Welcome to Creighton Digital Repository (CDR)

The CDR is an open source solution for capturing, managing, promoting, sharing, and preserving digital collections in any format. It provides both open and secure access to collections or individual items within the repository. Open CDR collections are discoverable via all the major web search engines, which makes the CDR an invaluable tool for promoting and sharing your work with the world-wide scholarly community.

Communities in Creighton Digital Repository

Select a community to browse its collections.

Now showing 1 - 5 of 17

Recent Submissions

  • No Thumbnail Available
    Item
    Noninvasive Respiratory Support Strategies for Extremely Premature Neonates
    (Creighton University, 2024-05-09) Uram, Jamie
    Purpose: To implement a noninvasive respiratory support protocol, standards of practice, and an alternative, effective noninvasive respiratory support system for extremely premature neonates after birth and extubation to improve noninvasive respiratory support success. Background: Noninvasive respiratory support failure causes increased incidences of intubation, prolonged durations of invasive mechanical ventilation (IMV) usage, and poor outcomes. Improving provisions of noninvasive respiratory support decreases morbidities and mortality in this population. Sample/Setting: Extremely premature neonates born at less than 29 0/7 weeks gestational age managed in a Midwest level III NICU from May 2023 through January 2024. Methods: The implemented noninvasive respiratory support system offered the ability to follow a protocol which prioritized utilizing an occlusive mask and the Nasal Intermittent Positive Pressure Ventilation (NIPPV) noninvasive mode. The changes were implemented in the included neonates (n=14) after birth and after any extubation and outcomes were followed for 10 days after. Five neonates did not exclusively utilize the implemented noninvasive respiratory support system so a separate cohort of neonates (n=9) which did were stratified. Results: Significantly more neonates only required intubation for surfactant administration and IMV use less than 24 hours when exclusive utilization of the new noninvasive respiratory support occurred (t(8)=2.53, p<0.05). The number of intubations were significantly lower (t(13)=1.88, p<0.05; t(8)=2.45, p<0.05) even though rates of unplanned extubations were similar. Rates of noninvasive success after birth and after initial extubation attempts were significantly higher post-implementation (t(13)=2.48, p<0.05; t(8)=2.29, p<0.05) with lower cumulative durations of IMV usage post-implementation. Conclusion: The outcomes of neonates utilizing the implemented changes to noninvasive respiratory support provisions were shown to be effective in improving noninvasive success and providers moved to full adoption of the system. This project could serve as model to improve noninvasive success in extremely premature neonates and decrease associated morbidities.
  • Loading...
    Thumbnail Image
    Item
    Pneumococcal Disease in Patients with Diabetes– Increasing Vaccination Rates
    (Creighton University, 2024-05-09) Norman, Katelyn
    Background: Patients between the ages of 19-64 with diabetes are at an increased risk of contracting pneumococcal infections and experiencing associated complications. However, vaccination rates for this patient population remain below optimal levels. Purpose: This quality improvement project focused on increasing pneumococcal vaccination rates among patients aged 19 – 64 with diabetes, emphasizing the significance of vaccination as a preventive measure. It highlights the heightened risk of pneumococcal pneumonia in diabetic patients and the underutilization of vaccines in this group. The project aimed to boost vaccination rates through a 13-week quality improvement project at the Community Health Center of Yavapai County in Cottonwood, Arizona. Methods: A multi-faceted intervention was designed, which included (1) provider education sessions on the significance of pneumococcal vaccination for special population diabetic patients, (2) patient educational materials emphasizing the importance and safety of the vaccine, (3) decision tree algorithm for clinical staff to determine who qualifies for vaccination, and (4) a tracking form to track vaccination assessments and barriers. Results: The results demonstrate an increase in vaccination assessment, discussions, and administration within the target population. During the implementation period, there was a noticeable increase in the percentage of eligible patients being assessed for and offered the pneumococcal vaccine. The provider and patient education components of the intervention have been well-received. This project underscores the importance of targeted public health initiatives and customized interventions to enhance vaccine uptake in high-risk populations.
  • Loading...
    Thumbnail Image
    Item
    Utilizing Rolling Refresher Simulation to Enhance Skills for the Prevention of Respiratory Failure in the Pediatric Cardiac Intensive Care Unit
    (Creighton University, 2024-05-09) Norwood, Bethany
    Purpose: This quality improvement project (QI) evaluated the impact of repeated exposure to in-situ, simulation-based training on cardiac intensive care unit (CICU) staff’s time to appropriate intervention and performance of technical skills when responding to a simulated patient’s respiratory decompensation. Background: Respiratory failure is the most common cause of pediatric in-hospital cardiac arrest (IHCA). In 2022, the CICU at Children’s Hospital Colorado had a 47% increase in cardiac arrests compared to the prior year, with 55% occurring due to respiratory failure. Pediatric IHCA survival rate to discharge is 41%. Respiratory decompensation is often seen prior to a cardiac arrest. Retention of pediatric advanced life support (PALS) resuscitation skills and knowledge declines post-training with subsequent deviation from the American Heart Association’s (AHA) recommended guidelines during resuscitation events. Deviation from these guidelines results in poor patient outcomes. Setting: Children’s Hospital Colorado 22-bed CICU. Sample: 68 CICU RNs. Methods: Monthly rolling refresher in-situ simulations focusing on pediatric respiratory decompensation. RN performance was scored by time in seconds to initiate bagging and completion of critical interventions (calling for help, bagging at the recommended rate with appropriate technique). The simulation experiences were unannounced and occurred in an unoccupied CICU room during the RNs’ scheduled shift over a 3-month period. Results: RN participation declined from 58.8% (n=40) to 29.4% (n=20) during project implementation. Call for help had clinical significance with a completion increase of 15%. Time in seconds for participants to recognize and begin bagging the mannequin significantly improved (p<0.001) and the average time went from 63.1 seconds in the first month to 20.1 seconds by the last month. Conclusion: Exposure to rolling refreshers in-situ simulation training for CICU nurses appeared to improve adherence to the AHA-recommended pediatric resuscitation interventions and improved time in seconds to recognize and rapidly intervene in respiratory decompensation scenarios.
  • Loading...
    Thumbnail Image
    Item
    Oral Pharyngeal Administration with Mother’s Breast Milk to Neonates in the CVICU
    (Creighton University, 2024-05-09) Schottler, Carrey
    Purpose: This project aimed to create and implement a standardized protocol for oral pharyngeal breast milk administration for infants that cannot feed orally in the cardiovascular intensive care unit (CVICU) at a Midwest Children’s Hospital. Background: Newborns who are admitted to the hospital immediately after birth with severe congenital heart disease (CHD) are usually not permitted to eat anything by mouth, often for long periods. This causes an interruption to the natural mother-baby connection and often affects the ability of the infant to receive the benefits of breastmilk. Breastmilk as an oral immune therapy is one documented method available to critically ill neonates unable to feed orally, which provides immune benefits to infants and offers potential risk reduction in infections. Sample/Setting: The setting was a 25-bed CVICU at Children’s Minnesota. Participants included cardiac patients aged 0-30 days in the acute care setting and registered nurses in the CVICU. Methods: An oral pharyngeal breast milk protocol was created and implemented utilizing evidence collected from current data. Before implementation, education was provided to all staff. Nurses were surveyed pre- and post-implementation via a Likert to ensure an understanding of the project and the protocol. Data was collected and reviewed from the EMR for six weeks to determine participation in oral pharyngeal breastmilk administration and documentation compliance. Results: The pre-education survey had 37 respondents, and the post-education survey had 39 respondents. The results indicated a statistically significant improvement in education concerning OPA and consistent attitudes toward supporting its importance. Twelve neonates (six pre- and six post-education) were eligible for inclusion, and compliance with practice standards improved but was still below 50%. Conclusion: Changing clinical practice in a large CVICU during unprecedented high acuity is difficult. One quickly identified barrier was that the former standard oral care kits were still available in the rooms and used by nurses instead of breastmilk oral care. The use of breastmilk for oral cares in newborns with CHD is critical and needs to be reinforced as a standard with nursing staff.
  • No Thumbnail Available
    Item
    Global Criminal Justice Applied to the War in Ukraine: A Legal Framework for U.S.-Led International Ad Hoc Tribunals
    (Creighton University School of Law, 2024) Trinidad, Patrick S.
    The present study focuses on U.S.-led efforts to create an ad hoc international tribunal for the War in Ukraine. The aim of this paper was to outline three main requirements that must be met for such a tribunal to be formed: U.S. legal authority, international legal authority, and Ukrainian constitutional authority. This paper explored the power of the U.S. Executive Branch in foreign affairs, legal frameworks from the Nuremberg Trials, and the Ukrainian Constitution in order to better understand how an international ad hoc tribunal can be implemented in Ukraine. As a result, it was determined that the U.S. President possesses high levels of authority regarding the creation of ad hoc tribunals; legal frameworks from the Nuremberg Trials can be applied to an international ad hoc tribunal for the War in Ukraine; and such a tribunal can be established while respecting the constitutional sovereignty of Ukraine.