Pediatric Nursing Commons^™

Evaluating Implementation And Barriers To Sustainability Of An Asthma Clinical Quality Improvement Project, Holly Uphold Phd, Ms, Diane Liu Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Purpose and Objectives

Asthma is an important public health issue in Utah and quality asthma care is essential to addressing the burden of asthma. The purpose of this initiative was to evaluate clinical asthma quality improvement (QI) program delivery formats and identify barriers to sustaining QI processes.

Intervention Approach

The focus of the intervention was to improve clinical asthma care through reducing variation in clinician knowledge about recommended asthma care and facilitating process improvements in asthma care delivery using Academic Detailing (AD) and Learning Collaboratives (LC) QI delivery formats.

Evaluation Methods

A pre/post-test design was used to compare improvements between …

Pediatric Obesity In Primary Care, Lynne Liggins

Electronic Theses and Dissertations

The purpose of this evidence-based quantitative quasi-experimental research was to compare if providing the parents with information on the health risk associated with childhood obesity would cause the parents to make healthier food choices and encourage their children to be involved in a full hour of physical activity a day. Participants included parents and pediatric and adolescent children 5 to 18 years of age at a solo practice primary care office in a large city in Southern, California, which specializes in treating pediatric and adolescent patients. A pre- and postquantitative intervention design were used and analyzed using the paired t …

Effectiveness Of End-Of-Life Strategies To Improve Health Outcomes And Reduce Disparities In Rural Appalachia: An Analytic Codebook, Radion Svynarenko, Guoping Huang, Theresa L. Profant, Lisa C. Lindley

Faculty Publications and Other Works -- Nursing

Appalachia is one of the most medically underserved areas in the nation. The region has provider shortages and limited healthcare infrastructure. Children and adolescents in this area are in poor health and do not receive the needed quality care. Implementation of section 2302 of the 2010 Patient Protection and Affordable Care Act (ACA) enabled children enrolled in Medicaid/Children's Health Insurance Program with a terminal illness to use hospice care while continuing treatment for their terminal illness. In addition to being more comprehensive than standard hospice care, this relatively new type of care is more culturally congruent with the end-of-life values …

Screenings To Decrease Pediatric Suicide, Jordan Bridges, Dana Schildmeyer, Amanda Austin, Laura Boesken

Posters-at-the-Capitol

This project aimed to examine the current practice related to mental health and depression screenings in pediatric patients. The benefits of implementing screening in schools in identifying depression and suicide risks sooner were also considered. This project focused on the correlation between earlier mental health screening and identification of these mental health disorders earlier in the life of pediatric patients and suicide rates. Current, published literature notes mental health screening in the pediatric population in schools is an effective method to facilitate monitoring and early intervention in detecting a mental illness. Schools implementing mental health screenings can result in increased …

Medically Accurate Evidence-Based Sex Education And Abstinence-Only Sex Education: Impact On Teen Pregnancies In The United States, Nicole Chiu

Nursing | Senior Theses

The U.S. has funded abstinence-only programs to combat pregnancy rates for a long time. With numerous factors contributing to teen pregnancies, there have been a lot of ways that people have decided to try to decrease the number of teen pregnancies. For example, schools have either decided that they intend to fully educate their teenage students using medically accurate evidence-based sex education or come from a more conservative approach and give abstinence-only education. The objective of this investigation is to identify whether evidence-based sex education or abstinence-only sex education is more effective at combating teen pregnancy and abortion rates. This …

Using Family Focused-Care Solutions To Improve Child’S Quality Of Life, Joshua M. Del Sol

Nursing | Senior Theses

Chronic illness in children impacts not only themselves but their families too. Everyone in the family supports each other and provides each other with pretty much all our physiological needs including our emotional needs. Parents/caregivers are the role models for their young children and really shape the person they become because basic values and their early relationships are formed. A family provides that consistent balance in our life that is the center of our life at a young age. When children are diagnosed with a chronic illness, parents may feel responsible, ashamed, guilty, or angry. Families may turn on each …

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, …

Effective Distraction Techniques During Immunizations For Pediatric Patients, Shae Eguchi

Master of Science in Nursing Family Nurse Practitioner

Purpose: Immunizations are the single most common painful procedure pediatric patients experience in the healthcare setting. The repeated pain experienced during immunizations potentiate negative, long-term sequelae for the patient. The primary aim of the literature review was to evaluate the effectiveness of distraction techniques for pain reduction during pediatric immunizations.

Designs and Methods: A literature search was completed to review studies evaluating the effectiveness of distraction techniques on pediatric pain scores as measured by the Wong-Baker FACES pain rating scale. A systematic and critical analyses was conducted on the results of seven randomized controlled trials.

