Pediatric Nursing Commons^™

A Quality Improvement Initiative Evaluating Factors Influencing Patient Experience With Virtual Reality During Awake​ Interventional Radiology Procedures, Quynh Dao-Payne

Doctoral Projects

Procedural anxiety and pain are common among pediatric patients undergoing awake interventional radiology (IR) procedures and may negatively affect patient comfort, cooperation, and overall patient experience. Virtual reality (VR) has emerged as a promising nonpharmacologic intervention to reduce anxiety and improve patient-centered outcomes. The purpose of this quality improvement project was to evaluate patient-reported experiences and perceived outcomes associated with VR use during awake pediatric IR procedures at Children’s Hospital Los Angeles.​ A qualitative descriptive quality improvement design was utilized. Twenty pediatric​ patients ages 10–21 years undergoing awake IR procedures with VR as part of standard clinical​ care completed structured …

Improving Emergency Department Throughput: Implementation Of A Nurse-Driven Protocol In Pediatric Fast-Track Patients Presenting With Fever, Kerrigan A. Teeple

Evidence-Based Practice Project Reports

Overcrowding in the emergency department presents significant operational challenges and is associated with adverse patient outcomes (Gottlieb et al., 2020). Despite throughput initiatives, increasing patient acuity and rising census levels continue to strain emergency department efficiency. This quality improvement project evaluated whether implementing a fever-reduction standing order protocol could reduce door-to-provider and door-to-disposition times for pediatric fast-track patients presenting to the emergency department. A review of evidence across 6 databases identified nurse-initiated standing orders as a best-practice strategy to expedite care, improve throughput, and reduce delays in disposition. Guided by this evidence, a standing order protocol for acetaminophen administration was …

Beyond Pico: Building Your Ppco Question For Pediatric Falls, Mayra Garcia

PPCO Resources & Education

No abstract provided.

Measles Vaccine Hesitancy Improvement Bundle To Improve Vaccination Rates In A Rural Outpatient Clinic, Ramie Malone

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction

Despite the Centers for Disease Control and Prevention's recommendations to vaccinate children against measles, a decline in measles vaccination rates has been observed at a rural family medicine clinic. While numerous factors contribute to the decline in vaccination rates—including parental doubts about the necessity of vaccination, concerns about vaccine side effects, and insufficient education—the latter remains a fundamental underlying cause of suboptimal vaccination coverage.

Objectives

This project focused on surveying, educating, and boosting parents' confidence in measles vaccines for children under five to raise the measles vaccination rate.

Methods

This project used a pre- and post-intervention bundle over an …

Benefits Of Animal Assisted Therapy In Pediatric Inpatient Units: A Literature Review, Logan M. Shiflett

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review of literature was to establish if animal assisted therapy (AAT) is helpful in the reduction of stress for patients on pediatric inpatient floors. The PICOT question that led this review was: In pediatric patients, how does animal assisted therapy affect patient outcomes related to increased hospitalizations? The EBSCOhost database, as well as the Web of Science and CINAHL Complete information sources, were used to find relevant studies for this review that assessed the benefits and contraindications for AAT. Key terms such as “animal assisted therapy,” “pediatrics,” and “inpatient” were used to narrow down the …

Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas

Dissertations

Increasing Pediatric HPV Vaccination Rates

Abstract

Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).

Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …

Bowel Regimen Protocol Implementation For Pediatric Patients Following Cardiac Surgery, Eryn Watson

Dissertations

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

Parent’S Health Literacy And Stress Level In The Inpatient Pediatric Setting, Tina C. Smith

Dissertations

Purpose: This study examined the relationship between parent health literacy and stress levels during their child’s inpatient hospitalization.

Background: In 2019, over five million pediatric hospitalizations occurred in the United States. Parents are central to their child’s care, but stress and sociodemographic factors may hinder their ability to understand and apply health information. This study explored how stress and other variables impact parent health literacy during hospitalization.

