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Full Study Title: Food Insecurity Screening of Families in a Level III Neonatal Intensive Care Unit Background: Early infancy food insecurity (FI) is linked to poor health later in life, and Neonatal Intensive Care Units (NICUs) are often overlooked. Routine FI screening can help identify and assist the families suffering from FI seen in the NICU before being discharged home. Purpose: The aim was to identify if families were assessed for FI by social workers or if they were more likely to report FI in a brief survey. Method: A randomized chart review of social work notes for 30 NICU patients at Regional One Health from January 2023 to June 2023 was conducted to determine if FI was screened. A three-question-FI screening tool was placed in all patient charts from October 2023 to December 2023. The NICU nurses and researcher asked admitted families to complete the survey during visits. Inclusion criteria included parents greater than or equal to 18 years old and English-speaking. Results: The chart review identified no explicit statements surrounding FI in the social work notes. The team anticipated 50 or more returned surveys throughout the study but received only 33 completed surveys. Thirty surveys were included in the study. Around 17% of families discussed receiving food assistance with social workers, whereas 39% reported FI via the survey. Conclusion: Screening via a brief survey was successful but not cohesive to the Regional One Health NICU. A different distribution method may offer better results.

Purpose/Background The purpose of this quality improvement project is to provide and increase educational awareness and knowledge regarding iron deficiency anemia (IDA) in pregnant patients at an urban primary care clinic in Memphis, TN. This project is intended to decrease the number of individuals with IDA in pregnancy while decreasing the occurrence of IDA-related complications in pregnancy. The study aimed to introduce a cost-effective approach to help decrease or eradicate complications related to IDA during pregnancy. The World Health Organization (WHO) estimates the prevalence of anemia-complicating pregnancies to be more than 40 percent. Pregnant women with IDA residing in low and middle-income countries are at a higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Memphis is known as an urban, predominantly Black city, in which studies have shown that the prevalence of Black gravidas was >15 percent in the first trimester, around 20 percent in the second trimester, and close to 50 percent in the third trimester. Introducing IDA educational sessions can beneficially impact Memphis maternal and infant mortality rates and the number of complications and interventions related to IDA. Methods Researchers collaborated with the Midwives at Regional One Health Center’s (ROH) Hollywood Primary Care Clinic in Memphis, TN, to educate 25 pregnant women. The participants were administered a pretest before reviewing the IDA content. After completion of the pretest, an infographic was given to and reviewed with the patient during a 10-minute session. After reviewing the infographic, the participant took a post-test. All women gave consent to participate in this study in their first trimester (before 13 weeks gestation), were 18 or older, and had no known blood disorders or medical conditions that interfere with liver function. Results The pretest/post-test showed a significant correlation between IDA educational sessions and increased awareness. The results show the benefits of education in increasing awareness to help prevent pregnant women in Memphis, TN, from developing IDA and related complications. IDA educational sessions will continue to increase awareness amongst pregnant women. The likelihood of pregnant women complying with iron supplement regimens will steadily increase, thus decreasing the risk of IDA-related complications. Therefore, the results show that providing short educational sessions to mothers in their first trimester are not only cost-effective, but will also improve maternal and infant mortality rates, especially in underserved communities like Memphis, TN. Implication in Nursing Practice Pre- and post-tests will be administered before and after the iron deficiency anemia education session. The pre- and post-tests will be used to collect data regarding patient education on iron deficiency anemia in pregnancy before and after the education. This information will help determine if there is a correlation between patients receiving one-on-one education on iron deficiency anemia and their knowledge of patient compliance with iron supplementation. Once the education and data collection is completed, strengths and weaknesses should be identified for improvement throughout the project for more organized and efficient education.

Purpose: The purpose of this study was to describe the relationships among demographic characteristics, verbal abuse, violence prevention climate, and team psychological safety. Specific Aims: Specific aims were to describe: (1) demographic characteristics, verbal abuse, violence prevention climate, and the perception of team psychological safety by pediatric nurses; (2) relationships among select demographic characteristics, verbal abuse, violence prevention climate, and team psychological safety; and (3) the variance in team psychological safety accounted for by select demographic characteristics, verbal abuse, and violence prevention climate. Background: Psychological safety is a key element for nursing practice and healthcare teams. Patient and employee safety is a fundamental tenant in the healthcare industry. Unfortunately, violent acts towards healthcare professionals are 16 times higher than other industries. Verbal aggression has been increasing and pediatric nurses are particularly vulnerable to verbal abuse. Methods: A non-experimental study with a descriptive, correlational design was used to conduct this study. The sample size was 528 pediatric nursing professionals. Data were collected via email. Three instruments (Team Psychological Safety Survey, Verbal Abuse Questionnaire, Violence Prevention Climate 12) were used along with additional demographic questions and one COVID-19 related question. Results: All respondents reported receiving one or more types of verbal threats within the past three months. The most frequent perpetrators of verbal abuse in this study were parents/visitors (75.9%.) Most participants (63.1%) reported they had never officially reported any acts of verbal abuse. Although the multiple linear regression model was not significant, six of the predictor variables (VPC-12-B, being sworn at, receiving indirect threat, doctor as perpetrator, co-worker as perpetrator) from the model were individually significant and associated with perceived psychological safety of pediatric nurses. Implications: More research in this area is recommended. The findings of this study confirm verbal abuse and verbal threats are prominent problems in nursing practice whether nurses decide to report them or not. Interventions to mitigate the negative impact of abuse on a pediatric nurse’s personal and professional well-being are needed to prevent further stress, burnout, and loss of nurses in the profession.

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern California. Specifically, this study sought to describe RNs perceptions of their role as interpreters and their attitudes and beliefs regarding their interpersonal efficacy in this role. Ten RNs with a documented level of language proficiency from health care institutions in Southern California completed a semi-structured recorded interview. Using process and line by line coding, the 10 interviews yielded four main categories: protection of patient, uncertainty, challenges, and RN interpreter effect. The following descriptive summary emerged from this qualitative descriptive study: nurse interpreters may harm the patient-provider interaction by increasing noise, but they protect the patient by reducing uncertainty, increasing comfort, and creating a connection while offering interpreting services. Implications for future study include the need for the identification and analysis of the factors shaping the RN interpretive experience in the health care setting.

Child abuse and/or neglect (CAN) is a global problem. Although nurses are mandated CAN reporters, a lack of reporting has been an issue. New Mexico (NM) is faced with higher child poverty and CAN-related substance-abuse compared to other U.S. states. This quantitative study aimed to explore factors influencing intended/actual CAN reporting behaviors among NM registered nurses (RN)s, examine relationships of these factors, and compare differences in reporting behaviors between rural and urban locations. A survey to a sample of RNs (N=146) showed factors associated with CAN reporting intended behaviors were work status (r=.21, p < .05), cues to action (r=.20, p r=.20, p < .05). PBC (β =.21, p

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search of six databases yielded sixteen pieces of moderate to high-quality evidence supporting lifestyle modifications related to principals of the Mediterranean diet, physical activity, and increased adherence via parental involvement, education, psychosocial support, and frequent follow-up. A sample of 29 Hispanic adolescents, age 10-21, with a history of NAFLD or elevated ALT levels, from an underserved urban pediatric clinic in the Northeastern U.S., were provided an educational intervention based on the Mediterranean diet and physical activity recommendations. Over the next 12 weeks, to promote adherence to the lifestyle changes, four follow-up phone calls were made to promote compliance and provide psychosocial support. Two nutritional educational classes were also offered to all participants. The KIDMED tool was assessed at the beginning and end of the intervention. A Wilcoxon test examined the results of the pre-intervention mean ALT and postintervention mean ALT. No significant difference was found in the results (Z = -1.113, p > .05). The mean pre-intervention was 76.48 (SD = 43.92), and the mean post-intervention was 69.81 (SD = 33.65). These findings suggest more time may be needed to assess the longitudinal benefits of lifestyle interventions on NAFLD in Hispanic adolescents. Future research should address preventable health care disparities related to poor nutrition and improve access to healthy, affordable food in low-socioeconomic neighborhoods.

