Medicine and Health Sciences Commons^™

Hemodynamic Effects Of Bathing In The Pediatric Cardiac Intensive Care Unit, Andrea Torzone, Kuroush , Nezafati, Donghan Yang, Yang Xie, Julia Gerstmann, Joshua Wolovits, Javier J. Lasa

2025

RESEARCH

Purpose: Neonates and infants in a pediatric cardiac intensive care unit (CICU) are particularly susceptible to hemodynamic consequences of environmental exposure, agitation, and increased systemic vascular resistance associated with bathing. Clinical observations have generated significant debate regarding the physiologic changes that may occur related to patient bathing, leading to modified care practices surrounding routine bathing in the CICU. Due to the paucity of evidence surrounding physiologic changes associated with bathing in the CICU, we aim to describe the vital sign and hemodynamic profile of this high risk neonatal and infant population undergoing routine bathing in a pediatric CICU. …

Investigating The Mediated Relationship Of Stress Between Organizational Culture And Emotional Labor In Nurses, Elaine Beardsley

2025

RESEARCH

Purpose: Pediatric critical care nurses provide essential care to severely ill or injured children, yet high stress can impact the nurse’s well-being. Although it is known that exposure to traumatic events can contribute to secondary trauma for the nurse, it is becoming more widely understood how the work environment is a contributing factor on how stress is experienced by the nurse. It is also known that emotion regulation strategies to meet organizational display rules, called emotional labor, can increase or decrease felt stress, but it is not known if this is impacted by organizational culture types. The purpose …

Munch N’ Learn: Building Competence And Confidence In Pediatric Hematology Oncology Nurses, Shareta N. Jackson, Jaime N. Gebhard

2025

INNOVATION & LEADERSHIP

Background: As clinical nurse educators, we have observed a significant gap in continuing education opportunities for experienced nurses, particularly in the wake of the COVID-19 pandemic. Lifelong learning is essential for enhancing personal development and professional responsibility, enabling nurses to stay updated with evolving medical practices and improve patient care. The COVID-19 pandemic shifted nursing education priorities toward onboarding new hires and graduate nurses, leaving experienced nurses with limited continuing education opportunities. This gap has created a need for educational programs that cater specifically to the needs of seasoned nurses, helping them stay current with evolving …

Oh, My Baby! A Qi Initiative To Improve Neonatal Thermoregulation Compliance Via Nurse-Led Training And Development Of A Resource Binder, Gene Mae Estoya, Rose Dela Cruz, Deb Lathrop

2025

QUALITY IMPROVEMENT

Background: Plan- Problem: Decrease in Neonatal Thermoregulation Compliance (0% in January 2024 to 10-33% in April to December 2024) and Staff comfort level (1- 5 Level) in caring for patients with Neonatal thermoregulation issues and equipment use. Background: In December 2024, the capacity of this pediatric hospital expanded from 72 to 212 beds with more neonate admissions. For effective compliance, the executive leaders decided in January 2025 to train the same group of nurses and cohort neonate admission in a single acute care unit. Goal: Increase in Neonatal Thermoregulation Compliance (above 90% goal) and Staff comfort level …

Peripherally Inserted Central Catheter Use And Complications In A Pediatric Heart Center, Melanie Walsh, Alexandra Birely, Lynn Clark, Jared Young, David Lee, Sonali S. Patel

2025

RESEARCH

Purpose: To identify patient and device-related factors associated with PICC complications in the CICU and ACCU at Children's Health Dallas

Methods: - Single center, retrospective study using data abstracted from electronic medical records (EMR). - All PICCs inserted in HC during January 2022 through November 2024 were analyzed. - Retrospective review completed to identify patient physiology (at time of insertion), tip terminating location, tPA doses given (if applicable), and removal reason. - Univariate analysis conducted to determine risk factors associated with line occlusion and tPA usage.

Results: - Occlusion was the most frequent indication for early …

Revolutionizing Ed Transitions: Cutting Low-Acuity Visits Through Resource Optimization And Addressing Social Determinants Of Health, Crystal Salazar, Christa Combs

2025

INNOVATION & LEADERSHIP

Background: Frequent emergency department (ED) visits for non-emergent issues contribute to overcrowding, strain healthcare resources, and raise costs for families and the system. Many of these low-acuity visits—non-urgent cases manageable in primary care—worsen ED congestion and delay care for critical patients. A major factor is caregivers’ lack of awareness about alternatives like primary care, urgent care, and telemedicine. This leads to unnecessary ED use and further system strain. To address this, a family-centered care coordination program was created to reduce low-acuity ED visits by tackling care barriers, offering illness-specific education, and providing ongoing RN-led caregiver support. …

Characterization Of Antiretroviral Therapy (Art) Adherence Phenotypes And Psychosocial Symptom Clusters Among Black/African American (Aa) And Hispanic/Latine Adolescents And Young Adults (Ayas) With Hiv In The Adherence Connection For Counseling, Education, And Support (Access-Ii) Trial, Ann-Margaret Navarra, Taehoon Ha, Eva Liang, Maurade Gormley, David R. Garcia, Jason Fletcher, Lloyd A. Goldsamt, Michael G. Rosenberg, Karin Hasegawa, Jie Yang

School of Nursing Faculty Publications

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived …

Pediatric Nurses’ Perceptions Of The Quality And Usefulness Of Clinical Summaries: Surgeons Versus Generative Ai, Lindsey Patton, Nikki Marshall

2025

RESEARCH

Purpose: The purpose of this study was to compare the performance of AI-generated summaries and physician-written summaries in the pediatric surgery population from nurses’ perspectives.

Methods: The study occurred at a large, academic-affiliated pediatric healthcare system designated as a Level 1 Children’s Surgery Center. Three clinical nurses independently reviewed and compared AI-generated summaries to physician written summaries for patients admitted to the surgery service line utilizing the validated Physician Documentation Quality Instrument (PDQI-9) tool. The nurse evaluation team met prior to scoring to ensure consistency of interpretation and scoring of PDQI-9 domains.

Results: AI-generated and physician …

Improving Confidence And Competence In Treating Pediatric Peripheral Intravenous (Piv) Extravasation, Ann Gosdin, Hector Murillo, Taffi Marchand, Brook Warren

2025

EBP

Literature Review: Targeted nursing education has demonstrated it may lead to improved nursing care and patient safety. Nurses who received high-fidelity simulation and targeted traditional education on extravasation treatment had higher competency scores than those who did not received this education. Specific nursing education classes have demonstrated statistically significant improvement on nurses' knowledge, practice and minimized patients' complications of extravasations.

PICO: In hospitalized pediatric patients can additional education and training by the Vascular Access Team (VAT) for Peripheral IV Infiltration and Extravasation (PIVIE) on extravasation treatment increase knowledge, confidence, and competence in providing the appropriate treatment and increase the …

Importance Of Expressed Breast Milk Verification And Patient Identification, Deb Lathrop

2025

QUALITY IMPROVEMENT

Background: Due to changes in Texas reimbursement, the Plano campus was transferring neonates, infants under 28 days of life, to the Dallas campus. It was decided in 2023 to obtain a neonatal designation for the Plano campus. A Program Manager was hired as part of the requirements and a quality and Patient Safety committee was formed. As part of the program, quality data collection was required. As a Level I designated facility, expressed breastmilk verification was one of the required data sets to be collected. It was discovered that staff at the Plano campus were not scanning …

The Evolution Of A Pediatric Cardiac Catheterization And Interventional Quality Review Program, Susanne Roberts, Andrea Torzone, Surendranath Veeram Reddy

2025

QUALITY IMPROVEMENT

Background: With a change in leadership, substantial increases in the number and complexity of cardiac catheterization and interventional procedures, we identified an opportunity for a formal programmatic quality review to identify potential gaps in data and missed opportunities for quality improvement.

Methodology: Plan, Do, Study, Act (PDSA) methodology was utilized to develop the Cardiac Catheterization and Interventional Quality Review Program. Over the course of 2021 to present, four cycles of the PDSA process have been completed. Cycle I: Action focused on accuracy validation of outcomes reports and initiation of a programmatic dashboard. Cycle II: Initiation of …

Bibbidi-Bobbidi No Boo-Boo Pulse-Oximeter: A Child-Friendly Prototype To Improve The Pediatric Experience, Holly Dickens

2025

INNOVATION & LEADERSHIP

Background: This prototype design project addresses the critical need to enhance pediatric patient comfort by reimagining common medical equipment to be child-friendly. A significant gap exists in pediatric device development, as most tools are repurposed from adult models and fail to consider the unique psychological, emotional, and developmental needs of children (Espinoza et al., 2020). Devices such as pulse oximeters, though essential in monitoring oxygenation and widely regarded as the “fifth vital sign” (Al-Beltagi et al., 2024), often cause distress for young patients. Traditional models feature intimidating adult-centric aesthetics, bright red sensor lights, and sticky wraps …

