Maternal, Child Health and Neonatal Nursing Commons^™

Implementing A Competency-Based Cross-Training Program To Enhance Patient Flow, Jill E. Shanklin

DNP Projects

Objective: To evaluate the effect of a competency-based cross-training program on perinatal nurses’ preparedness to care for medical-surgical (med-surg) overflow patients and to support patient flow.

Design: Quality improvement project using a quasi-experimental pre–post design.

Setting: A 44-bed perinatal unit within a university-affiliated medical center in the United States.

Participants: Registered nurses employed in the perinatal unit for ≥6 months; 24 completed the preintervention survey and 28 completed the postintervention survey.

Interventions: A competency-based cross-training program consisting of e-learning modules, simulation-based competency validation, and structured policy and procedure review.

Main Outcome Measures: Self-reported comfort, …

Building Confidence And Team Communication: Implementation Of A Rapid Response In Situ Simulation Program In The Neonatal Intensive Care Unit, Janell F. Hacker

DNP Projects

Background: Neonatal code events are high-risk, low-frequency occurrences in the neonatal intensive care unit (NICU). Simulation-based training is used to support skill development, maintain competencies, and enhance team performance.

Purpose: The purpose was to determine if a multidisciplinary, high-fidelity, rapid response in situ simulation program would impact confidence and communication among frontline healthcare providers during neonatal code events.

Methods: A quasi-experimental, pretest-posttest study was conducted in a 90-bed Level IV NICU. A multidisciplinary, high-fidelity in situ rapid response simulation program was implemented over a 3-month period for frontline NICU healthcare providers. Pre- and post-surveys assessed perceptions of role clarity, …

Supporting Nursing Care Transition For Late Preterm Infants From Nicu To The Level 1 Nursery, Megan R. Deans

DNP Projects

Late preterm births are increasing each year due to increasing rates of IVF, multiple births, and advancing maternal age (Visruthan et al., 2015). This group has been traditionally cared for in the NICU, but facilities may consider transitioning this care to the level 1 nursery due to the relative physiologic stability of this population (Visruthan et al., 2015). The transition, without appropriate planning, creates a potential for inconsistencies in caring for the diverse needs of 35.0-35.6 week late preterm infants (LPIs), including variations in education provided to parents and care of the LPI (Visruthan et al., 2015). This project aimed …

Integration Of Depression And Anxiety Screening Among Uninsured And Underinsured Patients In A Mobile Nurse-Led Clinic, Samantha Hamm

DNP Projects

This quality improvement project sought to increase screening rates and referrals for pregnant and postpartum depression/ anxiety using the Edinburgh Postnatal Depression Scale (EPDS) and increase the rate of mental health referrals as a result of that screening in an underserved population /community health mobile clinic. Maternal mental health is a key public health concern. In the most recent community health needs assessment (2022-2025) in one Midwestern rural community, priority needs were identified with the top priority of building families with access to culturally competent healthcare, including access to mental health services (Central MN Alliance, 2022). Under-reporting anxiety and depression …

Knowledge And Attitudes Toward Baby-Led Weaning In Primary Care, Taylor Schreiner

DNP Projects

Objective

Adequate nutrition is critical for an infant’s growth and development. Around the age of six months, most infants can begin the process of being introduced to table foods. The debate is about what method is safest for the infant, spoon-led feeding or baby-led weaning (BLW).

Methods

This project explored the beliefs, attitudes, and knowledge of both parents of infants and primary care providers (PCP) on baby-led weaning. Data were obtained through the use of pre-and post-surveys following the implementation of specific education for parents and PCPs.

Results

The findings from parents who participated would suggest that most parents who …

Obstetric Education For Critical Care Nurses, Anna Forberg

DNP Projects

Background The purpose of this study was to educate ICU nurses on the care of obstetric women in critical care through the use of a toolkit with intentions to increase knowledge and confidence.

