Nursing Research

2018 Prince Nurse Scholar Grant

Lindsey Hird-McCory, BSN, RN, CPN & Julie M Novak, BSN, RN

Supporting home health nursing education for the technology dependent, medically fragile pediatric patients

Background: There is a critical shortage of private duty home nurses willing and qualified to care for medically fragile, technology dependent (MFTD) children. In the United States, the number of medically complex children is approximately 0.4-0.7% of the total population, but account for $50-110 billion of annual health care costs.

Purpose: Further education of home health nurses is needed to increase their comfort and competence caring for children with tracheostomy, ventilator, enteral tubes, ostomies, and central venous catheters.

Methods:  Lurie Children's and the Division of Specialized Care for Children (DSCC) hosted a half-day conference geared towards providing up-to-date education to home health nurses caring for MFTD children.  Lurie Children's Hospital partnered with DSCC to present a half-day conference geared towards providing up-to-date education to home health nurses caring for MFTD children. 

Results: 59 nurses attended the conference. Their ratings of comfort and competence increased for all devices. Their comfort and competence with emergency care and breakage of central venous catheter’s increased the most, followed by ventilator management and airway clearance.

Conclusions: While there was no immediate increase in access to qualified home health nurses, we continue to monitor patient outcomes of safety, hospital readmissions, and length of stay to assess the impact of the conference.

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2018 Prince Nursing Scientist Grant

Stephanie K. Wiegert, DNP, APRN, CPNP & Huong Mai, BSN, RN, CPN

Effectiveness of dual blanket phototherapy compared to combination phototherapy on rate of bilirubin decline and treatment duration

Introduction: The purpose of this study was to evaluate the effectiveness of dual LED blanket phototherapy compared to combination LED phototherapy on rate of total serum bilirubin (TSB) decline and treatment duration among full-term infants with hyperbilirubinemia.

Methods: A retrospective chart review of 255 newborns with hyperbilirubinemia admitted to a free-standing, university-affiliated, non-profit, tertiary care children’s hospital was conducted. Phototherapy type, duration, and rate of TSB decline were compared.

Results: Rate of TSB decline was significantly higher among infants treated with combination LED phototherapy when compared to infants treated with dual blanket phototherapy (p <.0001). There was no significant difference in phototherapy duration. 

Discussion: Combination phototherapy resulted in more rapid decline in TSB; but did not shorten phototherapy duration when compared to dual blanket phototherapy. However, phototherapy duration may have been confounded by prescriber variability in TSB thresholds for phototherapy discontinuation. Further comparative effectiveness studies are recommended.

Manuscript: 

Wiegert SK & Mai, H Effectiveness of dual blanket phototherapy compared to combination phototherapy on rate of bilirubin decline and treatment duration. In Peer-review

Posters: 

Peer-reviewed
Wiegert SK & Mai, H Effectiveness of dual blanket phototherapy compared to combination phototherapy on rate of bilirubin decline and treatment duration. [poster].  Society of Pediatric Nursing, Virtual conference, 2020.

Wiegert SK & Mai, H Comparative effectiveness of phototherapy methods on rate of bilirubin decline and treatment duration: Preliminary results. [poster].  Lurie Children’s Nursing Research Council Clinical Inquiry Conference. 2019, October; Chicago, IL.

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Carroll Scholar Award

Bob and Emily Carroll chose to recognize the inspirational and innovative efforts of our pediatric nurses who have dedicated their careers to advance pediatric nursing care at the bedside and in direct care of patients. They are committed leaders of professional nursing practice. This award recognizes their vigilance, expertise, creativity and compassion. This $10,000 award funds their time and efforts to pursue pediatric nursing excellence through scholarly activities and clinical inquiry.

2017  Laura Schlenker, BSN, RN, CPHON (2000-present)

Timing of Pegfilgrastim: Association with Chemotherapy Delays and Admission for Febrile Neutropenia in Pediatric Solid and CNS Tumor Population

Purpose:  While recommended timing of pegfilgrastim administration is > 24 hours after chemotherapy, patient barriers to next day administration, available adult evidence, and pharmacokinetic data have led to earlier administration in some pediatric patients with solid and central nervous system tumors. The purpose of this study was to compare patient outcomes by timing of pegfilgrastim after chemotherapy.

Methods: A retrospective chart review examined timing of 932 pegfilgrastim administrations to 182 patients, 0-29 years of age. The primary outcome was febrile neutropenia (FN); the secondary outcome was neutropenic delays (ND) >7 days to next chemotherapy cycle. To account for multiple pegfilgrastim administrations per patient, a generalized mixed model was used with a logit link for the dichotomous outcomes (FN & ND), timing as the dichotomous independent variable, and random effect for patient. 

Results: FN occurred in 196 of 916 cycles (21.4%); and ND in 19 of 805 cycles (2.4%). The fixed effect of pegfilgrastim administration < or >24 hours after chemotherapy was not significant, p = .50; however, earlier or later than 20 hours was significant, p = .005. FN odds were significantly higher when pegfilgrastim was given <20 hours (OR 1.78, 95% CI: 1.19-2.65) after chemotherapy.

