Pediatric Nursing Commons^™

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 …

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 …

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 …

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 …

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 …

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 …

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, …

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 …

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 …

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 …

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 …

Parental Report Of The Association Between Screen Time And Social Emotional Development Of Children Aged 18 And 36 Months Old In The District Of Gombak, Malaysia, Catherine Thamarai Thamarai

Student Works (2020-2029)

The increasing popularity of screen-based media has raised public health concern on potential effects of their excessive usage among developing children. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) call for limitation of screen time to one hour per day for children aged two to five years old and children below the age of two are encouraged for screen time avoidance. This study is aimed to determine the influence of screen-based media on early childhood social emotional development from an ecological techno-subsystem perspective. Divided into two phases, the first phase of study involves translation into Malay language …

Non-Traditional Component Of Metabolic Syndrome In Children With Obesity: Assesment Of Tg:Hdl-C Ratio As Insulin Resistance Component, Nur Zati Iwani Ahmad Kamil

Student Works (2020-2029)

Paediatrics metabolic syndrome (MetS) is on the rise parallel to the increased prevalence of childhood obesity. Although insulin resistance (IR) is an important variable in the diagnosis of MetS, the existing paediatric definition of MetS only measures elevated fasting blood glucose (FBG). Arguably, many children with severe IR can still regulate their FBG, especially in children with obesity. Therefore, this study aims to assess the utility of triglyceride to high-density lipoprotein-cholesterol (TG: HDL-C) ratio as an IR marker in the modelling of paediatric MetS among children with obesity using structural equation modelling (SEM). This is a cross-sectional study in which …

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 …

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 …

The Youthful Pandemic, Brook Sahlemariam

Nursing | Senior Theses

This paper attempts to examine the neurological, physical, and societal effects of e-cigarette use among youth and young-adults in North America. Furthermore, the paper investigates the parallels between e-cigarette users, tobacco users, and dual users in regard to behavioral patterns, reasons for use, and age of initiation.