Pediatric Nursing Commons^™

Improving Pediatric Asthma Outcomes Through Pictorial Asthma Action Plans, Julia Donovan

Dissertations

Problem: Asthma is the leading chronic disease of children and the leading cause of childhood emergency department (ED) visits, hospitalizations, and missed school days. Asthma action plans (AAPs), including photographs or pictures of asthma medications, symptoms, triggers, and devices, have improved parents’ understanding of their child’s asthma and have increased their comfort level in caring for their child.

Methods: An interventional pre-post study with a mixed-method research design, at a large, urban, primary care pediatric clinic with two locations, evaluated the effectiveness of a pictorial AAP on a child’s asthma control. A pictorial AAP was provided, and a childhood asthma …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh

Dissertations

Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …

Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala

Dissertations

Problem: Working in the Pediatric Intensive Care Unit (PICU), staff encounter critical patient events without warning. Debriefing after adverse patient events has been shown to give staff the opportunity to process these events in an open, honest, and judgement-free environment. Debriefing has been recognized as a tool for detecting medical errors, improving team communication, providing emotional support, and analyzing team performance.

Methods: A descriptive, observational pilot study was used to implement the DISCERN tool into a large, midwestern, urban PICU. The aim of the quality improvement project was to achieve a debriefing tool completion rate of 20% over a one-month …

Effect Of A Trauma Informed Care Tool In A Pediatric Cardiac Intensive Care Unit, Taylor Park

Dissertations

Problem: Parents of infants less than one-year-old with complex congenital heart disease (CCHD) experience significant stress while their child is admitted to the pediatric cardiac intensive care unit (PCICU), often resulting in trauma to parents and their families. Trauma informed care (TIC) seeks to minimize the impact of emotional trauma and it acknowledges previous trauma an individual may have experienced.

Methods: The purpose of this quality improvement (QI) project was to assess the thrive guide’s ability to decrease parental stress in the pediatric cardiac intensive care unit (PCICU). The aim was to decrease parental Perceived Stress Scale (PSS) scores by …

Screening For Social Determinants Of Health In A Comprehensive Pediatric Sickle Cell Disease Clinic, Marie Turner

Dissertations

Problem: Social determinants of health (SDOH) affect health outcomes across the lifespan. The American Academy of Pediatrics recommends routine screening for SDOH. Poverty is a SDOH affecting health outcomes in children, especially in children with a chronic disease such as sickle cell disease (SCD). Children with sickle cell disease have a high burden of SDOH. This project sought to describe the SDOH barriers experienced by pediatric patients with SCD.

Methods: A descriptive survey/observational design, using a convenience sample of pediatric patients ages 0-19 years old in a comprehensive SCD clinic at a large, urban, Midwestern academic medical center was utilized …

Standardized Approach To Early Mobilization Of The Critically Ill Pediatric Patient, Courtney Mccarty

Dissertations

Problem: Many pediatric intensive care units (PICU) do not have early mobilization guidelines in place. Early mobilization (EM) is defined as any exercise initiated for a patient within 48 hours after PICU admission. Several studies show that use of early mobilization in this setting can lead to improved outcomes for pediatric patients such as reduced delirium, maintenance of muscle strength, and little reduction in functional deficits. Initiation of an EM guideline should be done to improve patient outcomes by discharge.

Methods: This QI project used a descriptive design to collect prospective data after a new EM guideline was implemented. …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Evaluating The Rass And Cap-D In A Pediatric Cardiac Intensive Care Unit, Sarah Anderson

Dissertations

Abstract

Problem: Pediatric delirium is highly prevalent in the intensive care setting, as much as seventy to eighty-seven percent. Kalvas & Harrison (2020) found that sixty-six percent of critically ill children in a pediatric intensive care unit suffered from a diagnosis of delirium. Delirium has been widely linked with increased costs, mortality, and length of stay.

