Capstones: Master of Science in Nursing: 2023

KATHOL, Alyssa, OBORNY, Patricia, & SHAVER, Robin. (Spring 2023). The purpose of this evidenced-based project was to show how patient centered psychosocial nurse led screening measures can lead to a decrease in the length of stay, increase in patient satisfaction, and increased nurse job satisfaction. The problem that led to this paper was understanding that patients with chronic pain often have unidentified chronic care needs which results in costly and unnecessary use of hospital resources. This paper aims to address the PICOT question “among hospitalized adult patients with chronic pain (P) how do additional psychosocial nurse screening measures (I) versus no additional screening measures (C) affect length of stay (O)?” Results showed that multiple psychosocial interventions were beneficial in adult patients who are suffering from chronic pain. Future recommendations include further research on studies that utilize nurse-led psychosocial measurement tools and how these impact overall length of stay. In conclusion, there are different causes for chronic pain which means there needs to be different ways to assess how patients perceive and deal with their pain.

CORMIER, heather, MILLER, Jennifer, PAITZ, Stacy, SMITH, Cody. (Spring 2023). Delirium is a serious and complex complication in hospitalized geriatric adults (aged 65 and older). The under-recognition of delirium in the hospital setting can lead to negative patient outcomes. The purpose of this integrative review is to determine if the consistent use of a delirium assessment tool increases the correct and early identification of delirium in non-ICU geriatric patients. This evidence-based project sought to answer the PICO question: In non-ICU geriatric patients, does the consistent use of a delirium assessment tool effectively identify delirium? This integrative review shows that delirium is frequently missed in this population. The evidence supports the use of assessment tools for early and effective identification of delirium. Future recommendations for nursing include implementing delirium protocols, utilizing non-pharmacological interventions to prevent delirium, and educating nurses on the use of delirium screening tools. The evidence found in this review can positively influence clinical practice.

BOUCHE, Melissa, KAUFMAN, Kathleen, & SEGOVIA AYALA, Katya. (Spring 2023). The postpartum period can be an overwhelming time for many women, eliciting a variety of feelings on the emotional spectrum. While many women experience feelings of joy, postpartum depression (PPD) and its stigmas are still prevalent despite in-office screenings. Literature reviewed for this evidence-based project looked at the impact that technology-based screenings had on postpartum women and their depression care. The PICOT question addressed in this project is “in postpartum women (P), does a depression screening being delivered in-person compared to via a mobile application (C) impact PPD findings (O) within 6 weeks of hospital discharge (T)”. The evidence supports PPD screening delivered through a mobile application and benefits postpartum women by identifying PPD symptoms earlier than their six week follow-up, allowing mental health concerns to be addressed sooner. Future research on mobile-enabled interventions is necessary to understand the opportunities, costs, benefits, and limitations of digital health modalities for the postpartum population. Likewise, nursing administrators and educators should explore the efficiencies, barriers, and practical implications of such programs. It is possible to bridge that gap by delivering PPD screenings to patients via mobile applications, so postpartum women can complete screenings in a more realistic timeframe and send the results to their providers

COLE, Jeremy, GUY, Richelle. (2023). Nurse burnout is a growing problem that can lead to reduced work efficiency, compassion fatigue, impact hospital team functioning and increase overall costs to hospitals. The purpose of this study can be summed up in the following question: For acute/critical care nurses (P), how does a multimodal approach to burnout prevention and intervention (I) compared to no approach to burnout prevention and intervention (C) affect reported work-related stress and burnout in acute/critical care nurses (o) who have worked (T) within a hospital setting between 2010 to 2022? The literature included in this study highlights the rising rates of burnout and the many impacts it can have on health systems and patients. Some research includes multiple modalities for identifying burnout and sometimes preventing burnout. However, there are no clear studies focused on effective interventions in reducing the rates of burnout. After a review of the literature, more research is needed to assess what combination of interventions could potentially decrease this growing epidemic and the negative burden it has created in the field of healthcare.

