Critical Care Nursing Commons^™

Reduction Of Order-To-Scan Times To Increase Patient Throughput And Improve Patient Outcomes: A Quality Improvement Project, Jason Harrington

Master's Theses and Capstones

Background: Throughput is a key metric for both the emergency department and the hospital system. Diagnostic tests, such as CT scans, can lead to a large delay in patient throughput which can negatively impact patient satisfaction and patient outcomes. Finding ways to reduce delays in CT scan acquisition can positively impact patient satisfaction and patient outcomes.

Aim: The specific aim of this quality improvement project was to decrease the amount of time it takes to complete abdominal CT scans with IV contrast once ordered from 61 minutes to below 35 minutes by July 1^st, 2022

Methods: Plan was …

Enhancing Peripheral Intravenous Line Maintenance Practices Among Nurses In A Critical Care Setting: A Quality Improvement Project, Jaylene Velasquez

Honors Theses and Capstones

Abstract

Background: One of the major risks of infection lies in a patient’s intravenous (IV) access. On a cardiac intensive unit, a Levell II trauma center, preventing adverse events (i.e. infections, sepsis, etc.) is essential within this unit due to the nature of these health conditions. To ensure patient safety, nurses must abide by evidence-based practices and facility guidelines regarding intravenous line management. This quality improvement (QI) project implemented interventions to enhance nursing practices for peripheral intravenous therapy.

Methods: This project included statistical analysis and audits to measure the impact of the interventions. The variables being observed in this project …

Development And Psychometric Testing Of An Instrument To Identify Factors That Predict Intentions Related To Post-Mortem Organ Donation Among Saudi Arabian Nurses, Salman Alreshidi

Theses and Dissertations--Nursing

Organ donation shortage is a major international concern. Global data on organ donation and transplantation activities from the World Health Organization indicate that in 2019 organs were available for less than 10% of transplantations needed. In Saudi Arabia alone, the organ donation shortage accounts for 28.8% of deaths annually. Nearly 31% of donated organs are from donors outside of the country because many eligible donors in Saudi Arabia do not donate.

While post-mortem organ donation has the potential to increase available organs for transplantation, in many countries, including Saudi Arabia, hesitancy among candidate donors and their family members can present …

Impact Of Mindfulness Practice On Compassion Fatigue In Pediatric Cardiovascular Critical Care Nurses: A Quality Improvement Project, Kendy Luu

Doctoral Projects

Background: A considerable proportion of the extant literature on healthcare has documented compassion fatigue (CF) as a major factor that contributes to poor job performance, satisfaction, and negative patient outcomes (Figley, 2002). CF is well known to negatively impact patient care and outcome, relationships, and job satisfaction among pediatric cardiovascular intensive care (CVICU) nurses. Developing interventions to reduce burnout and CF bear the potential to reduce costs and improve quality care; one particularly promising approach in this regard is the practice of mindfulness-based stress reduction (MBSR). Purpose: This quality improvement project aimed to determine the impact of an abbreviated MBSR …

Reducing Patient Handoff Inadequacies Using An Electronic Medical Record Based Standardized Handoff Tool In The Critical Care Unit, Mariah E. Needham

Master's Theses and Capstones

INTRODUCTION: Inadequate handoff communication is a contributing factor in sentinel events and adverse patient outcomes. Research has shown that the use of a standardized handoff tool can improve quality of handoff communication. This quality improvement (QI) project sought to standardize handoff and reduce the risk of adverse patient outcomes by utilizing the I-PASS handoff tool available in the electronic medical record (EMR).

AIM: The aim of this quality improvement project was to improve the accuracy of nurse-to-nurse patient handoffs.

METHODS: The outcomes measured by the post-intervention survey were the number of reported handoffs received with omissions, the percentage of staff …

Improving Disinfectant Cap Use On Central Lines In The Icu To Reduce Patient Risk For Clabsi: A Quality Improvement Project, Tali Cherim

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention …

Caring For Ourselves Before We Care For Others: A Mindfulness-Based Intervention For Acute Care Nursing Staff, Kent Brouwer

DNP Projects

Background: Acute care nursing staff have recently faced increasing rates of anxiety, stress, emotional exhaustion, and burnout. Nursing burnout is directly linked to patient outcomes, nurse retention, and the resilience of our nurses. Therefore, it is in the best interest of hospital organizations to focus efforts on the well-being of the nursing workforce. A recent innovative technology to prevent burnout teaches mindfulness through the utilization of smartphone applications. There is limited evidence regarding the implementation and impact of brief mindfulness interventions on intra-professional acute care providers.