Methods: The quality improvement (QI) project used a descriptive design to collect retrospective and prospective data before and after an individualized bedside education session was completed. The QI project used a purposive convenience sampling to assess the ability to accurately identify the presence of …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull

Dissertations

Problem: Over 1/3 of children in the United States are overweight or obese and children’s nutritional status while hospitalized worsens rather than improves. Hospital meals have too many calories, too much sugar, and too few nutrients compared to recommended guidelines for children. The primary purpose of this quality improvement project is to increase the amount of healthy foods ordered by children in a southeastern pediatric hospital unit through implementation of a menu guide.

Methods: A quality improvement pre-post interventional pilot study was done through implementation of a child friendly menu guide promoting healthful eating. Data was collected by retrospective and …

Dental Screening And Caries Prevention In Pediatric Primary Care, Amy Hoch

Dissertations

Problem: Early childhood caries (ECC) is the most common chronic condition worldwide. Although the American Academy of Pediatrics (AAP) recommends all children through age five receive a fluoride treatment during well-child visits, this often does not happen. This project aimed to implement caries risk assessment (CRA) in the pediatric primary care setting and increase the rate of fluoride varnish applications and pediatric dental referrals.

Methods: An observational, descriptive study design was used to review retrospective data and collect prospective data on fluoride varnish applications in a pediatric primary care office located in a Midwestern suburban community. A validated CRA was …

Intimate Partner Violence Education For Pregnant And Postpartum Adolescents And Young Adults, Tatiana Filajdic

Dissertations

Abstract

Problem The commencement of intimate partner violence (IPV) often begins with relationships during adolescence and young adulthood; hence, young age is a risk factor. Young adult females, pregnant and post-partum adolescents are at high risk of experiencing intimate partner violence (IPV).

Methods A prospective, descriptive design evaluating the impact of three IPV education sessions offered over a three-month period at a non-profit shelter specific for young adult, pregnant and post-partum adolescents.

Results Twelve participants attended the sessions (N=12), and seven (n=7, 61.5%) of shelter residents attended at least one IPV education session. A two-proportion z …

Implementing The Richmond Agitation-Sedation Scale To Assess Delirium In A Pediatric Icu, Leigh Paridy

Dissertations

Purpose: The purpose of this quality improvement project was to establish early identification of delirium in the intensive care setting to reduce the impact of long-term patient outcomes. Description of project: A retrospective-prospective medical chart review was completed. The retrospective chart review looked at fifty-two patients admitted to the pediatric intensive care unit (PICU) between October 1, 2020 and December 1, 2020 for patient demographics and State Behavior Scale (SBS) and the Cornell Assessment for Pediatric Delirium (CAPD) charting compliance especially with children with developmental delay and those with a high susceptibility to delirium. The prospective chart review looked at …

The Effect Of Pre-Procedural Opioid Video Education On Pediatric Patients Undergoing Orthopedic Surgery, Amy Pham

Dissertations

Problem The opioid epidemic is a continuing public health threat, growing amongst the pediatric population. Contributing to the issue are their accessibility within the community, and lack of education on safe storage and disposal of opioids.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify the opioid storage and disposal habits of patients and their caregivers at home. The participant and caregiver dyads were shown a brief opioid educational video pre-operatively and were followed up with via emailed survey two weeks post-operatively. The survey contained questions pertaining to disposal and storage habits of …

Preventing Ocular Surface Disease In The Pediatric Intensive Care Unit, Emily Mallette

Dissertations

Preventing Ocular Surface Disease in the Pediatric Intensive Care Unit

Problem: Ocular surface disease in the Pediatric Intensive Care Unit is a significant problem in intubated patients due to altered eye protective mechanics, leading to exposure of the eye surface and dry eye. The purpose of this quality improvement project was to evaluate how an eye care protocol affected the frequency of artificial tear ointment administration.

Method: A descriptive, cohort design utilizing a retrospective chart review with convenience sampling of intubated children in the PICU from two cohorts was used. Comparisons were made between the preintervention cohort in 2020 and …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Implementing A Depression Screening In A Pediatric Acute Care Setting For Adolescents With Type 1 Diabetes, Kelcie Marler

Dissertations

Problem: Depression among adolescents with Diabetes Mellitus type 1 (DM 1) is three times more prevalent than adolescents without chronic disease. Diagnosis of depression has been found to negatively affect the quality-of-care management, quality of life, and results in an increase in hospital admissions with hypoglycemia or hyperglycemia events.