FRY, Sara, HUNKE, Katelyn, WALTER, Kayla. (2023). Surgery is often a primary treatment modality for many cancer-related conditions. Inadequately managed postoperative pain can lead to poor patient outcomes. Patient-centered care goals involve strategies to optimize pain control and improve the patient experience. The purpose of this evidence-based project was to examine the effect of preoperative pain management education on postoperative pain control in cancer patients undergoing surgery. A PICOT question was developed: In cancer patients undergoing surgery (P), how does a formal nurseled preoperative pain management education session (I) compared with no formal preoperative pain management education (C) affect pain control (O) within the first six weeks after surgery (T)? The studies indicated an association between preoperative education and improved postoperative pain management outcomes, establishing support for nursing practice that incorporates a preoperative education intervention. The evidence also revealed that preoperative education can influence other dimensions of postoperative care, such as mental health. Future recommendations include additional research on the impact of the education intervention on length of stay, readmission rates, and patient satisfaction scores

ROUCKA, Jennifer, STINNETTE, Michelle, & WEILER, Anna. (2023). The purpose of this evidenced-based project was to evaluate the surgical recovery process and how it is influenced by decreasing preoperative fasting time and carbohydrate loading, which leads to the PICO question: In adult surgical patients, how does carbohydrate loading and decreased fasting times compared to fasting 12 hours before surgery affect patient recovery and satisfaction? Current presurgical fasting guidelines are outdated and need revision. Patients often arrive at surgery dehydrated and unhappy due to extended fasting times and struggle with recovery due to nausea, dizziness, and pain. There is strong evidence to support carbohydrate loading and decreased fasting times in adult surgical patients. The recommendations for the findings include a revision of the current preoperative fasting time guidelines, as this study showed preoperative fasting times can be shortened without increasing harm to the patient and, in turn, improve patient outcomes and satisfaction. This evidenced-based project concluded that patients experienced smoother recoveries and higher satisfaction when allowed a shorter preoperative fasting time and carbohydrate loading.

HANSEN, Heather, JOHNSON, Nicole, MATHEWS, April, PEACOCK, Michelle. (Spring 2023). The incidence of new graduate nurses leaving acute care nursing within the first two years of practice raises concerns for hospital and nursing administration. As the nursing workforce grows older and the number of nurses in acute care hospitals decreases, it is essential to retain new graduate nurses for the well-being of the community and the financial success of hospital organizations. This evidence-based project investigated the connection between transition to practice programs and the turnover rate of new graduate nurses working in the acute hospital setting. The PICO(T) question was: For graduate nurses, how do transition to practice programs impact nurse retention in acute care nursing? The evidence showed new graduate nurse participation in transition to practice programs experienced less stress and exhibited more confidence. Results implied mentoring could improve graduate nurse’s clinical competency and job satisfaction. Research suggests millennial new graduate nurses have a higher turnover intent with decreased job embeddedness. Future recommendations include longitudinal research studies defining the reasons new graduate nurses are leaving acute care and the effectiveness of specific transition to practice programs.

BYERS, Carleigh, KLUG, Vanessa, & O'DANIEL, Amy. (2023). Poor management of chronic obstructive pulmonary disease (COPD) symptoms increases acute exacerbations of symptoms, hospitalizations, and adverse patient outcomes. Using a pulmonary rehabilitation (PR) program implemented by nursing can improve patient outcomes and reduce hospital readmissions. The purpose of this evidence-based project was to decide if participation in PR post-discharge had an effect on readmission rates following hospitalization for an acute exacerbation. Examination of the PICO(T) is as follows: In patients recently hospitalized with acute COPD exacerbation, how does participating in a pulmonary rehabilitation program within 30 days of discharge affect readmission rates compared to those who do not participate? A literature review was conducted for the years 2018-2022 through the following databases: CINAHL Complete, MEDLINE Complete, PubMed, ProQuest Nursing & Allied Health, and Google Scholar. After applying inclusion and exclusion criteria, six journal articles met the PICOT question. A correlation existed between adherence and nursing reinforcement in acute COPD exacerbations requiring hospitalization. Patient outcomes improved with each PR session and reinforcement. The result included decreased hospital readmissions and improved physical and emotional fitness. Initiation periods and program content varied among PR programs between articles. However, all articles supported that PR effectively reduces hospital readmission rates after acute exacerbation of COPD. The recommendations include further research on program content and time of initiation of PR after a hospital admission for an acute exacerbation.

