Critical Care Nursing Commons^™

Evaluating The Efficacy Of A Progressive Mobility Protocol Among Adult Icu Patients, Clayton Chroust

DNP Projects

Background: Many intensive care unit (ICU) patients are critically ill and require ventilator support, and they often do not receive any progressive mobility interventions until after they are liberated from the ventilator or receive transfer orders out of the ICU. Current literature suggests that patients in the ICU face deconditioning, increased ventilator days, development of deep vein thrombosis, pressure ulcers, pulmonary embolism, muscular atrophy, and increased days in the ICU which can be attributed to a lack of mobility. Current evidence-based research identifies that utilization of a progressive mobility protocol is one way to improve patient outcomes and reduce …

Implementation Of A Process To Improve Compliance With A Nurse Driven Foley Catheter Removal Protocol In Nursing Staff Of A Medicine Intensive Care Unit, Kendall L. Pfister

DNP Projects

Background: Catheter associated urinary tract infections (CAUTI) are the most prevalent healthcare acquired infection (HAI) in the acute care setting. Unfortunately, CAUTIs can lead to high morbidity and mortality rates, longer length of stay (LOS) and increased healthcare costs. Unfortunately, in critically ill patients which often suffer multi-organ failure/injury, there remains an increased risk for infection and poor outcomes.

Purpose: The purpose of this project is to increase medical intensive care unit (MICU) nursing staffs’ knowledge of existing nurse driven indwelling urinary catheter removal protocol and to implement an electronic medical record (EMR) prompt for removal of unnecessary urinary catheters …

Implementation And Evaluation Of A Competency-Based Phased Orientation Program For Nurse Practitioners In The Intensive Care Unit Setting, Meredith Sherer

DNP Projects

Background: Research has demonstrated that structured orientation helps to integrate new nurse practitioners (NPs) into practice, ease role transition, decrease NP turnover, and lead to better patient care. However, at University of Kentucky HealthCare (UKHC) clinical orientation programs for NPs are not standardized.

Purpose: The purpose of this project was to implement and evaluate a competency-based phased orientation program for NPs in the intensive care unit (ICU) setting at UKHC.

Methods: This project utilized a prospective, single group, presurvey-postsurvey design to examine the effect of a three-phased competency-based orientation program on the outcome variables of NP confidence, autonomy, proficiency of …

The Effect Of A Hospital Community Garden On Healthcare Workers’ Professional Quality Of Life, Madelyn Renee Cline

DNP Projects

Background: Healthcare professionals experience a variety of stressors which negatively impact their professional quality of life (ProQOL) potentially leading to increased turnover and nurse shortages in hospitals. There are growing studies addressing ways to improve healthcare ProQOL, yet few have examined the impact of alterations to the workplace on these outcomes.

Purpose: The purpose of this project was to evaluate the effect of a dedicated outdoor green space for nurses during shift breaks on their ProQOL.

Methods: This project used a one-group pretest-posttest design. Data analysis was completed using descriptive and inferential statistics using SPSS software. The Professional Quality of …

Implementation Of A Pilot Post-Code Debrief Tool Initiated By The Chaplains And Unit Lead Nurses Within The Medicine Intensive Care Unit, Sarah Stigall

DNP Projects

Background: Post-code debriefs are shown to improve teamwork and communication, increase performance, and reduce burnout. According to the University of Kentucky HealthCare (UKHC) policy, teams are to perform a post-code debrief immediately after an in-hospital cardiac arrest (IHCA). However, the current policy does not provide guidance on what to include during a debrief session. At UK post-code debrief sessions are documented as occurring 60-72% of the time; however, personal observation and discussions with other bedside and rapid response nurses suggest that post-code debriefs are underperformed when compared to the documentation. Purpose: This study aimed to explore barriers to post-code debriefs …

A Triage Process To Decrease Door To Ekg Times For Adult Patients With Suspected Cardiac Abnormalities In The Emergency Department, Khay Douangdara

DNP Projects

Objective: The emergency department (ED) triage process for adult patients presenting with suspected cardiac abnormalities should be reliable; however, delays in identifying significant cardiac rhythms can negatively impact patient outcomes. The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend that patients presenting to the ED with cardiac-related concerns undergo an electrocardiogram (EKG) within 10 minutes of arrival. This project aimed to educate ED nurses and implement changes in the triage process to reduce door-to-EKG times for adult patients with suspected cardiac abnormalities.