Methods: A depression screening, the patient health questionnaire 9 (PHQ-9), a validated screening tool for use among adolescents was implemented in this quality improvement (QI) project. It was the first cycle of a plan-do-study-act (PDSA) cycle for in a pediatric ICU. Adolescents between the ages of 12 – 18, were …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Timing Of Therapeutic Hypothermia & Short-Term Infant Outcomes, Brooke Rakes

Dissertations

Background: Hypoxic-ischemic encephalopathy (HIE) can result in devastating long-term neurological morbidity and/or death. Current evidence recommends initiating Therapeutic Hypothermia (TH), as early as possible, however, research specifically describing TH timing in relation to short-term infant outcomes is limited with mixed results.

Purpose: Examine TH timing (TH initiation time & time to target temperature) on short-term outcomes (neonatal seizure; brain injury) of infants >35weeks, with suspected HIE, born at a large urban women’s medical center.

Methodology: Retrospective, cross-sectional, correlational design examining data extracted from electronic health record from November 1, 2012- March 31, 2020. Descriptive and inferential statistics were performed.

Results …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Utilizing High Flow Oxygen Therapy In Infants With Bronchiolitis, Sarah Ulses

Dissertations

Problem Bronchiolitis is the leading diagnosis of hospitalizations for children under one-year. The purpose of this study was to evaluate the effectiveness of supportive high-flow oxygen (HFO) therapy for infant patients requiring more than 2L/min nasal cannula (NC).

Methods An observational, descriptive design with convenience sampling of infants aged one-year or less, hospitalized with bronchiolitis and requiring HFO therapy. Comparisons were done between 2019 when no HFO was allowed on the general unit and in 2020 when HFO was allowed.

Results Of 28 patients (N = 28), 13 (n = 13) were in the 2019 cohort and 15 …

Multidisciplinary Team Approach Effect On Pediatric Severe Asthma, Lila Kertz

Dissertations

Problem. Children with severe asthma are more likely to be non-adherent with their prescribed medications, often related to barriers. A holistic assessment of these patients has been suggested, but is not typically performed in most pediatric asthma clinics. The purpose of this project was to evaluate the effects of severe pediatric asthma clinic services designed to perform holistic assessments and provide comprehensive care.

Methods. An observational, descriptive design was used to evaluate the Severe Asthma Clinic for Kids (SACK) created in 2013 using a retrospective database review. A convenience sample of data collected on all children treated in the clinic …

Intimate Partner Violence Screening In Adolescent And Young Adult Females, Emily Myers

Dissertations

Abstract

Problem Adolescents and young adult females are at risk for experiencing intimate partner violence (IPV). Females aged 16- to 24-years of age experience IPV three times more likely than males. Universal screening for adolescent IPV is considered a gold standard for adolescent anticipatory guidance. The purpose of this quality improvement initiative was to evaluate the impact of an adolescent IPV screening instrument in an urban, Midwestern shelter for pregnant adolescent and young adult females.

Methods An observational, descriptive design. All adolescent and young adult females presenting for intake evaluation were screened for IPV using the Healthy Relationship Quiz over …

Fathers' Experiences With Their Premature Infants Or Unhealthy Neonates, Lisa Cummings

Dissertations

Author: Lisa Cummings PhD RN

Fathers’ Experiences with Their Premature Infants or Unhealthy Neonates

Purpose and Background/Significance: Fifteen million babies worldwide are born prematurely each year, impacting a multitude of fathers. The importance of an early close father-infant relationship has been identified as central for the development of the child. Fathers influence on a child’s emotional and cognitive development and their physical well-being and health. Many times, the Neonatal Intensive Care Unit (NICU) is the initial contact environment between a father and his premature infant. Studies have shown that the NICU can be a stressful environment for parents, producing emotional …

Nitrous Oxide Use For Minor But Painful Pediatric Procedures, Samantha Kremer

Dissertations

Problem: Nitrous oxide (N₂O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N₂O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N₂O administration by providers, and cost difference between them.

Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …