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- Creators: Sebbens, Danielle
- Creators: Arizona State University
Description
Extracorporeal membrane oxygenation (ECMO) is a high-risk, but highly successful intervention for the survival of critically ill neonatal and pediatric patients. Patients supported by ECMO require continuous infusions of anticoagulant medications to prevent clotting of the ECMO circuit, thrombotic events in the patient, and other bleeding complications. Close monitoring, care, and management of the ECMO circuit and its components, with specific focus on systemic anticoagulation, is vital as many factors may influence the efficacy of the anticoagulant and ultimately the patient condition. Globally accepted guidelines exist for the correct management of anticoagulation while supported on ECMO; however, health care centers frequently deviate from these recommendations. This project report synthesizes the most current literature on anticoagulation management in the pediatric ECMO supported population, discusses the limitations in current research, and demonstrates the necessity to use standardized anticoagulation protocols for the safest and most successful outcomes. To implement these findings, this project report suggests the need for an evidence-based project that focuses on the quality improvement of current ECMO anticoagulation guidelines.
ContributorsHolmes, Lauren Michelle (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Background: Traumatic brain injury (TBI) is a leading cause of death and long-term disability among children. The Brain Trauma Foundation (BTF) guidelines integrate initiation of early enteral nutrition which is essential for achieving best clinical outcomes. Gaps in knowledge, consistency, and collaboration when managing these patients hinder adherence to the guidelines and puts the patient at risk.
Objective: This project purpose was to review the updated BTF guidelines and implement a rounding checklist to increase the early initiation of enteral feeding following a TBI.
Methods: This quality improvement project was conducted in the pediatric intensive care unit (PICU) at a level one pediatric trauma center and included all patients admitted with severe TBI. A pre- and post-test accompanied education regarding the guidelines and instructions for checklist completion. The checklists included all BTF guidelines, with a primary focus on early initiation of feeds. Checklist data was presented by the bedside nurse during rounds.
Results: Using descriptive statistics, the average pre-test score was 69% and average post-test score was 93%. Prior to the education, 82% of registered nurses believed a bedside checklist would help manage patients with severe TBI and increased to 95% after education. The checklist was used on 7 (100%) patients and 43% had feeds initiated within 72 hr post-injury (n = 3).
Conclusions: Early initiation of feeding in critically ill patients impacts patient outcomes. A rounding checklist can improve interprofessional communication and healthcare quality by delivering standardized pediatric TBI care. Research regarding enteral nutrition is needed to ensure nutrition is provided in a safe, timely manner.
ContributorsMichael, Holly N. (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
Description
All-terrain vehicles (ATVs) are a leading cause of pediatric trauma. Children may experience a range of injuries from concussion and fractures to severe traumatic brain injury and even death. ATV safety is a priority. Research emphasizes the importance of helmet use while riding an ATV and adhering to manufacturing guidelines for ATVs. These findings have led to the initiation of an evidence-based project to identify behavioral changes within the pediatric population, specifically children 12-18 years of age who are on the Trauma Service of Phoenix Children’s Hospital. Each patient was given a pre-test survey to assess their knowledge regarding ATV safety. After the pre-test survey was completed, an educational component was implemented, the participant used teach-back to the project personnel to demonstrate understanding, and a post-test survey immediately followed. The posttest had several open-ended questions that identified the patient’s intention to follow the safety recommendations when riding their ATV in the future.
ContributorsO'Donnell, Elly (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
Description
Introduction: Palliative care can significantly benefit children managing a life-limiting illness; unfortunately, services are generally reserved for end of life. The aim of this project was to demonstrate how established guidelines coupled with provider education could impact referrals.
Methods: Educational sessions developed using information processing theory and outlining referral recommendations were offered to providers in the NICU, PICU, and Center for Cancer and Blood Disorders at a tertiary care facility. Presurveys and postsurveys were administered at the time of the intervention and referral numbers for the organization were collected for two months prior and two months following.
Results: Descriptive statistics and paired t-tests were used to compare survey data and referral rates.
Discussion: Palliative care is imperative for meeting patient goals and optimizing quality of life. Provider knowledge of referral criteria ensures that patients receive this service early in their disease trajectory and can benefit from its inclusion within their care team.
Methods: Educational sessions developed using information processing theory and outlining referral recommendations were offered to providers in the NICU, PICU, and Center for Cancer and Blood Disorders at a tertiary care facility. Presurveys and postsurveys were administered at the time of the intervention and referral numbers for the organization were collected for two months prior and two months following.
Results: Descriptive statistics and paired t-tests were used to compare survey data and referral rates.
Discussion: Palliative care is imperative for meeting patient goals and optimizing quality of life. Provider knowledge of referral criteria ensures that patients receive this service early in their disease trajectory and can benefit from its inclusion within their care team.
ContributorsNewton, Katelyn A. (Author) / Sebbens, Danielle (Thesis advisor)
Created2018-04-27
Description
Children are five times more likely to be overweight at the age of 12 years if they are overweight during the preschool period, and 60% of overweight preschoolers are overweight at the age of 12 years (Matusik & Malecka-Tendera, 2011). Primary care interventions are urgently needed to improve healthy lifestyle behaviors in families. Parental influence plays an important factor in the development of healthy behaviors in children. Cognitive behavioral interventions have demonstrated preliminary success in promoting healthy lifestyle behaviors in both adults and children. Mobile technology used to supplement interventions aimed at behavior change offers an outlet to bridge gaps in health disparities and generate innovative evidence. Therefore, the purpose of this research was to establish the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (TEXT2COPE) synergized with mobile technology on the healthy lifestyle behaviors of parents of overweight and obese preschoolers. Primary aims of the proposed pilot study were to (a) examine the feasibility and acceptability of the TEXT2COPE program among parents of overweight or obese preschoolers with mobile phones; (b) evaluate the preliminary effects of the TEXT2COPE program on healthy lifestyle behaviors in families with overweight or obese preschoolers; and (c) evaluate the relationship among the study variables (i.e., cognitive beliefs, perceived difficulty, and healthy lifestyle behaviors). Findings indicate that this program is feasible and acceptable in this population. The intervention improved healthy lifestyle beliefs and behaviors in parents. Further supported are the interconnected relationships between parental beliefs, thoughts, and behaviors.
ContributorsMilitello, Lisa K (Author) / Melnyk, Bernadette M (Thesis advisor) / Small, Leigh (Committee member) / Hekler, Eric (Committee member) / Jacobson, Diana (Committee member) / Arizona State University (Publisher)
Created2014
Description
This study tested the preliminary effectiveness of a health belief and text messaging intervention for parents of five- to eight-year-old children to determine whether health beliefs and influenza vaccine receipt differ when compared to a text messaging control group. Children are almost four times more likely to be infected with influenza than adults (Belshe Piedra, & Block, 2009), shed the greatest quantities of influenza virus, and have been recognized as vectors for spread of disease (Neuzil, Mellen, Wright, Mitchel, Jr., & Griffin, 2002b). The influenza immunization rate for school-age children is less than 56% (Centers for Disease Control and Prevention [CDC], 2014). Reasons for the low vaccination rate include parents’ misperceptions of influenza disease and vaccinations (Bhat-Schelbert et al., 2012; Taylor et al., 2002). There are few theory-based interventions for increasing influenza vaccination rates of school-age children; however, promising results have been found when using the constructs of the health belief model (HBM) (Chen et al., 2011; Coe, Gatewood, Moczygemba, Goode, & Beckner, 2012). Mobile technology using Short Message Service (SMS) text messaging may increase vaccination rates to a greater extent than traditional vaccine reminders (Daley et al., 2002; Grajalva, 2006). Prior to starting this study, only one randomized controlled trial testing text messaging to increase children’s influenza vaccination rates was found (Stockwell et al., 2012). In this study, text messaging was effective in promoting behavioral changes leading to a 4% increase in influenza vaccination (27.1% vs. 22.8%, RR = 1.19, p < .001). This study was a randomized controlled trial using a two-group pre- and posttest experimental design. This study found that a theory-based intervention (SayNo2Flu) guided by the HBM and combined with the use of mobile technology (SMS text messaging) did change parents’ influenza vaccination perceptions. It had an overall increase of 38.1% in Influenza vaccination rates in the intervention group (OR: 4.46, 95% CL, 1.705-11.706, p < .001). These results offer some insight into the use of theory-based preventative interventions for parents of young school-age children.
ContributorsWiseman, Patricia (Author) / Reifsnider, Elizabeth G. (Thesis advisor) / Cesarotti, Evelyn (Committee member) / Black, Andy (Committee member) / Kim, Sunny (Committee member) / Arizona State University (Publisher)
Created2015
Description
During the nineteenth century, children's physical health became a dominant theme in France and Great Britain, two of Europe's pediatric pioneers. This dissertation examines how British and French doctors, legislators, hospital administrators, and social reformers came to see the preservation of children's physical health as an object of national and international concern. Medical knowledge and practice shaped, and was shaped by, nineteenth-century child preservation activities in France and Great Britain, linking medicine, public health, and national public and private efforts to improve the health of nations, especially that of their future members. Children's hospitals played a significant role in this process by promoting child health; preventing and combating childhood diseases; fostering pediatric professionalization and specialization; and diffusing medical-based justifications for child welfare reforms in the second half of the century. This deeply contextualized tale of two hospitals, Great Ormond Street Hospital for Children in London (1852) and Sainte-Eugénie in Paris (1855), traces a crescendo in the interest, provision, and advocacy for children's medical care over time: from foundling homes and dispensaries to specialized hospitals with convalescent branches and large outpatient clinics. As a comparative study of the medicalization of children's bodies between 1820 and 1890, this dissertation also investigates the transnational exchange of medical ideas, institutions, and practices pertaining to child health between France and Great Britain during a period of nation-building. Specialized pediatric institutions in Paris and London built upon and solidified local, national, and international interests in improving and preserving child health. Despite great differences in their hospital systems, French and British children's hospital administrators and doctors looked to one another as partners, models, and competitors. Nineteenth-century French and British concerns for national public health, and child health in particular, had important distinctions and parallels, but medical, institutional, and legislative developments related to these concerns were not isolated activities, but rather, tied to transnational communication, cooperation, and competition.
ContributorsSchreiner, Stephanie (Author) / Fuchs, Rachel G. (Thesis advisor) / Green, Monica (Committee member) / Szuter, Christine (Committee member) / Thompson, Victoria (Committee member) / Arizona State University (Publisher)
Created2014
Description
There is a gap between today's scientific advances and their application--between what is known and what is actually being done. This gap occurs because of the process of knowledge translation required to digest research findings for policymakers and practitioners. Studies have repeatedly shown that because of this "know-do" gap, approximately one-half of patients in the United States and Europe are not receiving care according to the most recent scientific evidence. Children are a medically unique and underserved population that stands to be most affected by this gap. Therefore, in this study, the research-practice gap in the pediatric field was calculated and discussed in the context of knowledge brokers, who facilitate opportunities for knowledge translation. Article mentions from the journal Pediatrics were identified in policy documents and analyzed for the years 2010, 2013, and 2016 with the use of the Altmetric platform as a quantitative means of identifying patterns and drawing conclusions about the knowledge translation gap in pediatrics. Altmetric is a bibliometric tool that offers viable insights into the types of impact not covered with traditional methods of citation analysis. The expert policymaking bodies that cited the Pediatrics articles in their policy documents were coded, categorized, and subcategorized to clarify how and where Pediatrics research is ultimately being used to create health policy and to discover whether the gap is similar or different between the various types of policymaking organizations. This allowed the quantitative findings to be nested within a qualitative context. It took a mean of 7.1 years for research to reach the point of policy uptake for practitioners, with a range of 0-32.8 years. There were more international policy mentions than U.S. mentions, but information made its way through the knowledge translation process more quickly in the United States than it did elsewhere. In fact, nearly 40% of articles were cited in policy fewer than five years after original publication. The gap in pediatrics is thus significantly shorter than the 17-year average reported in the literature. However, knowledge brokerage activities performed by technical communicators are continually needed to build links between research, policy applications, and practice.
ContributorsBabiar, Heather (Author) / D'Angelo, Barbara (Thesis advisor) / Brumberger, Eva (Committee member) / Maid, Barry (Committee member) / Arizona State University (Publisher)
Created2018
Description
Oral health in the pediatric population is an overlooked topic in primary care, yet it is vital to their overall health. Dental caries, otherwise known as cavities, are a significant problem among the pediatric population. Dental caries is the most common non-transmittable disease across the globe. Dental caries can have painful effects that can lead to serious health implications and reduce the quality of life. Prevention is key when addressing dental caries and oral health care. Oral health prevention and education should begin early on in life and continue throughout the lifetime.
Pediatricians and primary care practitioners play a vital role in the prevention identification, and treatment of dental caries. Individuals in these care roles must become familiar with dental caries and the best evidence-based practices. Furthermore, these health care providers can have an active role in policy creation and change within the community to address the issue. A project was conducted to help improve oral health in the pediatric population. The project consisted of a well-child template modification at the 9-month well-child visit that would prompt providers to encourage a dental visit by the 12-month appointment. The results were limited, and the outcomes were not statistically significant. A recommendation for future studies will be to verbalize the recommendation and provide a handout or recommend a specific pediatric dentist.
ContributorsCox, Karen N. (Author) / Sebbens, Danielle (Thesis advisor)
Created2020-05-01
Description
Introduction: Pediatric delirium has a 25% prevalence rate in the pediatric intensive care unit (PICU). The project purpose was to implement a nonpharmacological nursing bundle in the PICU to assess the effects on delirium reduction.
Method: A nonpharmacological nursing bundle was implemented for PICU patients, 2-18 years of age, admitted to an Arizona metropolitan, children’s hospital. Data was collected using the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool.
Results: Prebundle CAP-D and postbundle CAP-D scores (M=5.57, SD=5.78; M=7.10, SD=5.61) did not differ among the participants. Prebundle participants required an intervention 26.7% of the time for delirium compared to 31.6% in the postbundle population. No statistical significance was seen between the prebundle and the postbundle CAP-D scores t(59)=7.46; t(205)=18.17 (P=0.08, fisher’s exact test).
Discussion: Nonpharmacological bundles for delirium prevention are needed in the PICU. This project shows that significant barriers exist when implementing them in a complex pediatric environment.
ContributorsFranken, Aimee (Author) / Sebbens, Danielle (Thesis advisor)
Created2018-04-30