Background: Unintentional childhood injuries are ranked as the fourth leading cause of death in the United States, with an average of 31 million children each year arriving in hospital emergency departments across the nation with accidental trauma related injuries (CDC, 2016). Pediatric providers are in a key position to assess, identify, and implement interventions to improve the rates of unintentional injuries that occur within the pediatric population. Purpose: This study will examine pediatric providers’ knowledge of injury prevention and practice behaviors regarding educating families and/or caregivers regarding injury prevention, and the frequency that patients and/or caregivers are provided with safety education. Method: An evidence-based educational intervention regarding home and environmental safety measure was delivered during a Phoenix Children’s Hospital “Grand Rounds”. The data was collected using a pre-test and post-test survey to assess providers’ pre-knowledge of unintentional injury and their practice behaviors. Aim 1: (a) assess the knowledge of pediatric healthcare providers regarding home and environmental age-appropriate safety measures for children, (b) determine the practice behaviors of pediatric healthcare providers in educating patients and/or families regarding injury prevention, and (c) examine the frequency that patients and/or caregivers are provided safety education by their healthcare provider. Aim 2: To evaluate the impact of the educational session on provider knowledge regarding unintentional injury in children. Results: The McNemar test was used to analyze changes in providers scores from pre- to post-test. The level of significance was set at 0.05. The McNemar test revealed a significant increase in the providers’ knowledge of injury prevention between pre- and post-test in the following areas: providers’ definitions of injury; providers’ knowledge of the organization that developed the Children Risk Assessment; the approach providers take to educate caregivers about age-appropriate injury prevention measures in the infant/child home and environment; and examination of how often providers assess patient developmental age. Conclusion: The results of the study showed a statistically significant improvement in providers’ understanding of the prevalence of unintentional childhood injuries from pre- to post-test and the importance of providing patients and families with information that aid in their understanding of injury prevention and home environmental safety interventions.

The hepatitis C virus (HCV) disproportionately affects the prison population. Studies demonstrate that healthcare provider knowledge of HCV risk factors is insufficient and many individuals are not aware that they are HCV positive. Early identification of HCV status can prompt early treatment and avoidance of complications that contribute to poor outcomes resulting in chronic disease progression. This doctor of nursing practice (DNP) project addresses provider identification of HCV risk factors at initial inmate intake to prison and whether providers obtained HCV testing based on guidelines from the Centers for Disease Control and Prevention (CDC). The principal investigator (PI) conducted a retrospective medical record review at Arizona State Prison Complex (ASPC) Lewis focusing on initial inmate intake forms identifying two of the CDC risk factors for HCV: drug abuse and tattoos; and ascertaining if a providers ordered a HCV test if inmates had one or both of these risk factors. The PI reviewed 51 randomly selected medical records; 40 records met inclusion criteria of 1) inmates who had an initial inmate intake evaluation occurring from 1 October 2013 to 1 October 2014 and 2) documentation of positive HCV risk factors. Analysis of the records showed a mean inmate age of 26.78 years with a variable racial distribution. The risk factor of tattooing was present in 37 (92.5%) of records reviewed and the risk factor of intravenous drug use (IVDU) was present in 7 (17.5%). Only 4 (10%) records of inmates with positive risk factors had a HCV test ordered by the provider: One physician (n=2) and one nurse practitioner (n=2). This project demonstrated a gap in HCV testing in the presence of risk factors in the inmate population at ASPC Lewis which is consistent with studies in the general population. This study does not identify any reasons for this consistency, but raises questions for future studies focused on provider knowledge, education and the institution of HCV testing protocols. This DNP project provides the foundation for a future full quality improvement Plan-Do-Study-Act based project aimed at educating providers about HCV testing according to CDC (2013a) guidelines and subsequently re-evaluating their HCV test ordering practices.

The spectrum of acute pancreatitis (AP) affects between 4.9 and 73.4 patients out of 100,000 worldwide annually (Tenner, Baillie, DeWitt, & Vege, 2013). AP uses the Atlanta classification system to establish a diagnosis of mild, moderate, or severe. The American College of Gastroenterology (ACG) has established comprehensive clinical practice guidelines (CPG) for the management of AP, the most recent version published in 2013 (Tenner et al., 2013). There have been similar CPGs published internationally that integrate current evidence-based research into recommendations for practice. These guidelines along with the ACG's guidelines recommend initiating a diet for mild acute pancreatitis patients due to research findings of improved patient outcomes (i.e. reduced length of hospital stay, decreased rate of infections, and reduced mortality) (Horibe et al., 2015; Lariño-Noia et al., 2014). There is an international awareness of the need for increased CPG nutrition recommendation compliance in the practice setting as many studies have found providers prefer to keep patients nil per os (NPO) and do not adhere to CPGs (Andersson, Andrén-Sandberg, Nilsson, & Andersson, 2012; Greenberg et al., 2016; Sun et al., 2013). The purpose of this doctor of nursing practice (DNP) project is to assess providers' current nutrition therapy practice and knowledge of the ACG’s CPG nutrition recommendations for mild AP patients. The researcher conducted the assessment with a hospitalist practice at Banner University Medical Center in Phoenix, Arizona. The results of the project contribute to the current body of research on national adherence to CPGs for AP and act as a needs assessment for future projects where a nutrition protocol order set may be established. The investigation of nutrition therapy for AP patients seeks to improve and standardize the care this patient population receives while in the acute care setting.

Unintended pregnancies are a long-standing public health issue nationally, with percentages hovering around 50% for at least the last five years. Vermont is doing slightly better than the national average, but is faced with it's own challenges due to it's rural nature. Agencies and organizations, such as the World Health Organization, March of Dimes and the Vermont Department of Health have made decreasing unintended pregnancies one of their priorities to improve maternal and fetal health outcomes, as well as social and economic opportunities for families. Current evidence-based guidelines call for long- acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and implants, as the first-line recommendation by healthcare providers for decreasing unintended pregnancies. This study, in collaboration with several Vermont state organizations and agencies, engaged healthcare professionals throughout the state with an electronically disseminated survey aimed at assessing their knowledge of LARCs. The aim of this study was to ascertain whether healthcare professionals caring for women of reproductive age, are using current evidence-based practice guidelines to counsel women in their contraceptive choices. Survey results revealed that the majority of the respondents consider themselves to be knowledgeable about and had received a high level of training in IUD counseling and/or insertion. Areas of uncertainty were primarily about side effects and the insertion and removal processes of the implant, as well as a few categories of medical eligibility. This was especially apparent when results were stratified by urban and rural regions of Vermont. Although there seems to be a high level of provider confidence in knowledge about LARCs and reported counseling of LARCs as first-line, there is a discrepancy between what providers think they know and current evidence based contraception guidelines. Many factors exist that could explain this discrepancy, including but not limited to lack of training, provider bias, and system barriers. This study aims to illuminate gaps in provider knowledge to improve uptake of LARCs and over time make a shift in the numbers of unintended pregnancies in Vermont.

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