Master's Theses and Capstones

INTRODUCTION: Inadequate handoff communication is a contributing factor in sentinel events and adverse patient outcomes. Research has shown that the use of a standardized handoff tool can improve quality of handoff communication. This quality improvement (QI) project sought to standardize handoff and reduce the risk of adverse patient outcomes by utilizing the I-PASS handoff tool available in the electronic medical record (EMR).

AIM: The aim of this quality improvement project was to improve the accuracy of nurse-to-nurse patient handoffs.

METHODS: The outcomes measured by the post-intervention survey were the number of reported handoffs received with omissions, the percentage of staff …

Improving Disinfectant Cap Use On Central Lines In The Icu To Reduce Patient Risk For Clabsi: A Quality Improvement Project, Tali Cherim

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention …

Caring For Ourselves Before We Care For Others: A Mindfulness-Based Intervention For Acute Care Nursing Staff, Kent Brouwer

DNP Projects

Background: Acute care nursing staff have recently faced increasing rates of anxiety, stress, emotional exhaustion, and burnout. Nursing burnout is directly linked to patient outcomes, nurse retention, and the resilience of our nurses. Therefore, it is in the best interest of hospital organizations to focus efforts on the well-being of the nursing workforce. A recent innovative technology to prevent burnout teaches mindfulness through the utilization of smartphone applications. There is limited evidence regarding the implementation and impact of brief mindfulness interventions on intra-professional acute care providers.

Methods: A pretest-posttest design with a midpoint evaluation was utilized in this pilot study. …