Perioperative, Operating Room and Surgical Nursing Commons^™

Preoperative Education: A Patient-Centered Care Approach, Gia L. Wendt

Master's Projects and Capstones

Abstract

This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education …

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Is Dexamethasone 4mg A More Effective Anti-Emetic Than Dexamethasone 8mg For The Prevention Of Early Post-Operative Nausea And Vomiting In Women Undergoing Laparoscopic Gynecological Surgery?, Steven B. Doyle

Doctoral Projects

Postoperative nausea and vomiting (PONV) is a common problem in the surgical setting. It affects as much as 20 to 80 percent of patients undergoing surgery (D'souza, Swami, & Bhagwat, 2011). PONV can lead to increased patient costs and recovery time by causing the patient to stay in the healthcare facility for a longer period of time. A retrospective cohort study was completed to examine whether or not there was a significant difference between patients who received 4mg and 8mg of dexamethasone in the incidence of PONV. All patients studied received ondansetron intraoperatively as their primary anti-emetic. English speaking patients …

The Use Of An Intraoperative Forced Air Warming Device Alone Versus Warmed Intravenous Fluid Infusion And Forced Air Warming Versus Warmed Intravenous Fluid Alone In Patients Undergoing Open Intra-Abdominal Surgery, Charlie Adderley

Doctoral Projects

Patients undergoing open abdominal surgery with general anesthesia are at increased risk for adverse outcomes associated with disturbances in thermoregulation during the intraoperative phase of the surgical experience. The purpose of this quantitative capstone project was to examine and compare the differences between the use of an intraoperative forced air-warming device and a forced air warming device plus warmed intravenous fluid (IVF) in the management of postoperative hypothermia, as measured by the postoperative temperatures of patients undergoing open abdominal surgery. A comparative retrospective chart review was performed using two groups to assess the effectiveness of preventing postoperative hypothermia in this …

Utilization Of A Focus Group To Evaluate The Perceived Stress Levels And Coping Mechanisms Of Student Registered Nurse Anesthetists, Cillora Hicks

Doctoral Projects

Each year, thousands of Student Registered Nurse Anesthetists (SRNAs) matriculate into a nurse anesthesia educational program, confronted with unforeseen challenges and stressors. Although a certain amount of stress is essential to stimulate learning, excessive stress can have dire consequences in delaying a students’ academic and clinical progression. The purpose of this Capstone Project was to explore and describe the perceptions of 12 SRNAs relevant to their stress levels and coping behaviors in the management of academic and personal stress. The clinical research questions guiding the study examined the stress levels and coping behaviors of the SRNAs as measured by the …

Phenylephrine Versus Ephedrine: Safest Vasopressor For The Neonate During Caesarean Section, James S. Hale Jr.

Doctoral Projects

One of the most common side effects of spinal anesthesia is the development of hypotension. Data collected has determined that 80% of parturients that undergo spinal anesthesia for this mode of delivery experience hypotension (Chestnut et al., 2014).

Hypotension, if sustained and severe, can lead to fetal hypoxia, neonatal depression or injury, and decreased uteroplacental perfusion. Hypotension can also cause severe health issues for the parturient including apnea, altered level of consciousness, cardiac arrest, and pulmonary aspiration. This systematic review of the literature was conducted to determine whether the administration of phenylephrine or ephedrine was safer for the neonate to …

In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, Martha Claudine Boos

Doctoral Projects

It is estimated that up to 45% of surgical patients will have postoperative residual neuromuscular blockade (NMB) upon arrival to the postanesthesia care unit (PACU), and incomplete recovery can impair upper airway function and contribute to adverse respiratory events (Nagelhout & Plaus, 2014). This retrospective cohort study examined whether there was an increased incidence of postoperative adverse respiratory events with the neuromuscular blocking agents Rocuronium or Vecuronium. Inclusion criteria included any surgical patient ages 18-65 receiving NMB agents Rocuronium or Vecuronium during the procedure. Exclusion criteria included any surgical patient ages 18-65 with ASA classification > 4, any emergent cases, any …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, Jini K. Paek

Master's Projects and Capstones

Abstract

The Clinical Nurse Leader project took place at a 106-bed community hospital in Washington. The microsystem has five operating rooms where they provide outpatient, and inpatient surgical procedures. The goal of this project is to reduce and sustain a near zero number of surgical site infections by implementing the use of a no rinse 2% CHG cloth in the surgical patient. The specific aim of the project is to reduce the rate of SSIs by 80% by December 31^st, 2015. Due to a lack of a standardized care, specifically designed for the prevention of SSIs, the microsystem …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

The Effectiveness Of A Preoperative Multimodal Antiemetic Regimen On Reducing Early Postoperative Nausea And Vomiting In Total Joint Arthroplasty Patients, Jerry Mosley

