Nursing, 2012
  • Twelve Hour Work Shifts and Nursing Medication Errors
    Alison Berens, Mike Gentner, Lisa Re', Kyle Miller
    Mentor: Barbara Duane

    Medication errors by nurses are caused by a number of factors. Fatigue, shift length, sleep patterns as well as education level are all potential contributors. As the 12-hour work shift is becoming the most popular in the hospital setting, the literature was reviewed to identify whether this extended shift contributes to an increase in nursing medication errors. The literature found that while medication errors associated with fatigue do begin to increase after 8 hours, a statistically significant increase in medication errors is associated with working at least 12.5 hours. Suggestions for possibly reducing errors include ensuring enough time for nursing staff to hand off their patients at the end of their shift, limiting the number of 12 hour shifts worked consecutively, increasing the number and length of breaks, and educating the nursing staff about sleep, nutrition, and stress management practices. Future research needs to be done to determine if these changes have a significant positive impact on the reduction of medication errors by nursing staff. Finding a way to work 12-hour shifts in a safe and productive way ensures that patients, nurse managers, and nursing staff are satisfied with this scheduling preference in the hospital setting.

    Hourly Rounding for Patient Safety and Satisfaction
    David Boyer, Taylor Carter, Melissa Parker
    Mentor: Barbara Duane

    As the patient load increases and the nursing shortage intensifies, nurses need to be used in an effective manner while increasing patient safety and satisfaction. Hourly rounding, which is intentionally checking on patients at regular intervals, has been adopted in many facilities. Hourly rounding’s purpose is to anticipate patients’ needs and ensure their safety (Shaner-McRae, 2007). This allows the nursing staff to address problems before they occur (Studer Group, 2005). As a part of hourly rounding, four Ps: pain, personal needs, positioning, and placement, - which are the most frequent reason for call lights, are addressed by the nurses before they leave the room (Studer Group, 2007). Literature has reported reductions in falls, use of call lights, and development of pressure ulcers for facilities practicing hourly rounding (Meade et al., 2006), which are promising outcomes of this practice.

    Comparison of Hands Only Cardio Pulmonary Resuscitation (CPR) to Traditional CPR: A Literature Review and Synthesis
    Amanda Breitfeller, Erik Barenwald
    Mentor: Kathleen Lux

    Although bystander CPR can more than double survival from cardiac arrest, the reported prevalence of bystander CPR remains low, roughly 27% to 33%. For this reason, in 2005 the American Heart Association introduced new Cardio Pulmonary Resuscitation (CPR) bystander guidelines which use a hands only (compressions only) technique versus the traditional 30:2 ratio of compressions to breaths. A literature review evaluating twenty-one research-based articles was used to develop matrices for data analysis. The results of this analysis showed that there was no significant difference in survival rates to hospital discharge between the two forms of CPR but there was a significant increase in bystander participation with hands only CPR. Other studies suggest that hands only CPR is easier for dispatchers to teach to bystanders over the phone and hands-only bystander CPR reduces the time to initiation of CPR resulting in delivery of a greater number of chest compressions with fewer interruptions for the first several minutes after adult out-of-hospital cardiac arrest. Implications for nursing practice include educating lay people about this new lifesaving CPR technique. Identified recommendations for future research include conducting clinical trials to demonstrate that hands only CPR increases the overall performance by bystanders.

    Is Intensive Insulin Therapy the Better Practice for Critically Ill Patients?
    Naomi Burlacu, Joanna Dilley, Paul Pollack, Ashley Sperry
    Mentor: Barbara Duane

    A hyperglycemic state is the body’s natural response to trauma, even in those who have not previously had diabetes. The purpose of this scholarly literature review was to compare and contrast the benefits of intensive insulin therapy (IIT) in critically ill patients in a hyperglycemic state. The goal of IIT is to maintain a blood glucose level between 80 and 110 mg/dL. This treatment modality came to the attention of the medical community after a landmark study completed by Van den Berghe et al. (2001). This study of 1548 intensive care patients showed intensive insulin therapy reduced mortality by 8%. A more recent study of 6104 adult ICU patients, however, found that a blood glucose target of 180 mg or less per deciliter (conventional control) resulted in lower mortality than did a target of 81 to 108 mg per deciliter (intensive insulin therapy). This review will include a discussion of differences between the two studies that may explain the conflicting results, and provide evidence-based recommendations for practice.

