Critical Care Nursing Commons^™

A Compilation Of Written Instructional Practice Reflections On The Acue (Association Of College And University Educators) Course In Effective Teaching Practices, Sheryll Go

Q2S Enhancing Pedagogy

This is a compilation of written instructional practice reflections on The ACUE (Association of College and University Educators) Course in Effective Teaching Practices, from January – April 2020. This online course has prepared Nurse Educators like me in gaining a foundation in evidence-based teaching practices that increase student motivation, engagement, and learning. The attached assignment include reflections from completed modules.

Eliminating Routine Gastric Residual Volume Assessments In The Intensive Care Setting, John Marshall Smith

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

This evidence-based project sought to evaluate the practice change of routine GRV elimination within a 14 bed adult intensive care unit (ICU) at a large teaching hospital in the southeastern United States. For decades, the gold standard to determine tolerance to enteral nutrition (EN) has been routine GRV assessments via aspiration. However, recent studies have concluded the practice ineffective. Critical Care guidelines published in 2016 now recommend cessation of routine GRV assessments (Ozen, et. al, 2018). In-servicing, education, and implementation of a validated protocol from the University of Virginia Medical Center was used to enact the practice change. A 30-day …

Family-Centered Care In The Neonatal Intensive Care Unit, Sarah Brown

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Family-centered care has not always been integrated with patient-care. In the mid-1900's, a movement began that altered the role of the family from observer to participant. With the help of family advocates, inclusive practices and partnerships between families, patients, and providers was initiated (Kuo et al, 2012). Now, family and patient-centered care is a widely practiced form of individualized care and relationship building between families, patients and their providers. Five principles shape the foundation for family-centered care. These include information sharing, respect and honoring differences, partnership and collaboration, negotiation, and care in the context of family and community (Kuo et …

A Protocol Driven Stroke Code's Impact On Door-To-Needle Times, Jesse Osborne

Electronic Theses and Dissertations

Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

The Need For Change In Emergency Medical Approach When Caring For Individuals With Autism, Hannah Watkins

Undergraduate Theses and Capstone Projects

This paper highlights the need for policy changes and additional training related to caring for individuals with autism in emergency situations. Individuals with autism spectrum disorder are at risk of receiving inadequate care due to the challenges that come with such a complex diagnosis. Depending on the severity of autism for each individual, behavioral outbursts and aggression can often occur due to the overwhelming amount of stimulation in the emergency department environment. While medical professionals have the potential to be a great help during times of crisis, there is often very little training given to providers in regard to delivering …

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.

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’ …