Purpose The purpose of this scoping review is to gather evidence on best practice for the administration of pediatric suicide screening in a variety of healthcare settings.

Purpose/Background Pediatric pain management is often overlooked due to time constraints and lack of resources or education on interventions used, such as distraction or pharmacological therapy. Lack of pain management leads to patient and caregiver distress, as well as an increased number of attempts to perform the procedure. This scoping review evaluates the efficacy of distraction therapy compared to nonopioid pharmacological interventions for acute needlestick pain in children ages 6 to 12 years; patient and caregiver levels of distress were also evaluated in most studies. Methods The UTHSC (University of Tennessee Health Science Center) Library database was searched for full-text articles published in the last 5 years. Terms used included “pediatric needlestick pain”, “pain management”, “distraction and acute pain”, “lumbar puncture”, and “venipuncture”. 37 articles resulted, 25 underwent rapid critical appraisal for quality of evidence which resulted in 10 articles being selected based on ages 6 to 12 years, pain scale, intervention, and relevance to our PICOT question. Results Of our 10 articles, 6 articles demonstrated reduced pain when using distraction techniques. 7 articles showed decreased anxiety, fear, and distress. 5 articles stated increased parental and patient satisfaction. 2 articles reported decreased staff distress. However, only 3 articles demonstrated a statistically significant reduction in pain scores. Implications for Nursing Practice Although few of our articles showed statistical significance in pain reduction, most of our articles report lower pain scores with interventions used. Separating pain and anxiety in the pediatric population is difficult, therefore any reduction in pain scores should be seen as significant and interventions should be implemented appropriately.

Nurses experience the relationship dynamics between pediatric patients and their families firsthand. Being informed by the goals of holistic care, nurses should be assessing for unhealthy dynamics among pediatric patients and their caregivers so they can respond appropriately when a potential for abuse is present. Healthcare workers have the duty to provide safety and healing to their patients. Through the unique contact nurses have with patients, their training for accurate assessment skills, and their responsibility as healthcare workers, nurses are placed with the opportunity to help children out of abusive situations. Prompt identification of the potential for abuse can prevent a child from experiencing an abusive situation or save them from actual abuse already occurring. By virtue of their age and inability to fully care for themselves, children belong to a vulnerable population. They often lack the ability to defend themselves or speak up when they are being abused. Research studies have identified risk factors for abuse, the effects of abuse on children both long and short term, and the implications of this information on healthcare professionals. Nurses who are knowledgeable about these aspects related to abuse can use the accessible pathways to help a child out of abuse. There is a potential for further research about the best ways to handle situations that have been accurately identified as abuse. Since each child’s situation is different, research should be conducted to guide the follow-up with children experiencing abuse and the role of nurses in the child’s care.

ABSTRACT ONE VOICE Training to Enable Nurses and Anesthesia Providers to Mitigate Pediatric Presurgical Anxiety Sarah E. Hinnant Background: Children in the preoperative area experience presurgical anxiety at rates of up to seventy-five percent. Increased pediatric anxiety is directly linked to increased anesthetic requirements, increased risk for development of emergence delirium, and increased time spent in the post anesthesia care unit. Numerous high-quality studies show that intervention by a certified child life specialist mitigates preoperative pediatric anxiety. Often child life specialists are not available to meet with all children prior to surgery. Registered nurses (RNs) and certified registered nurse anesthesiologists (CRNAs) are present in the presurgical area and have the potential to reduce pediatric presurgical anxiety. Purpose: The purpose of this quality improvement project was to increase provider adherence to the ONE VOICE intervention and to reduce pediatric presurgical anxiety. Methods/Interventions: This prospective quality improvement project used an unpaired cohort design to evaluate the effectiveness of the ONE VOICE intervention on pediatric presurgical anxiety. A group of trained raters used the modified Yale Preoperative Anxiety Scale-short form (m-YPAS-sf) to assess baseline anxiety. Pediatric RNs and CRNAs completed a self-assessment of baseline adherence to the ONE VOICE intervention. Then the RNs and CRNAs were trained on the ONE VOICE intervention. After one month, the RNs and CRNAs took the self-assessment again. Next, post intervention pediatric anxiety was assessed using the m-YPAS-sf. Results: Implementation of the ONE VOICE teaching mnemonic led to a statistically significant increase in RN and CRNA adherence to ‘educating the child before the procedure about what is going to happen.’ A self-assessment Likert survey distributed via Qualtrics survey software, pointed to a clinically significant increase in adherence of seven of the eight ONE VOICE components. Pediatric anxiety in the presurgical area at West Virginia University Medicine (WVUM) Children’s was reduced by 28.3%. Conclusion: Use of the m-YPAS-sf in the preoperative area at WVUM Children’s would allow more metrics to be evaluated. Medication requirement, length of stay, incidence of emergence delirium, and development of pediatric medical traumatic stress are areas of study showing a correlation to pediatric presurgical anxiety. Continued evaluation of this project should focus on measuring the impact of the ONE VOICE intervention on medication requirement, length of stay, and the incidence of emergence delirium.

Purpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs.

The purpose of this DNP project is to determine if receiving school-based depression awareness education affects the depression scores of adolescents between 10 and 19 years of age.

The nation is experiencing a pediatric mental health crisis amid a shortage of pediatric mental health care providers. The Connecting and Communicating project explores a strategy pediatric primary care practitioners can employ to bridge this gap and maximize their impact on supporting youth mental health in a community. For this project, a pediatric primary care nurse practitioner created a pilot educational video with the dual purpose of educating parents and school staff on the importance of connecting with adolescents using the proven evidence supported communication technique of validating strong emotions without judgement, and partnering with pediatric health stakeholders by requesting input on the pilot video. Validating strong emotions to strengthen relationships and promote resilience is informed by Carl Roger’s person-centered theory, Marsha Linehan’s Dialectical Behavioral Therapy (DBT) and John Gottman’s meta-emotion philosophy. The success of the project was measured using pre and post surveys and interviews. The survey responses and discussions indicated that creating this video was an effective way to educate individuals about a mental health topic and form local partnerships to support youth mental health. Requesting input on the pilot video led to numerous conversations with stakeholders about the need for collaboration on youth mental health initiatives. The project ignited a conversation in the community about youth mental health and led to presentations, meetings, and programs. The project identified the need for additional research on ways pediatric health stakeholders can form local partnerships on mental health initiatives and the impact of such partnerships on youth mental health outcomes.

Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in infancy can be the initiation of childhood and adult overweight and obesity. We investigated the association between postpartum depression and child overweight and obesity, evaluating maternal feeding practices and beliefs as mediating factors in this relationship. Methods. We performed a secondary analysis on data from 1,425 mother/child dyads from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study that enrolled healthy pregnant women in Shelby County, Tennessee, from 2006 through 2011. We performed logistic regression analysis to investigate the relationship between PPD and child BMI trajectories from birth to 4-6 years, and child overweight and obesity at years 1, 2, 3, 4 – 6; multiple linear regression to investigate the relationship between PPD measured at 4 weeks and maternal feeding behaviors and beliefs as measured by the Infant Feeding Questionnaire (IFQ); and causal mediation analysis to investigate the association between PPD, maternal feeding behaviors and beliefs, and child overweight and obesity.

ABSTRACT Moral Distress in an increasing problem in nurses and other healthcare professionals due to the many challenges nurses face in proving care to their patients and families. These challenges can be magnified when the nurse is conflicted and unable to successfully navigate the moral and ethical responsibilities of the profession leading to moral distress. The COVID-19 pandemic has had profound and global widespread consequences including the impact on pediatric nurses. This descriptive correlational study examined the relationship between moral distress and ethical climate among pediatric nurses who cared for patients during the COVID-19 pandemic. This study used Corely’s Theory of Moral Distress as the theoretical background to examine this relationship. The sample consisted of 81 pediatric inpatient nurses from across the US that were recruited by two professional organizations. All participants completed the Measure of Moral Distress – Healthcare Professionals (MMD-HP) the Hospital Ethical Climate Survey (HECS) and a demographic data collection tool developed by this researcher. The results of this study found a statistically significant inverse relationship between moral distress and perceived ethical climate among the study participants. Other demographic data information was analyzed and there were no significant findings for years of experience, type of education, and type of unit setting. However, there were statistically significant findings for those participants who stated they were considering leaving their position due to moral distress and those that were not, as well as those who stated they received adequate training to COVID-19 patients and those who stated they did not. This is the first known study to investigate the relationship between moral distress and perceived ethical climate in pediatric nurses who cared for patients during the COVID-19 pandemic. Since the end of the COVID-19 pandemic is not fully in sight, findings of this study will help bring awareness to this issue and promote improving an ethical climate in order to mitigate the feelings of moral distress. This is of paramount importance to mitigate the negative consequence of moral distress among pediatric nurses. Key words: COVID-19, pediatric nurse, ethical climate, moral distress

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments.SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma.

Abstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative care for pediatric patients cared for in the inpatient setting for at least three days decreases death in the ICU setting. Methods A literature search was conducted using an online database utilizing MeSH headings from 2013 until 2021. Eligibility criteria included peer-reviewed articles from any country but available in English. An annotated literature table was developed to synthesize findings. A critical appraisal tool was then used to narrow the six articles for scoping review. Results Literature analysis noted that early palliative care involvement could affect mortality, patient and family quality of life, and financially impact hospitals. Palliative care was shown to reduce mortality in the ICU, shift the location of death out of ICU, and provide cost savings to hospitals from unnecessary treatments, and decrease hospitalizations. Implications for Nursing Practice The scoping review yields insight into the utilization of pediatric palliative care and how it reduces mortality in the ICU and at the same time there are cost savings to hospitals. The adaptation of clear consult criteria has the potential to increase palliative care use in children and be beneficial to children, their families, and to hospitals.

Children hospitalized for critical care require increasingly complex and technical care, which can be very stressful for parents. Awareness of the importance of parents’ role while their child is receiving critical care is vital to deliver care within a family-centered philosophy that is mutually beneficial to parents and nurses. This descriptive correlational study examined the relationships between and among parental perception of Family-Centered Care (FCC) nursing practices, parental beliefs regarding their role and their hospitalized child, and parental stress during their child’s admission to the Pediatric Intensive Care Unit (PICU). This study utilized the Family-Centered Care theoretical framework to examine these relationships and obtain a better understanding of the antecedents, characteristics, and consequences of family-centered care in the hospitalized child. The sample consisted of 43 parents whose child was admitted to a single PICU in New Jersey. More than 35% of these parents had a child with chronic medical complexity. All parents completed three established survey instruments while their child was actively admitted to the PICU, which measured the main study variables: Family-centered Care Scale, Parental Beliefs for the Hospitalized Child, and Parental Stressor Scale: Pediatric ICU, in addition to an original demographic instrument developed by the researcher. The results of this study were not statistically significant to address the predictive relationship between FCC, parental beliefs, and parental stress. However, there were statistically significant findings related to parental beliefs and children with medical complexity, particularly if they had had previous PICU admissions. There were also statistically significant findings for the demographic variables of marital status and parental stress, as well as number of days in PICU and parental stress. Finally, there was a small positive correlation with parental beliefs and FCC that was statistically significant. These findings elucidate the importance of parental beliefs and how nurses may influence parents’ experiences when their child is faced with a critical care hospitalization through the provision of FCC. The implications of this study are important for further research on these variables and how to tailor our approach to better understand parents’ role while their child is in the PICU to minimize negative outcomes.

Purpose/Background The pediatric craniotomy procedure is a complex and painful procedure that requires adequate pain management and frequent neurological assessments. Generally, evidence for pediatric pain management is severely lacking in research, and evidence for pediatric craniotomy patients is lacking even further. This scoping review aims to collect, condense, and review the current data in order to fuel future studies to establish more data, protocols, and evidence-based recommendations for analgesia in the pediatric craniotomy patient population. Methods The studies selected were peer-reviewed, published in a medical or nursing journal, included study ages 0-21 years, or provided evidence on pediatric analgesia. Sources used include randomized controlled trials (RCT), systematic reviews, cohort studies, and qualitative studies. An excel spreadsheet and tables comparing the following data were created: age, gender, diagnosis, analgesia intra/post-operatively, pain scores for baseline and breakthrough pain, and the need for rescue pain medication. All data was reviewed and synthesized. Results The results were variable. The studies provided no uniform recommendation for a specific protocol for pediatric craniotomy pain management. Many of the studies suggested the combination of non-opioid (acetaminophen) and opioid agents in order to decrease the use of opioids and provide better overall pain relief. NSAID use cannot be definitively recommended because safety standards have not yet been established. Due to their risk of respiratory and central nervous system depression opioids remain a major cause of adverse events post-craniotomy. Implications for Nursing Practice Evidence supporting standardized analgesia is lacking for pediatric craniotomy patient. While studies continue to be conducted and published, medicine is behind in evidence-based recommendations for postoperative pediatric analgesia. Current available data supports concurrent use of opioid and non-opioid in pediatric post-operative pain management, and there is a strong foundation to support further research for a regimen that adequately manages pain and preserves neurological assessments.

Purpose/Background Recognizing mental illness is crucial in adolescence. It is the second leading cause of suicide and death in children 10-19 years of age. Early identification and recognition of signs and symptoms could prevent progressive mental health illness in early childhood and adulthood. We are seeking to answer the PICO question: In adolescents between 10 and 19 years of age who are enrolled in school (P), how does receiving education on depression awareness (I) compared to not receiving education on depression awareness (C) affect depression scores (O)? Methods This review was conducted on articles about adolescent children. These articles were written within the past ten years and were scientifically researched, peer-reviewed, and published by a professional medical journal in the English language. The research was conducted in a school-based setting throughout the country and abroad. The information was evidence-based and included systematic reviews. In the fall of 2019, we began searching the literature on school-based education programs and the effectiveness of education in identifying signs and symptoms of depression. Results The review yielded 40 results. Ten articles of high quality were used to support positive findings that school-based programs such as ADAP programs effectively taught signs and symptoms of depression and help-seeking behavior. This program was administered by teachers, nurses, and other school personnel educated before the program's start. The program consists of a 6-week program with education on depression provided. Pre and post-tests were given to show improvement in knowledge of depression. There was an increase in depression scores from 0% pretest to 74.5% post-screening. Implications for Nursing This scoping review reveals evidence that education on depression awareness improves help-seeking behavior and increases knowledge on signs and symptoms of depression. The ADAP curriculum and other curricula have effectively promoted positive outcomes. However, further research is needed to make these programs available to all students.

Purpose/Background: Pediatric health is significantly affected by social determinants of health. Screening for and addressing social determinants of health helps to decrease negative effect on health outcomes. The purpose of this project is to determine if there is an association between addressing or not addressing social determinants of health by the healthcare provider and parents’ adherence to treatment recommendations in children with urinary tract infections. Methods: Between October 2020 and November 2021, a literature review was performed to obtain data from studies regarding urinary tract infections, social determinants of health and adherence to treatment recommendations. The University of Tennessee Health Science Center (UTHSC) online databases, Pubmed, CINAHL, Medline and EBSCO were used to obtain data using the search terms listed above and others. Using these methods and a modified version of the PICOT question, “In children who experience urinary tract infections, how do provider inquiries regarding social determinants of health affect caregiver adherence to treatment plans?”, data were obtained from relevant articles. The primary goal was to determine if addressing or not addressing social determinants of health affected treatment adherence in patients with urinary tract infections. Results: During research and data collection, 13 articles were cited and consisted of cross sectional surveys, controlled trials without randomization, randomized controlled trials, quality improvement projects, case controlled/case-case study and an expert panel report. Four articles maintain a positive relationship between race/ethnicity, socioeconomic status and risk of urinary tract infection. Also, comprehensive education of parents on urinary tract infections improves outcomes. Implications for Nursing Practice: Provider screening for and addressing social determinants of health can help mitigate the negative effects of these social determinants of health on the family. This and equipping parents with knowledge will also help in the care of their children with urinary tract infection.

