Critical Care Nursing Commons^™

Parental Contextual Factors And Decision-Making Related To Periviable Birth: An Integrative Review, Amy L. Wright, Elizabeth Mens, Gausiha Rathitharan

The Qualitative Report

Parents facing a periviable birth, or birth before 25 weeks of gestation, commonly engage in antenatal consultation with healthcare providers to determine a plan of care. Parents’ pre-existing contextual factors, beliefs, and values influence their decisions regarding birth and the care of their infant. This study aims to understand the role of parental contextual factors and best-practices to their integration during antenatal consultation The Whittemore and Knafl (2005) approach to conducting an integrative review along with thematic analysis was employed to determine and present the findings. Results describe three themes related to how contextual factors influence parental decision-making: personal values …

The Relationship Between Endotracheal Tube Different Cuff Pressure Measurements And The Incidence Of Ventilator-Associated Pneumonia, Menattallah Mohamed

Nursing

Endotracheal tube cuff pressure measurement is an essential practice for management of mechanically ventilated patients. Based on guidelines, it’s recommended to maintain the endotracheal tube cuff pressure within a range between 20-30cm H2O. When the endotracheal tube cuff pressure is lower than the normal range, it increases the risk of micro-aspirations and the passage of contaminated secretions of the oral cavity into the trachea; this potentially causing aspiration pneumonitis and ends with ventilator associated pneumonia. This study aimed to assess the relationship between endotracheal tube different cuff pressure measurements and the incidence of ventilator associated pneumonia. A non-randomized descriptive correlational …

Icu Cauti Incidence Reduction, Michelle Gamble

Nursing Posters

Situation:

Catheter-Associated Urinary Tract Infection (CAUTI) rates in the adult Intensive Care Unit (ICU) increased from nine infections in FY21 to 18 in FY22.

Backgroud:

CAUTIs are the most reported healthcare acquired infection. It is important for healthcare providers to understand the complications and effects of CAUTIs. CAUTIs contribute to extended length of stay, increased healthcare costs, and patient morbidity and mortality.

Most CAUTIs are directly related to inadequate urinary catheter care. Evidence based practice demonstrates a decrease in CAUTIs related to the use of Theraworx^® Protect wipes twice daily (BID) and as needed (PRN) for patients with a …

Pupillometry, Elizabeth Plante, Casey Schmidt

Nursing Posters

Background:

• Measuring pupillary light reflex is a standard part of neurological assessment.
• Changes in pupil reactivity may indicate unfavorable outcomes, such as increased intracranial pressure and brain herniation.
• Physiologic and pharmacologic agents may affect pupil reactivity.
• In some instances, pupillary light reflex is the only piece of neurologic assessment readily testable.

What I Need: Self Care At The Unit Level, Jessica A. Tindal

Nursing Posters

Purpose:

Self-care is individualized and best done when awarded on a small scale.

Goals:

For all employees of the ICU to:

• Feel valued outside of work
• Be recognized for taking care of themselves
• Participate in positive discussions
• Be rewarded for work life balance
• Be reminded of self-care
• Not feel alone with their thoughts
• Pause and reflect
• Help others, spouses, kids, etc.

Future plans include:

• Seasonal questions of things to see, places to explore
• Recipe sharing
• Hobby experts
• Focusing on staffs' interests

Safe Intra-Hospital Transport Of Adult Patients On Non-Critical Care Units, Teresa Jahn, Janelle Maciej, Greta Titus

Nursing Posters

Plan:

Between 2021 and 2022, two non-critical adult patients returning from the imaging department after an invasive procedure developed increased oxygen needs, which ended in death for on patient and a transfer to critical care for the other.

No formal guidelines exist for the intra-hospital transport by unlicensed personnel may be absent. An intra-hospital transport checklist was developed for non-critical care patients leaving the unit for procedures in the imaging department.

Do:

• A "RN Pre-Invasive Procedure Transport Safety Checklist" was created by a telemetry RN (MSN student, Greta Titus) and CNS, Teresa Jahn
• The checklist was designed to answer questions …

Transitions To Normal Saline Only For Cvads, Megan Lehn, Ann Backes

Nursing Posters

Purpose Statement:

The purpose of this project is to implement a practice change throughout the system to remove heparin flushes for Central Venous Access Devices (CVADS) pending a successful pilot on Medical Oncology.

