Pediatric Nursing Commons^™

Overcoming Obesity: Provider Reminders And Education In Pediatrics, Michelle Warren

Evidence-Based Practice Project Reports

The prevalence of pediatric overweight and obesity is rising globally (Di Cesare et al., 2019) and results in lifelong chronic health problems and an estimated annual healthcare cost of $14.1 billion (Trasande & Chatterjee, 2009). The purpose of this evidence-based practice project was to address overweight and obesity in patients between the ages of five and 12 years through the provision of provider reminders, education, and guidelines. Primary outcomes included frequency of diagnosis, frequency of patient referrals, return to see times, and frequency of patient nutrition and activity education while secondary outcomes included patient weight, body mass index (BMI), and …

Dnp Final Report: The Impact Of The Care Coordination Management Tool On Children With Special Health Care Needs, Keisia N. Sobers-Butler, Ms, Bsba, Rn, Cmcn

DNP Final Reports

Children with Special Health Care Needs (CSHCN) population, account for 30% of spending or $233.5 billion of the costs (Bui et al., 2017). Identifying barriers to care in the CSHCN population can be multi-faceted and complex incorporating high utilization of time, and clinical resources. This project aims to evaluate the impact of care coordination, and utilization on the CSHCN population through a Patient-centered Medical Home, use of embedded case management assessing this population through using the evidence-based Care

Coordination Management Tool (CCMT). CSHCN (N=117) and families were assessed using the CCMT at every interaction from September 1, 2020 – November …

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 …

Effects Of Socioeconomic Status On Glycemic Control In Children And Young Adults With Type 1 Diabetes, Julianna Morgan

Undergraduate Research and Scholarship Symposium

The purpose of this research presentation is to identify the relationship between socioeconomic status and glycemic control in children and young adults living with Type 1 diabetes. Poor blood glucose regulation can often lead to various lasting complications such as chronic kidney disease, loss of eyesight, infection, and even death. These can be devastating to an individual, yet preventable. The complications resulting from the lack of strict glucose regulation are a significant problem currently facing healthcare and disproportionally affecting patients from lower socioeconomic groups. Using CINAHL, research studies about the relationship between type 1 diabetes control and socioeconomic status were …

Improving The Quality Of Care For Pediatric Psychiatric Patients In The Emergency Department, Joseph L. Greene

Doctor of Nursing Practice Projects

Pediatric patients (17 years and younger) in mental health crisis are arriving in the emergency department in increasing numbers because there is a lack of mental health crisis care in the community setting. The emergency department is crowded, lacks a dedicated area for psychiatric patients that is quiet and safe, and staff are inadequately trained in psychiatric competencies. A quality improvement project was approved by Boise State IRB to train RNs in psychiatric competencies. Telepsychiatry provided timely evaluation by a qualified psychiatric provider. Patients’ perceived meaning of the ED visit was evaluated using the Patient Evaluation of Emotional Comfort Experienced …

2021 Nursing Annual Report, System Of Texas Children's Health

2021

No abstract provided.

Enteral Nutrition Protocol For Pediatric Burn Patients: A Quality Improvement Initiative, Margaret Tepe

Doctoral Projects

Objective: This quality improvement project was conducted to determine the efficacy of an enteral feeding protocol to improve nutrition supplementation in pediatric burn patients.

Methods: Non-ICU patients with >10% total burn surface area requiring enteral nutrition supplementation were fed within 12 hours of admission or with the first sedated dressing change, whichever took place first. Pre (n = 3) and post (n = 5) implementation of the enteral feeding protocol data were obtained. Data were collected via chart audit and survey.

Results: Patients and nurses had similar characteristics; and nurses had similar nutrition practices. Total intake of calories (93.8%) and …

Utilizing Educational Materials To Change Vaccine Compliance In Children Under 24 Months Of Age, Kelsey M. Arnold

Doctoral Projects

Background: Childhood vaccinations are critical to preventative care for the pediatric population. The goal for the clinic’s combination 10 insurance quality measure, which reflects the number of fully vaccinated children by 24 months of age, is to be greater than 68%.

