Pediatric Nursing Commons^™

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 …

After Discharge Call Management Utilizing A Centralized Call Hub, Susan Webber, Ann Gosdin

2021

Practice Problem
No clearly defined process exists for clarification of discharge instructions or other parental concerns after discharge. Follow-up appointments with the primary care provider or a subspecialist are listed on discharge instructions with the main hospital number to call after discharge. Hospital operators send calls to inpatient units where the patient was most recently discharged. This causes disruptions for nursing floor staff and unnecessary emergency room visits. No literature was identified for calls to a centralized call center after discharge. Literature shows the most frequent reason for calling after discharge were common concerns such as fever, ENT, respiratory and …

Ir Unplanned Line Removals, Toni Haynes

2021

Problem
In 2020, the Hematology/Oncology unit noticed an increased trend in Intravascular Access Devices (IVADs) needing to be removed due to infection or dehiscence of the incision.

Key EBP Practices
A Clinical Nurse Specialist, Central Line Nurse, Bone Marrow Transplant Doctor, and four Interventional Radiologist Surgeons came together to discuss potential causes of the increase in line removals. Team decided to track unplanned line removals. Unplanned line removal criteria are met when a central line is removed within 30 days of placement from an infection or dehiscence. Evidence shows studies looked at 30-day periods for line removals, and line removals …

Nurse: Are You In Pain? Patient: (No Answer), Katie Mclaurin

2021

Many infants and children admitted to the pediatric intensive care unit (PICU) have difficulty self-reporting pain requiring nurses to score pain utilizing the FLACC scale. However, when surveyed, PICU nurses at Children’s Health expressed dissatisfaction with the FLACC scale because it did not accurately assess pain in the PICU population (mean=4.1). An extensive literature review was conducted to determine the best behavioral pain scale to use for nonverbal patients in the PICU. Based on the literature, the COMFORT-B scale was selected. The COMFORT-B scale is a behavioral pain scale validated in the PICU in children 0 to 10 years and …

The Associations Among Parental Emotional States, Adolescent Emotional States, And A1c In Adolescents With Type 1 Diabetes, Jennifer L. Yenke

DNP Projects

Background: This study examined depression and diabetes distress (DD) in adolescents with type 1 diabetes (T1D) and in their parents. Depressive symptoms and DD are associated with poor glycemic control.

Objectives: To describe the prevalence of parental and adolescent depressive symptoms and DD in the sample and to evaluate correlations among depressive symptoms, DD, and A1c in parent-adolescent dyads in which the adolescents have T1D.

Methods: Thirty-two parent-adolescent dyads completed measures assessing depressive symptoms (Patient Health Questionnaire-9) and DD (Problem Areas in Diabetes- Parent of Teen and Teen versions), self-reported socio-demographic and clinical variables, and responded to questions about living …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Anxiety Screening In Children & Adolescents With Type 1 Diabetes Using The Gad-7 Tool, Allison B. Reynolds

DNP Projects

BACKGROUND: Children and adolescents with type 1 diabetes (T1DM) can encounter a variety of factors that affect proper management of their diabetes, including mental health. Youth with diabetes have significantly higher rates of depression, anxiety, and mental health problems compared to the general population. Anxiety is especially prevalent. PURPOSE: The objective of this project was to evaluate anxiety screening of children and adolescents with T1DM during their routine diabetes visits. Specifically, to assess for any trends in anxiety levels and patient characteristics including demographics, insulin regimen and A1C levels. METHODS: A cross- sectional, retrospective review of ambulatory electronic health records …

Optimizing A Pediatric Dka Protocol In A Tertiary Care Hospital System In Northern West Virginia, Jennifer L. Burky

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body compensates for insufficient insulin, producing dangerously high levels of ketones. Without proper treatment, DKA can be fatal. For that reason, staff in the pediatric intensive care unit (PICU) at a tertiary care hospital in northern West Virginia expressed concerns about the complexity of and lack of adherence to a poorly referenced and dated DKA treatment protocol.

Objective: The purpose of this project was to assess the feasibility and sustainability of optimizing the DKA protocol in the PICU. The primary objective was to implement an updated, …

Perceived Neighborhood Characteristics And Parental Role In Physical Activity Of African American Youth, Kashica Webber-Ritchey, Elizabeth A. Moxley, Sungsoon Hwang, Desale Habtzghi, Sai Yalla

Faculty Articles, Papers, and Other Scholarship

Introduction: Lack of physical activity (PA) serves as one of the contributing factors to pediatric obesity in African American (AA) youth.

Objective: Further examination of the Social Ecological Model [SEM] influences on PA in AA youth is vital. The purpose of this pilot study is to explore environmental factors, built environment (BE) and parental role, in PA promotion.

Methods: Using mixed method data collection, a convenience sample of 28 AA parents/caregivers of school-aged children (6-12 years) enrolled in Chicago Youth Programs (CYP) completed an online survey. Parents/caregivers along with their child participated in focus group sessions (n=18 parent/child dyads). …

Perceptions Of Paediatric Surgeons On The Selection & Admission Processes In Master Of Paediatric Surgery : A Qualitative Study, Anand Sanmugam

Student Works (2020-2029)

The selection and intake criteria for the paediatric training surgery training program (Master of Paediatric Surgery) has undergone changes. Changes were instituted to ensure a more robust selection system to ensure that the best candidates were selected into the program. However, there has not been any data to show that these changes have resulted in selection of candidates that could graduate on time and possess the attributes that predicted the development of competencies required. The aim of this study aim was to explore the perspectives of senior paediatric surgeons on the Master of Paediatric Surgery selection and intake process. The …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

An Evaluation Of Adolescent Concussion Management And Guidelines By Primary Care Providers In The Outpatient Setting: Dnp Scholarly Project, Mary Beth Newkirk

Doctor of Nursing Practice Scholarly Project

Understanding the pathology of a concussion has been a challenging task for many experts in healthcare. An agreed upon definition has yet to be developed and many health care providers are not properly educated to assess and care for those suffering from a concussion. Management of concussion in adolescents, a vulnerable population, requires even more consideration and training. The purpose of this study was to determine the knowledge current providers in the four-state region regarding sport-related concussion management in the adolescent population, to improve patient care and outcomes, and to improve knowledge learned through exposure to a clinical practice guideline-based, …

Standardized Bedside Report During The Transfer Of Care, Lauryn Fanning-Goff

MSN Capstone Projects

Optimization of our communication processes can prevent multiple adverse/sentinel events that will also prevent the organization from potentially being held liable to cover those costs. The use of a standardized form of handoff is supported by literature as a way to ensure critical information is not omitted. Completing the report at bedside allows the patient and family to be involved in care, improve patient safety, and enhance patient satisfaction scores (Baldwin & Spears, 2019). Because of this, the PICOT question is: “In staff nurses on a pediatric surgical unit (P), how would a standardized bedside report during the transfer of …

Readiness For Insulin Pump Use In Pediatric Type I Diabetes: A Quality Improvement Project, Valeria Marin

Doctor of Nursing Practice

Background: Insulin pumps are essential in the management of type 1 diabetic pediatric patients because of their versatility in meeting the developmental needs of childhood and adolescence. Summary of the Evidence: There is lack of evidence for standardized pump initiation program in pediatric patients (ADA, 2019). Moreover, adverse events from insulin pump misuse, such as diabetic ketoacidosis, arise from lack of anticipatory guidance of pump management and troubleshooting (Evert et al., 2016; Grunberger et al., 2014, Wheeler et al, 2014). Project Purpose: The purpose of this quality improvement (QI) project was to reduce and prevent adverse outcomes of insulin pumps …