Results: The …

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 …

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 …

Can Non-Pharmacological Interventions Effectively Reduce Anxiety And Pain In Chronic Pediatric Patients?, Kiara Harvey

Symposium of Student Scholars

Abstract

Pediatric anxiety and pain have been historically poorly managed. The failure of providers to adequately address medically-induced anxiety and pain in pediatric patients has been shown to prevent them from proactively seeking medical care in the future and has been linked with both altered brain development and increased risk of opioid abuse. Furthermore, poorly managed pain leads to sustained levels of cortisol and exposes patients to several long-term health risks like hypertension. Because non-pharmacological interventions are often preferred by providers, patients, and their caregivers, this research question poses an exploration of the efficacy of non-traditional methods in alleviating procedure-related …

Pediatric Spinal Cord Injury Spasticity Interventions, Zola Lopeman

Symposium of Student Scholars

Muscle spasticity is a common spinal cord injury sequela that causes muscle stiffness, spasms, and painful involuntary contractions. Spasticity can result in difficulty walking, deformed joints, lack of head control, and impairment performing activities of daily living. Spasticity is dynamic and often requires a multifaceted approach to manage symptoms and achieve patient goals. The leading treatment for spasticity is oral Baclofen. Additional treatment methods include electrical stimulation and phenol injections. Oral baclofen is frequently prescribed in combination with these.

Research suggests SCI induced spasticity can cause changes in the muscle. Thus, it is important to assess neural and muscle impacts …

High Anxiety In Pediatric Oncology Patients? What About Art Therapy?, Rebekah Love

Symposium of Student Scholars

Anxiety and depression are becoming more prevalent in the pediatric population today. In addition to the general pediatric population experiencing an increased risk of mental illness, children with an oncology related diagnosis have an even heightened risk. Most pediatric oncology patients reported fear or worry daily, which is cited to be most severe when they had an appointment or went to the hospital for a fever. It is imperative we discover interventions to lessen the anxiety and depression pediatric oncology patients experience daily. A literature review revealed conclusive interventions have not been determined. The purpose of this research is to …

Reducing Skin Injury And Breakdown In Neonatal Patients, Emily Herring

Symposium of Student Scholars

Abstract

The integumentary system is known for being the body’s largest organ, comprised of water, fats, protein, and minerals, for which composition plays a significant role in protecting the body against thermal, chemical, and microbial agents. However, the skin’s functionality is reduced in neonates as the stratum corneum is thin at birth due to diminished water-holding capacity (Oranges et al., 2015). The skin’s fragility is further stressed among preterm neonates and newborns in neonatal intensive-care units (NICU) due to medical status, procedures, and exposure to skin irritants (Visscher et al., 2009). Reduction in skin injury and breakdown in NICU patients …

Effectiveness Of Distraction Techniques In Reducing Pain And Anxiety During Pediatric Venipuncture, Gina Hernandez

Symposium of Student Scholars

Abstract

Venipuncture is consistently identified as one of the most painful and feared experiences of hospitalized children, often resulting in traumatic memories and resistance to future procedures. Currently, standard practice for pediatric venipuncture involves physical restraint, either by another person or by utilizing a restrictive tool. This proposal will explore the efficacy of various distraction techniques in mitigating pain and anxiety experienced by pediatric patients undergoing venipuncture. Current research shows that procedural pain and anxiety can be significantly reduced by implementing distraction techniques such as bubble-blowing, deep breathing, audiovisual distraction, and immersive virtual reality. Effectiveness of each technique varies based …

Educating Parents On Infant Safe Sleep To Reduce Sleep-Related Deaths, Marleni Cervantes

Symposium of Student Scholars

During my pediatric clinical rotation, I saw parents practicing unsafe sleeping practices with their infants. Infants would sleep with their pillows, blankets and in non-supine positions. There are around 3000 sleep related infant deaths annually in the United States (Patrick et al., 2021). To combat this issue a safe sleep education program should be implemented in labor and delivery and NICU units to ensure parents are getting the proper training before discharge. Parents will attend an education program before discharging from the hospital. The program will be completed in 2 days to ensure the parents are able to ask questions …

Best Practice For Confirmation Of Nasogastric Tube Placement In Pediatric Patients, Joey Gondhalekar, Hannah Baines, Jacob Barcenas, Kaci Giles, Katie Crocker

Symposium of Student Scholars

Abstract

Background: Nasogastric (NG) tubes are used to provide nutrition or charcoal to patients who cannot swallow or are intubated. For pediatric patients, auscultation confirmation is often used to confirm placement despite the evidence that x-ray confirmation is a more accurate way to confirm placement. Incorrect placement leads to incidents of higher rates of healthcare acquired infections, financial strain on the hospital, and longer lengths of stay for patients.

Objectives: The objective of this evidence-based review is to review relevant published studies in determining the best practice for confirmation of NG tubes in pediatric patients.

Methods: A database search was …

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 …

The Emerging Epidemic Of Type 2 Diabetes And Obesity Amongst Young Children, Juliana Morales

Nursing | Senior Theses

Background:

In the past years childhood obesity has increased tremendously and currently ⅓ of children in the United States are obese today. Obesity and Type 2 Diabetes are illnesses that can later on lead to more severe health complications when as a child enters adulthood. Children who are obese have a greater risk of developing Type 2 diabetes, and currently more than 80% of children who already are diagnosed with Type 2 diabetes are obese. In school and often by health care providers we are told daily physical activity and healthy diet are the best ways to maintain optimal health, …

Childhood And Adolescent Obesity: Related Comorbidities And Interventions, Jasmine Wong

Nursing | Senior Theses

Background

The prevalence of childhood and adolescent obesity in the United States has steadily risen over the years and has become a public health concern. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Obese children and adolescents are at risk for poor health and poor quality of life. Furthermore, there are numerous comorbidities associated with childhood and adolescent obesity. While some of the associated diseases are acute, others can become chronic and result in lifelong conditions.

Objective

The purpose of the present thesis is to explore …

Exploring Parent Adverse Childhood Event Influence On Offspring Weight And Development, Angela Wurzer

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: The purpose of this literature review is to explore the impact of parental adverse childhood events on weight and development in their offspring. This includes occurrences of offspring obesity, delays in social and cognitive development, and secondary factors that could have affected development or weight in childhood. Purpose: To support a more holistic and trauma-informed approach to nursing care, a systematic review was conducted examining the relationship between parent ACEs and offspring development and health status. Method: A literature review was conducted over 20 peer reviewed articles found on CINAHL Complete, PubMed and MEDLINE (Ebsco) databases. Results: A summary …

Psychiatric Medications: Does Education Affect Medication Prescriptions?, Surina M. Narine, Mary D. Ramos, Sarah Chu

Symposium of Student Scholars

Background: There is a lack of research on racial challenges among underrepresented adolescents regarding prescription drug use for mental illnesses. Purpose: This study addressed the following question: In adolescent minorities, how does education about racial disparity and culture affect the stigma and number of prescriptions written for psychiatric medications? This evidence-based practice project aimed to identify if racial awareness directly impacts the amount of psychiatric medication prescribed for adolescent minorities. Methods: Literature reviews analyzed qualitative and quantitative data to provide correlating information on racial disparities and psychotropic medications. This study examined the following possible factors for decreased prescribed drugs within …

Tip-Over Injuries Among Children: Data From An Urban Emergency Department Of Karachi, Pakistan, Rubaba Naeem, Asrar Ali, Ahmed Raheem Buksh, Ayesha Quddusi, Uzma Rahim Khan

Department of Emergency Medicine

Introduction: Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department.
Methods: We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information …

Routine Immunization Coverage And Immunization Card Retention In Pakistan: Results From A Cross-Sectional National Survey, Imtiaz Hussain, Ahmad Khan, Dale A. Rhoda, Imran Ahmed, Muhammad Umer, Uzair Ansari, Muhammad Akram Shah, Soofia Yunus, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children aged 12–23 months, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV).
Methods: The survey was a descriptive cross-sectional national household survey carried out across Pakistan. …

Follow-Up Household Assessment For Child Unintentional Injuries Two Years After The Intervention: A Community-Based Study From Karachi, Pakistan, Uzma Rahim Khan, Asrar Ali, Umerdad Khudadad, Ahmed Raheem Buksh, Nukhba Zia, Iqbal Azam Syed, Aruna Chandran, Junaid Abdul Razzak, Adnan Ali Hyder

Department of Emergency Medicine

Background: Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions.
Methods: This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a …

Pick Your Plate: A Nutrition Education Study, Emmalyn Tucker

Honors College Theses

Childhood obesity has become a cause for concern among many nutrition experts. Childhood obesity can contribute to several health problems such as type 2 diabetes, asthma, high blood pressure. The large percentage of children affected with childhood obesity suggests a lack of essential nutrition education in our country. Junk food consumption and inadequate intake of the USDA’s MyPlate food groups have become essential areas for intervention. Multiple school-based nutrition education interventions have been explored to improve both children’s nutrition knowledge and improve healthy eating behaviors. “Pick Your Plate” is a nutrition education study designed to improve nutrition knowledge regarding junk …

Nurse-Initiated Treatment Reduces Costs For Acute Asthma In A Pediatric Emergency Department, Michael D. Johnson Md, Ms, Minkyoung Yoo Phd, Richard E. Nelson Phd, Amanda K. Nielson Md, Lauren Allen Mas, Nanette Dudley Md, Brandon Andersen Rrt, Amanda Orme Dnp, Cpnp-Ac, Cameron Mcfarland Np-C, Michael Mundorff Mba, Mhsa

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized …

Outcomes Of Asthma Quality Improvement In Pediatric Patients, Kathryn M. Murray Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative is a quality improvement initiative designed to standardize asthma care in pediatric patients and improve the overall assessment and patient education process for both healthcare providers and patients. The aim of the Asthma QI Project was to improve the diagnosis and management of asthma for patients in the state of Utah by implementing a standardized approach to the identification and treatment of patients with asthma.

Methods. Patients scheduled to see a healthcare provider at our pediatric clinic were screened for …

Screening For Social Determinants Of Health To Improve Care In Pediatric Patients With Recurrent Urinary Tract Infections: A Scoping Review, Emily Gray Msn, Fnp-C, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs.

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. …