Synthesis of Evidence:

• Shama et al (2019) conducted a systematic review and meta-analysis including 886 participants that revealed no clear differences in CVC patency between heparin and NS.
• Klein et al (2018) conducted a pilot study on a 30-patient bone marrow transplant unit, each patient had a new CVC and were divided into two groups. Among 698 catheter-associated events overall incidence of central line issues were similar …

Examining The Impact Of De-Escalation Training Among Emergency Department Nurses, Jonathan Recchi, Jeffrey N. Doucette, Janice E. Hawkins

College of Health Sciences Posters

Workplace violence is a growing concern for US nurses, especially in the context of COVID-19 and patient incivility. De-escalation training can help mitigate high-risk incidents, but its psychological benefits are not well understood. This study aimed to determine if de-escalation training for emergency department nurses provided psychological benefit. This pre-experimental pre-test, post-test study evaluated nurse confidence in coping with patient aggression, caregiver resiliency, professional quality of life, and intention to stay with the organization. Participants completed a pretest survey, attended a two-hour verbal de-escalation training via zoom, and then completed the posttest survey. The study showed that attending the two-hour …

Examining The Effects Of Music Therapy On Physical And Psychological Symptoms Among Cancer Patients Undergoing Chemotherapy, Guadalupe Saldana

Nursing | Senior Theses

Background: Patients undergoing chemotherapy experience undesirable physical and psychological effects in which medications are the preferred method of management. However, standard medications are often insufficient for patients. Failure to attend to the adverse effects can lead to worsening of the patient’s cancer diagnosis and quality of life. The importance of managing chemotherapy symptoms creates an urgent need to implement an approach that is noninvasive, non-pharmacological, and one that still meets the physical and psychological needs of patients receiving chemotherapy.

Objective: The purpose of this thesis is to examine the effects of music therapy (MT) on physical and psychological …

Recognition Of Nonconclusive Seizures In Patients After Cardiac Arrest Using, Teresa Jahn, Elizabeth Plante

Nursing Posters

Background:

Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest.

Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring …

From Silos To Collaborative Working Relationships With Ems And Ed, Angela Moscho

Nursing Posters

Opportunity:

To establish a strong, collaborative relationship between St. Cloud Hospital Stroke Center, St. Cloud Hospital Emergency Department and Emergency Medical Services.

Background:

Two separate health care systems with one goal in mind: best stroke care for a community member experiencing stroke-like symptoms.

Current Practice in 2017:

• Code stroke activation with LTKW (last time known well) up to 6 hours.
• Inconsistent pre-notifications and pre-activations by EMS and ED.
• St. Cloud Hospital and Mayo Clinic Ambulance with siloed/individualized protocols for their respective health systems.

Heated High Flow Oxygen Therapy Management Of Respiratory, Swallowing/Dysphagia And Nutrition Needs, Jenelle Overgaard

Nursing Posters

Problem

• Patients diagnosed with COVID-19 pose challenges for oxygenation. Often requiring heated high flow oxygen therapy (HHFOT) for days to weeks, with literflow commonly over 40 L/min with maximum of 60 L/min.
• There is minimal research on aspiration risk at higher literflow, therefore practice included decreasing liter flow to 20 L/min for oral intake was standard.
• During oral intake, with literflow decreased to 20 L/min, patients' oxygen saturations would quickly trend down.
• Alarms indicating low saturation would create anxiety, cause patients to eat faster potentially increasing risk for aspiration.

Solution

• For adult inpatients meeting criteria, increase maximum literflow allowed during …

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Implementation Of A Revised Intubation Checklist For A Critical Care Transport Team, Teresa M. Zuber

Regis University Student Publications (comprehensive collection)

Critical care transport teams are often tasked with performing endotracheal intubation (ETI) during transport while adhering “to the same standards as in-hospital emergency anesthesia” (Lockey et al., 2017). One transport team adopted a checklist in 2014 to meet this high standard, but because of changes in equipment and practice expectation, an updated version was needed. The purpose of this quality improvement (QI) project was to design an updated checklist and measure the following primary outcomes: first pass success and steps taken to mitigate hypoxia and hypotension (and/or elevated shock index) prior to intubation. Additionally, a survey was administered to the …

