Pediatric Nursing Commons^™

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 …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

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 …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Clinical Practice Panel: Improvements In Pediatric Food Insecurity Screening; A Qi Project To Increase Pediatric Food Insecurity Screening, Casey Katzman, Brandy Rachel Frye, Hsiang-Fen Su

2023 South Division Nursing Research Conference

No abstract provided.

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. …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

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 A Situation, Background, Assessment, Recommendation (Sbar) Patient Handoff Tool In The Electronic Medical Record (Emr), Kristen L. Chandler

Dissertations

Abstract

Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

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. …

Suicide Screening Among Adolescents With A History Of Mental Or Physical Abuse- Evaluating The Effectiveness Of Suicide Screening: A Scoping Review, Tiffany Nicole Jackson Bsn, Rn, Cody Tyler Cottrell Bsn, Rn, Allison Tucker Mcculley Bsn, Rn, Cen, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose The purpose of this scoping review is to gather evidence on best practice for the administration of pediatric suicide screening in a variety of healthcare settings.

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 …

Improving Diabetes Management For School Health Workers Using A Live, Virtual Training Course, Bonnie Mccann-Crosby, Lisa Setchfield, Yvonne Barham, Dawn Espinosa, Jennifer Bailey, Beth Pali, Amanda Garey, Sarah Lyons, Rona Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Type 1 diabetes is one of the most common chronic diseases in childhood. Optimal school nurse and staff education is critical to creating a safe learning environment and influencing long term outcomes of students with type 1 diabetes. The purpose of this project was to develop a virtual continuing education diabetes management course for school health workers to improve their knowledge of diabetes management and evaluate the effectiveness of the learning platform.

Methods: A total of 199 participants completed the live, virtual continuing education course. Participants completed a pre and post-test to assess improvements in the key learning objectives …

Optimizing Npo Times In Infant Outpatient Surgical Patients, Julie Colangelo Ward

DNP Projects

Background: All patients are standardly kept NPO prior to surgery to minimize aspiration risks. Increased NPO times for infants has been found to lead to patient distress, hemodynamic instability, ketoacidosis and acid-base imbalances. Optimizing NPO times for young pediatric patients helps to decrease fasting times, which minimizes the safety concerns listed above.

Objectives: The objective of this project was to implement specific education instructions to parents of infants during the pre-operative phone calls and confirm their understanding of this education through the teach-back method.

Methods: The intervention for this project added educational instructions with a teach-back question into the verbal …

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 …

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 …

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 …

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. …

Implementation Of Infant Driven Feeding™ In A Level Ii Nicu, Kelly Gardner

Graduate Theses, Dissertations, and Capstones

In the United States, currently, 1 in 10 babies are born premature. Due to the immaturity of their neurological, gastrointestinal, and cardio-respiratory functions, preterm infants can experience the inability to coordinate sucking, swallowing, and breathing that is essential to oral feed. Cue-based oral feeding methods are designed to give the caregiver the ability to recognize signs of readiness and respond appropriately to the infant cues to adjust the manner in which feeding intervention is performed to match the infant’s current state of physiologic tolerance. The Infant Driven Feeding™ program incorporates scales to assess readiness and quality of the oral feeding, …

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 …