    Hope Quilt
    Jennifer Davis, Daston Campell, Brooke Fox, Jesi Howell, Courtney Otto, Jennie Pabst, Ryan Ross, Mary-Helen Skowronski, Ashley Stotesbery, Jessica Woodruff
    Mentor: Michelle Barsnack, Sharon Stout-Shaffer, Deborah Shields, Amy Oehlschlaeger, Andrea Thomas, Renda Ross, Dina Lentsner, Janette McDonald, Andrea M. Karkowski

    Art has been used as a way to inspire hope in people through times of crisis. The purpose of this project was to create a hope quilt. Students studying hope imagined what hope looked like and portrayed hope through a symbol or an image. Students were asked to think of a color that represented hope for them and then were asked to think of a symbol that represented hope for them. Students then designed the image that incorporated their color of hope and used different quilting techniques. Each piece was stitched together to create an enlarged quilted wall hanging. This project expands our understanding of hope by exploring the colors, images and symbols associated with hope.

    Experiences of Hope in a College Population
    Jennifer Davis
    Mentor: Andrea M. Karkowski, Sharron Stout-Shaffer

    Hope is a vital part of life because it helps people cope with adversity and motivates people to achieve their goals. The purpose of this study was to examine how college students defined and experienced hope. I interviewed students and asked about their experiences with hope and how they defined hope. I expected to find two themes of hope. The first theme of hope would be concerned with their academics because college students feel a pressure to succeed in school. The second theme of hope would focus on the development of relationships because college students are transitioning from strong relationships with their families to strong relationships with their peers. Most of the literature on hope that exists used definitions of hope that had been developed by professionals. This study contributes to our understanding of hope by examining hope within a different population.

    Medical Line Entanglement Risk Checklist: Development and Implementation
    Michelle Guy, Sarah Finkel, Nicole Truckor, Nichole Wood
    Mentor: Heather Janiszewski Goodin

    Patients in the pediatric setting are at risk for strangulation from their medical lines. The development of a medical line entanglement risk checklist could identify children most at risk and have a Medical Line (ML) wrap in place to prevent entanglements. This study used the development of a risk checklist to assess the pediatric patient’s potential for medical line entanglement. Research articles were analyzed, an interview with the medical line wrap inventor was conducted, and the risk checklist was pilot tested with 68 patients. Construct validity was also explored with prevalence data previously collected on 486 patients. The use of the risk checklist is a beneficial component when assessing the patient’s needs. The risk checklist can help prevent harm and potential death in pediatric patients. With the use of a risk checklist for medical line entanglement as an indicator for use of a medical line wrap, clinicians are able to identify which patients are at greatest risk for injury from their medical lines. Once the wrap is in place on high risk patients, the incidence of entanglement has the potential to decrease. At this time, further research is necessary to establish the effectiveness of the checklist in clinical practice.

    Interrelationships between Obesity and Depression in the Adolescent Population: A Literature Review and Synthesis
    Kelsey Hill
    Mentor: Kathleen Lux

    Obesity, defined as an individual being 20% or more over their ideal body weight, is a concern for United States. One third of children ages 2 through 19 are overweight or obese. The purpose of this study was to examine the relationship between obesity and depression in the adolescent population. A literature review evaluating 21 empirical articles was used to develop matrices for data analysis. The results of this analysis showed a link between depression and obesity, especially in females. Although this relationship is not well understood, many variables including an adolescent’s Body Mass Index, depressive symptoms, age, gender, self-esteem, socio-economic status, and family status can contribute to an adolescent’s weight and psychological state. Nursing practice implications include teaching parents about adolescent depressive symptoms and disease management and role modeling positive health behaviors. Other implications include early screenings for depression by school nurses and educating school faculty about adolescent depression. Nurses also need to develop culturally appropriate screening tools and educational materials for use with high-risk ethnic groups. Recommendations for future research include developing standard measures for the adolescent population, identifying the various causes of obesity, and improving our understanding of the relationship between adolescent obesity and depression.

    Nursing Challenges for Patients with Dementia
    Rebecca Kabat, Kari Mason, Meghan Peters, Molly Schoonover
    Mentor: Barbara Duane

    As the population ages, the occurrence of dementia is increasing. Staff nurses find it difficult to accommodate the needs of a person with dementia, as those needs are both physical and mental and include communication difficulties (Webster, 2011). Patients with dementia may be confused and agitated during treatment, and the symptoms they display can be intimidating for nurses not experienced in caring for these individuals, or for who do not have specialized training. Interaction and communication are paramount in providing quality care for patients with dementia (Elkins, 2011). A development called the Butterfly Scheme, used to identify patients with dementia, including the philosophy of a REACH response, has shown improvements in patient satisfaction and care in the UK (Williams, 2011). We present the challenges that nurses face when working with a patient with dementia and present a methodology called the Butterfly Scheme which may help bridge the communication gap between nurses and dementia patients.

    The Representation of Hope among Various Spiritual Traditions
    Courtney Otto
    Mentors: Janette McDonald, Deborah Shields, Sharron Stout-Shaffer, Renda Ross

    Hope is perceived, experienced, defined, and represented in different ways in different spiritual traditions. In order to be effective clinicians and researchers, psychologists need to understand different worldviews. The author studied literature pertaining to the definition of hope in various spiritual traditions, as well as artistic representations of and metaphors for hope from these different spiritual traditions. It was expected that the concept of hope would be similar across spiritual traditions, but the symbolic representation of hope would be different in each spiritual tradition. Most of the current literature does not compare concepts of hope from the perspective of different spiritual traditions, even though many relate their definition of hope to their spiritual tradition. This study is important because it examined hope from a spiritual perspective and included both definitions and explanations of hope and artistic and symbolic representations, important components of spiritual traditions.

    A Box of Hope, a Case of Despair
    Jennie Pabst
    Mentors: Janette McDonald, Deborah Shields, Sharron Stout-Shaffer, Michaele Barsnack, Renda Ross

    Hope and despair are important aspects of the human experience and different people see these emotions in different objects and images. The purpose of this display is to depict the variety of images that represent hope and despair. I created a display that incorporates items and images that symbolized both hope and despair and I have analyzed these in the context of the literature about hope. I found both similarities and differences in the images that people reported to me. This research contributes to our understanding the interrelationships between hope and despair and how those interrelationship manifest through visual imagery.

    The Correlation between Childhood Obesity and Socioeconomic Status
    Nicole Pfenning, Chris Huebner
    Mentor: Deborah Janssen

    The prevalence of childhood obesity is rapidly increasing and is reported to have reached epidemic levels. Children who are overweight or obese are at an increased risk of developing serious health conditions such as type II diabetes, heart disease, and a variety of musculoskeletal disorders. One factor that has been known to influence a child’s weight is the family’s socioeconomic status. So as to investigate a possible correlation between childhood obesity and low socioeconomic status, CINAHL, EBSCO host, and MEDLINE were used to create a research matrix. A strong correlation was found between childhood obesity and low socioeconomic status. With this research, interventions can be aimed at children who are overweight, or at an increased risk, in order to decrease the prevalence of this growing problem.

    Effective Delegation Strategies between the RN and UAP
    Sarah Reid, Taylor Randas, Colleen Davis, Emily Baker, Chelsea Rankin, Shay Riker
    Mentor: Barbara Duane

    In 2004, the American Association of Colleges of Nursing estimated that 44 states would experience nursing shortages by 2020. The shortage coupled with new funding mechanisms that decrease income has caused a rise in paraprofessionals known as unlicensed assistive personnel (UAP) (Kleinman & Saccomano, 2006). UAPs typically provide routine, non-invasive care to stable patients. Tasks are delegated to UAPs by a registered nurse (RN), who is ultimately responsible for their actions (Conway & Kearin, 2007). Ohio RNs must abide by state law, which dictates what can be delegated and who can carry out those directives. Many nurses have not received formal training on how or what to delegate. The American Nurses Association (ANA) – a national organization – has provided some guidance; however, it is in the process of revising its delegation principals (ANA, 2012). Additionally, conflicts between the UAP and RN that center on each other’s role, age, tenure, work ethic and/or personality can occur. Management also plays a role in conflict resolution and the process of delegation. This literature review aims to identify what skills or environment is needed for delegation to be conducted effectively and how that affects patient care.

    Stress Busters for the Acute-Care Nurse
    Sarah Reid, Lisa Crews, Erin Smith Ney, Brandon Juarez
    Mentor: Barbara Duane

    Stress and nursing are usually inseparable. In a 2001 American Nurse Association survey, 70.5 % of nurses polled said that overwork, chronic and acute stress were their top three health and safety concerns. Studies have shown that the inability to manage stress is associated with difficulty communicating with patients, difficultly maintaining relationships with co-workers and judgment issues. Traditionally, stress avoidance has been emphasized; however avoidance is not always possible in the healthcare setting (Laws-Chapman & Sergeant, 2012). This literature review attempts to identify common sources of nurse stressors, with particular focus on the acute care setting. Two evidence-based practice coping strategies were also identified and outcomes were compared with the results of an avoidance-based coping study.

