Capstones: Master of Science in Nursing: 2021

BEGLIN, Ashley, MCMAHON, Janae, & PIKA, Jessica. (2021). The purpose of this evidence-based problem project was to examine the effective identification of postpartum anxiety using the Perinatal Anxiety Screening Scale (PASS) as compared to the Edinburgh Postnatal Depression Scale (EPDS). A comprehensive literature search in the CINAHL complete, Medline complete, and ProQuest Nursing and Allied Health databases was conducted to gather information on the topic of screening methods utilized to identify perinatal anxiety. Three quantitative research level VI descriptive studies were selected and systemically reviewed for quality of evidence, validity of the scientific methodology, reliability of statistical findings, and overall applicability in medical practice. Two studies provided findings identifying the EPDS measurements involved identification of depressive symptoms rather than symptoms associated with perinatal anxiety. One study provided strong evidence that the PASS identified 68% of women diagnosed with an anxiety disorder compared to 36% detected through the utilization of the EPDS in the same perinatal population. Further comparative research in larger perinatal populations is indicated to further solidify the PASS as the primary screening tool to utilize in the identification of perinatal anxiety as compared to the EPDS. This evidence-based project concluded the PASS as a valid and useful instrument for the identification of pregnant women and new mothers who present with problematic anxiety.

KOCH, Shelly, SCHLEIDT, Alissa, SCHLICHTING, Ann, & O'DONNELL, Shannon. (2021). The purpose of this evidence-based project was to identify best practice ICT interventions having an impact on depression scores among socially isolated older adults. The problem identified is social isolation in older adults can lead to a lack of support and deterioration of physical and emotional health. Nearly one fourth of residents who reside in a facility are socially isolated. There is an increase in early death and other adverse health outcomes from isolation. Depression and suicide are a concern in adult communities, with one fifth of older people suffering from depression. A systematic literature search was completed in CINAHL, Medline Complete, and Psychology & Behavior Science Collection. From these sources 448 articles were reviewed for inclusion, exclusion, and duplication with 7 selected that address all aspects of the PICO question. The analysis confirmed ICT has a positive impact to reduce isolation through a variety of platforms, such as social media, video call/chat, gaming, group exercise, videos, and music. Information Communication Technology (ICT) reduces isolation, loneliness, and increases quality-of-life. The implications for practice include implementation of ICT interventions in skilled facilities during isolation to prevent adverse events. Future recommendations for research include additional research to identify if ICT interventions prevent or decrease depression in those who already have depression compared to those who do not have a diagnosis of depression.

SAK, Holly, KINSER, Kathleen, & DOWNING, Megan. (2021). The purpose of this project is to answer the PICOT question: In youth, ages 10-24 years, how do interventions based on a Gatekeeper Suicide Prevention Training program for nurses compared to no training affect suicide rates? Suicide is the second leading cause of death in those ages 10 to 24 years old. Gatekeeper Training offers options for professionals working with youth at-risk for suicide, offering a promising prevention strategy, yet training programs are highly variant and guidelines for best practice are elusive. Utilizing three databases (CINAHL, Medline Complete and Academic Elite Search), the search strategy resulted in 6 articles selected. The inclusion criteria limited the study methods to quantitative studies yielding the highest levels of evidence including systematic reviews, randomized Level II and nonrandomized Level III quantitative studies. The evidence showed that the costs and resources to implement Gatekeeper training with staff range widely. Gatekeeper programs demonstrate statistical effectiveness regardless of the length of training time ranging from <3hr to >8hr. The role of Gatekeepers is statistically correlated with a positive effect on knowledge and referral/interventions with youth with the strongest effect in schools. Research maintains a stronger positive intervention effect among Gatekeeper programs studied with professionals versus general population Gatekeepers. Comparable rates of suicide across 479 counties found significantly lower suicide rates of all ages of people in counties with funded Gatekeeper Training programs. In agencies servicing youth, the positive effects of Gatekeeper Training programs should be considered with stakeholders aimed at decreasing rising suicide rates.