Methods: A cross-sectional design included a demographic survey, the Perceived Stress Scale (PSS-10), and the Newest Vital Sign (NVS). Bivariate analyses (Chi-square, t-tests) and logistic regression were used to assess …

Effectiveness Of The Use Of An Opt-Out Script To Increase Hiv Screening In Adolescent Clients In Pediatric Primary Care Clinics In West Tennessee: A Scoping Review, Julie Cupples Msn, Rn, Allison Johnson Ms, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.

Methods

A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and …

Improving Medication Adherence For Post-Operative Pediatric Patients With Spanish-Speaking Caregivers Using A Written Medication Action Plan, Carissa Vicente

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This project aims to improve written discharge education, medication adherence for pediatric patients, and medication education retention for Spanish-speaking caregivers.

BACKGROUND

The project was implemented in a children’s hospital in the Pediatric Post-Anesthesia Care Unit. The discharge process for post-operative pediatric patients lacked appropriate written medication education for Spanish-speaking families, placing patients at an increased risk for improper medication use.

METHODOLOGY

A quality improvement method utilizing Plan-Do-Study-Act (PDSA) cycles was used for implementation, with three cycles completed. A written Spanish-translation medication action plan (MAP) was implemented during discharge for Spanish-speaking caregivers, including adaptions to an electronic health record version …

Improving Pediatric Delirium Assessment Documentation And Nursing Knowledge In A Pediatric Cardiovascular Intensive Care Unit, Heather E. Herrera

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Pediatric delirium is prevalent in the Pediatric Cardiovascular Intensive Care Unit (PCICU). It is associated with longer PCICU stays, extended hospital stays, prolonged duration of mechanical ventilation, and higher hospital costs (Mallick et al., 2022). It has also been associated with increased mortality risk and decreased quality of life after hospital discharge (Rohlik et al., 2021). Due to the adverse sequelae associated with pediatric delirium, routine screening with a validated screening tool is recommended (Flagg & Mauney, 2023). Despite consensus guidelines advocating routine screening for pediatric delirium, routine screening is not being completed (Flagg & Mauney, 2023).

Pediatric Medical Traumatic Stress: The Effects Of A Medical Trauma On Development, Psychological Well-Being, And Interventions For Prevention, Emilee M. Stevens

Senior Honors Theses and Projects

Background Pediatric medical traumatic stress (PMTS) is a syndrome of physiological and psychological responses that occur in children following exposure to stressful or traumatic medical events. Experiences such as painful procedures, admission to pediatric intensive care units (PICU) or neonatal intensive care units (NICU), and acute injuries may be traumatic to some children. This integrative review aims to identify risk factors associated with PMTS, examine its impact on child development and psychological well-being, and outline nursing interventions for prevention. Methods A search of ProQuest and PubMed was conducted to identify peer-reviewed articles published in English between 2020 and 2025. Inclusion …

Evaluating The Effect Of A Mindfulness App On Pediatric Nurses Caring For Adolescent Patients Diagnosed With Disordered Eating, Kaitlyn Green

DNP Projects

Abstract

Background. The health and wellbeing of nurses are affected by the demands of their workplace and the people that they care for. In turn, nurses’ wellbeing affects their work and patient outcomes. There are opportunities to address certain workplace structures, systems, and policies that create stressors and lead to burnout, fatigue, and poor mental and physical health. For nurses to continue to provide quality care in environments that have increasing demands, they must first feel healthy, well, and supported themselves. Healthcare leaders have a role in ensuring the wellbeing of their nursing staff. Compassion fatigue is a large focus …

Nursing Simulation For Pediatric Communication: An Integrative Literature Review, Jayla R. Call

Honors Undergraduate Theses

The aim of this thesis is to explore literature focused on enhancing nursing students' communication skills with pediatric patients through simulation. Effective communication is key to building rapport and trust, which are essential for improving patient outcomes. However, nursing students may experience anxiety when interacting with pediatric patients due to limited training in communication techniques. Simulation offers a valuable opportunity for students to practice and refine their skills in a risk-free environment, allowing them to build confidence and competence. An integrative literature review was conducted, utilizing three databases and PRISMA guidelines (Page et al., 2021) to gather relevant studies for …

