Nursing Commons^™

Perceived Barriers Of Early Mobilization In The Intensive Care Unit, Melissa Sonderman, Emily Miles, Joshua Ferge

Doctor of Nursing Practice Projects: College of Nursing

Purpose

Early mobilization of Intensive Care Unit (ICU) patients can improve patient outcomes but also includes barriers to implementation. Nebraska Medicine has continued to have ongoing quality improvement initiatives like the ABCDEF liberation bundles and early mobilization that have been attempted but have never fully come to fruition. This project surveys Nebraska Medicines ICUs staff to better understand attitudes, knowledge and behavior regarding early mobilization using a validated tool. The aim was to identify barriers, so the organization could better understand the needs of ICU staff for future implementations of early mobility and related assessment tools.

Materials and Methods

A …

Cost Benefit Analysis Of Anesthesia Providers Within Gastroenterology Outpatient Practices, Jennifer Buffum Brown

UNLV Theses, Dissertations, Professional Papers, and Capstones

Anesthesia delivery in ambulatory and office-based settings has seen significant growth in the last 25 years. The advances in effective short-acting anesthetic drugs, combined with the rise in demand for minimally invasive surgery, allows for an increase in the number of surgical procedures to be achieved outside the hospital setting. Ambulatory anesthesia promotes patient health by reducing recovery times. It also contributes to sustainability by lowering costs otherwise associated with overnight hospital stays. Patient preferences for minimally invasive outpatient surgery, and faster recovery times have spurred an increased demand for business relationships between modern medical practices and anesthesia providers. Certified …

Trends In Racial/Ethnic Disparities In Postpartum Hospital Readmissions In California From 1997 To 2018, Curisa M. Tucker Phd, Rn, Chen Ma, Mahasin S. Mujahid, Alexander J. Butwick, Anna I. Girsen, Ronald S. Gibbs, Suzan L. Carmichael

Publications

BACKGROUND: Postpartum readmission is an important indicator of postpartum morbidity. The likelihood of postpartum readmission is highest for Black individuals. However, it is unclear whether the likelihood of postpartum readmission has changed over time according to race/ethnicity. Little is also known about the factors that contribute to these trends. OBJECTIVE: This study aimed to: (1) examine trends in postpartum readmission by race/ethnicity, (2) examine if prenatal or clinical factors explain the trends, and (3) investigate if racial/ethnic disparities changed over time. STUDY DESIGN: We examined trends in postpartum readmission, defined as hospitalization within 42 days after birth hospitalization discharge, using …

A 5-Year Longitudinal Structural Equation Model Of Social Isolation And Probable Major Depression Among Participants With Spinal Cord Injury, Chao Li, Susan Newman Phd, Rn, Crrn, Faan, Jillian M. Clark, James S. Krause

Publications

OBJECTIVE: To develop longitudinal structural models of social isolation and probable major depression (PMD) over a 5-year interval among participants with spinal cord injury (SCI). DESIGN: Longitudinal structural equation modeling of self-report assessments collected during two follow-ups (2013 as Time 1, 2018 as Time 2) of a 45-year multicohort longitudinal study. Participants (n = 557) were identified from a specialty hospital in the Southeastern United States and two Midwestern hospitals and were initially enrolled in 1973-1974, 1984-1985, 1993-1994, or 2003-2004. PMD symptomology was measured by the Patient Health Questionnaire-9 (PHQ-9) and was defined by PHQ-9 scores ≥ 10. Social isolation …

Mentorship Program Including Alumni, Nicole Brainin

Doctor of Nursing Practice Projects

The landscape of advanced education in nurse anesthesia presents considerable challenges for Student Registered Nurse Anesthetists (SRNAs), accentuated by demanding clinical hours and the transition from experienced ICU nursing to novice learners. This study explores the implementation of alumni mentorship within Nurse Anesthesia Programs (NAPs) to alleviate these stressors. An initial survey gauged alumni interest in mentorship roles, while a follow-up survey assessed the program's impact on student satisfaction and communication. Findings suggest that engagement and communication frequencies are lower than optimal, while alumni mentorship is perceived positively. Recommendations for enhancing the program include diversified communication channels, structured interactions, and …