Patient Positioning To Prevent Pressure Injuries, Maria D. Trevis

Theses and Graduate Projects

Skincare is an important intervention to prevent pressure injuries (PIs) during hospitalization. Prolonged pressure on a body part can result in restricted blood flow and oxygen, inadequate nutrition, and varying degrees of tissue damage, ultimately leading to a PI. Patients who have undergone surgery or have limited mobility are particularly vulnerable to developing PIs. The Centers for Medicare and Medicaid Services made a ruling in 2008 that hospitals would not be reimbursed for any hospital-acquired PIs as they are costly and preventable. Unfortunately, there is a knowledge gap in PI prevention due to a shortage of nursing staff, and changes …

The Implementation Of A Palliative Needs Screening Intervention In A Neuro Critical Care Unit:, Marcus Goodfellow

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Purpose: Palliative care (PC) is an important and yet underutilized discipline in neuro critical care units (NCCUs). The purpose of this project was to integrate and improve PC in a NCCU by implementing a Palliative Needs Screening Intervention (PNSI). A PNSI consists of a list of criteria used to screen patients to identify family and patient PC needs.
Methods: A quality improvement project using a PNSI was implemented in a NCCU. Nurses completed 2 hours of pre-implementation PC education and a palliative perceived self-efficacy scale pre/post-implementation. A PNSI was developed and integrated into the NCCU’s daily rounding process.
Results: PNSI …

Understanding Language Barriers And Its Implications On Patient Outcomes In The Urgent Care Situation, Nicolo Co

Nursing | Senior Theses

Background

A common goal for healthcare is healthcare for all, through which can be achieved when communication between the client and healthcare team is established. There are millions of immigrants worldwide who are not granted the healthcare that they deserve simply because of a lack of understanding in a country’s dominant language.

Patients with a limited language proficiency in a new country can have difficulty in understanding the care that they receive, which leads them to toil with understanding their healthcare options, let alone establishing expectations. This issue also stretches onto the risks of patient safety, in which urgent needs …

Clinical Care Protocol For Enhanced Nurse Competency In Caring For The Patient With An External Ventricular Drainage (Evd) Device, Lauren Orson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The focus of this Doctor of Nursing Practice Project surrounds the need for an evidence-based clinical nursing protocol to augment nurse competency and therefore streamline care to patients with an external ventricular drain (EVD).
Methods: A clinical protocol alongside tailored education was used to promote nurse competency for EVD management. A pre-implementation survey was completed evaluating the nurses’ baseline competency when managing an EVD. The nursing protocol was then implemented for bedside use. After 2 months, the survey was completed once again and paired for statistical analysis.
Results: Statistical analysis using the Wilcoxon signed-rank nonparametric test with dependent matched …

Efficacy Of Gabapentin Versus Benzodiazepines In The Management Of Alcohol Withdrawal Syndrome, Douglas R. Fredona

Master's Projects

Alcohol abuse, complicated by a dependency relationship, is the third leading modifiable cause of death in the United States. In patients with chronic alcohol use disorder who experience a sudden cessation or significant decrease in alcohol consumption, half will experience symptoms of alcohol withdrawal syndrome. Benzodiazepines are the typical first line treatment for alcohol withdrawal. However, benzodiazepines carry with them significant risks and side effects. As a result, ongoing research has taken place to find either an alternative treatment or a method of reducing total benzodiazepine dosage during treatment. Gabapentin is a medication that is primarily used for seizure control …

The Effect Of Providing End Of Life Care On The Mental Health Of Critical Care Nurses, Christy Nelson

Master's Projects

Critical care nurses are providing care to acutely ill patients now more than ever and may experience moral or emotional distress due to providing end of life care to their patients. The purpose of this literature review is to determine the mental health effects of a critical care nurse providing palliative end of life care. A literature search using PubMed and CINHAL was conducted and fourteen published articles between 2012-2023 were included in this review. Several interventions were identified which may be useful in decreasing burnout and moral distress in critical care nurses. Overall, nurses experienced the most negative mental …

Implementing Universal Suicidality Screening In A Critical-Access Emergency Department, Delaney M. Kjendal, Kerry Nolte, Sara Robinson, Kimberly Force

Honors Theses and Capstones

Background: Implementation of a universal suicidality screening is considered best practice as it is associated with improved the detection of occult, or latent, suicide risk and can reduce subsequent risk. This quality improvement (QI) project evaluates the implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) to screen patients over the age of twelve at a regional healthcare system.

