Medicine and Health Sciences Commons^™

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

An Evaluation Of Adolescent Concussion Management And Guidelines By Primary Care Providers In The Outpatient Setting: Dnp Scholarly Project, Mary Beth Newkirk

Doctor of Nursing Practice Scholarly Project

Understanding the pathology of a concussion has been a challenging task for many experts in healthcare. An agreed upon definition has yet to be developed and many health care providers are not properly educated to assess and care for those suffering from a concussion. Management of concussion in adolescents, a vulnerable population, requires even more consideration and training. The purpose of this study was to determine the knowledge current providers in the four-state region regarding sport-related concussion management in the adolescent population, to improve patient care and outcomes, and to improve knowledge learned through exposure to a clinical practice guideline-based, …

Standardized Bedside Report During The Transfer Of Care, Lauryn Fanning-Goff

MSN Capstone Projects

Optimization of our communication processes can prevent multiple adverse/sentinel events that will also prevent the organization from potentially being held liable to cover those costs. The use of a standardized form of handoff is supported by literature as a way to ensure critical information is not omitted. Completing the report at bedside allows the patient and family to be involved in care, improve patient safety, and enhance patient satisfaction scores (Baldwin & Spears, 2019). Because of this, the PICOT question is: “In staff nurses on a pediatric surgical unit (P), how would a standardized bedside report during the transfer of …

Readiness For Insulin Pump Use In Pediatric Type I Diabetes: A Quality Improvement Project, Valeria Marin

Doctor of Nursing Practice

Background: Insulin pumps are essential in the management of type 1 diabetic pediatric patients because of their versatility in meeting the developmental needs of childhood and adolescence. Summary of the Evidence: There is lack of evidence for standardized pump initiation program in pediatric patients (ADA, 2019). Moreover, adverse events from insulin pump misuse, such as diabetic ketoacidosis, arise from lack of anticipatory guidance of pump management and troubleshooting (Evert et al., 2016; Grunberger et al., 2014, Wheeler et al, 2014). Project Purpose: The purpose of this quality improvement (QI) project was to reduce and prevent adverse outcomes of insulin pumps …

The Youthful Pandemic, Brook Sahlemariam

Nursing | Senior Theses

This paper attempts to examine the neurological, physical, and societal effects of e-cigarette use among youth and young-adults in North America. Furthermore, the paper investigates the parallels between e-cigarette users, tobacco users, and dual users in regard to behavioral patterns, reasons for use, and age of initiation.

Reflections On Southwestern Diabetic Foundation Internship, Katherine Hamilton

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Residential diabetes camp plays an important role in the health care plan of children with diabetes. The multidisciplinary team at Camp Sweeney provides primary care and continued diabetes health education for their patients, empowering them to build healthy lifelong habits. An internship with the Southwestern Diabetic Foundation allowed me to gain more hands on experience with a pediatric population, acquire a greater understanding of the complex variables that go into treating chronic illness, and create age appropriate teaching presentations. The purpose of my position was to engage with children in order to create a positive experience for both their physical …

An Extensive Literature Review On Neonatal Pain Assessment & Management, Bailey Bishop

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Neonatal pain assessment and management is a field requiring much more research. This literature review outlines the current climate of neonatal pain assessment, compares a variety of neonatal pain scales on validity and clinical utility, and implications for how neonatal pain management can be improved. Neonates experience pain to the same degree, if not more, than everyone else. Unmanaged pain during the neonatal period leads to adverse health outcomes. In order to prevent these atrocities from this vulnerable population, NICU pain assessing needs to become the standard of care.

An Altitude Adjustment: Implementing A Clinical Practice Guideline In The Newborn Nursery At Moderate Altitude, Leeann Blaskowsky

Student Scholarly Projects

Practice Problem: All infants undergo many changes at birth, but for some, the transition from intrauterine to extrauterine life presents more of a challenge, especially at altitude. Despite continuing research, neonatal prescribing guidelines for oxygen therapy remain ambiguous.

PICOT: For term and late preterm infants requiring oxygen beyond transition, does a clinical practice guideline compared to practice without a guideline, provide consistent, evidence-based care, support the mother-infant dyad, and impact nursing perceptions over a six-week pilot period?

Evidence: Birth at moderate altitude presents the newly born with less oxygen than those delivered at sea level. Several studies …

5th & 6th Grade School-Based Asthma Self-Management Program: Toolkit For Facilitators, Sarah Laroe, Jasmine Terrell, Tracy L. Brewer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

This toolkit will aid school nurses in facilitating an asthma self-management program in their school. School-based asthma self-management programs have been shown to significantly improve school absences and improve health care outcomes in children living with asthma. Although there are many programs out there, this toolkit will utilize the Iggy and the Inhalers© program by Booster Shot Media. The program has several resources available online for free at their website, as well as resources that may be purchased. The program will be enlightening for the students and a fun way to learn about managing their asthma before they attend middle …

Use Of The Cameo Ii Acuity Tool To Decrease Burnout For Nurses Working In A Pediatric Intensive Care Unit, Frances Lynn Feria-Clement