ENGLE-WRYE, Hannah, & ROGERS, Maggie. (2023). A knowledge gap exists between academic nursing programs and licensed clinical practice for new graduate nurses to face the challenges of today’s nursing. Nurses who demonstrate competency are aware of safety standards and best practice guidelines, and they possess the knowledge and skills necessary for adequate nursing practice. A delay in solidifying a nurse’s competency may result in unsafe patient care, higher rates of nursing turnover, and ultimately increased healthcare costs. The purpose of this evidence-based review was to appraise current research literature to determine the impact of new graduate nurse residency programs on nursing competency, using the following PICOT question as a guide: in new graduate nurses, how does a new graduate residency program affect nursing competency within the first year of practice? A thorough search was completed using three databases with specific inclusion and exclusion criteria to determine the existing evidence related to new graduate residency programs and their effect on nursing competency during the first year. Eight articles were critically appraised to evaluate the value of residency programs for improving nursing competency. New graduate nurses who attended residency programs reported increased confidence and improved clinical decision-making skills when compared to those who did not complete residency programs. Secondary outcomes included increased job satisfaction and safer patient care. It was concluded that residency programs positively impact competency within the first year for new graduate nurses and are cost-effective strategies for healthcare organizations to improve patient outcomes through strengthening the competency of their new graduate nurses.

BARNES, Tara, KOHLMAN, Harleigh & WAECHTER, Lora. (2023). A cardiac arresting patient requires professionals to successfully lead in cardiopulmonary resuscitation, administer medications, and scribe the event. This process can be physically and mentally tasking. Staff shortages, collective experience, and a lack of resources can further this burden. The objective was to review research on automatic compression devices (ACD) to reduce the nurse code burden, identify the effectiveness of Advanced Cardiac Life Support with the use of an ACD, and understand the emotional and physical effects on nursing related to patient codes. With patients in cardiac arrest (P), does the use of ACDs (I), compared to manual chest compressions (C), reduce the emotional and physical burden of nurses (O)? A comprehensive search (2010-2022) was conducted using CINAHL, Medline, Psychology & Behavior Science, and ProQuest databases; peer-reviewed, full-text, English, meeting publications inclusion criteria. To avoid bias, articles were independently reviewed, and the search was conducted twice. ACD use was found to be more effective than manual compression. In addition, researchers found a positive correlation between CPR and healthcare providers emotional burden, stress, and need for emotional support associated with CPR. Seven studies identified emotional post-code experiences and the effectiveness of ACD use. Further recommendations include more research on the impact of manual chest compressions on healthcare professionals’ mentation, disseminating evidence, identifying how to support their mental health needs, and training all staff on using ACDs.

BROWN, Larry, KOWALSKI, Meghann, SWANSON, Amelia. (2023). One of the most relevant concepts in nursing is the emotional strain that results from an overload of stress for each individual nurse, leading to decreased resilience in nurses. The purpose of this evidence-based project was to assess and evaluate if the utilization of purposeful interventions will strengthen resilience in acute care nurses. The PICO question driving this research was: In bedside nurses, how do interventions aimed at increasing resilience compared to no interventions affect a nurse’s level of resilience? A systematic search was conducted using three computerized databases. The search was conducted four times using keywords and Boolean operators to narrow results. Exclusion criteria were applied to eliminate duplicate articles, non-acute care areas, nursing students, and a lack of purposeful intention. Inclusion criteria included the highest level of evidence, healthcare professionals, and purposeful intentions. The resulting seven articles chosen were evaluated using critical appraisals tables to evaluate rigor, strength, and trustworthiness of each study and compiled in a matrix table using identical criteria for each article and provided as an appendix. The results were inconclusive with three level I systematic reviews revealing that no interventions can improve resilience, and the remaining level I systematic reviews showing minimal evidence that interventions can improve resilience. Recommendations noted for future research include the necessity of developing a uniform construct of resilience in nursing to establish consistency with research. Randomized control trials must also be improved by strengthening the rigor and validity of the research in regard to bias, heterogeneity, and ensuring utilization of random sampling methods.