Method The toolkit was created via the platform WordPress™ and topics were chosen based on the most common admission diagnoses found during the literature review. Data were collected via forms manager and voluntary participation among ICU nursing staff was obtained.

Results Mean scores from the pretest to the post-test showed improvement from 7.08 to 8.50 and the minimum and maximum scores increased from pretest to post-test supporting …

Increasing Awareness Of Implicit Bias And Systemic Racism Among Clinical Staff Caring For Non-Hispanic Black Maternal Patients, Melissa Courtney

DNP Projects

Background: Kentucky is ranked 17^th in the nation for the highest maternal mortality rate in the U.S. with a rate of 22.9 per 100,000, and 78 percent of those maternal deaths were considered preventable. The Non-Hispanic Black maternal death rate in the U.S. and Kentucky is 2.9 times higher than that of the Non-Hispanic White maternal counterparts (Kentucky Department of Public Health Division of Maternal and Child Health (KDPHDMCH), 2022). The fundamental cause of maternal health inequities is structural racism, which leads to poor treatment and experiences in the healthcare system (Chinn et al., 2020). Structural racism and implicit …

Evaluating Healthcare Workers’ Knowledge, Attitudes, And Practices Regarding Language Access Services In The Clinical Setting, Rachel Archibald

DNP Projects

Background: Barriers to accessing and understanding healthcare can place patients with low English proficiency at an increased risk of poor health outcomes. Language-based inequities in healthcare exist due to lack of interpretation and translation services available, lack of healthcare workers’ knowledge of resources, and/or perceptions that these services require too much time or effort. Failing to address barriers affecting this population leaves them vulnerable in the healthcare setting.

Purpose: The purpose of this DNP project was to educate nurses, providers, and staff on an inpatient unit at a rural hospital of the language interpretation resources available, best practices for implementation, …

An Educational Intervention To Improve Neonatal Icu Nurses’ Breastfeeding Support Knowledge, Self-Efficacy, And Breastfeeding Rates At Discharge, Sarah Money

DNP Projects

Background: The benefits of breastfeeding for both mother and baby are known. It is recommended that all infants be exclusively breastfed until six months (Meek & Noble, 2022; North et al., 2021). Despite this, breastfeeding rates remain low, especially in medically fragile infants requiring care in the neonatal intensive care unit (NICU) (Rollins et al., 2016). Receipt of evidence-based breastfeeding support by healthcare providers has been shown to improve breastfeeding success; however, many healthcare providers report not being comfortable or knowledgeable enough to offer support consistently (Mulcahy et al., 2022; Rollins et al., 2016).

Purpose: This study aims …

Knowledge & Attitudes Towards Pediatric Pain With Needle-Based Procedures In The Emergency Department Setting, Charlstyn Paige Brown

DNP Projects

PURPOSE: By the time a child enters kindergarten, they may have faced as many as thirty-three vaccine-related injections. Throughout these experiences, parents and patients associated pain and fear regarding the administration of multiple vaccines concurrently to a child has played a role in vaccine hesitancy and refusal. Parents and patients experience associated fear and pain regarding the administration of multiple concurrent scheduled vaccines, thus leading to vaccination hesitancy and refusal. In addition to scheduled immunizations, there is also the possibility of unexpected needle-based procedures taking place when emergencies arise. The purpose of the study is to explore the current …

Increasing Patient Satisfaction Of Post-Cesarean Mothers: An Evidence-Based Practice Quality Improvement Project, Amanda Jones

DNP Projects

Introduction: The first hour after delivery, referred to as the “Golden Hour” or “Sacred Hour,” is when the mom, baby, and the support person get 1-hour of uninterrupted bonding time together. This time is critical because it promotes neonatal thermoregulation, decreases newborn stress levels, improves mother–newborn attachment, and encourages breastfeeding. Unfortunately, most cesarean births do not receive the Golden Hour and instead experience delayed bonding time.

Purpose: The purpose of this Evidence-Based Practice (EBP) project was to incorporate the Golden Hour for post-cesarean section mothers in a mid-sized community-based hospital in XXX, CT in order to increase patient satisfaction post-c-section; …

Implementation Of A Zone Of Silence During Administration Of Breastmilk To Decrease Nurses’ Distractions In A Neonatal Intensive Care Unit: Quality Improvement Project, Lauren Crociata

DNP Projects

Introduction: In the NICU, breastmilk is handled and administered as safely and carefully as a medication. Administration errors occur when incorrect breastmilk is administered to the wrong patient. This can lead to the transmission of infectious disease and create the loss of trust between families and the healthcare team during a neonate’s NICU stay. Nurses are often faced with interruptions and distractions during administration, and evidence shows that interventions to reduce nurses’ distractions lead to reduction of administration errors in inpatient settings. This quality improvement project took place in a level III NICU. It implemented an evidence-based zone of silence …

Effect Of Anticipatory Guidance On Parental Knowledge And Anxiety Prior To Discharge Of Infant From The Neonatal Intensive Care Unit To Home, Stephanie Kelty

DNP Projects

Background: Lack of adequate parental education and discharge readiness from the Neonatal Intensive Care Unit (NICU) increases the risk for poor infant outcomes, hospital readmissions, postpartum depression, parental anxiety, and post-traumatic stress disorder. One component of parental readiness at discharge is receiving anticipatory guidance from a trusted healthcare provider prior to discharge.

Purpose/Objectives: This study aimed to evaluate the effectiveness of provider-led anticipatory guidance to enhance parents’ knowledge regarding high-risk infant behaviors and decrease anxiety related to caring for their high-risk infant after NICU discharge. Additionally, this study aimed to assess parental opinions about the value of anticipatory guidance sessions. …

Assessment Of Postpartum Nurses' Knowledge And Teaching Habits Of Maternal Morbidity And Mortality, Mikayla Dodson

DNP Projects

The postpartum period is a joyous time of mother-infant bonding, but it can also be a risky time for women. Despite the education that is provided to postpartum women after birth, many women are still questioning whether or not the signs and symptoms they are experiencing are sufficiently alarming to alert a health care provider. Any delay in seeking care can contribute to poor health outcomes and even maternal mortality. Registered nurses oftentimes provide the bulk of discharge education to postpartum patients. When their knowledge or confidence levels regarding specific topics are low, this can negatively impact the education they …

Population Assessment To Determine The Eligibility For Birth Center Care At University Of Kentucky Midwife Clinic, Dolores Polito

DNP Projects

Background: The COVID-19 crisis prompted patients to inquire about their options to avoid going to the hospital for birth. Outside of the hospital, birth center care has been identified as an evidence-based model for healthy women during pregnancy and birth, but it is not available in Kentucky.

Purpose The purpose of this study was to determine if there are women eligible for birth center care who have been part of a nurse midwifery service and given birth in a large, academic, tertiary care setting.

Methods: A retrospective chart review was used for this study. It involved a collection of …

Antibiotic Prescribing For Treatment Of Acute Pediatric Illnesses By Advanced Practice Nurses, Deborah J. Whitehurst

DNP Projects

Antibiotic over-prescribing by physicians for the treatment of acute respiratory tract illnesses have been examined in a variety of settings. Different studies have examined nurse practitioner (NP) prescribing practices both in the United States and various international settings. There have been limited studies specifically examining antibiotic prescribing practices in the pediatric population. However, no studies were found which compared population specific NP groups. The purpose of this study was to understand differences in antibiotic prescribing practices among advanced practice pediatric providers.

The goal of this project was to describe and compare antibiotic prescribing practices of pediatric nurse practitioners (PNP) and …

Evaluation Of Kentucky Nurses' Knowledge And Self-Efficacy Related To Safe Sleep And Sudden Unexpected Infant Death Risk-Reduction Strategies, Lisa Mcgee

DNP Projects

Sudden Unexpected Infant Death (SUID) claims the lives of about 3700 infants in the United States each year (CDC, 2015). It is the second leading cause of infant death in Kentucky (KDPH,2015) where it has a rate almost three times that of the nation. The American Academy of Pediatrics (AAP) has made recommendations to decrease the risk of SUID and indicates hospital professionals, including nurses, have a responsibility to educate and model safe sleep strategies for parents. An evaluation of the knowledge and self-efficacy about safe sleep and SUID risk-reduction strategies of neonatal and perinatal nurses in Kentucky birthing and …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

Effect Of A Parent Empowerment Program On Length Of Stay And Parental Stress In The Neonatal Intensive Care Unit, Holly L. Nieves

DNP Projects

PURPOSE: Research surrounding topics in the Neonatal Intensive Care Unit have long been focused on mortality and morbidity of this population. However, consideration of the parent-infant relationship and subsequently adverse outcomes that could be formed during the intensive care stay should be examined. Parent empowerment programs in the NICU have been shown to decrease length of stay, parental stress, and depression. The purpose of this study was to evaluate the impact of the COPE for HOPE parent empowerment program on length of stay, parental stress, maternal depression, and parent satisfaction in the Neonatal Intensive Care Unit with parents of infants …

Breastfeeding Intention Within A Rural Postpartum Population: Does Education Matter?, Brooke Hawkins

DNP Projects

Purpose: The purpose of this scholarly project was to determine breastfeeding intention in a rural population after receiving education from a certified lactation consultant.

Review of the Literature: The benefits of breastfeeding for both mother and child are clearly stated in the literature. Despite the known benefits, rates of breastfeeding are decreased within rural populations. Previous research suggests education about breastfeeding benefits is beneficial in increasing these rates. In particular, previous studies focused on the contributing factors affecting a mother’s decision to breast or formula feed. However, few studies were found strictly evaluating breastfeeding intention after receiving formal …

Evaluation Of Nurses' Knowledge Of "Period Of Purple Crying" Program: Shaken Baby Syndrome Prevention, Cynthia L. Brubaker-Vincent

DNP Projects

Shaken baby syndrome (SBS) and pediatric abusive head trauma (PAHT) continue to be the leading cause of child abuse death and most common causes of mortality and morbidity due to the physical child abuse in the United States (Barr, 2014). According to the CDC of the nearly 2,000 children who die from abuse each year, PAHT and SBS are responsible for 10-12% of those fatalities (CDC, 2015). There are 1450-1700 cases of reported shaken injuries to infants and children reported in the United States each year (Barr, 2014). Shaken Baby Syndrome is 100% preventable through the proper education to our …

A Study Of Provider Practices In The Screening, Diagnosis, And Treatment Of Childhood Overweight And Obesity In A Rural Eastern Kentucky Clinic, Ashley R. Healy

DNP Projects

Objectives: The purpose of this study is to assess the current practices of providers for overweight and obese children at well visits, and how the demographics of age, sex, race, ethnicity, primary language spoken, insurance type, and provider type influence the care provided to overweight and obese children at the study site, which is a rural primary care clinic in eastern Kentucky.

Methods: This study is a retrospective design auditing well child charts (n = 571) from the study site over a two year period. Charts were audited for the data points of age, sex, race, ethnicity, primary spoken language, …

The Effect Of Nurse Dose On Breastfeeding Exclusivity - A Patient Level Analysis, Gwen Moreland

DNP Projects

Background: Breastfeeding is strongly associated with health benefits for children and their mothers. Despite this knowledge, breastfeeding rates in the United States have increased only slightly. Current research examines the relationship between nurse characteristics and patient outcomes in adult intensive care and acute care settings. To date there is very limited research examining nurse variables and outcomes in women and children, and very little knowledge regarding the characteristics of the nurse in relation to patient’s breastfeeding success.

