Critical Care Nursing Commons^™

From The Top Down: Assisting Critical Care Nurses In Coping With Job Stresses, Cynthia R. Bryant

Senior Honors Theses

Critical Care nurses are faced with traumatic scenarios on a daily basis at work and are expected to remain professional in the face of chaos. In the midst of caring for their patients and catering to each family’s emotional needs, their own mental health tends to get pushed aside. Nurses are expected to remain supportive to sick patients and their families while enduring psychologically disturbing images and sounds, witnessing phases of the dying process, and hearing end-of-life care decisions being made. Because these nurses are only human, their energy reserves are rapidly depleted and they are left emotionally exhausted. Nurses …

Nursing Perspective Of Preparedness To Deliver End-Of-Life Care: A Descriptive Study, Caitlin B. Mccann

Nursing Masters

Abstract

Background: Death of patients in the intensive care unit (ICU) is often sudden and unexpected. When ICU care transitions from curative to palliative, nursing staff frequently feel ill prepared to effectively care for dying patients and their families [1, 2]. The purpose of this study was to identify ICU nursing staff’s perception of the effectiveness of current end-of-life care (EOLC) education methods and their preparedness to deliver EOLC to dying patients and their families.

Methods: A newly developed online survey was utilized on Qualtrics survey generator and distributed through social media to allow for snowball sampling. Descriptive statistics were …

Improving Tissue Integrity In Intensive Care Unit Patients, Stacie L. Hearell

Scholars Week

Throughout clinical experiences in western Kentucky intensive care units, it has been observed that critically ill patients are not receiving fully implemented skin care practice according to hospital and company policy. Patients are not turned completely to one side or the other due to size, mechanical intubation, and other medical devices that may be intimidating to staff. Alderen et al., (2011) states that “in mechanically ventilated, critically ill patients, pressure ulcer risk is high and may result in negative patient outcomes and increased healthcare costs.” Gallant, Morin, St-Germain, and Dallaire (2010) state that “In practice, pressure ulcers are indicators of …

Preventing Sepsis Mortality, Karli Tabers

Scholars Week

This research project explores recent evidence based research on preventing sepsis mortality in inpatient units. Sepsis mortality is an increasing problem in the state of Kentucky and demands immediate intervention. At Baptist Health Paducah, 44 deaths were related to sepsis in a 5-month period. Most deaths related to sepsis can be prevented. This research looks at how these deaths can be prevented and how nurses must change their practice to avoid further mortality from sepsis. This paper includes a literature review of recent research proving that sepsis mortality can be prevented by focusing on discharge teaching to all patients, implementing …

Exploring Affects Of Critical Care Work Environments On Professional Quality Of Life, Marissa Monroe

DNP Projects

Burnout and compassion fatigue among critical care nurses can affect individual patients, healthcare systems, and nurses’ health and wellbeing. Both burnout and compassion fatigue have been well described in the literature as key elements that contribute to a nurse’s overall professional quality of life, and can be directly influenced by the health of the nurses’ work environment. The AACN defined six standards of a healthy work environment, which include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. The purpose of this project is to explore which of the AACN Healthy Work Environment standards have the …

Critical Care Nurses' Perceptions Of End-Of-Life Care Obstacles: Comparative 17-Year Data, Renea L. Beckstrand, Nicole Lamoreaux, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years.

Objective: The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since …

The Use Of Physical Restraints In Long-Term Care In Spain: A Multi-Center Cross-Sectional Study, Gabriel J. Estévez-Guerra, Emilio Fariña-López, Eduardo Núñez-González, Manuel Gandoy-Crego, Fernando Calvo-Francés, Elizabeth Capezuti

Publications and Research

Background: Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.

Methods: We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was …

Primary Care "Catches" Up With Behavioral Health, Michael Hannes Thorarinson

Nursing Theses and Capstone Projects

The problems caused by the lack of care coordination between primary care and behavioral health are well documented. Patients with uncontrolled mental health issues along with chronic health problems cost two to three times the health care dollars to manage than patients who have the same chronic health problems but without uncontrolled mental health issues. Despite this, in rural North Carolina, the de facto level of care coordination is none. Mental health and primary care are completely separate, distinct systems that do not routinely communicate. One of the identified barriers to care coordination is the lack of reimbursement for the …

Improving Cardiopulmonary Resuscitation Skills Using Unit Based Simulation, Lesa R. Smith

Nursing Theses and Capstone Projects

The performance and quick interventions by nurses during a code blue event can have significant impact on patient outcomes. Code blue events can be stressful for nurses practicing in the medical surgical environment where, since the implementation of rapid response teams, the number of code blue events has decreased. The traditional basic life support (BLS) offering in the acute care settings offers nurses the opportunity to practice cardiopulmonary resuscitation (CPR) with manikins and automatic external defibrillators (AED). However, the experience is lacking real working environment teams and equipment in which nurses practice every day. It is also well documented in …

Telephone Follow-Up To Reduce The Readmission Rate In Gynecologic Oncology Surgery Patients, Karla Kenyon Fernandez

Nursing Theses and Capstone Projects

Unplanned hospital readmissions are commonly viewed as a marker of poor quality care and result in increased costs for both healthcare institutions and patients. Factors associated with readmission for gynecological oncology patients can be related to the radical surgical interventions required for the management of their disease, as well as complex comorbidity profiles, surgical complexity, cancer stage, and perioperative complications. The purpose of this study was to explore and examine the impact of nursing-led telephone follow up on the reduction of the readmission rate in gynecologic oncology abdominal surgery patients following initial discharge post-operatively. A cross-sectional research study was used …

Utilization Of Emergency Departments: Examining Patient Perception Of Urgency, Susan Dale O'Shields

Nursing Theses and Capstone Projects

Nationwide volumes of those utilizing an emergency department (ED) for care have increased significantly over three decades with health professionals witnessing a significant increase of those triaged as non-urgent. Despite alternative healthcare resources, utilization has continued. Multiple factors are influential in the decision-making process with seriousness of condition having a direct link. However, a gap of knowledge exists between the professionals’ actual measured level of acuity and the patient’s perceived level. The term “urgency” has no standard definition in healthcare. Few studies have examined urgency from the patient’s perspective. The purpose of this study was to identify primary factors influential …

Registered Nurse Satisfaction: The Impact Of Organizational Communication On Satisfaction Among Registered Nurses In The Acute Care/Hospital Setting, Lori Michelle Lovelace

Nursing Theses and Capstone Projects

Organizational communication can impact the satisfaction of registered nurses in the acute care hospital setting. With the projected growth of the nursing profession, recruitment and retention of registered nurses is essential in building a highly engaged workforce. Literature review identified areas that impact nurse satisfaction including salary and benefits, nursing leadership, nursing engagement, and nursing workload and staffing. The researcher recognized a gap in the literature regarding the impact of organizational communication on satisfaction of registered nurses in the acute care hospital setting. This study evaluates the difference in the satisfaction of organizational communication among registered nurses who spend less …

Compassion Fatigue And Burnout Of Critical Care Nurses, Lyndsey Brooke Couch

Nursing Theses and Capstone Projects

The purpose of this study was to explore levels of compassion satisfaction, compassion fatigue, burnout, and secondary post-traumatic stress of critical care nurses. Compassion fatigue is a combination of physical, emotional, and spiritual depletion that caregivers experience when they care for patients who are in physical or emotional distress. Compassion fatigue has affected many nurses and has a direct effect on patients' satisfactions. Jean Watson's Theory of Human Caring served as the theoretical framework for this study. The literature shows that there is a prevalence of compassion fatigue of acute care nurses. A quantitative study was performed using the ProQOL …

Effects Of Engaging Hospitalized Heart Failure Patients In A Self-Care Management Protocol On Self-Care Self-Confidence Levels, Michele Denise Blakely

Nursing Theses and Capstone Projects

Delivering high quality heart failure (HF) management and education to empower patients to manage successfully in the community is imperative. Common trends observed impacting HF patients and concerning inpatient nurses on a medical cardiology unit were identified and discussed. Understanding accessing and adhering to a low salt diet, fluid restriction, and daily weights were all commonly identified challenges by direct care nurses of HF patients. Nurses reported increased frustration with patients not knowing or possessing little awareness of their fluid restriction or how to manage or articulate restrictions during the inpatient stay. Nurses felt intake and output (I&O) and daily …

Patient Safety In The Ambulatory Oncology Environment: A Teamstepps® Journey, Tammi Phelps Hick

Nursing Theses and Capstone Projects

Problem: Children have reported that pain and anxiety were the most difficult part of hospitalization, and under treatment of pain and anxiety can have short and long term effects on health outcomes. Most healthcare professionals recognize a link between emotional health and physical health, but this may be especially true for pediatric patients who may not be able to marshal adequate coping skills due to their developmental age. Providing age appropriate alternatives, such as distraction therapy, may result in less invasive treatments for pediatric patients. Distraction therapy is an effective non-pharmacological intervention that is often under-utilized in the acute care …

Patient Characteristics Associated With False Arrhythmia Alarms In Intensive Care, Patricia R.E. Harris, Jessica K. Zègre-Hemsey, Daniel Schindler, Yong Bai, Michelle M. Pelter, Xiao Hu

Collected Faculty Scholarship

Introduction

A high rate of false arrhythmia alarms in the intensive care unit (ICU) leads to alarm fatigue, the condition of desensitization and potentially inappropriate silencing of alarms due to frequent invalid and nonactionable alarms, often referred to as false alarms.

Objective

The aim of this study was to identify patient characteristics, such as gender, age, body mass index, and diagnosis associated with frequent false arrhythmia alarms in the ICU.

Methods

This descriptive, observational study prospectively enrolled patients who were consecutively admitted to one of five adult ICUs (77 beds) at an urban medical center over a period of 31 …

Oral Hygiene Practices In Non-Ventilated Intensive Care Unit Patients, Kimberly P. Emery

Honors Undergraduate Theses

Introduction: Oral hygiene is a significant aspect of nursing care. Endocarditis, stroke, lung cancer, and hypertension have been associated with poor oral hygiene. Research exploring oral care practices for mechanically ventilated patients is well documented. In contrast, oral hygiene for the non-mechanically ventilated acute care population remains underestimated. The purpose of this study was to establish a baseline of the type, frequency, and consistency of oral hygiene being performed on non-mechanically ventilated ICU patients and explore how the oral care provided was documented.

Methodology: A literature search was conducted and reported as a literature review. The databases CINAHL Plus with …

Defining A Person: The Nurse At Risk For Compassion Fatigue, Ellen Johnston

Honors Undergraduate Theses

The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, …

Evaluating Adherence To The Sepsis Bundle And The Effectiveness Of Best Practice Alerts, Kate M. Burnett

DNP Projects

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, …

Evaluation Of Move Early Mobility Screening Protocol In Non-Surgical Mechanically Ventilated Patients In The Intensive Care Unit, Lauren Johnson

DNP Projects

Objective: To evaluate the effectiveness of a previously implemented, nurse driven early mobility screening protocol, called “MOVE”, during its first 6 months of use.

Methods: A retrospective electronic medical record review was conducted (n=100) at Norton Audubon Hospital in Louisville, KY. Eligible electronic medical records were randomly selected and audited for the following variables: age, sex, ethnicity, admission diagnosis, comorbidities, ventilator days, invasive catheters, utilization of vasoactive or inotropic medications, restraint use, continuous sedation medications, Richmond Agitation Sedation Score (RASS), Confusion Assessment Method for the ICU (CAM-ICU), nurse adherence to charting of MOVE enrollment eligibility, physical …