Conclusions: While attempts should be made to administer pegfilgrastim >20 hours after chemotherapy, if barriers exist, modified timing based on individual patient characteristics should be considered. Prospective randomized trials are needed to identify lower risk patients for early administration. 

Publications: 

Peer-reviewed
Schlenker, L & Manworren, RCB. Timing of Pegfilgrastim: Association with Febrile Neutropenia in a Pediatric Solid and CNS Tumor Population.  Journal of Pediatric Hematology Oncology Nursing.  Accepted for publication, October 2020.

Presentations: 

Invited 
Schlenker, L. Carroll Scholar Presentation:  Diving into Research: A Bedside Nurse's Journey Through the Carroll Scholarship Program? Lurie Children’s Nursing Research Council Clinical Inquiry Conference. 2019, October; Chicago, IL.

Schlenker, L. Carroll Scholar: Support Makes all the Difference: Supporting Bedside RN’s in the Conduct of Research.  Lurie Children’s Patient Care Operations Meeting.  2019, December; Chicago, IL.

Schlenker, L. Carroll Scholar Presentation: Timing of Pegfilgrastim Project. Presentation to Krehbiel Family.  2019, December; Chicago, IL.

Schlenker, L. Carroll Scholar Presentation: Timing of Pegfilgrastim Project. Presentation to Magnet Appraisers for Lurie Children’s Site Visit.  2020, January; Chicago, IL.

Posters:

Peer-reviewed
Schlenker, L., Rademaker, A.   Timing of Pegfilgrastim: Association with F&N Admits and Chemotherapy Delays in a Pediatric Solid/CNS Tumor Population [poster].  Association of Pediatric Hematology Oncology Nurses Conference.  2018, September; Savannah, GA. 

Schlenker, L., Rademaker, A.   Timing of Pegfilgrastim: Association with F&N Admits and Chemotherapy Delays in a Pediatric Solid/CNS Tumor Population [poster].  Lurie Children’s Nursing Research Council Clinical Inquiry Conference.  2019, October; Chicago, IL.

2018   Kerri Benbrook, BSN, RN, CPHON (2006-present)

The neonatal pain, agitation, and sedation scale (N-PASS), and bedside nurses’ assessments.

Background: The Neonatal Pain Agitation and Sedation Scale (N-PASS) is the only tool to measure sedation of critically ill neonates. Few studies have compared N-PASS scores with bedside NICU nurses’ assessments, particularly among chronically ventilated, medically fragile infants.

Purpose: The main objective of this study was to determine the clinical validity and utility of the N-PASS scale by evaluating agreement of NPASS scores with Neonatal Infant Pain Scale (NIPS) scores and bedside nursing assessment of pain/agitation and sedation. 

Methods: In a 64-bed tertiary NICU, bedside nurses trained to use N-PASS and NIPS prospectively collected 201 pain, agitation, and sedation assessments from a convenience sample of 88 infants. Scores were obtained simultaneously, but independently, with those of nurse investigators.

Results: There was moderate agreement between N-PASS pain scores and nurses’ recommendations (kappa=0.52; 95% CI=0.41, 0.63); and very strong association between N-PASS pain and NIPS bedside scores (p<.001). There is good interrater reliability (ICC=0.83) between bedside nurse and independent investigator N-PASS pain. During 93% of assessments bedside nurses reported N-PASS captures sedation well or very well. No associations between patient characteristics and N-PASS score were found. 

Implications for Practice: When selecting a tool to assess pain, agitation, and sedation, N-PASS provides an objective measure of sedation reflective of nurses’ subjective assessment to help guide pain management.

Practice Change.

The NICU adopted NPASS pain and sedation scales as policy in 2020.

Presentations: 

Invited 
Benbrook, KB. Innovations in Clinical Inquiry- Building and Sustaining a Hospital-Based Nursing Research Program. Ann & Robert H. Lurie Children's Hospital of Chicago and Shirley Ryan Ability Lab Nursing Research Conference, Lurie Children's Hospital. March 4, 2021; Chicago, IL. 

Benbrook K, Entler A, Mai H, Plotkin M, Wiegert S. How did you start out in research? Lurie Children’s Hospital of Chicago Nursing Research Conference; Oct 2019; Chicago, IL.  

Posters 

Peer-reviewed
Benbrook K, Ricca P, Entler A, Greene T, Myler C, Riendeau K, Sills K, Valles E, Zuravel R. (2020, October). Correlation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With Bedside Nurse Assessments. 2020 National Association of Neonatal Nurses (NANN) Conference, Virtual (previously New Orleans, LA).    

Benbrook K, Ricca P, Entler A, Greene T, Myler C, Riendeau K, Sills K, Wischmeyer G, Zuravel R. (2019, October). Correlation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With Bedside Nurse Assessments-Preliminary Results.  Lurie Children's 2019 Innovations in Clinical Inquiry, Lurie Children's Hospital of Chicago, Chicago, IL.  

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2017-20 ANCC Magnet site investigator: Maureen Haugen, MS, APRN, CPNP-PC, CPHON

Nurse-led Parent Educational Discharge Support Strategies (PEDSS) for Children Newly Diagnosed with Cancer

Prime Institution: Duke University

PI: Marilyn Hockenberry, PhD, RN-PPCNP-BD, FAAN                     

Study Overview:

Background: Educating parents of children newly diagnosed with cancer has the potential to positively affect the child’s illness-related experiences and health outcomes. Parents often report confusion and worry with the complexity and large volume of information received during the initial hospitalization that leads to concerns in caring for their child after discharge.

Purpose: The goal of this study is to determine the effectiveness and feasibility of two parent education discharge support strategies (PEDSS –symptom management vs. PEDSS –support for the parent/caregiver) for parents of children newly diagnosed with cancer

Aim 1: Explore the effects of parent education discharge support strategies on childhood cancer symptoms (fever, pain, fatigue, nausea, appetite changes, and sleep problems) and parents’ perception of their ability to care for their child with a new cancer diagnosis.

• Research Question 1.1: How does use of PEDSS -symptom management (PEDSS) compared to PEDSS -support for parents & caregivers (PEDSSPC) affect symptoms experienced by children newly diagnosed with cancer the first 2 months after initial hospitalization?
• Research Question 1.2: How does use of PEDSS compared to PEDSSPC impact parents’ perception of their ability to care for their child newly diagnosed with cancer during the first 2 months after initial hospitalization?

Aim 2: Determine whether implementation of parent education discharge support strategies decreases unplanned use of healthcare services (unscheduled clinic visits, emergency room visits, hospitalizations), and preventable toxicity (malnutrition, sepsis) among children newly diagnosed with cancer.

• Research Question 2.1: Do unplanned use of healthcare services differ during the first 2 months after initial hospital discharge among children with cancer whose parents use PEDSS compared to PEDSSPC?
• Research Question 2.2: Do preventable toxicities differ during the first 2 months after initial hospital discharge among children with cancer whose parents use PEDSS compared to PEDSSPC?

Aim 3: Examine the feasibility & fidelity of implementing PEDSS and PEDSPC for 2 months after initial hospital discharge among parents of children newly diagnosed with cancer at participating Magnet hospitals

Book Chapter:

Haugen,M., Zupenic,S., Landier,W. (2020). Improving Care Through Patient and Family Education. Hinds, P., Linder, L. (Eds.). Pediatric Oncology Nursing: Defining Care Through Science. Switzerland: Springer.

Publication: 

Peer-reviewed
Haugen M, Skeens M, Hancoc, D, Ureda T, Arthur M, Hockenberry M. Implementing a Pediatric Oncology nursing Multisite Trial. Journal of Specialists in Pediatric Nursing. 2020;e12293.DOI: 10.1111/jspn.12293

Poster 

Peer-reviewed
Haugen M. Study Nurse Investigators: McKenzie I, Schwartz C, Newmark M, Strubhar A, Shoop J, Dunn A, Rosenstock P, Baby A, Karr B, McDonough E. ANCC PIs: Hockenberry M & Rodgers C. Nurse-Led Parent Education Discharge Support Strategies (PEDSS) for Children Newly Diagnosed with Cancer. Lurie Children's 2018 Innovations in Clinical Inquiry, Lurie Children's Hospital of Chicago, Chicago, IL

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2020 NIH site Investigator: Jenny Shoop, DNP, APRN, CPNP-PC, CPHON, CPN

Biologic Mechanisms and Dosing of Active Music Engagement in Children with Acute Lymphoblastic Leukemia and Parents

NINR R01NR019190

Prime Institution: The Trustees of Indiana University

PI: Sheri Robb, PhD, MT-BC                                                   
Funding: 3/1/2020-6/30/2024

Study Overview:

This study will examine biologic mechanisms and dosing of an Active Music Engagement (AME) intervention previously tested to provide support for emotional distress in parents and young children (ages 3-8 years) with cancer during acute treatment. The purposes of this two-group randomized controlled trial are to examine mechanisms of effect and dose-response relationships of AME on child/parent stress over time.  Specific aims are to: 1) establish whether AME lowers child and parent cortisol during Acute Lymphoblastic Leukemia (ALL) treatment, 2) examine cortisol as a mediator of AME effects on child outcomes (immune function, emotional distress, quality of life) and parent outcomes (emotional/traumatic stress, quality of life), and 3) examine  the dose/response relationship of AME on child/parent cortisol during ALL treatment.

Parent participants will complete self-report measures at 2 time points: pre-intervention and immediately post-intervention. These measures take about 30 minutes to complete. Both child and parent participants will give saliva samples pre- and post- AME or Attention Control sessions for the first four sessions. Child blood samples will be collected as part of a routine draw before sessions 1 and 4 (for all participants) and before session 8 (for high risk ALL participants only).

Poster 

Peer-reviewed
Robb, SL, Stegenga, K, Holochwost, S., Russ, K., Perkins, S., Jacob, S., Henley, A., Haase, J., Shoop, J., MacLean, J. Biologic Mechanisms of Active Music Engagement. Electronic Poster American Academy of Nursing Policy conference October 2020.