WALTERS, Mindy, KLUTHE, Melissa, & PEITZMEIER, Laura. (2021). The purpose of this review is to identify integrated care transitional methods that are evidence-based to reduce hospital readmission rates in older adults. Transitional care creates complicated challenges for providers and leaves patients vulnerable to errors and potential hospital readmissions. Discovering ways to fix these gaps in transitional care is essential. How does an integrated transition of care affect hospital readmission rates in older adult patients? A search and analysis of the literature pertaining to the question in four databases (CINAHL, Medline Complete, ProQuest Nursing, and Allied Health PubMed) resulted in six articles representing Level I and II evidence with meta-analysis and a randomized controlled trial. Findings revealed that when specific dimensions of care continuity were addressed, there was a decrease in readmission rates within 30 days of hospital discharge. Common themes were also identified among several articles, including using a patient-centered multidisciplinary approach such as starting early discharge interventions within the acute care setting and continued follow-up in the community with access to resources. Future Recommendations include encouraging administrative support for care transition approaches and education among healthcare providers regarding effective communication styles and community resource opportunities availability. Ongoing research is needed to identify other specific strategies related to interdisciplinary involvement with care transitions.

JANDRON, Nicole, ROBERTS, Kourtney, & WHITE, Marie. (2021). Purpose: Opioid administration can cause several adverse reactions which can hinder the postoperative phase of care. Opioid sparing techniques including ketorolac administration can decrease opioid administration in the post anesthesia care unit (PACU) and optimize recovery postoperatively. PICOT: In surgical patients, how does intraoperative administration of ketorolac, compared with no ketorolac administration, influence opioid administration frequency for pain control in the PACU? Method: A Boolean search was performed using key words developed from the PICOT question. The databases CINAHL, MEDLINE, Academic Search Elite, and Cochrane Control Trials were searched, and inclusion and exclusion criteria were applied to each article found. Six articles were chosen which met all criteria for this evidencebased paper. Analysis: All articles were analyzed by the researchers to determine statistical significance of ketorolac administration effects on pain postoperatively. Results: The research showed how ketorolac administration intraoperatively can reduce opioid administration in the PACU and reduce pain levels after surgery. Recommendations: Future research should be done on specific routes of ketorolac administration intraoperatively and additional surgical procedures to understand the impact of ketorolac on opioid administration frequency postoperatively.

ELSASSER, Dana, KRUGER, Jamie, & RUTTER, Amanda. (2021). Advancements in technology have revolutionized the delivery of healthcare. Nursing professionals have a pivotal role in utilizing information technology, specifically telehealth interventions, to enhance communication channels that lead to high-quality and cost-effective patient care. Telehealth interventions are a modern and advantageous approach in managing Type 2 diabetes mellitus (T2DM), a complex and chronic disease. The widespread and crippling disease of T2DM urges nurses to vigilantly advocate for innovative resources that increase health care accessibility to a diverse patient population. The purpose of this paper was to explore the evidence of nurse-led telehealth interventions that have an effect on disease management in patients with T2DM. The following PICO question guides the research: In adult T2DM patients (P), what is nurse-led telehealth's effect (I) compared with no nurse-led telehealth (C) on disease management? (O). A search strategy conducted from scientific databases, CINAHL, PubMed, and ProQuest, yielded six evidence-based articles that examined the relationship between nurse-led telehealth interventions and T2DM disease management. Nurse-led telehealth interventions can improve disease outcomes, specifically hemoglobin A1c (HbA1c), and profoundly impact psychosocial self-management behaviors with sustained intervention. This study provides evidence regarding the efficacy of nurse-led telehealth interventions to improve T2DM health outcomes. Further studies are needed to identify the most suitable telehealth methods to reach vulnerable populations who have difficulty participating in telehealth services due to socioeconomic barriers.

BIERYLA, Amy, JENSEN, Kelcie, & SINCLAIR, Kathryn. (2021). Central-line associated bloodstream infections (CLABSIs) can have a severe impact on patients. The purpose of this project was to perform a literature search, literature summary, and synthesis of evidence to determine if the use of EBP strategies reduce CLABSI rates of patients in the intensive care unit (ICU). The PICOT question for this project was: In ICU patients who have a central line, how does evidence-based strategies for central line care compared to nonstandard central line care affect CLABSI rates after a six-month time period? CLABSIs can result in increased hospital length of stays, sepsis, and/or mortality. Five articles were analyzed for this project. These articles were critically appraised by the authors to address what the outcomes were when central line bundles were utilized in an adult ICU. The evidence did demonstrate that the use of central line bundles positively affected the reduction of CLABSI rates. The studies demonstrated many different interventions in the care bundles, however, despite the varied interventions, CLABSI rates were reduced as long as practitioners were compliant with the central line bundle. Overall, the use of bundles reduced mortality, reduced costs to the patient and facility, and increased the quality of care and compliance for nursing staff. Future recommendations would be to conduct research on the bundled care approach to standardize a care set to continue to reduce CLABSI rates

