Critical Care Nursing Commons^™

Dying Well: Improving End-Of-Life For Those Affected By Life-Limiting Illness, Fawna R. Allen

MSN Capstone Projects

Healthcare at End-of-life (EoL) in the older adult with a life-limiting illness is often crisis-driven, incongruent with patient and family preferences, and futile. Advance care planning (ACP) is an effective means of aligning EoL goals of care to values and preferences. ACP near EoL in the United States healthcare system is frequently under-utilized and fragmented. Without timely communication and education regarding EoL care options patients and their families are susceptible to spending their last days consumed by ineffective and potentially painful treatments. Alignment of goals of care with patient and family preferences has been shown to reduce crisis-driven care and …

Qt Monitoring In The Icu: A Benchmark Project, Jeffrey S. Woodward

MSN Capstone Projects

In adult Intensive Care Unit (ICU) patients, does QT/QTc monitoring compared to no QT/QTc monitoring affect mortality or ventricular tachyarrhythmia rates during their ICU stay? Not monitoring changes in the QT interval can lead to poor outcomes since mortality rates are higher in patients with arrhythmias (Uvelin, Pejakovic, & Mijatovic, 2017). Approximately 300,000 sudden cardiac deaths occur in the United States each year with an estimated 15,000 because of a lethal ventricular tachyarrhythmia rhythm called Torsades de Pointes (TdP) that occurs when a QT interval is prolonged (Dave, Bessette, & Setnik, 2017). Some risk factors for developing prolonged QT intervals …

Impact Of Meaningful Recognition On Work Environment Perception Of Critical Care Nurses, Kristin Meinershagen

Dissertations

Problem: Absence of nursing staff recognition can lead to compassion fatigue, burnout, job dissatisfaction, and increased turnover rate resulting in high costs for hospitals. Meaningful recognition has been found to decrease compassion fatigue and reduce burnout. A meaningful recognition program was implemented over a 3-month period for staff nurses in an Intensive Care Unit (ICU) at a large midwestern, metropolitan hospital to determine its effect on nurse’s perception of work environment and turnover rate in the ICU.

Methods: This was an observational, descriptive, cohort design utilizing the AACN Healthy Work EnvironmentSurvey instrument for assessing results before and after implementation …

Controlled Donation After Circulatory Death: Benchmark Study, Marilyn R. Strait

MSN Capstone Projects

Abstract

In potential organ donors after circulatory death (P), does the utilization of an evidence-based critical pathway from identification of potential donor to organ donation (I) versus no utilization of an evidence-based critical pathway (C) increase the rate of organ procurement and the satisfaction of donor families with the donation process (O)? A benchmark study was conducted to answer this question, and in short, yes, it does. The utilization of a critical pathway, when individualized to a local population and hospital’s organization increases the organ procurement rate, the donor family satisfaction with the process, and increases staff satisfaction with the …

Healthcare Provider Overlap On Evidenced-Based Practice In Intubated Patients Using The Theoretical Domain Framework: A Case Study, Katie Bull

CUP Ed.D. Dissertations

Intubation by endotracheal or tracheostomy means is a common life-saving intervention bearing significant, yet preventable risk. Evidence-based practice (EBP), intended to mitigate risk, is often inconsistently adhered to by healthcare providers (HCPs) due to a variety of factors, leaving patients vulnerable to adverse outcomes such as ventilator-associated pneumonia or tracheostomy-related stenosis. A review of the literature identified socially related barriers resulting from overlapping roles and expectations of primary HCPs. Little research has been conducted to understand the impact of overlap on EBP adherence. Using the Theoretical Domains Framework (TDF), this case study explored HCP overlap in one critical care unit …

The Effects Of Non-Pharmacological Interventions Consisting Of Earplugs And Eye Masks, Reducing Environmental Factors To Improve Self-Reported Sleep Quality In Icu Patients, Stephen Risch Msn, Rn, Ccrn, Ccns

Doctor of Nursing Practice Projects

Background: Intensive Care Units (ICU) are noisy environments that hinder sleep. Sleep disruption may have negative affects in ICU patients’ recovery.

Aims/Objectives The aim was to determine the feasibility, patient’s comfort level, and the effects of ear plugs, eye masks, and limiting nursing interventions on self-reported sleep quality during ICU stay.

Methods: This quality improvement project was conducted in a community hospital using a quasi-experimental design. Patients in the intervention group wore earplugs and eye masks with limited nursing interventions during nighttime hours compared to patients in the control group who received routine care. Patients subjective sleep quality was measured …

Honoring Patient Do Not Resuscitate Wishes And Reducing Harm During Transitions Of Care: A Quality Improvement Project, Emily L. Kraus

Doctoral Projects

Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.

Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.

Results: Patient charts were audited (N=261 [pre=124; …

Using Non-Pharmacological Interventions To Promote Sleep In The Intensive Care Unit, Regan Kull

Scholars Week

When patients are in critical condition in the ICU, sleep is not prioritized among all of the patients’ other issues. The lack of sleep may result in a decreased immune system and neurocognitive changes producing delirium, potentially increasing the length of stay, and increasing morbidity, especially in older adults and those who have been in the ICU for a long period of time. The purpose of this review of literature is to examine evidence which studied the effectiveness of non-pharmacological interventions on sleep quality of patients in the ICU. Among the evidence for this project, it was found that the …

Utilization Of Music Therapy In The Icu Setting, Danielle York

Scholars Week

This topic was selected in the hopes of bringing awareness to music therapy and the positive benefits it can have on patients and their pain in a high stress environment. The evidence shows that music therapy can have a positive effect on patient outcomes and is a cost-effective measure that hospitals can easily implement. The education needed to implement this intervention would be geared toward patients that nurses could present to them upon pain report. The evidence proves that this is an efficient way to control patient pain and allow for a more relaxing environment.