Qualitative Vs. Quantitative Train Of Four, Caleb Culbreath

Doctor of Nursing Practice Projects

The growing body of evidence linking residual neuromuscular blockade (NMB) to postoperative complications has underscored the need to integrate quantitative neuromuscular monitoring techniques into anesthesia practice. This study, conducted at a tertiary care center in southern Illinois, investigates the gap between current clinical practices and the latest evidence advocating for objective monitoring. The study utilized a non-experimental pretest-posttest design to evaluate an educational intervention's effectiveness in increasing anesthesia providers' knowledge of quantitative neuromuscular monitoring techniques and enhancing their awareness of the incidence and clinical implications of postoperative residual neuromuscular blockade. Analysis of the pretest and post-test responses revealed significant improvements …

Educating Srnas On Barriers And Facilitators Of Clinical Learning, Mesud Dedic, Richard Heuermann

Doctor of Nursing Practice Projects

A national survey of 143 Student Registered Nurse Anesthetists (SRNAs) conducted by Clancy and Bruinius (2022) revealed that factors impeding effective SRNA clinical education include unstable preceptorship, hostile environments, limited autonomy, and heavy didactic burdens. Clancy and Bruinius (2022) also found that facilitators of SRNA clinical education include rapport with preceptors, effective feedback, strong clinical site orientation, and beginning of day discussions. This project aimed to enhance second-year SRNAs' clinical success by mitigating these evidence-based barriers and employing these evidence-based facilitators by developing a presentation for SRNAs and assessing its effectiveness through a pre-implementation survey and post-implementation survey. The literature …

Emotional Intelligence And Srna Success Utilizing A Sim Experience, Melody Gassoway, Kaleigh Peters

Doctor of Nursing Practice Projects

Student registered nurse anesthetists (SRNAs) face many challenges in meeting the rigorous demands of their doctoral-level training. Research demonstrates that high levels of emotional intelligence (EI) contribute to SRNAs’ academic and clinical success and improve patient safety and quality of care. Simulation is emerging as an educational tool to enhance the EI skills of students training in highly stressful professions and demonstrates promising benefits for SRNAs, such as improved decision-making, critical thinking, self-awareness, and self-regulation (Moriber & Beauvais, 2017; Dix et al., 2021). This doctoral project aimed to determine the efficacy of a high-fidelity simulation for strengthening the EI skills …

Development Of High-Fidelity Simulations For Srnas: Airway Fire And Venous Air Embolism, Ashlyn Russo, Brooke Skaggs

Doctor of Nursing Practice Projects

Student registered nurse anesthetists (SRNAs) must swiftly recognize and treat high-risk, low-incidence complications in a high-stress environment. Most SRNAs do not experience high mortality or rare emergencies throughout their training. This project involves developing and implementing two high-fidelity simulations for airway fire and venous air embolism (VAE) to help SRNAs improve their skills in a safe learning environment. Objectives for this project include examining current evidenced-based literature to determine the efficacy of high-fidelity simulation on the SRNA’s knowledge and performance post-simulation, determining the incidence, pathophysiology, and treatments for airway fires and VAE, creating two high-fidelity simulation scenarios, and integrating the …

Educating Anesthesia Providers On The Physiological Effects And Anesthesia Implications Of Cannabis, Carmel Loud

