Critical Care Nursing Commons^™

Nurse-Led Interprofessional Pressure Injury Prevention In The Medical Intensive Care Unit, Chelsea Lannoo

Articles, Abstracts, and Reports

Background:

The patient population in Medical Intensive care units (MICU) have the highest risk of developing pressure injuries. These pressure injuries can be attributed from medical devices such as Endotracheal tubes, nasogastric tubes, chest tubes etc. Diligent care and assessment of skin is crucial upon admission. Aggressive measures need to be implemented early through prevention protocols, the Air-tap turning system, appropriate bed education, placement of foams/Z-flex boots on arrival to unit. Appropriate staff education will help ensure policies are being initiated early on and decrease hospital acquired pressure injuries.

Purpose:

The Medical Intensive Care Unit (MICU) has seen a gradual …

Racial And Geographic Disparities In The Management And Care Of Sepsis, Luke Dommaschk Burwell

Nursing | Senior Theses

Sepsis, a severe condition triggered by the body's response to infection, requires prompt treatment to prevent tissue damage and organ failure. The SEP-1 Sepsis bundle, developed by Center for Medicare and Medicaid Services (CMS), aims to standardize care, particularly in rural hospitals with limited resources. However, disparities in bundle adherence and mortality rates persist, with rural areas facing more significant challenges. Studies show racial differences in care quality, emphasizing the need for interventions to address systemic biases. While sepsis bundle adherence and simulation training are strong indicators of care improvement, the literature review underscores the need for targeted interventions in …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

A Pulse For Progress – Examining The Efficacy Of Best Nursing Developmental Care Practices For Children With Congenital Heart Disease At Risk For Developmental Delay In The Pcicu: A Prospective Quasi-Experimental Cohort Study, Jasmyn Jansen

Nursing | Senior Theses

Emerging advances in pediatric cardiovascular surgery have significantly decreased the mortality rates in infants born with critical congenital heart disease (CHD), in turn, leading to increasing prevalence in adolescence and adulthood. At the same time, developmental delays (DD) are on the rise among children with CHD. Recent research suggests that prolonged exposure to the pediatric cardiac intensive care unit (PCICU), with its environmental stressors, negatively implicates neurodevelopment raising the question, and risk, of DD. In January 2023, the American Heart Association (AHA) issued a scientific advisory calling hospitals to implement developmental care practices for hospitalized infants and young children with …

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

Nursing | Senior Theses

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 the …

Nurse Suicide: Examining Depression And Anxiety In Critical Care Settings, Arianna Bernardine Barata

Nursing | Senior Theses

Nurses play a critical role in healthcare, yet the demanding work environment often exposes them to stressors, leading to the development of depression and anxiety. According to the National Library of Medicine (NLM) (2021), 50.8% of nurses have stress, 74% have anxiety, 70.8% have depression, and 79.1% have at least one of them. Burnout, understaffing, COVID fatigue, alarm fatigue, patient ratios, and disrupted sleep patterns are some of the stressors nurses contend with in every shift. While some nurses may cope and overcome these challenges, many face more severe issues, such as suicide. Nurse suicide is an issue that has …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Senior Theses

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Nursing Care During Natural Disasters, War Zones, And Mass Casualty Incidents: Implications For An Educational And Professional Overhaul, Erin N. White

Undergraduate Honors Theses

Emergency situations around the world are inevitable. Any nurse who practices for any period of time is sure to encounter situations like these. Their hospital may be flooded with traumatic and severely life-threatening patient cases where supplies can become scarce. In these situations, a nurse and all other healthcare personnel are expected to act effectively, efficiently and in a highly organized way. Despite this need, many hospitals fail to implement effective disaster preparedness programs and plans. This leaves healthcare workers at a loss for how to treat patients, communicate within and outside of the hospital, coordinate transport, and all the …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Student Research Posters

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Impact Of Nursing Education On Kangaroo Mother Care: Neurodevelopment Outcomes In Preterm Infants, Giana Usac

Nursing | Student Research Posters

Preterm birth poses a significant risk to the normal trajectory of brain development, particularly in the cortex, which is responsible for higher cognitive functions, motor control, and socio-emotional processing. However, Kangaroo Mother Care (KMC) has emerged as an important early intervention capable of improving neurodevelopmental outcomes in preterm newborns. This quantitative research proposal aims to assess the influence of nurse education on KMC practices, identifying pivotal periods in infancy when KMC has the most significant impact on neurodevelopment outcomes in preterm infants. The literature critique focuses on the efficacy of nursing education, the optimization of KMC regarding duration and frequency, …