Methods: This quasi-experimental study utilized a pre- and post-intervention design to evaluate the effectiveness …

Facilitating Caregiver Involvement In Reducing Delirium Among Critically Ill Children In The Pediatric Intensive Care Unit, Emma R. Bilberry

DNP Projects

Background: The pediatric intensive care unit (PICU) is a dynamic, fast-paced, and high-acuity unit where children are prone to the development of pediatric delirium (PD). PD is a condition of neurologic dysfunction increasing risk of morbidity and mortality among patients. Literature on PD is rapidly expanding, providing an opportunity for increased research on how to manage PD. Caregivers know their children, are often readily available at the bedside, and invested in being included in care. Additionally, literature shows that caregiver presence at the bedside is one non- pharmacological intervention that can aid in reducing PD. The development and implementation of …

Primary Nurse Framework: All-Registered Nurse Staffing Model In A Twelve Bed Critical Care Unit, Jeanette E. Sanders

DNP Projects

Background: Registered Nurses (RNs) comprise one of the largest professions in healthcare, and they play a critical role in delivering patient-centered care. The nursing shortage exacerbates inadequate nurse staffing levels, leading to increased workloads, higher patient-to-nurse ratios, and a high-stress work environment.

Purpose: This project aimed to evaluate the implementation of a primary-nurse-led care delivery model with an all-RN staffing design and its effects on nurse-sensitive patient outcomes, patient length of stay, nurse-sensitive related outcomes, and associated financial implications in the Intensive Care Unit (ICU) setting. Nursing knowledge and opinions about the all-RN staffing model were also assessed.

Methods: Staffing …

Evaluating The Impact Of Epic Integration And Dual Registered Nurse Check-Off On Pressure Injury Prevention Workflow Compliance, Darlene Y. Olowu

Doctor of Nursing Practice Final Project Abstract

Background

Hospital-acquired pressure injuries (HAPIs), particularly sacral and heel injuries, remain a persistent challenge in critical care settings, leading to increased morbidity, mortality, and healthcare costs.

Purpose

This quality improvement project aimed to improve compliance with a pressure injury prevention (PIP) workflow by integrating a dual RN check-off system within EPIC, thereby reducing sacral and heel pressure injuries. The project sought to enhance accountability, standardize documentation, and optimize compliance with evidence-based PIP measures.

Methodology

A Plan-Do-Study-Act (PDSA) framework guided the project implementation in an oncologic intensive care unit (ICU). Key interventions included: (1) EPIC integration of a dual RN check-off …

Reframing Recovery: Comparing Music Interventions And Traditional Rehabilitation Methods For Cognitive Function In Traumatic Brain Injury Patients, Laura Velez

Honors Undergraduate Theses

Traumatic brain injury (TBI) affects millions annually, often resulting in long-term cognitive deficits that hinder independence and quality of life. While traditional rehabilitation methods address many physical and functional limitations, cognitive impairments—such as deficits in attention, memory, and executive function—often persist. Emerging evidence highlights music-based interventions as a promising complement to standard therapies, yet comparative research remains limited. This integrative literature review examined the effects of music interventions versus traditional rehabilitation methods on cognitive function in adults with TBI. Using a systematic search of databases including MEDLINE, CINAHL Ultimate, APA PsycInfo, and Music Index, eight peer-reviewed studies were selected for …

Beyond Involuntary Movements: A Case Of Diabetic Striatopathy Complicated By Cardiac Arrest, Deepa M

Manipal Journal of Nursing and Health Sciences

Abstract

Diabetic striatopathy (DS) is a rare neurological manifestation of poorly controlled diabetes mellitus, typically characterized by hemichorea–hemiballismus and distinctive basal ganglia abnormalities on neuroimaging. We report the case of a 57-year-old woman with type 2 diabetes mellitus who presented with generalized choreiform and ballistic movements and subsequently developed an in-hospital cardiac arrest. Diagnostic evaluation revealed uncontrolled hyperglycemia (random blood glucose 243 mg/dL; HbA1c 8.3%) without ketosis, with neuroimaging findings consistent with DS. The patient was initially managed in the casualty department and subsequently admitted to a neuro stepdown intensive care unit, where she remained for 10 days. Comprehensive medical, …

Post-Traumatic Stress Disorder Among Critical Care Nurses Caring For Covid-19 Patients, Marwa Abdo

Nursing

Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global health, with a substantial number of severe cases requiring admission to isolated intensive care units (ICUs). This unprecedented situation exposed critical care nurses (CCNs) to a highly stressful traumatic environment, placing them at increased risk for developing post-traumatic stress disorder (PTSD). Early identification and intervention for PTSD are crucial to mitigate the negative consequences for nurses' well-being, job performance, and overall quality of life. Aim: This study aimed to assess post-traumatic stress disorder among CCNs caring for COVID-19 patients. Method: A descriptive cross-sectional design with a convenience sample of 109 CCNs …

