Critical Care Nursing Commons^™

Implementation Of A Process To Improve Compliance With A Nurse Driven Foley Catheter Removal Protocol In Nursing Staff Of A Medicine Intensive Care Unit, Kendall L. Pfister

DNP Projects

Background: Catheter associated urinary tract infections (CAUTI) are the most prevalent healthcare acquired infection (HAI) in the acute care setting. Unfortunately, CAUTIs can lead to high morbidity and mortality rates, longer length of stay (LOS) and increased healthcare costs. Unfortunately, in critically ill patients which often suffer multi-organ failure/injury, there remains an increased risk for infection and poor outcomes.

Purpose: The purpose of this project is to increase medical intensive care unit (MICU) nursing staffs’ knowledge of existing nurse driven indwelling urinary catheter removal protocol and to implement an electronic medical record (EMR) prompt for removal of unnecessary urinary catheters …

Implementation And Evaluation Of A Competency-Based Phased Orientation Program For Nurse Practitioners In The Intensive Care Unit Setting, Meredith Sherer

DNP Projects

Background: Research has demonstrated that structured orientation helps to integrate new nurse practitioners (NPs) into practice, ease role transition, decrease NP turnover, and lead to better patient care. However, at University of Kentucky HealthCare (UKHC) clinical orientation programs for NPs are not standardized.

Purpose: The purpose of this project was to implement and evaluate a competency-based phased orientation program for NPs in the intensive care unit (ICU) setting at UKHC.

Methods: This project utilized a prospective, single group, presurvey-postsurvey design to examine the effect of a three-phased competency-based orientation program on the outcome variables of NP confidence, autonomy, proficiency of …

The Effect Of A Hospital Community Garden On Healthcare Workers’ Professional Quality Of Life, Madelyn Renee Cline

DNP Projects

Background: Healthcare professionals experience a variety of stressors which negatively impact their professional quality of life (ProQOL) potentially leading to increased turnover and nurse shortages in hospitals. There are growing studies addressing ways to improve healthcare ProQOL, yet few have examined the impact of alterations to the workplace on these outcomes.

Purpose: The purpose of this project was to evaluate the effect of a dedicated outdoor green space for nurses during shift breaks on their ProQOL.

Methods: This project used a one-group pretest-posttest design. Data analysis was completed using descriptive and inferential statistics using SPSS software. The Professional Quality of …

Implementation Of A Pilot Post-Code Debrief Tool Initiated By The Chaplains And Unit Lead Nurses Within The Medicine Intensive Care Unit, Sarah Stigall

DNP Projects

Background: Post-code debriefs are shown to improve teamwork and communication, increase performance, and reduce burnout. According to the University of Kentucky HealthCare (UKHC) policy, teams are to perform a post-code debrief immediately after an in-hospital cardiac arrest (IHCA). However, the current policy does not provide guidance on what to include during a debrief session. At UK post-code debrief sessions are documented as occurring 60-72% of the time; however, personal observation and discussions with other bedside and rapid response nurses suggest that post-code debriefs are underperformed when compared to the documentation. Purpose: This study aimed to explore barriers to post-code debriefs …

A Triage Process To Decrease Door To Ekg Times For Adult Patients With Suspected Cardiac Abnormalities In The Emergency Department, Khay Douangdara

DNP Projects

Objective: The emergency department (ED) triage process for adult patients presenting with suspected cardiac abnormalities should be reliable; however, delays in identifying significant cardiac rhythms can negatively impact patient outcomes. The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend that patients presenting to the ED with cardiac-related concerns undergo an electrocardiogram (EKG) within 10 minutes of arrival. This project aimed to educate ED nurses and implement changes in the triage process to reduce door-to-EKG times for adult patients with suspected cardiac abnormalities.

Methods: This quasi-experimental study utilized a pre- and post-intervention design to evaluate the effectiveness …

Facilitating Caregiver Involvement In Reducing Delirium Among Critically Ill Children In The Pediatric Intensive Care Unit, Emma R. Bilberry

DNP Projects

Background: The pediatric intensive care unit (PICU) is a dynamic, fast-paced, and high-acuity unit where children are prone to the development of pediatric delirium (PD). PD is a condition of neurologic dysfunction increasing risk of morbidity and mortality among patients. Literature on PD is rapidly expanding, providing an opportunity for increased research on how to manage PD. Caregivers know their children, are often readily available at the bedside, and invested in being included in care. Additionally, literature shows that caregiver presence at the bedside is one non- pharmacological intervention that can aid in reducing PD. The development and implementation of …

Primary Nurse Framework: All-Registered Nurse Staffing Model In A Twelve Bed Critical Care Unit, Jeanette E. Sanders

DNP Projects

Background: Registered Nurses (RNs) comprise one of the largest professions in healthcare, and they play a critical role in delivering patient-centered care. The nursing shortage exacerbates inadequate nurse staffing levels, leading to increased workloads, higher patient-to-nurse ratios, and a high-stress work environment.

Purpose: This project aimed to evaluate the implementation of a primary-nurse-led care delivery model with an all-RN staffing design and its effects on nurse-sensitive patient outcomes, patient length of stay, nurse-sensitive related outcomes, and associated financial implications in the Intensive Care Unit (ICU) setting. Nursing knowledge and opinions about the all-RN staffing model were also assessed.

Methods: Staffing …

Use Of Machine Learning Models To Predict Microaspiration Measured By Tracheal Pepsin A., Annette Bourgault, Ilana Logvinov, Chang Liu, Rui Xie, Jan Powers Phd, Rn, Ccrn, Mary Lou Sole

Nursing Publications, Posters, & Presentations

BACKGROUND: Enteral feeding intolerance, a common type of gastrointestinal dysfunction leading to underfeeding, is associated with increased mortality. Tracheal pepsin A, an indicator of microaspiration, was found in 39% of patients within 24 hours of enteral feeding. Tracheal pepsin A is a potential biomarker of enteral feeding intolerance.

OBJECTIVE: To identify predictors of microaspiration (tracheal or oral pepsin A). It was hypothesized that variables predicting the presence of tracheal pepsin A might be similar to predictors of enteral feeding intolerance.

METHODS: In this secondary analysis, machine learning models were fit for 283 adults receiving mechanical ventilation who had tracheal and …

Beyond Involuntary Movements: A Case Of Diabetic Striatopathy Complicated By Cardiac Arrest, Deepa M

Manipal Journal of Nursing and Health Sciences

Abstract

Diabetic striatopathy (DS) is a rare neurological manifestation of poorly controlled diabetes mellitus, typically characterized by hemichorea–hemiballismus and distinctive basal ganglia abnormalities on neuroimaging. We report the case of a 57-year-old woman with type 2 diabetes mellitus who presented with generalized choreiform and ballistic movements and subsequently developed an in-hospital cardiac arrest. Diagnostic evaluation revealed uncontrolled hyperglycemia (random blood glucose 243 mg/dL; HbA1c 8.3%) without ketosis, with neuroimaging findings consistent with DS. The patient was initially managed in the casualty department and subsequently admitted to a neuro stepdown intensive care unit, where she remained for 10 days. Comprehensive medical, …

Evaluating The Impact Of Epic Integration And Dual Registered Nurse Check-Off On Pressure Injury Prevention Workflow Compliance, Darlene Y. Olowu

Doctor of Nursing Practice Final Project Abstract

Background

Hospital-acquired pressure injuries (HAPIs), particularly sacral and heel injuries, remain a persistent challenge in critical care settings, leading to increased morbidity, mortality, and healthcare costs.

Purpose

This quality improvement project aimed to improve compliance with a pressure injury prevention (PIP) workflow by integrating a dual RN check-off system within EPIC, thereby reducing sacral and heel pressure injuries. The project sought to enhance accountability, standardize documentation, and optimize compliance with evidence-based PIP measures.

Methodology

A Plan-Do-Study-Act (PDSA) framework guided the project implementation in an oncologic intensive care unit (ICU). Key interventions included: (1) EPIC integration of a dual RN check-off …

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative, Haley Lynne Johnson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative

Haley Lynne Johnson, BSN, RN

Background: Stroke and brain injuries remain among the leading causes of mortality in the United States, accounting for 162,890 deaths in 2021 (Centers for Disease Control and Prevention [CDC], 2021). Although frequent neurological assessments are essential for monitoring patient status, limited evidence supports the prolonged use of hourly neuro-checks (LaBuzetta et al., 2022). Excessive neuro-check frequency has been linked to sleep deprivation, an increased risk of delirium, and inefficient resource utilization (Kishore et al., 2021).

Purpose: This project aimed to assess the impact of …

Design And Implementation Of A Nursing Peer Practice Case Review Program In An Academic Surgical/Trauma Icu, Natalie Tredway

DNP Scholarly Projects

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on …

Effect Of Implementing An Educational Program About Post Kidney Transplant Care On Critical Care Nurses' Knowledge, Marwa Abdo, Asmaa Ibrahim Aboseda

Nursing

Background: Critical care nurses (CCNs) play a pivotal role in post-kidney transplant care, necessitating a comprehensive understanding of transplantation procedures, complications, and patient management. So, any knowledge gaps among CCNs may impact the quality of care provide to kidney transplant program. Aim: This study aimed to assess the effect of implementing an educational program about post-kidney transplant care on critical care nurses’ knowledge. Methods: A quasi-experimental study was conducted among 50 critical care nurses. A structured educational program was implemented, and nurses’ knowledge was assessed pre- program, post- program, and three months follow-up. Data was collected using a kidney transplantation …

Noise In The Acute Care Patient Setting, Taylor A. Cota, Brynn Roberts

Honors Theses and Capstones

Noise levels in hospital environments can negatively impact patient satisfaction and recovery, particularly in high-acuity units such as Progressive Care Units (PCUs) (Choiniere, D. B., 2010). Patient satisfaction surveys at the PCU at Exeter Hospital have consistently identified noise as a concern, highlighting the need for rigorous quality improvement (QI) planning phase to determine whether a structured intervention, such as white noise implementation, is indicated.