Purpose: This quality improvement project sought to implement evidence-based interventions to improve childhood vaccine compliance by increasing the parent/caregiver’s knowledge about vaccines and increasing the communication with their healthcare provider.

Methods: A parent friendly vaccine schedule, information pamphlet, interactive video, and survey were given to parents/caregivers during well-child visits. A total of 117 parent/caregiver surveys were collected. Vaccine compliance …

Tracheostomy Education For Pediatric Patients And Parents, Jonathon Batts, Kendall Baker

Scholars Week

To begin this project, we found that this specific facility did not have proper education given to parents about pediatric tracheostomies. Pediatric patients with tracheostomies are a very delicate population that requires extensive, round the clock care. We were able to establish a theoretical framework with Orem’s Self-Care theory that matched very well with our topic, and finally we were able to find research articles that looked at this patient population specifically. The need for a tracheostomy in pediatric patients can lead to extreme anxiety in patients and parents. Our recommendations for this facility would be to implement the “Trach …

Joining Forces: A Response To Limited Clinical Sites During The Covid-19 Pandemic, Katherine Dixon, Leah Hawsey, Jan Shows, Candace Gandy

Journal of Interprofessional Practice and Collaboration

Students who are unable to attend Pediatric clinical during the COVID-19 Pandemic needed an alternative method to meet the clinical objectives of the nursing curriculum. Utilizing semester-five management students to implement a simulation activity with the semester three pediatric students allowed the opportunity to simulate clinical experiences and develop interpersonal, clinical, and professional skills. Allowing the semester five students to pre-brief, implement, debrief, educate and mentor the semester-three pediatric students allowed the students to meet their course objectives and develop skills in patient-centered care, safety, informatics, documentation, delegation, education, and mentoring.

Preventing Insulin Storage And Administration Errors, Makena Reddick

Scholars Week

■The research problem was discovered when nurses were observed storing and administering insulin improperly. The objectives of this project were to find the correct policies for these procedures, obtain research that backed these policies, and present this information to nurses to create a safer habit. In researching, it was found that reducing the physical distance between a person completing work and the materials required to do so increased compliance (Gibbs & McLernon, 2017). In a second study, the delivery of safe, effective and high-quality care for patients with diabetes in the community is dependent upon (district) nurses having appropriate knowledge …

Evidence-Based Practice: Delaying Infant Bathing, Gabrielle Wadle, Grace Frankland

Scholars Week

A hospital's policy regarding infant bathing is currently not congruent with best nursing practice. The hospital’s current policy is to bathe an infant once they are stable and their rectal temperature is at or above 98.6 °F. Although the infant may become stable within the first 24-hours of birth, the World Health Organization recommends that, “Bathing should be delayed until 24 hours after birth.” (2013, p. 4). Research has been completed to support delaying infant bathing until 24 hours post-delivery, suggesting potential modifications to current policy.

Pediatric Wound Care: Establishing A Consensus Group To Develop Clinical Practice Guidelines, Ryan Krasnosky, Geran Barton, Linda Highfield, Sheila Martinez, Stephen Linder, Edward Buchanan, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care.

Methods. The goal was to recruit a …

Exploring Parent Perception Of Adverse Childhood Experiences Screening In Pediatric Primary Care: A Clinical Inquiry Project, Kathryn Stevens

The Eleanor Mann School of Nursing DNP Capstone Projects

This manuscript explores the incidence and implications of Adverse Childhood Experiences (ACEs) and outlines a project assessing parental perception of their own ACEs screening during their child’s wellness visit. ACEs are adversarial events occurring during childhood, which may be chronic or singular. Abuse, neglect, and household dysfunction result in negative outcomes, including compromised neurological development and cognitive behaviors, developmental delays, poor lifestyle choices, and reduced mental and physical health. Additionally, a growing body of literature supports the impaired parenting skills in those with a history of ACEs. This can perpetuate intergenerational trauma, deprived opportunities, and poor familial health. Despite the …

Program Evaluation Of Parent Engagement Activities In The Pediatric Cardiac Intensive Care Unit, Cheryl A. Bos

Doctoral Projects

Introduction: Leaders of a six-bed pediatric cardiac critical care unit identified the need to evaluate family engagement in patient care activities prior to implementing quality improvement initiatives. This program evaluation identified staff and family perception of barriers and facilitators to parent engagement in the Pediatric Cardiac Intensive Care Unit.

Methods: Data were collected through quantitative and qualitative methods. Surveys collected staff baseline and parent pre-/post-hospital perception of the role of family engagement in caring for the child.

Results: The Questionnaire of Factors That Influence Family Engagement survey of 58 registered nurses indicated the nurse workflow (τb = .579, p = …

Connected Care: The Relationship Between Infant-Caregiver Interaction & Preterm Infant Development, Amelia G. Williams

University Honors Theses

This thesis encompasses how families and healthcare workers alike can uplift preterm infants’ development in the Neonatal Intensive Care Unit. The use of positive facial expressions, skin-to-skin contact, verbalizing with the infant, quality time, and focused attention are explored to promote the preterm infant’s positive development. Additionally, this thesis includes research on optimizing the transition from hospital to home for both parents and infants.

This thesis aims to gather information that caregivers can easily reference and put into action with preterm infants. At the end of each body paragraph, the reader can promptly locate summarizing bullet points of how caregivers …

A Practice Innovation To Improve Staff Vaccination Knowledge And Skills, Ijeoma Ugochukwu

Nursing Posters

Abstract:

The practice improvement project explored the best practices for equipping CentraCare Health System's (CCHS) Licensed Practical Nurses (LPNs) and Certified Medical Assistants' (CMAs) with childhood vaccination knowledge and communication skills necessary to educate hesitant patients and parents about the benefits of vaccination compliance. Innovative computer-based education (CBE) was identified and developed to empower LPNs and CMAs working in the ambulatory setting with childhood vaccination knowledge and communication skills to improve their ability to educate hesitant patients and parents about the benefits of vaccination. The CBE module was guided by the Theory of Planned Behavior in identifying vaccination knowledge and …

Nursing Student’S Expectancy-Value Regarding Sudden Infant Death Syndrome Knowledge Retention, Raquel Suba

Nursing | Student Research Posters

Sudden Infant Death Syndrome (SIDS) is a sudden and unexpected death within the first year of life, which is attributable to unexplained causes after autopsies and full case investigations are unable to resolve the reason for death. Annually in the United States, approximately 3,600 infants die unexpectedly and suddenly of Sudden Unexpected Infant Death (SUID) and in 2018, there were 1,300 infant deaths due to SIDS (CDC, 2018). Despite American Academy of Pediatrics (AAP) recommendations promoting the endorsement and modelling of SIDS risk-recommendations from birth, studies reveal that both nursing students and registered nurses have deficient knowledge in adequate SIDS …

Exploring Nurse Beliefs And Perceived Readiness For System-Wide Integration Of Evidence-Based Practice In A Large Pediatric Health Care System, Lindsey Patton, Mayra Garcia, Virginia Young, Jerithea Tidwell

2021

Background: Implementation of evidence-based practice within healthcare leads to improved patient outcomes, high quality care, job satisfaction, reduced nursing turnover, professional autonomy, and validates nursing practice. Although there is a plethora of research focusing on implementation of EBP, little attention has been given to assess organizational readiness for integration.

Aims/ Methods: The primary aims were to explore nursing beliefs and attitudes about EBP using the Evidence Based Practice Beliefs Scale (EBPB) and the culture and readiness among pediatric nurses for system wide integration of EBP using the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice (OCRSIEP).

Results: Overall …

How A Crew Of Experts Can Pave The Road To Quality Improvement Inpreventing Central Line-Associated Bloodstream Infections, Ginny Leinweber, Angie Morris, Kendra Shotts-Fraser

2021

Purpose

To improve outcomes for PICU patients with central lines by reducing central line-associated bloodstream infections (CLABSIs) and meeting a 2021 goal rate of < 1.3 infections per 1000 central line days.

