Implementation of an Evidence-Based Childhood Obesity Toolkit in a Rural Pediatric Clinic in Cookeville, TN: A Quality Improvement Project Dawn G. Johnson, MSN, APRN, FNP-BC Tennessee Technological University Nursing 6802 – DNP Project Development Dr. Victoria Pope & Dr. Candice Short March 23, 2022 Author Note Dawn G. Johnson https://orcid.org/0000-0002-7090-8036 College of Nursing, Tennessee Technological University There are no conflicts of interest to disclose. Correspondence concerning this manuscript should be addressed to Dawn G. Johnson, Tennessee Technological University, 248 Haven Lane, Algood, TN 38506 Email: djohnson@tntech.edu Abstract Purpose: The purpose of this quality improvement project is to increase the early identification of overweight or obese children in the primary care setting and provide education through the implementation of an evidence-based childhood obesity toolkit. Aims: This project aims to implement the Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan to educate patients and parents about childhood obesity. The Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan is an evidence-based questionnaire and action plan used by healthcare providers in the prevention and treatment of childhood obesity. Processes: Nurses will provide the toolkit to children ages 5-18 who present to the clinic for well-child examinations and have a BMI classified as overweight or obese. Providers will then review the screening toolkit with the patient and family and make a corrective plan of action. The screening tool will then be signed by the patient, caregiver, and provider and placed in the child’s electronic medical record. Results: To be determined after project implementation is complete. Results are anticipated to be that more overweight and obese children are identified by the clinic and proper education is provided to the patient and family. Limitations: The study is limited to one location and only available to the providers who perform well-child examinations. Conclusions: Implementation of an evidence-based childhood obesity toolkit in the pediatric setting with increase the early identification of overweight and obese children. Keywords: childhood obesity, pediatric obesity, toolkit, obesity, overweight

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Human papillomavirus (HPV) is a sexually transmitted disease that often presents as genital warts, but may also lead to cancers, including those of the vagina, penis, mouth and tonsils. Despite three vaccines being currently available to prevent HPV, the HPV vaccine retains a low national average vaccination rate when compared to the Tetanus-Diptheria- Pertussis (Tdap) vaccine. Considering the need for improvement it is important to identify factors that may be contributing to this low national immunization rate, one of them being parental race. The purpose of this literature review is to identify whether race affects parents' intent to vaccinate their children against HPV. A database search of CINAHL Plus with Full Text, MEDLINE, and PsycINFO was conducted and a total of 13 articles were reviewed based on the relevance to the purpose of the literature review. While racial differences were noted, there were other factors that also affect a parent's intent to vaccinate their children against HPV. There is more research to be done when looking at how race may independently affect a parent's intent to vaccinate their children against HPV.

Children may experience pain or discomfort during routine checkups, examinations, and procedures. The most common source of this pain is routine childhood vaccinations. This pain is known as procedural pain. Nurses have limited access to most nonpharmacologic pain relief interventions, but toys are simple to acquire and implementing this intervention falls within the nurses’ scope of practice. The purpose of this review of the literature was to explore current research and determine the efficacy of toys used as distraction to reduce procedural pain in children. A database search literature of CINAHL Plus with Full Text, APA PsychInfo, and MEDLINE databases was conducted. Six articles were evaluated for the effectiveness of toys on reducing procedural pain in the pediatric population. Relevant research suggested the use of toys as distraction is effective in less pain and less negative emotion in pediatric patients during simple procedures like vaccinations and phlebotomy. Further research is needed on the use of distraction for known painful procedures to further supports its routine use.

Thesis (M.H.A.)--University of Michigan, 1971.

Thesis (M.H.A.)--University of Michigan, 1971.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Childhood bullying affects over 25% of today’s youth and causes up to 160,000 missed school days per year. Bullying causes short and long term adverse effects to both mental and physical health. Many organizations encourage healthcare providers to take an active role in bullying prevention. However, there has been little research into the role of primary healthcare providers regarding childhood bullying and the effectiveness of different approaches to screening and management. Therefore the purposes of this dissertation were to a) explore childhood bullying and the role of the healthcare provider in bullying prevention, b) develop and evaluate the psychometric properties of Hensley’s Healthcare Provider’s Practices, Attitudes, Self-confidence, & Knowledge Regarding Bullying Questionnaire. Pediatric healthcare providers were asked to participate in this study if they conducted well-child exams on a weekly basis. Information on the provider’s current bullying assessment practices, attitudes, self-confidence, and knowledge regarding bullying was gathered. Results indicated that approximately one-half (46.6%, n=55) of the healthcare providers reported assessing their patients for bullying behaviors during well-child exams. The strongest predictor of positively assessing for bullying was attitudes, recording an odds ratio of 1.24. This indicated for every one-unit increase in attitudes score, the odds of assessing for bullying will be 24% higher. The odds ratio of self-efficacy or self-confidence was 1.18, indicating that for every one-unit increase in self-efficacy score, the odds of assessing for bullying will be 18% higher.

Thesis (MCur)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Recent escalation of medical costs, cost containment and decreasing public funds, drew attention to the importance of formulation and evaluation of standards of nursing care. Practice experience and consultations with nurse managers indicated a great need for standards to evaluate the quality of care in the pediatric units of the big hospitals in Swaziland. A non-experimental, explorative and descriptive study was conducted in the four regional hospitals in Swaziland. Checklists were developed by the researcher to evaluate standards of care relating to the structure, process and outcome dimension of care. Structure standards refer to minimum requirements regarding the facilities, equipment, supplies, and availability of generic documents and staff. Process standards are mainly concerned with the specific nursing procedures and practices, while the Outcome standards evaluate the parents' satisfaction with the nursing care of their child, the amount of information received prior to discharge and the level of communication between the parents and the nursing staff. The most important results are: .:. None of the hospitals met the pre-set requirement to be considered as delivering a satisfactory level of care for any of the three dimensions of care . •:. Critical nursing procedures were often performed ineffectively and inefficiently . •:. Most parents viewed their communication with the nursing staff negatively. Recommendations include the development and implementation of a formalized quality improvement programme on all levels of care, auditing of records and patient care and in-service education for all personnel regarding quality care. Keywords: Quality care, formulation and evaluation of standards - pediatric patients / AFRIKAANSE OPSOMMING: Die onlangse verhoging in mediese koste, kostebesparings en verminderde openbare fondse, het die aandag gevestig op die belang van formulering en evaluering van standaarde vir verpleegsorg. Praktykervaring en konsultasies met verpleegbestuurders het aangedui dat daar 'n groot behoefte bestaan vir standaarde om die gehalte van verpleegsorg in pediatriese eenhede in die groot hospitale van Swaziland, te evalueer. 'n Nie-eksperimentele, verkennende en beskrywende studie is onderneem in die vier streekshospitale in Swaziland. Kontrolelyste is deur die navorser ontwikkel om standaarde van sorg te evalueer ten opsigte van die struktuur-, proses-, en uitkomsdimensie van sorg. Struktuurstandaarde verwys na die minimum vereistes ten opsigte van die fasiliteite, toerusting en voorrade, die beskikbaarheid van generiese dokumentasie en die personeel. Prosesstandaarde hou hoofsaaklik verband met spesifieke verpleegprosedures en praktyke terwyl Uitkomsstandaarde die ouers se tevredenheid met die verpleging van hulle kind, die hoeveelheid inligting ontvang voor ontslag en die vlak van kommunikasie tussen die ouers en die verpleegpersoneel evalueer. Die belangrikste resultate is: .:. Geen hospitaal het ten opsigte van enige van die drie dimensies van sorg, aan die voorafbepaalde vereiste voldoen om beskou te word dat hulle 'n bevredigende vlak van sorg lewer nie . •:. Kritiese verpleegprosedures is dikwels oneffektief en ondoeltreffend uitgevoer. .:. Die meeste ouers het fn negatiewe siening gehad ten opsigte van die kommunikasie met die verpleegpersoneel. Aanbevelings sluit in die ontwikkeling en implementering van fn geformaliseerde gehalte verbeteringsprogram op alle vlakke van sorg, oudit van rekords en pasiëntsorg en indiensopleiding vir alle personeel ten opsigte van gehaltesorg. Sleutelwoorde: Gehaltesorg, formulering en evaluering van standaarde - pediatriese pasiënte