Methods: A pretest-posttest design with a midpoint evaluation was utilized in this pilot study. …

Increasing Staff Compliance With Routine Hcv Screening And Improving Linkage To Care Among Patients Testing Hepatitis C Positive In The Emergency Department, Carson G. Swartz

DNP Projects

Background: Hepatitis C virus (HCV) is a blood-borne pathogen that can cause severe liver disease, cancer, and death and is a significant source of morbidity and mortality in the United States. Several academic medical centers including University of Kentucky Healthcare have implemented routine HCV screening for patients presenting to the emergency department (ED) and have discovered a large viral burden amongst patients who are often symptomatic.

Purpose: The purpose of this doctoral project is to increase staff compliance, confidence, and education regarding the HCV screening process in an urban, Level I emergency department, as well as to evaluate whether an …

Exploring Palliative Care Education Needs And Desires Of Advanced Practice Providers In The Critical Care Setting, Jill Marie Clemmons

DNP Projects

Background: Critical care providers in the ICU setting are discovering that their patients are living longer with more comorbid conditions. They are confronted with palliative care situations almost daily. Recently palliative care has been thrust into the forefront of critical care and is a resource critical care nurse practitioners and physicians’ assistants need to be able to utilize. A gap in the literature has been found in the overall education of critical care providers regarding palliative care.

Purpose: The purpose of this study was to determine what palliative care training trauma/cardiac/neurological, and pulmonary critical care providers had previously received …

Implementation Of Education And Use Of A Screening Tool To Assess Palliative Care Needs In The Critical Care Setting, Megan Stoeckinger

DNP Projects

Purpose: The purpose of this study was to measure palliative care knowledge, attitudes, perceived empowerment, and familiarity of the Supportive Palliative Care Indicators Tool (SPICT) among critical care nurses and advanced practice providers (APPs) before and after viewing a web-based educational video on an adult medicine intensive care unit (MICU).

Methods: This study was a one group pre- and post- implementation assessment using a web-based educational video and electronic surveys. The population included critical care nurses and advanced practice providers (APPs). This study spanned the timeframe between January 2022 and March 2022.

Results: Paired t-tests comparing pre-intervention …

The Impact Of Icu Telemedicine On Patient Outcomes In The Surgical Critical Care Setting: An Observational Study, Megan Steely

DNP Projects

Abstract

Background: In April 2020, the University of Kentucky (UK) implemented a division entitled the Enhanced Care through Advanced Technology Intensive Care Unit (eCAT ICU) to provide tele-critical care (TCC) services in all critical care areas at UK Healthcare. The eCAT ICU at UK HealthCare was the first TCC delivery system of its kind in the state of Kentucky. Use of TCC has been associated with improved patient outcomes and decreased costs.

Purpose: The purpose of this study was to analyze targeted outcomes in the surgical critical care population pre- and post-implementation of TCC at UK HealthCare. Specifically, the aims …

Effects Of An Educational Module On Perceived Knowledge, Perceived Barriers, And Attitudes Related To Sleep-Promoting Practices Among Bedside Nursing Staff Within A Medical Intensive Care Unit, Arden Gross

DNP Projects

Background: Adult patients in the critical care setting are at risk for experiencing sleep disruption due to critical illness and environmental factors. The effects of disruption to the sleep/wake cycle has been associated with dysregulation of biological processes such as healing and immune system functioning. Current literature includes the use of sleep-promoting protocols that aim to reduce environmental disruptors of sleep in the critical care setting. However, there is a disconnect between the perceived importance of sleep and clinical practice. Additionally, there is a gap in literature exploring the effects of educational-modalities on nursing staff knowledge, perceptions, and attitudes related …

A Multifaceted Approach To Improving Sedation Practices In The Cardiovascular Intensive Care Unit, Casey Mingua

DNP Projects

Purpose: Sedation protocols have been positively correlated with improved patient outcomes in the intensive care unit (ICU). Therefore, healthcare leaders should direct efforts to improving protocol compliance through evidence-based strategies. The purpose of this study was to evaluate the impact of a multifaceted intervention, consisting of educational outreach, point of care (POC) reminders, and audit and feedback (A&F), on nurse compliance with an ICU sedation protocol. A secondary data analysis was performed to evaluate the impact of the intervention on patient outcomes.

Methods: This was a before/after comparative analysis. A Research Electronic Data Capture (REDCap) pre-survey (n=58) was distributed to …

The Measurement Of The Impact Of Well-Being Resources On Moral Distress And Burnout Following The Covid-19 Pandemic In Front-Line Nurse Leaders, Benjamin Hughes

DNP Projects

Background: Due to the COVID-19 pandemic, there is significant burnout among front-line nursing staff. Little literature has been published about the measurement of burnout among front-line nursing leaders, such as nurse managers and directors, nor the interventions used to help with this ever-growing issue among this group. Since the pandemic began, there have been many resources identified to help front-line staff members with burnout, but none specifically looking at what has worked or been utilized by front-line nursing leaders.

Purpose: The purpose of this project was to describe what well-being resources were identified as being effective in decreasing moral distress …

Countering Moral Distress In Ecmo Nurses With Case-Review Debriefings, Sherry D. Griggs

DNP Projects

Abstract

Background: Moral Distress occurs when nurses know the ethically correct action to take, but they are restrained from taking it. It is especially prevalent in nurses caring for critically ill patients, such as those on extra-corporeal membrane oxygenation (ECMO). Effectively addressing moral distress is crucial to the growth and health of the nursing profession, which is the cornerstone of quality and safety in healthcare.

Purpose: The purpose of this project was to evaluate the effectiveness of case-review debriefings on moral distress of ECMO nurses.

Conceptual Framework: Analysis of Moral Distress Process was utilized. This framework addresses moral distress …

Increasing Adherence To Protocolized Diuresis For De-Resuscitation Of Icu Patients By Increasing Nursing Knowledge And Confidence, Jenna Haupert

DNP Projects

Background: Fluid overload in patients requiring intensive care leads to increased costs for hospitals and patients, increased length of intensive care unit (ICU) and total hospital stay, ventilator days, acute kidney injuries, and mortality rates. Multiple studies have indicated that aggressive de-resuscitation with diuretics can decrease length of stay, ventilator days, organ injury, and mortality rates. A nurse-driven diuresis protocol utilizing intravenous (IV) push furosemide was introduced to the University of Kentucky Medicine ICU, but patients are still commonly still over-resuscitated with no plan to diurese until organ damage has occurred. By educating bedside nurses, improving their knowledge and confidence …

Implementation Of An Advanced Training Program To Increase Nurses’ Knowledge Of Continuous Renal Replacement Therapy Management, Shane M. Brost

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Continuous renal replacement therapy (CRRT) is a complex, life-preserving treatment for unstable patients who require hemodialysis in the intensive care unit (ICU). Nurses responsible for managing the CRRT machine in this large academic medical center’s cardiovascular ICU (CVICU) complete a one-hour basic training course focused on setting up the machine, responding to basic alarms, and changing out the CRRT circuit when necessary. Staff nurses, advanced practice providers (APPs), and nursing administrators agree that training is insufficient. Research evidence supports rigorous staff training as essential to improving the quality of CRRT delivery. Purpose: This Doctor of Nursing Practice (DNP) project …

Implementation Of Stress Management And Resiliency Training To Address Nursing Burnout In A Neuroscience Critical Care Unit, Jessica May Marie Hughes

Graduate Theses, Dissertations, and Problem Reports (ETD)

In the United States, over one-third of nurses experience symptoms of burnout (Reith, 2018). If left unchecked, poor stress management and resiliency skills can contribute to nursing burnout, leading to costly employee turnover. Stress management and resiliency training (SMART) provides the tools necessary to develop resiliency, improve stress management and decrease burnout (Resilient Option, 2020). Nursing staff under the age of 36, who work in a Neurosciences Critical Care Unit (NCCU) demonstrate lower resiliency scores and a higher risk of burnout. This project aimed to evaluate: (a) the effects of a SMART program on the wellbeing of nursing staff in …

A Call To Create: Poetry As Healing And One Nurse’S Self-Discovery, Kim Cornett Henry, Kim Cornett Henry

English Theses

Florence Nightingale’s vision for nursing has changed greatly in the past one hundred and fifty years, with nursing’s identity replaced with an emphasis on science over caring. The fast-paced, technologically sophisticated environments, designed to meet the declining health of an American public, have resulted in nurses who are being pulled away from nurse-to-patient caring acts and the reasons they felt called to become nurses. These changes have had detrimental psychological and emotional effects on nurses and are especially evident in Intensive Care nurses. Expressive writing as poetry, autoethnography, and participation in vibrant writing communities offer nurses experiences for healing, voice, …

