Critical Care Nursing Commons^™

Poster: Moral Injury & Nurse Work Performance Following The Covid-19 Surges, Annette Callis, Trisha Saul, Ross Bindler

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Eliminating Hospital Acquired Pressure Injuries (Hapis) In The Intensive Care Unit, Luzbel Diaz

2023 South Division Nursing Research Conference

No abstract provided.

Poster: Clinical Practice Panel: Don't Skip A Beat, Follow The Sheet! Designing A Clinical Care Map For Open Heart Patients In The Icu, Danielle Fogel, Nico Vargas

2023 South Division Nursing Research Conference

No abstract provided.

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

Nursing Perspectives On Intimate Partner Violence Screening In The Emergency Department, Justin Cabrera

Dissertations, Theses, and Capstone Projects

Using descriptive and quality descriptive (QD) analysis, emergency department nurses from around the country completed a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool to gain insight on their attitudes, knowledge, and preparedness about working with patient survivors of intimate partner violence (IPV) regarding their willingness to and comfort in engaging in IPV screening practices. In total, 1,523 responses were received from emergency department nurses currently or formerly in practice.

Findings show that there was no correlation between emergency department nurses’ education and training on IPV and willingness and comfort with IPV screening with …

Early Mobility In The Intensive Care Unit, Kimberly Masse

Master's Projects and Capstones

Abstract

Problem: Within the intensive care unit (ICU) environment, the inconsistent implementation of early mobility practices poses a significant challenge, resulting in suboptimal patient outcomes. This quality improvement project addressed the critical issue of lower mobility scores and the barriers faced in promoting early mobilization due to the complex nature of the ICU, including the patient population and therapeutic interventions.

Context: Situated in a 327-bed hospital, the 20-bed ICU caters to critically ill patients with diverse diagnoses, such as stroke, heart failure, sepsis, and Covid pneumonia. The ICU staff comprises registered nurses (RNs), patient care technicians (PCTs), and other …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Early Mobilization In Critical Care: A Benchmark Study, Monica Paige Voelkel

MSN Capstone Projects

Critically ill patients often have complex injuries to multiple organ systems creating barriers to mobilization and a decrease in functional status (Bergbower et al., 2020). Early mobilization (EM) in hospitalized patients has shown to improve patient outcomes and decrease length of stay (LOS) (Bergbower et al., 2020). The link between EM and LOS is one that warrants further investigation with the PICOT question: In critically ill patients (P), how does early mobilization (I), compared to standard mobility (C) improve patient outcomes (O) over a three-month period (T)? The purpose of this paper is to discuss the rationale for the benchmark …

Improving Safety In The Emergency Department: Utilizing Metal Detectors To Mitigate Weapon Possession, Jonathan Garcia

MSN Capstone Projects

Today’s high risk-healthcare environment has prioritized patient safety with great initiatives and, unfortunately, placed staff safety second. However, safety for both groups should be equal priorities. Evidence suggests that Emergency Departments (ED) often care for patients with a history of crime and mental health diagnoses, creating an environment where the threat of violence and weapons is increasingly prevalent compared to other clinical settings. (Erlyana, 2019) Risk mitigation is possible if we consider studies by Malka et al. (2015) and Laidlaw et al. (2017) that indicate the efficacy of metal detectors in accurately identifying concealed weapons. To improve clinician and patient …

Increasing Repeat Lactate Collection For Sepsis Bundle Management Of Care, Rahwa Teklehaimanot

Master's Projects and Capstones

Abstract

Problem: In 2020, sepsis was the leading cause of mortality in this Northern California Hospital Organization. This QI project aimed to reduce the number of fallouts for collecting repeat lactate levels to less than two per month, from a baseline of five per month, within three months.

Context: This Northern California Emergency Department serves a broad range of patients, from pediatrics to geriatric patients, with an average daily census of 80-90 patients. In this 20-bed Emergency Department, approximately 650 patients were diagnosed with sepsis in 2022.

Intervention: The hospital sepsis committee collaboratively developed a new standardized workflow for sepsis …

Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Implementing An Emergency Severity Index (Esi) Triage Refresher Training To Decrease The Under-Triage Rate In The Emergency Department (Ed), Monique Wallace

Doctor of Nursing Practice Projects

Background: The Emergency Severity Index (ESI) is a triage tool used in most emergency departments in the United States (U.S.) that assesses acuity and resource allocation for emergency care patients. Registered nurses (RNs) must assign the appropriate triage category to ensure patients are seen in a proper time frame, have ideal patient outcomes, and have efficient patient throughput.

