Critical Care Nursing Commons^™

Examining Rural Acute Care Clinical Nurse Specialist Roles, Jessica Camp, Jessica Baltz, Amanda Mcmillon, Christopher Zumbach, Angie Smith, Michael Anderson

Rural Health Professions Projects

Clinical Nurse Specialists are extremely valuable healthcare team members that may be underutilized in times of crisis. This case study examines how the role of the clinical nurse specialist proved worthy and evolved to meet the demands of the COVID-19 pandemic as it impacted one rural hospital in the southern United States of America.

A Multi-Faceted Intervention To Reduce Low Value Diagnostic Studies In A Medical Intensive Care Unit., Jessica Caicedo

DNP Projects

Routine daily chest x-rays (CXRs) and laboratory studies have been identified as low-value care practices that contribute to the rising cost of healthcare without improving quality or outcomes. There is a large body of evidence as well as recommendations from multiple professional organizations for providers to not order unnecessary daily or routine diagnostic studies. Rather, these should be ordered in an on-demand fashion as a response to a specific clinical query. Despite the strength of recommendations, practice remains variable across the U.S. The reasons for resistance to practice change as well as the most effective strategies for implementing sustainable change …

Is This Really Happening? Family-Centered Care During Covid-19: People Before Policy, Terri Savino, Karri Crispino

Patient Experience Journal

In the middle of a global pandemic, hospitals created policies for visitor restrictions to reduce the transmission of coronavirus to protect patients and staff and developed protocols allowing only one support person to call the critical care unit for patient updates. Late on a Tuesday afternoon, the Manager of Patient Experience received a phone call asking her to call Karri, the wife of one of our patients who was on a ventilator. Karri was struggling with updating her mother-in-law because she was very upset with the news she received, making it difficult to call her husband’s mom. Karri asked the …

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Impact Of Meaningful Recognition On Work Environment Perception Of Critical Care Nurses, Kristin Meinershagen

Dissertations

Problem: Absence of nursing staff recognition can lead to compassion fatigue, burnout, job dissatisfaction, and increased turnover rate resulting in high costs for hospitals. Meaningful recognition has been found to decrease compassion fatigue and reduce burnout. A meaningful recognition program was implemented over a 3-month period for staff nurses in an Intensive Care Unit (ICU) at a large midwestern, metropolitan hospital to determine its effect on nurse’s perception of work environment and turnover rate in the ICU.

Methods: This was an observational, descriptive, cohort design utilizing the AACN Healthy Work EnvironmentSurvey instrument for assessing results before and after implementation …

The Effect Of A Nursing Knowledge Practice Improvement Project For Icu Acquired Weakness (Icuaw) And Mobility Protocols To Increase Knowledge And Self-Confidence In Icu Nurses, Renee Rogers

DNP Projects

Objective: The purpose of this project is to conduct a knowledge improvement program about ICU acquired weakness (ICUAW), mobility protocols, and self-confidence for ICU nurses at the University of Kentucky's Trauma & Surgical service.

Aim: The aim of this project is to improve the ICU nurses’ knowledge about ICUAW, mobility protocols/charting, and nursing self-confidence performing the knowledge within clinical practice. As well as assess if there is any correlation between the years of nursing experience and ICU location on knowledge and self-confidence.

Background: A condition that is under recognized in critical care, is ICU acquired weakness (ICUAW), which is muscle …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Moral Distress In Critical Care And Emergency Department Nurses, Morgan Timberlake, Nicole Phillips

Senior Honors Projects, 2010-2019

Moral distress is a phenomenon that occurs when a person is unable to carry out what they believe is the ethically appropriate action due to various external constraints. This literature review seeks to explore the interventions that are most effective in reducing moral distress in critical care and emergency department nurses who have experienced moral distress in practice.

Burnout Syndrome In Critical Care Nurses, Katie Burke, Kelly Claridge, Mallory Bidlen

Williams Honors College, Honors Research Projects

Burnout syndrome among nurses, especially within the critical care setting, has been a persistent and increasingly prevalent problem in the healthcare field. This systematic review aims to explore the common causes of burnout among nurses associated with working in a critical care setting. Twenty-five peer-reviewed articles, published between the years of 2000 and 2018, were selected for analysis and synthesis using the databases PubMed and CINAHL. The group included research studies conducted in the United States, Spain, France, China and Iran with sample sizes ranging from 42 to 2,392 intensive care unit (ICU) nurses. The articles included in this review …

Evaluation Of A Critical-Care Pain Observation Tool Quality Initiative, Caissy A. Goe

DNP Projects

Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes.

Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management.

Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, …

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

Impact Of A Nurse-Physician Communication Intervention On Psychological Empowerment And Effectiveness Of Collaboration Between Medical Staff And Critical Care Nurses, Kristen Wieder

DNP Projects

Background: Nurse-physician communication is an essential element of safe, effective patient care, nurse engagement and job satisfaction. Communication breakdowns can lead to poor patient outcomes and disengagement among nurses.

Purpose: The purpose of this project was to determine the impact of a nurse-physician communication intervention on psychological empowerment of critical care nurses. A second purpose of the study was to evaluate the effectiveness of communication between critical care nurses and members or the cardiothoracic surgery team and understand barriers and communication challenges.

Methods: A quasi-experimental pre-test/post-test design was utilized to evaluate the impact of a nurse-physician communication intervention …

Critical Care Nurses’ Suggestions To Improve End-Of-Life Care Obstacles: Minimal Change Over 17 Years, Renea L. Beckstrand, Kacie Hart Hadley, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background: Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients.

Objectives: The purposes of this study were to collect CCNs’ current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions …

Post-Intensive Care Syndrome: Comparison Of Educational Interventions To Educate Parents Of Children Hospitalized In The Pediatric Intensive Care Unit At St. Louis Children’S Hospital, Stephanie A. Esses

Dissertations

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS). Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or …

Efficacy Of The Adherence To An Evidence-Based Early Mobilization Protocol On Patient Outcomes Post Thoracic Surgery, Blair Eberhardt

DNP Projects

Background: Immobilization is a commonly observed problem for adults in the intensive care unit (ICU) that may lead to ICU delirium, ICU associated weakness, increased length of hospital stay, and increased mortality¹⁷. Therefore, early mobilization has become an increasingly imperative priority regarding the treatment plan for patients in the ICU. Mobilization is often delayed or completed on a subjective provider basis due to scarcity of resources and outdated evidence-based knowledge⁷. This examination of adherence to an evidence-based protocol helps to assess efficiency of therapeutic outcomes regarding early ambulation of surgical thoracic patients in the critical care …

Bedside Nurses' Perceptions Of Intensive Care Unit Telemedicine In A Rural Setting, Susan Parker

Nursing Theses and Capstone Projects

Healthcare is a rapidly changing and continuously advancing field. Currently, virtual care technology (e-ICU) is moving into many rural healthcare facilities in an effort to improve patient care outcomes and bridge physician and nursing shortages. The purpose of this Masters of Science thesis is to determine the impact that electronic telemedicine has on the quality of nursing care at the bedside. The study done by Mullen-Fortino et al. (2012) in an urban academic center was replicated to compare the bedside nurses’ perception of ICU telemedicine in a rural hospital setting. Thirty-eight rural ICU nurses working with ICU telemedicine responded to …

Intensive Care In Oncology: Admission And Outcomes In Adult Patients With Cancer, Surya John

Honors Undergraduate Theses

Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care.

Methods: A total of 768 articles were found in a literature search including all literature from 2005 to …

Use Of High-Fidelity Simulation Training For New Cardiothoracic Intensive Care Unit Nurses, Bryan Boling

DNP Projects

Critical care nursing is one of the most challenging, high-stress fields in healthcare. This is especially true for nurses in the highly specialized environment of the cardiothoracic intensive care unit (CTICU). The experience level of nurses in critical care is positively linked with patient outcomes; however, with older nurses retiring or moving away from the bedside and younger nurses increasingly moving into advanced practice or management and leadership roles it is becoming more difficult to maintain a high degree of nursing experience in the ICU. Simulation training has been used to provide safe, effective training, and it is even possible …

The Emotional Intelligence Of Registered Nurses Commencing Critical Care Nursing, Yvette Nagel, Amanda Towell, Elzabe Nel, Fiona Foxall

Research outputs 2014 to 2021

Background: Critical care is described as complex, detailed healthcare in a unique, technologically rich environment. Critical care nursing requires a strong knowledge base and exceptional clinical and technological skills to cope in this demanding environment. Many registered nurses (RNs) commencing work in these areas may lack resilience, and because of the stress of the critical care environment, coping mechanisms need to be developed. To prevent burnout and to enable critical care nurses to function holistically, emotional intelligence (EI) is essential in the development of such coping mechanisms.

Objective: The aim of this study was to describe the EI …

Reinforcing Teach-Back Method Regarding Pain Management For Non-Verbal Patients And Their Families, Renee Krystle Doll Lazaro

Master's Projects and Capstones

Pain has been known to have physiologic, psychologic and emotional consequences. Education in pain management has been part for standard care for nurses. The purpose of this study was to reinforce teach-back techniques with nurses when delivering pain management education with non-verbal patients in order to improve patient outcomes in the adult ICU. By using the teach-back method, the nurse will be able to hone a more collaborative approach in dealing with pain, encourage autonomy and include the patient/family in making informed decisions regarding treatment for pain. Reinforcement regarding teach-back was focused on teaching points, and rewording teach-back cues to …

Patient Satisfaction Related To Noise In The Coronary Care Unit, Anjanette S. Dominguez

Master's Projects and Capstones

Background The CCU staff recognized a department trend for low patient-satisfaction score related to environmental noise levels. Based on the Press Ganey score, the patient-satisfaction score plummeted in relation to noise level beginning in March 2014.

Purpose To improve patient satisfaction regarding noise level in the CCU to 100% by November 21, 2014.

Methods Senior & Fleming’s Hard System Model of Change guided this literature search of CINAHL and Fusion for articles published from 2009 to 2014. Specific terms used were noise, critical care, and sleep promotion. From September to November 2014, earplugs were offered to all alert/oriented patients entering …

Family Presence During Resuscitation Of Adults: The Impact Of An Online Learning Module On Critical Care Nurses' Perception And Self-Confidence, Kelly Powers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family presence during resuscitation (FPDR) involves offering family members the option to remain with their loved one who is undergoing life-saving measures. FPDR has been shown to enhance comfort and facilitate grieving, and 90% to 100% of patients and family members support it as an option. However, critical care nurses are not fully supportive of FPDR and approximately only one-third implement it in their care of patients. The perceived risks of FPDR are cited as a primary reason for lack of support and implementation. Yet, the perceived risks have not been proven, while the benefits have been established in research. …

Nursing Retention In Critical Care, Jeannine A. Eckman

Nursing Theses and Capstone Projects

The purpose of the study was to examine anticipated turnover in critical care nurses and if having previous nursing experience prior to working in critical care affects that turnover. Using the Anticipated Turnover Scale (ATS) by Hinson and Atwood, nurses that had been employed in the critical care areas five years or less were asked to participate. They were asked to complete the ATS and answer the question relating to previous nursing experience. Findings of the study indicated that the nurses with previous nursing experience before working in critical care had a higher ATS score than the nurses with no …

Job Satisfaction Among A Multigenerational, Critical Care, Nursing Workforce, Sara Clay

Nursing Theses and Capstone Projects

Despite the slight ease of the nursing shortage due to the current recession, the United States is expected to still have a shortage of approximately 260,000 registered nurses by the year 2025 (American Association of Colleges of Nursing, 2011). Healthcare is an ever changing profession where nurses, no matter their generation, must learn to adapt to their constantly changing environment and expectations. Job satisfaction is a strong and constant predictor of retention and can vary greatly across generations. The purpose of this study was to get insight into generational differences related to job satisfaction and to use these data to …

The Experienced Critical Care Rn's Perception Of New Graduate Rns Competence In Critical Care Using Benner's Novice To Expert, Denise H. Reid

Nursing Theses and Capstone Projects

The purpose of the study was to describe the experienced critical care RNs' perception of the new graduate RNs' competence in critical care areas. Using the Six-Dimension Scale of Nursing Performance (Six-D Scale) by Patricia Schwirian, experienced nurses from critical care areas with at least three years of experience were asked to rate new graduate RNs in their critical care area on specific nursing activities. Benner's theory of Novice to Expert is used as the theoretical framework. Findings revealed that experienced critical care RNs perception of new graduate RNs is greater than expected. All activities on the Six-D Scale were …

Does Culture Influence The Needs Of Critical Care Families?, Naomi Alston

Master's Projects

Purpose: This study explores ICU patient's family member needs, particularly Vietnamese and Latino families. Design: Convenience sampling at 24 bed ICU in acute care community hospital serving ethnically diverse population. Methods: Non-experimental survey with pretest-posttest design using Demographic sheet, Critical Family Needs Inventory (CCFNI), and Needs Met Inventory (NMI). Information pamphlets were distributed. Data analysis was by ethnic groups using measures of central tendency and descriptive statistics. Findings: CCFNI results indicate family members of all ethnicities experience the same priority of needs; support and information are top two needs. English, Spanish and Vietnamese pamphlets met information needs of the majority …

Analysis Of End-Of-Life Content In Critical Care Nursing Textbooks, Karin T. Kirchhoff, Renea L. Beckstrand, Prashanth Reddy Anumandla

Faculty Publications

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted. Critical care nursing textbooks used for review were published in 1995 or later and identified from the libraries at the University of Wisconsin-Madison and Brigham Young University. The end-of-life content areas identified by the American Association of Colleges of Nursing (AACN), under which the AACN end-of-life competencies for undergraduate nursing students can …

Update - March 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Celebrating our contributors: Convocation, 2001
-- Paternalism and Autonomy in Dentistry
-- Care Ethics in Pediatric Critical Care Nursing