Purpose The purpose of this scoping review was to address trauma-informed care, juvenile justice systems, and recidivism rates. The literature review conducted identified key research and analysis of effective trauma-informed treatment methodologies, referrals, and accessibility of care for justice-involved youth, and the rate change of recidivism related to trauma-informed treatment and interventions. Background The high rates of recidivism in the juvenile court systems matched with the increased prevalence of psychological trauma in justice-involved youth represent the need for implementing trauma informed care. The scoping review analyzed the research implementing the intervention of trauma informed care to determine if it resulted in justice involved youth more likely to have a higher success rate of regulating trauma symptoms and behaviors, thereby decreasing recidivism rates. Methods The scoping review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) reporting guidelines for scoping review. A computerized database search of PubMed, Social Science Research Network (SSRN), and Scopus was performed. Scientific articles, approved by an international peer review board and published in medical, social science, or nursing journals were included. Results The findings of the scoping review analyzed trauma-informed approaches and effective justice interventions in the juvenile justice system’s impact on reducing recidivism. Common trends included the ongoing need to establish standardized assessments of trauma, improve trauma-informed programs, and development of trauma interventions system-wide. Implications for Nursing Practice Nursing serves as a trauma informed intervention for justice involved youth to reduce recidivism rates. Creating awareness of trauma informed care through nursing education provides current and future healthcare workers the education and tools to effectively reduce recidivism in justice-involved youth. The goal of utilizing nursing’s unique role in this patient population is to implement trauma informed care and prevent additional trauma experiences.

The Measles-Mumps-Rubella vaccine (MMR) is a proven necessity for the prevention of measles, mumps, and rubella, which possess severe and possibly life-threatening complications. However, the means in which these vaccines are produced, mandated, or scheduled raise certain concerns within the medical and pharmaceutical consumer community. In fact, there are various communities around the globe that willfully choose to refuse the MMR vaccine, along with many other pediatric vaccinations, resulting in diminished vaccination rates and risk of possible outbreak of any of these three diseases. With this impending threat on the rise, it is necessary to engage in research to best understand the reasoning for parental vaccine refusal and address alternative research approaches for this vital immunization series.

Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was to examine the contributions of parenting stress and child health to NCD in a sample of diverse, urban mother-child dyads. In addition, the study aimed to describe maternal and child characteristics associated with child neurocognitive development (NCD) at age 3 years. We examined the differences in parenting stress levels in mothers of 3-year-old children with and without special health care needs. The primary factors of child health and parenting stress along with child and maternal characteristics and covariates (i.e., maternal depression, IQ, and knowledge of child development) were examined for their contributions to child NCD. Method. The Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study data was used for a secondary data analysis for this study after submission and approval of a Manuscript Analysis Plan Proposal (MAPP) from the CANDLE primary investigation team and IRB approval by University of Tennessee Health Science Center. The CANDLE study has a large, longitudinal collection of data on a diverse sample of urban mother-child dyads in the southern U.S. that examines contributions of maternal and child factors to child development. Applying the bioecological model of Bronfenbrenner, this study uses descriptive analysis, chi-square method, and linear models based of CANDLE study data to examine the relationship of parenting stress, child health, and child NCD at age three years and associated child and maternal characteristics. Finally, models will be created to explain the effect of child health and parenting stress on NCD, considering select covariates. Results. Sixteen percent, 171 of 1039 children met the criteria of special health care needs. Of the children identified with special healthcare needs, 25% of mothers reported concerns regarding their child’s health and or development compared to 9% of mothers of children who do not have any special health care needs. Nine percent of mothers of children not identified with special health care needs reported concerns over health and development. Parenting stress scores were significantly higher in mothers of children with special health care needs (odds ratio = 1.72; 95% CI = 1.158-2.6753; p=.0152). Cognitive scores were significantly different between children with and without special health care needs controlling for parenting stress with an effect of 0.5 (SE= 0.17; p=.0056). Models examining associations of child health and parenting stress, considering covariates, found that child health and parenting stress explained child NCD, specifically receptive communication. Implications. Efforts to increase child NCD in this population are needed. Reduction of parenting stress related to psychological, biological, and environmental factors can assist in promoting the development of children in this sample. Identifying, intervening, and reducing these sources of stress through appropriate screening, education, policies, and support is needed. In addition, the consequences of child health can influence parenting stress and child NCD. Support for child health initiatives such as health promotion, illness prevention, and appropriate early intervention will contribute to the reduction of parental stress and can improve child NCD. Sustained interventions to promote child health and reduce parenting stress will lead to a more optimistic future for children and their NCD.

Evaluating the Feasibility of a Collaborative Care Clinical Pathway for the Treatment of Adolescent Depression and Anxiety in Rural Pediatric Primary Care Kayla Watson Background: Due to a national shortage of Child and Adolescent Psychiatrists (CAP), Primary Care Providers (PCP) are often required to manage patients with mental health disorders despite a lack of focused training and lower self-efficacy or confidence in the management of these disorders. Referral to CAPs for management following the diagnosis of adolescent depression and anxiety is a common practice. The integration of mental health services within the primary care setting can overcome many of these barriers and have been shown to improve patient outcomes. This model involves PCPs prescribing psychotherapeutic drugs while the patient receives evidence-based psychotherapies provided by community Behavioral Health Clinicians (BHC). Purpose: The purpose of this quality improvement (QI) project is to incorporate evidenced-based practice recommendations and select components from integrated care models (ICM) to design a collaborative care, decision making pathway for PCPs to utilize in the management of adolescent depression and anxiety and to evaluate the feasibility of the intervention within the primary care practice setting. Methods: A literature review and synthesis was completed to gather current recommendations and determine the most effective components of ICMs. A collaborative clinical decision-making pathway was designed and presented to the project participants in the form of a PCP packet containing a medication guide, a treatment algorithm, a BHC provider directory, and a list of built in EMR visit and patient handout templates for clinical use. A focus group was held with project participants following a 12- week implementation period to determine the feasibility of the project. Focus group data were evaluated by coding responses and identifying common themes relating to feasibility. Future directions of the project were also discussed. Pre-implementation and post self-efficacy mean scores on a modified version of the Mental Illness Management (MIM) questionnaire were calculated as a secondary outcome measure. Results: The clinical decision-making pathway was determined to be feasible within the intended practice setting based on the feasibility areas of emphasis: acceptability and demand. Mean scores of the MIM questionnaire showed a positive trend for each of the survey items suggesting the intended effect on care delivery. Discussion: This QI initiative met each project aim through successful implementation and by an increase in provided collaborative care, an increase in the level of integration within the practice setting, a positive trend in PCP self-efficacy following implementation, and a decrease in the time from diagnosis- to- treatment of adolescent depression and anxiety. Following the determination of intervention feasibility, further testing within the organization is recommended and warranted.

Background: Parents caring for a child with an acquired disability often report a negative impact on physical, psychological, emotional, and spiritual health associated with caregiver burden related to their child’s complex health needs. This is further complicated by additional challenges related to the loss of a previously healthy child. Traditional patterns of loss follow linear, time-bound stages that have been observed to be unrelated to the experiences of these specific parents and their families. Therefore, the concept transforming loss has been developed to better understand how these parents navigate loss and find meaning in spite of their suffering. Purpose: The purpose of this study was to (1) gather empirical evidence about the concept of transforming loss, and (2) use the evidence to offer guidance for nursing practice on how to assist families who are navigating these significant life experiences. The research question was, “How do parents describe living through the experience of caring for a child with an acquired disability?” Method: The study used qualitative directed content analysis guided by the core qualities of transforming loss: unveiling, light, and darkness. Eight participants were recruited from online support groups, where tape-recorded, semi-structured interviews were used to gather their stories. The stories were transcribed verbatim, reconstructed, and confirmed via member check. Data analysis included various stages using specific descriptors, condensed meaning units, subthemes, and themes. Results: Eight themes were derived from predetermined categories within the concept. Unveiling, or the active process of freely choosing meaning is being strong and overcoming challenges to care, creating a life space of connecting with others and giving grace, and viewing goodness and joy in watching ongoing progress. Darkness, or the suffering associated with loss is knowing and not knowing the terrifying consequences of loss, unrelenting vigilance and being on the edge that weighs on family wellbeing, and the unending worry about life-long care. Light, or finding purpose and meaning is envisioning possibilities and hope for the future and valuing relationships within the family to foster a caring way of being. Conclusions: Findings from the study were congruent with previous literature on caregiving, loss, and meaning, coherent with the theoretical and conceptual frameworks, and grounded in the discipline of nursing. Implications for future research, practice, and policy include supportive measures to assist parents in the transformation of their loss, and additional studies are needed to further explore the concept transforming loss for its use in other settings and populations.

Due to recent circumstances, the incidence of loneliness and social isolation has skyrocketed. Fortunately, there have already been countless studies examining the longer-term implications of these two factors on health. Loneliness and social isolation have been found to impact cardiovascular health, stress response, immune function, resilience, mental health, attachment, spiritual health, and many other determinants of health. A variety of research was examined outlining the psychological implications of loneliness and social isolation. These factors also influence physiological processes and can exacerbate a variety of diseases. After presentation of this evidence, a collection of possible interventions will be discussed, and their efficacy will be reviewed.

Previously underutilized, telemedicine has been implemented within a wide variety of health settings as a safe and efficient way of delivering healthcare during the COVID-19 pandemic. Maintaining operations during the pandemic made implementation of telemedicine an important aspect of college and university health center reopening plans. The purpose of this project was to evaluate the acceptance and quality of a telemedicine program implemented at the health center of a medium sized private university. Data were collected via patient and staff surveys to measure satisfaction with the program and a retrospective review of electronic medical records was conducted to obtain data regarding utilization of telemedicine services. Baseline usage of telemedicine was collected 4 weeks following initiation of the program and again 16 weeks later to measure staff and patient acceptance of the program. Student access to healthcare providers was evaluated by comparing student access to providers with extended telemedicine hours during the 2020-2021 academic year with standard office hours. Use of telemedicine resulted in an increase in access to university healthcare providers by 32 hours per week during the Fall 2020 and Spring 2021 semesters. Student satisfaction with the program increased significantly between the fall and spring semesters with overall satisfaction growing from 62% in the fall to 92% in the spring and a year-end staff survey and campus partner interviews showed strong support with 100% of participants recommending continuation of the program. The findings suggest that telemedicine can be used to successfully deliver quality care and extend access to care providers in a college health setting.

Incidents of workplace violence (WPV) are pervasive in healthcare settings. WPV in the US occurs four times more frequently in the healthcare sector than in the private sector. However, the true incidence of WPV in healthcare settings is thought to be much higher secondary to significant under-reporting. The American Nurses Association (2019) reports, while one in four nurses are assaulted, only 20-60% of the incidents are reported. This extensive range is due to the lack of an accepted definition of what constitutes WPV, variable reporting mechanisms, and an overall perception by healthcare workers that WPV is “part of the job”. The factors contributing to WPV have been identified in previous studies predominantly within adult ED and psychiatric clinical settings. However, nurses working in the pediatric intensive care unit also treat patients and family members who possess similar risks factors towards perpetrating violence. This study utilized the Careful Nursing model to examine the relationship of altruism and nurses’ self-concept in order to better understand the relationship of these variables on PICU nurses’ reporting incidents of WPV. No known previous research had been performed in the PICU setting that evaluated the relationship of altruism and nurses’ self-concept on reporting incidents of WPV among PICU nurses. An online survey evaluating altruism, nurses’ self-concept, the incidence of WPV and reporting of incidents of WPV was distributed to PICU nurses working the US. Two instruments were included in the survey, the Self-Report of Altruism Scale (SRA) (Rushton, Chrisjohn, & Fekken, 1981) and the Nurses’ Self-Concept Questionnaire (Cowin, 2002). A total of 119 participants completed the study. The results demonstrated 60% of the participants experienced an incident of WPV in the past five years. A total of 55.6 % of participants stated they did not report the incident of WPV. These results indicate PICU nurses both experience incidents of v WPV and report those incidents at a similar rate to those of previously published studies within adult settings. Logistic regressions were performed to assess for a relationship of altruism or nurses’ self-concept on reporting incidents of WPV. There was no significant relationship present between altruism (p= 0.61) or nurses’ self-concept (p=0.1) and PICU nurses’ decisions to report incidents of WPV. This study demonstrated that neither altruism nor NSC had a relationship on PICU nurses’ reporting incidents of WPV. However, this study elucidated that PICU nurses are equally vulnerable to WPV and report incidents similarly to other nurses. The implications of these findings are important for further research on barriers to reporting WPV, policy development to enhance reporting, and methods to improve the overall safety of healthcare workers in all settings.

Autism Spectrum Disorder (ASD) is a condition that primarily affects neurological development, causing decreased social aptness, diminished executive function, and abnormal sensory processing, among many other characteristic symptoms. Additional problems that often accompany ASD include anxiety disorders, depression, and attention deficit hyperactivity disorder (ADHD). Canine assisted animal therapy is one non-pharmacologic therapy option that has been researched for children with ASD to improve their social, psychological, mental, and other difficulties. Studies thus far have shown positive results in children with ASD who have dogs as pets or access to therapy dogs, including improved social functioning, decreased anxiety, overall improved behavior, and increased responsibility and task completion.

Abstract Childhood obesity is an unrelenting public health problem disproportionately affecting racial and ethnic minorities. There are multiple, complex factors related to the prevalence of childhood obesity from genetics to behavior to environment. Although ethnic minorities are disproportionately affected by childhood obesity and have a variety of cultural identities, research rarely examines cultural factors. In addition, qualitative research into childhood obesity rarely seeks the perspectives of children. This research study sought to address these gaps by interviewing children from an ethnic minority. The purpose of this study was to discover cultural influences that contribute to or prevent childhood obesity from the perspectives of Burmese-American children and adolescents of Karen ethnicity in the southeast U.S. Leininger’s Culture Care Theory (CCT) was the theoretical framework. The study was designed using the ethnonursing research method developed by Leininger to be used with the CCT. Karen children between 8 and 15 years-of-age along with their parents and non-Karen community members who knew them participated in open-ended interviews. Observation and field notes contributed data. Four themes important to healthy weight care in Karen children were discovered: views of a healthy child, food and food preparation, physical activity, and mutual support among family and community. These themes included both Karen and non-Karen influences. Nurses and interprofessional health care teams may use knowledge gained from this study for promotion of healthy weight care in Karen families, and advocating for community changes which could benefit all children. Contribution to theory along with research, policy, and nursing education implications are identified and discussed.

The prevalence of pediatric overweight and obesity is rising globally (Di Cesare et al., 2019) and results in lifelong chronic health problems and an estimated annual healthcare cost of $14.1 billion (Trasande & Chatterjee, 2009). The purpose of this evidence-based practice project was to address overweight and obesity in patients between the ages of five and 12 years through the provision of provider reminders, education, and guidelines. Primary outcomes included frequency of diagnosis, frequency of patient referrals, return to see times, and frequency of patient nutrition and activity education while secondary outcomes included patient weight, body mass index (BMI), and zBMI. A review of literature was conducted, and a multimodal, nonpharmacologic approach was determined to be most effective. Over a 12-week period, pediatric patients who met specified BMI percentile criteria were flagged by nurses who supplied provider reminders. A provider education session was also conducted. Statistical analysis was performed utilizing a two-group comparison design. Pre-intervention data (n = 111) was collected on frequency of diagnosis, frequency of patient referrals, and frequency of patient nutrition and activity education and was compared to intervention data (n = 391) using a chi-square test for independence to determine if the intervention made a statistically significant impact. A statistically significant increase in number of diagnosis was found (X2 (1) = 8.636, p = .003) while the results for the frequency of nutrition and activity counseling (X2 (1) = 1.587, p = .208), return to see times (t (500) = 1.263, p = .207), and frequency of referrals (X2 (1) = 2.296, p = .317) were not significant. To examine secondary outcomes, a paired t-test comparing the weight, BMI, and zBMI of repeat patients (n = 27) was performed. While patient weight increased significantly (t = -3.620, df = 26, p = .001), this was expected as height also increased. No significant difference in BMI (t = -.792, df = 26, p = .436) or zBMI (t = .166, df = 26, p = .869) was found. Future longitudinal research should aim to examine if an increase in diagnosis contributes to decreased patient weight, BMI, and zBMI.

Women of color in the United States experience disproportionately higher rates of adverse pregnancy-related outcomes, both in the prenatal and postpartum period. Group prenatal care (GPC) has been gaining popularity in recent years and has demonstrated improved health outcomes. The aim of this systematic literature review was to examine and summarize the impact of group prenatal care on health outcomes for women of color in the United States. Using a systematic approach and PRISMA guidelines, two electronic databases—CINAHL and PubMed—were used to search the literature. Quantitative research studies that were published in peer-reviewed journals between 2010 and 2020, written in the English language, and examined health outcomes for women of color in the United States were screened for inclusion. Study strength and quality were assessed, and 10 studies (nine retrospective cohort studies/medical chart reviews and one meta-analysis) were systematically reviewed. Overall, published studies support efficacy of group prenatal care in improving health outcomes for pregnant women of color. Rates of preterm birth and low birth weight were decreased, and breastfeeding initiation and continuation were increased. Group prenatal care is an effective intervention for improving health outcomes for women of color. To close the racial gap in infant and maternal mortality, more high-quality research examining specific outcomes for women of color, particularly Black women, participating in group prenatal care is needed.

Background: Hypoxic-ischemic encephalopathy (HIE) can result in devastating long-term neurological morbidity and/or death. Current evidence recommends initiating Therapeutic Hypothermia (TH), as early as possible, however, research specifically describing TH timing in relation to short-term infant outcomes is limited with mixed results. Purpose: Examine TH timing (TH initiation time & time to target temperature) on short-term outcomes (neonatal seizure; brain injury) of infants >35weeks, with suspected HIE, born at a large urban women’s medical center. Methodology: Retrospective, cross-sectional, correlational design examining data extracted from electronic health record from November 1, 2012- March 31, 2020. Descriptive and inferential statistics were performed. Results: Infants with neonatal seizures had higher initial lactates (M=13.39, SD=5.31) a significant difference of 4.38mmol (95% CI -6.89 to -1.86), t(113)=3.44, p=.001; lower arterial blood gas pH values (M=3.331, SD=4.41) a difference of 0.07mEq/L (95% CI, 0.01 to 0.14), t(109)= 2.37, p=.020; fewer minutes to reach target temperature (mean rank=39.11), a significant difference (U= 533, z= -2.677, p= .007). Infants with brain injury had higher initial lactates (M= 13.04 , SD= 5.52) a significant difference of 4.27mmol (95% CI -6.45 to -2.07), t(113)= -3.85, p< .001; lower arterial blood gas pH values (M=7.12, SD= 0.15), a significant difference of 0.09mEq/L (95% CI 0.0 to 0.14), t(109)= 3.16, p=.002. Infants with early initiation had higher initial lactates (M=11.43, SD=4.90) a significant difference of 2.49mmol (95% CI, 0.45 to 4.52, t(113) =2.42, p= .017, Cohen’s d= .607). Infants within target temperature had higher initial lactates (M = 10.57, SD = 5.46) a significant difference of 2.44mmol (95% CI, 0.49 to 4.40), t(113) = 2.47, p= .015, Cohen’s d = .481). Implications: Infants with neonatal seizures and/or brain injury had more acidotic cord and blood gas results, as well as higher initial lactates than those without neonatal seizures and/or brain injury. This study demonstrated the importance of TH timing, specifically time to target temperature, as infants with seizures required significantly less time to reach target temperature. A greater understanding of cord and blood gas results, initial lactates, and target temperature may increase the nurses’ ability to anticipate complications.

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, simplified, evidence-based DKA protocol in the PICU to promote adherence by staff members. Methods: A literature search was performed based on the PICOT question “In pediatric patients, how does using a protocol to manage DKA compared to not using a protocol affect patient outcomes throughout hospital admission?” A total of 26 articles were used: 6 that directly supported implementation of a DKA protocol, and 20 that supported various aspects of DKA management that were essential for an updated, evidence-based protocol. Based on these, updates were made to the existing protocol to make it easier to use but still conform to clinical guidelines set forth by the International Society for Pediatric and Adolescent Diabetes (ISPAD). The Duffy Quality-Care Model and the Star Model of Knowledge Transformation were the theoretical frameworks for this project. Focus groups were used to assess demand and practicality for the protocol changes and assimilate the evidence-based guidelines into the revised protocol. Staff was educated to the changes, and the revised protocol was implemented for a 90-day trial period. Staff satisfaction and protocol usage evaluation were evaluated through staff surveys with both quantitative Likert scale data and qualitative open-ended question data. Rapid cycle quality improvement strategies of staff interviewing and survey data analysis were used to troubleshoot protocol issues during the trial period. Results: Using evidence-based literature, a fully optimized DKA protocol was successfully developed and implemented in the PICU. Feasibility of long-term sustainability was confirmed by staff surveys with 78.9% reporting they were likely to use the new protocol. There was report through the interview and open-ended question answers that patient glucose levels remained high longer with the new protocol, though the acidosis still corrected without issue, leading to the identification of a missed logic step in the protocol algorithm for rebound hyperglycemia during the dextrose infusion. There were no medical complications related to this missed step, but it was identified as an area of the protocol needing further development. Discussion: Though there was a high percentage of staff members reporting they were likely to use the new protocol, there were mixed results for whether the old or new protocol was preferred. The missed step in the algorithm for rebound hyperglycemia with the dextrose infusion is under review by the PICU medical staff, but recommendations have not yet been determined for appropriate correction as this rebound hyperglycemia also has some protective effects against hypoglycemia during acidosis correction. Attention to this issue with the algorithm will likely improve staff satisfaction with the protocol. Conclusion: At present, the PICU staff plan a sustained adoption of the revised DKA protocol. Using an algorithmic, evidence-based DKA protocol standardizes care provided to patients, reducing morbidity and mortality and promoting patient safety and improved patient outcomes.

An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates. For this project, 158 NICU nurses at a large metropolitan children’s hospital in New York City were given a survey consisting of ten images of simulated emesis volumes on standard hospital linens and asked to estimate the emesis volumes (Appendix B). Nurses were also surveyed on demographics, their attitudes and beliefs related to emesis in neonates, and personal practices regarding this issue. Compiled data results revealed that nurses were able to correctly estimate the simulated emesis volume presented to them an average of 34.5% of the time, regardless of educational level, years of experience, or presence of certification in their specialty. It is clear that visual quantification of emesis volumes is a highly inaccurate method to assess feeding tolerance and guide feed advancement in the NICU. Further research is needed on how these methods affect time to full feedings and overall NICU length of stay.

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a single patient, facility, region, or country. We described a forecasting model for estimating essential chemotherapy in the treatment of childhood ALL to multipliers. Multipliers were obtained from a reference population of 10 million children evenly distributed (2.5 million each) across four age cohorts at 5-year intervals (0-4, 5-9, 10-14, and 15-19 years). The forecasting model and multipliers were applied to 171 countries with age-specific population data available in the United Nations 2017 World Populations Prospects. Results from the forecasting model and multipliers were compared to determine differences for each country and for countries with extreme population distributions across the pediatric age range. The multipliers produced results no greater than 15% of those obtained using the forecasting model. Multipliers allow healthcare providers, cancer centers, hospitals, countries, and drug manufacturers to accurately estimate the essential chemotherapy needs for a patient, facility, region, or country. This practical tool can be applied to other cancer diagnoses and treatment protocols.

