Critical Care Nursing Commons^™

Peripheral Iv Bundle, Alicia Hanna

Graduate Theses, Dissertations, and Capstones

Abstract

It is estimated that over 90% of hospitalized patients require IV access during their hospitalization. Peripheral IVs (PIVs), while less risky than central lines, are not without risk to the patients. Intravenous (IV) infiltration in pediatric patients is a very common complication associated with IV access, accounting for about 67% of IV catheter removals; a less common complication, but much more serious complication of a PIV can be a blood stream infection (BSI) which can account for up to 35% of BSIs seen in patients. BSIs are associated with increased length of stay, increased morbidity and can result in …

What Are The Nurse’S Perception Of The Effectiveness Of The Electronic Go-Jo Monitoring System On Hand Hygiene Compliance And Hospital Acquired Infection’S?, Patricia James

Seton Hall University DNP Final Projects

Background: The importance of hand hygiene compliance in preventing hospital acquired infections is well known. Yet national averages for compliance rates with hand hygiene among healthcare workers remains unsatisfactory. Noncompliance with hand hygiene practices can contribute to increased patient mortality, prolonged length of hospitalization, increase healthcare costs and decreased reimbursement for hospitals from the Centers for Medicare and Medicaid. Project Aim: The purpose of this quality improvement project was to explore the nurses’ perceptions of the effectiveness of the electronic Go-Jo monitoring system on hand hygiene compliance and hospital acquired infections. Methods: This was a performance …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Cardiac Resuscitation Training: An Integrative Literature Review, Dominick Pahl

Nursing Masters Papers

Despite highly trained healthcare professionals being readily available to respond to In-Hospital Cardiac Arrest (IHCA), a patient experiencing an IHCA often remains a devastating event for the patient. Each year in America, 13.5% of all deaths result from sudden cardiac arrest. Even with healthcare professionals certified in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS), the survival rates following an IHCA are not inspiring. The median survival rate to hospital discharge of an adult experiencing IHCA is 26.4% and 49.5% for the pediatric population. Despite a continued focus on improving CPR quality from the American Heart Association (AHA), …

Exploring The Mental Health Needs Of Intensive Care Unit Nurses Facing The Pandemic Of Covid-19, Bushra Salamah

The Eleanor Mann School of Nursing DNP Capstone Projects

Coronavirus disease (COVID-19) has spread domestically and internationally, with approximately 134 billion confirmed cases worldwide and over 2 million deaths attributed to the virus. Frontline healthcare workers are at a substantially higher risk of infection and death due to excessive COVID-19 exposure while also facing mental health challenges. Epidemiological data on the mental health statuses of frontline nurses is still limited. The aim of this study was to examine mental health (burnout, stress, emotional exhaustion, disengagement) and associated factors among Intensive Care Unit (ICU) Nurses who are caring for COVID-19 patients to support and maintain their psychological well-being.

Reducing The Incidence Of Pressure Injuries In Adult Icu Patients At Mcallen Medical Center With The Implementation Of A Pressure Injury Preventive Bundle: A Quality Improvement Project, Cheryl Cruz

Student Scholarly Projects

Practice Problem: Pressure injuries (PIs) are a significant healthcare problem globally. Adult patients in the intensive care setting are especially vulnerable to the development of PIs given the acuity of their diagnoses requiring extensive treatments, procedures and the use of multiple medical devices.

PICOT: The PICOT question that guided this project was, “In adult intensive care unit (ICU) patients, how does the effect of implementing a pressure injury prevention bundle compare in patients who received the bundle, and patients receiving standard pressure injury prevention in reducing the incidence of pressure injuries after two months?”

Evidence: Evidence exist that bundle implementation …

The Effect Of Medication Reconciliation Timeout On Patient Safety: An Evidence-Based Project, Renante Dizon

Student Scholarly Projects

Practice Problem:There was a report of a high rate of medication errors from inaccurate medication reconciliation during admission to a local hospital in South Texas. The medication error rate was 14.88% on 20 reviewed charts, and 85% of all evaluated charts contained at least one medication discrepancy.

PICOT: This evidence-based, system-change project was guided by the following PICOT question: For nurses administering medication in a long-term acute care hospital, does the implementation of Medication Reconciliation Timeout Process (MRTP) decrease the medication errors, compared to the usual medication practice, in one month?

