Pediatric Nursing Commons^™

Evaluating The Use Of Stopcocks For Lab Collections From Central Venous Access Devices Related To Central Line Associated Blood Stream Infections, Heather Hollingsworth

DNP Projects

PURPOSE: Central line associated blood stream infections pose a threat to patient safety and are costly to healthcare systems. Heath care professional frequently access central venous access device (CVAD) to obtain blood samples for laboratory analysis. A commonly accepted procedure practice involves exchanging 3-4 syringes during the collection process. Each time a syringe is exchanged during the lab collection process the opportunity for bacteria to be introduced into the bloodstream exists. Decreasing the number of times a CVAD is accessed removes opportunities for bacteria to be introduced to the line thus decreasing the risk of infection. Due to the occurrence …

Parental Knowledge Of Car Seat Safety, Breanne P. Webb

DNP Projects

Background: Injuries sustained from motor vehicle accidents are one of the leading causes of death in children every year. In one year, more than 618,000 children 0-12 years of age rode in vehicles without the use of a proper restraint device at least some of the time. Of the children ages 12 years and younger who died in a motor vehicle accident in 2016 (for which safety restraint use was known), 35% were not buckled up (Centers for Disease Control and Prevention, 2017).

Purpose: The purpose of this project is to evaluate parental knowledge and understanding of car seat and …

Identifying Rates, Barriers And Facilitators For Hpv Vaccines In Children Ages 11-14 In A Kentucky Primary Care Clinic, Sarah J. King

DNP Projects

Background: Among all of the pediatric vaccinations recommended by the CDC, the HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The CDC recommends that adolescents start receiving the human papillomavirus (HPV) vaccine at the ages 9-11 to provide protection against certain strains of HPV that can cause cancer. The goal is to administer the HPV vaccine before the adolescent would be exposed to the virus. However, there has been much resistance and non-adherence to the HPV vaccination. Purpose: The purpose of this study was to identify the current rates of HPV vaccination …

Provider Adherence To Recommendations For Hpv Vaccination In A Family Practice And Pediatric Clinic, Kara Saling

DNP Projects

Background: The HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The Advisory Committee on Immunizations Practices (ACIP) now recommends that children (both male and female) 11 to 12 years of age should start to receive the HPV vaccine before exposure to the virus. However, even with the change in the new guidelines, the HPV vaccine administration rates still trail other adolescent vaccinations.

Purpose: The purpose of this project is to identify pediatric and family practice provider adherence to ACIP/CDC recommendations on HPV vaccinations in a Southeastern United States health system in …

An Examination Of The Knowledge And Screening Practices For Child Maltreatment Among Primary Care Providers, Nicole Cirincione

DNP Projects

Background: Child maltreatment can affect any race, economic status, gender, and age. Primary care providers have contact with children and their caretakers daily and develop bonds that encourage open communication. Screening for child maltreatment risk factors can help discover those in danger and decrease abuse rates. Purpose: The purpose of this study was to examine provider’s knowledge of child maltreatment risk factors and assess screening and documentation practices. Methods: This was a descriptive study that included an electronic survey to primary care providers to assess current knowledge and practices for child maltreatment risk factors. Second, a retrospective chart review was …

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 …

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

Impact Of Education On Provider Knowledge And Screening Practices Related To Childhood Obesity, Natalie B. Fulk

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effect of a provider education program on BMI screening practices and provider knowledge related to childhood obesity by implementing an educational intervention to advanced practice providers in a primary care clinic setting.

METHODS: A pretest/posttest design was used to examine changes in provider knowledge about BMI screening practices in children and adolescents, and lifestyle recommendations after a brief educational intervention was provided. A retrospective chart review was used to assess the screening and management practices for an elevated BMI percentile and provider documentation of lifestyle recommendations.

RESULTS: A total of …

Pilot Of An Educational Module For An Adolescent Congenital Heart Transition Program In The Pediatric Setting, Katie J. Dust

DNP Projects

Abstract

PURPOSE:The purpose of this project was to pilot an educational module on a new congenital heart transition program to be instituted at a large Midwest medical system.The transition program is meant to assist pediatric cardiology patients in transferring from pediatric to adult care. An educational module was developed for inpatient health disciplines who will be involved in the transition program. Before offering the program throughout the medical system, a pilot was conducted to determine if the education was at the appropriate level. The educational module was modeled after the Got Transition Six Core Elements designed by the National Health …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Dyslipidemia Screening In Children Between The Ages Of 9 And 11 Years: An Evidence-Based Approach, Meredith Toms

DNP Projects

PURPOSE: The purpose of this study is to examine the outcome of healthcare provider education on the incidence of dyslipidemia screening in a pediatric primary care clinic.