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing motivational interviewing (MI) to deliver multicomponent lifestyle interventions and family involvement is considered best practice for childhood obesity treatment. For six weeks, seven participants and their parents received a weekly, 30-minute, face-to-face, individualized: MI session integrating the 5-2-1-0 healthy habits messages. The mnemonic, 5-2-1-0 represents healthy eating and physical activity habits each day: five or more fruits and vegetables per day, two hours or less screen time per day, one hour or more of physical activity per day, and zero sugar drinks coupled with plenty of water, and low-fat milk consumption (Tucker et al., 2013). The BMI measurements of the same participants were collected prior to the initiation of the 5-2-1-0 obesity program and after the program completion at six weeks. A paired t-test was used to compare the pre-implementation BMI data to the post-implementation BMI data. Statistically significant differences in BMI were found (p = 0.012; N=7) over the six-week intervention period. Future projects with similar objectives to this EBP project may benefit from using the 5-2-1-0 program to combat childhood obesity.

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that incorporates cryotherapy and vibration was selected and used during vaccinations in children ages newborn to seven years of age. The Johns Hopkins Nursing Evidence Based Practice Model was selected as a guide for the EBP project development, planning, and implementation at an outpatient family practice office in Northern Indiana. The nursing staff performed vaccinations using standard of care for pain for four weeks, then the implementation of Buzzy® was used for four weeks. Data were collected using two pain rating scales associated with specific ages. The Face Legs Activity Cry Consolability Scale (FLACC) was used to observe the pain behavior of children ages newborn to two years. The Wong- Baker FACES Pain Rating Scale was used for children ages three to seven years. Data were collected through electronic medical record and then analyzed through chi-square for demographic information and chi-square for independence for outcomes on pain. The demographic differences between the two groups were statistically insignificant. The FLACC outcome scores were significantly different between the pre- and post-intervention groups (x2(4, N=28) = 12.48, p < 0.05) while the FACES outcome scores were insignificant (x2(3, N=28) = 5.94, p > 0.05). The results showed that future research for pain management strategies during needle-based procedures is still essential for improving patient comfort, as well as improved patient compliance.

Postpartum depression (PPD) is depression that occurs in women following childbirth occurring during the postpartum period and affects 1 in 7 women (The United States Preventive Services Task Force, 2019). The American Academy of Pediatrics [AAP] (2019), recommends that pediatric healthcare providers utilize their position to screen for PPD. The purpose of this evidence-based practice (EBP) project was to implement a PPD screening intervention within a pediatric healthcare setting using the Edinburgh Postnatal Depression Scale (EPDS). The Academic Center for Evidence-Based (ACE) Practice Star Model guided this EBP project with evidence-based interventions developed after a comprehensive literature search. Implementation of the EBP project occurred in a pediatric office in northeast, Indiana in which eligible mothers were screened at their child’s 1, 2, 4, and 6-month well-child visits. A total of 30 participants were screened for risk for PPD at their child’s initial well-child visit and then 12 weeks later with a follow-up phone call. Interventions to increase awareness of PPD were delivered to participants based on their EPDS scores. Participants scoring greater than 10 were identified as highest risk for PPD and were provided with community resources, PPD educational information, and a referral to their obstetrician/gynecologist (OB/GYN), or primary care provider (PCP). Those who scored less than 10 received community resources and PPD educational information to review at their convenience. A 12-week follow-up phone call was conducted for all participants post-intervention. A paired-samples t-test indicated a significant decrease from pre-intervention EPDS total score was found t(29) = 6.625, p < .001. The mean of the pre-intervention EPDS score was 4.83 (4.65) and the mean of the pre-intervention OB/GYN or PCP follow-up was 2.67 (0.76). A significant decrease from the pre-intervention EPDS score to follow-up was found t(29) = 2.259, p < 0.05. A one-way between subjects’ ANOVA was conducted to compare the effect of past medical history on EPDS total scores. There was a significant effect of past medical history on EPDS total scores at the p < .05 level for the three conditions F(4, 25) = 3.121, p = 0.033.

Many NICUs around the country are moving away from traditional open-bay designs in favor of single-family rooms (SFRs) as more is understood about the impact of the sensory environment on neurodevelopment in preterm infants. SFRs house one infant and their family for the length of the infant’s stay and are associated with improvements in numerous outcomes, including increased milk intake and weight gain and earlier transition to enteral feeding. Oral feeding remains a critical requirement for NICU discharge; however, the impact of NICU design on feeding outcomes remains unknown. The purpose of this study was to compare feeding outcomes between infants cared for in an open-bay NICU and infants cared for in SFRs, via retrospective chart review. The primary outcome variable of interest was feeding-related length of stay (FRLOS). A secondary outcome measure was gestational age at first oral feeding. The key findings from this study were no significant differences in either outcome measure between groups, suggesting that for relatively healthy preterm infants, NICU design has no significant impact on feeding-related length-of-stay or age at first oral feed. Infants progressed to full oral feeding at roughly the same rate whether cared for in an SFR or an open bay nursery.

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care practice. A comprehensive literature search utilizing 6 databases and hand search yielded 14 relevant articles. The articles were appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Research and Non-Research appraisal tools and level of evidence using The Melnyk and Fineout-Overholt’s (2015) Hierarchy of Evidence for intervention questions. The participants of the project comprised of 80 children aged from 6-months up to 6 years old received preventive oral health care services over a 3-month time. Interventions included: a) caries risk assessment, b) application of fluoride varnish, c) caregiver education, and d) referrals to a dentist for establishment of dental home and care for children at risk of developing dental caries. The Health Belief Model (Hochbaum, Kegels, & Rosenstock, 1952) and the Iowa Model Revised (Iowa Model Collaborative, 2017) were used to guide the project. Primary outcomes were fluoride varnish application rate, dental referral success rate, and adherence by caregivers to oral health recommendations. Data were collected using a questionnaire and will be analyzed. Implications of this project for practice will be discussed.

Antibiotic misuse and overuse are major contributors to antibiotic resistance which is responsible for the death of 23,000 American’s annually. There is a growing body of evidence that antibiotic stewardship programs are successful in reducing antibiotic prescribing rates while maintaining safe patient care. Research supports a multifaceted approach with an ongoing commitment to antibiotic stewardship. This quality improvement project aimed to reduce the overuse of antibiotics in pediatric acute respiratory tract infections (ARTIs), improve the percentage of children who received laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis, and to implement and measure the efficacy of watchful waiting for children diagnosed with acute otitis media (AOM) and upper respiratory tract infections (URI). At the start of the project, the quality improvement team implemented on-site educational sessions for 17 pediatric and family practice providers. After 3 months of data collection, there was a 1.8% increase in the percentage of children who were diagnosed with URI and were not dispensed an antibiotic prescription. There was a 10.5% increase in the percentage of children who received proper laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis. In addition, 70% of watchful waiting protocol patients with AOM improved without the use of antibiotics. Although these improvements were incremental, they demonstrate the success of a single quality improvement cycle and illustrate need for continued improvement efforts in an organization wide outpatient antibiotic stewardship program.

Background: Opioid use and drug abuse has led to an increase in fetal exposure to illicit drugs in the United States, putting these infants at risk for developing neonatal abstinence syndrome (NAS). Parental involvement in the care of these infants during their hospitalization has become an essential part of the treatment process Purpose: The purpose of this project is to implement rooming in for infants with in utero exposure to opioids as a quality improvement practice change. Methods: A literature search relating to improving the care of infants with NAS was conducted. Educational handouts were provided to staff regarding the practice change, and to the parents that described NAS and the process of rooming in. Rooming in was then initiated and data was collected relating to hospital length of stay (LOS), pharmacologic treatment, and breastfeeding. Feedback for this practice change was conducted with a staff survey. Results: Data was collected on 19 infants over a 90-day period. This data was compared to hospital averages previously collected. LOS decreased from an average of 14.4 days in the comparison group to 6.11 days in the study group (P= 0.0004). Pharmacological utilization to treat infants with NAS, decreased from 62% in the comparison group to 5.3% in the study group (P < 0.0001). Breastfeeding rates at discharge increased from 14.1% in the comparison group to 26.3% in the study group (P =0.1891). Discussion: The change in LOS and pharmacological treatment was found to be statistically and clinically significant. It is predicted that LOS and use of pharmacological treatment will continue at this current trend if rooming in continues. Breast feeding rates were found to be clinically but not statistically significant.