Preparing Nurses For Medical-Assistance In Dying: The Role Of Comprehensive Education And Training, Keira O'Reilly

Nursing | Student Research Posters

Medical-assistance in dying (MAID) is a process in which a physician prescribes lethal medications that the consenting patient will self-administer with the intention of ending their life. By April 2024, medical-assistance in dying was legal in 10 states as well as the District of Columbia (“Death with Dignity,” 2024). With an evolving legal landscape around MAID, healthcare professional training on this procedure is often overlooked and inadequate (Winters et al., 2022). This is especially true for ICU nurses who manage critical and often end of life cases. This lack of education leaves nurses underprepared for the legal, ethical, and emotional …

Assessing Disparities In Culturally Competent Care In Ethnic Burn Patients, Min Kang

Nursing | Student Research Posters

One of the most debilitating injuries one can suffer is a burn. It is even worse when certain individuals can not access the high quality care such as immigrants. With immigration rates increasing over the last several decades, these populations often lack the proper medical care that they deserve. The overarching theme in this population is that they face challenges in attaining positive patient outcomes due to cultural differences.

• Lack of Culturally Competent Care in Burn Care
• Addressing Cultural Safety and Quality of Care in Burn Injury Management
• Analyzing Disparities in Access to Culturally Competent Burn care

Optimizing Discharge Education For Hf Patients, Connie-Rose Pangan

Nursing | Student Research Posters

Heart failure is a chronic condition in which the heart cannot adequately provide blood and oxygen to tissues in the body. Heart failure patients account for the highest 30-day readmission rate in Medical-Surgical conditions (Nair et al., 2020). It is the leading cause of hospitalization in adults over 65 years old in the US. Constant readmission is costly, and therefore additional interventions must be done to prevent it. Due to the severity of heart failure, these patients require a copious amount of information at discharge to understand the pathophysiology of their disease, their medication regimen, and important lifestyle changes needed …

Impact Of Personal Continuous Glucose Monitor Use During Hospitalization On Rates Of Hypoglycemia And Provider Confidence, Rebecca Longo

DNP Scholarly Projects

Continuous Glucose Monitors (CGMs) are an essential tool for managing diabetes in the outpatient setting, helping individuals achieve glucose goals. However, CGMs are not currently FDA-approved for use in the hospital setting. Despite this limitation, many individuals continue using their personal CGM during hospitalization or begin using them prior to discharge if the care team believes the technology will support glucose management during and after leaving the hospital.

This project aimed to evaluate whether individuals using personal CGMs during hospitalization experienced less hypoglycemia and whether reviewing CGM data could improve provider confidence in insulin dosing. While initiating CGM use during …

Implementation Of Unit-Based Preceptor Orientation: The Effects On Perceived Orientee Competence And Self-Confidence Of The Precepting Cvicu Nurse, Laura K. Marcum

DNP Projects

Purpose: The purpose of this study was to assess how unit-specific preceptor training impacted the perceived readiness of new graduate nurses, self-confidence of preceptors, and the correlated job satisfaction.

Background: The nurse attrition rate is resulting in inexperience at the bedside. Nursing inexperience leads to lower quality patient care. If improving the efficiency of training and education can improve perceived readiness, then in turn we can increase the longevity of our new nurses. Improving the longevity of nurses has significant implications on the budget of each hospital, the patient outcomes, and the staff’s resulting job satisfaction.

Methods: New graduate nurse …

Say No To Drugs: Nonpharmacologic Interventions For Preventing Delirium In Critically Ill Patients Intubated & Sedated In A Pediatric Icu, Jessica C. Ellzey

DNP Projects

Background. Delirium is an acute clinical syndrome that is characterized by features of disrupted arousal, attention, cognition, sleep, and perception. Delirium is a well-documented phenomenon in critical care settings in both adult and pediatric populations, particularly among patients with length of stay greater than or equal to 48 hours. Delirium has multiple adverse effects, including increased mortality rate, prolonged duration of mechanical ventilation, higher reintubation rates, prolonged intensive care unit (ICU) admission, prolonged hospital admission, short- and long-term cognitive impairment, and posttraumatic stress disorder. There are currently no accepted guidelines or FDA approved medications to treat ICU delirium in the …

