Nursing Annual Report: 2022, Centracare Health

Nursing Annual Report

Message from the CNO

Message from Central Operations, SVP - St. Cloud Hospital President

St. Cloud Hospital Statistics

Magnet Program Director Message, Nursing Strategic Plan FY 2022

Patient Experience

Nursing Care Delivery

Exemplary Professional Practice

Shared Governance

Working Relationships

Professional Development

Nursing Makes a Difference

It's Time To Break Old Habits: Admitting Stemis To The Telemetry Unit, Teresa Jahn, Tanya Glenz

Nursing Posters

Beginning December 2020 uncomplicated ST-Elevated MI patients will be admitted directly to Telemetry following intervention instead of CICU.

June 2020: Review and develop evidence- based exclusion criteria for admission to Telemetry

June 2020: Create a process for communication between the nursing supervisor, cath lab, Telemetry Unit and CICU for patient placement

Fall 2020: Meeting with Telemetry and CICU charge nurse, nursing supervisor and cath lab RN to discuss communication process

Dec 2020: Begin tracking STEMI patients

• Unit admitted to (Telemetry or CICU/ICU)
• Requiring transfer to CICU/ICU from Telemetry

A Multidisciplinary Approach To Reduce Complications From Blind Small Bore Feeding Tube (Sbft) Insertion, Teresa Jahn, Jennifer Burris, Peggy Lange, Elizabeth Plante, Mithun Suresh Md

Nursing Posters

Between 2019 and 2021, six lung perforations related to blind placement of SBFTs.

A multidisciplinary team reviewed current methods of placing SBFTs and the feasibility of each:

• Fluoroscopy
• 2 Step X-Ray
• Capnography
• Electromagnetic visualization

Capnography was selected as a safe and cost-effective way to attempt to identify insertion location in real time.

• Four team members were selected and trained to insert SBFT using capnography
• Each placement attempt and outcome of placement was tracked
• Outcomes were identified as successful or unsuccessful
• Any adverse events were to be tracked

Open All Hours!: Bariatric Surgery Patients Love Csc, Naomi Schneider, Mallory Mondloch

Nursing Posters

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.

Early Detection Of Sepsis, Holly Kockler, Evalyn Michira

Nursing Posters

The aim for this project was to improve early identification and intervention for sepsis to lower mortality rates and increase sepsis order set usage.

Key Drivers:

• Sepsis mortality rate is higher than compare groups
• Sepsis Order Set utilization is low
• Sepsis core measure performance is below benchmark

Centracare Launch Of Covid Antiviral Therapy, Jessica Miller, Todd Lemke Pharmd, Dennis Heinen Rph

Nursing Posters

• Efficiently monitor the limited available stock of oral antiviral COVID therapies during surge states
• Prescribe safely and appropriately
• Dispense to patients close to home.

Icu Liberation: Early Mobility And Exercise, Leann Volkers, Holly Kockler, Kristi Patterson

Nursing Posters

The aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.

Key drivers identified:

• Site specific variation
• Underutilization of Epic functionality
• Use of data to understand performance

Promoting Patient Outcomes: Clabsi Prevention, Woon Paek

Nursing Posters

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:

• Perform hand hygiene
• Don proper PPE
• Sterile/aseptic technique during insertion
• Prioritize for cares related to central line first
• Daily assessment for need of central line
• Daily chlorhexidine gluconate bathing
• Remove catheters that are unnecessary
• "Scrub the hub" BEFORE EVERY access
• Change dressings every 7 days or as needed
• Assessment of site/dressing condition
• Change purple Ultrasite caps with dressings
• Tubing changes per CentraCare policy
• Discard …

Innovative Use Of Ehr To Support Admission Screening For Emerging Pathogens, Patricia Dumonceaux Msn, Rn, Cic, Phn, Carolyn Harlander-Zimny, Elizabeth Kiffmeyer, Ellen Simonson, Tamara Welle

Nursing Posters

• CentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen.
• 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs).
• C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.

Improving The Management Of Tardive Dyskinesia On An Inpatient Mental Health Unit, Jennifer Krebsbach

Nursing Posters

Implement a practice change on the adult mental health unit to improve the accuracy and increase the rate of completion of the abnormal involuntary movement scale (AIMS) for tardive dyskinesia (TD).

Perioperative Glucose Monitoring Protocol, Nicole Helgeson

Nursing Posters

Currently, there is no established glucose management protocol for our surgical patients. Poor outcomes related to hyperglycemia may include increased morbidity/mortality, surgical site infection (SSI), sepsis, renal, and cardiac concerns. The purpose of this protocol is to improve the care and outcomes for surgical patients through a consistent standardization of glucose management.

Purewick External Female Catheter, Elizabeth Kiffmeyer, Mallory Mondloch

Nursing Posters

Catheter-Associated Urinary Tract Infection (CAUTI) rates increased in FY21 compared to FY20, and many units continue to not meet their National Database of Nursing Quality Indicators (NDNQI) target goal even through FY22.

A group of CentraCare stakeholders gathered, including bedside nursing staff, urology techs and nursing leadership, to discuss barriers and areas for opportunity. Representatives from BARD®, our urinary catheter supply company, were invited to conduct an analysis on our urinary catheter/ CAUTI reduction practices. Findings from the analysis included an opportunity to implement an external female catheter.

Icu Liberation: Early Mobility And Exercise, Vanessa Fuller, Andrea Nyquist

Nursing Posters

ICU Liberation:

The Society of Critical Care Medicine’s (SCCM) Intensive Care Unit (ICU) Liberation Bundle was created to reduce the harmful effects of events that occur in the ICU setting. Early mobility and exercise is part “E” of the ICU Liberation Bundle; goals are to reduce ICU and hospital length of stay (LOS), prevent readmissions, reduce discharges to long term care facilities, reduce delirium and coma days, and reduce likelihood of hospital mortality (SCCM, 2021)

Preoperative Weight Loss For Patients Undergoing Lumbar Spine Surgery Utilizing Motivational Interviewing To Decrease Postoperative Complications: A Quality Improvement Project, Amanda Welle

Nursing Posters

Do patients who are obese, based on BMI>30 and are offered lumbar spine surgery, who undergo preoperative MI via telehealth to lose weight, compared to those who don’t undergo MI have decreased postoperative complications at 30 days postoperatively?

Conclusions/Implications:

• Results from this QI project suggest a higher BMI class is associated with postoperative complications-wound infection.
• However, given the small sample size no conclusions could be drawn
• This QI project should be replicated on a larger scale
• The process for recruitment and intervention is established. The Neurosurgical providers are supportive of the continued study.

Very Important Discharge Appointment (Vida), Jennifer Burris, Holly Kockler, Gail Olson, Kristi Patterson, Natasha Pflueger, Jennifer Salzer, Leann Volkers

Nursing Posters

To improve patient flow, access, and decrease strain on resources by enhancing the current process of Discharge and Loop Back Huddle by identifying two patients for early discharge the next day.

Current Practices:

• Discharge huddle and Loopback (Discuss care progression for all pts)
• Discharge planning using the IDEAL Model (Patient and Family Engagement with Discharge)
• Electronic Discharge Readiness Tools (Exp Discharge Date, Discharge milestones, etc.)

Next piece of the puzzle:

• VIDA: a framework to identify 2 patients to be discharged before 11 am – so the bulk of our discharges do not occur between Noon and 4:00 pm.
• Decreasing the …

Neurointerventional Post-Procedure Assessment And Documentation Compliance, Chandra Brower

Nursing Posters

Per stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.

Use Of Academic Detailing To Improve Reporting Of Peri-Operative Events, Allyn Sara Miller-James

Doctor of Nursing Practice Projects

Problem: Four million people worldwide die within thirty days of surgery. The EPIC Corporation has created the opportunity to collect and analyze data on the peri-operative care of patients. Initially, implementation of the program has identified barriers to event reporting by anesthesia providers. Barriers identified in the literature and in semi-structured interviews are fear of liability and retribution by patients, employers, and governing bodies. Significance: Despite national efforts to increase the reporting of medical errors, they remain grossly under- reported. The integration of the National Anesthesia Clinical Outcomes Registry (NACOR) events data collection tool into the EHR for anesthesia providers …

Perceived Effects Of Covid-19 On K-5 Educators And Learners, Fairbee Mintz

Master of Science in Nursing Theses and Projects

The COVID-19 pandemic disrupted traditional teaching methods at all academic levels bringing about unprecedented changes in the way education was delivered. In-person learning was halted all over the world as educators scrambled to transition to virtual education. The purpose of this Master of Science in Nursing research was to examine the perceived effects of systematic learning changes caused by the COVID-19 pandemic on primary and secondary educators and students as reported by educators. This research will then be applied to implications for future nursing educators and students. Nine K-5 educators were interviewed via Zoom in the spring of 2021 and …

Implementing An Evidence-Based Preceptor Program To Improve The Orientation Process, Emily Nobles

Graduate Research Showcase

This Quality Improvement project conducted at a 245-bed acute care hospital in the southeastern United States, aimed to develop an evidence-based preceptor program to improve retention rates. Specific goals were to create a positive experience for preceptors and preceptees by improving the training, support, and recognition. Secondary goal was to increase the number of trained preceptors. The training focused on safe practice, employee satisfaction, and self-efficacy. Retention data supplied by HR for 2020 showed increasing trend of nursing turnover with a 33% total nursing turnover, and 50.25% turnover rate for nurses with less than three years of experience. A 2019 …

Mitigating Weight Stigma In The Medical System: Self-Compassion For Nursing Students, Ellen C. Joseph

Electronic Theses and Dissertations

Weight stigma is a form of oppression that has been shown to have a detrimental impact on the well-being of people with higher weight. Healthcare providers are one of the most common sources of weight stigma, and their stigmatizing beliefs have been found to be associated with differential care for patients with “obesity”. The current study aimed to explore the feasibility of the loving-kindness meditation (LKM) as a brief intervention that reduces weight bias in nursing students by increasing self-compassion, positive, other-focused emotions, and cognitive flexibility, in order to improve compassionate care for patients with higher weight. Participants (189 nursing …

The Relationship Between Nursing Faculty Stress And Gratitude Journaling, Kathleen L Whalen

Regis University Student Publications (comprehensive collection)

“The relationship between nursing faculty stress and gratitude journaling”

Kathleen L. Whalen, MS RN – Regis University

The National League for Nursing (NLN) has reported a national shortage of nursing faculty. Some of the factors involved are limited qualified faculty, schools’ inability to offer competitive wages, and faculty leaving due to stress or retiring. A quality improvement project was developed for full-time faculty in a university nursing program in dealing with stress, which could aid in retention. A quasi-experiment with a pre-test and post-test design was used to measure participants’ stress using the Perceived Stress Scale–10 (PSS-10) before and after …

The Feasibility Of Transitional Psychiatric Care Service In A City With A Population 20, 171 In A Midwestern State, Aubri Ashbacher

Doctor of Nursing Practice Scholarly Project

Psychiatric patients are a known vulnerable population. This population often ends up in a cycle of decline post-hospitalization that leads to rehospitalization. The purpose of this study is to establish the feasibility for bringing psychiatric transitional care services to the local community. The methods for the study include a qualitative analysis of common themes discussed from the presentation of the idea of transitional care services for this area to area mental healthcare providers. Using a qualitative approach, the project will involve conducting interviews with mental healthcare providers in a midwestern community via Zoom about the feasibility of transitional psychiatric care …

Is Healthcare In The United States A Right Or A Privilege, Candace Balavage

Student Research Poster Presentations 2022

No abstract provided.

The Effectiveness Of An Aprn-Led Pain Service On Patient Satisfaction Scores: A Retrospective Analysis, Maripatricia Welz-Bosna

West Chester University Doctoral Projects

Abstract

This quality improvement (QI) project examined if the implementation of an Advanced Practice Registered Nurse (APRN) led consult pain service, was able to improve patient satisfaction measured on the HCAHPS and Press Ganey pain satisfaction scores. A one-way ANOVA analysis was used to examine if mean outcome scores varied at a statistically significant level (p<.05) by year (2018, 2019, 2020). Bonferroni Post Hoc tests reflecting How Often Staff Talk About Pain by year using the dependent variable Top Box Score, indicated that the mean score for year 2020 (M=74.10, SD=17.45) was significantly higher than year 2018 (M=63.22). The mean score for year 2019 (M=64.62, SD=22.80) did not differ significantly from the other two years. Bivariate analysis indicated that Press Ganey Scores reflecting Staff Talk About Pain Treatment did not vary significantly by year, F(2, 445) = .41, p=.66. Results from this QI project and the effectiveness of an APRN-led pain service on patient satisfaction scores are inconclusive, and further research is needed. Pain is complex, and a patient's satisfaction with pain is never straightforward. The effectiveness of an APRN-led pain service on patient satisfaction remains under-researched and in need of more methodological evaluation. APRNs need to focus on multidimensional validated outcome measures, which can measure our effectiveness in the management of patients with pain.

Keywords: Patient Satisfaction, Pain, HCAHPS, Advanced Practice Registered Nurse (APRN), Effectiveness

Clinical Nurse Specialist Job Description Assignment, Diane R. Maydick Youngberg

Open Educational Resources

The Clinical Nurse Specialist (CNS) is an advanced practice registered nurse with expertise in assessment, diagnosis, and treatment of specialty patient populations. In addition to direct care, the CNS role expands to other areas including research, education, quality improvement, and inter professional teamwork. Creating a detailed CNS Job description helps to clarify the role.

Nursing Student Self-Efficacy In Clinical Skills, Levels Of Anxiety, And Utilization Of Alternative Education Experiences During The Covid-19 Pandemic, David S. Hart

Honors Theses and Capstones

No abstract provided.

Engaging Nurses In Public Policy, Carlene Ferrier

DNP Scholarly Projects

Background: Nurses have been engaged in public policy since the inception of the profession. Academicians and thought leaders recognize the importance of nurses engaging in public policy to improve health and healthcare. Nurses are also the largest healthcare group and the most trusted profession for twenty years, yet they are minimally represented in the state and federal legislature. Nurses possess a skill set that is directly transferable to the policy arena such as listening and communicating effectively, leading by inspiring a shared vision, applying evidence-based research, and collaborating and building relationships to achieve a common goal. Locally, the New Hampshire …

Implementing A Health-Related Quality Of Life Assessment Tool In An Outpatient Hematology/Oncology Clinic: A Pilot Quality Improvement Project, Jennifer Holl

DNP Scholarly Projects

BACKGROUND: Although overall and disease-free survival remain the goals of cancer care, health-related quality of life (HRQOL) during and after treatment is increasingly acknowledged as vital to the patient’s outcomes. The purpose of this project was to identify and implement a valid, reliable HRQOL assessment tool into daily clinical practice in an outpatient hematology/oncology clinic at a 25-bed critical access hospital in rural New Hampshire.

METHODS: This project used a methodological design. Descriptive and inferential statistics, plus qualitative analysis were used to determine results. Three nurses and seven patients participated in this quality improvement project.

INTERVENTIONS: The interventions …

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 …

Patient Transitions Between Acute And Post-Acute Care Organizations: Can Nursing Communication Prevent Patient Readmission?, Penny Gilbert

DNP Projects

Preventing Patient Readmission

Background and Review of Literature: Communication is the foundation of patient safety. As patients move from the acute to post-acute care setting, risk for insufficient communication rises. Research demonstrates a vast array of communication hand-off tools currently exist for and between different care arenas. No one tool has been standardized for patients transitioning from acute to post-acute care settings. The Institute of Medicine (IOM) and The Joint Commission (TJC) have published multiple documents discussing communication plagues within health care resulting in readmission.

Purpose: The purpose of this project is multifaceted: 1) identifying current nursing communication practices between …