Winners of the Outstanding Dissertation and Capstone Project Awards
Nancy Crego, PhD, RN, CCRN
The Excellence in Advancing Nursing Science Award for an outstanding dissertation from a student in a PhD in nursing or DNS program was presented to Dr. Nancy Crego (pictured above), who graduated in 2013 with her PhD from the University of Virginia. Her dissertation chair was Dr. Elizabeth I. Merwin. For her study titled Influencing Pediatric Sedation Safety, Dr. Crego utilized big data to discover sedation practices, compared nurse and physician sedation teams, and made recommendations for evidence-based practice guidelines.
DESCRIPTION OF DISSERTATION
Background: Every year, thousands of children require sedation for diagnostic and interventional procedures. Despite regulations by accreditors and guidelines by professional organizations, adverse sedation events and variations in how sedation care is delivered continue to occur.
Purpose: This study presents a review of sedation standards shaping RN practice and exemplars of state Boards of Nursing sedation regulations in the United States.
Methods: The Pediatric Sedation Research Consortium (PSRC) database was used to learn more about RN sedation practices in diagnostic radiology; findings revealed that RNs often plan to achieve deep levels of sedation and administer combinations of two or more sedative medications for diagnostic procedures. Outcomes of sedation for cases where RNs monitored and delivered sedation alone were compared to outcomes of RN and physician teams and physicians working alone to deliver sedation. Cases in which RNs alone provided sedation had similar American Society of Anesthesiologists risk scores compared to cases with physicians alone and RN and physician sedation teams.
Results: Adverse event rates in sedated children range from 0.4% to 20.1% in the U.S., and include cases of desaturation, inadequate sedation, and respiratory depression requiring bag valve mask ventilation. The rate of sedation adverse events when RNs provide sedation is unknown due to small sample sizes and few RNs participating in reported studies. Limitations of most investigations regarding pediatric sedation include frequent use of single site samples, reporting on only one type of procedure, and using sample sizes that are underpowered to detect sedation adverse events that are estimated to occur once in many thousands of cases. Many studies of RN sedation practice have examined a particular aspect of sedation care, such as determining differences in outcomes of sedation using different sedative medication regimens or the number of failed sedations; these outcomes are not compared to other sedation provider outcomes. As a result, these studies provide limited information on the safety of RN administered procedural sedation, the factors that increase the likelihood of adverse sedation events, and the differences in sedation administered by RNs compared to other sedation providers. Findings revealed that cases in which RNs alone or physicians alone monitored and delivered sedation had lower odds of experiencing adverse events than when sedation was administered by RN and physician teams.
Conclusion: This study revealed inconsistencies in state Board of Nursing regulations and in RN sedation care standards in the U.S. Data from this study could be used to improve RN sedation care processes, and guide the development of consistent nursing sedation licensing regulations, hospital standards, and policies. The lack of data on RN sedation practice and safety hinders the development of evidence-based regulations. Differences in sedation care may be related to the type of specialist providing sedation, their scope of sedation practice, and methods used to induce sedation. Sedation is performed by a variety of health care providers including registered nurses (RNs), but there are limited data on current regulations governing RN sedation, descriptions of RN sedation practice, or comparisons of outcomes of sedation by different types of providers.
Honorable mention went to:
Erica Schorr from the University of Minnesota for her dissertation titled Characterization of the Peripheral Artery Disease (PAD) Symptom Experience
Yafen Wang from Case Western Reserve University for her dissertation titled Associations Among Academic Stress, Dispositional Optimism, and Resourcefulness in Fifth and Sixth Graders in Taiwan
Jennifer L. Titzer, DNP, RN, RT(R), RCIS
The Excellence in Advancing Nursing Practice Award for an outstanding capstone from a student in a Doctor of Nursing Practice (DNP) program was presented to Dr. Jennifer L. Titzer (pictured above). Dr. Titzer graduated in 2013 with her DNP from the University of Southern Indiana; her capstone Chair was Dr. Maria R. Shirey. For Dr. Titzer’s capstone project, titled Nurse Manager Succession Planning: Strengthening Health Systems for the Future, she developed and implemented a model for strategic succession planning for the chief nursing officer in a large hospital system.
DESCRIPTION OF CAPSTONE
Background: Traditional nurse manager selection methods usually result in promoting excellent clinicians lacking formal education and mentoring. Ineffective nurse manager selection increases role stress, unhealthy work environments, poor patient outcomes and turnover rates. Inconsistent leadership results in a loss of community and employee confidence. Competent and effective nurse managers contribute to a healthy work environment, improved employee morale and favorable outcomes. Succession planning increases nursing leadership competence and continuity. Ensuring a competent nurse manager pipeline demands deliberate and strategic succession planning methods. Healthcare lags behind other business industries in strategic succession planning threatening the future nursing leadership pipeline. Evidence regarding succession planning outcomes is limited and hinders implementation efforts. Deliberate and strategic implementation and evaluation of successful planning is critical.
Purpose: The purpose of the capstone was to develop, implement, and evaluate a nurse manager succession plan at an acute care hospital. The primary project objective was to create a strategic method for identifying and developing intellectual talent creating an internal leadership pipeline. Development of an internal leadership pipeline with the intent of reducing recruitment and replacement costs, decreasing nurse manager turnover, and increasing nurse satisfaction was the end goal.
Methods: Nurses working in an acute care hospital were recruited for participation in a 12 month leadership program. Recruitment included completion of a formal and systematic application process. A quasi-experimental one-group pre-test/post-test design evaluated program outcomes. The measurement tools included the Leadership Practices Inventory (LPI) and the Nurse Manager Skills Inventory (NMSI).
Results: A strategic succession planning process was developed at St. Mary’s Medical Center targeting the nursing director position. All staff nurses not formally in leadership roles were invited to apply. Selection was based on an objective scoring worksheet and interview process. There were a total of 12 participants selected and invited into a 12 month leadership development program. Six months into the program, one participant transferred to another facility due to re-location. The remaining 11 participants completed the program. Monthly, six-month, and final program evaluations were overwhelmingly positive and the pre/post leadership and management surveys indicated statistically significant increases in participants’ competency perceptions (p < 0.05). Five nurses from the leadership pool were promoted either during or after program completion (three nursing director and two unit coordinators). In addition, three participants transitioned into quality analyst, staff development specialist, and informatics roles.
Conclusion: The model created for the inaugural program provided a pilot that can be evaluated and adapted accordingly. Ongoing evaluation beyond the initial customer satisfaction and learning and growth metrics will provide a cost benefit analysis and determine a return on investment as well as the impact on the overall nursing satisfaction. Additional recommendations included offering similar programs to professional staff outside of nursing ensuring an organization wide leadership pipeline.
Honorable mention went to:
Joelle Hargraves from Chatham University for her capstone titled Glycemic Control in Cardiac Surgery Patients: Revising and Educating Nurses on an Evidence-based Insulin Infusion Protocol
Rebecca Russo-Hill from Duke University for her capstone titled Screening for Depression in Patients with Diabetes: Addressing the Challenge