Perioperative, Operating Room and Surgical Nursing Commons^™

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey

Doctoral Projects

Improper positioning of patients in the lateral decubitus or prone positions can lead to significant complications, including but not limited to: airway and invasive line loss, physiologic derangements, soft tissue injury, and peripheral nerve injuries (PNI) (Barash et al., 2017; Butterworth et al., 2018). Chui et al.’s (2018) analysis found that PNIs accounted for 12% of anesthesia malpractice since 1990, making PNIs costly. PNIs effects are not limited to cost and result in increased lengths of stay, increased pain levels, and decreased quality of life (Wojtkiewicz et al., 2015). The massive effect poor positioning can have requires that the anesthesia …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Nursing Students’ Perceptions Of Using Branching Simulation: A Qualitative Descriptive Study, Mohammad Rababa, Dania Bani-Hamad, Shatha Al-Sabbah

The Qualitative Report

Previous intervention studies have shown that branching simulation (BS) unfolds the complex multidimensional aspects of challenging health problems. The present study aimed to examine graduate nursing students’ perceptions of using BS in professional training. This study used a qualitative descriptive design with semi-structured interviews with a sample of 20 graduate nursing students. Four main themes emerged from the results: (a) BS as a support to students’ professional training, (b) BS leads to changes in clinical practice, (c) whether BS is a stressful learning experience, and (d) BS versus traditional lecturing. The participating students perceived BS as a valid learning tool …

Factors Impacting Organ Transplant Outcomes, Katelyn Grubich

Nursing | Senior Theses

Organ transplants are crucial to the survival of those on the receiving end. With medicine advancing, so has transplantation. Health care providers are becoming more aware of the strategies necessary to prolong the transplanted organ and how to obtain better outcomes. Heart, lungs, kidney, liver, pancreas, and some where more than one organ are involved, are the types of organ transplants performed.

Providing patients information will allow them to be a part of their treatment and can help to ease their anxiety knowing what is being performed and what can be expected. Health care providers must ensure that patients and …

Dnp Final Report: Multimodal Pain Management To Improve Patient Satisfaction In Total Joint Replacement Patients, Dana A. Carns

DNP Final Reports

Pain is a costly result of total joint replacement (TJR) surgery. The effect of pain can extend not only to chronic medical problems for patients but also to the hospital’s bottom line by decreasing patient satisfaction. A systematic literature search was performed, and evidence was appraised that supported the efficacy of a standardized multimodal pain management protocol to decrease pain and improve satisfaction in TJR patients. The evidence-based multimodal pain management protocol was implemented during a one-month period in patients undergoing total knee or total hip replacements. Key outcomes were examined and compared to the body of evidence and to …

Improving The Perioperative Experience Of Patients And Families In A Pediatric Setting, Anjanette Pong

Student Scholarly Projects

Practice Problem: The experience of surgery for pediatric patients and their families can be dependent on multiple factors including adequate preparation, English language proficiency and realistic expectations. Anxiety can contribute to a negative experience that may result in poor outcomes and a damaging reflection of the healthcare team and organization.

PICOT: The PICOT question that guided this project was: In preoperative pediatric patients and their families, how do therapeutic communication style and the provision of information about the perioperative experience affect their healthcare experience over eight weeks?

Evidence: A multi-modal approach to providing tailored preoperative education for the child and …

Uncovering The Benefits Of Naturalistic Blue-Depleted Lighting In Hospitals: A Qualitative Study, Sam P. Cotton

Symposium of Student Scholars

With exponential technological advances, hospitals are tasked with prioritizing which expensive innovations truly impact as many patients as possible to give them the greatest chance of recovering and discharge them earlier. It is no surprise that most of the attention is focussed on pharmaceutical drugs and a variety of different equipment and machinery, but hospital facilities should look into simpler additions that can aid every patient admitted. The use of naturalistic blue-wavelength lighting is something that can benefit each patient’s recovery immensely. Multiple studies have proven positive effects that blue-depleted lighting compared to standard indoor fluorescent lighting has lowered stress …

Objective Structured Clinical Evaluation For Volume Control And Pressure Control Ventilator Modes, Brian Bailey, Anthony Newsom

Doctoral Projects

The purpose of this doctoral project was to create a tool to teach student registered nurse anesthetists (SRNAs) in The University of Sothern Mississippi’s (USM’s) anesthesia program about pressure control and volume control ventilator modes, and how to use them. To accomplish this goal an Objective Structured Clinical Examination (OSCE) was developed. The framework used for creating this OSCE was Kolb's Theory. Kolb's Theory uses a four-stage learning cycle in which the learner encounters a new experience, reflects on the observations of said new experience, conceptualizes or modifies a concept based on this experience, and then applies their idea to …

Teaching Time: Postoperative Urinary Catheter Care In The Preoperative Setting Before Surgery, Lynn Utecht

Master's Projects and Capstones

Abstract

Problem: Patients who have same day surgery often have little or no recall of the postoperative home care instructions when delivered in the aftercare area. The number of instructions that are required for home care, combined with medications given for pain and nausea as well as anesthesia, can make recall of these instructions difficult. The purpose of this quality improvement project was to provide the postoperative instructions for post prostatectomy patients discharged with an indwelling urinary catheter in the pre-operative area before the patient underwent surgery to decrease the length of time the patient spent in the recovery unit. …

Utilization Of A Block Excellence Specialty Team Is B.E.S.T, Lauren E. Pittman

Master's Projects and Capstones

Perioperative registered nurses and anesthesiologists that rely on a process for placing regional anesthesia (R.A.) blocks on the correct side for surgical patients consistently provide high-quality, safe care. Infrequently anesthesiologists place the wrong side peripheral nerve blocks (P.N.B.). Due to the sensitive nature of sentinel events, the frequency of its occurrence at this quality improvement (Q.I.) project site is unavailable. Therefore, a report by Harris et al. (2021) was referenced for the incidence of wrong side blocks (W.S.B.), which were recorded in worldwide, national, and multihospital health care system cohorts as 3.63/10,000, 1.6/10,000, and 1.28/10,000 respectively. The PreOp/PACU nursing staff …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone

Master's Projects and Capstones

Abstract

Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.

Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.

Intervention: A …

Optimization Of Postoperative Length Of Stay, Sadia Imran

Master's Projects and Capstones

Abstract

Problem: The increased patient postoperative length of stay (LOS) is impacting the throughput of the operating room and resulting in prolonged wait time for new post-anesthesia care unit (PACU) admissions from the operating room. The baseline data indicated that average LOS of laparoscopic cholecystectomy patients after surgery was 153 minutes, which is longer than the regional 90-minute standard.

Context: To deliver more efficient care, the healthcare team determined that improving LOS for laparoscopic cholecystectomy patients would increase patient care experience, improve department efficiency, and decrease healthcare cost (Health Catalyst, 2018).

Intervention: The microsystem adopted the continuous improvement methodology to …

Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White

Patient Experience Journal

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the …

Cognitive Preference And Skill Acquisition: The Relationship Between Student Nurse Anesthetists And Certified Registered Nurse Anesthetists Thinking Styles, Thomas Diller

Electronic Theses and Dissertations

Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making.

The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher …

Myasthenia Gravis, Rebecca Wheeler

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …

Anesthetic Considerations For Patients With Aortic Stenosis, Owen Diehl

Nursing Student Class Projects (Formerly MSN)

Aortic Stenosis places surgical patients at greater risk for adverse events during surgery. Due to the pathological process of Aortic Stenosis, the left ventricle must generate high systolic pressures to ensure adequate cardiac output. These increased pressures result in left ventricular hypertrophy, placing the patient at greater risk for myocardial ischemia. For induction of anesthesia, it is imperative to maintain hemodynamic stability as this is where problems arise. Five research articles were reviewed to determine how to administer anesthesia to these patients safely. Additional sources were gathered for a background on the pathophysiology of aortic stenosis. The research articles reviewed …

Reducing Falls Related To Toileting, Brian Locastro

Student Scholarly Projects

Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days.

PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)?

Evidence: Nine high-quality articles supported a toileting …

Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill

Student Scholarly Projects

Practice Problem: Immobility of patients in the hospital intensive care unit can cause longer stays in the intensive care unit and the hospital. Evidence-based early mobilization of patients helps to reduce length of stay (LOS) and avoid many detrimental sequelae, leading to short and long-term debilitation.

PICOT: The PICOT question that guided this project was: In the adult medical and surgical intensive care units (P), how does implementation of a nurse-driven protocol for early mobility (I), affect the LOS in the intensive care units and the LOS in the hospital (O), as opposed to not using a protocol for early …