Some Like It Hot -Structural Changes In Extremophile Rubredoxin At 120 °C., Tzanko Doukov, Igor Leontyev, Francis E. Jenney, Dominic George, Stephen P Cramer

PCOM Scholarly Works

How does the structure of a protein change as the temperature is raised from cryogenic conditions at 100 K to 393 K? Understanding the structure and dynamics of proteins under environmental extremes is relevant for human health, biotechnological applications, and our search for life elsewhere in the universe. Here we reveal the high temperature crystal structure of a hyperthermophilic (Pyrococcus furiosus) rubredoxin at 393 K (120 °C), together with multiple complementary structures down to 100 K. The results are compared with molecular dynamics calculations. Significant changes in H-bonding are observed. Discussions about high-temperature protein structure and stability need to recognize …

Healthlitpro™: Development Of An Ai Driven Audit & Feedback Tool For Organizational Health Literacy, Carol J. Howe, Yunhe Feng, Song Fu, Donger Chen, Lindsey Patton

2025

RESEARCH

Purpose: Organizational Health Literacy (OHL) refers to the ability of healthcare institutions to support patients and families to access, understand, and use health information. Nurses play a key role in OHL using evidence-based health literacy practices (i.e. plain language, teach-back, open-ended questions, chunking information, and three to five key points) when educating patient families. Yet, implementation is challenging. Audit and Feedback (A&F) is an implementation strategy for promoting fidelity to health literacy practices. Conventionally requiring expert human evaluations that are costly, labor-intensive, and difficult to scale.

Methods: HealthLit was trained using a dataset of simulated nurse-patient education …

Shorter Stays, Collaborative Care: Tackling Bronchiolitis Together, Alyssa Gestring, Sharmila Chowdary Kanuru

2025

QUALITY IMPROVEMENT

Background: Bronchiolitis is a leading cause of pediatric hospitalization. Despite American Academy of Pediatrics recommendations to reduce unnecessary care and costs, management variation persists. Modest reductions in length of stay (LOS) can meaningfully impact cost and hospital throughput. During our baseline period (Aug 2021-Dec 2022), our average LOS for bronchiolitis admissions was 51 hours, in comparison to 40.8 hours (1.7 days) for the 10th percentile of Children’s Hospital Association peer hospitals. Our aim was to reduce the average LOS of patients with uncomplicated bronchiolitis by 12 hours between January 2023 and the end of 2024, without increasing …

Building Confidence And Competence: Pediatric Early Immersion Tracks For Nursing Students, Candice Hogan, Sana Iqbal

2025

INNOVATION & LEADERSHIP

Background: Literature suggests nursing students often enter pediatric clinical settings with limited exposure, heightened anxiety, and minimal preparedness for the acuity and complexity of pediatric care. Many academic programs lack adequate pediatric clinical hours, leaving graduates underprepared for practice. To address this gap, a pediatric hospital created two education development tracks for pre-licensure nursing students to foster early immersion.

Implementation: Track one is a 10-week summer program for students who have completed at least one clinical rotation. Track two supports senior-level students to complete capstone clinical hours on the unit where they transition into Nurse …

The Development And Implementation Of On-Demand Nsqip Visualization Tools In A Pediatric Health System, Tess Davis, Karisa Price, Courtney Russ

2025

INNOVATION & LEADERSHIP

Background: Children’s Health System of Texas (CHST) is comprised of campuses in Dallas and Plano. Located thirty miles apart, the distance places a strain on communication within the enterprise. While Semiannual Reports (SARs) provide retrospective data, our surgeons frequently voiced a desire to visualize timely postoperative occurrences in an attempt to provide on-time interventions.

Implementation: Surgical Clinical Reviewers (SCRs) queried available resources including National Surgical Quality Improvement Program (NSQIP) surgeon champions, an otolaryngologist, and our perioperative data analyst. Each player brought a unique perspective and assisted in prioritizing metrics. As a team, the Tableau educational …

Walk The Talk: Elevating Quality One Step At A Time, Hayden Dutton, Jesse Castro, Maria Leal, Megan Mysliwiec

2025

QUALITY IMPROVEMENT

Background: The Clinical Quality Improvement Consultant (CQIC) role was established in 2023 for Acute Care Services (ACS) and Clinical Resource Teams (CRT). This role was developed to accurately track data and facilitate quality improvement initiatives. ACS includes acute pediatrics, renal, trauma, gastroenterology, pulmonary, neurology, integrated therapy, and observation units. CQICs performed a gap analysis which uncovered a lack of knowledge of current unit state and pro-active hospital acquired condition (HAC) data. In partnership with clinical leaders, a weekly Quality Leader Rounding (QLR) was created to address this, environmental state, and patient family education. The goal of QLR …