Purpose: This quality improvement project aims to decrease the under-triage rate of patients in the emergency department (ED) by implementing an Emergency Severity Index (ESI) triage refresher training.

Methods: This project used an A3 methodology. The triage specialist completed retrospective chart reviews …

Interfacility Transfer Of Pediatric Patients To A Comprehensive Children's Hospital, Kim Zaky

Student Scholarly Projects

Practice Problem: Secondary transfers to pediatric centers have increased by 25% due to the regionalization of specialty care. Low pediatric volume and the lack of access to pediatric subspecialty confounds the need for transfer requests to comprehensive children’s hospitals. Referring hospitals rely on pediatric teams to determine the level of service and mode of transportation decisions due to a lack of comfort in caring for and managing pediatric patients.

PICOT: This project was guided by the following question. In pediatric patients transferring from other healthcare facilities to a comprehensive children’s hospital (P), does the implementation of a nurse-led pediatric illness …

On The Respiratory Syncytial Virus Vaccine, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Reducing Acute Kidney Injuries In The Cardiovascular Intensive Care Unit By Implementing A Nurse Driven Hydration Protocol, Chelsea N. Singleton

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project was to implement a nurse-driven hydration protocol to potentially decrease the risk of acute kidney injuries (AKI) in patients undergoing contrast procedures, which in turn should reduce length of stay.

Background

The project was implemented in a CVICU and Cardiac Catheterization Lab (CCL) Lab in an academic center in Houston, Texas.

Methodology

The project utilized Lean Six Sigma methodology and SBAR communication among staff utilizing a nurse-driven protocol to ensure hydration orders were activated during pre- and post- procedure. The staff were educated on how to implement the protocol prior to the start of …

Amniotic Fluid Embolism Diagnosis & Treatment Pathway, Jeremy May

Doctor of Nursing Practice Projects

Access to care in rural areas can prove difficult for any patient, but especially for the expecting mother. Healthcare providers in these rural settings often lack the staffing and experience to effectively recognize and treat rare obstetric emergencies. Amniotic fluid embolism (AFE) is a rare medical emergency that requires healthcare providers to rapidly diagnose, monitor, and treat the sequela of resulting symptoms in the obstetric patient. After a literature review, a teaching session was developed and implemented as part of the annual training for 20 nursing staff at a small 50-bed rural hospital in central California. An 8-question pre-test was …

Early Sepsis Recognition: Improving Sepsis Education In A Medical-Surgical/Telemetry Unit, Kathileen Tran

Master's Projects and Capstones

Problem: This quality improvement project aimed to increase sepsis education and bundle compliance within the medical-surgical/telemetry unit to improve sepsis mortality and morbidity rates.

Context: A microsystem assessment was completed by Clinical Nurse Leader (CNL) students in the medical-surgical/telemetry unit at Hospital X located in the San Francisco Bay Area. This microsystem cares for patients diagnosed with sepsis, congestive heart failure (CHF), electrolyte imbalance, and alcohol withdrawal.

Interventions: Due to time constraints, an intervention was not implemented; however, the students provided recommendations for interventions to the leadership team for follow up. The recommended interventions encompass implementing sepsis protocol reference cards, …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis: Bundle Elements, Grace Jenks

Master's Projects and Capstones

Problem: Based on the findings of a pre-survey conducted, it was observed that around 6% of the Medical-Surgical nurses who participated from Hospital A possessed "expert knowledge" of the "inpatient handoff sepsis bundle checklist." The results highlight the potential for educating and boosting the confidence of nurses working in a healthcare organization located in Northern California, enabling them to provide better care for patients afflicted with sepsis.

Context: The microsystem is a Medical-surgical unit situated within Hospital A, which is one of the 21 hospitals located in Northern California. Dr. Theresa Mostasisa conducted a survey on February 15, 2023, …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Gregory James Trevino

Master's Projects and Capstones

Problem: Providing high-quality sepsis care in a San Francisco Bay Area emergency department (ED) is an organizational priority, however Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis bundle compliance has decreased to an average of 79% compliance since October of 2022. It was revealed that CMS SEP-1 sepsis bundle compliance issues have resulted in increased patient fallouts.

Context: A microsystem assessment was conducted by the quality improvement team to help identify gaps in practice. After an assessment survey of nursing staff, it was revealed that barriers such as physician order sets, lack of communication, lack of staffing during peak …

Increasing Sepsis-Bundle Adherence On A Medical-Surgical/Telemetry Unit: A Quality Improvement Project, Tiffany Liu

Master's Projects and Capstones

Problem: Sepsis is a life-threatening complication of infection that can lead to tissue damage, organ dysfunction, and death. Early recognition and intervention are crucial in the management of sepsis. Delays in sepsis care can lead to adverse health outcomes and even death. Sepsis bundles are guided by evidence-based practice. They serve as guidelines for effective and timely management of sepsis. Adherence to these sepsis bundles is associated with overall improved morbidity and mortality.

Context: This quality improvement project was led by Clinical Nurse Leader (CNL) students from the University of San Francisco. It was implemented at a 244-bed …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Jessica Lee

Master's Projects and Capstones

Sepsis is a deadly condition if not treated promptly and urgently. To help lower the mortality rate from Sepsis, education on Sepsis is essential for nurses at all levels and experience. Opportunity at a healthcare organization in Northern California arose when it was found through a survey that about 6 percent of Medical-Surgical nurses have "expert knowledge" of the sepsis bundle elements. Only about 35 percent of these nurses who reported having "expert knowledge" are confident in treating sepsis patients. A team of clinical nurse leader students implemented a quality improvement project. The project was designed to expand nurses' knowledge …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Spencer Forest

Master's Projects and Capstones

Problem: This quality improvement project aims to increase SEP-1 sepsis bundle compliance among nursing staff at a 16-bed emergency department through targeted continual staff education on sepsis screening and best practices. Currently, the unit is experiencing cases of sepsis fallout and is not meeting the 90% threshold on three treatment metrics as defined by the institutional sepsis bundle time goals. Bundle compliance that adheres to the time goals decreases incidences of sepsis fallout and overall days in the hospital, while increasing positive patient health outcomes.

Context: A microsystem assessment was completed along with a staff gap survey to determine areas …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto

Master's Projects and Capstones

Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.

Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.

Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.

Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …

Implementation Of A Nurse-Led Clinical Algorithm For Pressure Injury Prevention Associated With Non-Invasive Ventilation Medical Device Use, Capri Steinkuhler, Kaitlin Rogge

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Medical device related pressure injuries (PI) account for as much as 61-81% of all hospital reported wound incidents (Gefen et al., 2020) and are frequently caused by respiratory devices such as non-invasive ventilation (NIV). Use of NIV in critically ill patients dramatically increased during the pandemic. PI are one of the leading causes of injury to hospitalized patients and lengthens hospital stays (National Pressure Injury Advisory Panel [NPIAP], 2019). The NPIAP recommends routine skin assessment under devices, proper mask fit, protective barrier, moisture reduction, and interdisciplinary collaboration to prevent PIs from NIV masks. This feasibility study’s purpose …

Increasing Communication Of Patient Daily Goals During Interdisciplinary Rounds In An Inpatient Pediatric Cardiac Unit, Sage Bailey

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Ineffective communication between interdisciplinary team members in a pediatric inpatient setting results in poor documentation compliance and decreased staff satisfaction of daily goals. The use of a standardized patient daily goal sheet improves effective communication among interdisciplinary team members. The primary aims of this study were to improve RN satisfaction and knowledge regarding interdisciplinary communication, improve verbalization of patient daily goals in daily rounds, increase the number of daily goals verbally discussed and improve the quality of documentation in the electronic medical record (EMR). Methods: Data were collected on a pediatric academic 30-bed cardiac care unit involving 100 nurses. …

Icu Nurses’ Adherence To The Cdc’S Central Line Bundle: A Qualitative Study, Cherie Burke, Cherie Burke

Electronic Theses and Dissertations

Background: Central line associated bloodstream infections (CLABSIs) are one of the most common healthcare associated infections and result in prolonged hospital stays, significant morbidity, and increased costs to the healthcare system. Adherence to the CDC central line maintenance bundle has been shown to be effective in decreasing CLABSI yet these infections continue to be a problem. ICU nurses play a vital role in managing central lines and adhering to the maintenance guidelines, however different situations may arise during the care that may impact CLABSIs.

Objectives: 1) To determine nurses’ adherence to the CDC’s maintenance central line

bundle; 2) To determine …

An Examination Of The Impact Of Covid-19 On The Job Satisfaction And Emotional Well-Being Of Icu Nurses, Laura Ruth Daffron

Undergraduate Honors Theses

Healthcare systems have been demonstrably altered because of the COVID-19 pandemic. Resources were stretched and patient conditions deteriorated on a scale previously unseen, leaving nurses at the forefront to face the adversities brought about by the pandemic. In this study, a questionnaire was utilized to better understand how COVID-19 has impacted the stress level, resilience/well-being, moral distress, job satisfaction/enjoyment, practice environment, and intent to remain in the nursing profession of nursing alums from East Tennessee State University. This study focused on a subset of nurses working in critical care, to consider the impact that the pandemic had on ICU nurses’ …