Perioperative, Operating Room and Surgical Nursing Commons^™

A Quality Improvement Initiative To Reduce Pressure Ulcers In Spinal Cord Injury Patients, Nicholas Post

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Pressure ulcers are a significant concern for hospitalized patients, leading to various complications and increased medical costs. Despite common preventative interventions, pressure ulcer rates remain elevated. The prevalence of pressure ulcers contributes to patient suffering, extended hospital stays, increased healthcare expenses, and even fatalities. This emphasizes the critical need for additional prevention strategies. The reported increase in pressure ulcer injuries among spinal cord injury patients in the Surgical Intensive Care Unit (SICU), along with 7E and 8NE step-down units, at a large academic hospital highlights the pressing issue.

Purpose: The purpose of this project was to develop and …

The Impact Of Night Shift On New Nurses: Effects On Mental Health And Work-Life Balance, Avery Windham, Abby Maruskin, Elizabeth Yoder

Williams Honors College, Honors Research Projects

This research examines the impact of night shift schedules on new nurses' mental health and work-life balance as they transition into professional practice. The transition from nursing school to the workforce presents challenges that are further compounded by shift work, which can disrupt circadian rhythms and contribute to stress, fatigue, and reduced job satisfaction. The purpose of this research is to evaluate how starting on night shift versus day shift influences nurses’ self-evaluation of work-life balance within their first year of practice. This systematic review synthesizes findings from peer-reviewed sources to assess the physical, emotional, and professional consequences of night …

Professional Quality Of Life Among Medical Surgical And Telemetry Registered Nurses, William Lim, Emy-Lee Marie Anglo Ricafrente, Jenny Carrillo

Publications 2026-present

No abstract provided.

Promoting The Use Of Smoke Evacuation Systems In The Operating Room: A Quality Improvement Initiative, Andrea Leigh Drayer

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Surgical smoke produced during procedures poses serious health risks to operating

room (OR) staff and patients, yet many hospitals, including an academic medical center in

northern West Virginia, have underutilized smoke evacuation systems. The imminent

enforcement of West Virginia House Bill 4376, mandating smoke evacuation use, provided both

urgency and opportunity for an intervention.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project

was to increase timely compliance with the use of smoke evacuation systems during all smoke-

producing procedures, ensuring alignment with safety standards and legislative requirements.

Methods: A systematic evidence review of academic …

Enhancing Tray Integrity: A Quality Improvement Project To Reduce Central Sterile Processing Defects, Ashley Conn

DNP Projects

Background: Instrument tray defects contribute to surgical delays, workflow disruptions, rework in sterile processing, inefficient instrument utilization, and patient safety risks.

Purpose: The purpose of this quality improvement project was to reduce orthopedic instrument tray defects through targeted education and standardized tray audits with double-check verification in a large academic medical center.

Methods: A quasi-experimental pre-post design was utilized to evaluate the impact of the intervention. Tray errors were captured using a standardized binary indicator. Staff satisfaction and confidence surveys were measured using Likert-scale surveys.

Results: Orthopedic trays were analyzed before (n=1,017) and after (n=941) implementation. Post-implementation, tray errors decreased …

Improving Compliance With Preoperative Antibiotic Protocols For Cardiac Implanted Electronic Devices: A Quality Improvement Project, James Kaup

DNP Projects

Abstract

Background

Cardiac implantable electronic device infections remain a serious complication of permanent pacemaker implantation despite evidence-based infection prevention guidelines.

Local Problem

An academic electrophysiology laboratory identified inconsistent guideline-concordant antibiotic selection despite consistently high compliance with recommended antibiotic timing.

Methods

A nurse-led, quasi-experimental pre-post quality improvement project evaluated implementation of a standardized preoperative antibiotic prophylaxis protocol. Data from 36 permanent pacemaker implantations (16 pre-intervention, 20 postintervention) were analyzed.

Interventions

The intervention included a standardized antibiotic protocol, multidisciplinary staff education, and performance feedback.

