Critical Care Nursing Commons^™

Copd Management And Role Of The Nurse Coach: Increasing Referrals And Participation In Pulmonary Rehabilitation, Carol Upcraft, C. Hoover, Joy Plamann, Jessica Oman

Articles

Chronic obstructive pulmonary disease (COPD) remains a significant cause for hospitalization and with complex management issues upon discharge a significant portion are being re-admitted within 30-days of first hospitalization. The beneficial effects of pulmonary rehabilitation (PR) in the management of COPD is well documented but continues to be underutilized as an important management strategy to reduce hospital readmissions. Transitional care programs which include nurse coaches, have immerged to empower patients to manage their disease and facilitate transitions through multiple care environments. Little is known about the efficacy of such programs on referral and participation in PR and subsequent reductions in …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Pediatric Intensive Care Unit Skin-Care Team, Anna Therianos Konstantin

Master's Projects and Capstones

In the United States, pressure injuries (PIs) cost $9.1–$11.6 billion per year and claim more than 60,000 patient lives. The large Northern California hospital where this CNL project was conducted has had an 8.33% incidence of hospital-acquired PIs at or greater than stage two in the pediatric intensive care unit (PICU). Pressure injury prevention was not a high priority for the nursing staff; nurses were unaware of current PI prevention protocols or the PI prevalence in the PICU. The goals are to reduce PIs by 20% in 3 months, increase PI nursing education, and improve patient outcomes. Nursing skin-care rounds …

Reducing Alarm Fatigue In Critical Care, Janice A. Winfrey

Master's Projects and Capstones

Reducing Alarm Fatigue in Critical Care

Abstract

This improvement project took place on the Critical Care Unit (CCU) of a non-profit hospital in Northern California. The unit houses 54 beds, employs over 210 employees, and houses the facility’s central cardiac monitoring station which utilizes unit staff. The objective was to improve patient safety through reducing the risk of alarm fatigue by decreasing the total number of clinical alarms on the unit. Specified goals included a 20% reduction in the number of alarms sounding on the unit with a 20% reduction in telemetry utilization. Goals were chosen based on unit assessment …

Standardization Of Shift Report By Implementing A Nursing Report Sheet And Addressing Patient Values To Meet Patient Needs, Roman A. Salas

Master's Projects and Capstones

Bedside shift report is a complex process, which involves the transition of care from one clinician to another. The Agency for Healthcare Research and Quality (AHRQ) (2013) reported that approximately 70% of patient adverse events are attributed to communication failures between healthcare providers. Nurses remain inconsistent with information sharing during bedside shift report leading to communication gaps. The object of the clinical nurse leader (CNL) internship project is to provide true patient-centered by standardizing bedside shift report by implementing a nursing report sheet and addressing patient needs. The project was conducted in a level-one trauma center in San Diego, CA …

Improving Stroke Documentation On A Stroke Unit, Yvette Melgoza

Master's Projects and Capstones

The aim of this project is to improve adherence of stroke documentation per stroke protocols on a stroke unit at an acute hospital setting through nursing education and EPIC modifications. A comprehensive retrospective data collection was done to determine the inconsistencies of nursing documentation per organizational protocols. Firstly, a randomized sample of 163 stroke patients (Site 1 = 98; Site 2 = 65) was generated for retrospective data collection. For this project, the main focus was Site 1 (n = 98). The sample from Site 1 consisted of 4 types of stroke patients, which were patients who either received alteplase …

An Eicu/Icu Collaborative To Reduce Sepsis Mortality, Laura S. Maples Ms.

Master's Projects and Capstones

Sepsis costs over 20 billion dollars annually to treat making it the most expensive diagnosis for hospitals (Afrefian, et al., 2017) and carries with it an average mortality rate of 45% (SCCM, 2016). The eICU/ICU collaborative project was developed to improve sepsis mortality at Sutter Health’s Solano hospital affiliate from 41.2% to the system-wide goal of 18.8% over the course of a year by implementing two technologies. The first was the onboarding of the non-invasive cardiac output monitoring (NICOM) technology by Sutter Solano to fulfill the 6-hour bundle compliance for septic shock resuscitation. The other technology was the activation and …

Delirium: A Cnl-Led Protocol To Clear Up The Confusion, Shanda N. Whittle

Master's Projects and Capstones

Project objectives: Delirium is a form of organ failure defined as an acute change in cognition, evidenced by altered consciousness and impaired attention that fluctuates over time, and is associated with increased morbidity, mortality, and healthcare services utilization. In the hospital where this evidence-based practice project took place, there was no formal protocol or guideline for assessing or managing delirium. Therefore, this project focused on improving the practice of identifying patients at risk for developing delirium with the AWOL tool and treating patients with signs and symptoms of delirium found using the Short-CAM assessment. Population and setting: This project took …

Implementation Of Sbar Reporting In The Ed, William Russel Carpenter

Master's Projects and Capstones

Implementation of SBAR reporting in the ED

Abstract

In our emergency department, reports given to the accepting floor nurse, transfer of care between emergency department nurses and nurses reporting to physicians are given in many different formats with no continuity. It has been reported that 1,744 deaths and $1.7 billion in hospital costs related to miscommunications (CRICO Strategies, 2015). With the implementation of the SBAR reporting tool, we can begin to see a decrease in miscommunications, and improve patient and staff satisfaction. The SBAR framework not only enhances the clarity and efficiency of communication between team members but also assures …

The Application Of Grounded Theory: An Example From Nursing Workforce Research, Latoya J. Lewis-Pierre 4572586, Joann Kovacich, Linda Amankwaa

The Qualitative Report

The application of grounded theory was the conduit to theory development in this study. The intent was to explore nurse manager, educator, preceptor, and new graduates’ perceptions of workplace readiness for new graduates entering an Intensive Care Unit. Research participants were drawn from five different ICUs: Medical, Coronary Care, Surgical, Neuroscience, and Trauma. One-on-one interviews were conducted to collect participants’ perspectives on readiness to practice in the ICU. Using grounded theory, four themes emerged giving rise to the novice nurse embracing the ICU theory (NNEIT). Reflections on the type of grounded theory used, reasons for the selection, challenges faced in …

Rural Emergency Nurses’ Suggestions For Improving End-Of-Life Care, Renea L. Beckstrand, Kelly E. Smith, Karlen E. (Bethy) Luthy, Janelle L. B. Macintosh

Faculty Publications

Introduction: Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments.

Methods: A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify …

End Of Life Care Practices For Patients Who Die In Intensive Care Units (Icu), Jila Ghabeljoo

Doctoral Projects

Today, one in five hospital deaths happens in the intensive care unit with the expectation of twice as many by 2030. Increasing, mortality has triggered a growing attention to end-of-life (EOL) care in the ICU. However, the lack of coveted EOL and palliative care skills creates a challenge for ICU nurses. The aim of this study was to assess the current practices of EOL care in the ICU. In this quantitative research, a retrospective chart review method was employed to analyze the collected data from a population 60 EOL patients who died in the ICU of a Southern California hospital. …

The Influence A Multiple Teaching Modalities Course On Knowledge And Self-Confidence Of Newly Trained Emergency Nurses, Anna C. Montejano

Doctoral Projects

Many new graduate residency programs exist supporting new registered nurses (RN) transition from theory to practice, but what is not reported in the literature are programs for RNs transitioning in practice to specialty care units, such as the emergency department. Furthermore, literature addressing the use of multiple teaching modalities as a method in course work is limited. A quasi-experimental design study explored the influence a multiple teaching modalities course on the knowledge and self-confidence of newly trained emergency department nurses. Results indicated using multiple teaching modalities provided a benefit to newly trained ED nurses with an increase in knowledge and …

An Exploratory Study Of The Utilization Of Evidence-Based Pharmacological Treatment On Heart Failure Patients In Mississippi And Its Impact On Readmission, Keri A. Barron

Dissertations

The purpose of this study was to explore the relationship of adherence to evidence-based guidelines for pharmacologic management by select Mississippi hospitals and their hospital readmission rates. This was an exploratory study with a retrospective design. This design offered insight into the relationship between readmissions of heart failure patients and adherence to the national guidelines for the pharmacologic treatment of heart failure. The study took place in a hospital in the southeastern section of the United States. Data were collected from a database of patients with heart failure seen between January 2011 and June 2014.

The unit of analysis for …

Study Of Nurses' Attitudes And Practices Towards Pain Evaluation In Nonverbal Patients, Rebekah Lovin

Senior Honors Theses

Pain, and the appropriate treatment of it, has recently come to the forefront of issues addressed with healthcare providers. Since the cornerstone of pain management is an appropriate assessment, methods of accurate pain evaluation are necessary. This need is particularly important in the population of patients who cannot express their pain. While pain assessment tools are available for use with nonverbal patients and hospitals typically mandate the use of one of these tools, actual compliance with such policy may not actually occur. Various barriers, such as education in the use of a tool, time, and the personal views of the …

Grounded Theory And The Conundrum Of Literature Review: Framework For Novice Researchers, Mohamed T. El Hussein, Andrea Kennedy, Brent Oliver

The Qualitative Report

The issue of the literature review remains a conundrum and a controversy within the discourse on grounded theory methodology. Grounded theory researchers are expected to minimize preconceptions to ensure the concept of interest is grounded in data, yet at the same time are required to evaluate existing literature to support institutional ethics and scientific review of the research proposal. In addressing this dilemma, we espouse that literature review in grounded theory should comprise a multistage nonlinear approach to the literature and introduce a framework for novice grounded theory researchers. This framework offers a reflexive, dynamic and integrative process for conducting …

Post-Intensive Care Syndrome: Comparison Of Educational Interventions To Educate Parents Of Children Hospitalized In The Pediatric Intensive Care Unit At St. Louis Children’S Hospital, Stephanie A. Esses

Dissertations

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS). Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or …

Improving New Graduate Critical Care Nurse Practitioner Knowledge And Retention Using A Dedicated Orientation And Mentoring Program, Katherine Huffer

Dissertations

Abstract

Background: There has been a significant amount of research into the many challenges that nurse practitioners (NPs) face as they transition from school to practice, however, there is limited research on how to improve this transition. Regardless of the setting in which the NPs are working, novices NPs alike report feelings of being unprepared and experiencing high levels of stress, anxiety, fear, and frustration. New research suggests that a comprehensive NP orientation and residency programs may provide a way to integrate the new NPs into their practice environment successfully.

Method: Kern’s Six Step Approach to Curriculum Development for Medical …

The Acute Care Pediatric Nurse Practitioner In Missouri: An Analysis Of Needs Assessment, Jessica L. Mann

Dissertations

Introduction: Due to an increasing number of acutely ill pediatric patients and changing healthcare demands, there is an even greater need for nurse practitioners (NPs) to work in the area of pediatric acute care (AC). There is a lack of alignment of education and certification with the scope of practice of the AC Pediatric Nurse Practitioner (PNP). The development and implementation of a graduate level AC PNP program in Missouri will support the alignment of education, clinical training, and certification with the scope of practice of the AC PNP and improve access to a quality program for nurses that currently …

Cerebrovascular Accident Survival: Strategies Of Flight Nursing And Aeromedical Transport, Alexis Caudle

Senior Honors Theses

Cerebrovascular accidents (CVA), known as strokes, are a leading cause of death worldwide. The delivery and timing of treatment for CVAs is a critical factor in restoring health to the patient. One of the variables in recovery is the method of transport used in bringing the patient to a health care facility. Aeromedical transport remains a valuable resource to achieve full recovery in stroke patients. An ongoing debate of risk versus benefit of helicopter emergency services will be included as well as examination of variables including location, time, physiology of the flight, and the patient’s condition to be scrutinized. In …