Pediatric Nursing Commons^™

Early Intervention Referral Process Improvement In Primary Care Pediatrics: An Evidence-Based Algorithm, Katherine G Mcmahon Thompson

DNP Scholarly Projects

Early Intervention programs provide evidence-based services to children with developmental delay from 0 to 3 years of age. Many children eligible for Early Intervention programs are not successfully referred to services provided by health care professionals for evaluations. The purpose of this doctoral project is to describe the evidence-based steps in a referral algorithm for early intervention evaluation to increase referrals by primary care health care providers and to increase evaluation rates of referred children. A draft algorithm was based on content analysis of empirical and theoretical literature. Experts in early intervention primary care services reviewed the draft algorithm, rank …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White

Patient Experience Journal

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the …

Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier

Patient Experience Journal

Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles …

Implementation Evaluation Of A Leadership Development Intervention For Improved Family Experience In A Private Paediatric Care Hospital, Pakistan, Muneera A. Rasheed, Ayesha Hussain, Amin Hashwani, Johannes T. Kedzierski, Babar S. Hasan

Department of Paediatrics and Child Health

Background: A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods: A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the …

Performance Of Machine Learning Classifiers In Classifying Stunting Among Under-Five Children In Zambia, Obvious Nchimunya Chilyabanyama, Roma Chilengi, Roma Chilengi, Michelo Simuyandi, Caroline C. Chisenga, Masuzyo Chirwa, Kalongo Hamusonde, Rakesh Kumar Saroj, Najeeha Talat Iqbal, Innocent Ngaruye

Department of Paediatrics and Child Health

Stunting is a global public health issue. We sought to train and evaluate machine learning (ML) classification algorithms on the Zambia Demographic Health Survey (ZDHS) dataset to predict stunting among children under the age of five in Zambia. We applied Logistic regression (LR), Random Forest (RF), SV classification (SVC), XG Boost (XgB) and Naïve Bayes (NB) algorithms to predict the probability of stunting among children under five years of age, on the 2018 ZDHS dataset. We calibrated predicted probabilities and plotted the calibration curves to compare model performance. We computed accuracy, recall, precision and F1 for each machine learning algorithm. …

Newborn Weight Change And Predictors Of Underweight In The Neonatal Period In Guinea-Bissau, Nepal, Pakistan And Uganda, Valerie J. Flaherman, Amy S. Ginsburg, Muhammad Imran Nisar, Muddassir Altaf, Khushboo Liaquat, Benazir Baloch, Najeeb Rehman, Yasir Shafiq, Shabina Ariff, Fyezah Jehan

Department of Paediatrics and Child Health

In low- and middle-income countries (LMIC), growth impairment is common; however, the trajectory of growth over the course of the first month has not been well characterised. To describe newborn growth trajectory and predictors of growth impairment, we assessed growth frequently over the first 30 days among infants born ≥2000 g in Guinea-Bissau, Nepal, Pakistan and Uganda. In this cohort of 741 infants, the mean birth weight was 3036 ± 424 g. For 721 (98%) infants, weight loss occurred for a median of 2 days (interquartile range, 1-4) following birth until weight nadir was reached 5.9 ± 4.3% below birth …

Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh

Dissertations

Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …

Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala

Dissertations

Problem: Working in the Pediatric Intensive Care Unit (PICU), staff encounter critical patient events without warning. Debriefing after adverse patient events has been shown to give staff the opportunity to process these events in an open, honest, and judgement-free environment. Debriefing has been recognized as a tool for detecting medical errors, improving team communication, providing emotional support, and analyzing team performance.

Methods: A descriptive, observational pilot study was used to implement the DISCERN tool into a large, midwestern, urban PICU. The aim of the quality improvement project was to achieve a debriefing tool completion rate of 20% over a one-month …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner

Dissertations

Problem: Social determinants of health (SDOH) affect health outcomes across the lifespan. The American Academy of Pediatrics recommends routine screening for SDOH. Poverty is a SDOH affecting health outcomes in children, especially in children with a chronic disease such as sickle cell disease (SCD). Children with sickle cell disease have a high burden of SDOH. This project sought to describe the SDOH barriers experienced by pediatric patients with SCD.

Methods: A descriptive survey/observational design, using a convenience sample of pediatric patients ages 0-19 years old in a comprehensive SCD clinic at a large, urban, Midwestern academic medical center was utilized …

Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park

Dissertations

Problem: Parents of infants less than one-year-old with complex congenital heart disease (CCHD) experience significant stress while their child is admitted to the pediatric cardiac intensive care unit (PCICU), often resulting in trauma to parents and their families. Trauma informed care (TIC) seeks to minimize the impact of emotional trauma and it acknowledges previous trauma an individual may have experienced.

Methods: The purpose of this quality improvement (QI) project was to assess the thrive guide’s ability to decrease parental stress in the pediatric cardiac intensive care unit (PCICU). The aim was to decrease parental Perceived Stress Scale (PSS) scores by …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Dental Screening And Caries Prevention In Pediatric Primary Care, Amy Hoch

Dissertations

Problem: Early childhood caries (ECC) is the most common chronic condition worldwide. Although the American Academy of Pediatrics (AAP) recommends all children through age five receive a fluoride treatment during well-child visits, this often does not happen. This project aimed to implement caries risk assessment (CRA) in the pediatric primary care setting and increase the rate of fluoride varnish applications and pediatric dental referrals.

Methods: An observational, descriptive study design was used to review retrospective data and collect prospective data on fluoride varnish applications in a pediatric primary care office located in a Midwestern suburban community. A validated CRA was …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Evaluating The Rass And Cap-D In A Pediatric Cardiac Intensive Care Unit, Sarah Anderson

Dissertations

Abstract

Problem: Pediatric delirium is highly prevalent in the intensive care setting, as much as seventy to eighty-seven percent. Kalvas & Harrison (2020) found that sixty-six percent of critically ill children in a pediatric intensive care unit suffered from a diagnosis of delirium. Delirium has been widely linked with increased costs, mortality, and length of stay.

Methods: The quality improvement (QI) project used a descriptive design to collect retrospective and prospective data before and after an individualized bedside education session was completed. The QI project used a purposive convenience sampling to assess the ability to accurately identify the presence of …

Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull

Dissertations

Problem: Over 1/3 of children in the United States are overweight or obese and children’s nutritional status while hospitalized worsens rather than improves. Hospital meals have too many calories, too much sugar, and too few nutrients compared to recommended guidelines for children. The primary purpose of this quality improvement project is to increase the amount of healthy foods ordered by children in a southeastern pediatric hospital unit through implementation of a menu guide.

Methods: A quality improvement pre-post interventional pilot study was done through implementation of a child friendly menu guide promoting healthful eating. Data was collected by retrospective and …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Physician Assistant Global Advancement Through The Use Of Medical Relief Organizations, Kara Crafts Pa-C, Sarah Mistrot Pa-C, Mary Henningsgaard Pa-C, Kaley Morris Pa-C, Tamarrah Oliver Pa-C, Kevin Tran Pa-C, Trevor Crafts Md

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Objectives: The physician assistant (PA) model has been adopted by many nations to alleviate health care disparities. The objective of the project is to understand how medical relief organizations are utilizing physician assistants and contributing to the advancement of the career globally.

Methods: A search was conducted to create a list of all U.S. based medical relief organizations. An 18-question online survey was sent to 493 organizations that met inclusion criteria.

Results: Total response rate of the survey was 56.2%. 75.6% of organizations reported using PAs on their medical relief projects, and PAs were used in clinic/hospital/and operative settings.

Conclusions: …

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. …