Medicine and Health Sciences Commons^™

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

School Nurses’ Participation In Accommodations For Children With Epilepsy: A Quality Improvement Project., Paula A. Johnson

Doctor of Nursing Practice Papers

Abstract

Epilepsy is the most frequent, chronic, neurological condition in childhood, impacting 0.5 to 1% of the population. Documented learning problems associated with childhood epilepsy include memory problems, attention deficits, reading difficulties, and processing speed abnormalities. Epilepsy also impacts psychological health with poor self-esteem, a high incidence of bullying, and poor school performance. The Every Student Succeeds Act identifies the school nurse as a leader in chronic disease management; advocating for students to receive the resources and support they need to achieve academic success. The large Midwestern school system, studied in this capstone project, has 804 known students with epilepsy. …

A Community Educational Intervention To Improve Firearm Safety Behavior In Families, Elizabeth G. Choma Msn, Rn, Cpnp-Pc

Doctor of Nursing Practice Projects

Background: Every day in America children, are injured or killed from the accidental shooting of firearms. Additionally, few households with children report storing all guns unloaded and locked up. Recent evidence supports education on safe firearm storage as an effective intervention in promoting firearm safety in families with children. However, Pediatric healthcare providers often do not have enough time for firearm education during well visits.

Objective: This Quality Improvement (QI) project aimed to use an educational intervention with statistics on firearms in children and implemented the Asking Saves Kids (ASK) campaign to assess and improve firearm safety behaviors in families …

Increasing Referrals To School Counselors By Integrating An Evidence-Based Program For Educators Identifying Adolescents At Risk For Suicide In A Rural High School, Wendy Holloway

Doctor of Nursing Practice Projects

Background: Addressing suicide in America's youth is imperative. Teachers play an essential role in identifying and intervening with adolescents experiencing psychological distress leading to suicide. Teachers and staff lack professional development addressing the identification of students in psychological distress.

Purpose: This project aimed to increase referrals to school counselors by integrating an evidence-based program for educators identifying adolescents at risk for suicide in a rural high school.

Design Method: This was a quantitative quality improvement project with a pre-/post-test design. Additionally, referrals to the school guidance counselors before implementing the program and after the completion of the program were …

Overcoming Obesity: Provider Reminders And Education In Pediatrics, Michelle Warren

Evidence-Based Practice Project Reports

The prevalence of pediatric overweight and obesity is rising globally (Di Cesare et al., 2019) and results in lifelong chronic health problems and an estimated annual healthcare cost of $14.1 billion (Trasande & Chatterjee, 2009). The purpose of this evidence-based practice project was to address overweight and obesity in patients between the ages of five and 12 years through the provision of provider reminders, education, and guidelines. Primary outcomes included frequency of diagnosis, frequency of patient referrals, return to see times, and frequency of patient nutrition and activity education while secondary outcomes included patient weight, body mass index (BMI), and …

Evaluation Of An Interdisciplinary Ketogenic Diet Clinic For The Treatment Of Pediatric Refractory Epilepsy, Britt Schloemer

Graduate Theses, Dissertations, and Capstones

Pediatric refractory epilepsy affects approximately 30% of all children diagnosed with epilepsy. Childhood refractory epilepsy patients pose a challenge for traditional approaches to epilepsy management due to their complex and unique needs. Refractory epilepsy negatively impacts a patient’s ability to attend school or hold a job, and patients have a generally poor health status related to seizures as well as pharmaceutical side effects (Conway et al., 2016). The ketogenic diet (KD) is an alternative option for the treatment of pediatric refractory epilepsy due to established efficacy, manageable side effects, and reduced health care-associated costs due to reduced emergency department (ED) …

Effectiveness Of A Multi-Component Intervention Program For Treating Childhood Obesity, Suzy Free

Evidence-Based Practice Project Reports

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing …

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Implementation Of Tiny Tusks: A Breastfeeding And Infant Support Space At The University Of Arkansas Athletic Events, Brittany Lyons

