AACN Grants: Driving Change in Nursing Through Research

Serving as a surrogate decision maker (SDM) for a critically ill patient with stroke can elicit intense psychological distress that may interfere with the SDM’s ability to make value-concordant decisions on behalf of the patient. While music therapy is associated with improvements in adverse psychological symptoms in other caregiving populations, its effects among SDMs has not been examined. Therefore, this study will evaluate the feasibility, acceptability and preliminary effects of a psychodynamic music therapy intervention for SDMs of critically ill patients with stroke.

Post-intensive care syndrome (PICS) describes a combination of physical, mental health and cognitive impairments that often exist following critical illness, affecting both patients and families. Current literature supports the use of intensive care unit (ICU) diaries as one of the only interventions to positively improve recovery from PICS in ICU survivors and their families. When piloting an ICU diary program, nurses also identified personal improvement. The objective of this mixed methods study is to evaluate the effect of ICU diary programs in mitigating the burnout and moral distress experienced by critical care nurses by helping them identify value in their teams, themselves and their work through reflection and writing.

Pressure injuries (PIs) are a significant global health concern, especially for patients in intensive care units, leading to extended hospital stays and substantial financial burdens on patients, families and healthcare institutions. Nurses play a pivotal role in preventing PIs through risk factor understanding, proactive preventive measures, and promoting effective wound care. The project's goal is to develop and pilot a mobile learning app, the gamified learning experience, focusing on PI assessment and prevention. This initiative aims to evaluate how gamified teaching methods for PI assessment impact nurses' knowledge, skills and attitudes, thereby enhancing PI prevention efforts.

Anastomotic leak is one of the most severe complications in pediatric patients following esophageal atresia repair. Considered a gold standard in postoperative care, an esophagram is routinely performed to rule out anastomotic leak but has many risks, including ionizing radiation exposure, aspiration of contrast and patient, family and provider stress. This study (as part of a goal to identify relevant risk factors for anastomotic leak) will examine patient and procedural characteristics and post-operative esophagram practices for patients who underwent esophageal repair at a single institution. Findings will inform the development of a Pediatric Esophagram Risk Stratification (PERS) Tool that can help guide clinical decision making for patients who may or may not need a postoperative esophagram.

Left ventricular assist devices (LVADs) are the only available treatment option to improve survival and quality of life for patients with advanced heart failure who are not eligible for cardiac transplant. Poor sleep quality is highly prevalent for patients with heart failure and persists after LVAD implantation, which may impact recovery and quality of life. Participants will wear a wristband device, which will provide continuous recording throughout the night to calculate accurate sleep time. The study will examine changes in objective and subjective sleep quality for patients with advanced heart failure, before and after they’ve had an LVAD implanted.

Survivors of critical illness frequently experience new or worsened cognitive, mental health and physical impairments, known as post-intensive care syndrome (PICS). These ongoing impairments may hinder individuals from returning to work after discharge, with joblessness common among those who were previously employed. This study will explore individual, relationship, community and societal factors and how they interact to help enable or inhibit successful return to work.

Many newly designed critical care units have moved away from a centralized hub to decentralized workstations characterized by individual alcoves between patient rooms. The potential unintended consequences of these unit layouts include increased feelings of isolation and fewer opportunities for collaboration. This study will explore how unit layouts influence nursing teamwork and the work environment.

Sepsis remains the number one cause of death for hospitalized patients worldwide, and survival is critically dependent on early detection and timely intervention. Changes in oxygen consumption serve as a differentiating metabolic measure in critically ill patients with or without a diagnosis of sepsis. The study will use data collected from skin sensors to determine oxygen consumption parameters for patients with sepsis. The findings may help clinicians recognize disrupted metabolism in real time, leading to objective, early recognition and diagnosis of sepsis.

This study will compare the effects of an eight-week mobile health (mHealth) meditation intervention with those of a cardiovascular education intervention on anxiety and stress levels in individuals recovering from their first myocardial infarction. Pamela Barthle, MSN, RN, APRN-CNP, professor of nursing at Augustana University in South Dakota and a PhD student at the University of Missouri - Kansas City, received the grant.

Patients who survive critical illness often experience sleep disturbances and ICU-acquired cognitive impairment. This study seeks to identify the best time of day for cognitive interventions to promote circadian realignment and cognitive function in older ICU survivors. Maya Elias, PhD, RN, a geriatric critical care nurse scientist and an assistant professor at University of Washington School of Nursing, Seattle, will lead the study. This study builds on prior research funded by the National Institutes of Health, for which she conducted a longitudinal cohort study that examined the effect of rest/activity and sleep/wake cycle disturbances on cognitive impairment in older ICU survivors.

This study seeks to externally validate and modernize a hospital-acquired pressure injury risk-prediction model that uses artificial intelligence via machine learning. Expanding on prior research supported by AACN, the research team will apply data from a nationally recognized individual database to assess the model. If validated, the model could eventually be applied to easily accessible electronic health record data and to support clinical decision-making in real time. The lead researcher is Jenny Alderden, PhD, APRN, CCRN, CCNS, associate professor at Boise State University, Boise, Idaho.

Using a retrospective case-control study, the research team will compare characteristics of critically ill adults who developed medical device-related pressure injuries (MDRPIs) from oxygen delivery devices and NG tubes to those of critically ill adults with similar devices who did not. The analysis will help them identify common risk factors, as well as unique risk factors to determine the best model for predicting MDRPIs and potentially providing new knowledge to enhance prevention protocols. Susan Solmos, MSN, RN, CWCN, a PhD student at University of Nebraska Medical Center, is the principal investigator.