CHOC Nursing :: CHOC Nursing Research Fellowship Program
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At Children’s Hospital of Orange County (CHOC), our vision is to achieve national recognition as a premier children’s hospital by providing services that offer the best possible outcomes for children and their families. The next decade holds much in store for CHOC as we begin our journey toward achieving this vision, and one of the steps in this process is the creation of a nursing research program.

The Walden and Jean Young Shaw Foundation awarded a grant to the Department of Nursing at CHOC that will assist in laying the groundwork for the development of a formal infrastructure for evidence-based practice and the creation of a Nursing Research Fellowship program. This infrastructure and program will enable nurses to develop research skills and carry out research projects that will contribute to the growing body of knowledge in our community and nationally. Ultimately, a nursing research program at CHOC will directly impact patients and families and result in improved care.

The Nursing Research Fellowship program at CHOC officially started with the arrival of Virginia Egbert Maikler, RN, PhD on June 21, 2005. She is our Expert Nurse Researcher and consultant for the development of this program. Dr. Maikler recently retired as Chairperson of the Department of Maternal-Child Nursing at Rush University College of Nursing in Chicago, Illinois and has extensive experience in nursing research. Further, she has been involved in several Walden and Jean Young Shaw Foundation grants at Children’s Memorial Hospital in Chicago.

Dr. Maikler worked closely with CHOC’s personnel to design the Nursing Research Fellowship program.  Toni Christopherson, EdD, MSN, RN, CNS, BC, as Director, Special Projects was the on-site coordinator working closely with Dr. Maikler on the development.  Most notably, Dr. Maikler guided the inaugural three nurse research fellows through their initial research project and resulting publication process.

Dr. Maikler was joined by a local team of nursing research experts: Dr. Sharon Valente, Greater Los Angeles Healthcare System, VA; Dr. Marilyn Klakovich, Azusa Pacific University; Dr. Cindy Greenberg, California State University, Fullerton; Dr. Margaret Brady, California State University, Long Beach; Dr. Maryanne Garon, California State University, Fullerton; Dr. Dana Rutledge, California State University, Fullerton.

Nursing Research Fellowship Program, 2005-2007
Our founding Fellows have completed workshops and intensives, received Institutional Review Board (IRB) approval, completed or in are in the process of data collection (including staff nurses), conducted statistical analysis, and have presented to nursing organizations and outside nursing research councils about their studies.  In order to allow staff nurses to gain research experience for future projects, these Fellows included staff nurses as co-investigators and/or data collectors for their projects.

Current Principle Investigators and their projects include:

Kathleen Adlard, MN, RN, CNS, Cancer Institute completed a nursing research study, "Examining the Push-Pull Method of Blood Sampling from Central Venous Access Devices".

Kathleen gained IRB approval January 30, 2006, began her data collection July 17, 2006, and completed her data collection on November 21, 2006.  As a part of her study, two staff nurses functioned in the research assistant role and received education and training regarding the protocol, consent process, obtaining consents, procedure for obtaining blood samples using the push-pull method, and data collection. The charge nurses and staff nurses were in-serviced on the protocol, eligibility criteria, and methods of data collection. They also assisted in recruiting subjects. Data analysis has been completed. The research study, data analysis, and results were presented on a poster at the annual Association of Pediatric Hematology/Oncology Nurses (APHON) conference on October 4-6, 2007 in Milwaukee, WI. The manuscript entitled, Examining the Push-Pull Method of Blood Sampling from Central Venous Access Devices, was published in the Journal of Pediatric Oncology Nursing. CHOC also adopted this practice approach into nursing policy and procedure.

Kathleen most recently received the Chancellor's Awards for Outstanding Community Research Nurse award from the Institute for Clinical and Translational Science, University of California, Irvine. She will receive the award on Wednesday, September 10th, 2008. Further, she will receive the Dianne Fochtman New Author Award for her fellowship study publication. This award will be presented at the APHON Conference in Albuquerque on September 27th, 2008.

Dianne Baker, BSN, RN, EDAC Manager is examining: “Determining the Best Predictor of Need for Developmental Services after Discharge from a Neonatal Intensive Care Unit.”

Dianne gained IRB approval on June 2, 2006.  Her project was amended and re-approved with the addition of new CCS criteria and two additional co-investigators to assist with obtaining consents.  It was re-approved August 7, 2006.  She gained first patient consent on June 15, 2006.  As of June 2007, 85 families have consented and data collection was completed in September 2007. The data has been analyzed and findings indicated that there was weak agreement between the current method of identifying infants for developmental follow up and the use of developmental testing.  Although not statistically significant, infants were not identified with the current tool that exhibited delays at discharge.  Dianne’s research has been featured in the September issue of “Advance for NURSES” monthly feature “Facts and Figures”, and she will be presenting a podium presentation at the April Society of Pediatrics Annual Nursing Symposium.  She has also shared her research with the State organization California Children’s Service, California Perinatal Quality Care Collaborative High Risk Infant Follow-Up Quality Improvement Initiative Executive Committee. There is a pilot being developed to introduce developmental testing at discharge, using the Test of Infant Motor Performance. 

"Methods of Identifying Infants for High Risk Infant Follow up" - Presented at Annual SPN Conference (Society of Pediatric Nurses), April 1-3, 2009 in Atlanta, GA

Dawn Tucker MSN, RN, CPNP-AC/PC in the Cardiovascular Intensive Care Unit is studying, “Open vs. Closed Methods for Endotracheal Tube Suctioning in Post-Operative Pediatric Cardiac Patients.”

Dawn gained IRB approval May 26, 2006 and began her completed her data collection on August 2, 2007.  As part of her study, twelve staff nurses have been involved in assisting with data collection and collaborating with Principal Investigator.  Data analysis has been completed, and the results were presented at the CHOC Research Symposium September, 2007.  Dawn also disseminated her findings via poster at the 2008 11th Annual Update on Pediatric and Congenital Cardiovascular Disease at Scottsdale Arizona., Dawn’s manuscript has been accepted for publication in the American Journal of Critical Care spring 2009.  Dawn also was published in the journal of Advance Critical Care on the topic of Venous Oximetry.

In 2006, a search was conducted for a local Nursing Research Expert. Dr. Karen Sechrist of Berlin Sechrist Associates accepted the position as a consultant. Based upon the feedback of the fellows and faculty, the program curriculum was revised to include monthly vs. weekly intensives and smaller faculty team specific to content areas. Dr. Sechrist was joined by Dr. Marilyn Klakovich to teach quantitative research; Dr. Maryanne Garon to facilitate the work related to qualitative research; and Dr. Dana Rutledge to provide an introduction to the concepts of evidence-based practice.

Nursing Research Fellowship Program, 2006-2008
These Fellows were also selected via competitive process; three were selected from seven who applied.  They were selected based upon well-prepared proposals, demonstrating a high standard necessary for research projects.  The selected Fellows designed study proposals, attended workshops and intensives, presented to the Nursing Practice Research Council comprised of staff nurses, other nursing representatives, Research Institute personnel, and outside faculty. They have each received IRB approval and have started data collection.

These Fellows and their respective studies include:

Jennifer Cohen, MSN, RN, CNS, CCRN, CNRN is studying Interrater Reliability and Predictive Validity of a New Coma Scale in the PICU.  Jennifer gained approval from the Nursing Practice Research Council on October 17, 2006, and IRB approval November 8, 2006.  Data collection for her project started January 1, 2007 and ended on January 1, 2008.  Approximately 70 staff nurses were educated on the use of the two assessment tools (Glasgow [GSC] & FOUR Score), and participated as nurse raters. 

This is the first study to evaluate the FOUR Score neurological assessment tool for its application to the pediatric patient population.  Study results indicated that the FOUR score and the GCS were comparable in predicting outcome in this population. The high level of agreement between nurse raters using the FOUR score suggests that the tool is consistent and reliable and that nurses with differing levels of experience and expertise are more likely to correctly assess the patient and assign the same score using the FOUR score than the GCS. Additional studies need to be conducted on the use of the FOUR score to add to the existing body of knowledge and provide further evidence to support its use in assessing neuroscience patients of all ages.

Jennifer presented her research study, data collection and analysis at the American Association of Critical Care Nursing, National Teaching Institute in Chicago in May 2008.  Her manuscript, “Interrater Reliability and Predictive Validity of the FOUR Score Coma Scale in a Pediatric Population” was recently accepted for publication in the Journal of Neuroscience Nursing.

Elyse B. McClean, MSN, RN, CPN is studying Tracheal Suctioning in Children: Applying Suction both While Inserting and Removing the Catheter During Suctioning.  Elyse gained approval from the Nursing Practice Research Council November 21, 2006.  IRB approval for this research study was received January 8, 2007 which included an amended Spanish version of the consent. She has applied to CHOC IRB to continue with this study.  Enrollment is continuing at this time. 

This study has been shared at Medical Surgical Clinical Practice Council with staff nurses and charge nurses. Elyse is a preceptor for two graduate students and has discussed this study with them. Elyse has also mentored Janice Jeune, 2007-2009 Fellow and Katie Pelland and Deidre Fitz-Williams. She has mentored the co-investigator on this study, who is the night shift educator, an active member of the Nursing Research Practice Council, and a Scholar in the Evidence Based Practice Scholars Program.

The research study was presented as a poster at the California State Fullerton, Upsilon Beta Chapter, Sigma Theta Tau Evidence-Based Practice and Induction Ceremony in May 2007, and at the 12th Joint Southern California Sigma Theta Tau International Nursing Odyssey Conference in October 2007.