Comparing In-Person Discussions Versus Online Learning Modules On Post-Pda Ligation Care Knowledge Retention Among Night Shift Nurses In A Level 4 Nicu, Jeffrey Canlas, Olga Deleon, Sharon Summers, Jerithea Tidwell, Noorjahan Ali

2025

QUALITY IMPROVEMENT

Background: Postoperative management of neonates following patent ductus arteriosus (PDA) ligation is critical in a Level 4 Neonatal Intensive Care Unit (NICU). Night shift nurses are faced with unique challenges when caring for these patients. The night shift NICU leaders wanted to determine the most effective educational method to enhance learning retention and clinical competency. The purpose of this quality improvement project was to evaluate whether in-person discussions lead to better retention and understanding of post-PDA ligation management among night shift NICU nurses compared to online learning modules.

Methodology: A comparative, quasi-experimental design was used to …

Advocating For Health Equity: A Quality Improvement Project Surrounding Social Determinants Of Health Screening, Rose Anne Dela Cruz, Amanda Marquez, Madison Lemmons

2025

INNOVATION & LEADERSHIP

Background: Social Determinants of Health (SDOH) can gravely impact patient recovery. Health organizations should prioritize identifying high-risk SDOH patients to improve patient outcomes. Current research suggests SDOH screening should be standard practice in preventative care. With this awareness, healthcare team members must identify patients with complex social determinants of health needs to ensure essential resources are offered to enhance their healing process during hospitalization and sustain it post-discharge. The most straightforward approach to identifying patients from diverse backgrounds with SDOH requirements is via SDOH screening. The collaborating health system, serving a diverse pediatric population in the …

Circling Together To Support Transitioning Nurses With Mentorship, Martha Shaw, Jill Hesler, Sarah Ritchie

2025

QUALITY IMPROVEMENT

Background: Nurses orientating to new environments can experience transition shock as they navigate new professional experiences, challenges, and identities. While much attention is given to supporting new graduate nurses, experienced nurses changing specialties frequently receive less structured support, despite facing unique challenges. Experienced nurses enter their new roles with a level of competence and expertise from a previous specialty, only to find themselves functioning as beginners in a new practice setting. Mentoring practices have been shown to increase confidence, decrease anxiety, and improve rates of retention and growth behaviors over the course of a career leading to …

Epilogue: Postoperative 30-Day Follow-Up, Tess Davis, Karisa Price, Courtney Russ

2025

INNOVATION & LEADERSHIP

Background: The NSQIP-P Surgical Clinical Reviewers (SCR) of Children’s Health of Texas initiated a quality project with the goal of maintaining an 80% postoperative follow-up rate. To remain relevant in the ever-changing landscape of healthcare, we recognize the need for thoughtful and individualized approaches to follow-up. Unprecedented growth in the healthcare sector creates a demand for innovative solutions to address the ever-changing needs of the pediatric surgical population. Patient expectations have driven the desire for organizational transparency and robust approaches to ensure optimal, holistic outcomes. This has been accomplished using tailored follow-up strategies to meet organizational …

Impact Of An Escape Room Educational Intervention For Telephone Triage Nurses, Susan Webber, Kathleen Ellis

2025

RESEARCH

Purpose: This study examines the impact of an escape room educational intervention on the knowledge, preparedness, and confidence of nurses who work in pediatric telephone triage, as well as examining the effect of the intervention on perceptions of teamwork.

Methods: This study used a quantitative pre-post study. Six Likert-scale questions focused on pre- and post- intervention comparisons, while four questions addressed participant satisfaction.

Results: The sample had a long tenure in nursing, with 81.57% having 15 years or more of nursing experience. Length of time working in telephone triage was fairly equally divided between groups who …

Reducing Unexpected Nasogastric Tube Reinsertions Through Interdisciplinary Education: A Pediatric Ambulatory Initiative, Jordon Delatorre, Nadia Gose, Leslie Moore, Aren Parker, Shivani Patel, Iman Rahim-Tejani

2025

INNOVATION & LEADERSHIP

Background: In late 2024, pediatric GI clinic RNs noted a rise in unexpected visits for nasogastric tube (NGT) reinsertion, continuing into early 2025. These visits disrupted clinical flow and strained limited RN resources. Caregivers were often unable or unwilling to perform reinsertion at home. RNs escalated the issue to leadership, prompting collaboration with the ambulatory clinical program director. Weekly planning meetings began in April 2025 to develop a safe, efficient workflow aimed at reducing unplanned NGT-related visits and improving care delivery.

