Working Under Pressure: Evidence-Based Risk Assessment And Pressure Injury Prevention In The Pediatric Intensive Care Unit, James A. Hutcheson Iv, Allyson M. Neal

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

Background: The hospital-acquired pressure injury (HAPI) can have physiologic, psychologic, and financial sequelae. Children are at increased risk secondary to immature physiology, developmental differences, and severity of illness. Evidence suggests presence of medical devices exponentiates HAPI risk.

Local Problem: Upward trends in HAPIs revealed nearly 50% are device related in the project setting, an urban Pediatric Intensive Care Unit. The Braden QD Scale was identified as best evidence for HAPI risk assessment. This initiative aimed to observe the ability of the Braden QD Scale as a predictor of HAPI risk as compared to current practice utilizing the Braden Q …

Implementation Of A Continuing Education Module On Triage Practices For Pediatric Emergency Room Nurses, Catherine Nicholson, Lindsey Lakas, Marian Malone

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

BACKGROUND: More than 35 million U.S. children visit the emergency department (ED) each year. Triage is the family’s first interaction with the healthcare team and a crucial component of care that directs the course of the ED visit. The use of standardized triage protocols, like the Emergency Severity Index (ESI) algorithm, is shown to improve overall patient health outcomes in the pediatric ED. For triage algorithms to be safe and effective, continuing education for pediatric ED nurses is important.

LOCAL PROBLEM: Patients at a local pediatric emergency department are being inaccurately triaged - assigned a higher or lower acuity level …

Mindfulness-Based Educational Module For Nurses Caring For Pediatric Mental Health Patients, Brianna Mai Desjardins, Katherine Marie Newnam

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

BACKGROUND: Emergency pediatric nurses have the added stress of not only caring for medical patients but must also care for patients experiencing mental health issues. Many nurses feel unprepared to care for this specialized patient population. To bridge this gap, mindfulness-based interventions (MBIs) have been shown to provide nurses with the skills needed to care for mental health patients. This same concept can be applied to pediatric patients. Pediatric-focused mindfulness-based techniques can be used to help pediatric patients manage their symptoms.

LOCAL PROBLEM: The setting for this project was an urban pediatric emergency department in East Tennessee. At the state …

Improving Human Papillomavirus (Hpv) Vaccination Rates Through Age-Based Flagging, Savannah Jo Garcia, Karen Lasater

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

DNP SCHOLARLY PROJECT ABSTRACT

BACKGROUND: Over forty million Americans are currently infected with human papillomavirus (HPV). HPV can cause life threatening cancers of the cervix, vagina, vulva, penis, anus, and throat. Only half of U.S. adolescents have completed the HPV vaccine series.

LOCAL PROBLEM: The setting for this evidence-based improvement project is a rural family practice clinic in Texas. Texas has the largest group of teenagers not protected against HPV in the country. The project’s purpose is to investigate the effect of age-based flagging on adolescent vaccination rates in a rural community through evidence-based practice.

METHODS: Project …

Pediatric Vaccine Pain Management & Perceptions Of Caregivers And Nursing Staff: An Evidence-Based Project, Madison K. Bears, Tami H. Wyatt

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

Background: In an age with many diseases controlled through immunization and herd immunity, the significance of immunization can wane in public memory. In children, injection pain is an obstacle to vaccination and can cause anxiety around medical visits, healthcare avoidance, delayed immunizations, and needle fear (McMurty et al., 2015; Shah & Sui, 2019; Taddio et al., 2022). Evidence-based vaccine pain relief techniques are described in the literature (Shah et al., 2009; Wu et al., 2022; Taddio et al., 2015), yet their use in practice is minimal (Taddio et al., 2022).

Local Problem: An evaluation of a pediatric clinic …

Acute Stress Disorder And Post-Traumatic Stress Disorder Screening In Pediatric Trauma Patients, Samantha Irizarry, Marian Malone, Megan Waddell

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

BACKGROUND: Two-thirds of U.S. children and adolescents report experiencing one or more potentially traumatic events by age seventeen. 13.4% of the North Carolina pediatric population ages 0-17 have undergone two or more traumatic adverse childhood experiences, compared to 14% of the U.S. population. Early identification reduces the by-products of underdiagnosis of ASD and PTSD, such as mental illness, developmental delays, poor academic performance, and challenges with social interactions.

LOCAL PROBLEM: The project site is a level-one pediatric trauma hospital in Charlotte, North Carolina, seeing more than 130,000 patients annually. Before project implementation, there was an absence of ASD …

Reducing Iatrogenic Opiate Withdrawal In The Picu: An Evidence-Based Practice Improvement Project, Kaitlin Kirk Ogle, Marian Malone, Will Guider

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

BACKGROUND: Current recommendations to reduce pain associated with mechanical ventilation is the administration of opiate and benzodiazepine infusions for Pediatric Intensive Care Unit (PICU) patients. If these infusions are weaned too quickly, iatrogenic withdrawal syndrome (IWS) often occurs. IWS symptoms include tachycardia, hypertension, diaphoresis, fever, irritability, tremors, clonus, hyperactive reflexes, vomiting, and diarrhea. Untreated IWS can lead to life-threatening complications.
LOCAL PROBLEM: The PICU at the project site contains fourteen beds and treats critically-ill pediatric patients. There was no standardized withdrawal assessment tool in practice. The purpose of this project was to implement the Withdrawal Assessment Tool-Version 1 …

Educational Intervention On Pediatric Concussions For Providers, Melissa Callaway, Robert Cornette

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

The purpose of this project was to find a gap in care within my community and fill the need with evidence-based practice. The process of evidence-based practice requires systematically searching and grading existing literature and basing a recommended practice change based on what is discovered. The recommendation is then applied translated to clinical practice. For the purposes of this project, the community which I am a part of needed improvement on the education of healthcare providers regarding post- concussive care in the pediatric population. Regardless of the explosion of research in concussions- translation to practice remains deficient. Concussions remain a …

How Nurses Perceive Their Task Load When Caring For Behavioral Mental Health Patients In The Pediatric Emergency Department, Emily Cameron, Robert Cornette

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

Abstract

Introduction: Pediatric behavioral mental health patients are being seen more frequently in the emergency department setting. With this ever-growing number of cases comes the need for trained staff, including registered nurses, to care for these children during a mental health crisis. With this increase comes increased stress of nurses’ workload. The purpose of this project was to identify nurses’ perceptions of their workload when completing three identified tasks: communication, procedures, and initial intakes. Methods: The National Aeronautics and Space Administration (NASA) Task Load Index tool was used to measure nurses’ perceptions of how difficult each task was to complete. …

Effectiveness Of An Evidenced-Based Cognitive Behavioral Therapy Intervention For Adolescents In A School Setting, Sarah Ellen Gray, Kimberly Michaela Carter, Amanda Harper

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

Abstract

The adolescent years are a formative time when rapid hormonal and physical changes stimulate the developing mind. Exposure to poverty, abuse, violence, and lack of peer and social support causes an increase in vulnerability to the development of mental health problems. The COVID-19 pandemic has also exacerbated symptoms of depression and anxiety. Regardless of the risk factors, anxiety and depression continue to be significant health problems, affecting thousands of adolescents yearly in the United States. The first-line treatment recommendation for managing anxiety and depression symptoms is cognitive behavioral therapy (CBT). However, access to a provider for CBT treatment is …

Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey

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

Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …

Implementation Of Provider-Completed Asthma Action Plans In A School Setting, Madison G. Branham, Amanda Harper

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

This evidence-based practice project aimed to implement and evaluate the use of a provider-completed asthma action plan (PCAAP) in a school-based setting by evaluating the number of school absences and unscheduled healthcare visits related to asthma exacerbations. This project was implemented in a middle school setting over a three-month period, using the Iowa Model to guide intervention. Data were collected via chart review to compare the number of absences and unscheduled asthma-related healthcare visits from the current academic year to the same time in the previous year. Although the number of unscheduled asthma-related healthcare visits was not impacted, data show …

Educating School Nurses To Improve Bowel Continence In Children With Spina Bifida, Mckinley J. Waugh, Tracy L. Brewer, Lisa Wagoner

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

Children born with spina bifida, a neural tube defect, can have associated loss of bowel control resulting in bowel incontinence. The National Patient Spina Bifida Registry found that 87% of those living with spina bifida had bowel incontinence, and less than 30% were bowel continent (Sawin et al., 2015; Wiener et al., 2017). Unfortunately, providers may never start a child living with spina bifida on a bowel management program. Evidence suggests that children with spina bifida should begin a bowel management program early, using a stepwise approach. School nurses, who interact with children living with spinal bifida while attending school, …

Education Of Staff Nurses On The Implementation Of A Standardized Clinical Care Pathway For Patients Who Undergo Correction Of Pectus Excavatum, Amber Jones, Tracy Brewer, Sally Mcquilkin

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

Objective: Educate staff nurses on a new standardized clinical care pathway (SCCP) for Nuss Procedure patients to decrease the length of stay, decrease hospital costs, decrease postoperative complications, and improve pain control. Design: Evidence-based practice improvement initiative. Setting/Local Problem: An inpatient surgery unit at a local pediatric medical center with no previous standardized care plan for Nuss Procedure patients. Participants: All staff nurses working on the inpatient surgery unit of a pediatric medical center. Intervention/Measurements: An SCCP was created by a multidisciplinary care team. All staff nurses on the inpatient surgery unit at a local pediatric medical center were assigned …

Coping With Congenital Heart Disease: Implementation Of An Evidence-Based Intervention In A Pediatric Cardiac Intensive Care Unit, Victoria M. Raphael, Tracy L. Brewer, Sherry Pye

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

Caregivers are exposed to many stressors in the pediatric cardiac intensive care unit (CICU) setting. In caregivers of children diagnosed with congenital heart defects admitted to the CICU, symptoms of psychological distress are prevalent (Doherty et al., 2009). These symptoms include, but are not limited to, feelings of acute and chronic stress, worry, anxiety, and depression. Without intervention, these symptoms can negatively influence the health and behavioral outcomes of the admitted child (Commodari, 2010). Providing support for these caregivers during their child’s admission can reduce the significance of these adverse psychological symptoms and promote both patient and caregiver well-being (Melnyk …

