Central-line dressing protocols: The effectiveness of a standardized dressing change protocol in reducing central-line associated bloodstream infections (CLABSI) in critically ill patients requiring central lines

Purpose/Background In the Intensive Care Units (ICU), central lines are an essential way of life. However, central lines have risks such as central line-associated bloodstream infections (CLABSI), which increase hospital stays and mortality. CLABSI significantly impacts patient outcomes in critical care, increases mortality and morbidity, increases medical costs, increases hospital-acquired infections, and reduces hospital reimbursements. Typically, antimicrobial dressing has been associated with decreased mortality and improved CLABSI rates. The scoping review will evaluate the literature and examine the effectiveness of various antimicrobial dressing strategies on CLABSI rates. This study aims to synthesize these findings to develop improved CLABSI prevention protocols in ICUs, ultimately enhancing patient outcomes. Methods Following PRISMA guidelines, a literature review was performed from August 2022 through December 1, 2024, synthesizing research published within the last five years. Articles were selected based on their relevance. Individual searches of Clinical Key, Elsevier, Cochrane, NCBI, CDC, LBM, and Washington Medical Therapeutics were completed using the following keywords: “adult patients hospitalized with CLABSI,” “dressing change protocol,” “no protocol,” “affect the incidence of CLABSI,” “in the intensive care unit,” “central line infection,” dressing changes,” “dressing change protocol,” and “CHG.” Out of eighteen potentially appropriate articles, a rapid critical appraisal and in-depth discussion of these articles yielded a final section of 8 articles. The goal was to note that proper CVAD dressing changes reduce CLABSI rates. Results Building on Paquet et al. (2019), who transitioned from CHG-impregnated dressings to dry dressings without increasing CLABSI rates, we emphasize the need for a structured dressing change protocol. Webster et al. (2017) found no significant difference in CLABSI rates between CHG and PHMB dressings, attributed to their existing dressing bundle. Research by Pook et al. (2022) suggests CHG locking solutions are more effective than standard methods for reducing bacterial growth. Mitchell et al. (2020) demonstrated the benefits of sutured central lines with CHG discs and integrated securement devices. Wei et al. (2021) reported a 68% decline in CLABSI due to comprehensive protocols, while Hunger et al. (2020) and Reynolds et al. (2021) emphasized the importance of adherence to established protocols for reducing rates. Conversely, Yu et al. (2019) found that CHG dressings did not significantly decrease CLABSI rates despite less frequent dressing changes. Implications for Nursing Practice This scoping review underscores the importance of standardized central line dressing change protocols in reducing CLABSI rates and improving patient outcomes in ICU settings. Nurses and nursing staff are pivotal in implementing and adhering to these protocols. The findings suggest that continued refinement and compliance with dressing change protocols, particularly CHG dressings, should be prioritized to enhance patient safety, reduce infection- related complications, and shorten hospital stays. Future research should focus on the optimal design and long-term outcomes of various dressing change protocols to further inform best practices in ICU settings

Evaluating the Efficacy of Discharge Education on Readmission Rates in Pediatric Patients with Chronic Conditions: A Scoping Review

Abstract Assignment Purpose/Background Children with multiple chronic health conditions account for a significant portion of hospital readmission and healthcare expenses. A scoping review was completed to analyze and summarize the available research regarding the effectiveness of discharge education on readmission rates and associated outcomes in children with chronic conditions. The following PICOT question was created: In pediatric patients with chronic disease, how does a discharge education bundle compared to no discharge education bundle affect readmission rates within 30 days of discharge? Methods A systematic approach was utilized for analysis to determine article eligibility. The initial search yielded 30 articles; however, through critical appraisal 10 articles met specified criteria. The types of available evidence were mainly a mix of meta-analyses, systematic reviews, and quality improvement projects. These articles are depicted in the synthesis table to visualize data points of interest including 30-day readmission rates, impacts on healthcare utilization and costs, and the effectiveness of discharge bundle components in reducing readmission rates. Data points of interest were analyzed to evaluate the impact of discharge education practices (discharge education bundle vs no bundle) on 30-day readmission rates in pediatric patients with one or more chronic diseases. Results 100% of the literature analyzed demonstrated the benefits of a discharge education bundle, whether through verbal or written education or specific elements of the discharge bundle, on readmission rates. Specifically, studies explicitly found decreased healthcare costs (90%), decreased readmission rates (80%), increased patient satisfaction (60%), and reduced healthcare utilization (30%) associated with proper discharge education. Implications for Nursing Practice The findings that a discharge education bundle reduces 30-day readmission rates, healthcare utilization, and costs indicate the need for the implementation of core discharge education bundles with specific methods for common chronic pediatric diagnoses. In the future, these results should be used to study the efficacy of the various discharge education methods and protocols to identify the most effective teaching strategies for optimal patient education. Focusing additional research on more specific data will help identify evidence-based education methods to continue improving discharge education bundles and further reduce pediatric hospital readmissions of chronic pediatric patients within 30 days of discharg

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts. Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google Scholar. Studies were eligible if published in English, focused on adult patients requiring ventilatory support, and reported extubation time as a primary or secondary outcome. Eight high-quality studies, including randomized controlled trials and systematic reviews, were selected after critical appraisal. Extracted data included extubation time, intubation duration, postoperative complications, ventilator adjustments, and ICU or hospital length of stay. Results: Of the eight studies reviewed, five reported that ASV reduced extubation times, and three showed shorter intubation durations. All studies demonstrated a reduction in postoperative complications and fewer ventilator adjustments. Three studies associated ASV with decreased ICU or hospital stays. Variability in extubation outcomes appeared related to patient characteristics and clinical practices. Implications for Nursing Practice: ASV has the potential to enhance patient outcomes by expediting weaning, reducing complications, and shortening ICU stays. Standardized protocols are needed to optimize ASV implementation across diverse clinical settings

Social Determinants of Health Screening – Evaluating Its Influence on Glycated Hemoglobin Levels in the Pediatric Population: A Scoping Review

Purpose/Background Social determinants of health (SDOH) have a significant impact on health outcomes. Pediatric patients with type one diabetes mellitus (T1DM) with adverse SDOH have inferior glycemic control, higher healthcare utilization, and increased risks of complications. SDOH screenings are not standard practice in pediatric T1DM care despite literature demonstrating that screening can improve outcomes. This scoping review aims to summarize existing evidence surrounding SDOH screenings and their impact on pediatric T1DM outcomes. Methods A scoping literature review was conducted from August 2022 to November 2024 via CINAHL, Cochrane, EBSCO, Elsevier, and PubMed. Inclusion criteria included peer-reviewed articles, English language, publication within fifteen years, and free, full-text availability. The Ohio State University rapid critical appraisal tool was used to assess validity and reliability. Twelve articles were selected based on their relevance and quality. An outcomes table was utilized to identify common effects and recommendations among these articles. Results This review determined that SDOH influence pediatric T1DM outcomes and that SDOH screenings can improve outcomes, including glycated hemoglobin levels. The literature recommends various screening tools and implementation strategies, but no standard tool or strategy has been established. We were unable to conduct a study evaluating real-time T1DM patient biomarkers or outcomes following SDOH screening without student access to our local facility’s electronic charting system. However, our literature review was able to outline SDOH screening’s positive influence on outcomes in this population. Implications for Nursing Practice Our review demonstrates that the literature supports universal implementation of SDOH screenings. Their incorporation can improve glycemic control, healthcare utilization, and caregiver support. This scoping review highlights a need for further research to establish a standard SDOH screening tool and evaluate its effect on pediatric T1DM outcomes

The Effectiveness of GAD-7 Screening in High School Students

Purpose/Background Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students. Methods A comprehensive search was conducted across PubMed, CINAHL, PsycINFO, Cochrane, and Scopus databases, focusing on studies published between 2014 and 2024. Inclusion criteria targeted peer-reviewed articles evaluating GAD-7 implementation in adolescents aged 14–19 years, with measurable outcomes such as mental health referral rates and anxiety symptom reduction. Studies not meeting these criteria or published in languages other than English were excluded. Four articles meeting the inclusion criteria were critically appraised and synthesized. Results The review revealed that three of the four studies demonstrated significant increases in mental health referrals following GAD-7 implementation. Two studies reported reductions in anxiety symptoms among students referred to mental health services. The GAD-7 consistently showed reliability in identifying moderate to severe anxiety cases, facilitating earlier intervention and access to mental health resources. Implications for Nursing Practice Integrating the GAD-7 into high school settings can address gaps in adolescent mental health care by promoting early identification and timely referrals. These findings support the development of school-based mental health programs incorporating the GAD-7 to mitigate long- term consequences of untreated anxiety and enhance overall student well-being. Further research is recommended to explore the tool’s long-term impact and cost-effectiveness in diverse educational settings

Ultrasound-Guided Epidural Placement vs. Conventional Technique - Evaluating Effectiveness: A Scoping Review

Purpose/Background Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia. Methods This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, or literature made accessible through the UTHSC Library’s Interlibrary Loan. Primarily utilized MeSH terms included: conventional techniques, ultrasound-guided epidural placement, and first-pass success. Studies were selected if they evaluated USG versus conventional EP techniques, focusing on FPSR, needle passes or redirections, skin punctures, and procedural time. Articles involving pediatric populations or patients with contraindications to epidural anesthesia were excluded. Data from eight high-evidence articles, including one systematic review and seven randomized controlled trials, were analyzed. Results USG EP demonstrated higher FPSR, reduced needle passes and skin punctures, and improved patient satisfaction in six out of eight studies reviewed. However, procedural time was prolonged in cases involving providers inexperienced with USG techniques. These findings suggest that USG EP may offer significant advantages over conventional techniques, particularly in improving accuracy and reducing complications. Implications for Nursing Practice Integrating USG EP into clinical practice can enhance the quality and safety of epidural anesthesia. Its implementation may require training programs to address proficiency gaps, particularly for novice providers. By adopting evidence-based practices, anesthesia providers can contribute to better patient outcomes, reduce procedural risks, and optimize perioperative care

GAD-7 Screening in Middle School Students: Evaluating the Effectiveness on Referral Rate Scoping Review

Purpose/Background The prevalence of anxiety disorders among adolescents, mainly middle school-aged students, highlights the critical need for practical screening tools to support early detection and intervention. The Generalized Anxiety Disorder-7 (GAD-7) scale is widely utilized in various settings, but its efficacy in this specific population remains underexplored. This scoping review examines the use of the GAD-7 in middle school-aged students, evaluating its reliability, validity, and impact on referral rates to mental health services. The review also considers factors influencing anxiety and identifies gaps in current research. Methods Ten articles, published in peer-reviewed journals within the past decade and involving human participants aged 10 to 19, were included. The review adhered to PRISMA guidelines utilizing databases such as PubMed, Elsevier, Medline and BMC Public Health. The Rapid Critical Appraisal (RCA) tool was used to evaluate the quality and relevance of the articles. Results The studies collectively underscore the GAD-7 scale\u27s reliability and validity in assessing generalized anxiety disorder (GAD). The significance of the assessment tool signifies its use for early detection and monitoring of anxiety symptoms in the adolescent population. The scoping review demonstrates the importance of early detection and supports timely referrals to mental health providers. It is acknowledged amongst all the studies that variables such as economic status, education level, gender, and psychosocial factors, such as suicidal ideation, depressive mood, loneliness, perceived stress, and subjective health status, influence the development and course of generalized anxiety disorder. Implications for Nursing Practice The outcomes of this scoping review demonstrate the efficacy of the GAD-7 in the early detection of anxiety disorders among adolescents. Positive findings suggest that improved outcomes are achieved by early identification and promoting prompt referrals to mental health services. Furthermore, according to the evidence gathered, using the GAD-7 as a standard in all middle schools helps prevent detrimental effects associated with undiagnosed and untreated anxiety

Evaluating the Effectiveness of a Non-Pharmacological Sleep Bundle for the Prevention of Delirium in Geriatric Patients in the Intensive Care Unit: A Scoping Review