Electronic Theses and Dissertations

The World Health Organization (WHO) reported registered nurse burnout is an occupational hazard resulting in serious consequences for patients, healthcare organizations, and individual registered nurses (Woo et al., 2020). The purpose of this project was to see if the Complexity Assessment and Monitoring to Ensure Optimal Outcomes II (CAMEO II) Acuity Tool, used as an intervention for staffing and scheduling, would have a positive effect against nurse burnout in a pediatric critical care setting in a pediatric medical center. Maslach’s Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSSMP) was used as a pre- and postsurvey to measure the emotional …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Type 2 Diabetes Mellitus In The Pediatric Population, Lorna Santiago

DNP Qualifying Manuscripts

The incidence and prevalence of diabetes in youth in the United States is increasing. In particular, type 2 diabetes mellitus (T2DM) is becoming more common in individuals younger than 20 years. Nurse practitioners and other primary care providers that see children should be knowledgeable about the condition and confident in participating in multidisciplinary management. Screening should begin at age 10 or at puberty, whichever comes first. Providers should screen all children who are overweight or obese or of Native American, African American, Latino, Asian American, or Pacific Islander race or ethnicity. Children of these ethnicities have a greater risk for …

Implementing Music As A Distraction To Reduce Pain And Anxiety In Pediatrics, Marcanah Frye

Scholars Week

Music therapy is a safe and inexpensive intervention that can be used to reduce pain and anxiety in pediatric patients. There are several research articles that have proven that music therapy can positively affect patients. Various factors, like pain and anxiety scores, heart and respiratory rates, blood pressure, and oxygen saturation levels were observed throughout the study to help base the decision on whether or not music therapy was effective at reducing pain and anxiety. This therapy can be based upon the nursing theory of comfort by Katharine Kolcaba. Her goal for this theory of comfort was to put comfort …

Peripheral Iv Bundle, Alicia Hanna

Graduate Theses, Dissertations, and Capstones

Abstract

It is estimated that over 90% of hospitalized patients require IV access during their hospitalization. Peripheral IVs (PIVs), while less risky than central lines, are not without risk to the patients. Intravenous (IV) infiltration in pediatric patients is a very common complication associated with IV access, accounting for about 67% of IV catheter removals; a less common complication, but much more serious complication of a PIV can be a blood stream infection (BSI) which can account for up to 35% of BSIs seen in patients. BSIs are associated with increased length of stay, increased morbidity and can result in …

Assessing Biobehavioral Effects Of Exposure To Traumatic Events In Palestinian Children, Mohammad Asia

Journal of the Arab American University مجلة الجامعة العربية الامريكية للبحوث

Background: A growing body of work suggests that exposure of children to the trauma of war threatens their physical and psychological development. Children exposed to such childhood adversity have an increased risk of developing mental health problems, including posttraumatic stress disorder (PTSD), emotional and behavioral problems, and psychobiological ailments. Methods: This pilot study used a descriptive cross-sectional design to explore the relationships among traumatic event exposure, child stress, and biological stress markers (salivary cortisol and salivary alpha-amylase) measured in a sample of 37 West Bank Palestinian children aged 10-12 years. Results: Findings revealed moderate correlations between perceived child stress scores …

Decreasing Readmissions In Medically Complex Children, Colleen Bartlett

Student Scholarly Projects

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions.

PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe?

Evidence: The literature revealed 18 …

Accuracy Of Rn Visual Quantification Of Emesis Volumes In The Neonatal Intensive Care Unit, Stephen Stoever

Seton Hall University DNP Final Projects

An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates.

For this project, 158 NICU nurses at a …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich, Tracy L. Brewer, Jennifer G. Tourville Dnp

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then …

Elaia 2020/2021, Stephen Case

ELAIA

Volumes 3/4, 2020/2021

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Standardizing Assessment And Management Of Ankyloglossia, Marcia Nicole Cowen

Doctor of Nursing Practice Scholarly Projects

Ankyloglossia, which is characterized by a short, tight or thick lingual frenulum, can negatively impact breastfeeding. It has been recognized as a problem for centuries. Frenotomies have traditionally been performed to remove the lingual frenulum when indicated. The use of frenotomies and a focus on ankyloglossia fell out of favor in the twentieth century with renewed attention in the past several decades. Limited high-quality studies have been undertaken on ankyloglossia. There remains no standardized diagnosis or management recommendations. In efforts to promote a standardized approach that is based on current knowledge, this study will involve an educational in-service on ankyloglossia, …

Prematurity, Socioeconomic Status, And Childhood Asthma: A Canadian Cohort Study, Crystal P. Mcleod

Electronic Thesis and Dissertation Repository

Introduction: Preterm birth (PTB) and socioeconomic status (SES) have both been associated previously with the onset of childhood asthma in high income countries. Yet, these factors have been studied minimally outside of an exposure or confounded relationship, and amongst the Canadian population.