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This honors thesis focuses on my internship of assisting in the design and management of a breastfeeding and infant support space at home athletic events at The University of Arkansas with emphasis on the importance and the promotion of breastfeeding. Breastfeeding provides a wide variety of benefits for mother and infant and I have been honored to work and assist in building Tiny Tusks Breastfeeding and Infant Support Tent and the implementation of these ideas. This honors internship has allowed me to increase my knowledge on the positive aspects of breastfeeding, as well as promote community involvement by collaborating with …

Childhood Anxiety, Cognitive Behavioral Therapy And/Or Pharmacological Treatment, Jennifer S. Mccarthy

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: Evaluate best practice in managing anxiety in the pediatric population, including both school age children and adolescents. This literature review compared pharmacological treatment and cognitive behavioral therapy (CBT)’s effectiveness on the management of anxiety within the pediatric population.

Background: Up to 25% of children in the United States are affected by a mental health disorder, anxiety being the most prevalent. Childhood anxiety can have a distressing impact on social, family, and academic functioning. If persisting into adulthood it increases the risk of developing other co-occurring mental health conditions, substance abuse issues, and contributes to impaired employment retention and socioeconomic …

Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif

Evidence-Based Practice Project Reports

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …

Childhood Obesity: Getting Back To The Basics, Fanny Powell

DNP Qualifying Manuscripts

Childhood obesity is an epidemic that affects the nation. The Centers for Disease Control and Prevention (CDC) (2015) states that over the past thirty years, the prevalence of childhood obesity has more than doubled in younger children and quadrupled in adolescents (CDC, 2015). Although obesity is a multifactorial health issue that is affected by genetics, metabolic factors, socioeconomic factors, and lifestyle choices (Stanford, 2018), a majority of pediatric obesity is as a result of consuming more energy than the body utilizes. There are both immediate and long-term consequences of obesity that negatively affect a child’s health which may carry over …

Implementation Of An Asthma Action Plan In A Pediatric Outpatient Clinic, Noelle Cerdan

UNLV Theses, Dissertations, Professional Papers, and Capstones

A combination of asthma evidence-based education by nurse practitioners and other healthcare providers as well as self-management by patients with asthma and their caregivers are necessary to provide effective asthma care. According to the National Asthma Education and Prevention Program (NAEPP) guidelines from the National Institute of Health (NIH), effective asthma care includes a detailed Asthma Action Plan (AAP). However, despite this evidence-based recommendation for all patients with asthma, studies suggest many healthcare providers do not routinely utilize an AAP.

The purpose of this Doctor of Nursing Practice (DNP) project was to develop and evaluate a process for the integration …

Final Defense: Sepsis Screening Tool Assessment At A Freestanding Children’S Hospital In The Midwest, Cassandra Cummings

Doctoral Projects

Pediatric sepsis is a major contributor to childhood morbidity and mortality. Tools for predicting sepsis in pediatric patients have had poor predictive ability nor been validated. Risk assessment screening tools are effective at earlier detection of sepsis. The implementation of an evidence-based pediatric sepsis screening tool could reduce time to detect and diagnose severe sepsis so that patient treatment could occur earlier. This was a quality improvement project that evaluated a sepsis screening tool predictive validity at a children’s hospital.

Examining Caregiver Vigilance For Child Sexual Abuse, Kate K. Chappell

Theses and Dissertations

Child sexual abuse (CSA) affects approximately one in four US children through adolescence. As an adverse childhood experience (ACE) implicated in long-term health and wellbeing, CSA is a pervasive safety concern. The influence of caregivers and healthcare providers is under-realized in CSA prevention. Examining the thinking processes preceding CSA vigilance response has been limited in research. Understanding the complexities in healthcare related to addressing CSA will facilitate caregiver-focused intervention in primary care. Guided by social ecology and protection motivation theories (PMT), the goals of this two-phase study were to explore caregiver cognitive processes towards vigilance for CSA and the challenges …

Screening Amblyopic Risk Factors In A Pediatric Population Using An Automated Vision Screener, Rebecca Dawn Slominski

Evidence-Based Practice Project Reports

Amblyopia is the most common visual disorder in children and is potentially curable if detected early and treated properly in the first few years of life. Amblyopia is the leading cause of monocular vision loss in children (Bradfield, 2013). It is a developmental neuroplasticity which derives from birth causing structural and functional changes in the eye and brain. With this structural and functional disruption, visual blur occurs due to refractive amblyopia, strabismic amblyopia, cataracts (form-deprivation amblyopia), or a combination of any of these (Solebo, Cumberland, & Rahi, 2015). Refractive errors related to amblyopia can also occur. The purpose of this …

Sun Prevention Fun (Spf): A Multicomponent Sun Prevention Program For Children In Kindergarten And First Grade, Sarah Gouker

Evidence-Based Practice Project Reports

Skin cancer is an important topic in the United States due to the recent increase in cost and mortality. The purpose of this evidence-based practice (EBP) project was to determine if the early implementation of a multicomponent sun prevention program positively impacted kindergarten and first grade students’ knowledge and behavioral intentions to practice safe sun techniques after a one week period. Kotter’s Model of Change and the ACE Star model were utilized to guide this EBP project. An exhaustive review of the literature yielded 12 articles which were used to develop best practices for education on sun safety. The quality …

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

Implementation Of Screening Guidelines To Improve Quality Of Care In A Small, Ethnically Diverse Pediatric Primary Care Practice…Then What?, Brooke Basford

Doctor of Nursing Practice Final Manuscripts

Although best practice guidelines have been shown to be effective, the process of translation into everyday practice can be challenging. The purpose of this evidence-based project (EBP) was the implementation of standardized screening tools into annual well-child visits in a small, ethnically diverse pediatric primary care practice in southern California. Standardized screening is recognized as an important process in identifying conditions early to facilitate early intervention. The practice site identified obesity has a priority and consequently the Department of Health Care Services: Child Health and Disability Prevention (CHDP) Program Guidelines for Diet and Nutrition Screening for Children assessment form was …

Childhood Sexual Abuse Screening And Prevention In The Primary Care Setting: A Survey Of Pediatric Healthcare Providers In The State Of Vermont, Kelley Eileen Groll

Graduate College Dissertations and Theses

ABSTRACT

Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA.

Objective. The overall goal of this study is to gain an understanding of the …

Effects Of Multimodal Fever Education On Parents Of Febrile Children, Teresa S. Parkhouse

Evidence-Based Practice Project Reports

Insufficient knowledge regarding the physiology and appropriate management of fever in children often contributes to an increased parental anxiety, inappropriate antipyretic use, and overutilization of medical resources (Chang, Liu, & Huang, 2013; Crocetti, Moghbeli, & Serwint, 2001; Schmitt, 1980). Parental concerns regarding childhood fever can lead to an overuse of health care resources as febrile illness in children accounts for approximately 20% of emergency department visits, 30% of office visits, and over 50% of after-hour phone calls to private physicians (Zomorrodi & Attia, 2008). Research shows that multidimensional educational interventions are most effective in improving parental management of fever (Young …

The Effects Of An Evidence-Based Food Allergy Management Plan To Keep Children With Food Allergies Safe At School, Scarlet R. Spain

Evidence-Based Practice Project Reports

The prevalence of food allergies in children has increased 18% between 1997 and 2007 (CDC, 2013). Furthermore, 84% of food allergic children will experience a reaction at school (Powers, Bergren, & Finnegan, 2007). An exposure in a sensitive child may progress quickly into potentially life threatening symptoms and death if not treated. The purpose of this evidence based practice (EBP) project was to determine if implementation of a food allergy management policy in a school setting reduced overall incidence rates of food allergy reactions in school children and to examine compliance to policy guidelines. The project encompassed implementation of a …

Examining The Relationship Between Type And Extent Of After-School Care Use And High Bmi In Children Ages 5-17, Morgan E.B. Chojnacki

DNP Projects

Objectives: The purpose of this study was to examine the relationship between body mass index (BMI) and after-school care use in school age children and adolescents in Kentucky. The specific aims of this study were to examine differences in BMI groups (high versus normal/low) by: a) type and b) extent of after-school care use.

Methods: Parents of children age 5-17 years were administered a 21-item survey which assessed the amount of time their children spent in specific types of after-school care. BMI of the child/adolescent participants were obtained at the time of the survey. High BMI was defined …

Implementation Of Sleep Problem Screening In A Pediatric Primary Care Office, Jennifer Erin O'Donnell

Dissertations

Sleep problems, a major problem for children and their parents, are the most common complaint brought to pediatric clinicians (advanced practice nurses and other healthcare providers) attention but are often ignored and underdiagnosed in the pediatric population (Faruqui, Khubchandani, Price, Bolyard, & Reddy, 2011). “Sufficient amounts of good quality sleep are necessary for healthy development in childhood” (Bordeleau, Bernier, & Carrier, 2012, p. 254). Inadequate sleep in children has been linked to numerous adverse outcomes psychologically as well as physically (Owens, Jones, & Nash, 2011). The American Academy of Pediatrics (AAP), issued recommendations in 2002 stating screening for snoring, one …

Influence Of A Palliative Care Protocol On Nurses' Perceived Barriers To Palliative Care And Moral Distress, Christina Cavinder

Evidence-Based Practice Project Reports

The World Health Organization (2013) states palliative care for children should begin at diagnosis which may even occur prenatally. Neonatal palliative care is variable due to the high technological, curative environment in the newborn intensive care unit, and the uncertain prognoses of infants born at the edge of viability. The purpose of this EBP project was to determine the influence of establishing a neonatal palliative care protocol on nurses’ perceived barriers to palliative care and moral distress. Corley’s Moral Distress theory and Stetler’s Model were used as guides for the framework of the project. The protocol, based on guidelines supported …

Reducing Anxiety In Pediatric Bone Marrow Transplant Patients Using Reiki, Robyn Ait Ali

Theses and Graduate Projects

Reiki, meaning universal life force energy, facilitates the flow of energy that travels naturally in and around the body. Blockages in energy flow create disease and or pain in the body; the Reiki practitioner facilitates the removal of blockages which allows for healing and restoration of balance. Anxiety in children undergoing Bone Marrow Transplant (BMT) manifests itself across all body systems and effects the care they receive during hospitalization. Children are open to the concept of energetic healing therefore, the use of Reiki for children undergoing BMT to reduce anxiety, facilitate relaxation, and ease pain makes sense. The introduction of …

Effects Of A School-Based Education Intervention On Bmi And Physical Activity, Lauren M. Panner

Evidence-Based Practice Project Reports

In 2011, the CDC reported that there are 12.5 million obese children and adolescents living in the United States (U.S.). The financial burden of childhood obesity in the U.S. is estimated to be 14 billion dollars. The objective of this evidence-based practice (EBP) project was to answer the question: In school-aged children, how does school-based, structured, family-oriented physical activity education affect body mass index (BMI) compared to usual education over an eight week time period? The Stetler Model of EBP and the health belief model were used to guide this project in a rural, Northwest Indiana elementary school. For eight …

Healthy Skin Is In: Effects Of A Multifaceted Sun Safety Program For Adolescents, Lindsay A. Munden

Evidence-Based Practice Project Reports

Skin cancer is a common, potentially life threatening disease notably on the rise among young Americans. A substantial portion of lifetime exposure to ultraviolet (UV) radiation, the greatest modifiable risk factor for skin cancer development, occurs during childhood and adolescence. Schools infrequently integrate sun safety education into the classroom and many lack essential sun safety policies. The purpose of this EBP project was to implement a multifaceted educational intervention providing middle school students with the knowledge behavioral skills needed to minimize the risk of developing skin cancer. The Health Belief Model and ACE Star Model of evidence-based practice guided this …

Opioid Withdrawal Signs And Symptoms In The Pediatric Patient During Opioid Tapering, Deborah Fisher

Theses and Dissertations

Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to …