Motivated2move: Icu Liberation And Early Progressive Mobility In Ventilated Patients, Leslie S. Bigler

Master's Projects and Capstones

The Motivated2Move: ICU Liberation and Early Progressive Mobility in Ventilated Patients project was implemented in a 24-bed intensive care unit (ICU) in a 241-bed general care, stroke certified not-for-profit community hospital in northern California. The primary purpose of this project was to educate the nurses on the structure and implementation of the Society of Critical Care Medicine’s evidence-based ICU Liberation (ABCDEF) Bundle (Society of Critical Care Medicine, n.d.). A secondary purpose of this project was to coordinate an early progressive exercise and mobility protocol for all ventilated patients. The primary goal of the project is 100% compliance with the ICU …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Preventing Pressure Injuries On Patients Undergoing Treatment With Extracorporeal Membrane Oxygenation (Ecmo), Hediyeh Shakeri

Master's Projects and Capstones

One of the top National Patient Safety Goals by The Joint Commission is to prevent hospital-acquired pressure injuries, which is reiterated by Centers of Medicare and Medicaid as a valuable metric in determining the quality of patient care and safety as well as hospital performance. The Agency for Healthcare Research and Quality reports over 2.5 million patients affected by hospital-acquired pressure injuries per year, costing between $9.1-$11.6 billion per year with the cost of individual patient care ranging from $20,900 to 151,700 per pressure injury (Agency for Healthcare Research and Quality, 2014). Approximately 30% of these cases are related to …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Nursing Management To Reduce Hospital Readmissions After Percutaneous Coronary Interventions- Integrative Review, Jeena S. Daniel, Doreen Wagner

Master of Science in Nursing Final Projects

Abstract

Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses' …

Consultation/Liaison Psychiatry During Covid-19, Robert Frierson, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

Consultation/liaison psychiatrists care for people with co-existing medical and psychologic difficulties. The coronavirus pandemic is stressful for patients and their psychiatric caregivers. Patients have lost support systems and harbor fears about exposing family to the virus. COVID-19 sometimes exacerbates previous psychiatric conditions, while diminishing intimacy with physicians. Everyone is oversaturated with COVID-19-related news focusing on rising concerns about the illness and about jobs, school, and housing insecurities.

The psychiatrist maintains a hospital presence despite fear of contracting the disease. Challenges include addressing staff morale, evidencing empathy despite telecommunication devices, and treating anxiety, depression, sleep phobias, post intubation flashbacks, COVID-19-induced cognitive …

Practice Development Trajectories Of Experienced Nurses: Adaptive Experts, Routine Experts, And Non-Experts, Dee Mulcahy

Nursing ETDs

This qualitative study examined practice development among experienced, acute care nurses (n = 9) with at least 10 years of experience. Using an interpretive biographical approach, with participants’ written practice narratives and in-depth interviews, the study focused on how the work environment and life experiences influenced or impeded practice development. Participants were classified as routine- or adaptive experts (n = 3 of each type) with one intermediate case and two not readily classifiable. Antecedents to becoming a nurse included family influences, personal interests, altruistic values, and financial need. Experience was necessary but not sufficient for adaptive expertise. Compared …

Implementation Of Teach-Back For Discharge Teaching In A Critical Access Hospital: A Quality Improvement Project, Katie Beth Notch

Theses and Dissertations

A lack of comprehension of discharge instructions may cause high readmission and emergency room revisit rates for organizations. At the project site, there was no current evidence-based practice to ensure patient comprehension of discharge instructions. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the Institute for Healthcare Improvement (IHI) Always Use Teach-Back Toolkit would impact emergency room revisit rates among adult medical-surgical patients in a critical access hospital in rural Minnesota over four weeks. Afaf Meleis’ transitions theory and the Iowa model for evidence-based practice were the scientific underpinnings of the project. …

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Minimizing Musculoskeletal Injury Risk In Health Care Professionals With Education On Safe Patient Handling, Aubrey Graves

Honors College Theses

Introduction: Nursing is a high-risk occupation for musculoskeletal injuries due to the strenuous activity of patient handling. These tasks include, assisting a patient in bed, moving a patient from the bed to a wheelchair, and assisting with walking. These work-related tasks can create a large amount of stress on the body, especially the back if proper technique is not utilized and/or if excessive loads are applied. The purpose of this study is to examine if teaching proper body mechanics and the dangers of not performing the tasks properly is an effective way of reducing musculoskeletal injuries.

Methods: The NUR 202 …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …