Matching Items (6)
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- All Subjects: Pediatrics
- Creators: Bucci, Aimee
- Creators: Davis, Mary
Description
Early childhood environment is critical to subsequent physical health in children and is influenced by children's primary caregivers \u2014 typically mothers. Maternal stress, one aspect of a child's environment, may shape the functioning of the child's physiological stress response system, which has been linked to later health outcomes, including pain. The current study evaluated whether: 1) early maternal stress, defined as maternal depressive symptoms and low socio-economic status, predicts later child pain; 2) early maternal stress relates to later child daily cortisol output; and 3) child's cortisol output across the day mediates the relation between early maternal stress and child pain. Maternal stress was assessed via questionnaires at twin age 12-months. At twin age seven years, twins' salivary cortisol was collected three times per day for three days. At twin age nine years, twins rated how often they experienced stomach, headache, and back pain weekly or more frequently. Results of multilevel linear and logistic regression analyses showed that early maternal stress did not predict later children's daily cortisol output or extent of child pain. Therefore, findings were inconsistent with the proposed mediation model. However, there was a marginally significant negative relation between child daily cortisol output and later extent of child pain. Current findings suggest that functioning of the stress response system, reflected in cortisol output, may have implications for the development of child pain. Future work evaluating intensely stressful early environments may provide clues about the links between a child's early environment and the development of his/her stress response system.
ContributorsRoth, Winter Rayne Nicole (Author) / Davis, Mary (Thesis director) / Miadich, Samantha (Committee member) / Department of Psychology (Contributor) / School of Molecular Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-12
Description
Children's chronic pain has many contributing factors, including family environment, genetics, and parenting. Still, pediatric chronic pain remains understudied, and little research has been conducted on predictors of child pain onset. This study aims to elucidate some of these factors by examining the role of parenting style and parental pain in children's chronic pain experience. The study answered the following questions: 1) Is child chronic pain heritable?; 2) Do parenting styles and/or parental pain predict child pain?; and 3) Is parenting style the mediating variable in the relation between parent pain and child pain? A twin study design was employed to account for both genetic and environmental influences in pain. Primary and secondary caregivers completed pain questionnaires regarding their own and their children's pain. The caregivers also completed questionnaires regarding their own parenting styles. Observer ratings were used as additional measures of primary caregiver parenting. Results indicated that child pain is heritable and that parental pain was significantly related to child pain. However, parenting style did not predict child pain and was not a mediator in the relationship between parental pain and child pain. Further research on other parenting factors or predictors of pain may lead to prevention of pediatric chronic pain or more effective management of child pain symptoms.
ContributorsPatel, Maya (Author) / Davis, Mary (Thesis director) / Lemery, Kathryn (Thesis director) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
Objective: Delirium frequently occurs in Pediatric Cardiac intensive Care Units (PCICU) of hospitals with critically ill patients. An inflammatory process of the brain causes neurotransmitters imbalances and neuronal alterations, leading to increased days on mechanical ventilation, length of stay in the ICU, and possible self -harm. Delirium can be reduced and controlled if detected early through frequent patient monitoring and screening. The purpose of this project is to evaluate the implementation of a delirium screening tool along with education on delirium
Study Selection: An education module on delirium and the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool along with a non-pharmacological bundle was implemented on a pediatric cardiac intensive care unit for patients 2 to 18 years of age, admitted to an Arizona metropolitan children’s hospital. All nurses were required to attend the education session. Data was collected by using pre- and post-survey questions on delirium for those nurses who chose to participate in the study.
Data Synthesis: The results from the pre- and post-tests suggest there was an increase in education. The average score for the 15 nurses on the pre-test was 87.1% while the same nurses scored 100% on the post-test. Chart reviews of the CAP-D screening tool from November 2000 – February 2021 had 71 patients on the unit and had 8 patients scored on the CAP-D screening tool. Chart reviews after implementation of the education module from November 2021 – February 2022, were conducted and 118 patients were on the unit while only 23 patients were scored on the CAP-D screening tool.
Conclusion: So far, the use of an education module and implementation of a non-pharmacological bundle has proven some promising results in helping with delirium and its reduction in the PCICU.
ContributorsHernandez, Ricardo (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Objective: To understand and prevent adverse discharge events, the project assesses the needs and gaps of discharge care coordination for child(ren) with medical complexities (CMC). The National Survey of Children’s Health show 87.4% of CMC does not receive care in a well-functioning system, and 47.4% did not receive adequate care coordination 1. Therefore, does initiating measurement tools and communication before and after discharge identify and prevent discharge related adverse events?
Methods: After IRB approval, a mixed-methods approach project occurred at southwestern pediatric free-standing hospital. Through eight weeks of convenience sampling, CMC caregivers were recruited in the inpatient setting (n=5). Qualitative and quantitative data were obtained through: [Pediatric] Care Transitions Measurement Tool – 15 (CTM- 15), with a Cronbach’s alpha of .932; a demographics survey; a post-discharge survey; and electronic health records.
Results: The CTM-15 post-discharge score was 83.3 (N = 4, SD = 9.83, SE¬M = 4.92). CTM-15 qualitative data included: communication issues; rushed discharge; poor discharge anticipatory guidance; hospital policy concerns; follow-up appointment issues; and prescription errors. LOS average for all participants was 137.8 days (SD = 102.75, SEM = 45.95) with 40 unintended hospital days (SD = 41.55, SEM = 18.51). Issues encountered 30 days post-discharge included: prescription errors, follow-up issues, and home health issues.
Conclusion: Hospitalized CMC have an increased risk to encounter a discharge adverse event because of a complex intertwining of disciplines, services, medications, and needs. Communication, tools, and surveys did not capture all the problems encountered by families with CMC; however, it did identify areas of notable concern.
ContributorsChalla, Hannah (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-02
Description
Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated, triage-based CS administration and determine the effect on overall length of stay (LOS). Methods: For this quality improvement initiative, ED nurses at a large, freestanding, children’s emergency department in the southwestern United States were given education on inclusion and exclusion criteria for nurse-initiated CS in ED triage. Time to CS administration, LOS, and whether the ED nurse or provider ordered the CS were evaluated through chart reviews of patients presenting with a chief complaint of difficulty breathing. These metrics were compared to charts from the previous year during the same timeframe to evaluate for improved timeliness of CS delivery. Results: Time to CS administration decreased from a mean of 98.6 minutes to 57.6 minutes. LOS decreased from an average of 259.3 minutes to 169.6 minutes. The effect of timely CS on LOS was significant for December p =.003, January p =.002, and February p = <.001. Conclusion: A streamlined process for CS delivery to pediatric patients experiencing an asthma exacerbation can enable providers to achieve efficient and effective care in the ED and decrease a patient’s overall LOS.
ContributorsBain, Ilyssa D. (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-23
Description
Objective
A needs assessment identified a nursing knowledge gap of chemotherapy-induced neurotoxicity (CIN) symptoms as a significant factor in delayed recognition of patients' neurologic decline. The quality improvement (QI) project aimed to increase nursing comfort levels and knowledge related to screening for CIN in hospitalized pediatric hematology, oncology, and bone marrow transplant (Heme/Onc/BMT) patients.
Methods
Nursing CIN education and pre- and post-education assessment questions were created using best practice parameters to screen and monitor CIN in Heme/Onc/BMT pediatric patients. Pre- and post-surveys included a valid Likert-type scale to assess comfort levels using neurotoxicity screening tools (NST) followed by knowledge-based formative assessments. ASU IRB and hospital QI board standards were maintained.
Results
Heme/Onc/BMT nurses (n=37) participated. The most frequent pre-education comfort level was three or somewhat comfortable (n=13). Most frequent post-education comfort level is four or very comfortable (n=21). The two-tailed Wilcoxon signed rank test for pre- and post-education comfort levels was significant based on an alpha value of .05 and p < .001.
Conclusion
Nursing comfort and knowledge of screening for CIN increased. Early recognition of CIN will improve outcomes for high-risk hospitalized Heme/Onc/BMT pediatric patients.
ContributorsBest, Brianne (Author) / Bucci, Aimee (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27