Medicine and Health Sciences Commons^™

Addressing Gaps In Breastfeeding Education Among Pediatric Nurses, Bethany Stokes, Shannon Abbott

2025

INNOVATION & LEADERSHIP

Background: Breastfeeding is a modifiable health-related behavior widely recognized for its short-and long-term health benefits (Standish, 2022). The American Academy of Pediatrics (AAP) recommends breastfeeding for at least two years or as long as mutually desired (Meek, 2022). Despite this guidance, pediatric nurses outside of neonatal units often receive minimal breastfeeding education, creating a gap in care for breastfeeding families admitted to other areas of the hospital. This project aimed to assess the breastfeeding knowledge needs of pediatric nursing staff across two hospital campuses. A lack of standardized breastfeeding education was identified. To quantify this gap, …

Blinatumomab Without Borders: Taking Life-Saving Treatment Home, Susan Mccollom, Tami Beaudin, Shareta Jackson, Jamie Gebhard

2025

INNOVATION & LEADERSHIP

Background: Blinatumomab administration has become a standard treatment for acute lymphoblastic leukemia (ALL), following promising early outcomes from the AALL1731 study. The randomized groups in this trial demonstrated a 3-year disease-free survival (DFS) rate of 96% in those receiving blinatumomab, compared to 87.9% in the non-blinatumomab arms. Blinatumomab is administered in two non-consecutive 28-day blocks with ideally approximately 24 days of treatment at home.

Implementation: The staff at the Center for Cancer and Blood Disorders (CCBD) at Children’s Health faced a significant challenge due to the volume and urgency of the therapy to start. We …

Defying Gravity: Fall Prevention Quality Improvement Project, Taylor Ryan, Madeline Bartush

2025

QUALITY IMPROVEMENT

Background: In March of 2025, an increase in inpatient falls led to a hospital-wide containment period. In response, a fall prevention nurse role was created to identify gaps, provide targeted education and lead improvement efforts. Initial surveys of 101 nurses revealed that while 91% reported using the teach-back method of education as part of their practice with patients and families, only 36.6% reported they always use this method, and just 19.8% reported feeling very comfortable doing so. Direct observations revealed families unable to teach-back fall prevention strategies despite nurse documentation of education completion. A gap analysis also …

Development Of A Continuous Renal Replacement Therapies (Crrt) Team, Lainey Segovia, Taelor Pena, David Zolezzi, Tami Turrubiarte, Keri Drake

2025

INNOVATION & LEADERSHIP

Background: Our organization identified an opportunity to provide Continuous Renal Replacement therapy (CRRT) to more patients while simultaneously reducing time to initiation by building a dedicated CRRT team. Although CRRT has been provided for years, it lacked formal standardized education and oversight.

Implementation: Recognizing these gaps in care we formed a CRRT team in May 2024, consisting of three RN coordinators, one Advanced Practice Provider (APP), a nursing director, and a nephrology medical director. The aim was to improve CRRT delivery by authoring guidelines, providing formal in-person education for nurses and providers, creating a centralized …

Embedding Health Literacy Practices Through A Champion Program: A Strategic Expansion, Diana Montoya, Cameron Stine, Kelli Williams, Leslie Moore, Carol Howe

2025

QUALITY IMPROVEMENT

Background: The importance of becoming a Health-Literate Organization gained momentum in our pediatric organization, driven by the Healthy People 2030 initiative, Social Determinants of Health Screening and organizational strategies focused on enhancing patient outcomes. The Health Literacy Champion Program (HLCP) was expanded in 2024-2025 to embed subject matter experts into inpatient care units, thereby infusing health literacy best practices to enhance patient communication.

Methodology: The initial phase involved aligning the HLCP interventions with organizational strategic priorities and establishing shared goals among stakeholders. The program leads identified key priority indicators and metrics to evaluate the program. The …

Empowering Nurses: A Training Initiative On Essential Oils For Pediatric Neurosurgery Patients, Sheri Sacks

2025

EBP

Literature Review: Pediatric neurosurgery patients often face increased anxiety and agitation. Nurses may lack knowledge of non-pharmacological interventions to reduce agitation and anxiety in their patients. Literature review used MeSH Headings and keywords to find recent English articles. Evidence shows EO reduces anxiety. Lavender inhalation lowers anxiety, pain, and vital signs in pediatric dental patients. In adults, aromatherapy decreases anxiety, pain, blood pressure, and improves sleep, also reducing pain and extubation time.

PICO: In pediatric neurosurgical bedside nurses, does education on lavender essential oil, compared to no education, improve knowledge, confidence and intent to integrate it as a complementary …

Enhancing Sepsis Education And Staff Engagement Through Gamification: A Qi Project Using Escape Rooms In A Pediatric Ed, Angie Rodick, Nicole Bizzack, Virginia Elizondo

2025

QUALITY IMPROVEMENT

Background: Sepsis is a leading cause of morbidity and mortality in hospitals, making early recognition and intervention critical. Traditional education methods often fail to ensure retention of essential knowledge, leaving staff underprepared. To address this gap, a Quality Improvement (QI) project was launched in the Emergency Department (ED) of an urban Level 1 Pediatric Trauma Center. Nursing leaders identified the need for engaging, sustainable education and collaborated with educators to design an escape room training activity. The aim was to evaluate whether gamification could increase engagement, improve understanding of a new sepsis screening tool, and enhance overall …

Got Ebm? Increasing Scanning Compliance With Nursing Led Initiatives, Angela Randles, Rose Dela Cruz, Lily Lawrence

2025

QUALITY IMPROVEMENT

Background: This General Pediatrics unit had just 78% staff compliance in scanning Expressed Breast Milk (EBM) in January 2025, a crucial gap in safe handling and documentation. The risk to patient safety prompted a targeted quality improvement project to improve compliance and workflow. A thorough process mapping exercise and pre-survey bedside nurses helped understand noncompliance. The aim of this project is to identify ways to increase compliance with EBM scanning by understanding the root cause of non-compliance and identifying nurse led initiatives to improve patient outcomes.

Methodology: In April 2025, improper reporting of breast milk pumping …

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 …

Geographic And Socioeconomic Predictors Of Early Follow-Up Loss In Patients Undergoing Pituitary Neuroendocrine Tumors (Pitnets) Resection: A Retrospective Review Of 1143 Cases, Daniel Quintana, Rithvik Ramesh, Robert C. Osorio, Wesley Shoap, Paul Mcmillan Villalobos, Philip V. Theodosopoulos, Sandeep Kunwar, Jose Gurrola, Ivan H. El Sayed, Manish K. Aghi, Ezequiel Goldschmidt

School of Medicine Faculty Publications

OBJECTIVE: Postoperative follow-up after PitNET resection is essential for monitoring tumor recurrence and endocrinological deficits. Despite advances in telehealth, loss to follow-up remains a persistent challenge across neurosurgical patients. This study aims to identify factors to identify patients are at higher risk of being lost to follow-up after surgery. METHODS: A retrospective analysis was conducted on 1,143 adult patients who underwent PitNET resection between 2012 and 2019 at a single institution. Clinical and radiological data were analyzed to assess loss to follow-up in the cohort. Multivariable logistic and negative binomial regression models were used to identify factors independently associated with …

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 …