Medicine and Health Sciences Commons^™

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Tatyana Grib, Macy Therese G. Andrada, Julie C. Barragan, Amanda K. Dailor, Samantha T. Gerber, Mercedes S. Greenberg

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause- Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures …

Identifying Pediatric Obesity In The Retail Health Setting And Implications For Quality, Jodie Nicole Guardi

College of Science and Health Theses and Dissertations

Pediatric obesity has reached an epidemic status. The purpose of this study was to examine the prevalence of overweight and obese patients, as well as how often and how accurately a diagnosis was coded. The population for this study included children ages 3-18. This cohort presented to retail health clinics in a large urban health system for school or sports physicals from June 1, 2017 to November 30, 2017. Method. A retrospective chart review was conducted. Statistical analysis was performed to determine if there was a relationship between obesity and age, ethnicity, race, and gender. Results. The study identified 15.9% …

Prescribing Probiotics In Tandem With Antibiotics In A Pediatric Setting., Allyson Riggs

Doctor of Nursing Practice Papers

Gastrointestinal (GI) discomfort including antibiotic associated diarrhea (AAD) is a common side effect of antibiotic therapy. As antibiotic use continues to increase, more patients are affected by AAD. Significant evidence has been found on using probiotics for the treatment and prevention of GI distress and AAD. Provider education is needed in the clinical setting to share evidence and make recommendations on best practice. The goal of this intervention was to increase the rate at which providers prescribe probiotics in tandem with antibiotics, via increased provider education. A retrospective Electronic Health Record (EHR) review was conducted once before and once after …

Propofol Administration For The Prevention Of Emergence Agitation In Pediatric Anesthesia, Casey L. Pesch

Nursing Capstones

No abstract provided.

Multilingual Postpartum Depression Screening In Pediatric Community Health Clinics, Margo Cohen

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidence-based project is to screen all mothers for postpartum depression at their infant’s 1-week, 1-month, 2-month, and 4-month well-child visits and to educate pediatric providers and mothers on the importance of early detection, referral and utilization of mental health services.

Background: Every year, 400,000 infants are born in the United States to mothers with depression, most of which have not been diagnosed or treated. The prevalence of postpartum depression (PPD) among immigrant and low-income women following birth, is estimated to be as high as 22%. Despite their high rate of prevalence, recognition and treatment …

Improving Acute Pain Management For Pediatric Patients: Development Of A Ketamine Infusion Protocol, Oksana Koeppen

Doctor of Nursing Practice Projects

Multimodal analgesia is a recommended approach for acute pain management for adults and children (ASA, 2012; Chou et al., 2016). This approach is becoming a prominent modality in pain control strategies in the pediatric population. An intravenous anesthetic, ketamine, may be a useful adjunct for acute pain management in children. Development of a pediatric ketamine infusion protocol and its subsequent introduction to the key stakeholders at the host facility in central Illinois were the focus of this project. Research has demonstrated the effectiveness of low-dose intravenous ketamine in acute pain management when used as an adjunct to other medications (Asadi …

Transitioning Pediatric Patients With Special Needs, Dimi Resch

Doctor of Nursing Practice Projects

Transitional care, which encompasses both the sending and receiving aspects, is essential for pediatric patients with complex care needs.A provider in a small, Midwest pediatric primary care clinic agrees with researchers that transitional guidelines are needed for consistency among pediatric and adult providers. This clinic currently has no process in place to guide the transition of patients with special needs. The primary goal of this project was to develop a communication tool that aids in the transition of patients with special needs into the adult primary care setting. The literature reviewed provided a variety of tools used to communicate healthcare …

Pediatric Pain Management During Intravenous Line Placement: Nursing Perceptions And Interventions, Kate Shaffer

Honors Theses

Children are under assessed and under treated for pain associated with medical procedures, specifically during venipuncture. Recent studies show that procedural pain is preventable and that pain management interventions are underutilized. Failure to provide adequate pain relief can mentally and physically hurt children - in addition to inducing fear, suffering and lack of trust, exposures to pain can alter the central nervous system and increase a child’s sensitivity to pain. Pediatric nurses are responsible for assessing and managing pain before, during and after a procedure. Therefore, this review of literature and pilot study examines how registered nurses practicing in the …

Human Papillomavirus Vaccination Status And Endorsement Among Undergraduate Nursing Students: A Secondary Data Analysis, Ashley Hollins

Dissertations & Theses (Open Access)

Background: Human papillomavirus (HPV) vaccination has immense potential to prevent HPV-related infections but vaccination rates remain suboptimal. Nurses could potentially increase vaccination rates by providing recommendations and addressing vaccine concerns. As student nurses’ transition into practice, it is important to identify factors that could influence their attitudes and uptake of the HPV vaccine; however, these factors remain unknown.

Purpose: We proposed to: (1) identify factors associated with HPV vaccination status and (2) to identify student nurses’ perception of parental vaccine hesitancy, preferred counseling strategies, and factors associated with intention to counsel parents on HPV.

Methods: The current study was a …

Caring For The Pediatric Neurofibromatosis Type-1 Patient: Improving Nursing Knowledge Through An Innovative Educational Tool, Samantha Ingerick

Doctoral Projects

Standardized nursing education can help equip nurses with appropriate skills needed to care for certain patient populations. Pediatric neurofibromatosis type-1 (NF1) patients have unique health needs, and often seek care at institutions where no NF1 training has been provided. The purpose of this project was to explore existing nursing NF1 knowledge and knowledge perception in a pediatric oncology infusion center within a large bay area children’s hospital, a location where nurses have varied NF1 education and have recently been asked to care for this population. Malcolm Knowles’ adult learning theory was used to design an NF1 educational tool for nurses. …

Treatment Of Pediatric Graves’ Disease With Thyroidectomy, Danielle J. Mullin

Nursing Capstones

No abstract provided.

Watchful Waiting And Antibiotic Stewardship: A Quality Improvement Project, Rebecca Couper

Seton Hall University DNP Final Projects

Antibiotic misuse and overuse are major contributors to antibiotic resistance which is responsible for the death of 23,000 American’s annually. There is a growing body of evidence that antibiotic stewardship programs are successful in reducing antibiotic prescribing rates while maintaining safe patient care. Research supports a multifaceted approach with an ongoing commitment to antibiotic stewardship. This quality improvement project aimed to reduce the overuse of antibiotics in pediatric acute respiratory tract infections (ARTIs), improve the percentage of children who received laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis, and to implement and measure the efficacy of watchful waiting …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Did You Wash Your Hands?, Kelley Coyne

Interprofessional Research and Innovations Council

Did You Wash Your Hands?

Kelley Coyne, RN, OPD Maine Medical Center

Introduction: While there is great focus and education regarding the importance of hand hygiene among healthcare workers there appears to be less focus and education on the importance of patient’s hand hygiene. My observation, as a healthcare provider in pediatrics, is that patient’s compliance with hand hygiene is rare and it appears that there is a need to educate patients on the importance of hand hygiene. Hand Hygiene has the highest efficacy and is a cost effective measure for preventing infection. Researchers in London estimate that if everyone …

Developing And Implementing Trauma Informed Care Principles: A Pilot Project, Lisa Blair Bell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Exposure to childhood trauma have lifelong consequences effecting the health and well-being of the individuals who experienced or witnessed the trauma. As healthcare providers, we must recognize patients who have been exposed to trauma and ensure that it is responded to appropriately. This approach is known as trauma informed care.

Objective: The purpose of this quality improvement project was to increase knowledge, opinion, and self-rated competence related to trauma informed care through the use of an educational intervention. Application of trauma informed care into daily practice was monitored through semi-structured interviews with project participants.

Methods: Registered nurses from the …

Improving Emergency Department Nurses' Self-Perceived Self-Efficacy In Early Recognition Of Patients In A Mental Health Crisis, Mary Kay Silverman

DNP Scholarly Projects

Abstract

The two largest counties within Southwest Florida (SWFL) are Lee and Collier where mental health evaluations for children under the state’s Baker Act have more than doubled between 2011 and 2017 (Gluck & Zeitlin, 2019, p. 4). Given the marked increase in mental health evaluations, early recognition, assessment with initiation of treatment by nurses in the pediatric emergency department (ED) who present with behavioral health complaints must be a priority for emergency department leaders. Purpose: This quality improvement (QI) project proposed to improve a nurses’ self-efficacy through expanding knowledge in the recognition and identification of the signs and symptoms …

Addressing Human Papillomavirus Vaccination In Primary Care Pediatrics, Natasha Marie Subramaniam

Walden Dissertations and Doctoral Studies

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Despite most common transmission, HPV immunization in adolescents remains below target rates of 80% as outlined by Healthy People 2020 Objectives. Nearly all individuals will contract HPV during their lifetime. The purpose of this project was to educate providers on successfully promoting HPV immunization in adolescents utilizing evidence-based methods. The health belief model (HBM) was the theoretical underpinning utilized to teach providers on discussions about 9vHPV immunization with parents of adolescents. The practice focused question explored whether an education program using concepts from the HBM would …

Addressing Bullying Behavior In Pediatric Patients Using A Clinical Practice Guideline, Barnitta Latricia Moses

Walden Dissertations and Doctoral Studies

Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner'€™s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in …

Enhancing Comfort Care Techniques In The Pediatric Inpatient Setting, Nicole Rae Mansky

Walden Dissertations and Doctoral Studies

The benefits of pharmacological and nonpharmacological interventions for children undergoing painful medical procedures are well documented in extant nursing literature; however, such techniques continue to be underused in practice. Improving comfort during medical procedures is necessary to enhance the patient and family experience. The purpose of this project was to provide education to nursing staff about pediatric pain theories and evidence-based practice recommendations that support the use comfort interventions for pediatric patients of all ages. The practice-focused question addressed the development of an educational program designed to enhance staff knowledge of comfort intervention options and the benefits provided to patients. …

Evaluating The Use Of Stopcocks For Lab Collections From Central Venous Access Devices Related To Central Line Associated Blood Stream Infections, Heather Hollingsworth

DNP Projects

PURPOSE: Central line associated blood stream infections pose a threat to patient safety and are costly to healthcare systems. Heath care professional frequently access central venous access device (CVAD) to obtain blood samples for laboratory analysis. A commonly accepted procedure practice involves exchanging 3-4 syringes during the collection process. Each time a syringe is exchanged during the lab collection process the opportunity for bacteria to be introduced into the bloodstream exists. Decreasing the number of times a CVAD is accessed removes opportunities for bacteria to be introduced to the line thus decreasing the risk of infection. Due to the occurrence …

Pediatric Behavioral Health Best Practices In The Children's Emergency Department, Kristina Marie Pickering

Walden Dissertations and Doctoral Studies

Emergency department (ED) use for behavioral-health-associated diagnoses has steadily increased in adult and pediatric populations, accounting for 1 out of every 8 ED visits. The increase in pediatric behavioral health ED visits, combined with limited resources for treatment, has created a challenge for EDs faced with extended boarding and constant observation of this population. The generalized behavioral health guidelines used at the practice site have not been adapted for the pediatric population. This project focused on providing age- and developmentally appropriate best practice guidelines for children under constant observation in the children's emergency department (CED) using Havelock's theory of planned …