Materials and Methods: Merging household interview data from Cycles 2 to 5 of the Canadian Health Measures Survey, this study analyzed data from weighted respondents in early (3-5 years, n = 1,096,609) and middle (6-11 years, n = 2,112,059) childhood. Bivariate, stepwise logistic regression, and logit decomposition were performed using STATA software. Intersectionality guided the study’s methodology.

Results: …

Self-Management And Quality Of Life In Young Adults After Healthcare Transition, Jennifer Herbert

Grace Peterson Nursing Research Colloquium

The transition from pediatric to adult healthcare has become healthcare concern of increasing importance as more adolescents with chronic conditions survive to adulthood requiring continuing care. In order to understand the current status of healthcare transition (HCT), we identified the HCT services received by young adults, their existing healthcare self-management skills and how skills correlated with their quality of life. A correlational and retrospective cross-sectional online survey of English-speaking young adults in the United States ages 18-26 with at least one pediatrically diagnosed chronic condition was conducted August-October 2019. Participants completed a healthcare transition feedback survey, the TRANSITION-Q self-management skills …

Improving Care For Homeless Young Adults: A Shelter Client And Health Service Provider Perspective, Kenya Kawanee Hemingway

Grace Peterson Nursing Research Colloquium

The purpose of this study was to determine if the healthcare needs of homeless young adults from the client, shelter staff, and shelter healthcare provider’s perspectives. Data was collected via focus group with homeless unaccompanied young adults (n=4), and an online survey with shelter staff and healthcare staff (n=8) of The Night Ministry (TNM) and Ignite Promise. The focus group was recorded, transcribed, and coded for themes. Inductive analysis revealed themes focused on improving the quality of services provided. Based on the findings, recommendations include assessing the needs of homeless unaccompanied young adults from their perspective utilizing larger sample sizes, …

Empowering The Lowland Indigenous Community Through Child Health And Nutrition Program In Occidental Mindoro Province, Philippines, Artemio Morado Gonzales Jr

ASEAN Journal of Community Engagement

Nutrition and child health programs were integrated into the extension programs from 2016-2018 of the Occidental Mindoro State College, in partnership with the local government unit at the municipal and barangay levels. This paper presents the health extension tools and techniques used in preventative care and the promotion of child health services in the indigenous community of Sitio Bato Singit, in the Occidental Mindoro Province, Philippines. Health education, small group techniques, demonstrations, storytelling, informal talks, and open forums were the methods and techniques employed to implement the program. The common tools used were seating arrangements, flip-charting, props, social hours, and …

Pediatric Bullying Education In Arkansas Baccalaureate Nursing Programs, Jasmine Jackson

McNair Scholars Research

Over the years, there has been an ever-increasing spotlight on the issue of bullying among adolescents. Nurses are another adult-figure, in addition to parents and teachers, that can help identify and address bullying if educated properly. The purpose of this study was to examine pediatric bullying education in Arkansas baccalaureate nursing programs. Through the use of a mixed-method approach, the newly created survey was to be completed by one faculty member from each of the 12 BSN programs in Arkansas (12 participants; 6 respondents). The paper describes the quantitative and qualitative data analysis from this non-experimental descriptive pilot study. Results …

Utilizing High Flow Oxygen Therapy In Infants With Bronchiolitis, Sarah Ulses

Dissertations

Problem Bronchiolitis is the leading diagnosis of hospitalizations for children under one-year. The purpose of this study was to evaluate the effectiveness of supportive high-flow oxygen (HFO) therapy for infant patients requiring more than 2L/min nasal cannula (NC).

Methods An observational, descriptive design with convenience sampling of infants aged one-year or less, hospitalized with bronchiolitis and requiring HFO therapy. Comparisons were done between 2019 when no HFO was allowed on the general unit and in 2020 when HFO was allowed.

Results Of 28 patients (N = 28), 13 (n = 13) were in the 2019 cohort and 15 …

Multidisciplinary Team Approach Effect On Pediatric Severe Asthma, Lila Kertz

Dissertations

Problem. Children with severe asthma are more likely to be non-adherent with their prescribed medications, often related to barriers. A holistic assessment of these patients has been suggested, but is not typically performed in most pediatric asthma clinics. The purpose of this project was to evaluate the effects of severe pediatric asthma clinic services designed to perform holistic assessments and provide comprehensive care.

Methods. An observational, descriptive design was used to evaluate the Severe Asthma Clinic for Kids (SACK) created in 2013 using a retrospective database review. A convenience sample of data collected on all children treated in the clinic …

Intimate Partner Violence Screening In Adolescent And Young Adult Females, Emily Myers

Dissertations

Abstract

Problem Adolescents and young adult females are at risk for experiencing intimate partner violence (IPV). Females aged 16- to 24-years of age experience IPV three times more likely than males. Universal screening for adolescent IPV is considered a gold standard for adolescent anticipatory guidance. The purpose of this quality improvement initiative was to evaluate the impact of an adolescent IPV screening instrument in an urban, Midwestern shelter for pregnant adolescent and young adult females.

Methods An observational, descriptive design. All adolescent and young adult females presenting for intake evaluation were screened for IPV using the Healthy Relationship Quiz over …