Doctoral Projects

Postoperative nausea and vomiting (PONV) occurs frequently in all types of surgeries including after total joint orthopedic procedures. The resulting PONV can lead to many unwanted occurrences including immobilization, distress, and many serious adverse health complications. These unwanted occurrences may then lead to increased cost to the patient and healthcare facility. Administration of a preoperative multimodal regimen known to reduce PONV has the potential to reduce such unwanted anesthetic side effects influencing a reduction in overall healthcare cost. The purpose of this study is to determine the effectiveness of the preoperative kit which includes the administration of metoclopramide, famotidine, ondansetron, …

Intravenous Acetaminophen Reduces Opioid Use For Postoperative Pain In Obese Patients Undergoing Laparoscopic Cholecystectomy, Kimberly S. Burks

Doctoral Projects

Opioid-induced respiratory depression is categorized as a sentinel event, which is an unanticipated occurrence that may result in severe injury or death. Although the incidence of opioid-induced respiratory depression is 0.2 to 2%, this issue persists as a substantial basis of morbidity and mortality. The obese population has multiple physiologic elements that increase their risk for opioid-induced respiratory depression. This retrospective study examined if intravenous (IV) acetaminophen reduces opioid consumption in the postoperative period in obese patients who underwent a laparoscopic cholecystectomy. Adequately controlled postoperative pain provides for greater patient satisfaction, decreased hospital length of stay (LOS), and reduced costs …

A Review Of The Evidence: Prewarming Adults Prior To General Anesthesia In The Prevention Of Unplanned Perioperative Hypothermia, Paige F. Wrigley

Senior Honors Theses

Unplanned perioperative hypothermia (UPH), a common event in the surgical setting, is associated with many adverse patient outcomes. In current perioperative practice, patient core temperature is monitored and active warming interventions are implemented during the intraoperative and postoperative phases in response to UPH. The literature suggests preoperative warming of patients as a proactive measure may be more effective in the prevention of UPH. In the form of an integrative review, this thesis seeks to address the research question: For adult patients undergoing general anesthesia, how does preoperative warming compared to no preoperative warming affect UPH incidence? A database search yields …

Performing A Correct Surgical Time Out, Natalia E. Mariscal

Master's Projects and Capstones

The ending data reflected what we expected in that we would see a significant incline but

not quite the 100% compliance rate we are looking for. Our highest compliance rate has reached

90% and we have contributed the margin error to new staff that requires the proper teaching and

education. In conclusion I feel that the majority of staff was aware that they were not in

compliance with the time out but would proceed anyways due to the rush of the case or surgeon

or simply that they had become laxed in practice. Once the data was brought to staff …

Emergency Response Improvement Project, Ewan Stephen Macdonald

Master's Projects and Capstones

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of …

Postoperative Pain Management, Taylor H. Schuler

Senior Honors Projects, 2010-2019

This literature review examined two pharmacological forms of postoperative pain

management and one nonpharmacological intervention to help reduce pain (See

Appendix A). Sources were gathered from the nursing research databases of

Cumulative Index to Nursing & Allied Health Literature (CINAHL) and PubMed.

Articles and studies between 2004 and 2015 were analyzed to write the review. The

focus was to look at postoperative patients and determine if epidural or patient

controlled analgesia (PCA) provided the same satisfaction for individuals who

underwent surgery. In addition, music therapy was researched to explore the effects

of listening to a pleasurable sound and how it …

Gap In Patient Expectations Of Deep Brain Stimulation For The Treatment Of Parkinson's Disease, Colleen D. Knoop Dnp-C

Graduate Theses, Dissertations, and Capstones

Abstract

Purpose: This project studied a specific group of patients with Parkinson’s disease to: determine if they were asked to verbalize expectations of DBS pre-operatively; determine if patient expectations were met post-operatively; gain information that could aid in improved pre-operative patient education for deep brain stimulation (DBS), address unrealistic expectations before surgery, and meet patient expectations post-operatively.

Methodology: This study was a retrospective, single academic center, two-part design that included a questionnaire and chart review of 29 patients. Those included were patients with Parkinson’s disease who had DBS programming at the academic center, between the years 2007 and 2014.

