Critical Care Nursing Commons^™

Use Of High-Fidelity Simulation Training For New Cardiothoracic Intensive Care Unit Nurses, Bryan Boling

DNP Projects

Critical care nursing is one of the most challenging, high-stress fields in healthcare. This is especially true for nurses in the highly specialized environment of the cardiothoracic intensive care unit (CTICU). The experience level of nurses in critical care is positively linked with patient outcomes; however, with older nurses retiring or moving away from the bedside and younger nurses increasingly moving into advanced practice or management and leadership roles it is becoming more difficult to maintain a high degree of nursing experience in the ICU. Simulation training has been used to provide safe, effective training, and it is even possible …

Do Call-Backs Help Patients Post Stroke, Taylor E. Clark

DNP Projects

Aim and Objective: To determine if the implementation of a post-discharge call-back intervention for patients discharged home from the hospital after stroke was associated with a decrease in 30-day readmissions and improved patient satisfaction.

Background: Stroke is a leading cause of death and disability in the United States (American Stroke Association, 2015). Several studies have examined various post-discharge interventions, including a call to the patient and/or family after their return home, to determine the benefit to patients, if any (Zolfaghari, Mousavifar, Pedram & Haghani (2012). Understanding and anticipating patient needs and removing barriers post-stroke may decrease readmission rates …

Family Presence During Resuscitation: An Evaluation Of Attitudes And Beliefs, Alysia Adams

DNP Projects

Background: Family presence during cardiopulmonary resuscitation has been provided for more than 20 years (Hanson & Strawser, 1992). The American Association of Critical Care Nurses, The Emergency Nurses Association, The American College of Emergency Physicians, The American Heart Association, and The American Academy of Pediatrics have all endorsed family presence during resuscitation (AACN, 2004; AHA, 2000; Dingeman, Mitchell, Meyer, & Curley, 2007; ENA, 1994; Lowry, 2012). Despite validation by distinguished professional organizations, the option of family presence remains inconsistent. Objectives: 1.) To explore the attitudes and barriers to family presence during resuscitation. 2.) To examine the relationship between pre, midpoint …

Need Assessment For Early Identification Of Delirium In Post-Operative Patients In Intensive Care Unit, Raji Rajan

DNP Projects

Background: Delirium is an acute dysfunction of cognition, memory, and attention resulting in changes in perception, mood, and activity. Delirium is associated with increased length of hospital stay, prolonged mechanical ventilator days, increased mortality rate, and a higher number of discharge disposals to rehabilitation centers. The purpose of the study is to assess the current practice in delirium assessment and management strategies among postoperative patients in Intensive Care Units.

Methods: A retrospective medical record review was conducted in postoperative patients admitted to Norton Women’s and Kosair Children Hospital between January 2015 and December 2015. Postoperative delirium was diagnosed in compliance …

Impact Of The Advanced Practice Registered Nurse On The Stroke Patient Population, Jessica Moldenhauer

DNP Projects

PURPOSE: The purpose of this study is evaluate the APRN care model utilized for stroke patients by examining the pre and post impact on outcomes of the stroke clinical practice guidelines (CPGs), patterns of service use, stroke patient outcomes, and patient satisfaction.

METHODS: This study was a single-center, pre-post implementation retrospective study of the impact for the stroke APRN care model on the stroke patient population at Norton Brownsboro Hospital. The sample consisted of 145 patients for the pre-implementation period, March 2012 to August 2012, and 202 patients for the post-implementation period, March 2014 to August 2014.

RESULTS: No differences …

Monitoring For Delirium In The Intensive Care Unit Following The Introduction Of The Confusion Assessment Method For The Intensive Care Unit, Charity A. Batman

DNP Projects

PURPOSE: The goals of this study were to: improve delirium recognition by implementing the Confusion Assessment Method for the ICU (CAM-ICU), evaluate adherence to routine delirium monitoring, measure the incidence of CAM-positive patients, and measure the use of analgesic and sedative medications in ICU patients.

METHODS: This study was a single-center post-implementation retrospective medical record review examining the adherence and incidence of delirium after the introduction of the CAM-ICU assessment on the surgical ICU. Prior to the beginning of the study the surgical ICU nurses were educated on how to assess for delirium using the CAM-ICU instrument. During the six …

Evaluation Of Early Mobilization Strategies In The Mechanically Ventilated Patient Population, Katherine B. Stewart

DNP Projects

Purpose

This practice inquiry project was designed to evaluate current mobility practice and identify associations between mobility practice and specific patient characteristics in a cardiovascular intensive care unit.

Population and Setting

The sample consisted of electronic medical records of adult patients that required mechanical ventilation in a 16-bed cardiovascular intensive care unit in a private, urban hospital in Southern U.S. Of the selected participants, 48 were male and 52 were female with an average age of 64.49 (SD = 14.58).

Inclusion Criteria

Inclusion criteria for this study were patients who 1) were aged 18 and older; 2) were mechanically ventilated …

Review Of Current Mobility Practice In Non-Surgical Mechanically Ventilated Intensive Care Unit Patients, Catharine Morgan

DNP Projects

Purpose: The purpose was to: (i) conduct a retrospective electronic medical record review to evaluate current practice related to mobility, (ii) determine the association between current mobility practice patterns and characteristics specific to the patient population, and (iii) make recommendations for the implementation of an evidence-based progressive early mobility protocol for non-surgical mechanically ventilated patients.

Population: Non-surgical, ventilated patients in the Intensive Care Unit (ICU)

Inclusion Criteria: Ventilated patients at least 18 years old who have been ventilated for at least 48 hours and did not have major surgery lasting more than one hour at any point during their hospital …

Preventing Delirium Through The Implementation Of The Abcde Bundle And Pad Guideline Into Everyday Care In A Community Hospital Intensive Care Unit: Opportunities For Practice Improvement, Mary Zody

DNP Projects

This DNP project focuses on the reduction of delirium through improvement of nursing knowledge of delirium and implementation of evidence based bundle ( Awake, Breathing, Coordination, Early Mobility, and Pain, Agitation, Delirium) into a twelve bed intensive care unit located in a 150 bed community hospital. Specifically, this project will review the literature supporting the evidence based bundle and report on a comprehensive gap analysis which was done to determine areas for practice improvement to reduce delirium and improve patient outcomes. The gap analysis included a comparison of current practice to the evidence, a review of administrative policies/ statements of …

The Emotional Intelligence Of Registered Nurses Commencing Critical Care Nursing, Yvette Nagel, Amanda Towell, Elzabe Nel, Fiona Foxall

Research outputs 2014 to 2021

Background: Critical care is described as complex, detailed healthcare in a unique, technologically rich environment. Critical care nursing requires a strong knowledge base and exceptional clinical and technological skills to cope in this demanding environment. Many registered nurses (RNs) commencing work in these areas may lack resilience, and because of the stress of the critical care environment, coping mechanisms need to be developed. To prevent burnout and to enable critical care nurses to function holistically, emotional intelligence (EI) is essential in the development of such coping mechanisms.

Objective: The aim of this study was to describe the EI …

Improving Patient Care Outcomes To Reduce Recurrent Admissions Of Patients With Chronic Obstructive Pulmonary Disease, Lisa Maria Friedrich

Seton Hall University DNP Final Projects

Purpose:Transitional care is time-limited, with the goal of ensuring safety and health continuity for at-risk patients with chronic obstructive pulmonary disease (COPD) as they move from one setting to the next. An acute care episode of COPD ranges from relatively healthy adults to adults with multiple chronic conditions or those in the end-of-life phase. The primary quality concern of an urgent need to improve health care is in response to the gaps of sufficient experience to manage patients with COPD, leading to hospital readmissions. Implementation of standards of care for the improvement of health-related quality of life (HRQL) of COPD …

Decreasing Risk Of Delirium With Early Progressive Mobility, Donna J. Larson Mrs.

