Critical Care Nursing Commons^™

Implementing An Acute Stress Disorder Screening Tool In The Trauma Intensive Care Unit Setting, Sierra Bridgers

Epsilon Sigma at-Large Research Conference

This is a quality improvement project that focuses on implementing screening for acute stress disorder using the Acute Stress Disorder Structured Interview–DSM-IV tool in a Trauma Intensive Care Unit (ICU) at a Level 2 Trauma Center in Nashville, TN. Currently, at this hospital there is not a screening process implemented for these patients. Every trauma patient meets the criteria for acute stress disorder. Starting the process early aims for patients to be properly educated about their trauma and gets them the resources they need to heal mentally from the trauma.

During the 6-week implementation period of this project, the trauma …

Post-Traumatic Stress Disorder Among Healthcare Professionals Working In Emergency Transport And Critical Care Settings, Keenan Mai

Nursing | Student Research Posters

No abstract provided.

Evidence-Based Practice Guidelines For The Optimal Assessment Of The Airway In Predicting Difficult Intubation, Meredith Louden

Doctor of Nursing Practice Scholarly Projects

Adverse respiratory events are the most common injuries in anesthesia; difficult intubation and ventilation contribute to most cases. Injuries following inadequate airway management include cerebral hypoxia, aspiration, and cardiac arrest. Despite the risk and consequences following inadequate airway management, most medical facilities lack standardized airway assessments for anesthesia providers. Current evidence implicates that ultrasound measurement of the hyomental distance demonstrates the highest specificity and accuracy in predicting difficult intubation. The traditional approach to conducting airway assessments includes Mallampati classification, which shows high specificity for predicting difficult airways only when combined with other airway assessments. The purpose of this evidence-based project …

Dnp Final Report: An Evidence-Based Initiative To Reduce Risk Of Ventilator-Associated Events, Bailey Dee Burge

DNP Final Reports

Ventilator-associated events have been considered an outcome metric for quality patient care. Ventilator-associated events are associated with unnecessary medical expenses. These events are multifactorial, yet bedside nurses can help decrease this nosocomial infection through proper oral care. A PICOT question was constructed to search the evidence systematically. The systematic literature search evidence was appraised to provide recommendations for the bundle of care process regarding ventilator-associated event prevention, specifically oral care. The body of evidence was comprised of five articles reporting statically significant outcomes. The evidence-based oral care protocol was implemented for a quarter of a year in patients with mechanical …

Teach-Back Education In Heart Failure Patients Benchmark Study, Bethany N. Johnson

MSN Capstone Projects

Heart failure exasperation is one of the most common causes of hospital readmission in the United States (Breathett et al., 2018). It is estimated that greater than half of all heart failure patients will be readmitted to the hospital within six months of discharge (Caluya, 2021). Additionally, one in four individuals with heart failure are readmitted within thirty days of discharge (Rahmani et al., 2020). This data shows a large area of improvement for hospitals in order to improve patient outcomes. Due to the lack of standardized discharge teaching, heart failure patients are often admitted to the hospital for the …

Targeted Temperature Management Following Cardiac Arrest, Kylie Carimi

MSN Capstone Projects

Cardiac arrest is often associated with the death of brain tissue resulting from the lack of oxygen supply caused by the interruption of blood circulation. For this reason, good neurological outcome following cardiac arrest is difficult to achieve. Targeted temperature management, formerly known as therapeutic hypothermia, is the maintenance of specific body temperature parameters after the return of spontaneous circulation (ROSC) following cardiac arrest (Donnino et al., 2015). The goal of therapy is to improve neurological status and facilitate healing by reducing the metabolic requirement of the brain. (Saigal et al., 2015). Therefore, the question arose, in adult patients who …

Mitigating Fatigue In The Triage Process: A Creative Solution To Shorter Shifts, Rebecca J. Arismendi

MSN Capstone Projects

Triage is a critical assessment process performed by a registered nurse by which Emergency Rooms (ERs) sort patients who present for a medical evaluation. With ER visits increasing, pressure on staff to move patients through the department is often palpable. Whether a patient decides to walk in, or come in by ambulance, the first person to assess the patient is the triage nurse. They determine the appropriate level of care needed for the presenting complaint.

After a review of literature, it was found that fatigue is correlated with shift length in triage with the highest level of fatigue being at …

Formal Unit-Based Shared Governance To Improve Nurse Engagement, Tracey A Larsen

Student Scholarly Projects

Practice Problem: Nurse engagement is a key driver of nurse satisfaction and nursing retention. Shared governance is an evidence-based practice proven to increase nurse engagement through shared decision-making and results in higher work satisfaction.