Background

PICU CLABSI rates increased from 2.2 in 2019 to 2.6 in 2020. Despite this increase, Quality and Safety data showed high compliance to CLABSI prevention bundles and no evident trends to inform improvement efforts.

Methodology

PICU leadership and CNS met to discuss quality improvement solutions to supplement routine safety cards and decrease CLABSI rates. This team developed a plan for a group composed of designated bedside staff and unit leaders who would focus on reducing …

Squashing Superbugs: Using Procalcitonin Levels Toidentify Bacterial Infections To Direct Antibiotic Therapy, Janna Berg, Tera Holland, Krista Westbrook

2021

The current standard in diagnosing and treating pediatric infections is obtaining cultures, interpreting complete blood count results, and following the trends of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Infection triggers an inflammatory response; if untreated or mistreated, this microbe invasion can lead to sepsis. The purpose of this submission is to address the promising use of procalcitonin levels (PCT) as a superior marker in the early detection of bacterial infection via a scholarly literature review. 

Studies involving PCT are more readily found in the evaluation of the neonatal population and in adults with respiratory illnesses. Pediatric studies are …

Exploring Child Anxiety And Family Satisfaction In Thepre Anesthesia Clinic, Ann Johnson, Bonita Conley, Brenda Fields

2021

Studies show that families experience anxiety in the perioperative period. From the child’s perspective, coping with stressful experiences varies according to their appraisal of the situation, their experience and cognitive stage. Child stress or anxiety is best ascertained by self-report, and there is lack of evidence about the child's perspective during the pre-anesthesia period, as well as factors that relate to child anxiety. Purpose: The purpose of this project was to explore child report of anxiety during the pre-anesthesia clinic visit prior to a scheduled procedure with general anesthesia in a sample of patients ages 7 to 17 years. We …

Picu Team Member Innovative Support Planintentional Caring Practices To Mitigate Moral Distress, Secondary Trauma, Andburnout In The Intensive Care Unit., Ginny Leinweber, Kendel Richards, Jessica Roumillat

2021

Situation:

PICU staff frequently verbalize feelings of moral distress, anxiety, and exhaustion related to repeated exposure to complicated, ethically challenging situations and the intense nature of work in the PICU. Stressors associated with complex long term patient cases, deaths, medical errors, and adverse events are compounded by factors like the pandemic, high patient acuity, and instability of staffing. Collectively, these situations increase the risk of burnout and decreased job satisfaction.

Background:

Research shows that cultivating resiliency practices can improve overall well-being of the individual and lessen burnout and turnover. Though the hospital offers a program (RISE) that promotes resilience, integrated …

Pediatric Emergency Department Nurse’S Knowledge And Attitudes Of Pediatric Fluid Resuscitation, Tannah Kimberly O'Brien, Kerry Nolte Phd, Fnp-C, Denise Downey Msn, Rn-Bc, Cpen, Debra Lajoie Jd, Phd, Msn, Rn, Esq., Allison Ivers Msn, Rn, Cnl, Kathleen Sultan Bsn, Rn, Cpen

Honors Theses and Capstones

Background: Rapid fluid resuscitation is essential to the management of pediatric shock, but there are many barriers to published guideline adherence. Limited evidence describing emergency department (ED) nurse’s knowledge and attitudes of fluid resuscitation exists. This study described pediatric ED nurse’s knowledge and attitudes of fluid resuscitation.

Methods: This single-site descriptive study used survey methodology. A 23-question survey was distributed to nurses in the ED at Boston Children’s Hospital. The survey measured nurse’s knowledge, attitudes, and perceived barriers to fluid resuscitation.