    Exploring Hope through Play
    Mary-Helen Skowronski
    Mentors: Janette McDonald, Andrea M. Karkowski, Deborah Shields, Sharron Stout-Shaffer, Michaele Barsnack, Renda Ross, Dina Lentsner, Andrea Thomas

    Research has shown that having hope enables the individual to successfully deal with the inevitable challenges encountered in life. Hope may allow us to have a clear sense of what our potential is and how we can make things better. Hopeful individuals feel that they have an important role to play in their family, community and world. By creating a "toy with purpose", I aim to highlight that children can develop an understanding of hope through the creative process of play. To that end, I used fabric to make a wall-hanging with various pieces that can be detached and reattached in a way that encourages children to develop self-awareness and to explore the notion of hope. This project extends our understanding of hope by examining hope through child's play.

    Best Practice of Umbilical Cord Care in Reducing Adverse Events
    Karen Steiger, Sarah Davis, Ashley Fields
    Mentor: Jane Hutcheson

    Umbilical cord infection leads to an average of 4 million neonatal deaths worldwide each year and is the leading cause of infant mortality. To review current research literature on the practice of umbilical cord care, effectiveness of various umbilical cord care practices, and determine best umbilical cord care practice for both high-income and low-income populations. A literature search, using CINAHL, Cochrane, and Proquest was completed. Twelve articles related to best practices for umbilical cord care were selected and analyzed. In low-income countries, the use of chlorhexidine for umbilical cord care showed a dramatic decrease in the incidence of umbilical cord infections. A single application of chlorhexidine was found to be statistically better in preventing neonatal deaths from umbilical cord infection than multiple applications, and reduced neonatal deaths by as much as 20%. In higher income countries the incidence of umbilical cord infection is significantly lower regardless of the umbilical cord care intervention used. The most common cord care practiced in high income countries is dry cord care. When chlorhexidine is used within the first 24 hours after birth, in low income populations, it has been shown to significantly reduce the incidence of umbilical cord infection and infant mortality. However, in places of higher socio-economic populations, dry cord care seems to be as effective in the prevention of infection.

    Nurse Staffing Levels Determined by Patient Acuity
    Valerie Tiu, Angie Myers, Annie Whitcraft, Zoe Kappelman
    Mentor: Barbara Duane

    In recent years, nurse staffing levels, and how those levels are determined, at hospitals around the country have come under scrutiny. Whether driven by a national nursing shortage or a general increase in patient acuity, the main focus of these investigations remains delivering adequate and safe patient care. Generally, patient acuity is defined as the predicted needs a patient requires for nursing care while in a hospital based on their degree of illness (Dumpel, 2005). Through literature review there is no national standard for staffing individual hospital units, which not only varies in acuity levels each day, but possibly each shift. Recently, the focus within the nursing and medical community has been on the benefits and drawbacks of mandated state nurse-patient ratios. Research has shown that nurse staffing levels for individual units based on current patient acuity results in positive outcomes for both nurses and patients. Nursing actions are improved as evidenced by an 11% increase in nursing engagement with patients and a 27% increase in viewpoints of other coworker competencies. Patient outcomes have improved as evidenced by shorter stays in the hospital, decreased falls, and overall patient satisfaction (Carter & Burnette, 2010).

    Figures of Hope
    Jessica Woodruff
    Mentors: Janette McDonald, Deborah Shields, Sharron Stout-Shaffer, Michaele Barsnack, Renda Ross, Dina Lentsner, Andrea Thomas

    Hope can mean different things to different people. Because hope is associated with creative process, I created a visual piece of artwork that allowed me to explore hope in the various contexts of my life and to develop a sense of personal awareness and self-knowing. I took 24 photographs of objects that describe hope to me and make me hopeful. I then developed a book from those photographs which I entitled "Figures of Hope." This visual depiction of my personal definition of hope has given me a deeper understanding myself. The process of sharing explorations of hope has a two-fold outcome: (1) to enhance my personal hope through self-explorations, and (2) to foster others’ hope by sharing these explorations with others. This work can empower others to be more conscious and self-reflective.