SCHOOLER, Elizabeth, CHATMON, Beverly, & KLUG, Tammy. (2021). Diabetes Mellitus is a growing health concern for millions of people in America. Diabetes can lead to complications that cause significant morbidity and mortality, but careful glycemic control can prevent or delay the onset of such complications. Interventions to achieve glycemic control may include lifestyle alterations, medication, and a combination of these methods. The purpose of this evidence-based research project is to answer the following PICOT question: In adult patients with type 2 diabetes, how does implementing a diet and exercise program impact HgbA1c levels compared to treatment with oral antihyperglycemic medication? This systematic review examined studies that focused on medical and lifestyle interventions for the treatment of type 2 diabetes. The research team searched three databases: CINAHL, Medline and Academic for peer-reviewed articles published between 2006 and 2021. Eight articles met the inclusion and exclusion criteria. The quality of evidence presented in each research study was critically appraised using predetermined criteria. Results showed evidence for both exercise and oral medications as effective interventions for decreasing HgbA1c levels in the patient with type 2 diabetes. It appears that a combination of medication and exercise may be the most effective method for managing type 2 diabetes. Research is lacking that directly compares a group of patients using exercise or lifestyle changes to manage their diabetes and patients relying on medication. Future studies comparing each of the interventions to a placebo or control group may lead to a better understanding of best practice for treating type 2 diabetes.

FRITSCH, Shamra, SHIMPACH, Mallory, & WILLIAMS, Haleigh. (2021). Patients in the intensive care unit (ICU) receive sedatives, opioids, and other analgesic medications for prolonged periods of time. With discontinuation of use, signs and symptoms of iatrogenic opioid withdrawal frequently occurs. The purpose of this evidence-based practice project was to identify if initiation of a protocol reduces the effects of opioid withdrawal in patients and improves patient outcomes. In long term ICU patients, how does the use of an opioid withdrawal protocol, compared to the lack of use of an opioid withdrawal protocol, affect the severity of opioid withdrawal symptoms, within the course of six weeks? No standardized withdrawal protocol currently exists for the adult ICU population in the United States. After an extensive literature search, three studies resulted that would help to answer the PICOT question. The analysis of the literature demonstrated that withdrawal symptoms were seen in patients when iatrogenic medications were administered for 72 hours or longer. There was no standardized withdrawal tool or protocol for adult patients. Provider assessments varied on the recognition of withdrawal symptoms. Iatrogenic opioid withdrawal signs and symptoms occur in the adult ICU patient population with prolonged exposure to these medications. Further research is needed to create a standardized withdrawal protocol to recognize symptoms, help reduce the severity of symptoms and to guide withdrawal treatment

MILLER, Jessica, POKORNY, Theresa, & MILLER, Vickie. (2021). Harmful effects of pain medication used during childbearing may be a concern for mothers and babies. Pain management may be difficult and alternatives to pharmacological pain relief may not be obvious. The purpose of this evidence-based project was to analyze the impact of a birthing doula on the need for pharmacologic pain interventions during labor and delivery. The PICO question asked, “In pregnant women, how does having a doula present during delivery compared with no doula present during delivery affect the need for pharmacologic pain interventions?” A literature search was completed in CINAHL, Medline, and Academic Search Elite. Five studies addressing the PICO question and meeting inclusion and exclusion criteria were critically appraised. The results indicated doulas were beneficial and successful at reducing the use of pharmacological pain interventions during labor and delivery. This was achieved by utilizing methods such as constant presence, massage, and physical touch. Further research on utilizing doulas during delivery for pain control is needed.

BARNA, Amber, HUDDLE, Morgan, MCMANUS, Ashley, & YANES, Mercedes. (2021). Approximately five million Americans suffer from Congestive Heart Failure (CHF). The combination of an increasing incidence of CHF, shortage of nurses, and an aging population contribute to higher nurse-to-patient ratios. The purpose of this study was to investigate the impact of higher nurse-to-patient ratios on CHF patient readmissions within 30 days of discharge. This will help improve the quality of care provided resulting in improved patient outcomes. The PICOT for the study was in adult hospitalized patients how do higher nurse-to-patient ratios compared to lower nurse-to-patient ratios impact readmissions of patients with congestive heart failure within 30 days of discharge? After an extensive literature search, four studies resulted which met inclusion criteria for this project. Analysis of these studies demonstrated a strong level of evidence which supported better nurse-to-patient ratios (less patients per nurse) are beneficial for patients and hospitals. The studies in this project all showed better staffing led to improved patient outcomes including reduced 30-day readmission for CHF patients. The findings highlighted improved nurse-to-patient ratios elevated the quality of care provided to this population resulting in improved patient outcomes. The evidence supports that better nurse-to-patient staffing ratios have the potential to impact future practice and education related to lowering CHF patient readmissions. This supports readjusting staffing grids to reduce patients per nurse. This will change not only patient outcomes but will drive staff engagement and retention due to improved working environment.

PAGE, Robyn, POLI, Brandy, & ZAVADIL, Katy. (2021). The rising rate of catheter-associated urinary tract infection (CAUTI) is an increasing concern in hospitalized patients who show signs of postoperative urinary retention. The purpose of this study is to determine infection rates between intermittent catheterization and indwelling catheters postoperatively and the length of time they are being utilized to improve patient satisfaction along with infection rates. This study is based on a review of the literature on postoperative infection rates between intermittent catheterization and indwelling catheters in hospitalized patients, excluding intensive care patients. Analysis of the literature research demonstrated there was no difference in the type of catheterization used and infection rates postoperatively. The results indicated that the type of catheterization does not impact postoperative infection rates, but there was a decrease in infection rates when catheters were removed within 24-48 hours postoperatively. With these results, it is recommended that hospital organizations implement a nurse-driven protocol tailored around postoperative catheter removal times to minimize postoperative CAUTIs. Further research is needed to identify other factors that could strengthen the effectiveness of this nurse-driven protocol

SHAPLAND, Amanda, KELLY, Olivia, & SHIELDS, Shelly. (2021). Immobility while being mechanically ventilated in a Pediatric Intensive Care Unit (PICU) can immensely affect a patient's outcomes. The lack of mobility can lead to increased length of stay, increased risk for a hospital-acquired condition, higher hospital bills, and higher risk of mortality. The purpose of this project was to look at the effect early mobilization can have on patients in the PICU. The PICO question was: In pediatric patients, does mobilization while on the mechanical ventilator lead to a reduced length of stay and improved patient satisfaction compared to no mobilization while on the mechanical ventilator? A literature search was conducted on three major databases: PubMed, CINAHL and Medline. Then a search plan was created using key terms that came directly from the PICO question. After the search was completed and the inclusion and exclusion criteria were met, nine articles were analyzed. Results found that early mobilization can decrease the loss of muscle tone, decrease the need for physical and occupational therapy after discharge, and have a positive impact on the mortality rate with minimal risk of adverse events. The research however, did not have enough evidence to claim that early mobilization for mechanically ventilated patients in the PICU would improve patient satisfaction or reduce length of stay. While these results showed staff felt that mobilization was safe and effective in pediatric patients, more research should be conducted on the outcomes of early mobilization with pediatric patients that require mechanical ventilation.

CECH, Holly, GENOWAYS, Heidi, STASTNY, Brittany, & HOLLAND, Jessica. (2021). Nurses in all areas of practice are faced with end-of-life (EOL) situations and knowing how to best educate patients and families on their decisions, respect their wishes, and advocate for their goals of care are important in providing holistic patient-centered care. Unfortunately, the lack of education and level of discomfort felt by nurses when providing EOL care makes mutual goal attainment and the nurse’s interactions with patients, families, and other healthcare providers difficult. The purpose of this evidence-based project was to answer the question: In acute care nurses, how does receiving an end-of-life (EOL) course affect the comfort level of nurses educating on EOL care? External evidence searches in CINAHL, Medline Complete, and Academic Search Elite were conducted, and eight studies were identified for review. Critical appraisal of studies and synthesis of the evidence was completed to analyze and compare results of current research. Results of the research showed an increase in comfort, knowledge, competence, and confidence levels of acute care nurses after receiving education through an EOL course or tool. The evidence-based project determined that nurses were more comfortable in providing EOL care education to patients and family members after receiving an educational course on EOL care. Increased comfort, knowledge, competence, and confidence by the nurse during EOL situations assists in ensuring that holistic patient-centered care is provided

HANISH, Nicole, THILL, Jennifer, & VESTLE, Jennifer. (2021). Rectal thermometry is an invasive route of measuring temperatures in pediatric emergency departments. To reduce patient discomfort, another reliable temperature source needs to be identified to detect fever. The purpose of this study is to identify the most accurate alternative route for temperature obtainment in infants one year old and younger in pediatric emergency departments, focusing on axillary and temporal thermometry, that is more practical and less invasive than the use of rectal thermometry. There was limited available research comparing axillary and temporal thermometers in the infant age group and the evidence found was conflicting for the use of other temperature measurement routes to replace rectal measurement. Axillary digital thermometer (ADT) was found to be the most accurate temperature route to predict rectal temperature in children aged 1 month to 4 years (Berksoy, Anıl, Bıcılıoğlu, Gökalp, & Bal, 2018). Tympanic thermometry was found to be the most optimal route in Dante, Franconi, Marucci, Alfes, and Lancia (2020) and the second-best method in the study of Berksoy, Anıl, Bıcılıoğlu, Gökalp, and Bal (2018). Temporal artery thermometry (TAT) was studied in many articles, however, differing conclusions were made on whether TAT could be used to replace rectal thermometry. Additional research is necessary to identify a noninvasive temperature route that maintains accuracy comparable to rectal thermometry in pediatric emergency departments for infants one year of age or younger.

JACKSON, Mia, NABITY, Katelyn, & CISLER, Tammi. (2021). Postpartum depression remains a prevalent problem for many women with rates increasing over the past decade. Nurses should provide holistic care to women in the peripartum period to address postpartum depression. Aromatherapy and essential oils have been utilized for thousands of years as a natural medicine. This evidence-based practice project seeked to evaluate the effect of aromatherapy on postpartum depression as measured using the Edinburgh Postpartum Depression Scale (EPDS). A thorough literature search and literature review were conducted to evaluate research on the subject. Research shows aromatherapy can be an effective therapy in the prevention and treatment of postpartum depression with a reduction in EPDS scores. Nurses can utilize aromatherapy when caring for pregnant and postpartum women to provide a non-pharmacological intervention to reduce the prevalence of postpartum depression

AURELIA, Taylor, CLARKE, Chelsea, & KRZYZANOWSKI, Ciera. (2021). The purpose of this paper is to explore evidence of how a nurse-driven indwelling catheter removal protocol compared to a physician-ordered removal influences the occurrence of CAUTI’s during an inpatient stay at the hospital. The project PICOT question is the following: In adult med-surgical patients, how does a nurse-driven indwelling catheter removal protocol compared to physician ordered indwelling catheter removal in the occurrence of CAUTIs within an inpatient stay. CAUTIs carry significant financial and health consequences. They increase a patient’s length of stay, could potentially cause sepsis, and cost the hospital money. A total of 58 articles were analyzed for inclusion and exclusion criteria from the following data bases: CINAHL, Medline Complete and ProQuest Nursing and Allied Health. With the criteria met, 6 articles were found to be usable to answer the PICO(T) question. The six articles were reviewed which all supported rationale for a nurse driven urinary catheter removal. The results showed that there were significantly fewer infections per patient with nurse-driven catheter removal, which positively affected costs and patient outcomes. A future recommendation is to conduct a large-scale high level of evidence research study examining the CAUTI rate, number of catheter days, and patient complications after a nurse driven catheter removal policy has been implemented and compare the results specifically to physician ordered removal to create irrefutable evidence that nurse driven catheter removal policies are best practice. It is recommended that organizations support these results with policies and procedures