Results

Guideline-concordant antibiotic selection improved from 37.5% to 95.0% (χ² = 11.27, P = .001). Antibiotic timing remained …

Improving First Case-On-Time Starts In The Operating Room By Implementing A Visual Patient Readiness Assessment Tool: A Pilot Quality Improvement Project, Xochitl I. Miranda-Khayat

Doctor of Nursing Practice Final Project Abstract

Purpose

Delays in first case on-time starts (FCOTS) impact operating room (OR) efficiency, causing compounding schedule delays. This quality improvement (QI) project implemented a visual readiness tool to standardize communication and increase FCOTS rates.

Background

The project was implemented in a 5-room OR in an academic teaching hospital in the Texas Medical Center.

Methodology

Plan-Do-Study-Act (PDSA) cycles and the Consolidated Framework for Implementation Research (CFIR) guided continuous improvement and contextual factors evaluation. Following multidisciplinary education, the visual tool was implemented. De-identified FCOTS data was extracted from the electronic health record (EHR). Qualitative feedback was gathered via Qualtrics (n=17 pre-implementation) and …

A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Improving Operating Room First-Case On-Time Starts And Reducing Turnover Times: A Quality Improvement Project, Ashley Cote

Master's Theses and Capstones

Abstract

Background: Delays in first case on-time starts (FCOTS) contribute to decreased operating room (OR) efficiency, increased healthcare costs, workflow disruptions, and reduced staff and patient satisfaction. Evidence suggests that standardized workflows, improved communication, and Lean Six Sigma methodologies can improve perioperative efficiency and reduce delays.

Local Problem: Baseline data from a local OR microsystem demonstrated an FCOTS rate of 77%, below the organizational benchmark of 80%. Root cause analysis identified inconsistent preoperative workflows, communication gaps, and variable staff adherence to standardized processes as primary contributors to delayed first-case starts.

Methods: A quality improvement project utilizing the Define, Measure, Analyze, …

A Quality Improvement Initiative: Implementing An Effective Massive Transfusion Protocol Cognitive Aid Tool Within An Operating Room & Post-Anesthesia Care Unit Setting, Jenna L. Farrell

Master's Theses and Capstones

Abstract

Background: Massive Transfusion Protocol (MTP) activations are low-frequency, high-acuity events in the post-anesthesia care unit (PACU) setting.  These events necessitate the rapid formation of codes teams, interdisciplinary communication amongst unfamiliar providers, critical decision-making, high-volume rapid blood transfusions, and critical laboratory marker monitoring.

Local Problem: Due to the infrequent nature of hemorrhagic events in the PACU, nurses may have limited experience participating in these protocols at their institutions, resulting in potential for documentation errors from retrospective back charting, decreased confidence regarding blood product sequencing and laboratory draw timing, and increased cognitive workload overall.  This quality improvement (QI) project implemented …

An Evidence-Based Practice Initiative To Promote Debriefing Within The Obstetrics Surgical Team, Rachel Lynn Runatz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Operating room debriefing is an evidence-based strategy shown to improve communication, efficiency, patient safety, and safety culture; however, debriefing is inconsistently performed in obstetric operating rooms due to workflow, cultural, and time-related barriers.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to increase the frequency of debriefings in the Birthing Center operating rooms at WVU Medicine Children’s Hospital through implementation of a nurse-driven, evidence-based debriefing initiative.

Intervention: A nurse-driven debriefing protocol was implemented using the Iowa Implementation for Sustainability Framework. Interventions included staff education, accessible laminated debriefing documents, identification of nurse champions, leadership support, and …

The Effects Of Music Therapy On Anxiety And Sedation Requirements For Total Knee Arthroplasty Patients Undergoing Regional Anesthesia: An Evidence-Based Practice Pilot Initiative, Kyra Marie Savrese

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Excessive noise in the operating room negatively impacts patient comfort and outcomes, particularly in patients undergoing spinal anesthesia who have the potential for awareness.

Background: Research demonstrates that music therapy is a low-cost, low-risk intervention that reduces perioperative anxiety and sedative requirements. Literature supports the use of music as an adjunct to anesthesia care, especially in orthopedic populations.

Purpose: At J.W. Ruby Memorial Hospital, orthopedic procedures with regional anesthesia expose patients to high noise levels, often leading to increased anxiety, sedation use, and longer recovery times. Addressing this problem aligns with institution goals for safe, patient-centered care.

Methods: Using …

Emergence Delirium In Post-Op Pediatric Patients With Pharmacological And Non-Pharmacological Care: An Integrative Review, Ava Yune, Chloe Renaldi, Morgan Taylor, Jennarose Rangel, Alysa Penicaro

Student Scholar Symposium

No abstract provided.

Mitral Valve Surgery Outcomes, Post-Robotic Assisted Surgery, Compared To Traditional Surgical Procedures: An Integrative Review, Joshua Laborete, Jenna Grace Young, Hannah Fitzgerald, Dylan Crowder, Madelyn Lam, Presely Radar

Student Scholar Symposium

No abstract provided.

Effect Of Implementing Safety Nursing Measures For Maintaining Fluid And Electrolyte Balance Among Critically Ill Patients With Acute Pancreatitis, Marwa Abdo

Nursing

Acute pancreatitis is a severe inflammatory condition that affects the pancreas and causes multiple organ failure. High rates of morbidity and mortality are caused by acute pancreatitis. Early fluid resuscitation, within the first 48 hrs., remains the hallmark for acute pancreatitis management. It lowers the incidence of pancreatic necrosis. Therefore, the foundation of treating acute pancreatitis in its early stages is safe fluid resuscitation. Aim: This study aims to evaluate the effect of implementing safety nursing measures for maintaining fluid and electrolyte balance among patients. Study design: A quasi-experimental research design was utilized in this study. Setting: This study was …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Anesthesia Informed Consent: An Objective Structured Clincial Examination, Joshua Powell

Doctoral Projects

Informed consent is a fundamental component of anesthesia practice and is recognized as professional Standard IV by the American Association of Nurse Anesthesiology (AANA). Despite its importance, anesthesia providers often face challenges in effectively obtaining consent from patients. Within The University of Southern Mississippi (USM) Nurse Anesthesia Program (NAP), a need was identified to strengthen student competency in conducting anesthesia informed-consent discussions. This project developed and implemented an Objective Structured Clinical Examination (OSCE) as a standardized, evidence-based approach to teach and assess informed-consent skills in alignment with the American Association of Nurse Anesthesiology (AANA, 2019) standards. The intervention was designed …

Point-Of-Care Gastric Ultrasound For Preoperative Assessment Of Gastric Contents: An Objective Structured Clinical Examination, Joshua Mann, Michael Sykes

Doctoral Projects

Pulmonary aspiration remains a leading cause of anesthesia-related mortality. The current nil per os (NPO) guidelines are proving unreliable in the presence of delayed gastric emptying due to comorbidities and the increasing use of glucagon-like peptide-1 (GLP-1) agonists. Gastric point-of-care ultrasound (POCUS) use provides a non-invasive, evidence-based, and cost-effective approach to assess gastric content and volume directly. However, limited formal training exists for advanced practice registered nurses (APRNs), and this lack of training contributes to the lack of its utilization. This doctoral project evaluated the effectiveness of an educational intervention that incorporated a didactic lecture as well as a hands-on …

The Fascia Iliaca Regional Nerve Block Using Ultrasound And Landmark Technique: An Objective Structured Clinical Examination For Nurse Anesthetists, Braxton T. Beech, Parker F. Rigby

Doctoral Projects

The fascia iliaca block (FIB) is an effective regional anesthesia technique used in various clinical settings, including operating rooms, emergency departments, and pain management clinics. Despite its advantages in reducing postoperative complications and minimizing opioid use, FIB remains underutilized among Certified Registered Nurse Anesthetists (CRNAs), primarily due to limited exposure and training. This doctoral project examines the implementation of an Objective Structured Clinical Examination (OSCE) as an educational intervention to enhance CRNA proficiency in performing FIB using both ultrasound-guided and landmark techniques.

A pre- and post-test study design was conducted with 18 CRNA participants attending a continuing education workshop. Demographic …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …