Date of Graduation

Summer 8-15-2017

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Susan Mortell

Second Advisor

Elena Capella

Third Advisor

Karin Blais



Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor performance of nursing documentation suggesting a knowledge deficit and lack of self-efficacy after the unit consolidation of the step-down unit. A pilot study was implemented, post-education feedback suggested improvements in nursing knowledge, confidence and competency related to epidural care. Now with MICU taking overflow EA patients, anecdotal interviews with MICU nurses identified a lack of formalized nursing education and competency training on current evidence-based practices on EA to adequately support and prepare MICU nurses to deliver EA care. The purpose of this Clinical Nurse Leader project is to implement and evaluate an evidence-based curriculum aimed at improving care management by improving process integration, timeliness, and self-efficacy for nurses who provide EA care in the MICU. The goal of this quality and process improvement project is to produce an updated evidence-based nursing procedure/protocol for EA management, a standardized delivery of EA care education for nurses, and to validate the accuracy of a competency checklist for nursing EA administration and monitoring.