Using The 4ms Framework To Prevent Falls, Gina L. Edgeworth

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Hospital falls are rising in inpatient facilities, requiring analysis and a plan of action to address the ongoing falls. A strategy taken among facilities is implementing a 4Ms Framework that allows the nurse to address what matters to the patient and assess their mentation, medications, and mobility upon admission. With an increase in falls on a med-surg unit, it was found that there was no straightforward process for addressing the needs and concerns of patients and no assessment of medications, mobility, or mentation for those aged 65 years and older. This knowledge gap prevents nurses from providing a structured framework …

Creation Of A Structured Rapid Response Team And Early Rrt Activation, Elizabeth Amaka Azie

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Cardiac arrest, unanticipated admissions to the intensive care unit (ICU), and mortality account for about 50% of serious inpatient adverse events (Ko et al., 2020). Efforts to prevent in-hospital cardiopulmonary resuscitation (CPR) require a system to identify deteriorating patients and include an appropriate interventional response, such as a rapid response team (Andersen et al., 2019). A well-structured rapid response team (RRT) has five categories that include team structure, organizational culture, expertise, communication, and teamwork (Jackson, 2017). A community hospital in Texas has been challenged in its attempts to have a well-structured RRT and had an increase in cardiac arrest. A …

Guideline To Decrease Nursing Turnover In Intensive Care Units, Carol L. Mention

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Turnover rates of registered nurses working in intensive care units continue to increase significantly after the pandemic. Many nurses have left the profession due to the increased workload and stress during and after the COVID-19 pandemic. Having staffing challenges and turnover can affect the outcome of this patient population. Intensive care nurses experience workplace violence at an increasing volume. Also, robust nurse onboarding and training programs can help decrease turnover rates. The current national guideline does not address these concerns about nursing turnover. A guideline project was performed to identify needed recommendations based on evidence for stakeholders to …

Bundle For Left Ventricular Assist Device (Lvad) In The Ed, Tina Morris

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose

Left Ventricular Assist Device (LVAD) is a high-risk, low-volume patient population with admission rates of up to 72%. The purpose of this study was to provide a care bundle to increase the knowledge of the emergency department (ED) staff and decrease the door to consult times to the advanced heart failure (AHF) team for LVAD patients presenting to the ED at a level I trauma center in Texas.

Methods

In collaboration with emergency clinical staff, the project team implemented a bundle that included a pathway for the LVAD patients upon presentation to the ED, targeted education for clinical staff …

A Quality Improvement Initiative To Reduce Preanalytical Blood Gas Errors, Layla Haver Newbrough

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Introduction: Laboratory testing is one of the most commonly performed procedures in healthcare and resulting data are paramount to clinical decision making. Background: Preanalytical blood gas laboratory errors often stem from the incorrect recording of a patient’s fraction of inspired oxygen (FiO2) within the laboratory collection application. Incorrect FiO2 may cause erroneous results or delays in reporting results that have the potential to negatively impact patient safety and medical management.

Purpose: The purpose of this quality improvement initiative was to reduce the occurrence of preanalytical blood gas laboratory errors. Methods/Interventions: This initiative combined modification of the laboratory collection application …

Implementing A Nurse-Driven Protocol To Reduce Routine Gastric Residual Monitoring: A Quality Improvement Project, Alondra N. Abreu Carlo

Master's Theses and Capstones

The American Society for Enteral and Parenteral Nutrition (ASPEN) and the Society for Critical Care Medicine (SCCM) updated the Adult Patient Enteral Nutrition Guidelines in 2016. These updates included discontinuing routine gastric residual monitoring due to its contribution to poor patient outcomes and mentioning the lack of evidence proving its relevance to gastric motility. Per ASPEN and SCCM, best practice suggests monitoring patients for intolerance symptoms and then checking gastric residual volume (GRV) if symptoms are present. If the GRV is greater than 500ml and intolerance symptoms are present, the recommendation is to perform further assessment, potentially leading to stopping …

Educational Interventions To Improve Icu Nurses’ Knowledge And Confidence Related To Pressure Injuries: A Quality Improvement Initiative, Benjamin R. Maltais

Master's Theses and Capstones

Background: The prevalence of pressure injuries (PI) in critical care is highest amongst inpatient units, and are associated with significant complications, decreased quality of life, increased cost of hospitalization, and poor patient care (Agency for Healthcare Research and Quality, 2019; Cox et al., 2022; Gorecki et al., 2014; Mervis & Phillips, 2019). Similarly, many PI are considered to be avoidable (Pittman et al., 2019). Despite an increase in focus on PI awareness and prevention, there still remains a challenge for patients in critical care units. In addition, research has indicated that nurses’ lack of basic knowledge of PI (risk assessment, …