METHODS: The design of this study was a descriptive pre and post design to evaluate if dyslipidemia screening rates, knowledge, and self-efficacy of healthcare providers changed following an education series at a general pediatric clinic in Lexington, KY. The rates of dyslipidemia screening were calculated prior to providing provider education as well as afterwards to see whether there was an improvement in screening rates. Provider’s knowledge and confidence before the education series was …

An Examination Of Primary Care Providers’ Assessment And Plan Of Care For Children And Adolescents Who Are Overweight Or Obese, Kevin Pinto

DNP Projects

Background: Childhood and adolescent obesity rates have more than tripled since the 1970s. Currently in the United States, one in five children is obese (6-19 years of age). It is important to identify children and adolescents who are overweight or obese because early intervention may help to reduce the long-term implications of obesity. The purpose of this project was to examine how often pediatric primary care providers diagnosed overweight or obesity and created a plan of care for children 6-17 years of age who were overweight or obese. Facilitators and barriers to diagnosing and creating a plan of care were …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

Parent Perception Of Child’S Developmental And Coordination Skills Related To Participation In The Gymnastics Through Early Movement Program, Allison M. Theobald

DNP Projects

This study aims to evaluate the effectiveness of the Gymnastics through Early Movement program in increasing motor ability in children with motor developmental delay or coordination deficits through the perception of the parent. The Gymnastics through Early Movement program is a therapeutic gymnastics program developed by a pediatric nurse and professional member of United States of America Gymnastics. The program was designed specifically for pre-school aged children who experience motor challenges. Over the course of six weeks, each 45-minute lesson included activities and obstacles focusing on fundamental preschool gymnastics skills to develop strength, coordination, and flexibility. The American Academy of …

The Effect Of Transition Readiness Interventions On Adolescents With Diabetes When Transitioning From Pediatric To Adult Clinic, Kimberly Walker

DNP Projects

PURPOSE: The purpose of this study was to initiate a transition readiness program which uses motivational interviewing at the Pediatric Endocrinology Clinic located within the UK HealthCare Kentucky Clinic. An evaluation of this program was conducted by assessing participant outcomes related to readiness for transitioning.

METHODS: This study was a quasi-experimental one group pretest posttest design to assess the effectiveness of transition readiness interventions on adolescent readiness and confidence in transition of care at the Pediatric Endocrinology Clinic located at the Kentucky Clinic. The sample consisted of 14 patients.

RESULTS: No statistical significance was found in the TRAQ tool and …

Getting The Most Out Of Pediatric Screenings, Carly R. Oliver

DNP Projects

Purpose: The purpose of this study was to compare the results of the Ages and Stages Questionnaire to the Survey of Well-Being of Young Children to determine if they produced the same outcomes. The Survey of Well-Being of Young Children offers additional screening tools that address risk factors for child abuse, that the Ages and Stages does not include. This project also surveyed the caregivers completing the questionnaires to determine which questionnaire they found more beneficial.

Background and Significance: In the United States, approximately 15% of children ages 3 to 17 years of age have at least one developmental disability. …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

The Use Of Magnets As Patient Appointment Reminders And Hpv Vaccination Rates, Hayden Kelley

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a patient reminder alert system implemented at a public health department in rural Indiana in an attempt to increase the facility’s human papillomavirus (HPV) vaccination rates.

METHODS: This study was a secondary data analysis utilizing the Children and Hoosiers Immunization Registry Program (CHIRP) database to compare HPV vaccination rates before and after the implementation of an HPV magnet reminder program. The sample consisted of 122 adolescents; 31 patients for the pre-implementation period, July 1, 2015- June 30, 2016 and 91patients for the post-implementation period, July 1, 2016- Jan …

Reducing Preoperative Anxiety In Adolescents Facing Spinal Fusion Surgery, Anna Gayle Parke

DNP Projects

Reducing preoperative anxiety for adolescents facing spinal fusion surgery for the treatment of scoliosis has significant implications for clinical practice and patient outcomes for this specific population. The reality of a pending surgery creates a difficult, uncomfortable, and exhausting state of being that can lead to increased postoperative pain, sleep disturbances, and maladaptive behaviors. This final capstone project inquiry report presents three manuscripts which focus on the reduction of preoperative anxiety in adolescents facing spinal fusion surgery. The first manuscript is a literature review examining current evidence related to preoperative anxiety, adolescents undergoing spinal fusion surgery, and teaching programs aimed …

Evaluating Provider Knowledge Of The Hpv Vaccine In Kentucky, Madeline A. Wilson

DNP Projects

According to the CDC, about 79 million Americans are currently infected with Human papillomavirus (HPV) with an additional 14 million infected annually, most of which are teenagers and young adults. Of these 14 million newly diagnosed cases, approximately 27,000 are diagnosed with a cancer caused by HPV. Kentucky’s HPV vaccination initiation and completion rates are below national estimates.

In 2013, Kentucky’s vaccine completion rate for girls age 13 to 17 was 26.8 percent compared to United States completion rate of 37.6 percent. Kentucky vaccine completion rate for boys age 13 to 17 was 19 percent compared to a United States …

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 …

Childhood Immunization Tracking Practices By Healthcare Providers, Erin E. Clarke

DNP Projects

Childhood immunizations protect children from life-threatening illnesses and are one of the most profound measures of the quality of pediatric primary care, however immunization rates for children under three years old still fall below national goals for up to date coverage. In addition to preventing children from getting serious illnesses, childhood vaccines prevent 21 million hospital visits, prevent 732,000 deaths, and save 1.38 trillion dollars in societal costs. Despite the many benefits of vaccines and the national recommendations, nearly 25% of children ages 19-35 months fall short of receiving all recommended vaccines. Kentucky demonstrates vaccination rates below the national average …

An Evaluation Of The Screening And Management Of Childhood Overweight And Obesity In The Primary Care Setting, Diane L. Crutcher

DNP Projects

Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check …

Assessment Of Migraine Management In Adolescents, Kara L. Scott

DNP Projects

Objective: The purpose of this study is to assess how providers are managing adolescent patients with migraines in Kentucky.

Methods: A cross-sectional descriptive study via a 28-item survey instrument, which is distributed electronically via member listserve to members of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM).

Results: Of the 35 survey respondents, there were 29 respondents who met criteria for participation in the survey. Respondents reported the most common presenting symptom for adolescent migraine was headache. Over half of the respondents (58.6%) initiated treatment with over-the-counter medications, with ibuprofen (65.5%) being the most commonly used. 62.1% of …

An Assessment Of Knowledge And Attitude Towards Stock Epinephrine Among Kentucky School Nurses, Brandi M. Duran

DNP Projects

This cross-sectional, pre-post intervention study was designed to gather information on Kentucky School Nurses attitude and knowledge toward non-prescribed epinephrine auto injectors in Kentucky Schools. All 500 members of the Kentucky Schools Nurses Association received a link to the pretest, educational intervention and posttest via email. Of those, 75 nurses responded and 72 were eligible to participate in the study. The data was analyzed through a paired t-test using SPSS. The results showed an increase in level of comfort with epinephrine, although it was not statistically significant. There was a statistical significance between the pretest and posttest when school nurses …

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 …

Stress In Parents Of Children With Type 1 Diabetes, Megan B. Carter

DNP Projects

Pediatric healthcare providers across the country care for many children with complex chronic diseases. Many of these children are not developmentally mature enough to manage their disease process, leaving the parent of the chronically ill child to manage their disease. The parent of the chronically ill child may experience stress related to their child’s illness, termed pediatric parenting stress, and may have difficulty dealing with this stress (Streisand, Kazak, & Tercyak, 2003). The manuscripts in this Practice Inquiry Project further investigate the relationship between pediatric parenting stress and the health of the parent and the chronically ill child. The instruments …

Pediatric Oncology Nurses’ Knowledge Of Safe Administration Of Chemotherapy/Biotherapy, Leslee A. Bertram

DNP Projects

The introduction of chemotherapy in pediatric oncology tremendously impacted the survival of children with cancer. In the past 60 years, the survival rates of children with cancer have drastically improved with 5-year survival rates of the most common types of childhood cancer nearing 90%. Use of chemotherapeutic agents is not without risk as they are administered in a variety of routes and doses. Disturbingly high error rate ranging from 4% to 18%, depending upon the administration setting (inpatient or outpatient) are reported in the literature (Watts & Parsons, 2013).

Chemotherapy errors have the potential to be lethal because of a …

Assessment Of Nurses’ Views And Current Practice Of Trauma-Informed Pediatric Nursing Care: Oncology, Alesandra S. Conley

DNP Projects

Purpose: The purpose of this project is to: (i) assess and evaluate the awareness, knowledge and current practice trends of pediatric oncology nurses as they relate to pediatric trauma-informed care. Methods: A prospective, cross-sectional sample of convenience was used to assess pediatric nursing staff at the Kentucky Children’s Hospital. The survey used in this study was replicated from a previous study, “Nurses’ Views and Current Practice of Trauma-Informed Pediatric Nursing Care,” authored by Kassam-Adams et al., nurses and doctors affiliated with Children's Hospital of Philadelphia, University of Pennsylvania, Penn State Hershey Children's Hospital, Nemours Child Health System, Children's Hospital of …

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

DNP Projects

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

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