Matching Items (25)
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
Successful management of pediatric procedures is challenging. Many procedures have a detailed list of pre-procedural requirements and post-procedural pain control regimens. Patients and families often get lost in the many requirements needed before scheduling the procedure and often delay intervention. This delay can cost both the families and facility time and money but often leave the patient needlessly suffering. Inadequate pain control results in emergency room (ER) visits or hospital admissions for acute postoperative pain management. The opioid epidemic has significantly impacted postoperative opioid prescriptions at discharge. The limited prescriptions available after discharge, paired with inadequate understanding and support of discharge postoperative instructions by the family, result in increased acute postoperative pain management admissions. Postoperative pain is the leading cause of hospital readmissions within 48 hours of discharge. These ER visits are typically for issues that are easily addressed at home. Teach-back methods have shown to be the cornerstone of education, resulting in knowledge gained and increased pain regimen adherence. A literature review exploring current evidence regarding postoperative pain control and interventions coupled with teach-back was conducted to address this concern, and an evidenced-based intervention is proposed.
ContributorsBarrante, Adrianne (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-20
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
Type II Diabetes Mellitus has detrimental effects on the human body. A1C levels reflect the attachment of glucose to hemoglobin-the protein in red blood cells that carries oxygen. Elevated A1C levels are an indicator of how controlled diabetes is. Uncontrolled diabetes not only affects glucose levels, but has detrimental repercussions in other organs of the body, causing peripheral vascular disease, risk of developing dementia, periodontal or gum disease, skin infections, neuropathy in lower and upper extremities, renal damage, erectile dysfunction, decreased blood flow, and cardiac conditions among others.
A diet low in calories positively affects glucose levels in the body. Type II Diabetes can be easily controlled when lifestyle modifications are included in the plan of care. Among those modifications, diet is an effective intervention for the management of this condition.
Establishing a diet among the patients that have an elevated A1C is the plan of care and ultimate goal for this project. The Mediterranean diet has demonstrated decreased blood glucose levels, improved weight control and enhanced quality of life.
ContributorsBurger, Ana Maria (Author) / Root, Lynda (Thesis advisor)
Created2019-04-26
Evaluating the Efficacy of Calcium Chloride versus Calcium Gluconate in ECMO Initiation for Neonates
Description
Purpose: Neonates who require Extracorporeal Membrane Oxygenation (ECMO) are at risk for calcium derangements and associated adverse outcomes. A large children’s hospital in the Southwest changed their practice from using calcium gluconate in priming their neonatal ECMO to using calcium chloride. The impact of this change was not investigated.
Methods: A retrospective chart review of 56 neonates who required ECMO support one year prior to and one year following the practice change was conducted. Descriptive data was collected along with the first ionized calcium measured following ECMO initiation.
Results: Upon review of the data, the post-ECMO calcium levels were not significant between the calcium gluconate and calcium chloride groups using a Mann Whitney U test (U = 315.5, z = -1.25, p = .213). However, a Chi-square test was significant (χ2(1) = 4.94, p = .026) for having calcium values outside of a normal range in the calcium gluconate group. Fisher’s exact test revealed an odds ratio of 3.43 for the first calcium being outside normal range in the calcium gluconate group.
Implications: While comparison of the first measured ionized calcium post-ECMO between the two groups was not statistically significant, there was a significant correlation with normal post-ECMO calcium in the calcium chloride group. This suggest that both calcium gluconate and calcium chloride are appropriate for use in priming the neonatal ECMO circuit, however calcium chloride may provide tighter control of calcium during ECMO initiation in neonates.
ContributorsStravitz, Stacy (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
Description
Breast cancer is one of the leading causes of cancer-related deaths among women in the United States. Uninsured women are less likely to receive breast cancer screenings, more likely to be diagnosed at an advanced stage, and more likely to have poorer outcomes following a breast cancer diagnosis (Abdelsattar et al., 2016; Akinlotan et al., 2021; Ko et al., 2020; & Ntiri et al., 2018). Women in underserved communities often experience socioeconomic barriers which impact obtaining preventative screenings, such as mammograms. Lack of patient navigation, transportation, and financial concerns interfere with obtaining breast cancer screening (Akinlotan et al., 2021 & Miller et al., 2019). Through the intervention of mobile mammography, uninsured women in underserved communities can be reached and access to screening mammograms can be achieved (Stanley et al., 2017 & Vang et al., 2018). Two mobile mammography events were hosted at the project site which provided 35 women with screening mammograms. All scheduled mammogram time slots at the events were filled and completed. Offering mobile mammography to this population has the potential to increase breast cancer surveillance.
ContributorsGlessner-Vallee, Paula (Author) / Santerre, Jennifer (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Introduction: The objective of this study is to emphasize the significance of exclusive breastfeeding (EB) and investigate methods to encourage and sustain it within a hospital environment. Using the self-efficacy theory, the study seeks to improve the current support system for breastfeeding mothers and their families. Methods: The project was approved by the university IRB and facility IRB; guidelines were maintained. The project takes place in a non-profit organization in the southwestern United States. Education was conducted at a required staff meeting for Women and Infant Services (WIS) floor about supporting breastfeeding mothers. A pre- and post-education Breastfeeding Knowledge Scale (BKS) survey was performed, effectiveness was measured using a two-tailed t-test. The reliability of the BKS scale is 0.83 and the validity of the scale is reported to be strong. The hospital measures the EB rates of patients that are greater than 37 weeks gestation without need for neonatal intensive unit care and the mom requests to breastfeed. Results: The goal was 42% rate of EB in the first 48 hours after birth. After education the average rate of EB was 39.6%, lower than the goal but higher than the 33.7% rate before education. A two-tailed paired sample t-test (n=27) was used for BKS and the results were significant based on an alpha value; thus, showing significant knowledge gain. Conclusion: Consistent staff education improves breastfeeding support for moms in the hospital, leading to successful exclusive breastfeeding. This project benefits various settings, such as pediatric, postpartum, labor and delivery, and pediatric offices.
ContributorsHudson, Jennifer (Author) / Esperas, Amanda (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized tool improves detection, diagnosis, and management of depression and other mental health illnesses.
Method: The Patient Health Questionnaire—modified for adolescents (PHQ9-A) was administered to all eligible adolescents, ages 12-18, during an annual well visit for a period of 6 weeks. Lewin's Change Theory guided a system change in the electronic health record, and the questionnaire results were documented and provided to the pediatric provider at the time of the appointment. A chart review was conducted to determine whether all eligible patients were administered the questionnaire and if a depression diagnosis or mental health referral had been made.
Results: Out of 76 eligible well visits, 65 (86%) patients completed the PHQ9-A. The average score was 5.29 (SD = 6.49) with a maximum score of 25. Out of those that completed screening, 11 (17%) had a positive PHQ9-A score resulting in 8 referrals to mental health services and 2 mental health diagnoses in the clinic.
ContributorsCoomer, Meagan (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27
Description
Background: There is growing evidence that persistent exposure to the adverse effects of stressful work conditions, abuse, and re-traumatization without proper intervention leads to compassion fatigue (CF) and reduced compassion satisfaction (CS). Without appropriate intervention, the outcome of CF affects the patient, staff, and the organization. Despite proposed self-care measures, mental health (MH) workers continue to struggle with CF and lack the resources to combat the issue.
Objectives: Ongoing awareness on the implications of trauma and its impact on one's behavior, supports the use of Trauma-informed care (TIC) skills in creating a conducive work environment. This quality improvement project examines the efficacy of TIC education as an intervention for CF pre/post-one-hour education session among MH workers.
Methods: MH nurses (n=8) from diverse backgrounds in a Phoenix inpatient psychiatric hospital gave consent for the study. Participation was sought via flyers and entailed attending the one-hour education session, filling out a demographic, and pre/post-professional quality of life (ProQol) surveys. The ProQol standardized tool measures CF, CS, and burnout with reliability >0.70. Expected outcomes include a reduction in CF and an improvement in CS. Data analysis using intellectus software involved descriptive analysis and paired t-tests to compare outcomes.
Results: Pre/post data analysis was statistically significant, P = 0.003, which shows a reduction in CF and an improvement in CS.
Conclusion: TIC as an intervention for CF looks promising. MH nurses can manage their stress symptoms and that of their patients using TIC skills.
ContributorsOnyia, Nneka (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29