Critical Care Nursing Commons^™

Post Evaluation Of A Nurse Driven Early Mobility Program, Paula Halcomb

DNP Projects

The goal of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). The purpose of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program (NDEMP) on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). Nursing staff are responsible for mobilizing patients to their maximum ability twice daily in addition to any therapy provided by Physical and Occupational Therapists. The study was an uncontrolled …

Evaluating Utilization Of An Early Mobility Protocol In An Adult Icu In The Veterans Administration System, Julie Duffy

DNP Projects

Purpose: To evaluate ICU staff’s adherence to a new progressive mobility protocol as part of a quality improvement project in an adult medical-surgical intensive care unit (ICU).

Background: Bedrest can lead to complications for hospitalized patients and current literature supports that mobility within the ICU is safe and feasible for critically ill patients. Current evidence based literature identifies barriers to patient mobilization which can be addressed through implementation of a mobility protocol. Utilization of mobility protocols is one way to improve quality of care and prevent common bedrest complications in the critically ill patient population.

Methods: Retrospective medical record reviews …

Efficacy Of The Adherence To An Evidence-Based Early Mobilization Protocol On Patient Outcomes Post Thoracic Surgery, Blair Eberhardt

DNP Projects

Background: Immobilization is a commonly observed problem for adults in the intensive care unit (ICU) that may lead to ICU delirium, ICU associated weakness, increased length of hospital stay, and increased mortality¹⁷. Therefore, early mobilization has become an increasingly imperative priority regarding the treatment plan for patients in the ICU. Mobilization is often delayed or completed on a subjective provider basis due to scarcity of resources and outdated evidence-based knowledge⁷. This examination of adherence to an evidence-based protocol helps to assess efficiency of therapeutic outcomes regarding early ambulation of surgical thoracic patients in the critical care …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

Family Rounds In The Medical Intensive Care Unit: An Intervention To Enhance Communication, Travis R. Klein

DNP Projects

Background: In the Intensive Care Unit (ICU) family member satisfaction is an important element of quality patient care. Families of ICU patients value communication with care providers and involvement in their relative’s care.

Objectives:

1. To determine if scheduled family rounds each day can improve the satisfaction and feelings of support with decision-making for family members of ICU patients?

2. Evaluate any associations between patient characteristics (hospital length of stay, ICU length of stay, and ventilator days) and family satisfaction?

Methods: This pilot project was conducted in a 12-bed medical ICU led by advanced practice nurses (APRN-MICU). Using the family …

A Biobehavioral Approach To Examining Moral Distress In Critical Care Nurses, Marian Altman

Theses and Dissertations

Moral distress is a complex and challenging problem that may cause negative biopsycohosical and professional outcomes for critical care nurses. The purpose of this work was to explore the relationship between the ethical climate of the work environment and moral distress as experienced by critical care nurses; and to explore relationships among mediators of stress (nurse characteristics e.g. education (BSN, nonBSN), years certified as a critical care nurse, and tolerance of ambiguity) and their relationship with perceived stress, moral distress, health status and salivary alpha amylase. A descriptive correlational cross-sectional design was used for this pilot study of 100 critical …

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Reducing Annual Emergency Department Visits Through Improved Asthma Discharge Teaching, Alvin R. Walters

Master's Projects and Capstones

Asthma is the most common pediatric condition in the United States, and a child's home environment plays an impactful role in the triggering of asthma exacerbations (Harper et al., 2015). Current emergency department (ED) ideology focuses on symptoms management, with little time spent on education, and virtually no attention paid to the home environment. Evidence shows that programs which incorporate home environmental assessments into asthma patient education produce a reduction in annual ED visits, fewer missed school days, decreased use of rescue medications, and improvements in quality of life (Gruber K.J., et al, 2016, Hollenbach J.P. & Cloutier M.M., 2015, …

An Apn-Led Copd Discharge Education Program To Decrease 30-Day Readmission Rates, Moira Elizabeth Kendra

Seton Hall University DNP Final Projects

The purpose of this project was to implement an APN-led COPD discharge education program to decrease 30-day readmission rates. This Doctorate of Nursing (DNP) project combined strategies obtained in the literature search and blended these into a cutting-edge and state-of-the-art discharge education program at a major medical center. The significance of chronic obstructive pulmonary disease (COPD) readmission rates include financial implications, a large number of Medicare patients who return to the hospital within 30 days, poor quality of patient care, and poorly coordinated discharge processes. An APN-led transitional care COPD education discharge plan was implemented on the pulmonary floor at …