Improving Mood Scores With Social Robot Dog ‘Pupper’ In Pediatric Cardiovascular Patients, Alyssa Lopez

Master's Projects and Capstones

Objective Pediatric hospitalization has been shown to increase the risk of developmental delays, social isolation, and mental health disorders. Consequently, decreased happiness also results from hospitalization, leading to reduced motivation and less engagement in their care. Aim The aim of this project is to improve the mood of pediatric patients aged 3-25 years by 50% from the patient’s baseline level within one month, from October 16, 2024 to November 13, 2024, on a pediatric cardiac step down unit by utilizing a social robot dog to motivate patients in engaging in their care. Methods Twelve participants between the ages 4-18 years …

An Integrative Review Of Trauma Informed Care With Pediatrics To Minimize Psychological Sequelae Post Discharge, Amber Lee, Courtney Heinzelman

Master's Projects

Each year, a significant number of children sustain injuries requiring hospitalization, and while many recover physically, some face long-term psychological challenges such as post-traumatic stress, anxiety, and depression. This integrative review focuses on adolescents aged 13–18 who have experienced accidental trauma, exploring how trauma-informed care (TIC) in nursing compares to traditional approaches in reducing psychological impacts after discharge. Research suggests that many young patients report mental health symptoms for months following traumatic events. Trauma-informed care prioritizes principles such as safety, trust, peer support, and empowerment, aiming to reduce emotional distress and promote recovery. This review examines the application of these …

Efficacy Of, And Barriers To, Treatment Options For Pans/Pandas, Kayla E. Pray

Senior Theses

Background: PANS/PANDAS are pediatric autoimmune disorders that cause an acute-onset of OCD-like symptoms and/or severe restricted eating, as well as anxiety, irritation, deterioration of fine motor skills, hyperactivity, and other psychiatric symptoms. An estimated 1-2% of the pediatric population is affected. Currently, there is little research published on the treatment options for PANS/PANDAS and there is no evidence-based consensus on the best treatment option.

Purpose: This study aimed to discover the efficacy of, and barriers to, available treatment options for PANS/PANDAS.

Methods: A convenience sample of individuals diagnosed with PANS/PANDAS or their parent/caregiver was recruited anonymously through Facebook support groups. …

The Impact Of Hourly Safety Rounding On Pediatric Fall Rates, Natalie Doskal-Poe

Dissertations

The Impact of Hourly Safety Rounding on Pediatric Fall Rates

Abstract

Problem: Falls are a common adverse event in the inpatient pediatric setting and are a significant risk to patient safety. Environmental factors, such as unclear pathways, bed rails down, beds in high position, and call lights out of reach, are considered avoidable causes of patient falls. The site’s fall data in a 12-month period from January 2023 to January 2024 showed (n=9) patient falls occurred with (n=5, 55.6%) due to environmental factors. The purpose of this Quality Improvement (QI) pilot project was to assess the …

Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces In The Picu, Emily Heth

Dissertations

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the …

Improving Nurse Response To Seizure Events In A Pediatric Epilepsy Monitoring Unit With Use Of A Standardized Process, Stacey Obst Paule

Dissertations

Problem: Nurses responding to seizure events in the pediatric epilepsy monitoring unit (EMU) should initiate a neurological exam in addition to managing seizure activity. When nurses respond to these events, however, there can be significant variability, which can result in diagnostic inaccuracy and adverse patient outcomes. The purpose of this project is to implement a nursing response checklist and neurological assessment guide to standardize the process of response to seizure events in the pediatric EMU.

Methods: This quality improvement (QI) project utilized a cohort study design. Standardized tools were placed in an accessible area outside patient rooms. Education was provided …

Best Practice: Implementation Of A Central Line Bundle To Reduce Central Line-Associated Bloodstream Infections, Alexis N. Montero

MSN Capstone Projects

Central line-associated bloodstream infections (CLABSIs) are among the most frequent health care-associated infections and are reported to be correlated with an increased number of inpatient days, higher cost, and attributable mortality rates (Devrim et al., 2016). For this reason, central line bundles (CLB) have been widely used in hospitals to aid in the decrease of CLABSIs. Through implementation of the prevention strategies included in CLBs, CLABSIs can be reduced by greater than fifty percent (Devrim et al., 2016). A decrease in CLABSIs is clinically significant with the avoidance of negative patient outcomes and a decrease in healthcare costs (Rinke et …

Development Of A Positive Urinalysis Criteria Using A Machine Learning Approach, Kari Flicker, Jessica Parrott, Tammy Speerhas, Turaj Vazifedan, Theresa Guins, Jeffrey Bobrowtiz, Anne Mcevoy, Jade Eves, Debra Conrad, Benjamin Klick

Ellmer School of Nursing Faculty Publications

Background: Urinary tract infections (UTIs) are a commonly encountered diagnosis at pediatric urgent care (UC) centers. The urinalysis (UA) is usually the initial study in UC settings used to guide decisions regarding initiating empiric antibiotics and/or pursuing urine culture. However, studies in pediatric UC settings examining the ideal threshold for a positive result are lacking.

Methods: UA result data were extracted from the records of 6,327 pediatric patients, which were collected as part of a previous QI project. Logistic regression was used to determine the predictors of positive urine cultures. Decision trees for a positive UA result for both clean …

Increasing Pediatric Vaccination Rates Through Parental Education At A Federally Qualified Community Health Center: An Evidence-Based Quality Improvement Project, Dayna Dicola

Master's Theses and Capstones

Background: Childhood immunization rates for children aged 2 years and under at a community health center were assessed and determined to be below optimal levels. Immunizations protect against preventable diseases (Hill, 2023). The project assessed the microsystem to understand low immunization rates and to guide strategies for improvement.

Methods: The Plan-Do-Study-Act (PDSA) model was used. In the planning phase, key stakeholders were consulted to assess current rates and barriers contributing to immunization rates. The chosen intervention was placed simplified immunization schedules in pediatric exam rooms to educate parents and promote adherence.

Intervention: A visual guide detailing the recommended vaccination schedule …

Dance Movement Therapy For Pediatric Oncology Patients And Its Effect On Cancer Therapy-Related Symptoms, Victoria M. Trautwein

Honors Undergraduate Theses

Background: Pediatric cancer patients are susceptible to emotional distress, depression, anxiety, and physical symptoms impacting their quality of life. Dance movement therapy is a non-pharmacological method that has been shown to improve feelings of depression, anxiety, emotional, somatic symptoms, and overall quality of life. While much of cancer research is dedicated to finding cures, it is also important to focus on identifying methods for improving the symptoms and quality of life for pediatric cancer patients.

Aim: The purpose of the literature review is to examine studies that show the effects of dance movement therapy on pediatric oncology patients’ cancer-treatment related …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

Implementation Of A Structured Discharge Checklist For Children Admitted To The Hospital With Acute Asthma, Nicholas Fleming

Dissertations

Abstract

Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge

Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an …

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 …

Efficacy Of Distraction Therapy In Reducing Needlestick Pain In Pediatrics: A Scoping Review, Ashlan Ritchie Bsn, Rn, Anne Evans Bsn, Rn, Charlotte Isabel Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac, Chppn, Bmtcn

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric pain management is often overlooked due to time constraints and lack of resources or education on interventions used, such as distraction or pharmacological therapy. Lack of pain management leads to patient and caregiver distress, as well as an increased number of attempts to perform the procedure. This scoping review evaluates the efficacy of distraction therapy compared to nonopioid pharmacological interventions for acute needlestick pain in children ages 6 to 12 years; patient and caregiver levels of distress were also evaluated in most studies.

Methods

The UTHSC (University of Tennessee Health Science Center) Library database was searched for full-text …