The Effect Of A Neonatal Palliative Care Education Program In Increasing Knowledge And Communication Self-Efficacy Among Nicu Nurses, Shiou-Huei Joy Wang

Doctoral Projects

Background: Neonatal palliative care is crucial to providing comprehensive, high-quality care to neonates with life-limiting or life-threatening health conditions and their families. One significant barrier to the inconsistent provision of neonatal palliative care is the lack of education. This project aimed to deliver an education training program to increase neonatal palliative care knowledge and self-efficacy in NICU nurses. Method: A pre-post-test study design was used to examine the efficacy of an educational training program on NICU nurses’ knowledge and communication self-efficacy in neonatal palliative care. A post-test was administered immediately after the training and again four weeks later to evaluate …

Increasing First-Attempt Endotracheal Intubation Success Rates In The Aeromedical Environment, Jared Copeland

Graduate Theses, Dissertations, and Problem Reports (ETD)

Problem Statement: In 2022, the first-attempt endotracheal intubation success rate of an aeromedical agency had steadily declined and was currently below the international average of 88.48%. This decreased success rate potentially placed patients at risk for adverse events that increase morbidity and mortality. Background: Patients who experience a failed first-attempt intubation are at greater risk of intubation related complications. These complications include hypoxemia episodes, severe arrhythmias, pulmonary aspiration, hypotension episodes, cardiac arrest, and death. Literature Review: Preoxygenation, patient positioning, maintenance of oxygenation, drug selection, and device utilization have been found to increase first-attempt endotracheal success rates. Project Aims: The project …

Promoting Inpatient Mobility To Improve Patient Outcomes: A Quality Improvement Project In A Rural Critical Access Hospital, Chantal Laplante

Master's Theses and Capstones

Background: Although beneficial to patient outcomes, inpatient ambulation is not a prioritized care intervention, and a task often deferred to physical therapy. Patient immobility is a complex problem that requires a multifaceted approach.

Local Problem: In a rural, critical access hospital, on an 18-bed medical surgical unit, nursing staff lacked ownership of patient mobility. There was no standardized process to document ambulation and mobility tasks were not scheduled, falling to the end of the nursing work list. Many patients did not have activity orders upon admission and nurses lacked resources for ambulation assessment and daily goal setting. There was no …

Using The Stop5 Debriefing Model To Increase Utilization Of Debriefing Practice In The Emergency Department: A Quality Improvement Project, Hallie Chancey

Master's Theses and Capstones

Abstract Background: The practice of debriefing has been an important process in critical care settings to promote team unity as well as best care practices. Literature has shown that debriefing can not only influence quality care and improved operations, but the process can also influence the emotional support staff receive. These implications are particularly important for nurses that work in critical care settings as the job can often be stressful and lead to moral distress as well as the need for evidence-based care practices is crucial when a patient’s life is on the line. Literature supports that any form of …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Enhancing Chest Pain And Oxygen Supplementation Protocol Adherence Through Nurse Education In The Emergency Department For Patients With Acute Coronary Syndrome And Unspecified Chest Pain: A Quality Improvement Project, Leah Gamble

Master's Theses and Capstones

Abstract Background: Acute Coronary Syndrome (ACS) and unspecified chest pain are common presentations in the Emergency Department (ED). Proper management, including appropriate oxygen supplementation, is crucial for optimal patient outcomes. However, discrepancies between current practice and evidence-based guidelines have been identified, highlighting a need for targeted educational interventions.

Local Problem: In the ED, knowledge gaps among nurses regarding the correct administration of supplemental oxygen for patients with ACS and unspecified chest pain have been observed. This inconsistency with the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines may lead to poor patient outcomes.

Methods: The Plan-Do-Study-Act (PDSA) …

Improving Patient Handoff In The Emergency Department Microsystem, Alahna V. Kinney-Sandefur

Master's Theses and Capstones

Abstract

Background: Gaps in communication in the patient handoff process have been directly linked to patient safety errors and unwanted patient outcomes. The reviewed literature highlights multiple factors impacting the handoff process and unanimously conclude that a standardized handoff process is necessary in maintaining a high standard of patient safety and a minimization of safety errors.

Methods: This intervention took place in an 86-bed, acute care facility, a level III trauma center macrosystem with implementation of this project taking place in the emergency department and medical/surgical microsystems. Utilizing the Plan, Do, Study, Act framework over a total of eight weeks, …