This project focuses on the initial planning phase of the Plan-Do-Study-Act (PDSA) cycle (Institute for Healthcare Improvement, n.d.) to assess the feasibility and necessity of introducing white noise machines to enhance patient experience on the …

Family Members’ Experiences Of Post-Cardiac Surgery Delirium In The Intensive Care Unit: A Narrative Inquiry, Amber Coral Mclean

Theses: Doctorates and Masters

Aim: This study explores delirium in the intensive care unit (ICU) following cardiac surgery from the perspective of family members.

Background: Delirium is a common complication affecting 28-52% of people following cardiac surgery in the ICU, which can lead to distress for both the person and their family members. While research has been conducted on clinical outcomes of family involvement in delirium care, there is a lack of understanding of how delirium impacts the family members themselves. This study seeks to provide detailed narrative accounts of families’ experience of witnessing delirium in their loved one following cardiac surgery in the …

Implementation Of An Advanced Practice Provider Into The Outpatient Neurology Clinic To Improve Access To Care And Medication Compliance, Sean O'Laughlin

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The American Association of Neurology (AAN) recommended that post-stroke and TIA patients receive follow-up care within 2–4 weeks of discharge to reduce complications, improve medication adherence, and decrease readmission rates (2023). However, in 2022, a Central Virginia neurology practice reported an average wait time of 98.66 days for outpatient follow-up appointments, significantly exceeding the AAN recommendation, while medication adherence was only 72.23%, compared to the national average of 80%. Research by the American Academy of Neurology Workforce Task Force (2013) and Woo et al. (2017) highlighted that incorporating advanced practice nurses into outpatient settings could enhance access to care and …

Improving Nursing Deployment Readiness, George Mcenroe

Doctor of Nursing Practice (DNP) Projects

Improving Air Force Nursing Deployment Readiness

Abstract

Background. Air Force nurses must be prepared for deployment to support military missions on short notice. During deployments, they may be asked to practice in demanding and austere wartime environments. The required competencies for deployment include the care of multi-trauma patients, mass casualty care, and military-specific skills.

Problem. Air Force nurses are required to maintain an annual Comprehensive Medical Readiness Program (CMRP) checklist, a list of clinical skills based on their nursing specialty. Assessing and maintaining deployment readiness is an ongoing challenge. The Air Force does not currently use any …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In The Adult Oncology Population Through Improved Compliance With Oral Hygiene Protocols, Kenneth R. Brown

Master's Projects and Capstones

Objective

Oncology patients receiving chemotherapy are at risk of complications such as mucosal barrier injuries (MBI) and aspiration pneumonia, and aspiration pneumonia rates are higher than desired. Improved oral hygiene protocols and compliance in this population reduces the incidence of these complications.

Context and Background

The microsystem assessed includes six oncology units at Hospital A, a large California academic hospital. Aspiration pneumonia, commonly associated with MBI, is a life-threatening challenge that increases costs and complications in oncological treatment settings. An aspiration pneumonia task force focused on six oncology acute care units is committed to reducing the incidence of hospital acquired …

Transforming Care: Elevating Oral Hygiene Compliance To Combat Nosocomial Aspiration Pneumonia In Adult Oncology Patients, Karina Larrea

Master's Projects and Capstones

Objective Aspiration pneumonia is a preventable, yet common complication in oncology patients undergoing chemotherapy, steered by suboptimal compliance with oral hygiene protocols and elevated susceptibility due to mucosal barrier injuries. Despite its major impact on healthcare costs and morbidity, compliance with evidence-based practices remains inadequate. Aim This project aimed to decrease nosocomial aspiration pneumonia rates from 1.5% to 1.3% by enhancing oral hygiene compliance from 41% to 70% over a 12-week period. Methods Proposed interventions included implementing paired oral hygiene order sets into electronic medical records, once-per-shift cues, staggered patient education sessions, and staff education on standardized protocols. Pre-intervention data …

Reducing The Incidence Of Nosocomial Aspiration Pneumonia In Adult Oncology Patients Through Improved Compliance With Oral Hygiene Protocols, Rickey Maung

Master's Projects and Capstones

Objective: Oncology patients undergoing chemotherapy are at increased risk of mucosal barrier injuries and aspiration pneumonia, with current aspiration pneumonia rates exceeding target levels. Enhanced oral hygiene protocols and improved compliance have been shown to reduce these complications in this vulnerable population.

Context: The microsystem under review comprises six oncology units within Hospital A, a major medical center in California. Aspiration pneumonia, frequently linked to mucosal barrier injuries, poses a significant threat to patient safety and increases treatment costs and complications in oncology care. Recognizing the critical need to address this issue, an aspiration pneumonia task force has prioritized efforts …