FEIGENBUTZ, Kelsey, FOX,Abbey, NELSON, Marissa. (2023). The Patient Health Questionnaire 9 (PHQ-9) and Geriatric Depression Scale (GDS-15) have both been recommended as screening tools for diagnosing depression in geriatric patients. This study sought to answer the question if depressive diagnosis differed in geriatric patients screened using the PHQ-9 versus the GDS-15. Depression among this population has gone relatively unnoticed despite its rising suicide rates over the past decade. The PHQ-9 and GDS15 are both used as tools to detect depression in geriatric patients, though neither is without criticism. Research studies chosen were analyzed for their use of these screening tools among geriatric patients, their rates of depression diagnosis, and their overall impact upon diagnostic and patient outcomes. Even though the results of this study did not directly answer the initial PICOT question, knowledge gained through this research is valuable. Future recommendations include additional research to establish a preferred screening tool, timing of assessment, and determining a uniform method of delivery. Data obtained emphasized the need for improved processes for depression diagnosis among the elderly and exhibited concerns regarding inconsistency, bias, and the overall lack of concern regarding this population’s mental health. Evidence supported the appropriateness and efficacy of the PHQ-9 and GDS-15 as screening tools for geriatric patients. Insights gained during this research study provided information contrary to existing concerns surrounding both screening tools. Additionally, the research exhibited concerns regarding the lack of importance placed upon this issue, inconsistencies in current diagnostic methods, and areas of potential bias among diagnosing providers.

ALBERTI, Laura, PECORARO, Amanda, TATE, Hanna. (2023). Individuals undergoing cancer treatment often require long-term intravenous (IV) access to receive treatment. Bloodstream infections (BSIs) can occur when having access for prolonged periods. Identifying the access type that is less likely to lead to a central line-associated bloodstream infection (CLABSI) can be challenging. The PICOT question steering this evidence-based project was to determine: For cancer patients with central line IV access, did having an internal implanted device, compared to those with peripherally inserted central catheters (PICCs), non-tunneled catheters, and tunneled catheters result in lower incidences of BSIs during the course of treatment? The overall purpose of this work was to determine if having an implanted port would reduce the risk of BSIs compared to having other forms of central lines. The search strategy utilized combinations of search terms using the databases of CINAHL Complete, Medline Complete and Academic Search Elite that resulted in ten articles for review. A critical appraisal was completed discussing researcher credibility. Proposals for future recommendations for all nursing fields suggested researching specific bacteria, understanding all central line options, and providing the proper education to nurses and patients to prevent infection. The data presented and reviewed in this paper discussed having an internal implanted port compared to other forms of central venous catheters (CVC) resulted in lower infection rates for cancer patients.

Madelyn Flowers, Hannah Hopson, Stacy Laue. (2023). The population of older adults in the United States is expected to continue to grow. This growing population of older adults may have significant challenges with managing their complicated daily medication regimens. This evidence-based project aimed to evaluate the effectiveness of pre-packaged medications on medication adherence and utilized the following PICO question: In patients 65 years and older, does pre-packaging of home medications compared to standard individual prescription medication bottles improve medication adherence for discharged patients? A systematic literature search in three databases of Medline Complete, ProQuest Nursing and Allied Health, and Academic Search Elite was performed with a hand search of the references of chosen studies. Four articles were used for the evidence-based project. All four studies concluded that packaging interventions significantly improved medication adherence. One study found that packaging interventions decreased missed medications by almost 14%, while another found that interventions increased medication adherence by 33%. Future research to evaluate other factors that impact medication adherence for this age group is needed to establish a plan of care for those with chronic diseases. There were limited studies focusing on medication packaging interventions and older adults, so further research can help to strengthen these findings.

Amanda Hunt-McCart. Kayla McKain, Amber Meyo. (2023). Diabetes is one of the most prevalent chronic health concerns among adults living in the United States. Diabetic patients living in rural areas across the country are less likely to receive adequate education and quality diabetes care, which significantly increases the likelihood for other comorbidities. The purpose of this evidence-based project was to examine the effectiveness of patient portal use in the rural diabetic population. The PICO question that guides this evidence-based project was: Among rural diabetic patients, how does the ability to send secure messages via a patient portal affect glucose control? A systematic search was completed using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Academic Search Elite (ASE), and Medline Complete databases. After applying limiters, inclusion criteria, and exclusion criteria, the search yielded six articles for analysis. The results showed that users of a patient portal recorded a follow-up AIC of < 7% whereas the nonusers did not. Secure messaging was associated with decreased emergency room visits and hospitalizations. Results also showed that A1C control was more likely for those with lower baseline AIC (p<0.01) and for users than non-users (p=0.032). Overall, results showed that patient portal usage affects glycemic control for diabetic patients. Further research is needed for rural populations and their ability to send secure messages via patient portals and how this can affect glucose control.