Doctor of Nursing Practice Projects

In the U.S., currently 37 states have legalized cannabis for medicinal use prescribed by qualified medical professionals (National Conference of State Legislatures [NCSL], 2022). In 2012, the legalization of recreational cannabis began; as of 2022, 19 states have legalized the recreational use of marijuana (NCSL, 2022). This project aimed to optimize care for patients using cannabis by increasing anesthesia provider knowledge about cannabis. The project's aim was accomplished through a thorough review of the current medical literature and implementation of education to anesthesia providers about the physiological effects and anesthesia implications of cannabis. Thirteen CRNAs took a pre- and post-quiz …

Application Of Ultrasound For Difficult Vascular Access In Obstetric Patients, Carly Mccleland

Doctor of Nursing Practice Projects

This project aimed to create a three-tiered educational program to introduce the benefits of ultrasound application for peripheral IV placement in obstetrical patients. The main goals of this project were to increase successful first-attempt IV placement in obstetric patients who may be difficult to obtain IV access on. The first tier of education consisted of presenting findings from the literature review as an educational PowerPoint to all project stakeholders. The second tier of education included stakeholders practicing using the ultrasound for PIV placement on mannequin arms. The third tier, which is still on going, included implementation of the first two …

Best Practice In Airway Management Of The Neonatal Population, Brittaney Montcalm

Doctor of Nursing Practice Projects

The historical idea that uncuffed endotracheal tubes (ETT) are the best method for pediatric airway management is being challenged in today’s current anesthetic practice. Whether to use a cuffed or uncuffed ETT in the neonatal population remains controversial. This project involved a comprehensive literature review of best-practice recommendations for neonatal airway management, focusing on the use of uncuffed versus cuffed ETTs. Literature review findings were presented as an educational PowerPoint presentation, and a quick reference guide for pediatric airway management was developed. A post-implementation questionnaire was administered to determine the effectiveness of the presentation and its perceived application in clinical …

Anesthetic Management Of The Parturient With Increased Intracranial Pressure Disorders, Madeline Olson

Doctor of Nursing Practice Projects

The parturient experiences various physiologic changes that contribute to the potential for increased intracranial pressure (ICP). Patients with preexisting neurologic conditions such as Chiari Malformation I, pseudotumor cerebri, and mass occupying lesions are at significant risk of increased ICP. A literature review was conducted to determine the safest labor anesthesia options for the parturient with increased intracranial pressure. After the literature review, a PowerPoint presentation and reference guide were given to a group of anesthesia providers at a central Illinois hospital that discussed the evidence-based recommendations. A voluntary survey was completed after the presentation to assess an improvement in knowledge …

Local Anesthetic Systemic Toxicity: Last Protocol Development, Implementation, And Evaluation For Healthcare Providers, Rachel Vaughn

Doctor of Nursing Practice Projects

LAST is an uncommon but deadly complication of local anesthetic administration. Healthcare facilities benefit from protocol implementation to help streamline best evidence-based practice. The American Society of Regional Anesthesia and Pain Medicine warrants a LAST emergency protocol for any healthcare facility practicing regional anesthesia. Healthcare personnel encountering patients at risk for LAST must understand the symptoms and treatment of LAST to improve response time and patient outcomes. The project implemented a LAST protocol at a rural hospital in Southern Illinois in July 2023. The investigator held an educational service to discuss the new LAST protocol and implementation. The educational service …

Discharge Lounge Utilization, Jessica Goneh, Areo Comonal

Doctor of Nursing Practice Projects

Efficient hospital throughput is crucial for maintaining quality patient care and managing healthcare resources effectively. This project examines the relationship between hospital throughput, measured by discharge lounge utilization, and the National Emergency Department Overcrowding Scale (NEDOCS) score. A mixed-methods approach was employed, combining quantitative analysis of discharge lounge utilization data with qualitative assessment of staff perceptions and operational challenges. The project was conducted over nine months in a large urban hospital. Results indicate a significant correlation between discharge lounge utilization rates and NEDOCS scores, suggesting that higher levels of discharge lounge utilization are associated with NEDOCS score improvement. Furthermore, qualitative …

Procedural Sedation Training: Competency Verification Through Simulation, Christine Hawknuff

Doctor of Nursing Practice Projects

A 450-bed tertiary hospital in Central Illinois lacked a standardized process for competency verification for procedural sedation care by registered nurses (RNs). Despite recommendations by many organizations, there are no consistent or standardized guidelines for verifying competency in nursing care of the procedural sedation. This project implemented a Procedural Sedation Training Course which comprised an in-person prelearning lecture, a group simulation learning experience, and an individual verification of competency through simulation.

Fifty-six RNs completed the Procedural Sedation Training Course and demonstrated competency through simulation, and 24 of these RNs completed a procedural sedation within the eight-month pilot period. Qualitative and …

Increasing Ob/Gyn Clinic Nursing Staff Knowledge And Comfort Level In Providing Breastfeeding Education, Nancy Moore

Doctor of Nursing Practice Projects

There are well known benefits of breastfeeding for both mother and child, yet the educational support from providers during prenatal visits is not consistent or well-documented. An educational presentation discussing guidelines of breastfeeding education, common breastfeeding problems and barriers to breastfeeding was developed and presented to a “Baby Friendly” hospital-based OB/GYN clinic staff at an urban St. Louis hospital. The goal was to increase staff knowledge and comfort providing education and resources surrounding breastfeeding to be used to increase discussion of breastfeeding during prenatal and postpartum visits. Evaluation of pre and posttest data showed an increase in knowledge regarding managing …

Education For Healthcare Professionals On Protocol For Prostate Cancer Screenings On Inmates, Heather Ackerman, Randi Janae Ballard

Doctor of Nursing Practice Projects

Cancer is the leading cause of death for incarcerated individuals, prostate cancer awareness and screening guidelines are essential areas of focus for healthcare professionals (Puglisi et al., 2021). Prostate cancer screenings recommend that males between the age of 55-69 be informed of evidence-based guidelines and offered these screenings as a part of routine health maintenance (USPSTF, 2018). In 2019, the Illinois Department of Corrections (IDOC) was ordered to follow these guidelines for incarcerated individuals (Raba, 2021). As of 2021, the IDOC had yet to implement these screenings for incarcerated individuals within the state facilities. Two separate one-hour educational sessions regarding …

Pneumococcal And Influenza Vaccine Co-Administration In The Incarcerated Population, Kaitlyn Stroh

Doctor of Nursing Practice Projects

Background/Significance: Streptococcus pneumoniae is responsible for 20-60% of U.S. bacterial pneumonia cases and has a mortality rate of 10-30%. Invasive pneumococcal disease (IPD) occurs when streptococcus pneumoniae invades otherwise sterile sites. Adherence to immunization guidelines is 60-70% effective at preventing IPD. Co-administration of pneumococcal and influenza vaccines has shown promise at increasing uptake of the pneumococcal vaccine and enhancing immunological response. Population/Setting: A state-run Department of Corrections (DOC) clinic system serving just over 30,000 individuals was the site for this project. Incarcerated individuals present an increased risk of contracting pneumococcal disease due to close living quarters. Other risk factors such …

Implementation Of Menstrual Cycle And Fertility Awareness Education For Community Healthcare Providers Serving Guatemalan Women, Alissa Struble

Doctor of Nursing Practice Projects

Research indicates that lack of reproductive knowledge, literacy & academic attrition, lack of educator support, poverty, religion, gender inequality, and decreased access to electronic devices contribute to high numbers of teenage pregnancies in Guatemala. Educating United States (U.S.) healthcare providers and Guatemalan volunteers/workers about fertility awareness using Standard Days Method® (SDM) and CycleBeads® has the potential to empower young Guatemalan women and encourage them to make independent, informed reproductive decisions. In December 2023, a quality improvement project was implemented in a Guatemalan rural health clinic. Likert scale questionnaires were utilized to assess knowledge and comfort levels regarding fertility awareness. Analysis …