Poster Presentation: The Lost Art of the Care Plan

Sarah L. Flores, MS, RNC is studying Alternate Site Testing for Hemoglobin A1c in Children with Diabetes.  Sarah gained approval from the Nursing Practice Research Council November 21, 2006 and presented to the IRB on December 11, 2006. She received IRB approval in March 2007. Data collection was completed on December 2007. Sarah mentored a RN to BSN student who learned about data collection and nursing research in general. Sarah has been revising her manuscript for publication and will be submitting it to a professional journal in December 2008. Sarah has been accepted to present a poster at the national conference of the American Academy of Ambulatory Care Nursing in March 2009.

Nursing Research Fellowship Program, 2007-2009
The program continued with Dr. Karen Sechrist as the research expert/mentor and by the same three local faculty.

The exploratory session was held June 27 – 28, 2007.  There were eight attendees on day 1 and six of these eight attended an individual session the following day to discuss research ideas and potential study format.  Applications were due in July and fellows were selected in August. We selected three fellows: one nurse from Nutritional Services and two staff nurses from the Pediatric Intensive Care Unit.

Mary T. DeNicola, MSN, FNP-C, CLC
Milk Supply in Mothers of Very Low Birth Weight (VLBW) Babies

The purpose of this research is to describe the effect of concentrated lactation support, including galactagogue therapy, on volume and duration of milk supply in mothers of VLBW babies. 

Mary gained IRB approval March 28, 2008, and began data collection June 23, 2008.  To date just over half of the necessary participants have been enrolled in the study.  One of the other lactation nurse practitioners is functioning as a co-investigator and received education and training regarding the protocol, consent process, obtaining consents, and data collection.  The NICU nursing staff, as well as the NICU CPQCC Committee were oriented on the protocol and eligibility criteria and are updated on a regular basis.  The next CPQCC update is scheduled for November 19, 2008. 

AnneMarie Mort, BSN, RN, CCRN
"Muscle Near-Infrared Spectrometry (NIRS) and Cardiac Output in the Pediatric Cardiac Patient"
The purpose of this study is to determine the role that muscle NIRS plays in predicting low cardiac output in the cardiac child.

AnneMarie obtained IRB approval July 7, 2008, and she is actively involved in the data collection phase of the study.  Two cardiac nurse practitioners have been trained as co-investigators and are aware of research protocol for purpose of gaining consent.  The clinical practice council (CPC) and unit nurses have been oriented on the protocol for data collection, with the patient nurse and charge nurse for the day taking an active role in data collection. 

Janice Jeune, RN
"Continuous vs. Intermittent Pain Control in Post-Operative Pediatric Cardiovascular Surgery Patients"
The purpose of this study is to evaluate and compare pain control in post-operative cardiac patients who receive pain control via continuous infusion compared with patients who receive pain control by intermittent boluses.

Janice is on maternity leave, but two patients who met the criteria were enrolled into the study with the assistance of Annie and the nurse practitioners in the unit.

Nursing Research Fellowship Program, 2008-2010
The 2008-2010 Nursing Research Fellowship program held its exploratory workshop on June 26 and 27th with Marilyn Klakovich, DNSc, RN, CNAA, BC, Director of Continuing Education and Program Evaluation for Second Careers and Nursing (SCAN) program from Azusa Pacific University assuming the research expert role. There were four potential fellows attending representing neonatal intensive care, pediatric intensive care, and ambulatory nursing. Three Fellows were selected and include education, practice, and administrative research topics.

For the ongoing intensives, Dr. Marilyn Klakovich will continue to teach quantitative research; Dr. Maryanne Garon continues to facilitate the work related to qualitative research; and Dr. Dana Rutledge likewise continues to provide an introduction to the concepts of evidence-based practice. The research team was also joined by Dr. Gwen C. Uman of Vital Research, Los Angeles, California, who is providing statistical analytical support.

The 2008-2010 Fellows selected via a competitive process are:

Debbie Jones, MN, RN
Education Coordinator Clinical Programs, Specialty Clinics

"Quality of Life in Teens with Migraines: A Comparative Study of Teens who Participate in a Headache Education and Support Group and Those who Receive Education During Routine Clinic Visits"
The purpose of this study is to determine if there are differences in quality of life between adolescents with migraines who participate in a headache education and support group and those who do not participate in such a program. Previous studies have indicated a considerable impact of migraines on quality of life in children. However, no study to date has measured the quality of life of those who participate in an education and support group.

Robyn Robinson, MSN, RN, NP
Nurse Practitioner, PSF Gastroenterology

"The Effect of Quality of Life following the Treatment of Complex Feeding Disorders in a Multidisciplinary Inpatient Feeding Program"
The purpose of this study is to determine if resolving feeding problems improves quality of life (QOL) in children with complex feeding disorders. Previous studies have focused on family and caregiver stress and have measured decreased stress following an intense feeding intervention. No study to date has measured the QOL benefit for a child. 

Gail Sundberg, MSN, RN, CCRN, NE-BC
Manager, Pediatric Intensive Care Unit

"Nurse Manager:  Friend or Foe?"
The purpose of this study is to explore nurse managers’ role expectations and tacit knowledge, as described by nurse managers, with the intent to identify relevant factors and resources needed to contribute to a healthy workplace environment and well-being of nurse managers.


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