Methods: The QI project was conducted at Littleton Regional Healthcare (LRH) emergency department, a critical-access hospital in Littleton, New Hampshire that serves about 206 patients per week. Implementation of suicidality screening was of interest to LRH to promote mental health in the …

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Student Research Posters

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care based training, with …

Polypharmacy: Increasing Medication Adherence, James C. Kelly

Nursing | Student Research Posters

Polypharmacy is a common problem among older adults where they take multiple medications concurrently, leading to negative health outcomes such as adverse drug reactions, drug-drug interactions, and non-adherence to medications. To address this issue, a randomized controlled trial (RCT) is proposed that will involve elderly patients (aged 65 years or older) who are taking five or more medications. Participants will be randomly assigned to either the intervention or control group, with the intervention group receiving nurse-led medication therapy management (MTM) and patient education to improve medication adherence. The Health Belief Model can be used to educate and empower older adults …

Implementation Of A Standardized Process To Increase Promotion Of Family Presence During Resuscitation, Eileen Hollis

DNP Scholarly Projects

BACKGROUND: Family Presence During Resuscitation (FPDR), has been studied and recommended as an important and relevant practice for decades, yet it remains controversial with frequent barriers to implementation. The benefits of this practice are numerous; and to truly embrace shared decision making, nurses and providers must encourage patients and families to participate in all aspects of care, even during resuscitation events. As evidence supporting the emotional and psychological benefits of FPDR began to grow, however, a global pandemic brought family presence to an abrupt halt.

METHODS: This quality improvement project’s focus was to standardize a process for offering and allowing …

Impact Of A Parent Education Program On Parents Of Children With Complex Congenital Heart Disease Prior To Discharge Home, Laura Elkhoury

DNP Projects

Abstract

Background and Purpose: Children with complex medical needs, such as children with complex congenital heart disease, are at risk for hospital readmission, morbidity, and mortality related to disease complications. Parents must be adequately prepared to care for their children following hospital discharge to prevent hospital readmission and complications. This study seeks to evaluate the impact of an education intervention on parental knowledge and stress related to caring for their child with complex medical needs.

Methods: The study design is a quasi-experimental, nonequivalent control pre-test/post-test design. The pre-test was administered prior to the educational intervention, with the post-test …

Use Of A Nurse-Led Daily Goals Checklist To Improve Multidisciplinary Rounds In The Icu, Marissa Riley

DNP Projects

Research has shown a multidisciplinary rounding approach can improve patient care outcomes in the intensive care unit (ICU). Due to the complexity and wide range of the healthcare team, many patient details and treatment goals may be overlooked during daily patient rounds without a daily goals checklist to help ensure collaboration and communication of the multidisciplinary team. A nurse led daily goals checklist could be useful for framing nurse-provider conversations to promote comprehensive communication and collaboration. The purpose of this project was to improve adherence to a nurse-led daily goals checklist to improve communication and collaboration between the nurses and …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

'Crying Wolf': Generating New Understandings Of Alarm Fatigue Using A Convergent Mixed Methods Approach, Meagan Rae Vidyaeva

Theses

Introduction: Alarm fatigue is a consequence of sensory overload due to frequent nuisance alarms from physiologic monitoring devices. This ‘cry wolf’ phenomenon occurs frequently in the context of continuous cardiac monitoring and ST segment monitoring.

Research significance: The effect of these alarm types on nurses’ perceived alarm fatigue in Australian settings is yet to be examined. Accordingly, this thesis explores registered nurses (RN’s) perception of alarm fatigue. The effect of ST segment monitoring on perceived alarm fatigue, as well as the necessary resources for RNs to reduce alarm fatigue is also a focus of this thesis.

Methodology: The research was …

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Reducing Blood Culture Contamination Rates Through Staff Education: A Quality Improvement Initiative, Kirsten M. Mutuberria

Honors Theses and Capstones

BACKGROUND: Blood cultures are a widely utilized tool that aids in diagnosis and treatment plans. Contaminated cultures are incredibly costly, resulting in increased length of stay, opportunistic infections, pharmacy costs, repeated laboratory tests, and decreased reimbursements. Evidence suggests higher incidence rates of blood culture contaminations (BCCs) are seen in emergency departments (ED) compared to any other unit within a hospital system. The internationally accepted threshold of 3% is not often met, although recent studies suggest a lower rate is possible, even in critical care environments. A literature review resulted in data showing that educational-based interventions focusing on adherence to facility …