Perioperative, Operating Room and Surgical 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 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 …

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

DNP Projects

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

One Voice Training To Enable Nurses And Anesthesia Providers To Mitigate Pediatric Presurgical Anxiety, Sarah E. Hinnant

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

ONE VOICE Training to Enable Nurses and Anesthesia Providers to Mitigate Pediatric Presurgical Anxiety

Sarah E. Hinnant

Background: Children in the preoperative area experience presurgical anxiety at rates of up to seventy-five percent. Increased pediatric anxiety is directly linked to increased anesthetic requirements, increased risk for development of emergence delirium, and increased time spent in the post anesthesia care unit. Numerous high-quality studies show that intervention by a certified child life specialist mitigates preoperative pediatric anxiety. Often child life specialists are not available to meet with all children prior to surgery. Registered nurses (RNs) and certified registered nurse anesthesiologists …

Implementing Aidet And Commit To Sit To Increase Patient Satisfaction In The Pediatric Outpatient Setting, Tiffany Nguyen

Master's Projects and Capstones

Problem: This quality improvement initiative aims to implement AIDET, Commit to Sit, and culturally competent care in a pediatric outpatient surgery clinic to increase patient satisfaction. The microsystem falls beneath the 85th percentile of patient satisfaction scores on their unit. They have a pre-intervention Net Promoter Score (NPS) of 80.7, indicating about 80% of patients were "promoters" and would likely return to the clinic, and 20% of patients were "detractors" and unlikely to return (Appendix F). "Detractors" were found in areas including patients trusting providers with care, care providers listening, care providers explaining things, and patients recommending the facility to …

Pain Management In Postoperative Pediatric Craniotomy Patients: A Scoping Review, Jessica M. Hiltenbrand Bsn, Rn, Sydney A. Scarbrough Bsn, Rn, Kaitlyn E. Shirley Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose/Background The pediatric craniotomy procedure is a complex and painful procedure that requires adequate pain management and frequent neurological assessments. Generally, evidence for pediatric pain management is severely lacking in research, and evidence for pediatric craniotomy patients is lacking even further. This scoping review aims to collect, condense, and review the current data in order to fuel future studies to establish more data, protocols, and evidence-based recommendations for analgesia in the pediatric craniotomy patient population.

Methods The studies selected were peer-reviewed, published in a medical or nursing journal, included study ages 0-21 years, or provided evidence on pediatric analgesia. Sources …

A Difficult Vascular Access Algorithm Using Intraosseous Devices In The Elective Pediatric Surgical Population, Cory R. Austin

Doctor of Nursing Practice Projects

In pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site …

Improving Nursing Adherence To Pediatric Pain Management Bundle Using The Pdsa Cycle, Stephen W. Lovern

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Given the current standards, pediatric post-operative pain management can be a distressing outcome to the patient and family. Adequate management of post-op pain in this population is a challenge despite the availability of evidence-based interventions combined to form care bundles. Tonsillectomies are common procedures in the pediatric population and often include moderate to severe pain with ineffective pain relief. Inadequate pain management leads to unplanned admissions, longer post anesthesia care unit (PACU) stays, slower oral intake, and longer recovery periods. In this project, two interventions were tested using the plan-do-study-act (PDSA) model for rapid cycle improvements. The first intervention was …

Behavioral Interventions Versus Pharmaceutical Interventions To Reduce Preoperative Anxiety In School Aged Children, Jennifer J. Cline

Honors Undergraduate Theses

Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and …

Implementation Of A Prone Position Pressure Injury Prevention Bundle In The Picu, Lauren Hacker

Dissertations

Pronation is a low cost, high value intervention used in treating children and adults with Acute respiratory distress syndrome (ARDS). Hospital-acquired pressure injury is the most common complication of pronation. While the presence of PI bundles and protocols have been shown to reduce incidence of PI in the prone position there is no standard bundle or protocol found in the literature, and no bundle or protocol specific to pediatric patients. The purpose of this quality improvement project is to create and implement a prone position pressure injury prevention bundle, called “Prone Pack”. This QI project setting was a 40 bed …