Research Grants Awarded

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.

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.

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.

The prospective cohort study will investigate delirium incidence and prevalence related to surgical stress and perioperative temperature in critically ill patients in the surgical intensive care unit. Doreen Wagner, PhD, RN, CNOR, FAAN, professor of nursing, Kennesaw State University, Kennesaw, Georgia, is the principal investigator for the study. Dr. Wagner’s research builds on the recent retrospective study she led that found a complex relationship between postoperative delirium and unplanned hypothermia. The results aim to determine the influence of unplanned perioperative hypothermia on the development of postoperative delirium in critically ill surgical patients across the life span.

The PERSIST-PICU study will analyze data from three pediatric critical care studies that were funded by the National Institutes of Health to explore the impact of sepsis-related inflammation on new morbidities in pediatric patients who survived acute respiratory failure. The study aims to understand physical function outcomes in critically ill children with or without sepsis. The goal is to develop a multivariable model to identify pediatric patients who may be at increased risk of physical morbidity and symptoms post-critical illness, leading to tailored interventions to optimize healing and recovery post-PICU. Mallory Perry, PhD, RN, CCRN, Provost’s postdoctoral fellow for academic diversity, Children’s Hospital of Philadelphia, is the principal investigator, with support from an expert mentorship team of pediatric critical care clinicians and researchers.

Telomeres are sections of DNA that provide genomic stability but shorten over time, reducing their protective attributes. Shorter telomeres have been associated with increased incidence of disease and poor survival, and critically ill patients are exceptionally vulnerable to telomere attrition and telomere damage. This innovative study will examine the relationship between telomeres and ICU- and post-ICU-related outcomes and the potential moderating effect of oxidative stress. The results will inform the design of larger studies targeting modifiable factors to improve patient outcomes. The lead researcher is Zhan Liang, PhD, assistant professor, University of Miami.

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.

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.

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.

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.

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.

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.

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 with COVID-19 respiratory failure are potentially more vulnerable to the effects of delirium due to differences in treatment, but the extent to which this is true remains unknown. The researchers will review data from a sample of 110 electronic medical records, evenly split between patients with respiratory failure and COVID-19 and those who are COVID-negative. The analysis will look at delirium incidence rates between the two groups and compare group differences in nursing and medical care factors. Brian Peach, PhD, RN, CCRN, assistant professor, University of Central Florida College of Nursing, Orlando, received the grant.

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.