Evidence: Thirteen pertinent studies recommended the use of …

New Graduate Nurses Experiences During Their Transition From Novice To Competent And How Mentorship Post Residency Affect Their Experiences, Kelsey N. Murphy

MSN Capstone Projects

Staffing competent nurses in specialized areas poses a unique challenge to hospitals across the country. Competent and experienced RNs are leaving the bedside for a multitude of reasons including dissatisfaction in workplace environment, retirement, and hospitals are facing a shortage of skilled nurses in acute care (Valdez, 2008). To address this growing concern and meet increasingly complex health care demands, hospitals are relying on nursing schools to produce competent graduate nurses (GNs) (Valdez, 2008). Hospitals recruit and hire GNs for highly specialized roles in acute care areas despite the stressors accompanied with these roles. Clinical educators have the opportunity to …

Tele Critical Care Implementation And Education Project, Jeffrey Dover

Master's Projects and Capstones

Abstract

Problem: The intensive care unit has the highest rate of mortality and patient care costs in the hospital. There are significant challenges in improving care and controlling costs. One solution adopted by many healthcare organizations is intensive care telemedicine. Commonly known as eICUs or Tele Critical Care (TCC). These specialty units provide access to intensivists and nurses 24-hours a day and has shown success in reducing mortality and length of stay while providing cost savings.

Challenges exist in introducing telemedicine to a new setting. Barriers identified are high initial cost of equipment, competing priorities for resources, and nurse acceptance. …

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …

Keeping Patients Vertical In The Intensive Care Unit, Melanie Smith

Master's Projects and Capstones

Problem: The critical care patients in a large medical center in Northern California are not consistently optimized medically for mobility and are not mobilized to their maximum capacity. The contributing factors to these problems include poor adherence to standard workflows, insufficient staff knowledge on use of mobility equipment and documentation of activities performed, inadequate provision and utilization of mobility equipment, reduced interdisciplinary staff motivation and skill, and inconsistencies in staffing levels/availability to meet the personnel needs to mobilize patients.

Context: Microsystem and culture assessments with gap analysis were performed to assess the need for quality care improvement. The microsystem’s current …

Is This Really Happening? Family-Centered Care During Covid-19: People Before Policy, Terri Savino, Karri Crispino

Patient Experience Journal

In the middle of a global pandemic, hospitals created policies for visitor restrictions to reduce the transmission of coronavirus to protect patients and staff and developed protocols allowing only one support person to call the critical care unit for patient updates. Late on a Tuesday afternoon, the Manager of Patient Experience received a phone call asking her to call Karri, the wife of one of our patients who was on a ventilator. Karri was struggling with updating her mother-in-law because she was very upset with the news she received, making it difficult to call her husband’s mom. Karri asked the …

Sepsis Pathophysiology, Samantha Kingsley

Nursing Student Class Projects (Formerly MSN)

Sepsis is one of the most common diagnoses in medical intensive care units (MICUs) worldwide. Sepsis is a medical emergency where prompt intervention is vital to promoting positive patient outcomes. Septic shock develops when sepsis has progressed to the point of persistent hypotension despite appropriate fluid resuscitation. It is important to recognize the early signs of sepsis and intervene to prevent further progression. As the understanding of the pathophysiology has developed further over the years, the treatments and outcomes associated with sepsis have also improved. However, prompt recognition and intervention have always been at the forefront of management and should …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …

Malignant Hyperthermia, Kathryn Hernandez

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia (MH) is a condition in which the body goes into a hypermetabolic state affecting skeletal muscle in response to receiving inhaled anesthetics or the neuromuscular blocking agent, succinylcholine. MH is an autosomal dominant disorder that is most closely related to a defect in the ryanodine receptor. The defective receptor causes a rapid increase of intracellular calcium causing hyperthermia, tachycardia, tachypnea, hypercapnia, increased oxygen consumption, acidosis, hyperkalemia, muscle rigidity, and rhabdomyolysis. With the complexity of this disorder and its unique pathophysiological process it is crucial that all parts of the surgical team, especially anesthesia providers, understand how to treat …

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Aortic Stenosis, Christina Lower

Nursing Student Class Projects (Formerly MSN)

Aortic Stenosis is the progressive and permanent narrowing of the aortic valve that is located between the left ventricle and the aorta. The pathophysiology is endothelial damage to the valve resulting in lipid penetration, calcific changesand valve stiffness.Major risk factors for aortic stenosis are natural aging>60 years(atherosclerotic changes in vasculature) and male gender.In the early phases of aortic stenosis, the body compensatesvia hypertrophy of the left ventricle to accommodateforthe increased pressure gradient. Progression is typically over years to decades untildecreased outflow of blood leads toinadequate perfusion to major organsystems including the heart itself. Patientsdo not typically have symptoms until …