Chelsea Craig, Payton Flowers, Terri Perry. (2023). Overcrowding in the Emergency Department (ED) is an epidemic across the nation. Overcrowding has resulted in poor patient outcomes and delays in life saving interventions. The current triage process can cause congestion in the ED as patient volumes continue to increase. Adding an advanced practice provider to the triage process may be one way to address this issue. The purpose of this evidence-based project was to determine if use of an advanced practice provider (APP) in triage alongside a nurse will improve patient outcomes, expedite patient care, and decrease the length of stay in the ED. The PICOT question guiding this project is: for patients being triaged in the ED, does the utilization of an APP working alongside a RN (Registered Nurse), expedite patient care and decrease patient length of stay? A literature search was completed utilizing CINAHL, Medline Complete and Academic Search Elite to find peer-reviewed research articles between 2010 and 2023. The search yielded four research articles, all supporting the utilization of the APP in triage to improve patient outcomes. Results showed a decrease in patient length of stay, LWBS (leave without being seen) rates, door-to-provider times, and improved patient satisfaction.

BROEKEMEIER, Jill, EVERS, Samantha, MARTIN, Paige. (2023). The purpose of this paper was to explore evidence surrounding the prevalence of catheter-associated urinary tract infections (CAUTIs) when considering the indwelling time for a urinary catheter. Catheter-associated urinary tract infections are associated with pain, discomfort, and increased length of hospital stays. Medical necessity needs to be addressed for appropriateness prior to the placement of an indwelling urinary catheter. The goal of this evidence-based project was to determine the relationship between increased urinary catheter replacement and the effects on the rate of CAUTIs in acute care patients. The PICO question was as follows: “For acute care hospital patients who require the insertion of an indwelling urinary catheter, what is the impact of replacing the indwelling urinary catheter prior to 30 consecutive days of dwell time on the incidence of catheter-associated urinary tract infection (CAUTI)”? An online search of CINAHL Complete, Medline Complete, and Cochrane Database of Systematic Reviews/Clinical Answers was conducted to extract research articles. Four selected articles were reviewed; common trends included ongoing skills lab and education training for clinical staff, nurse driven protocols, and prompt removal of the device. One implication of this study was the push for nursing autonomy regarding the removal of indwelling catheters. Findings suggest that the risk of infection is reduced once an indwelling urinary catheter is removed: no device, no infection. Further studies are needed on a larger-scale, providing high level of evidence, analyzing the number of catheter days in association of CAUTI rates to determine best practice guidelines.

CHEW, Darren, EVERS, Bailey, SEEVERS, Emily. (2023). Nursing burnout is a phenomenon that is increasing the incidence of the nursing shortages and negatively affecting the mental health of nurses. The purpose of this evidence-based practice project was to determine if the use of Employee Assistance Programs (EAP) decreased the rate at which nursing burnout is experienced. The PICO question was “In nursing burnout, what is the impact of using an employer provided EAP compared to no EAP on decreasing nursing burnout?” The databases CINAHL, Medline Complete, and PubMed were searched and four research articles were analyzed for this paper. The literature shows that the increased demands from the COVID-19 pandemic resulted in higher workloads and longer shifts for nurses, which greatly contributed to higher rates of nursing burnout. The usage of EAPs by nurses prior to and during the pandemic was discussed; however, usage was relatively unchanged. The literature discussed the need for increased usage of EAPs and the removal of the stigma around mental health. The lack of education and awareness of EAP was also discussed, leading to misconceptions about EAP, stigma about seeking counseling, and deteriorating mental health in nurses. Future recommendations for nursing practice include active promotion for the use of EAP through education and employer initiation.