TUHS Nurse Residency EBP Projects

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All Aboard the Antimicrobial StewardSHIP
(2018) Civil, Valery; Jones, Camilla; Poznek, Rachael; Ufberg, Daniel; Temple University. Hospital
According to the Centers for Disease Control and Prevention, antibiotic resistance is a leading topic in infectious disease control. As a result, the White House in March 2015 has established the National Action plan for Combating Antibiotic resistant Bacteria; this action plan calls for the establishment of antimicrobial stewardship programs in all acute care hospitals by 2020. Evidence shows that in order for a government-led initiative like this to be successful, nurses must engage and contribute to the task force. As nurses are the ones who administer medications, they are antibiotic first responders. According to evidence-based research, the most optimal way to ensure effective nurse participation will be through nursing education on an individual and organizational level. Through the support and engagement of nurses into the interdisciplinary campaign, antimicrobial stewardship can produce optimal outcomes for patients, hospitals, and communities.
Film + Foam= A Bundle of Protection
(2018) Delaney, Stacy; Moore, Danielle; Panosian, Anna; Pough, Lurena; Temple University. Hospital
2.5 million patients a year are effected by pressure ulcers, topical dermatitis, skin breakdown and infection; increasing length and cost of stay, death and liability. Skin, the first line of defense and the largest organ in the body is a vital source of protection. Aiding patients in guarding the skin from friction, sheer, and moisture related breakdown is one of the goals in nursing care. In review of journals, articles, and studies, the results show that application of a barrier film reduces damage to the dermis of patients who are at high risk of skin breakdown caused by friction, moisture and immobility.
Finding a Voice: Improving Communication In Aphasic Patients
(2018) Abraham, Nancy; Caruso, Christina; Luna, Elvin; Temple University. Hospital
Communicating is key between both patient and healthcare providers. On a neuroscience floor with the majority of patients diagnosed with stroke, the likelihood of a patient having aphasia or other communication difficulties is high. Adapting and adjusting to this new communication deficit poses unique barriers for patients in the post-stroke community. In order to improve communication between this distinct patient population and staff, a literature review was conducted from various databases in order to evaluate the effectiveness of using mobile applications as a means of improving communication. Current practices rely on using paper and pen or even communication boards. However, with modern day advances, technology has the ability to make communication seamless. Several articles have shown high satisfaction rates when using these mobile applications and an eagerness to continue to use them. However, many had mixed reviews regarding the applications’ ability to improve communication between staff. Although patients are likely to use electronic devices and have shown benefit with using them, the articles have not shown a definitive correlation in improvement of communication between patients and staff. In addition, research has found that older adults are less likely to utilize new technology. With the limitations found in these devices, there is much improvement to be made in order for electronic communication devices to be made effective in the clinical setting.
Registered Nurses: Finding the Will, To Retain your Skill
(2018) Worthy, Michael; Temple University. Hospital
This project reports a literature review examining factors that enhance and/or prevent retention of skills and knowledge after BLS/ACLS training, in order to identify best educational practices resulting in the best possible outcomes for victims of cardiopulmonary arrest. Poor knowledge and skill retention following resuscitation training for registered nurses (RNs) has been well documented over the past 3 decades. Statistics show many studies found that BLS/ACLS scores significantly decreased in various different sample subgroups of RNs employed in critical care areas within the first year after certification. Furthermore, consistent training and testing for RNs working on units where CPR is not practiced frequently will improve patient outcomes. The study will review the data collected regarding the retention of theoretical knowledge and clinical skills of registered nurses post BLS/ACLS certification in order to establish effective retesting timeframes with hopes of significantly increasing retention scores and ultimately, patient outcomes
LVAD Driveline Infection Readmission: Prevention by Standardization
(2018) Busorguina, Olga; Conley, Sean; Goodwin, Casey; Temple University. Hospital
Recurrent driveline infection is the most common readmission diagnosis for patients after being implanted with an LVAD. The literature shows that readmission on post LVAD implantation on average costs $35,000. Our review of literature shows that education and lifestyle changes can decrease the chance of readmission. The literature shows that certain implantation techniques can contribute to decreasing driveline infection.
Don’t Fail, Use Violence Predictor Scales
(2018) Antenucci, Laura; Evers, Joseph; Ley, Brittni; Russo, Emily; Weiss, Alexandra; Temple University. Hospital
The purpose of this evidence based practice project was to complete a review of the literature, compare different violence prediction scales, and determine if it would be beneficial to implement a scale into the standard of care at our institution. “Approximately 80% of violent acts from patients are directed at nurses”. Violence against nurses leads to psychological distress and eventually nurse burnout. According to a recent report by the American Hospital Association, “workplace violence cost U.S. hospital and health systems approximately $2.7 billion in 2016”. Multiple scholarly databases were utilized to obtain evidence based research on this topic. A total of five articles were reviewed, containing 2 levels of evidence. Based on the evidence found, a pilot of the BrosetViolence Checklist prediction scale is recommended as required nursing shift documentation in an EMR.
Make It Known: Patients Are At Risk When They Go Prone
(2018) Jackson, Kedeisha; Temple University. Hospital
In recent years, pronation therapy is being used utilized more frequently for patients diagnosed with Acute Respiratory Syndrome (ARDS) . For an ARDS patient, the effectiveness of pronation therapy results in a “16% percent mortality rate compared with a 32.8 percent rate” if these same patients were to remain supine. However, pronation in these critical patients has many other adverse effects; one of those being pressure ulcers. Pressure injuries come at an astronomical cost to healthcare systems; pressure injuries as a result of pronation therapy is no different. Pronation therapy as it relates to a life saving measures has received considerable attention especially in recent years; however, the same cannot be said specifically for patients Integumentary during pronation.
The Efficacy of Medical Grade Honey as a Treatment in Wound Care
(2018) Campbell, Marie; Dinh, Linh; Parisi, Catrina; Temple University. Hospital
Honey, known for centuries as a topical treatment for a wide range of wounds, has recently seen a revival in modern wound care. The objective of this literature review is to evaluate the available evidence regarding the role of honey in contemporary wound care. The search strategy was developed in the CINHAL and PubMed databases. Seven studies evaluating the use of honey in human burns, ulcers and other wounds were eligible for inclusion. In all three wound categories, honey was shown to have wound healing stimulating properties (Biglari et al., 2013). There is also evidence for the antibacterial capacity of honey on burns. Honey may also be used for deodorizing, debridement, anti-inflammatory and wound pain reducing properties; although, the evidence for these properties is rather limited (Robson et al., 2009). We suggest further research in relation to the clinical relevance honey has in the treatment of wounds. We also recommend the development and dispersal of education to patients and their families about medical honey.
The Use of Ginger with Chemotherapy Patients
(2018) Brownrigg, Kim; Molina, Joan; Temple University. Hospital
During chemotherapy many cancer patients experience episodes of nausea and vomiting. Despite the widespread use of antiemetics, nausea continues to be reported by over 70% of patients receiving chemotherapy. Ginger may be a safe and effective measure to help these patients receive comfort from these symptoms in a safe and natural way. Drinking a warm calming cup of ginger tea may provide the relief to these patients. Ginger acts within the gastrointestinal tract, by increasing the gastric tone and motility due to anticholinergic and antiserotonergic actions. It is also reported to increase gastric emptying. This combination of functions explains the widely accepted ability of ginger to relieve symptoms of functional gastrointestinal disorders, such as dyspepsia, abdominal pain, and nausea, which is often associated with decreased gastric motility. The importance of eliminating these chemotherapy side effects could make a difference to these patients. This literature review will examine studies that implement ginger products as treatment for chemo induced nausea and vomiting, providing recommendations for further research on this and other complementary and alternative medicines.
Ready, Set, Extubate: A Multidisciplinary Approach
(2018) Baumher, Jennifer; Zabala, Erica; Temple University. Hospital
The purpose of this project was to determine the effectiveness and outcomes of a multidisciplinary extubation protocol in post-operative cardiac ICU patients. Multidisiciplinary weaning protocols help initiate the process of early extubation by identifying patients who are ready to progress in their recovery. These protocols facilitate collaboration with nurses, respiratory therapists, anesthesia, and physicians. A comprehensive literature review was completed in order to identify studies that implemented multidisciplinary protocols. The results of these studies were compiled and synthesized. Ultimately, the studies showed that weaning protocols can lead to a decrease in prolonged extubation, length of hospital stay, length of ICU stay, and ventilator associated complications. Current mechanical ventilation weaning practices lack a definitive protocol and could immensely benefit from a centralized and outlined process.
Putting a Rest to Moral Distress
(2018) Aragon, Jacqueline; Badura-O’Connor, Lexi; Berardi, Arianna; Ortiz, Janelle; Temple University. Hospital
The purpose of this project is to examine how nurses, particularly in ICUs, are at risk for moral distress and compassion fatigue, leading to factors associated with nurse burnout, as well as the resulting decreased ability to provide compassionate patient care. Moral distress is stress that occurs in situations when one knows the right course of action but is unable to carry it out due to institutional constraints. Accompanying moral distress, compassion fatigue is a feeling that results from the inability to protect or heal a patient that leads to stress and self-blame (Mattioli, Walters, & Cannon, 2018). The most commonly reported causes of moral distress surround futility of care, lack of autonomy, and institutional constraints. The experience of moral distress leads to depersonalization of care, diminished interprofessional collaboration, and increased emotional distress within the nursing profession. Although not many interventions have been put in place or tested to address moral distress, common themes involve harboring constructive interprofessional communication, “offering critical stress debriefings” (Browning & Cruz, 2018), and involving all aspects of the care team in decision making including nurses, patients, and families (Pishgooie et al.,2018).
Where’s the gap? Sterile vs. Tap
(2018) Amendolia, Jennifer; Bale, Jade; O’Sullivan, Elizabeth; Temple University. Hospital
This project explores the evidence on the preferred water used when flushing a feeding tube in an immunocompromised lung transplant patient in preventing infection risk. After conducting a survey among the staff on a medical surgical post lung transplant unit, it was found that many nurses do not know the preferred method and are unsure of any policy in place. We conducted a database search through CINHAL and PubMed to discover research articles with the best practice procedures. It was found that sterile water was the preferred method of flushing a feeding tube in immunocompromised patients and one researcher who felt that it made no difference and was a waste of money to use sterile water. One recommendation from this project is that a hospital system should implement a universal sterile water policy for feeding tube flushes in all patients, especially immunocompromised because it ensures all staff uses the same water and it is the best way to ensure our patients safety, which will prevent complications of infection and further costs.
Taking the Sting out of Sticks: Increasing Patient Satisfaction by Reducing the Pain of PVCs
(2018) Haring, Katie; Temple University. Hospital
Venous catheterization is a common invasive procedure in the hospital setting. Current standard practice in many hospitals does not include the use of any anesthetic for the process, though it is generally understood that the procedure at a minimum results in patient discomfort and can result in anxiety and severe pain. Depending on a patient’slength of stay, several catheterizations may be required, increasing this discomfort andresulting in lower patient satisfaction. The aim of this project is to explore the use of localanesthetics as a means to reduce pain and anxiety and increase patient satisfaction withhospital stays. The references utilized not only studied the effect of various painmanagement strategies, but also examined patient preferences toward decision-making as it relates to overall patient satisfaction
Hair Hygiene & Central Line Infections in the Critical Care Setting
(2018) Breslin, Joseph; Le, Be-Ut; Von Hofen, Alexander; Temple University. Hospital
Central venous catheters (CVC) related infections are a significant cause of iatrogenic mortality, morbidity and increased length of stay in intensive care unit populations in the United States, with over 28,000 deaths and an associated cost of over $2 Billion US dollars per year. Pseudomonas aeruginosa and Escherichia coli were found to produce a significant amount of biofilm on hair shaft surfaces while E. Coli inhabited cuticle scale edges. E. coli and P. aeruginosa were found to be responsible for 8% and 16%, respectively, of central venous catheter related infections. Although a direct relationship between hair hygiene and central lines has yet to be determined, establishing a hospital-wide policy regarding CVC patient hair maintenance for central line infection prevention may be warranted.
“Talk to Me for Ten”
(2017) Brewster, Kelly; Morris, Jamie; Temple University. Hospital
Patient satisfaction is an effective indicator of measuring quality health care provided in hospitals. The Centers for Medicare & Medicaid Services (CMS), along with the Agency for Healthcare Research and Quality (AHRQ), developed The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) which is the first national initiative that has provided a “standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care” (CMS, 2017). This tool measures randomized patient perspectives using a 32 question survey, with one of the focuses being “communication with nurses”. Patient satisfaction is directly related to reimbursement for the hospital. Medicare now reimburses “centered on quality, not simply quantity, of services provided”. A specific focus was taken on a specialized IMU/Medical-Surgical unit in Temple University Hospital to increase the patient satisfaction score for “Communication with Nurses”. For the fiscal year of 2017, nursing communication score for the pilot unit, was 76.3 with a target of 78. After the implementation of the “Talk to Me for 10” on the IMU/Medical-Surgical unit, during the first 3 quarters of the 2018 fiscal year the communication with nurses score jumped to 81.5%. Through this research conducted on the unit, we examined the benefits of direct RN communication and an increase in patient satisfaction.
The Effects of Accurate Intake & Output Tracking in Heart Failure Patients
(2018) Costanzo, Dana; Mathew, Jicy; Temple University. Hospital
The purpose of the project was to observe whether or not accurate measurements of intakes and outputs in CHF patients will have correlation with improving cardiac function, reduce the length of stay in a hospital, and whether or not it would reduce hospital readmissions. The methods used for our evidence based literature review were to provide an intake and output measurement tool to CHF patients while in the hospital, and adequately keep track of how much fluid they were putting in and out of their body. Our findings suggest tracking intakes and outputs in a timely and specific manner would improve cardiovascular functions which would reduce hospitalizations, exacerbations, readmissions. -Recommendations: The RN caring for particular patient is responsible for ensuring that fluid balance charts are recorded regularly and with accuracy, using the correct notation throughout.
Implementation of Noise Reduction Interventions on Patient Satisfaction Scores: A Literature Review
(2017) Afolabi, Lola; Gorman, Marissa; Mamrol, Jennifer; Noble, Mary; Tucker, Diana; Temple University. Hospital
Nursing pioneer, Nightingale, advocated the importance of creating an optimal healing environment. Unwanted noises have been reported to be adverse effects to healing. The objective of this project is to review available literature in search of interventions that decrease noise and increase patient satisfaction in acute care settings. A Collection of five scholarly articles were reviewed analyzing the effectiveness of noise reduction interventions. Researchers observed a significant difference in participants rating of acceptable sleep. In another study, members of the intervention group reported increased satisfaction with their sleep as a result of noise reduction interventions. Another study found that reduced hourly peak sounds had lower the amount of perceived noise among patients. The lack of quality research exploring noise reduction specifically for Medical-Surgical units has been noted as a limitation on the value of implementing such interventions.
Addressing Lateral Violence in Nursing
(2017) Lawler, Kayla; Palic, Mary Beth; Temple University. Hospital
In 2008, the Joint Commission issued a Sentinel Event Alert regarding lateral violence as unacceptable in a culture of safety, and stated that it may have an effect on preventable negative patient outcomes. Studies have found that lateral violence is pervasive in nursing work environments, both among staff RNs and between staff RNs and management. Many different ideas as to how to address workplace violence among RNs exist, including educational programs and policies regarding the consequences of lateral violence. Nurses need to be aware of the definition of workplace violence, as well as the methods for resolving violence in a professional manner and plans to prevent workplace violence in the future.
Can Patient Hand Hygiene Reduce the Incidence of HAIs?
(2017) Brassington, Alex; Perry, Laura; Semon, Peter; Temple University. Hospital
The purpose of this project is to examine the available evidence to determine whether encouraging patient hand hygiene will decrease the incidence of hospital acquired infections (HAIs).HAIs pose a significant threat to the safety and welfare of patients. There is amounting evidence on how effective hand washing is in breaking the chain of infection. For years, healthcare centers have focused their efforts on hand hygiene and education among healthcare workers. Evidence suggests that patient’s flora and hospital environments are primary sources of HAIs. The emerging evidence suggests that patient hand hygiene is being overlooked. Hand hygiene among patients is one of the missing links in preventing HAIs. A reduction in HAIs at Temple University Hospital will reduce overall costs and decrease patient’s length of stay.
Work Breaks, Retention, and Burnout for Emergency Department Nurses: Related?
(2017) Xie, Alice; Temple University. Hospital
Thirty-five percent of nurses report taking their breaks rarely or never (American Nurses Association, 2009) and there is evidence to suggest that ED nurses take their breaks less often compared to their counterparts in other specialty areas (Faugier et al., 2001). A landmark study showed that when nurses take an additional ten minutes for their break, they decrease their chance of making a medical error by 10% (Rogers et al, 2004). Despite the evidence to support nurses taking consistent breaks and the increasing concern with burnout and nurse retention in the country, neither the consistency of breaks specifically among ED nurses, nor its effects on burnout and retention are well studied. The objective of this project was to review existing literature regarding how consistent work breaks affect nurse retention and burnout. After a search of three databases for related articles, only one article met inclusion/exclusion criteria. This article used subjective data collected from nurse interviews to conclude that lack of self care (including time to eat at work) affects caring for patients, which in turn affects burnout. However, no concrete data was collected to draw a direct relationship between work breaks, burnout, and retention. Further research is required to determine the effects of work breaks on ED nurse burnout and retention.

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