Purpose: The purpose of this practice inquiry project was to evaluate the relationship between the attributes of nurse dose and the immediacy and …

Community Level Assessment For Breastfeeding In The Gateway District, Vanessa Flannery

DNP Projects

Purpose: To assess community level support for breastfeeding in the Gateway District of eastern Kentucky.

Methods: A descriptive study was conducted to identify institutional support of breastfeeding women. Data collected during interviews included community level support based on the framework of the Ten Step program from the Baby-Friendly Hospital Initiative (BFHI) (WHO & UNICEF, 2009) and the Mother-Friendly Worksite Initiative (Texas Department of State Health Services, 2012). Respondents answered questions to determine breastfeeding support from the healthcare, education and business communities.

Results: Of the ten organizations whose representatives were interviewed, 100% perceived health benefits for mothers and infants from breastfeeding. …

Self-Management Education In Hispanic Women With Gestational Diabetes Mellitus (Gdm), Laura B. Hieronymus

DNP Projects

The purpose of this Practice Inquiry Project was to develop, implement, and evaluate the effectiveness of a diabetes self-management education intervention in a population of Hispanic women at risk for gestational diabetes mellitus within a CenteringPregnancy(R) model of care.

Prenatal Anxiety And Cesarean Delivery In A Clinic Population, Carol A. Kirby

DNP Projects

Although there is an abundance of literature on the topics of prenatal anxiety, stress, depression, etc. during pregnancy, very little research has been conducted on the impact of prenatal anxiety on cesarean delivery and the studies which have been conducted have resulted in conflicting results. This study focused on prenatal anxiety in a clinical population, the characteristics of participants with reported high anxiety, and its association with cesarean deliveries. Prenatal anxiety was defined as Spielberger’s state anxiety and measured with the STAI. Data was collected over all three trimesters of pregnancy and post-delivery. The characteristics of participants who reported high …

Assessment Of Organizational Readiness: Parent Advisory Councils In A Children's Hospital Within A Hospital, Suzanne R. Springate

DNP Projects

Background: A children’s hospital within a hospital (CHWH) in the Midwest region of the United States established a strategic goal to become the preferred provider for children in the region. Outcomes in patient and family experience had fallen short of established organizational expectations. Recognizing that parent advisors are an essential component of patient and family centered care, the strategic plan called for integrating parents into formal, advisory roles.

Purpose: The purpose of this practice improvement project was to perform an assessment of organizational readiness to incorporate parents into formal advisory roles at this CHWH.

Methods: A cross-sectional survey design was …

Childhood Nutrition And Lifestyle In Owensboro, Kentucky, Mckenzie J. Mattingly

DNP Projects

According to the CDC, childhood obesity is now one of the leading health problems in the United States. Thirty-five percent of adults in the United States are obese. Kentucky is the 12th most obese state for adults. and the 7th most obese state for children. The State of Obesity: Better Policies for a Healthier America, states that Kentucky’s adult obesity rate is currently 31.6 percent. This is up from 21.7 percent in 2000 and 12.7 percent in 1990. Primary care providers must work to help prevent these numbers from continuing to climb. Since our population of children who are overweight …

An Evidence-Based Toolkit For Human Papillomavirus Vaccine Education Of Female Adolescents In The School Setting, Nancy R. Kloha

DNP Projects

A new vaccine to prevent human papillomavirus infection was approved in 2006 in the United States (U.S.). Uptake of the vaccine has been less than optimal (CDC, 2010c). New venues for promoting vaccine acceptance are needed (Middleman & Tung, 2010). The goal of this capstone clinical project is to create an evidence based toolkit for use by school nurses in educating female adolescents, parents, communities and other healthcare providers about the HPV vaccine.

Schools nurses have daily access to young people in the target group for HPV immunization. A vital component of vaccine acceptance is education of those who are …