Results: Findings suggested gaps found between actual and perceived knowledge consistent with prior evidence. There was a 50.9% response …

Promoting Patient Safety Using Virtual Safety Huddles, Rachael Burris-Alcala, Julie Baker, Ann Gosdin

2021

Background: Staff Safety Huddles have been shown to improve communication and to help make patient safety a priority. Conducting daily safety huddles in Plano ACS are difficult because of how each nursing unit is structured. There are four units with 12 beds in each unit. The units are separated from each other and only have one charge nurse for all four units. Finding a solution to conduct daily huddles was a priority. Safety huddles occurred daily on both day and night shifts. Although the safety huddles helped identify safety concerns, it did not solve the problem of the entire …

Improving Pediatric Healthcare Workers Personal Safety Through The Implementation Of A Behavioral Rapid Response Team, Jennifer Brown, Diana Montoya

2021

From 2017 to 2018, a metropolitan pediatric hospital noted a 62.6% increase in calls to security for uncooperative patients related to physical aggression and acute behavioral decompensation. Even with annual de-escalation and restraint training, a 2019 survey conducted by clinical educators discovered only 27% of staff felt safe when handling an aggressive patient. This drove a collaborative initiative to formulate a multidisciplinary Behavioral Emergency Response Team (BERT) to standardize care, emergently respond in behavioral situations, and act as a resource to staff. Nurse professional development (NPD) specialists were used to create and develop a multifaceted education approach including instructor-led training, …

Improving Catheter Associated Urinary Tract Infection Rates Of Pediatric Patients Through Standardization Of Catheter Care, Shelby Beyers, Jenna Buys, Hayden Dutton

2021

Background/Significance: Pediatric patients with urinary catheters are at an increased risk for developing Catheter Associated Urinary Tract Infections (CAUTI). Standardization of urinary catheter care improves CAUTI rates. At Children’s Health, the CAUTI rate increased from 2 infections to 10 infections from 2018 to 2019. Review of organizational policy revealed that urinary catheter care practices were not standardized. Bedside staff performed catheter care with soap and water but utilized different methods and supplies, leading to variability in practice.

Purpose/EBP Question: The purpose of this Evidence Based Practice (EBP) project was to standardize catheter care throughout Children’s Health. Nurse resident sought …

Decreasing The Risk: Early Discontinuation Of Urinarycatheters Through Nurse Led Removal Program, Valerie Tidwell, Victoria Washington, Ginger Young

2021

Purpose- Improve outcomes and safety for PICU patients through an Evidence Based Practice (EBP) approach to reduce catheter associated urinary tract infections (CAUTI)

PICO For pediatric patients in the ICU does a nurse driven urinary catheter (UC) program with discussion in rounds decrease urinary catheter utilization as compared to current practice?

Background There was an increased rate of CAUTI in the PICU between 2018 and 2019. UC necessity was not often discussed in rounds. The cost of a CAUTI is estimated to be between $1000- $13,793 per episode. Also associated with CAUTI are increased LOS (approximated at 2.3 days), excess …

Improving Patient Safety By Predicting Early Deterioration In Thepediatric Pulmonary Population, Christina Smith, Lindsey Patton, Peng Chen

2021

Background: The inpatient pulmonary unit (D9) utilizes a modified pediatric early warning score (PEWS) to identify deteriorating patients. D9 emergency team activations and code event reviews found PEWS documentation discrepancies and inaccuracies. 66% of D9 nurses reported PEWS scores are inaccurate for the pulmonary population and this is a major barrier to using PEWS. The Iowa model was used to identify a different tool, compare psychometrics, and measure nurses’ perceptions to establish the best early warning tool for pediatric pulmonary patients.

Methods: Inclusion criteria was patients admitted to D9 with baseline tracheostomy, oxygen, or invasive/non-invasive ventilation. Literature review revealed no …

Initial Results Of The Asq (Ask Suicide Questions)Patient Questionnaire Inplemented At Children’S Health, Jane Miles, Karla Hutcherson, Jennifer Brown

2021

OBJECTIVE

Our goal was to assess the outcome of recently implemented hospital wide questionnaire ,Ask suicide Screening Questions (ASQ), for all patients seen at Children’s Health ER from April to December 2018.

BACKGROUND

Suicide is the second leading cause of death in youth ages 10-24 and is a significant public health problem. Early identification and treatment can have an impact on the number of youth suicides.

METHOD

Due to demand, a specific workflow was created and implemented hospital wide. ASQ questionnaire consists of 5 questions. If patient answers “no” to first four questions, the fifth question is not asked. If …