KEYWORDS: Music, therapy, pain, education, …

Chlorhexidine: The Fight To End Ventilator-Associated Pneumonia, Jeremy Gaspari

Scholars Week

There is a major problem that affects patient outcomes in the hospital setting. This problem is ventilator-associated pneumonia. Ventilator-associated pneumonia is the second most nosocomial infection in critical care patients. A new policy is needed to ensure that interventions are being done to decrease the risk of patients getting ventilator-associated pneumonia. Ventilator-associated pneumonia also has a high risk of mortality. If interventions are being done, the risk of ventilator-associated pneumonia and mortality will decrease. Prophylactic oral care with chlorhexidine solution is show through evidence to decrease the risk of both ventilator-associated pneumonia and mortality rates. The use of ventilator bundles …

Deep Tissue Injuries, Mary Pohlmann, Katie Meyer

Nursing Posters

Purpose Statement from Poster:

• Recognize and identify Deep Tissue Injuries
• Ability to describe and define Deep Tissue Injuries
• Increase awareness of Deep Tissue Injuries in order to promote early identification and treatment

Implementation Of Proper Lead Selection Based On Ecg Practice Standards In Hospitalized Patients, Teresa Jahn, Nicole Hubbard, Samantha Pohlmann, Lauren Hoeschen, Shayna Lahr

Nursing Posters

Ensure adult patients in a 36 bed Telemetry Unit and 14 bed Cardiac Intensive Care Unit (CICU) with the diagnosis of STEMI and NSTEMI are being monitored in the appropriate leads to detect acute or silent ischemia and arrhythmias.

Reduced Frequency Monitoring Post-Stoke Treatment, Melissa Freese

Nursing Posters

In 2020, the nation was faced with a pandemic that quickly depleted health care resources. Standards of care were reviewed to identify opportunities to reduce the burden on healthcare resources. One of the standards of care that was reviewed nationally and locally at the St. Cloud Hospital (SCH), was the postalteplase/ thrombectomy patient placement and monitoring.

The standard of care for the placement and monitoring of post-alteplase patients was established during the 1996 NINDS trial and has not been studied since. Very minimal literature is available on the standard of care for patient placement and monitoring post-thrombectomy.

Molecular Genetic Cancer Screening: Role Of Prediction Of Colorectal Disease In The Clinic Setting, Samantha Spinks

DNP Research Projects

Colorectal Cancer is the third most common cancer in men and women and the second leading cause of cancer related deaths (ACS, 2019). Colonoscopy screening can prevent colon cancer by early detection and removal of adenomatous colon polyps. The ACS has been lowered from age 50 to 45 due to an increase in the prevalence of colon cancer in people below the age of 50 years of age. Molecular genetic screening is a tool that providers can use to identify patients who are at risk for premature adenomas. People who have a genetic variant are more likely to develop adenomas …

Predictors And Outcomes Of Invasive Mechanical Ventilation, Ailin Puckett

DNP Research Projects

Objective: Invasive mechanical ventilation (IMV) is lifesaving and one of the most common interventions implemented in the intensive care unit (ICU). More than half of the patients in the ICU require IMV within the first 24 hours after ICU admission. This project aimed to evaluate and predict the mortality rate of hospitalized patients on IMV by examining their risk factors, such as patient demographic characteristics, disease status, social environment, and discharge status.

Methods: The National Inpatient Sample (NIS) database 2016 was used to identify patients requiring IMV. Mortality was the dependent variable. Independent variables had four major categories. First, patients’ …

Barriers To Care Among Uninsured Patients With Chronic Disease In A Free Clinic: A Quantitative Study, Stephanie Jinright

DNP Research Projects

No abstract provided.

The Observational Investigation Of Vitamin D And The Effect On Hypertension (Oiveh) Study, Warren Burke

DNP Research Projects

Background

It is uncertain if vitamin D supplementation improves cardiovascular health, more specifically, the systolic and diastolic blood pressures, and the data from previous trials investigating supplementation and the effects on the blood pressure are limited.

Methods

The following scholarly project was a retrospective observational study, examining randomly selected participants with chronic kidney disease and hypertension from a local nephrology practice. The Student’s t-test, Pearson’s r correlation, and ANOVA statistical tests were utilized to determine if vitamin D supplementation improved the systolic and diastolic blood pressures.

Results

A total of 260 participants were examined. The mean systolic blood pressure …

Debriefing Emergency Department Nurses During The Covid-19 Pandemic, Jessica Hailstock

Master of Science in Nursing Theses and Projects

This study examined the consequences of increased stress experienced by emergency department nurses related to the COVID-19 pandemic. The goal was to acknowledge that this particular population of nurses already experience high levels of stress and that being on the frontlines of healthcare during a pandemic exacerbates the issue. Nursing leaders within the emergency department must acknowledge and monitor the nurses’ stress. Findings suggest that debriefing led by qualified individuals is a powerful intervention to combat the negative effects of stress.

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

Gratitude Journaling As Intervention To Combat Nurse Burnout In Cardiac Surgery Intensive Care Nurses, Melinda Simpson

Master of Science in Nursing Theses and Projects

As a practicing registered nurse in the intensive care setting, this researcher witnessed an episode of burnout characterized by a public meltdown, crying, and yelling. This sparked an interest in an intervention to combat nurse burnout. Literature was found on gratitude which has been found to increase resiliency. An increase in resiliency, in various populations, has been found to decrease perceived stress and feelings of burnout. This researcher investigated the use of gratitude journaling for 21 days as means to decrease perceived stress and feelings of burnout while increasing gratitude and resiliency. The PSS, GQ, BRS, & BBI tools were …