Results: …

The Effects Of Implementing Best Practices On 30-Day Readmission Rates In Adults Following Cabg Surgery, Linda Elaine Kline

Evidence-Based Practice Project Reports

Coronary artery bypass graft (CABG) surgery is one of the most frequent and expensive cardiac surgical procedures in the U.S. today. Complications from CABG surgery are one of the top causes of 30-day hospital readmissions. Readmissions after CABG surgery are often preventable and add to health care costs. Recent government legislation mandates penalties for hospitals with excess readmission rates. The purpose of this evidence-based practice project was to determine if implementation of best practice recommendations effected 30-day readmission rates following CABG surgery. A critical appraisal of the literature was conducted to identify best practice recommendations. The Iowa model and Lewin’s …

Family-Centered Pediatric Radiation Therapy: A Nurse-Led Quality Improvement Collaboration Model, Elizabeth A. Austin

Doctoral Projects

Problem: Parents of children diagnosed with cancer face a number of physical, emotional, and social hurdles in the race for a cure. Family schedules shift dramatically to accommodate daily radiation therapy treatment appointments. Ambulatory procedure unit nursing staff attempt to teach and interpret the process without the benefit of a family-centered intradepartmental structured communication process to promote safe care with these families.

Methods: Implementation of a structured family-centered interprofessional standard work model to promote interdepartmental collaboration. The project implemented a structured family-centered interview and standard work algorithms to improve the radiation therapy family experience.

Results: A structured, streamlined, interdepartmental interview, …

Reducing The Risks Of Wrong Site Surgery Using The Joint Commission’S Targeted Solutions Tool For Safe Surgery, Stephanie Kelly Parks

Doctoral Projects

The purpose of this project was to utilize the ‘Institute for HealthCare Improvement’s Model of Improvement as a consultation framework to facilitate improvement in core processes for the prevention of wrong site surgery (WSS) using The Joint Commission Targeted Solutions Tool for Safe Surgery© Program at a surgery center in Mississippi. The TST Program was conducted across 6 months and had 6 phases: 1) Getting Started, 2) Training Data Collectors, 3) Measuring Risk Factors, 4) Analyzing Data, 5) Implementing Solutions, and 6) Sustaining the Gains. A convenience sample of 47 surgical staff participated and 8 data collectors observed behaviors. The …

Improve Intra-Operative Nurse-To-Nurse Communication Using A Safety Checklist, Silvinita Tadeo Rowe

Doctoral Projects

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers' diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian's structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In …

Bordered Silver Foam Dressings For Colorectal Surgical Patients, Jessica Maynard

Doctor of Nursing Practice Projects

Although a surgical site infection (SSI) is a risk of an operative procedure, most are preventable (Health Protection Agency, 2009). The Joint Commission National Patient Safety Goal 7 stipulates the implementation of evidence-based practice for SSI prevention in acute care facilities. The purpose of this pilot project was to implement a bordered silver foam dressing protocol for post-operative colorectal surgical patients. Using a pre- and post-comparison design, the new dressing protocol was implemented for a two-month pilot for colorectal surgical patients meeting the specified criteria at Cabell Huntington Hospital. SSI rate following the protocol was compared to the SSI rate …

Timeliness Of Patient Discharges: A Comparison Of The Acute Care Discharge Process For Medical And Surgical Patients, Robert Moore

Nursing Theses and Capstone Projects

Patient flow is becoming increasingly important to the efficient operations of an acute healthcare setting. Multiple factors peaking in their influence on the number of patients seeking healthcare services are on a collision course. When the true impact is felt in healthcare the potential for record numbers of patients to seek acute medical care are high. It is imperative to streamline patient flow processes to ensure healthcare facilities have the ability to provide the care sought by patients in a timely manner. This study’s purpose was to assist in increasing the number of patients an acute care facility can provide …

Lean And Six Sigma Impact On Operating Room Safety Attitudes And Efficiency, Nancy Marlene Geedey

Nursing Theses and Capstone Projects

Non-healthcare organizations have utilized Lean Six Sigma methodologies for several decades to eliminate waste, decrease expenses, and improve efficiency. This approach to problem-solving can be successfully applied to health care process improvement projects. Health care leaders and front line staff can use a prescribed set of steps to define steps in care processes and identify potential solutions. Health care leaders can use Lean Six Sigma tools such a fishbone diagram or a cause and effect matrix to identify issues. After carefully organizing the problems into groups according to priority, leaders can develop action steps toward resolution.

Ob-Pdcds Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Ob Qdts, Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Ob-Pdcds Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Improving Patient Safety In The Operating Room: Utilizing A Safety Checklist And Briefings, Lori R. Schacht

Theses and Graduate Projects

The perioperative care setting can be a hazardous environment for patients undergoing surgery. Surgical teams caring for patients undergoing complex surgical procedures may create an opportunity for surgical errors impacting patient safety. The purpose of this project is to improve consistent standardized Surgical Safety Checklist (SSC) use and briefings in the orthopedic perioperative care setting in a large Midwestern hospital, thereby supporting a culture of safety through staff engagement and a team-based communication approach. Watson’s Theory of Human Caring guided this project through the theoretical concepts of presence and faith. An initial implementation of the SSC and briefings revealed a …