Implementation Of The Novel Nurse Intuition Patient Deterioration Scale To Assess For A Correlation Among Nurse Intuition And Patients Returning To The Intensive Care Unit, Janie L. Walsh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Adult hospitalized medical and surgical patients at an academic medical center are being transferred out of the Intensive Care Unit (ICU) to the step-down floor and having rapid response calls in less than 48 hours after the transfer. Nurse intuition is not a consideration in the decision to transfer a patient. Physiological variables such as Modified Early Warning Scores (MEWS) and vital signs are relied on heavily as indicators for escalation or de-escalation of care. There is evidence supporting the use of acknowledging nurse intuition to better predict a patient’s readiness for transitions of care.

Purpose: To evaluate the …

Implementation Of An Evidenced Based Enteral Nutrition Protocol For Mechanically Ventilated Patients: A Quality Improvement Initiative, Hannah R. Nuzum

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Implementation of an Evidenced Based Enteral Nutrition Protocol for Mechanically Ventilated Patients: A Quality Improvement Initiative.

Hannah Nuzum

Background: Mechanically ventilated patients require supplemental nutrition as an important factor for their overall recovery. Malnutrition in hospitalized patients is reported as high as 35% (Ikram et al., 2022).

Purpose: Lack of an enteral nutrition (EN) protocol has contributed to variability in initiation of EN for post-intubated mechanically ventilated patients.

Intervention: The project interventions are threefold: the development of an EN protocol, EN initiated within 24 to 28 hours for post-intubation patients, and staff understands that EN should be initiated within …

Does Education On Aseptic Non-Touch Technique Affect Nurse Knowledge On Aseptic Technique When Placing Ultrasound Guided Peripheral Intravenous Lines? A Quality Improvement Initiative, Hannah G. Keyser

Graduate Theses, Dissertations, and Problem Reports (ETD)

This Doctor of Nursing Practice (DNP) project attempted to increase nurse’s knowledge of aseptic technique when placing USG-PIVs in hospitalized adult patients after educational training on the Aseptic Non-Touch Technique Clinical Practice Framework (ANTT CPF). Implementation of the ANTT CPF in the cardiovascular intensive care unit (CVICU) at Ruby Memorial Hospital, as a didactic educational session for nurses already trained to place ultrasound-guided peripheral intravenous lines, was utilized for this DNP project. Pre- and post-surveys were employed to determine changes in knowledge scores as well as feelings of comfort and knowledge related to the CPF. Results remained stable for survey …

A New Electronic Handoff Tool To Facilitate Patient Transfer From The Or To Sicu: A Quality Improvement Initiative, Kaylan Jean Kerrigan

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Transfer of care is a vulnerable time for patients. Continuity of care depends on good communication from the transferring team to the receiving team. Communication failures contribute to frustration among medical staff and poor patient outcomes. Purpose: The purose of this project was to improve handoff communication and satisfaction between the anesthesia team in the operating room (OR) and the receiving surgical intensive care unit (SICU) nurses. Intervention: A new electronic handoff tool was developed for the Epic electronic health record (EHR) to provide SICU nurses with patient information (name, age, allergies), procedure and diagnosis, intubation status, reversal status, …

Improving Timely Palliative Care Consultation In The Micu: A Nurse-Driven Quality Improvement Initiative, Sandy Louise Gray

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) …

Use Of Machine Learning Models To Predict Microaspiration Measured By Tracheal Pepsin A., Annette Bourgault, Ilana Logvinov, Chang Liu, Rui Xie, Jan Powers Phd, Rn, Ccrn, Mary Lou Sole

Nursing Publications, Posters, & Presentations

BACKGROUND: Enteral feeding intolerance, a common type of gastrointestinal dysfunction leading to underfeeding, is associated with increased mortality. Tracheal pepsin A, an indicator of microaspiration, was found in 39% of patients within 24 hours of enteral feeding. Tracheal pepsin A is a potential biomarker of enteral feeding intolerance.

OBJECTIVE: To identify predictors of microaspiration (tracheal or oral pepsin A). It was hypothesized that variables predicting the presence of tracheal pepsin A might be similar to predictors of enteral feeding intolerance.

METHODS: In this secondary analysis, machine learning models were fit for 283 adults receiving mechanical ventilation who had tracheal and …