Master's Projects and Capstones

Abstract

The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. This project took place in two, 12-bed critical care units. One is a cardiovascular, medical, surgical intensive care unit and the other is a neurotrauma critical care unit. The methods for implementation included writing the management of pain, agitation, and delirium policy based upon the recommended bundle from the Society of Critical Care Medicine referred to as the ABCDE bundle. As part of this bundle, the progressive mobility policy was revised so that a physician …

Reinforcing Teach-Back Method Regarding Pain Management For Non-Verbal Patients And Their Families, Renee Krystle Doll Lazaro

Master's Projects and Capstones

Pain has been known to have physiologic, psychologic and emotional consequences. Education in pain management has been part for standard care for nurses. The purpose of this study was to reinforce teach-back techniques with nurses when delivering pain management education with non-verbal patients in order to improve patient outcomes in the adult ICU. By using the teach-back method, the nurse will be able to hone a more collaborative approach in dealing with pain, encourage autonomy and include the patient/family in making informed decisions regarding treatment for pain. Reinforcement regarding teach-back was focused on teaching points, and rewording teach-back cues to …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

N653 Fall Prevention Final Project, Sam Clark

Master's Projects and Capstones

N653 Fall Prevention Final Project

by Samuel K. Clark, RN

This project was done with patient safety in mind through the use of the most current EBP available.

Alarm Management: Electrocardiographic Lead Management, Dale Elaine Dominguez Ms.

Master's Projects and Capstones

Abstract

Alarm Management: Electrocardiographic Lead Management

Quality improvement and safety that incorporates the Clinical Nurse Leader (CNL) competency of putting in place quality improvements plans that are bases on evidence, analysis, and risk anticipation is the thesis for this project. The associated problem is the myriads of electrocardiographic (ECG) alarms that alert staff to patient issues each day. Of those alerts, 88% to 90% are false or do not require immediate attention (Sendelbach & Jepsen, 2013). The high numbers of false alerts cause staff to become desensitized to the sound. This desensitization may cause staff not to respond to a …

Triage Training: Improving Access To Care, Leslie D. Simpson-Crawford

Master's Projects and Capstones

Left Without Being Seen (LWBS) rates have been described as “the gold standard of metrics” for high acuity units. In this project, the aim is to increase patient access to care by decreasing both wait times for patients and the LWBS rate for the unit, which approaches 6%. As part of a military hospital, the unit provides for veterans, active duty service members, and their families, with ages ranging from infant to elderly, in a 24 hour acute care hospital setting.

Triage training was identified as a necessary first-step for improving the unit efficiency and increasing patient satisfaction. While the …

Videoconferencing For Improved Access To Care, Alana L. Hernandez

Master's Projects and Capstones

The aim of this project is to increase the amount of education visits completed by pharmacy nurses in an outpatient infusion clinic for patients receiving 5-fluoracil chemotherapy. Two approaches have been applied: securing additional nursing staff; and implementing a telehealth delivery system that utilizes asynchronous video and videoconferencing. The intervention will employ an internet-based application to secure a videoconferencing session between patients and nurses that are 25 miles apart; and offer a patient education video that will be used and an adjunct to videoconferencing. Microsystem data obtained by auditing schedules and patient charts showed pharmacy nurses completed 0% of pharmacy-patient …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Comparison Of Outcomes In Heart Bypass Patients Undergoing Insertion Of An Internal Jugular Vein Central Line By Ultrasound Compared To Traditional Landmark Technique, Sayha Ol Ma

Doctoral Projects

Patients that undergo heart bypass surgery require central line placement from a healthcare provider. To place this device one must use either ultrasound guided or landmark technique. Using ultrasound guided compared to landmark technique may reduce complications. The goal of this project was to determine if ultrasound use of central line placement is a safer practice compared to using the traditional technique.

A retrospective chart review was performed to compare internal jugular central line placement by ultrasound with the traditional landmark placement to evaluate results related to patient outcomes. Data from fifty health records were analyzed using chi-square. The complications …