Debriefing In The Emergency Department, Alyssa Johnson

Master's Projects and Capstones

Emergency Department (ED) staff are repeatedly exposed to high stress situations and as a result suffer from compassion fatigue, secondary traumatic stress, symptoms of post-traumatic stress disorder, burnout and high turnover rates. Staff turnover is costly to the health system in the form of training new staff and potential poor patient outcomes due to under staffing or inexperience of staff. Based on a survey about debriefing, Level 1 Adult and Pediatric Emergency Department staff reported 81% felt there was inadequate support for critically stressful events that occur. Debriefing was identified by 75% of the staff as an option for support. …

Compassion Fatigue: Exploring The Impact On Emergency Department Nurses, Lauren E. Pittman

Nursing Theses and Capstone Projects

The purpose of this thesis project was to explore levels of compassion fatigue in emergency department nurses. Compassion fatigue has directly affected many nurses’ lives as well as impacting the field of nursing in various ways. Jean Watson’s Theory of Human Caring served as the theoretical framework for the study. The literature maintains that the prevalence of compassion fatigue has been established, yet severity varies among institutions and specialties. A quantitative study to determine the level of compassion fatigue in ED nurses was conducted by utilizing a group on the social media site Facebook that is specific to travel nurses …

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus …

The Effects Of Tranexamic Acid On Mortality Rate In Trauma Patients Compared To Trauma Patients With No Tranexamic Acid Treatment, Bradley Earl Tolar

Doctoral Projects

Traumatic injury is the leading cause of death for many age groups. Traumatic accidents caused over 130,000 deaths in the United States in 2014. This DNP project studied the effects of Tranexamic acid on mortality rate in trauma patients. After the completion of a needs assessment at a local level II trauma center, a literature review was performed. The literature showed a decrease in mortality rate when patients were administered Tranexamic acid within 3 hours of injury with statistically significant statistics. Also, the data from the literature showed no correlation between vascular occlusive events and Tranexamic acid use in trauma …

Regional Anesthesia Introduced Into An Emergency/Trauma, Jennifer Bryant Covalt

Doctoral Projects

Emergency rooms across the United States have an incredibly large number of shoulder dislocations that need to be manipulated and reset on a daily basis. A cost-benefit analysis in this Doctor of Nursing Practice Project will demonstrate a new form of care for shoulder dislocations in the emergency room with certified registered nurse anesthetists (CRNA) providing regional anesthesia with local lidocaine injections into the shoulder joint. A level II trauma center in Mississippi with many shoulder dislocations was the location that was used to evaluate conscious sedation, length of procedure, and pain scores. A retrospective chart review was performed at …

Older Adults Perspectives Of Bed Bathing, Nikki D. Sumner, Katherine C. Hall Phd

Undergraduate Honors Theses

The purpose of this qualitative pilot study is to explore the patient perspectives about what it is like to receive a bed bath. Examining studies of bath basins versus alternative methods has shown a decrease in the spread of nosocominal infections. However, there is not sufficient evidence evaluating the patient perspectives of assistive bed bathing and interactions with nurses and nursing support staff. This information can provide healthcare providers, especially nurses, with a better understanding of patient perspectives and values. It also supports the national healthcare approach towards patient-centered care.

Directly Comparing Handoff Protocols For Pediatric Hospitalists, Elizabeth H. Lazzara, Robert Riss, Brady Patzer, Dustin C. Smith, Y. Raymond Chan, Joseph R. Keebler, Sarah D. Fouquet, Evan M. Palmer

Publications

BACKGROUND AND OBJECTIVES: Handoff protocols are often developed by brainstorming and consensus, and few are directly compared. We hypothesized that a handoff protocol (Flex 11) developed using a rigorous methodology would be more favorable in terms of clinicians’ attitudes, behaviors, cognitions, or time-on-task when performing handoffs compared with a prevalent protocol (Situation Background Assessment Recommendation [SBAR]).

METHODS: Using a between-groups, randomized control trial design (Flex 11 versus SBAR) during a pilot study in a simulated environment, 20 clinicians (13 attending physicians and 7 residents) received 3 patient handoffs from a standardized physician, managed the patients, and handed off the patients …

Liver Transplant Education And Training For Medical Surgical Icu Nurses, Matthew Redila

Master's Projects and Capstones

This project focuses on the CNL curriculum element of Nursing Leadership and explores the need for appropriate education and training for liver transplant as a new patient population for Medical Surgical ICU nurses. The transplant experience for these nurses currently include critically ill Bone Marrow Transplant, as well as stable heart and lunch transplant. The methods used to implement the project were to develop an education curriculum, a clinical orientation program, and a process to ensure proper communication occurs between all parties prior to clinical orientation. The competency-based orientation document, which is still being drafted, is used to determine clinical …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …