PhD, University of Cincinnati, 2017, Nursing: Nursing - Doctoral Program

Background: In 2013, over 39,000 children in the United States died, with approximately 80 percent of deaths occurring in a pediatric critical care unit. The death rate for critically ill children treated in pediatric critical care units decreased by half in the last two decades, yet remains at 2.39 percent. There is a small body of current knowledge which examines the lived experience of nurses who care for dying children, the grief they experience, and how they individually or with the aid of organizational interventions resolve their grief. No current studies have examined the culture nurses create that helps them collectively manage work-related grief. Purpose: The purpose of this study was to explore how nurses in two pediatric critical care units use shared behaviors to help manage work-related grief and continue providing care in the stressful pediatric critical care environment. Method: Focused ethnography was the method used to examine the shared culture nurses create that helps them manage work-related grief. Thirty-three informants were interviewed, 20 from the pediatric intensive care unit (PICU) and 13 from the cardiac intensive care unit (CICU). Data were comprised of interviews, and researcher reflections, with themes and domains abstracted from the data. Findings: Study findings demonstrated that PICU and CICU nurses had very different strategies for grief management. These differences were explicated in the five domains abstracted from the research data. The five domains were further broken down into themes. Domain I: Values and Beliefs reviewed shared values and beliefs held by critical care nurses in both units. Themes which comprised this Domain are: Always Learning – Always New, Dignity in Life – Dignity in Death, Bringing Comfort, and Meaning in Work. Domain II: Causes of Grief, was comprised of the themes: Hyper-Responsibility, Prevented from Bringing Comfort, Bonding, Alive One Day, Dead the Next, and Acuity of the Unit. (open full item for complete abstract)

Committee: Donna Shambley-Ebron Ph.D. (Committee Chair); Erynn Casanova Ph.D. (Committee Member); Carolyn Smith Ph.D. (Committee Member) Subjects: Nursing

DNP, Walsh University, 2023, Nursing

Nurses that care for pediatric patients with behavioral disorders and aggression in a non-psychiatric setting face unique challenges. Pediatric nurses are usually not trained to care for children with aggression and behavioral outbursts, which result in high rates of burnout. Providing formal trauma-informed patient care education and training to pediatric nurses can improve their confidence and the quality of care in managing patient aggression. The purposes of this study were to a.) examine if Welle behavioral-management training is effective in improving pediatric nurse confidence in the management of pediatric aggression in a non-psychiatric setting and b.) examine the relationship between demographic characteristics and nurse confidence. A convenience sample of 13 registered nurses employed on the pediatric medical-surgical unit who received the Welle training educational intervention were recruited to participate in this study. A one-group pretest post-test study design was used to assess registered nurses' level of confidence in managing pediatric patients with aggression before and after the Welle training. To measure nurse confidence in the management of pediatric aggression, The Incidence of and Attitudes Toward Aggression in the Workplace questionnaire was administered before and up to two weeks after the Welle training. Results indicate that the Welle training was effective in improving nursing confidence scores in the management of patients with aggression. Findings from this study provide information on how training and education can improve nurse confidence scores in the management of pediatric aggression. These findings can be useful when designing nursing orientation programs and standardizing aggression management education across health systems.

Committee: Shelly Amato-Curran PhD, APRN-CNS,CRRN (Committee Co-Chair); Janeen Kotsch PhD, MSN/Ed, RN, CNE (Committee Chair) Subjects: Behavioral Sciences; Nursing

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); John Suozzi (Committee Member) Subjects: Epidemiology; Ethics; Gender Studies; Health; Health Care; Health Care Management; Language; Literacy; Medical Ethics; Medical Imaging; Medicine; Mental Health; Native American Studies; Public Health; Public Health Education

Master of Arts, The Ohio State University, 2021, Educational Studies

Background: Working in the pediatric intensive care unit (PICU) exposes nurses to intense and recurrent experiences with loss. Such experiences may result in unresolved grief or despair among nurses. Although previous studies have explored grief within the nursing profession, few have focused on grief following the death of children in the PICU, where sudden or traumatic deaths are more frequent. Aim: To examine how pediatric critical care nurses experience symptoms of grief or distress following the suffering or death of a patient in the PICU. Methods: An email invited PICU nurses to complete an online survey with demographic questions and an open-ended, qualitative question about grief experiences. Research team members coded open-ended responses, using thematic content analysis. Final themes were further validated via member checking with 10 participants. Findings: Of the 104 participants, most were Caucasian (96.3%), female (97%), bedside (83.5%) nurses with a bachelor's degree (85.4%). Participants had variable years of experience and included both day (59.6%) and night (40.4%) shift nurses. Four themes emerged when pediatric critical care (PCC) nurses were asked about grief symptoms and distress following the suffering or death of a patient in the PICU: (1) continuum of emotional responses (2) emotional moderators, (3) coping, and (4) resilience. Conclusion: This qualitative study provides a rich, contextualized understanding of PCC nurses' grief experiences. The 4 themes and underlying subthemes unveiled areas of need in nurse support programs, such as the necessity to know and recognize maladaptive grief responses, the importance of institutional peer support programs, and the value of teaching resilience amongst PCC nurses.

Committee: David Stein (Advisor) Subjects: Medicine; Nursing

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

Background: National healthcare has focused on diagnosis and treatment; while current evidence attributes population health and individual well-being largely to social determinants of health (SDH). Social determinants of health factors such as food insecurity, insufficient housing conditions, inadequate education services, safety, and limited access to medical care are associated with poor pediatric health outcomes. Problem: Nurses are uniquely positioned to address SDH in healthcare and have a professional obligation to screen for SDH when providing healthcare. However, nursing education has traditionally focused on acute care with minimal population health relevancy. The lack of association between nursing assessment of SDH and health outcomes impedes the advancement of population health and prevention. Global Aim: Promote population health and health equity by identifying and addressing SDH to improve the health and well-being. Objective aims include: (1) increase nurses' knowledge of SDH; (2) screen at least 50% of all admissions for core social determinants of health; and (3) appropriately refer 80% of patients who screened positive for SDH factors. Methods: Create an evidence based SDH education module and screening tool based on core SDH recommended by the Center for Medicare & Medicaid Services (CMS). After completing education, nurses will utilize the screening tool to efficiently identify unmet core SDH needs and make appropriate referrals. Results: Implementation of module significantly increased nursing knowledge and SDH screenings were completed on 47% of all admitted patients and families to the pilot unit. Additionally, nurses gave appropriate referrals to 85% of patients who screened positive for one or more unmet core SDH factor.

Committee: Debbie Van Kuiken PhD, RN, AHN-BC (Committee Chair); Susan Allen PhD, RN (Committee Member) Subjects: Nursing; Public Health

DNP, Otterbein University, 2014, Nursing

The World Health Organization (WHO) in 1995 described obesity as a chronic disease and one of the most important public health threats and in 2000 reported obesity as a global epidemic. The numbers of obese children are increasing in society; moreover, the onset of obesity is occurring at even a younger age than in the past. The prevalence of pediatric obesity is staggering and interventions need to be developed to decrease the risk for chronic and related psychological diseases. The objective of this project was to provide education on utilization of a tool kit to increase the nurse practitioner (NP) participants' knowledge base in regards to pediatric obesity prevention, recognition, and treatment. As the pre-intervention, a questionnaire was distributed to the participants to measure their knowledge of childhood obesity. The participants utilized a tool kit in their clinical practice for a two-month period. At the end of the intervention the Project Director met with the participants and distributed the same questionnaire to determine if participant knowledge, skills and perceptions changed after adopting the tool kit principles into their practice. Data analysis was completed utilizing an analysis of both the mode and median for each question to determine whether or not there was a change in the pre and post-intervention responses. An analysis of pre and post-frequency distributions was completed to determine the direction and extent of that change. Statistical significance of each change was tested utilizing the Mann-Whitney U-Test. Mode, median, and statistical significance were calculated utilizing Excel. Post-intervention participants reported that children would not outgrow overweight, and identified that a significant barrier to pediatric obesity treatment was not the patient, but lack of preparation on the part of NPs. The results supported that increased knowledge did translate into improved treatment practices in the ambulatory care setting. As mor (open full item for complete abstract)

Committee: Patricia Keane PhD (Advisor); Alicia Ribar PhD (Committee Member); Cynthia Yensel MSN (Committee Member) Subjects: Medicine; Nursing; Nutrition