Capstones: Master of Science in Nursing: 2022

BAIRD, Sara, BOKELMAN, Amanda, & MCATEE, Lindsay. (Spring 2022). This evidence-based project aimed to identify which temperature measurement device provides the most time-efficient, accurate, precise, and least invasive temperature reading among hospitalized patients. New developments in infrared technology have brought temporal devices to the hospital setting. The PICOT question for this evidence project asked, in hospitalized patients (P), does a temporal thermometer (I), compared to other thermometers (C), provide more accurate readings to diagnose abnormal body temperature (O)? ... It is recommended that nurses become proficient at using the specific devices available in their facility. Taking more than one reading and obtaining a reading via an alternate route is recommended when treatment decisions and interventions are based on patient body temperature.

BYLUND, Susie, EMMERICH, Melissa, HARDING, Julie, & SIEBELS, Nicole. (Spring 2022). The purpose of this evidenced-based project was to decrease depression in nurses during the COVID-19 pandemic using grief therapy as an intervention to improve mental health. This paper aims to address the PICOT question “in inpatient nurses taking care of COVID-19 patients, how does weekly grief therapy from a trained counselor compared with no grief therapy affect depression using the Patient Health Questionnaire-9 (PHQ-9) scores within six months?” The problem that led to this paper was that the COVID-19 pandemic has caused increased anxiety, depression, and burnout in nurses. Analysis of the literature showed that multiple types of
psychological interventions related to improving mental health all proved to be beneficial including virtual psychiatrist visits, individual psychotherapy, virtual meetings, and a holistic wellness retreat. Results showed that grief therapy was beneficial to decreasing depression in nurses. Future recommendations include further research and studies conducted on psychological interventions on nurses affected by the COVID-19 pandemic. In conclusion,
further research should be conducted on this topic as well as finding more psychological
interventions that improve the mental health of nurses. It was also concluded that weekly grief therapy should be incorporated in all inpatient facilities.

HOARTY, Timothy, LOTSPEICH, Whitney, & WHITE, Jessica. (Spring 2022). Double standards of resource availability in acute-care hospital settings such as the intensive care unit present numerous problems, including negative impacts on patient safety, outcomes, and staff stress levels. This evidence-based project explores one potential solution to the problem of decreased overnight resources in the utilization of a rapid response system in the intensive care unit. The specific question posed in this project is: in a non-academic, medicalsurgical intensive care unit, does the implementation of an intra-ICU rapid response system, compared to no intra-ICU rapid response system affect the incidence of negative patient outcomes within the intensive care unit during a 12-month period? ... Four main ideas emerged from the results. First, there is an existing lack of resources in inpatient care especially at night and on the weekends. Second, this lack of resources is associated with poor patient outcomes. Third, the implementation of a rapid response system improves patient outcomes and the more experienced the more the outcomes improve. Lastly, there is a potential that a rapid response system could be beneficial during times of limited resources in the intensive care unit.

KROUPA, Jamie, PEDERSEN, Cassandra, & RAGETH, Jessica. (Spring 2022). Nursing staff turnover and retention rates are at an all-time high. Nurse residency programs (NRP) are programs specific to nursing that can decrease the turnover rate while increasing retention rates and benefiting an organization. In reviewing the literature to determine the benefit of an NRP, this evidence-based project aims to identify how NRPs influence nurse retention rates and satisfaction of new graduate nurses (NGN). The PICOT question addresses the following: For new nurses (P), does the implementation of a Nurse Residency Program (I), compared to no Nurse Residency Program (C) improve nurse retention rates and career satisfaction(O) within a year of their hire date (T)? ... . Based on the supporting evidence, hospitals are encouraged to consider such programs to improve the turnover rate and staff satisfaction levels. New nurses who participate in NRPs show increased competence and confidence in the ever-changing healthcare world.

BAUER, Sandra & HUNTER WILLIAMS, Wendy. (Spring 2022). The purpose of this evidence-based project was to identify the effects of transformational leadership on burnout levels among inpatient nurses. High levels of stress within working environments can lead to increased inpatient nursing turnover rates. Nurse leaders (population) who practice transformational leadership (intervention) demonstrate lower turnover rates due to burnout among staff nurses (outcome) as compared to nurse leaders who do not practice transformational leadership (comparison) over the three-year period between 2018 to 2022. The findings of this evidence-based project provided nurse leaders with interventions to mitigate the effects of nurse-reported burnout. Transformational leadership provides nurses with idealized influence, inspirational motivation, intellectual stimulation, and individual consideration. With these tools nurse leaders inspire and motivate nurses to work together towards empowering one another and creating safe working environments. The future of nursing is dependent upon maintaining sustainable commitments to the work of transformational leadership within nursing research, education, administration, and practice in the effort to mitigate nurse-reported burnout.

