ItemDeveloping Critical Thinking through the Use of Unfolding Case Studies(2022) Vickers, Karen BSN, RN; Dr. Cheryl Brohard, PhD, RN, CNS-ONC, AOCN®, CHPCA®Background: Studies indicate that when nursing students transition to clinical practice, they do not possess enough critical thinking skills to deliver safe patient care. Unfolding case studies provides an opportunity for students to analyze, predict, interpret, and transform knowledge. PICOT: In baccalaureate nursing students, how does unfolding case studies compared with traditional lectures affect critical thinking over a semester? Synthesis: Eight articles met the inclusion criteria with 1-Level II, 6- Level III, and 1-Level IV. Plan for Change: Using the Advancing Research and Clinical Practice through Close Collaboration in Education framework, two unfolding case studies will be implemented in the first three semesters. During the capstone course, students will be given a pre-/post-test Health Science Reasoning Test as a means to evaluate the students’ critical thinking. Unfolding case studies is an effective strategy in improving students' critical thinking and connecting theory to clinical practice. ItemStandardized Management of Infant Reflux Symptoms in the NICU(2022) Valdez, Sandra RN BSN; Dr. Cheryl Brohard, PhD, RN, CNS-ONC, AOCN®, CHPCA®Background: Gastroesophageal reflux is very common among infants admitted to the NICU. However, many hospitals do not have standardized management reflux symptoms. The lack of standardization may delay an infant’s discharge, decrease family satisfaction, and increase the financial burden. PICOT: In full-term infants in the NICU, does a thickened formula compared to a non-thickened formula reduce reflux symptoms during their acute care stay? Synthesis: Anti-reflux formula improved regurgitation and most GI symptoms within 1 week of the intervention. Plan for Change: Using the Iowa Model, NICU RNs will implement a plan for full-term infants > 36 weeks of age with clinical symptoms of reflux. The infant’s response to symptoms will be assessed every day x 5 with the GERD Symptom Questionnaire and the number of regurgitate. Episodes including the amount (ml) of regurgitation, and clinician/family report will be tracked. The management of reflux symptoms among infants within the NICU should be based on an evidence-based, standardized feeding protocol of anti-regurgitation formula. ItemPressure Injury Prevention in Critically Ill Hospitalized Adult Patients(2022) Masenda, Mercy BSN, RN, CCRN, CVRN; Dr. Cheryl Brohard, PhD, RN, CNS-ONC, AOCN®, CHPCA®Background: Hospital-acquired conditions (HAC’s) such as pressure injuries are prevalent on a global scale. Over 2.5 million people develop pressure injuries with a cost of up to $50,000 each year in the U.S. Pressure injuries are painful to the patients, prolong hospital stays, and cause more than 60,000 death each year. PICOT: In critically ill, hospitalized patients, what is the effect of the continuous lateral rotation therapy (CLRT) compared to manual repositioning every two hours in preventing pressure injuries over a three-month period. Synthesis: Studies showed that not only does CLRT work, but that it is superior to manual repositioning in preventing pressure injuries. The purpose of this evidence-based project is to implement continuous lateral rotation therapy (CLRT) in place of manual repositioning, the gold standard in pressure injury prevention. ItemThe Effect of High-Fidelity Simulation on the Graduate Nurse’s Anxiety(2022) Lewis, Jazmine BSN, RNC-MNN; Dr. Cheryl Brohard, PhD, RN, CNS-ONC, AOCN®, CHPCA®Background: When a student has recently graduated from nursing school and passed their licensure exam, they are called a graduate nurse. The use of high-fidelity simulation can help the nursing students prepare for their professional roles. PICOT: In graduate nurses how does nursing education with high-fidelity simulation compared with nursing education with only low-fidelity simulation affect graduate nurses’ anxiety within the first year after graduation? Synthesis: Using CINAHL, PubMed, and INACSL literature search engines, only 7 articles were found, 3-Level I, 1-Level II, 3-Level III. Plan for Change: Using the ARCC-E model to guide change, high fidelity simulations are recommended for graduate nurses’ education to prepare them for the transition into the work setting and decrease anxiety. ItemDecreasing 30-Day Hospital Readmissions for Patients with CHF using Teach-Back Method(2022) Callahan, Robin BSN, CVRN-BC; Dr. Cheryl Brohard, PhD RN CNS-ONC AOCN® CHCPA®Background: Congestive heart failure (CHF) affects 6.2 million Americans. CHF has a high readmission rate within 30 days of hospitalization. Using the teach-back method (TBM) for discharge is an effective means of helping patients with self-management at home. PICOT: In hospitalized adult patients with CHF, how does TBM for discharge teaching compared to routine discharge teaching affect hospital readmission rates of acute exacerbation in 30 days? Synthesis: The evidence demonstrated the TBM increased understanding and compliance which reduced hospital readmission rates. Plan for Change: Implementation will occur in an acute care facility with patients with CHF, where RNs will be trained on TBM and accompanied by written education materials for the patient. The plan will be evaluated with a phone call 48-72 hours post discharge to assess patient’s knowledge.