Pediatric Nursing Commons^™

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

SPECIFIC AIM: We aim to Improve the medication administration process and involve all staff within 6 months

In the microsystem consisting of 14 family practice and urgent care clinics, there is not a standard process based on evidence based practices for medication administration. With and estimated of 400-600 medications (immunizations included) being administered per day, without a standard of care protocol, the risk for medication errors is evident.

Objectives and changes anticipated based on implementation of the project is to engage staff in support for improving medication administration standard of care based …

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

With no designated cardiovascular step-down unit at Phoenix Children’s Hospital, patient transitions to acute care are inconsistent following admission to the Cardiovascular Intensive Care Unit (CVICU). We aim to improve CVICU patient continuum of care through transferring patients to a step-down telemetry unit starting October 13^th, 2014 exemplified by a 95% patient satisfaction of care provided by January 1^st, 2015. The progression of the project was influenced by Lippitt’s theory, which includes seven phases in the change process. To accommodate post CVICU patients, the acute care unit was transformed to include cardiac monitors, telepacks, a central …

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient outcomes and nurse satisfaction by minimizing the avoidable interruptions that occur during medication administration. The microsystem is a pediatric and adult medical-surgical overflow unit at a large, urban teaching hospital in Northern California. A series of surveys for nurses and patients and observations of medication administrations were conducted to assess barriers during mediation administration. It was determined phone calls interrupt a nurse the most during medication administration. Interruptions leave the medication administration process vulnerable to errors because it disrupts the nurse’s workflow and thought process. Because most pediatric medication …

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents, Jennifer Mcguire Hitt

Theses and Dissertations (ETD)

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold …

Hearing The Child's Voice: Their Lived Experience In The Pediatric Intensive Care Unit, Andrea S. Prentiss

FIU Electronic Theses and Dissertations

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce.

Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. …

A Narrative Analysis Of The Stories Of Mothers Who Have Parented A Child Diagnosed With Hodgkin's Disease And Is Currently In Early Survivorship, Jennifer M. Darcy

Theses & Dissertations

With the growing number of survivors of childhood cancer in the United States, it has been essential for research to look more closely at the challenges these “children” and their families face later in life as they live to adulthood. While much has been written about childhood cancer survivors and their parents independently, there are unique struggles that a mother and a childhood cancer survivor face as a dyad. A diagnosis of cancer falling on one’s child is undoubtedly a life altering event. Examining the dyadic relationship over time offers a unique perspective to understanding the parenting experience with a …

Prevention Of Central Venous Catheter-Associated Blood Stream Infections In Pediatric Patients: A Review Of The Literature, Shanna Giedl, Brittany Cain

Nursing Student Work

No abstract provided.

Vitamin D Deficiency And Acute Lower Respiratory Infections In Children Younger Than 5 Years: Identification And Treatment, Allison Larkin, Jane H. Lassetter

Faculty Publications

Introduction: Acute lower respiratory infection (ALRI) is a leading cause of childhood mortality. Research suggests that vitamin D deficiency (VDD) puts children at risk for ALRI. The purpose of this review is to examine ALRI and VDD in children 5 years and younger. Common etiologies, diagnosis, prevention, treatment of ALRI, and recommendations for vitamin D supplementation are summarized.

Method: Databases were searched for studies investigating VDD and ALRI in children. Independent reviewers assessed the internal validity of the studies.

Results: Of 18 studies examined, VDD was found to be associated with increased risk or severity of ALRI in 13 studies; …

Rural Nurses' Perspectives On Their Capacity To Care For Pediatric Patients In Northern And Eastern Maine, Kimberly M. Harvell

Honors College

According to the 2010 U.S. census, approximately 59 million people (19%) in the United States reside in a rural area. More than fifteen percent of the nursing workforce is employed in a rural area. This creates a nurse to patient staffing ratio of 1 nurse for 117 people. This ratio demonstrates a large need for nursing personnel in the rural workforce. With a high patient to nurse ratio, rural nurses can be described to be valuable and in high demand. Rural nurses are valued for their ability to utilize different nursing specialties and care for patients all across the age …

Minimizing Pain During Childhood Vaccination Injections: Improving Adherence To Vaccination Schedules, Lacey M. Eden, Janelle L. B. Macintosh, Karlen E. Luthy, Renea L. Beckstrand

Faculty Publications

Pain experienced in childhood can lead to long-term and psychologically detrimental effects. Unfortunately, the most common pain experienced in childhood is caused by vaccinations and may lead to non-adherence to the recommended vaccination schedule. As a result, it is the health care provider's responsibility to take measures to reduce vaccination pain; however, there are a plethora of pain relieving interventions during immunizations and it is unclear which interventions are most cost efficient, timely, and effective. Studies have been conducted to investigate the efficacy of different pain management interventions during vaccinations. This review evaluates various pain relieving interventions and provide health …

A Safety Mnemonic For Pediatric Oncology Patients: Knowledge, Confidence And Skills Accuracy During Simulation, Luanne Linnard-Palmer, Barbara Ganley

Luanne Linnard-Palmer

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1]. Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2]. This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of …

“Young People These Days, Are Not Like We Used To Be ... #11;Or Are They?”, Harry B. Mayr

harry b mayr

No abstract provided.

