Nursing capstones explore process improvements

Students graduating in December with bachelor’s degrees in nursing wrapped up their classwork by presenting capstone projects that proposed practical improvements in nurses’ daily processes. The projects, presented via research posters and slide presentations, encompassed study from each of the final-semester courses: Adult Health Nursing III (taught by Pamela W. Baker, associate professor of nursing); Leadership & Management in Nursing (taught by Donnamarie Lovestrand, associate professor of nursing); and Research & Theory in Clinical Practice (taught by Barbie D. Harbaugh, assistant professor of nursing).

Based on scenarios they saw during clinical education experiences in Adult Health Nursing III, the students study how an element of nursing practice might be improved and explore how the “best practices” revealed by their research might be standardized and implemented in the workplace.

“The capstone project for the senior nursing students provides the experience in research and process improvement that is now linked to what are considered basic competencies for the prelicensure students,” Lovestrand explained. “Not all nursing programs provide this experience for nursing students.  According to the Governance Institute document from 2009, health care workers at the point of care are responsible for providing the evidence and the plan to improve care for patients. The senior nursing students grapple with the concepts of these competencies to develop their process plan based on current research. Their capstone day is the perfect time to showcase their hard work and dedication to providing evidence-based nursing care now and in the future. Some students have been offered positions based on their ability to prepare process-change projects.”

Their projects:

Outcomes of ventilator-associated pneumonia regarding the effects of oral care on intubated patients in the intensive care unit

Students: Nancy Chan, of Milton; Rory L. Foran, of Williamsport; Abigail Keister, of Middleburg; Morgan L. Lucas, of Milesburg; Kathryn N. Meeh, of Wyalusing; and Madelyn J. Williams, of Roaring Branch.

The students researched the effectiveness of implementing proper oral care – including the use of the antiseptic chlorhexidine – on the incidence of ventilator-associated pneumonia  among immunocompromised patients in an intensive care unit.

The hospital’s policy for proper oral care calls for cleaning the mouth every four hours and as needed using suction swabs, debriding agents and a 0.12-percent chlorhexidine rinse twice daily for one to two minutes.

The students found that:

• Poor oral health care before intubation increased ventilator-associated pneumonia risk and adverse outcomes.
• An advanced suction toothbrush with chlorhexidine gel is more effective than chlorhexidine-soaked gauze.
• A 0.12% solution of chlorhexidine is effective for ventilator-associated pneumonia prevention; higher concentrations may not be needed.
• Comprehensive oral care improves health, reduces ventilator-associated pneumonia and lowers mortality.

They proposed reeducating ICU nurses on the link between oral care and the prevention of ventilator-associated pneumonia, ensuring compliance with hospital oral care protocols and accurate documentation of oral care, and working with the care team to support consistent oral care practices.

Leveling arterial line transducers using a leveling tool vs. the naked eye in intensive care unit patients

Students: Julie Anthony, of South Williamsport; Lauren R. Bleistein, of Williamsport; Haley N. Damgaard, of Bellefonte; Madison N. Keiser, of Williamsport; Morgan C. McCormick, of Danville; Courtney Poorman, of Lock Haven; and Mya E. Rush, of Port Royal.

The students studied whether the method used to level an arterial line transducer had an impact on the accuracy of blood pressure measurement readings in adult ICU patients with arterial blood pressure monitoring.

In order to accurately measure arterial blood pressure, the system must be correctly set up. If the transducer is positioned above or below the catheter, it will produce inaccurate pressure readings.

The students recommended providing keychain-style laser leveling tools to each nurse in the ICU to promote their use and ensure accurate blood pressure readings.