Amblyopia is the most common visual disorder in children and is potentially curable if detected early and treated properly in the first few years of life. Amblyopia is the leading cause of monocular vision loss in children (Bradfield, 2013). It is a developmental neuroplasticity which derives from birth causing structural and functional changes in the eye and brain. With this structural and functional disruption, visual blur occurs due to refractive amblyopia, strabismic amblyopia, cataracts (form-deprivation amblyopia), or a combination of any of these (Solebo, Cumberland, & Rahi, 2015). Refractive errors related to amblyopia can also occur. The purpose of this evidence-based practice project was to determine if screening a pediatric population ages 9 months, 24 months, 36 months, and 48 months using an automated visual screener would affect the number of refractive errors detected. The Stetler Model’s stepwise process for gathering sound evidence was used to guide this evidence-based practice project at a busy Midwest pediatric clinic. Anyone that failed the screening was referred to ophthalmology for further testing. Post-intervention group data were collected on patients from the designated age groups receiving visual screening during a well-child check-up by two designated providers over a three-month period. Pre-intervention group data were collected from electronic health records for patients in the same designated age group receiving a well-child check-up by the same two providers as post-intervention data over a three-month period. Data were analyzed using Pearson’s Chi-Square Goodness of Fit test in an effort to show the sensitivity and specificity of the automated visual screener to screen for amblyopic risk factors. Of the total sample size (N = 322), there were 161 in the pre-implementation group and 161 in the post-implementation group. Results supported the PlusOptix™ S12 vision screener in identifying more refractive errors than traditional visual exams performed during routine well child check-ups (χ2 = 20.184a, p < 0.001, 99% CI).

Skin cancer is an important topic in the United States due to the recent increase in cost and mortality. The purpose of this evidence-based practice (EBP) project was to determine if the early implementation of a multicomponent sun prevention program positively impacted kindergarten and first grade students’ knowledge and behavioral intentions to practice safe sun techniques after a one week period. Kotter’s Model of Change and the ACE Star model were utilized to guide this EBP project. An exhaustive review of the literature yielded 12 articles which were used to develop best practices for education on sun safety. The quality of the evidence was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Kindergarten and first grade students of a public Midwestern elementary school were invited to participate. The project leader obtained IRB approval and parental consent, collected demographics, and created an original sun prevention program using child-friendly strategies. The sun prevention program was implemented thirty minutes per day for four days. The program interventions included the educational themes: safari time, take a splash, block party, and Ray’s future. An original tool that measured the students’ knowledge and behavioral intentions was utilized to evaluate project success. Outcomes were measured using a paired t-test and compared the pre-test and post-test results. The four day multicomponent sun prevention program for students in kindergarten and first grade was significant for the pre-test to post-test knowledge results (t (1) = -9.567, p

Introduction. Health-related quality of life (HRQOL) has become a meaningful area in research, medical management, and in the evaluation of health outcomes. However, in children with congenital adrenal hyperplasia (CAH), HRQOL is a long-neglected subject. Previous research in individuals with CAH typically focused on medical treatment and outcomes, which suggested that HRQOL is influenced by personal factors such as genital ambiguity, impaired growth, higher incidence of obesity, metabolic syndrome, hypertension, acute adrenal crisis, as well as losses in psychosexual milestones and psychological functioning. Social contexts, such as family, were identified as factors that contribute to an individual’s perceived HRQOL. Today, there is some agreement that non-disclosure, shame, secrecy, and stigma affect psychological well-being. Despite research efforts, there is limited information about which factors influence HRQOL and which factors are most relevant to female children with CAH. This indicates the need to go beyond identifying single factors, and address the complex relationship of factors that impact HRQOL, and individuals’ perception of these factors. Therefore, the bioecological model of human development was used to understand the different factors that impact HRQOL in female children with CAH. Methods. A convergent mixed methods design was selected whereby the quantitative and qualitative results were merged to provide a comprehensive understanding of HRQOL of female children with CAH. Qualitative methods (QUAL) involved using semi-structured interviews with child-caregiver dyads (N=20) to explore HRQOL and describe factors that impact HRQOL of female children with CAH. Member checking procedures were implemented to ensure trustworthiness or credibility and rigor of the QUAL component of this study. NVivo 10 was used to analyze the QUAL data. Additionally, the full sample of 25 child-caregiver dyads completed KINDL-R questionnaires, which provided a quantitative (QUAN) measure of HRQOL of female children with CAH. QUAN data were analyzed using SPSS version 24. Individual analysis of both QUAL and QUAN data were merged to ascertain findings for a mixed methods interpretation. Results. Children with CAH and their caregivers reported having good overall HRQOL. Children scored significantly lower on the School subscale compared to their caregivers (Mdn= 12.5, IQR= 18.75) Examination of the data revealed significant relationships between other health issues and how caregivers rated children’s HRQOL, p Discussion. Using a comprehensive approach offered an understanding of what it is like for children to live with CAH from the perspective of the child and caregiver. By quantitatively measuring HRQOL and using qualitative interview data, the information in this study may shed light on children’s and caregivers’ needs that are not met by current guidelines. Although the overall child- and caregiver-reported HRQOL of female children was not impaired, children’s and caregiver’s lived experiences highlight the many factors that impact HRQOL including the importance of friends and family, personal characteristics (i.e., the ability to adapt and self-esteem), the environment (i.e., home, school), and the impact of time (i.e., developmental time, past vs present). Knowing this, clinicians may better support children and families by expanding the focus beyond sex development to include: 1) information about the different ways of knowing (i.e., knowing how to talk with others and with their child); 2) self-management and independence (i.e., learning how to administer medication and handling responsibility as children grown older); and 3) psychological support (i.e., coping with a new diagnosis, adapting to the disorder.)

Achievement of optimal quality in today’s healthcare environment practices means that clinical practices must be based on evidence. Evidence-based practice (EBP) is the integration of research findings, clinician expertise, and patient-centeredness that includes a focus on preferences and values (Melnyk & Fineout-Overholt, 2015). An area within EBP needing increased attention is the aspect of patient preferences and values. The process of Shared Decision Making (SDM) incorporates assessment of preferences and values within a process in which where patients, families and healthcare professionals collaborate to make decisions regarding patient care. The purpose of this study was to describe perceptions of parents and nurses in a pediatric inpatient setting about SDM and to adapt an existing SDM tool for use in the pediatric clinical setting. Areas of focus include: (1) critical review of SDM literature focusing on care of acutely ill children; (2) adaptation of existing reliable and valid SDM physician and adult patient -focused tools to a pediatric nurse and parent-focused SDM tools, and (3) a mixed methods approach assessing parent and nurse perceptions of SDM in an acute care facility and interview sessions with nurses to share thoughts and suggestions on use of shared decision making in the pediatric clinical setting. A summary of the findings based on the completed research includes several overall insights. First, the existing adult tools were successfully adapted for use in the pediatric setting based on parent and nurse feedback. Second, the quantitative findings from the mixed methods study identified consistency in positive perceptions of nurses and parents with regard to SDM in caring for an acutely ill hospitalized child. The qualitative data from this study identified the need for enhanced parent-nurse communication and strategies for a team approach to hospital-based care.

Research suggests pre-pregnancy obesity is associated with an increased risk of macrosomia in the newborn. Since women are expected to gain weight during pregnancy, the standard recommendation of weight loss for obesity is not ideal for this population. In this systematic review of the literature regarding interventions for maternal obesity to reduce fetal macrosomia, 149 articles were screened using three different databases to identify recent randomized controlled trials related to this topic. A total of 11 full text articles were analyzed and included in the review. The articles addressed nutritional, lifestyle, and pharmacological interventions. The results indicated there is currently insufficient evidence to support specific treatment options for women with obesity during pregnancy to reduce the risk of fetal macrosomia.

In recent years, there has been a significant increase in pediatric onset of type II diabetes. This paper will examine elements contributing to this trend. Type II diabetes will be discussed, including related pathophysiology, manifestations, diagnosis, and complications, with differentiation between adult and pediatric onset. Possible prevention and treatment methods appropriate for pediatric patients will also be discussed, along with possible outcomes in pediatric patients that could result from this disease. Overall, this paper will provide insight on the causes of this growing trend, and ways to improve the risks imposed on pediatric patients.