Food For Health: An Investigation Of Infant Feeding Practices, Breastfeeding Self-Efficacy, And Perceived Barriers And Facilitators, Jessica W. Smith

Electronic Thesis and Dissertation Repository

Exclusive breastfeeding is associated with numerous health benefits for both mother and child, and is recommended for the first 6 months of an infant’s life. The purpose of this prospective study was to examine, using a survey-based design, the breastfeeding practices, self-efficacy, and perceived barriers and facilitators of primiparous mothers in London, Ontario. A total of 71 women (M_age = 30.0, SD = 4.3) participated in the study. Women (breastfeeding and non-breastfeeding) were asked to complete online surveys at three time points: < 4 weeks postpartum, 3 months postpartum, and 6 months postpartum. Results indicated that rates of exclusive breastfeeding decreased over time, whereas partial and non-breastfeeding rates increased. Women in the exclusive breastfeeding category reported the greatest levels of breastfeeding self-efficacy at all time points. Lastly, participants identified a number of breastfeeding-related facilitators (e.g., partner support, community services) and barriers (e.g., insufficient milk supply, latching difficulties).

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

The Lived Experience Of Parental Bereavement, Christine Denhup

Seton Hall University Dissertations and Theses (ETDs)

The purpose of this manuscript is to present a Heideggerian hermeneutic phenomenological nursing research study on the phenomenon of parental bereavement. The aim of this study is to describe the lived experience of bereaved mothers and fathers who have experienced the death of a child due to cancer. Van Manen’s (1997) method guided this qualitative inquiry. New knowledge describing the meaning of the lived experience of parental bereavement promotes a better understanding of the phenomenon from the perspective of parents, fills a significant gap in the literature, and informs nursing research, education, and practice.

Microbial Exposure And Asthma: Applying Strachan’S Hygiene Hypothesis To Nursing Practice, Elisabeth M. Campbell

Senior Honors Theses

The incidence of asthma has risen significantly in recent decades. Asthma is a complex disease process affected by multiple factors including environmental exposure, genetics, epigenetics, and lifestyle. In 1989, the hygiene hypothesis was proposed based on Strachan’s findings suggesting increased exposure to microbes may have protective benefits against allergic rhinitis and eczema. Since that time, research in this arena has exploded as investigators seek to establish a causal link between increased microbial exposure and decreased incidence of allergic disease. The aim of this literature review is to synthesize the current research regarding Strachan’s hygiene hypothesis and identify the nursing implications …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Reducing "Failure To Rescue" Occurrences: A Pilot Project Incorporating High-Fidelity Simulation During Mock Codes, To Enhance Pediatric Nurses' Clinical Knowledge And Skills, Denise Dawkins

Doctoral Projects

Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in …

The Experience Of Latino Parents Of Hospitalized Children During Family Centered Rounds, Lisa Ann Walker-Vischer

Doctoral Projects

Problem: Hospitalization of a child is stressful. The parental role is altered and parents have a primary need to receive timely information. Family centered rounds (FCR) provide a mechanism to exchange information and facilitates shared decision making with the medical team while parents advocate for their child's needs. FCR has been linked to increased satisfaction and improved outcomes. A recent study suggests that Latino parents have a suboptimal experience related to language barriers and a lack of empowerment. The purpose of this study is to describe the experience of Latino parents of hospitalized children during FCR in a public safety …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Examining General Versus Condition-Specific Health Related Quality Of Life Across Weight Categories In An Adolescent Sample, Autumn G. Dalton

Undergraduate Honors Theses

Approximately 34% of adolescents are overweight or obese which can be accompanied by physical, psychosocial, and economic consequences. Increasingly, pediatric overweight/obesity research has focused on Health Related Quality of Life (HRQoL) as a health outcome. This study examined differences in HRQoL across weight categories in adolescents, specifically, the sensitivity of using a general versus condition-specific measure. Further, the influence of gender was explored.

