Scholarship & Research
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/1
Browse
7 results
Search Results
Item Reducing ventilator days in the trauma ICU patient: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Olsen, Rette Marie Riley; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Mechanical ventilation saves many lives in the Intensive Care Unit (ICU) but can also pose a substantial risk. Prolonged mechanical ventilation is associated with ventilator-associated adverse events, leading to increased hospital stays and mortality. To lower risks for patients, healthcare teams must implement evidence-based measures to decrease ventilator-associated adverse events. The use of an ICU liberation bundle reduces ventilator-associated complications, is associated with less risk for patients, and improves overall outcomes. At a level I trauma center in the northwestern United States, average ventilator days of trauma patients were twice the national average. This facility encourages the use of a liberation bundle, but not all elements of the bundle are consistently implemented. Based on a review of the literature, all aspects of the Society of Critical Care Medicine's ICU liberation bundle along with daily rounding to standardize care. Education on the ICU liberation bundle and interdisciplinary rounding was given to staff members. Daily interdisciplinary rounding with a standardized checklist was implemented over a six-week period. Frequency of rounds and documentation compliance were recorded. Average ventilator days was compared to the average from the same time in the previous year. Rounding occurred 90.20% of the time and trauma ICU patients were discussed in rounds daily. Documentation of the ICU Liberation bundle only occurred 14.71% of the time during the study. The average ventilator days were 3.8 days, compared to 4.8 days the previous year. Implementation of the interdisciplinary rounding process was successful and average ventilator days were reduced, although the unit saw a low number of trauma patients. Documentation compliance of the ICU Liberation bundle was low, potentially related to the lack of in person education prior to the intervention. This demonstrates that the documentation process needs significant improvement.Item Implementation of a tummy time protocol: a quality improvement project in a level 3B NICU(Montana State University - Bozeman, College of Nursing, 2024) Chaffin, Taylor Christine; Chairperson, Graduate Committee: Benjamin J. Miller; This is a manuscript style paper that includes co-authored chapters.Background: Infants who spend prolonged periods in the supine position, particularly in the NICU, face an increased risk of plagiocephaly and developmental delays. Supine sleeping is recommended by the American Academy of Pediatrics, "Back to Sleep" campaign, which has successfully reduced sudden infant death syndrome by 40-60%. However, an increase in cranial abnormalities was observed following the widespread adoption. Daily tummy time supports motor development, reduces the risk of plagiocephaly, and promotes parental bonding. Methods: A six-week tummy time protocol was implemented in a level 3b NICU for infants who were 32 weeks corrected gestational age and medically stable. Brief 1-2-minute tummy time sessions were completed in the infant's bed or while holding with a parent. Tummy time sessions, education, and return demonstrations were documented on a bedside tracker. Pre- and post-implementation surveys were distributed to staff to gather perspectives. Parent surveys were distributed at discharge to evaluate readiness to complete tummy time at home. Results: Between January 15th and February 25th, only 23 out of 42 eligible infants had tracker sheets returned (55%). Out of 504 eligible days, tummy time sessions were recorded on 214 days, accounting for 42%. Post-implementation staff surveys showed positive results regarding their confidence in educating parents (M=4.7, sd=0.47) and the ease of implementation (M=4.38, sd=0.65). Comparing the results of the pre-and post-implementation surveys using a t-test yielded no significance. Obstacles to compliance included difficulty integrating new workflows, time constraints for education completion, tummy time, and documentation. Conclusion: Implementing the Tummy Time Protocol was crucial in changing practice patterns to align with best practices for infants admitted to the NICU. However, more work must be done to integrate tummy time sessions, early education, and documentation into a new workflow. Suggestions for improvement were provided, focusing on incorporating documentation into the electronic health record (EHR) system to improve compliance and reduce the risk of losing tracking sheets. In addition, future research is necessary to evaluate the long-term effects of tummy time implementation within the NICU. Specifically, research should focus on rates of plagiocephaly and outpatient therapy referrals following discharge from the NICU.Item Reducing instances of PTSD in ICU survivors(Montana State University - Bozeman, College of Nursing, 2016) Wozniak, Becky Ann; Chairperson, Graduate Committee: Charlene WintersRational: As many as 20-30% of adult ICU survivors will experience PTSD related to their time as a patient in the ICU. The symptoms of PTSD can last months or years and prevent a full recovery from critical injury or illness. Patients that experience ICU delirium are at the highest risk for developing post-ICU PTSD. Many hospitals in Europe have begun using ICU after care programs to help patients cope with traumatic ICU memories and prevent a PTSD diagnosis. Purpose and Methods: The purpose of this project was to develop a nurse-led ICU after care program to prevent instances of PTSD in adult ICU survivors. Patients volunteered to participate in this project after seeing advertisements posted in the ICU and after receiving invitation letters in the mail at home. Patients were screened for PTSD using the PTSS-14, had a chance to speak with an ICU nurse about their experiences in ICU, and one patent was even able to return to the ICU and speak about that experience. Patients were then re-screened for PTSD approximately 2 weeks after their after care experience. Findings: Small sample size precludes any evaluation of this intervention. However, all participants did demonstrate evidence of decreased anxiety scores after their participation. Implications: Future ICU aftercare programs may have increased participation if the data collection period is extended to at least six months and if the patients are contacted closer to 3 months post ICU discharge. PTSD itself and the Rural Nursing Theory may decrease participation in these programs without specific interventions to address them.Item Expectations of purposes and functions of intensive care units as expressed by immediate family members of patients(Montana State University - Bozeman, College of Professional Schools, 1972) Eickhoff, Karen MarieItem A descriptive study of patients hospitalized in an intensive care unit(Montana State University - Bozeman, College of Professional Schools, 1972) Siebert, Sheila Maureen; Chairperson, Graduate Committee: Virginia Ellen FeltonItem The use of a patient classification system in a medical/surgical intensive care unit : a pilot study(Montana State University - Bozeman, College of Nursing, 1988) Warren, Sue AnneItem How do nurses in critical care units assist patients and families to decrease fear and anxiety(Montana State University - Bozeman, College of Nursing, 1975) Scheer, Michael Anne