Critical Care Nursing Commons^™

Does A Nonstandardized Lactulose Administration Practice Affect Hepatic Encephalopathy In Patients With Liver Disease In The Acute Care Setting?, Mary Broadbent

DNP Projects

PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease …

Influence Of Muscle Strength On Mobility In Critically Ill Adult Patients On Mechanical Ventilation, Audrey R. Roberson

Theses and Dissertations

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated by …

Improving Trauma Activation Guideline Adherence In A Level Iii Emergency Department, Jesus Valdez

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase appropriate use of trauma activation guidelines by nurses in a level III emergency department. Care provided by a multidisciplinary trauma team is paramount for the severely injured patient, as this may facilitate rapid diagnosis and treatment. Trauma related mortality can be significantly decreased through the care provided. Trauma patients require specialized care at a precise time often called the “golden hour” to help prevent death or disability. Almost 30 Texans die every day from trauma related injuries, which averages to 10,000 people each year. Trauma is the leading cause of …

Stem Cell Therapy As An Effective Treatment Method For Traumatic Burn Injuries, Axita Patel

Grace Peterson Nursing Research Colloquium

Effectiveness of Stem Cell Treatment for

Burn Patients: An Integrative Literature Review

Axita Patel

Faculty Sponsor: Elizabeth Moxley

Abstract

Background: Current literature suggests that packing burn wounds with antimicrobial solutions and skin barrier creams are no longer considered to be effective in the patient’s recovery process. Stem cell therapy has been introduced as an alternative treatment strategy that aims to yield reliable and improved patient outcomes.

Objectives: To explore what research has been conducted regarding stem cell therapy as a treatment option for burn patients and to explore the benefits of using the suggested newly proposed method as opposed to …

Nurses Can Do Better At Recognizing And Treating Sepsis, Stefan Lindsay

Grace Peterson Nursing Research Colloquium

No abstract provided.

Sensitivity Of Pain Assessment For Critically Ill, Nonverbal Adults, Ruta Jarmontaviciute

Grace Peterson Nursing Research Colloquium

Abstract

Background: Patient’s self-report is a “gold standard” in assessing pain, yet it is not always possible in critically ill, nonverbal adults. In such cases, the use of reliable behavioral pain assessment tools is paramount to patient outcomes. However, the literature presented conflicting information regarding behavioral pain assessment tools and their sensitivity in assessing pain in critically ill, nonverbal adults.

Objective: This integrative research aimed to explore the effectiveness and barriers in the clinical guidelines of the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) assessment tools for the detection of pain in critically ill, nonverbal adults. …

Patient Experiences In Intensive Care Units: A Systematic Review, Serpil Topçu, Şule Ecevit Alpar, Bilgi Gülseven, Ayda Kebapçı

Patient Experience Journal

The aim of this systematic review is to analyze the data gathered from studies conducted to determine patient experiences in intensive care and levels of the recollection of the intensive care period that were published between December, 1998 – April, 2013. The systematic review was carried out screening of the related publications. The findings of the systematic review were studied under the following two titles: “remembering the intensive care period” and “recalled experiences” of patients. Studying 15 papers which were found suitable to the inclusion criteria of the review indicated that majority of the patients had recollection of the intensive …

Comparison Of The Behavioral Pain Scale And The Critical-Care Pain Observation Tool In Assessing Pain In Ventilated Critical Care Patients, John Weldon

Master of Science in Nursing Final Projects

Purpose: The study aimed to compare the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) in their effectiveness to identify the presence of pain in nonverbal mechanically ventilated critically ill patients. Nurses’ evaluation with the feasibility, clinical relevance, and satisfaction of the tools were also gathered and compared.

Design: This study followed a non-experimental, correlational, comparative design.

Methods: Nurses were recruited from the surgical intensive care unit in a midsized community hospital in the Southeastern United States. After training, nurse participants obtained pain assessments on ventilated critically ill patients at rest, following a normal blood pressure …

Knowledge And Attitudes Of Orthopedic Nurses Regarding Pain Management, Matthew Neumann

Doctoral Dissertations and Scholarly Projects

Nurses are at the forefront in the care of patient pain management; however, many nurses do not possess the knowledge, skills, and attitudes required for best pain management outcomes. Adequate pain management education is often infrequent in academic settings and in post-graduate health care environments. That shortcoming suggests a need to improve pain management education as advocated by The Joint Commission and U.S. Department of Health and Human Services. The purpose of this study is to measure 20 nurses’ knowledge and attitudes regarding pain and pain management while working in an orthopedic setting. It was an evidence-based practice project utilizing …

Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance

Doctoral Dissertations and Projects

Providers of healthcare have continued to focus on addressing patients’ chronic health outcomes. When understanding how to manage chronic disease, there remains many opportunities in facilitation of better management. With such a wide range of individuals who suffer with a chronic condition, better management to address this population is essential. Palliative care aids in accomplishing this task. It was seen that there was a lack of education in relation to palliative care, with perceptions that continued to be a barrier to the utilization of the service. Due to the lack in education, the strongest barrier to palliative care service utilization …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Programs That Can Support Nurses To Reduce Compassion Fatigue And Secondary Traumatic Stress: An Integrative Literature Review, Molly Gruettner

Grace Peterson Nursing Research Colloquium

Compassion allows a nurse to empathize with their patient and their family, but it does not prepare the nurse to cope with stressful events. Repeatedly being exposed to traumatizing events, pain, distress, and suffering can lead to nurse burn-out and fatigue. Compassion fatigue is a unique form of burnout and secondary traumatic stress (STS) encompasses ideas of compassion fatigue and the two terms are often used interchangeably. Objective: The goal of this systematic integrated literature review is to discover interventions to reduce compassion fatigue and STS in trauma nurses Methods: A systematic integrated literature review study was conducted using Ebscohost …

Barriers To Advance Directives, Anna Malia Connor Ticknor

Grace Peterson Nursing Research Colloquium

Abstract

Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of …

Higher Medication Administration Errors Associated With Automated Dispensing System Usage, Jillian Cramer

Grace Peterson Nursing Research Colloquium

According to a report by The Institute of Medicine, medical errors were associated with up to 98,000 deaths and more than 1 million injuries each year in the United States. These errors can result in poor outcomes, which increase harm or death. According to the Pennsylvania Patient Safety Reporting System, up to 15% of errors reported cite automated dispensing cabinets as the source of the drug involved in the error.Nearly 58% to 70% of hospitals nationwide use automated dispensing cabinets. Nurses play a critical role in promoting patient safety by surveilling and intercepting any possible errors that could occur during …

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education …