Data were extracted from Wave 2 of Team Up for Healthy Living, a school-based obesity prevention program targeting adolescents in Southern Appalachia. Participants (N = 918; 50% Female; 93% Caucasian; 90% 9^th graders) completed …

The Relationship Among School Playground Design And Conditions And Physical Activity Levels In Children, Ipuna Estavillo Black

UNLV Theses, Dissertations, Professional Papers, and Capstones

Almost 20% of children aged 6 to 11 years are obese in the United States, tripling over the last ten years. The rise in childhood obesity challenges nurses in their efforts to improve community health and sustainability. A decrease in physical activity (PA) levels has been associated with an increase in obesity. Schools have been identified as a primary setting to provide children adequate amounts of daily PA, and nurses working in the area of child health promotion can work with schools to provide opportunities for children to increase PA levels. The playground is one environment where children can increase …

The Baby Friendly Hospital Initiative, Kathryn E. Brackett

Senior Honors Theses

Abstract

The Baby-Friendly Hospital Initiative (BFHI) is a worldwide movement started by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) that is aimed at providing hospitals with a certification that guarantees the best possible patient-centered care for mothers and infants. It focuses on breastfeeding as optimal infant nutrition, and implements strategies to encourage and support mothers to breastfeed their infants exclusively for six months after birth. The Ten Steps to Successful Breastfeeding are a set of 10 simple, easy to understand guidelines developed by WHO and UNICEF for implementing this initiative in the hospital setting and …

Childhood Obesity And Familial Hypercholesterolemia: Genetic Diseases That Contribute To Cardiovascular Disease, Alyssa Caudle

Senior Honors Theses

Childhood obesity occurs as the result of an imbalance between caloric intake and energy expenditure. Genetic risk factors for obesity have become an area of research due to its permanency. Mutated genes such as Fat Mass and Obesity Associated (FTO), Leptin (LEP), Leptin Receptor (LEPR), Melanocortin 4 Receptor (MC4R), Adiponectin C1Q and Collagen Domain Containing (ADIPOQ), Proprotein Convertase Subtilisin/Kexin Type 1 (PCSK1), and Peroxisome Proliferator-Activated Receptor Gamma (PPARG) all contribute to the development of childhood obesity. In the presence of high cholesterol caused by obesity, the genetic condition known as familial hypercholesterolemia is exacerbated. Familial hypercholesterolemia is caused by a …

Caring For Caregivers: Assessing Grief And Coping Of Pediatric Palliative Care Nurses, Sophia Undseth

2014-2016 Undergraduate

The definition and implementation of pediatric palliative care has been increasingly studied in recent years. Within the United States, where children generally have adequate nutrition and access to advanced technology, the population of dying children is relatively small. Nevertheless, the number of pediatric patients suffering from both cancer and other chronic and life-threatening diseases has increased. While there has been a focus upon the need for support of the child and the family, the emotional response and grief of the caregivers, especially nurses, has often gone unnoticed. The five different kinds of loss that may be experienced by caregivers help …

From An Idea To Project Completion, To Poster To Publication: Research Made Easy!, Luanne Linnard-Palmer

Luanne Linnard-Palmer

Changing The Road To Recovery: A Lesson In Pediatric Surgery Efficiency, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

A Safety Mnemonic For Pediatric Oncology Patients: Knowledge, Confidence And Skills Accuracy During Simulation, Luanne Linnard-Palmer, Barbara Ganley

Collected Faculty and Staff Scholarship

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1]. Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2]. This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of …

Evidence-Based Practice In Action: Ensuring Quality Of Pediatric Assessment Frequency, Katelyn Mcdonald

Honors Projects

Optimal head to toe assessment frequency in hospitalized pediatric patients is unknown. Although pediatric patients have many accommodations based on their age, developmental state, and varied needs, healthcare professionals have not published any research regarding the optimal frequency for registered nurses to perform head-to-toe assessments in hospitalized pediatric patients. Healthcare professionals must make decisions based on evidence-based practice. A change in pediatric assessment intervals was proposed at a Midwestern regional medical center. The purpose of this pilot study was to ensure patient safety and staff satisfaction following a policy change in head-to-toe assessment frequency Chart audits were performed on all …

Combating Autism Reauthorization Act Of 2014, Kassandra Mores

Policy Analysis

On May 9, 2014, Representative Smith (R-NJ) and Representative Doyle (D-PA) introduced a bill to reauthorize the Combating Autism Act (H.R. 4631) for five years. Senator Menendez (D-NJ) and Senator Enzi (R-WY) are planning to introduce a Senate bill of the Combating Autism Reauthorization Act. The Combating Autism Act of 2011, due to sunset September 30, 2014, provides federal funding for autism research, public education, and early detection and intervention in Maine. We are hoping that you will consider voting in support of the Combating Autism Reauthorization Act.