FAULKNER, Erica, HERZBERG, Molly, KOLM, Staci, & WEHRLE, Stephanie. (Spring 2022). With the climbing rate of COVID-19 cases and rapidly rising death count, there was a surging increase in the risk of mental health problems among health care professionals who cared for patients suffering from the virus. Nurses have experienced increased mental distress due to numerous factors. The PICO question that guided this evidence-based project was “for nurses who work with COVID-19 patients (P), how does providing resources for depression and anxiety (I), as compared to no resources provided (C), affect anxiety and depression symptoms? (O).” ... The findings suggested that provision of mental health resources resulted in decreased anxiety, depression, and burnout experienced by the nursing staff. Various resource types, delivery methods, and strategies were explored and most provided evidence of a reduction of negative mental health symptoms of varying degrees. Future research regarding discovering and establishing interventions that can reinforce, support, and sustain the psychological equilibrium in the nursing professionals' lives is recommended.

KOCH, Jamie, PFEIFFER, Nolan, & SANDERS, Tiffany. (Spring 2022). The nursing shortage will become exponentially worse in the coming decade, with the majority
of health systems experiencing shortages. The retention of novice nurses is needed to combat the nursing shortage. This evidence-based project aimed to investigate the effect developmental training programs have on the retention of novice nurses in the acute care setting. The PICOT question is the following: in novice nurses with less than one year of experience, do developmental training programs, such as nurse residency programs, compared to no developmental program, increase retention rates of novice nurses in the acute care setting within one year after completion of the training program? ... . A total of three studies met the inclusion and exclusion criteria for this review. The studies were critically appraised and the results do support the use of developmental training programs to aid in the retention of novice nurses in the acute care setting. Training programs can provide vital education, training, and support to meet the challenges and stressors of the work environment. Nursing management can use developmental training programs for novice nurses within the first year of transition from student to professional. Increased retention rates will promote increased confidence in novice nurses, increased job satisfaction, and a more experienced workforce which will promote increased patient safety and quality of care.

BRICKEY, Steven, BURSOVSKY, Jessica, &WALKER, Justine. (Spring 2022). Blood cultures are one of the most widely used tests for the diagnosis of bloodstream infections and their results guide appropriate treatment for patients. Blood cultures are frequently obtained in the emergency department where contamination rates are often some of the highest in the hospital. Inappropriate treatment and blood culture contamination can lead to poor outcomes for patients, including increased mortality and morbidity rates. The purpose of this evidenced-based project was to determine if, in emergency department patients who required peripherally drawn blood cultures, use of a closed system collection device, also known as an initial specimen diversion device (ISDD), compared to a butterfly needle collection system decreased blood culture contamination rates?

HESSE, Jenna, PFEIFFER, Megan, & SUING, Brooke. (Spring 2022). Hypothermia is a leading cause of neonatal morbidity and mortality. Newborn thermal care is recognized as a critical and vital component of essential newborn care. The purpose of this evidenced-based project was to determine the best intervention to reduce hypothermia in the newborn. The focus of this project was to evaluate if in healthy, term newborns, does early skin-to-skin contact (SSC) of the neonate with the mother in the first hour of life, compared to drying and wrapping, have an impact on hypothermia of the neonate in the first 48 hours of life? ... The analysis of the research provided strong evidence that utilizing SSC has a greater impact on reducing hypothermia in healthy, term newborns compared to traditional methods of drying and wrapping. In conclusion, it is recommended that SSC be the preferred standard of care in healthy, term newborns over traditional methods to reduce the risk of neonatal hypothermia in the first 48 hours of life.

HASENJAGER, Kayla, SCOTT-SELLERS, Kia, & VOLTMER, Jennifer. (Summer 2022). Delirium is an underdiagnosed problem prevalent in healthcare. It is crucial that healthcare professionals recognize early symptoms, especially in critical adult patients in the intensive care unit (ICU). This evidence-based practice project examined and discussed the effectiveness of delirium assessment tools for early detection in the ICU. The PICOT question stated: In adult patients admitted to the ICU setting, how effective is the Confusion Assessment Method (CAM) compared to not using a bedside assessment tool in monitoring for delirium throughout their hospitalization? … A review and appraisal of the available research literature showed that delirium assessment tools utilized in the ICU can positively impact patient outcomes. Early detection and diagnosis of delirium benefits patients by decreasing their risk of further complications as well as decreasing the length of their hospital stay. Healthcare facilities benefit from detection as the length of hospital stay decreases, the cost is lowered, and patient outcomes improve. After developing this research, nursing practice can evolve by providing staff education on proper use and implementation of the assessment tool into daily workflows.

LEBBERT, Jessica, RING, Olivia, & ROSS, Kendra. (Summer 2022). On March 11, 2020, the World Health Organization (WHO) declared a global pandemic secondary to the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), with the subsequent disease called COVID-19 (Deng et al., 2021; Parizad et al., 2021; Toulabi et al., 2021). The WHO (2022) reports over 450 million confirmed cases and over six million deaths associated with COVID-19 worldwide. Increased patient volumes and staff shortages force professionals to focus on the physiological symptoms of COVID-19, leaving mental health such as anxiety and depression overlooked. The project aimed to find evidence regarding adult COVID-19 patients' anxiety through early identification and management. The PICO question for the evidence-based project is: How does early screening and interventions for anxiety in adult COVID-19 patients affect the need for additional oxygen conservation measures? New understandings included benefits from music therapy, social support, guided imagery, and frequent evaluations for psychiatric disorders in hospitalized COVID-19 patients. Existing research showed that COVID-19 survivors suffer from psychological and/or mental health problems, anxiety being the most common (Sahoo et al., 2020). Implications for practice included the introduction of early identification of psychiatric disorders with frequent evaluations, music therapy, psychological-behavioral intervention (PBI) as a method for social support, and guided imagery to manage anxiety and pain. Future recommendations included studying psychiatric disorders and the effects on COVID-19 patient outcomes. Research studies conducted showed small sample sizes. Future research ideas included local partnering with leaders on COVID-19 units to implement research recommendations and test the results for future research.

BONEY, Rachel, DORNBUSCH, Ashley, & PRICE, Cara. (Summer 2022). Chronic heart failure (CHF) is a leading chronic health condition costing patients and the healthcare infrastructure millions of dollars every year. The need for interoperable, accessible, cost-effective, and high-quality patient-centered care continues to be a problem in managing this patient population. Nurse-led telehealth interventions can positively affect these concerns and enhance patient outcomes and CHF disease management. This evidence-based project aimed to investigate the effects of nurse-led telehealth technologies on disease management for CHF patients. The PICO question stated: In chronic heart failure patients (P), how do telehealth applications (I) compared to no use of telehealth applications (C) affect disease management (O)? … Results indicated that nurse-led telehealth interventions showed statistically significant outcomes related to CHF disease management, reduced mortality and hospitalizations, and empowered patients to participate actively in healthcare decisions. Future research is needed on patients with multiple chronic health conditions and enhancing telehealth methods to reach at-risk populations and rural communities with socioeconomic barriers that negatively affect their health. This evidence-based project demonstrated the effectiveness of nurse-led telehealth interventions in positively improving CHF disease management.

ALLEN, Ariana, GREGALUNA, Jennifer, & KOCH, Dawn. (Summer 2022). Patients with congestive heart failure (CHF) are faced with multiple lifestyle changes and require considerable education. Congestive heart failure negatively affects quality of life and often has a poor prognosis. The purpose of this evidence-based project was to determine if the use of telemonitoring has an effect on exacerbations or rehospitalizations for patients with CHF. The specific question posed in the search is: Do adults with CHF who receive telehealth support have fewer exacerbations of symptoms when compared to standard discharge instructions within six months post-discharge? … Discovered themes showed that telemonitoring prevents mortality, positively affects the quality of life and wellness management, and reduces unplanned hospitalizations. Three studies revealed that patients have a higher quality of life with telehealth than those who do not support telehealth. However, further comparative studies are needed to solidify using telehealth as a standard of care and management of patients with CHF.

CRAIG, Ashley, OVERHOLT, Melissa, & SPETH, Jennifer. (Summer 2022). Increased nurse-to-patient ratios are of growing concern within health care systems. Patient census and acuity have increased, putting an increased strain on nursing. Medical errors associated with the increased strain negatively impact patients and health care systems. Risk factors need to be examined and mitigated to decrease medical errors and lessen the burden on nurses. This evidence-based practice project aimed to analyze research on the difference between high nurse-to-patient staffing ratios versus low nurse-to-patient staffing ratios and the effects on the incidence of medical errors. The PICO question was, "In acute care nurses, how does low nurse-to-patient ratios compared with high nurse-to-patient ratios affect the incidence of medical errors"? … Based on the supporting evidence, recommendations include mandated nurse-to-patient ratios, preferable at a ratio of 1:4. Reducing nurse-to-patient ratios is one step in the right direction to promote quality of care and mitigate medical errors. Implementing mandated nurse-to-patient ratios can positively impact patients, fiscally benefit healthcare systems, and create a manageable workload for nurses.