Decreasing Pain In Pediatric Patients During Intravenous Catheter Insertions On The Pediatric Inpatient Surgery Unit, Breonna Scott, Robert Cornette, Tammy Childers

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

Abstract

As healthcare in the United States transforms, the voice of advocacy for pediatric patients is also evolving. The act of inserting a peripheral intravenous (IV) catheter for medical care of a pediatric patient is one of the most common invasive procedures in the healthcare industry. However, the preventable pain accompanying such a common procedure is often overlooked. Pediatric patients are different than adults due to the lack of physiological and psychological development. When a peripheral intravenous catheter is inserted without pain prevention interventions, there are long-term and short-term consequences for the patient and family. In turn, there are many …

Educational Intervention To Increase Confidence And Knowledge Of Pediatric Nurses Caring For Pediatric Mental Health Patients, Alexa M. Wroblewski, Allyson Neal, Janie R. Holmes

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

Background: Given the rise in the mental health crisis, there is an increase of non-psychiatric nurses caring for pediatric mental health patients. This crisis leads nurses to experience feelings of doubt, hopelessness, stress, and insecurities in caring for this population. These feelings, combined with a lack of support and training, create a powerlessness loop of care. Local problem: In a Pediatric ICU, there is a lack of training and resources available to the nurses caring for pediatric mental health patients. Despite the lack of training, 35% of total admissions in 2020 were pediatric patients experiencing an acute mental health crisis. …

Improving Human Papillomavirus Vaccination Rates In Adolescents: A Quality Improvement Project, Keylea Marenda Harrison, Allyson Neal, Katie Ingram-Willard

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

Abstract

Objective: The purpose of this quality improvement (QI) project was to implement an evidence-based intervention to improve the HPV vaccine series completion rates in the pediatric primary care setting. The goal of the project was to increase HPV series completion rates in adolescents aged 11 to 12 by 10% within 3 months of implementation of the intervention.

Methods: A multicomponent intervention was implemented at a pediatric primary care office that included a chart review of 11- and 12-year-old adolescents who had received their first and second dose of the HPV vaccine from June 2019 to June 2020 and patients …

Pediatric Palliative Care Training To Advance Nurses’ Knowledge And Increase Patient Referrals, Whitney Lynn Stone, Lisa Merritt, Tammy Childers

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

Objective: The purpose of this evidence-based practice quality improvement project was to implement an educational intervention to improve pediatric palliative care services in a Pediatric Intensive Care Unit (PICU). The goal was to improve nurses’ knowledge of palliative care and increase the number of palliative care consults.

Methods: Educational sessions were created using the End-of-Life Nursing Education Consortium (ELNEC) Pediatric Curriculum. Participants included 46 PICU nurses. Knowledge of palliative care was measured at three timepoints; pre-, immediately post- and four weeks post-intervention. The number of palliative care referrals were measured at two timepoints; three months pre- and three months post-intervention. …

The Implementation Of An Evidence-Based Intervention To Increase Physical Activity In Overweight And Obese Children, Mollie Katherine Dowland

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

Abstract

Background: Childhood obesity is an expanding issue of social and medical concern that requires a multidisciplinary approach for prevention and treatment (Ross et al., 2014). With 13.7 million children and adolescents in The United States considered overweight or obese, it is evident that change needs to transpire. Literature supports the use of behavioral incentives to increase a child’s physical activity, maintain or decrease weight, and improve body mass index (BMI) over time (Allafi, A., 2020; Finkelstein, E. et al., 2013; Groffik, D. et al, 2008; Staiano, A. et al., 2017).

Methods: This project executed change through the facilitation of …

The Development Of Evidence-Based Practice Mentors Through A Competency-Based Educational Program: A Leadership Perspective, Laura C. Moore, Tracy L. Brewer, Pamela Hardesty, Diana Burdick

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

One of the most productive strategies to achieving the safest, high-quality patient care is promoting the widespread use of evidence-based practice (EBP) in clinical settings. Despite the considerable emphasis and support for EBP, many clinicians still fail to translate current research into clinical practice. To address the pervasive lack of EBP among clinicians, an EBP project was developed at an acute care pediatric facility to increase EBP utilization via the implementation of a virtual EBP educational program. The findings from this project describe the establishment of an EBP educational program with the intent to create a critical mass of EBP …

A School-Based Cognitive Behavioral Progrm To Improve Adolescent Mental Health, Amanda Harper

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

Problem. While anxiety and depression are prevalent in the adolescent population and can have significant long-term consequences, treatment rates remain low. The gold standard for treatment is cognitive behavioral therapy (CBT), but this is often unavailable.

Methods. This project aimed to increase access to CBT through a school-based program. Students from a local homeschool cooperative participated in the Creating Opportunities for Personal Empowerment (COPE). Measures of anxiety and depressive symptoms were collected at baseline, after the program, and one month after the program. A Friedman test was used to evaluate medians’ differences on the screening tools at all three time …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich

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 …