Purpose/Background Delirium is an acute disorder yielding cognitive deficits, such as disruption in attention and awareness. It impacts approximately 50% of individuals over the age of 65 who are admitted to the hospital and is prevalent with patients in the intensive care unit (ICU). ICU delirium is associated with adverse outcomes, including higher morbidity, prolonged hospital stays, and chronic neurocognitive deficits. Research demonstrates that implementation of a non-pharmacological sleep bundle can reduce the overall occurrence of delirium. The purpose of this scoping review is to examine the efficacy of a non-pharmacological sleep bundle on the incidence of ICU delirium in geriatric patients. Methods Between August 2022 and November 2024, a scoping literature review was conducted using the following keywords: ICU delirium in geriatric patients and non-pharmacological sleep aids for ICU delirium. The four primary outcomes for analysis were implementation of age-appropriate treatments (IAAT), incidence of delirium associated with non-pharmacological sleep interventions (IDNST), ICU sleep quality (ICUSQ), and length of stay in the ICU (ICULOS). 12 articles were chosen for inclusion in this review based on quality and relevance to the topic. Results This review shows that non-pharmacological sleep bundles can decrease the incidence of ICU delirium and create a marginal improvement in sleep quality in the ICU. There was not enough relevant research to show if non-pharmacological sleep bundles can decrease ICU length of stay or whether these bundles have any specific impact on the geriatric population. Implications for Nursing Practice Implementing a non-pharmacological sleep bundle in the ICU for geriatric patients above the age of 65 is associated with a lower incidence of ICU delirium. Further research is needed to examine the effectiveness of non-pharmacological sleep bundles on the quality of sleep in the ICU and the length of stay in the ICU, specifically in geriatric populations

Deciphering Genotype-Phenotype Connections: Leveraging Pangenomes and Comprehensive Genome Variation

My thesis explores the application of advanced techniques for discovery of genetic variation and pangenomic approaches to enhance our understanding of genetic variation and genotype-phenotype relationships in two key model organisms: the HXB/BXH recombinant inbred rat family and the BXD mouse family. Through deep sequencing and innovative computational methods, I constructed com- prehensive pangenome graphs that captured genetic diversity beyond what is accessible through conventional single-reference approaches. In the HXB rat family, I identified approximately 200 million base pairs of sequence absent from the reference genome and discovered novel variants associated with glucose metabolism and chromogranin expression through phenome-wide association studies. In the BXD mouse family, I leveraged linked-read sequencing data from 152 strains to create a detailed catalog of genetic variants, improving QTL mapping precision and enabling the identification of regions undergoing parallel evolution across independent populations. By develop- ing new methodologies for mapping reads to pangenome graphs and implementing pangenome-based QTL mapping, I demonstrated that these approaches significantly enhance variant discovery and resolution, particularly in complex genomic regions rich in repetitive elements.I also employed genotype-phenotype mapping to analyze adaptive signatures resulting from laboratory selection pressures. My work shows that even with short linked-reads, pangenomic analyses enable the detection of a truly comprehensive set of variants that would be missed by traditional methods. My research advances our understanding of complex genotype-phenotype relationships, establishes pangenomes as valuable tools for comprehensive genetic analysis in model organisms, and provides a foundation for future applications in precision medicine

2025 HEC Storytelling Recording 1

The art of storytelling is a vital component of oral history, serving as a primary method for preserving and transmitting cultural practices, knowledge, and history across generations. Historically, oral storytelling was the key to maintaining traditions before written language emerged. The oral traditions of storytelling been essential for passing down knowledge in societies without written records. Through interviews and recordings, oral histories capture individual experiences, enriching our understanding of past events. Storytelling exists universally across cultures and ages. Culturally, storytelling bridges cultures by offering insights into diverse perspectives, beliefs, and values. It dynamically connects generations and fosters a sense of community through shared narratives. Today, storytelling continues to connect generations, share personal narratives, and foster community bonds. It fuels the delivery of messages making stories effective tools for conveying information, sharing lessons, and inspiring actions that are relevant for modern times. We used storytelling during and following the health as expanding consciousness dialogue as a way to capture lessons learned and new messages about health as expanding consciousness (HEC) theory to create a shared meaning about theory use in nursing education, practice, and research. This site contains a few recorded stories from participants who attended the 2025 HEC dialogue. Additional stories will be uploaded for future listening