Implementation: An interdisciplinary team, including GI clinic RNs, inpatient GI and NICU nurses, educators, …

I Don’T Want To Be Alone: The Impact Of Cohorting Neonates On One Unit, Deb Lathrop, Rose Dela Cruz

2025

INNOVATION & LEADERSHIP

Background: The hospital has been caring for neonates since it opened in 2005. To comply with state regulations, a state designation for neonatal care is required. The facility hired a program manager to address specific needs and to apply for the state designation. A designation of Level 1 neonatal care was obtained at the end of 2023. The facility does not possess a Neonatal Intensive Care Unit. The program manager started collecting historical data on thermoregulation who are located on every unit of the facility in October 2023. It became evident that neonates in the hospital …

Nursing Care For The Sexual Assault Patient Using Trauma-Informed Care: Development Of Simulation Curriculum, Lauren Orr

2025

INNOVATION & LEADERSHIP

Background: In 1999, the American Association of Colleges of Nursing (AACN) called for nursing programs to include nursing care of patients who have experienced violence, including sexual violence. The care of these vulnerable patients requires specialized care, but also the use of specialized language through using trauma-informed care (TIC) to prevent revictimization and to further support healing. A simulation curriculum was developed that can both introduce the nursing care needed for a sexual assault patient and allow students to practice using TIC that is used when students practice independently as licensed nurses. Multiple studies have supported …

Improving Sdoh Screening Compliance In Pediatric Settings: Addressing Health Literacy In East Texas, Katie Bien

2025

QUALITY IMPROVEMENT

Background: Low parental health literacy is an under-screened social determinant of health (SDOH) that drives inequities in rural communities such as East Texas, where over 105,000 children lack access to a pediatrician, and families travel 80+ miles for care. Pediatric mortality in this region is 2.5 times the national average (UT Tyler SOM, 2023). National data indicate that one in three parents has limited health literacy (Tran et al., 2008), further exacerbating risks of missed appointments, medication errors, and poor outcomes.

Methodology: The initiative was conducted in a rural outpatient pediatric cardiology clinic within Children’s Health …

Development And Applications Of A Health Equity Summary Score Using The Medical Expenditure Panel Survey, Ronald R. Sanchez

Dissertations and Theses

Despite sustained national efforts, disparities in healthcare delivery persist among racial and ethnic minorities, low-income individuals, and socially at-risk populations. Monitoring modifiable aspects of care delivery, such as the structures and processes that health systems can directly improve, is a key strategy for addressing these gaps. However, most measures evaluate modifiable aspects of care delivery separately, limiting understanding of how improvements in one domain reinforce the other and how their combined effect influences equitable care.

This dissertation addresses this gap by combining patient experience and clinical quality, two modifiable aspects of care that captures how patients interact with the health …

Ask Me 3® In Action: Advancing Health Literacy In Pediatric Acute Care, Yaseming Medina

2025

EBP

Literature Review: Parents and caregivers’ understanding of how to provide safe and effective care at home is vital. However, elevated levels of stress and limited health literacy face significant challenges in understanding discharge instructions. Patients who understand heath instructions make fewer mistakes when they take their medicine, follow treatment plans, and prepare for medical appointments. Patients have reported higher satisfaction and found that the use of Ask Me 3 was helpful in learning more about their medical condition.

PICO: For parents of pediatric patients seen in an acute perioperative setting, how will the use of the Ask Me 3 …

Neutrophil Lymphocyte Ratio As A Marker Of Skin Disease Activity In Older Children With Juvenile Dermatomyositis, Shreya Swaminathan, Nidhi Naik, Susan Shenoi, Sarah Vandenbergen, Jessica L. Turnier, Zilan Zheng, Jessica Neely, James S. Andrews, Christian Lood

Student Papers, Posters & Projects

BACKGROUND: Neutrophils contribute to the pathogenesis of many autoimmune diseases. While the neutrophil to lymphocyte ratio (NLR) is associated with disease activity in adult dermatomyositis, its clinical utility in juvenile dermatomyositis (JDM) is unknown.

METHODS: Demographic, medication use, autoantibody profile, disease activity markers, and laboratory data from 97 JDM patients was collected using retrospective chart review. Patients were age-stratified (0–9 vs. 9–21 years of age), as white blood cell count stabilizes at 9 years. The relationships between NLR with JDM disease activity measures were analyzed using spearman’s correlation.

RESULTS: Patients were primarily white (56.7%) and female (71.1%). Older children had …