Nursing Commons^™

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

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

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

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

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

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

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

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

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

Theses and Dissertations (ETD)

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

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

Theses & Dissertations

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

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

Electronic Thesis and Dissertation Repository

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

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

Walden Dissertations and Doctoral Studies

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

The Lived Experience Of Parental Bereavement, Christine Denhup

Seton Hall University Dissertations and Theses (ETDs)

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

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

Doctor of Nursing Practice (DNP) Projects

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

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

Doctoral Projects

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

Patients and families place great trust in …

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

Doctoral Projects

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

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

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

Undergraduate Honors Theses

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

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

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

UNLV Theses, Dissertations, Professional Papers, and Capstones

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

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

Doctoral Projects

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

South Carolina School Nurses' Knowledge, Opinions, Perceptions, And Practice Measures Regarding Childhood Obesity, Logan Camp

Nursing Theses and Capstone Projects

Childhood obesity has become a significant national health issue due to rising incidences and associated chronic medical conditions. School nurses across the United States of America are in prime positions to address childhood obesity as they have access to large numbers of children and adolescents in school settings. A review of current literature demonstrated that school nurses were overall knowledgeable concerning childhood obesity, but encountered numerous barriers in enacting weight-related assessments and treatment programs. The purpose of this research study was to determine the knowledge, opinions, perceptions, and practice measures of South Carolina school nurses regarding childhood obesity. The "School …

Assessing Pediatric Nurses' Knowledge And Comfort Level With Recognition And Reporting Of Child Abuse, Andrea Sebastian

DNP Projects

Child abuse is a serious, yet preventable problem in the United States. Child abuse is defined in The Child Abuse Prevention and Treatment Act as “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation or an act or failure to act, which presents an imminent risk of serious harm” (United States Department of Health and Human Services [USDHHS], Children’s Bureau, Child Maltreatment 2009, 2010).

In 2010, there were an estimated 3.3 million referrals to Child Protective Services for the suspected abuse …

Role Of The "Tobacco Free Teens" Mobile Application In Adolescent Smoking, Juawanna L. Schuller

DNP Projects

Adolescent tobacco use rates have plateaued. Tobacco use education is not mandatory in all states, yet schools remain a good opportunity to reach this population. School nurses should be able to identify components of effective tobacco use prevention education programs and learn to overcome barriers to implementation of these programs. The "Tobacco Free Teens" mobile application is a novel tool that may decrease adolescent tobacco use rates. A pilot study found that the Tobacco Free Teens mobile application was satisfactory to most participants but appealed to girls more than boys. Further research is needed to determine the effectiveness of this …

Emergency Nurses' Knowledge Of Pediatric Complaints, Kari J. Blackburn

DNP Projects

Each year there are more than 25 million pediatric emergency department (ED) visits, with 37-60% of the complaints being non-urgent (Brosseau, Hoffman, Nattinger, Flores, Zhang and Gorelick, 2007). Injury is the number one reason children present to the ED and is strongly associated with a complaint of pain (AHRQ, 2013). While pain is a high volume reason for visiting the ED, there are other presentation causes that may pose a high risk to pediatric patients. Nausea and vomiting is not typically viewed as a high risk complaint, yet there are some high risk etiologies resulting in nausea and vomiting that …

Final Dnp Capstone Report: Improving Adolescent Hpv Vaccination Rates, Jessica L. Murray

DNP Projects

Background: Human papillomavirus (HPV) vaccines have been shown to be effective against HPV types that are linked to cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Despite Advisory Committee on Immunization Practices (ACIP) recommendations that all 11-12 year old males and females in the U.S. should be vaccinated with the three-dose HPV vaccine series, vaccination rates remain low. In 2012, only 34.9% of adolescent females and 6.8% of adolescent males completed the series. Efforts to increase vaccination rates are needed, and healthcare providers have been shown to be an important part of the solution.

Purpose: This investigation was conducted to …

Pediatric Obesity: Taking Advantage Of Well-Child Visits For Early Identification, James E. Gelement

DNP Projects

Background: Pediatric obesity has reached epidemic levels in the United States and the burden of early identification and prevention lies with Primary Care Providers. With this burden comes the responsibility of increased documentation in order for patients to obtain the appropriate counseling, treatment, and referrals.

Objective: The objective of this study is to identify missed opportunities to identify pediatric patients that meet the criteria for overweight or obesity during well-child visits within a primary care practice.

Method: A retrospective chart review of 100 randomly selected patients born between 9/1/2001 and 9/1/2010 that have received a well-child visit between 1/1/2010 and …

Prevention, Recognition, And Treatment Of Pediatric Obesity In The Ambulatory Care Setting, Susan Farrus-Brown

Doctor of Nursing Practice Scholarly Projects

The World Health Organization (WHO) in 1995 described obesity as a chronic disease and one of the most important public health threats and in 2000 reported obesity as a “global epidemic.” The numbers of obese children are increasing in society; moreover, the onset of obesity is occurring at even a younger age than in the past. The prevalence of pediatric obesity is staggering and interventions need to be developed to decrease the risk for chronic and related psychological diseases.

The objective of this project was to provide education on utilization of a tool kit to increase the nurse practitioner (NP) …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …