Medicine and Health Sciences Commons^™

Safe Sleep In The Nicu., Amy Rudd

Doctor of Nursing Practice Papers

Sleep related infant deaths continue to be an issue in Kentucky with 95% of deaths having at least one sleep related risk factor identified. Evidence from the literature suggests safe sleep practice in the neonatal intensive care unit is inconsistent and nurses may face many barriers when implementing safe sleep. The purpose of this project was to determine current nursing knowledge and practice of safe sleep, as well as how parent education occurs in a local NICU through the use of a survey. The survey was developed and distributed to staff at University of Louisville Hospital NICU nurses to determine …

Analysis Of Unplanned Extubations At A University Neonatal Intensive Care Unit., Elizabeth Turcotte

Doctor of Nursing Practice Papers

Unplanned extubations represent a serious adverse event that occurs within neonatal intensive care units. The current literature on unplanned extubations suggests that the incidence of these events can be reduced in the clinical setting. UEs represent the primary respiratory-related adverse event in the neonatal intensive care unit (NICU) and can result in cardiopulmonary collapse requiring emergent reintubation (Carvalho, Mezzacappa, Calil, & Machado, 2010). Staff members of the University of Louisville’s neonatal intensive care unit collected data surrounding unplanned neonatal extubations from November 2017 through December 2018. These data have been used to target modifiable risk factors temporally associated with unplanned …

Oxygen Use In The Delivery Room And The Outcome Of Bronchopulmonary Dysplasia: A Retrospective Review., Blair Wagner

Doctor of Nursing Practice Papers

Recent evidence confirms the first 10 minutes after birth are extremely important for the short and long-term outcomes of premature infants, specifically for the risk of developing bronchopulmonary dysplasia (BPD). Neonates who are resuscitated with 100% oxygen concentration in the delivery room during the first 10 minutes after birth have a 35% chance to develop BPD (Vento, 2009). Neonates who are resuscitated with lower oxygen levels in the first 10 minutes of life have a 15% chance of developing BPD. BPD is diagnosed when a neonate requires oxygen at ³28 postnatal days or at 36 weeks corrected gestational age, along …

Practice Vs. Evidence: Predicting Insertion Length And Verifying Placement Of Feeding Tubes In Neonates., Brittany L. Tipton

Doctor of Nursing Practice Papers

The placement of nasogastric (NG) and orogastric (OG) feeding tubes is one of the most common procedures performed in the Neonatal Intensive Care Unit (NICU). According to the literature, as many as 44% of feeding tubes are placed in the incorrect location in children (Parker, Withers, & Talaga, 2018). The purpose of this process evaluation project was to analyze the current processes and human factors in predicting insertion length and verifying placement of feeding tubes in neonates. The goal was to use the data obtained to compare current practices to current evidence. If warranted, the ultimate goal was for the …

Spring Into Action: Role Models For Sun Safety., Kelsey A. Grothouse

Doctor of Nursing Practice Papers

Ultraviolet radiation during childhood increases a person's risk for skin cancer later in life. Research has provided support for a multifaceted intervention that targets youth in order to decrease these future risks. The purpose of this paper is to discuss the implementation of an intervention that taught youth athletic football coaches and parent helpers to act as role models and influence sun safe behavior in their youth athletes in order to help reduce the carcinogenic effects of UV radiation in the future. The intervention consisted of a one-hour training session with coaches and parent helpers of a youth football team …

The Effect Of High Flow Nasal Cannula Weaning Protocol On Decreasing Length Of Stay In Pediatric Intensive Care., Debbie Farrell

Doctor of Nursing Practice Papers

Background: High-flow nasal cannula (HFNC) is a type of non-invasive respiratory support that has decreased the rate of intubation in infants and children. It is utilized in the PICU and the wards. Due to the increased volume of patients on HFNC, a standard HFNC weaning protocol was created to improve the management of these patients.

Methods: Potential patients were identified through the Virtual Pediatric System (VPS) with the criteria of ages 1 month to 6 years old, admitted to the PICU during the months of January to March of 2018 and 2019, with diagnosis of bronchiolitis and requiring HFNC. Chart …

Implementation And Evaluation Of A Neonatal Chest Tube Simulation Lab For App Competency., Tracey Miller

Doctor of Nursing Practice Papers

Pneumothorax in the neonatal period is a potentially life threatening condition that requires Neonatal Advanced Practice Providers to respond rapidly and competently in order to prevent complications of morbidity and mortality. It has become increasingly difficult to establish initial competency as well as maintain competency in low volume high acuity emergency procedures such as chest tube placement. The purpose of this practice based quality improvement project was to implement a simulation based training program in chest tube placement for the Neonatal Advanced Practice Providers within Norton Children’s Neonatology. The goal was to have all Advanced Practice Providers (APP) be able …

Decreasing Musculoskeletal Injuries Among Operating Room Personnel Through The Use Of Anti-Fatigue Mats., Hannah Raake

Doctor of Nursing Practice Papers

Work-related musculoskeletal disorders (WRMDs) are a common occurrence among operating room (OR) personnel due to certain job requirements including standing in a static position for long periods of time. The American Association of Operating Room Nurses (AORN) ergonomic guidelines support interventions (anti-fatigue mats, shoe in-soles, etc.) aimed at decreasing the rates of WRMDs among OR personnel. A 3-month pre- and post-intervention trial was established at one Southern Indiana hospital to assess the efficacy of anti-fatigue mats in the OR theatre. Two anti-fatigue mats were placed in each OR, cardiovascular operating room (CVOR), and endoscopy room for use with each case. …

Neonatal Nurses’ Knowledge And Assessment Of Necrotizing Enterocolitis (Nec) In The Premature Infant., Kathryn Taylor Van Hoose

Doctor of Nursing Practice Papers

Necrotizing Enterocolitis (NEC) is the most common gastrointestinal emergency seen in the Neonatal Intensive Care Unit (NICU) (Cleveland Clinic, 2015). NEC occurs most frequently in premature infants, accounting for approximately 60 to 80 percent of all cases (Singh et al., 2008). Mortality rates associated with NEC are estimated to be between 20 and 30 percent reaching upwards of 50 percent for patients requiring surgical intervention (Cleveland Clinic, 2015). There is an abundance of research surrounding the pathophysiology, potential causes, and protective factors related to NEC in the premature infant. Comparisons of various interventions such as: feeding practices and protocols, administration …

Perceptions Of Health Practices And Interactions With The Us Healthcare System Among Bhutanese Refugees: A Qualitative Approach, Amy E. Szajna

Journal of Refugee & Global Health

Purpose

The aim of this pilot study was to explore health practices of Bhutanese refugees and their interactions with the US healthcare system and providers.

Methodology

Researchers conducted 12 in-depth interviews and 7 patient-provider observation units as part of this descriptive qualitative study.

Results

Participants identified individual definitions of health and behaviors they value to maintain health. They identified significant trust and faith in their healthcare provider and valued provider-directed suggestions. Participants cited concerns with patient-provider communication resulting from limited English proficiency and frequent changes in primary care providers.

Discussion

This study is useful to inform further research and potential …

Advance Practice Pediatric Nursing Council., Emily Mountjoy Mcrae

Doctor of Nursing Practice Papers

Advance Practice Registered Nurses (APRNs) continue to grow in numbers in the inpatient hospital setting, as well as within children’s hospitals and subspecialty groups. As the number of APRNs continues to increase, thoughtful consideration within organizations is needed to address leadership specific to this population of healthcare professionals. The goal of this quality improvement initiative was to generate quantitative data to determine if the formation of a Pediatric Advance Practice Nursing Council in a children’s hospital was successful in improving APRN communication, collegiality, and networking. However, the formation of our APRN council was significantly impacted by a multitude of barriers. …

Treating Latent Tuberculosis Infection In Newly Arriving Refugees: An Advanced Practice Nurse Initiative At The University Of Louisville Global Health Center, Linda Goss, Dawn Balcom, Karen Mutsch, Ruth Carrico, Rahel Bosson

Journal of Refugee & Global Health

Background: A review of newly arriving refugees referred to the local health department for latent tuberculosis infection (LTBI) treatment during 2013-2015 revealed a treatment gap of 73%, supporting the need to identify new approaches to treat vulnerable populations and mirrored results in the literature.

Objectives: 1) Describe an advanced practice registered nurse (APRN) led alternative approach to LTBI treatment in the refugee population; and 2) evaluate the impact of a 12-week regimen for LTBI on treatment acceptance, adherence and completion.

Methods: During the initial health screening visit, treatment options were provided for those identified with LTBI consisting of either a …

Multistate Hepatitis A Outbreak: Vaccination Of Food Service Workers As Part Of The Kentucky Outbreak Response, Ruth M. Carrico, Dawn Balcom, Delanor Mason, Audria G. Denker, Alyson Holland, Kimberley A. Buckner, Stephen P. Furmanek, Wesley Trail

Journal of Refugee & Global Health

Background: In August 2017, a local outbreak of Hepatitis A was identified among homeless individuals in Louisville, Kentucky. This marked the first cases in what has now become recognized as the largest Hepatitis A outbreak in the US. When infection was identified in a Food Service Worker (FSW), vaccination efforts were expanded to target this group.

Objective: The purpose of this study was to describe: 1) the processes used to provide access to Hepatitis A vaccine for FSWs, 2) results from the immunization activities, and 3) lessons learned from the outcomes.

Methods: Through a partnership between the Louisville Metro Department …