PICOT: The PICOT question that guided this project was (P) in an ambulatory nursing clinic (I) what is the effect of a shared governance unit-based committee (C) compared to current practice (O) on nurse engagement (T) over 10 weeks?

Evidence: An exhaustive literature search resulted in 61 peer-reviewed articles. Eleven studies were included after filtering for duplicates and keywords and evaluating for strength and quality …

A Structured Life Review Intervention To Improve Life Satisfaction In Home Health Service Patients: A Feasibility Study, Leah Graf

University Scholar Projects

Two million older adults in the U.S. suffer with depression. Adults who live with the difficulties of depression concurrently experience dissatisfaction with life. Life review is a systematic recollection of past events. Dr. Robert Butler postulated that, as the elderly and those with terminal illness approach the end of their lives, there is a resurgence of life experiences in the conscience (1963). A successful life review conducted by an active listener assists the individual to process unresolved conflicts and attain ego-integrity in the final stage of life. Home health services have become an increasingly accepted option for managing chronic illnesses …

The Benefits Of Family Presence During Resuscitation, Abigail Harris, Payton Hale, Audrey Jeziorski

Scholars Week

The research provided analyzes the benefits and fears concerning Family Presence During Resuscitation (FPDR) as a standard practice in healthcare facilities. Evidence is available that FPDR supports increased familial satisfaction and psychological outcomes as well as benefits to the patient and healthcare team involved in resuscitation efforts, however this practice is not consistently implemented in healthcare facilities. Three main studies were analyzed throughout this research in order to determine the causation of inconsistent and absent policies regarding FPDR. The analysis of these studies determined that there is a lack of guidelines, education, and policies resulting in absence of family members …

Clabsi Prevention Methods, Noah Heine, Talon Cockrel

Scholars Week

Infection and the risk thereof is one of the major concerns regarding patient outcomes in the health care facility. One of the interventions with the highest causes of infection is the use of central lines. These lines provide necessary venous access for medication administration but can cause infections called CLABSI or Central Line Acquired Bacterial Infection. The purpose of our article was to research CLABSI prevention methods and provide a new policy using these safe effective methods. These new methods include the use of stat locks for central line securement, using antimicrobial lines, and flushing/locking the central line with a …

The Lived Experiences Of Icu, Med-Surg, And Er Nurses In The United States Attempting To Breastfeed During The Covid-19 Pandemic, Amy Seay

Dissertations

Breastfeeding is important to promote the health of both mothers and babies (Centers for Disease Control and Prevention [CDC], 2021). Many mothers experience workplace barriers and stress which negatively impact breastfeeding duration (McCardel & Padilla, 2020; Nagel et al., 2022). However, a gap in the literature exists surrounding specific barriers and the impact of stress on U.S. nurses who breastfeed. Specifically, workplace challenges and stress among nurses resulting from the COVID-19 pandemic lack exploration.

This interpretive phenomenological study explored the lived experiences of ICU, Med-Surg, and ER nurses who attempted to breastfeed during the COVID-19 pandemic. Roy’s adaptation model was …

Sch Icu Expanding Pics Throughout Centracare, Jessica A. Tindal

Nursing Posters

Purpose:

Sharing information about Post Intensive Care Syndrome (PICS) to all in CentraCare. PICS symptoms do not appear until weeks to months after a critical care illness so patients at home may not know what to do with their symptoms.

Future Plans:

• May 2023 - introducing CICU to the PICS process during their Nurse Practice meeting.
• May 2023 - updating the Hospital Medicine Section CNS
• Fall 2023 - meeting with the Ambulatory Work Cabinet group to see if our system of notification is working
• What opportunities do we have with teaching Progressive RNs about PICS and our Diaries?
• How can …

Preoperative Skin Preparation Protocol For Patients Undergoing Abdominal And Spinal Surgery, Lia Moyer

The Eleanor Mann School of Nursing DNP Capstone Projects

Surgical site infections are an avoidable complication in surgical patients and one of the most common hospital-acquired infections. Adverse effects of surgical site infections include increased hospital length of stay, increased costs to patient and healthcare system, disability, morbidity, and mortality. The purpose of this quality improvement project was to design a protocol with the objective of decreasing surgical site infections in abdominal and spinal surgery patients. The protocol developed used targeted depilation and antisepsis with a chlorhexidine wipe to mitigate infection risk. Results of the project showed a static hospital length of stay, no increase in preoperative time, and …

Dnp Final Report: Preventing Critical Care Nurse Burnout: An Evidence Based Approach To Raising Awareness, Trendalyn S. King

DNP Final Reports

Burnout has affected nurses nationally and globally for decades. Burnout in nurses is characterized by emotional exhaustion, depersonalization, and lack of feelings of personal accomplishment. Consequences of burnout include physical and emotional suffering in nurses, poorer patient outcomes, and lost revenue and increased cost in healthcare organizations. Burnout is prevalent in many healthcare settings, but 81% of critical care nurses have reported severe symptoms of burnout, Because of the high risk of burnout in critical care nurses, raising awareness about burnout and its prevention in those nurses was imperative. The following PICOT question guided the search for evidence to support …

Implementation Of An Artificial Airway Communication Tool, Grace Thacker, Macy Damron

Scholars Week

This evidence based practice research project evaluated the use of communication tools for patients with artificial airways in the hospital setting. It was determined through clinical experiences and article research that no standard communication tool has been recommended for this patient population. Moreover, research has suggested that patient satisfaction has improved with the use of new communication methods. Given the lack of a solution to this issue, we have suggested the implementation of a new hospital policy concerning the use of a communication tool. This communication tool is an eight and a half by eleven laminated piece of paper that …

Why Bladder Training Prior To Foley Catheter Removal Is Not Best Practice, Emily Winstead, Sydny Tucker

Scholars Week

Several studies have been completed on bladder training prior to foley catheter removal via intermittent clamping. While this practice initially appears to be beneficial to patient care, the studies we have researched all found the practice to be insignificant or not indicated for patient care. As we researched, we were able to compile evidence from multiple sources that support bladder training prior to catheter removal is not best practice. After compiling those results, we were able to gather a better understanding of the reasons this practice is not indicated and what risks it will pose to patients. In conclusion, we …

Relationship Between Treatment Comorbidities And Hiv Viral Suppression Among People Who Live With Aids In Johannesburg., Nwogo Immaculata Ekeji, Tolulope A. Osoba, Hebatullah Tawfik, Mehdi Agha

Journal of Social, Behavioral, and Health Sciences

HIV has globally infected over 37.9 million people, of which 28.2 million (73%) are on antiretroviral treatment, and 66% of those on treatment are virally suppressed. In South Africa, however, low rate of viral suppression (47%) among people living with HIV is a major health problem that has continued to fuel HIV prevalence. A cross-sectional quantitative research design was used to investigate the relationship between treatment comorbidities and viral suppression among HIV-infected adults aged 18–49 who were diabetic, had cancer, or tuberculosis in Johannesburg. HIV Care Continuum formed the theoretical framework for this research. An existing HIV-infected patient de-identifiable dataset …

Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah

DNP Projects

Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).

Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …

Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry

Providence Nursing Research Conference 2023 – Present

Development of a RN Clinical Coach program to improve retention of ICU residents and fellows

Background:
The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.

Purpose:
The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.

Methods:
In September 2021 the ICU manager at Providence Saint …

Performance Of A Sars-Cov-2 Rt-Pcr Assay With Non-Traditional Specimen Types, Subathra Marimuthu, Holly Aliesky, Heather Ness, Daniya Sheikh, Sathya Rashmit, Dawn Balcom, Leslie A. Wolf

The University of Louisville Journal of Respiratory Infections

During the first two years of the coronavirus disease 2019 (COVID-19) pandemic, nasopharyngeal (NP) specimens were the gold standard for clinical diagnostic testing. As information about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic continued to be shared, it was clear that the virus could be detected in other specimen types during an active infection. The University of Louisville Infectious Diseases Laboratory accepted non-traditional specimen types, most without a paired, positive NP result, for research purposes only to support local epidemiology efforts. A real-time reverse transcription-polymerase chain reaction (RT-PCR) assay originally validated for NP specimens was used …

What? Now A Respiratory Syncytial Virus Epidemic, Aya Allam, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Coronary Care Unit Nurses’ Experiences Of Care Management Self-Efficacy: A Qualitative Content Analysis, Fatemeh Mansouri, Parand Pourghane, Maryam Rajab Pour Nikfam, James C. Oleson

The Qualitative Report

Recognizing various aspects of the self-efficacy concept in specialized medical units such as intensive care units (ICUs) and coronary care units (CCUs) has the potential to help nurses improve their quality of care. Therefore, we conducted a qualitative content analysis study in 2018 in hospitals of the Guilan Province, northern Iran, to help explain nurses’ perceptions of self-efficacy in care management within CCU wards. Thirty-four semi-structured interviews were conducted with nurses from CCUs. Using Graneheim and Lundman’s (2004) analytical techniques, we extracted three main themes and nine sub-themes from the data: decline in self-efficacy (e.g., time constraint, high work pressure, …

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 …