Research Grants Awarded

Rhonda Board, PhD, RN, CCRN, Associate Professor at Northeastern University School of Nursing, and principal research investigator. Having a child hospitalized in a pediatric intensive care unit (PICU) can be a very traumatic experience for parents. This project will test the feasibility and acceptability of expressive writing in the PICU as an intervention to decrease parental stress and stress symptoms. Journal writing requires minimal financial investment for hospitals to implement and can provide parents an account of the hospitalization to reflect on following discharge.

Family members of patients who are critically ill have symptoms of post-intensive care syndrome-family, including anxiety, depression and post-traumatic stress disorder. Cognitive behavioral therapy has become the primary non-pharmacological treatment for an increasing list of psychological symptoms. Smartphone delivery of cognitive behavioral therapy via a mobile health app leverages technology in symptom self-management that can be used in collaboration with other nursing interventions without significant resource expenditures. This pilot study will allow collection of preliminary data needed for planning a fully powered randomized controlled study.

Many ICU survivors experience cognitive decline after hospital discharge. Physical activity and cognitive training have each independently shown promise in improving cognition; however, combining these two interventions to improve cognition has not been fully explored. This is especially true for middle-age ICU survivors who need well planned, accessible interventions that are effective in improving cognition and preventing accelerated cognitive decline as they resume previous life activities and transition into older age. In this randomized controlled trial, we aim to investigate the feasibility, acceptability and trends in cognition differences between a simultaneous physical activity plus cognitive training intervention (the SPECToR Study) and usual care.

A new acuity tool could provide much-needed practical insights into the cognitive workload and complexity of care among pediatric critical care nurses, first developed the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) tool in 2009. CAMEO has since been adapted and internally validated across all pediatric and neonatal settings at Boston Children’s Hospital. This study expands the research to eight other children’s hospitals to validate its use in external settings and further examine the current complexity of pediatric critical care.

Most research into clinician burnout focuses on the individual, without addressing the work environment and organizational elements. This study will examine burnout, secondary trauma and compassion fatigue in relation to AACN’s Standards for Establishing and Sustaining Healthy Work Environments and other factors. A research team from Banner Health System and Arizona State University will survey critical care nurses at 40 sites within the health system, providing considerable descriptive data for future research.

A new acuity tool could provide much-needed practical insights into the cognitive workload and complexity of care among pediatric critical care nurses, first developed the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) tool in 2009. CAMEO has since been adapted and internally validated across all pediatric and neonatal settings at Boston Children’s Hospital. This study expands the research to eight other children’s hospitals to validate its use in external settings and further examine the current complexity of pediatric critical care.

Critically ill older adults are at exceptionally high risk for developing pain, anxiety and/or delirium during their hospital stay, but more needs to be known about how to best deliver effective, nonpharmacological, palliative care to reduce pain and improve patient outcomes. Reiki is a complementary health therapy where trained practitioners place their hands lightly on or just above a person, in discrete positions, with the goal of facilitating the person’s own healing response. This AACN grant will support the Reiki Intervention for Seriously Ill Elders-Intensive Care Unit (RISE-ICU) study to assess whether Reiki is superior to sham Reiki and usual care when delivered to critically ill older adults who require mechanical ventilation.

Family caregivers can be active partners in bedside care in the intensive care unit (ICU), and this project aims to provide evidence-based strategies to involve them in specific ways. The researchers will develop and test an online educational resource to encourage family caregivers of mechanically ventilated patients to assess patients’ thirst and anxiety and guide them through appropriate, specific techniques to alleviate these common symptoms.

Most moral distress interventions focus on distinct groups of healthcare providers or specific ethically challenging situations, but the Moral Distress Consult Service of the University of Virginia (UVA) Health System is one of the few programs that are multidisciplinary and institution-wide in scope. A team from the UVA School of Nursing and Center for Biomedical Ethics and Humanities, led by Elizabeth Epstein, RN, PhD, and co-primary investigator, Mary Faith Marshall, PhD, BSN, FCCM, will formally evaluate the consult service and its effects on moral distress and elements of a healthy work environment.

Arrhythmia alarms alert nurses to changes in a patient’s heart rhythm, but the sheer number of alarms contributes to alarm fatigue, a known patient safety issue. Michele Pelter, assistant professor and director of the ECG Monitoring Research Lab at the University of California at San Francisco, will lead a research team to analyze a large dataset of annotated arrhythmia alarms to learn whether these arrhythmias have clinical significance or are associated with serious outcomes. Results will provide guidance to manufacturers to better define their alarms requiring action and to hospitals as they create policies and procedures to address alarm management requirements mandated by The Joint Commission.

Joyce Pittman, PhD, RN, ANP-BC, FNPBC, CWOCN, is both clinician and researcher providing system-wide wound/ostomy/continence expertise at Indiana University Health-Methodist, a 750-bed Level I Trauma Center, and Indiana University School of Nursing, Indianapolis. This study will examine patients with unavoidable pressure ulcers in the critical care setting, Pressure ulcer rates in critical care units are among the highest and are often attributed to patient acuity. Pittman’s practice and research focuses on improving the quality of life and the quality of care for individuals with wound, ostomy and continence conditions.

Scientific evidence overwhelmingly supports reducing healthcare-associated infections using CHG baths for skin antisepsis; but not for patients less than 2 months of age. Cheryl Toole, RN, MS, CCRN, NEA-BC, director of the Neonatal Intensive Care Unit at Boston Children’s Hospital, and co-primary investigator, Celeste Chandonnet RN, BSN, CCRN, infection prevention nurse, are studying the safety of biweekly CHG baths in a sample of Newborn Intensive Care Unit (NICU) and pediatric Cardiac Intensive Care Unit (CICU) patients to inform neonatal healthcare providers about the safety profile of CHG baths, leading the way to prevent healthcare-associated infections in this vulnerable patient population.

The research team from the University of California Los Angeles, Mayo Clinic and the Massachusetts General Hospital will test effectiveness of a proactive education program and screening protocol to support ethics deliberation and interdisciplinary communication about the care of complex critically ill patients and their families. Researchers will measure the impact of promptly identifying and collaboratively addressing ethically difficult situations.

Dr. Metheny will work with Kathleen L. Meert, MD, professor of pediatrics at Wayne State University, Detroit, to evaluate the pH method’s effectiveness in determining feeding tube placement (gastric versus pulmonary) in a population of critically ill children less than 1 year of age. Data collection will take place at the Children’s Hospital of Michigan.

A total of 200 gastric aspirates will be obtained near the time a radiograph is performed; pH comparisons will be made according to the use (or non-use) of gastric acid inhibitors and the use (or non-use) of recent gastric feedings. In addition, pH testing will be performed on 50 tracheal aspirates obtained during routine suctioning. Another purpose of the study is to determine the effectiveness of a rapid pepsin assay in distinguishing between tracheal secretions and high-pH gastric secretions.

Nurse practitioners are an increasingly important component of the nation’s acute care workforce, yet there is limited information on the specific care models across the diverse practice settings. Therefore, the specific aims of the study are to 1) describe the types of acute care NP care models currently in use in hospital and emergency department settings; 2) assess the impact of key system-level and regional-level factors on acute care NP care models; and 3) determine the relationship of state regulation of advanced practice registered nurse practice and the implementation of differing acute care NP care models.

Campbell’s research team will investigate the process of ventilator withdrawal for patients at the end of life. Their study will look at standardizing a nurse-led approach to patient comfort during the ventilator withdrawal process, reducing patient suffering and family distress.

The researchers will compare outcomes for patients who receive the new standardized approach with patients who receive usual care; the data will guide a future randomized trial.

Curley and her research team with colleagues from five pediatric hospitals will further assess the predictive validity of the Braden Q Scale for the development of immobility-related pressure ulcers.

In addition, they will test a new element, referred to as the Braden Q+D, to describe pediatric patients’ risk for medical device-related pressure ulcers.

Pediatric delirium, a common complication of pediatric critical illness, is associated with poor clinical outcomes. The purpose of this study is to examine the relationship between modifiable characteristics of the pediatric critical care environment (i.e., light and sound exposure, caregiving frequency), sleep disruption and delirium in a sample of 20 critically ill children 0-2 years old. The results of this study will inform future, large-scale studies as well as the design and implementation of nurse-driven sleep promotion interventions with the potential to prevent delirium and improve clinical outcomes in children.

Sherri McMullen, PhD, CNS, NNP-BC, focuses her clinical practice and scholarly research on preterm neonates and their caregivers. McMullen is investigating safe infant sleep practices to decrease the persisting sudden infant death syndrome rates across the nation. Her work seeks to standardize evidence-based practices for timing of transitioning preterm infants to supine sleep position that has potential to impact standards, policy and care procedures for this vulnerable population nationally and globally.

Mellott’s long-term aim is to determine how nurses can use ventilator technology and graphics to recognize patient ventilator asynchrony occurrence for integration into patient care decision making and management. This study will determine whether those nurses who participate in lecture and simulation teaching interventions demonstrate better transfer of learning to interpret patient ventilator asynchrony using ventilator technology at the bedside as compared with a control group that participates in a lecture-only teaching intervention.

VALIDATE (Variable AnaLysis for Infection Discovery and Treatment): An Exploratory Study, is a critical care nurse-led project to determine the feasibility of using a compact monitoring device (Biopatch™) to capture physiologic data on patients admitted to the hospital with a primary diagnosis of infection. The data collected will be then sent to a lab for analysis to determine usability as a predictor of morbidity and mortality in sepsis. If proven feasible, use of these monitors would highly impact nurses’ ability to assess, care for and assist the team in determining the appropriate disposition of such patients.

Alarm reduction strategies for critical care units have been promulgated but noise reduction and nurse stress on progressive care units have not been examined. A prospective, quasi-experimental, repeated measures design will be used to determine the effect of protocols to reduce noise pollution and nurse stress in a progressive care unit central nurses’ station of a 30-bed progressive care unit. A similar configured and sized non-monitored medical-surgical unit will serve as the control unit for the outcome variables.

Boehm’s study aims to explore the culture around interdisciplinary protocol use in the ICU and the influence of organizational factors. The primary goal is to study organizational structure and process variables that may contribute to ABCDE interdisciplinary bundle adherence. In addition, the study will evaluate the effectiveness of the ABCDE bundle in improving cognitive and physical outcomes for ICU survivors. The study will identify system and clinician issues that could subsequently be targeted to improve adherence to interdisciplinary protocols.

Mammone’s study is focused on assessing the effectiveness of nursing interventions to reduce alarm fatigue related to physiologic monitors in the neuroscience ICU.

She will examine sources of alarms and implement interventions to minimize the clinical risks associated with excessive alarms and alarm fatigue among clinicians.

Dionne-Odom’s long-term aim is to design and test novel, nursing-led decision support interventions for surrogate decision makers undergoing the often burdensome role of making choices for others who are dying in the ICU.

The study will address the creation of healing and humane environments and improve processes and systems that foster the optimal contribution of critical care nurses.

Rochman and her team will examine the relationship between nursing delivery system strategies and in-hospital cardiac arrest patient outcomes; the study will merge two unique large national databases and provide significant insight into the connection between nursing care and resuscitation outcomes.