Childhood Injury Prevention Program Ana Corona, FNP-Student University of Phoenix September 6, 2003 Problem Identification Preventable injuries are the leading cause of death of children in the United States. Killing more than all childhood diseases combined. Children < 5 years of age are at greatest risk. Injury Pyramid Injury Pyramid 145,655 Deaths 2,701,000 Hospitalizations 33,950,000 Emergency Department Visits 65,555,000 Visits to Office-based Physicians 59,550,000 Injuries Requiring Medical Attention National Center for Health Statistics (1999) Childhood Injury in California California: – About 2,200 children suffer fatal injuries. – About 38,000 children suffer injuries that require hospitalization. United States: – >400 people die of injuries every day – 58 of the daily death toll are children Childhood Preventable Injuries cost the United States: – >$13.8 billion per year. Proposed Innovation A possible intervention to reduce the incident of childhood preventable injuries is a childhood injury prevention program (CIPP) to be implemented by a Nurse Practitioner in a family practice community clinic. Identification of the Work Setting Problem This year in the United States preventable injuries will result in over 6,000 children deaths under age fourteen 120,000 permanently disable These are not accidents Preventable Injuries Preventable with awareness and appropriate supervision Work Setting Problem Parents don’t know what actions to take during emergency situations. They lack awareness on childhood preventable injuries. Have no clue in providing emergency first aid interventions, such as CPR and calling emergency medical services “911”. Some parents are afraid on calling “911”. They are afraid of having their children being taken away from them for no apparent reasons. Proposed Innovation and the Work Setting Problem A new innovation program can help prevent these needless tragedies. The implementation of a CIPP in a community clinic setting located in ELA can be indispensable in preventing childhood injuries and deaths and improving their quality of life. Innovation Description The proposed innovation will work to prevent childhood injuries by stringently teaching parents on ways to prevent this childhood injuries and actions to take if these tragedies were to happen. The CIPP will provide teaching to parents of children ages 0 to 5 years. Parents will be educated on five leading causes of fatal and nonfatal childhood preventable injuries: Falls Drowning Poisoning Suffocation Motor Vehicle Accidents/ Pedestrian Innovation Description: continued The CIPP will be implemented by a Nurse Practitioner. The proposed innovation will begin as a pilot project and will be limited to the community clinic’s parent population of small children 0 to 5 years of age. Innovation Description: continued Permission to participate in the CIPP will be obtained from all participants. Participants will be enrolled in the program as early as during pregnancy. All pregnant mothers will be automatically enrolled into the CIPP. It is estimated that a total of forty parents will be included in the pilot project. The Questionnaire All qualified participants will be given a CIPP application and a questionnaire which will include a Pretest. The questionnaire will assess their knowledge in childhood preventable injuries, CPR, first aid and emergency preparedness. The questionnaire will be easy to read based on 5th – 6th grade reading level in English and Spanish. Proposed Innovation Content Individual teaching during prenatal visits and well child visits. Handouts will be given with detailed explanation by the Nurse Practitioner. Handouts will include important telephone numbers: community clinic, local hospital, poison control and emergency medical services “911”. The Nurse Practitioner will document CIPP education on patient’s medical record. A checklist will be provided. Innovation Description: continued CIPP class sessions will be once a week. Snacks and gifts and raffles will be provided in order to motivate participants. A total of 12 sessions will be provided lasting 1 hour each. Parents will receive a certificate award at the end of the 12 sessions. Videos on childhood injury prevention will be included in these sessions. CPR and First Aid certification will be provided free to all participants. Innovation Description: continued Two field trips will be scheduled after the last session: local fire department and to community’s hospital emergency room. Parents will be given the opportunity to meet emergency medical services (EMS) personnel and ask questions about the EMS system. Parents will be given a tour to the hospital’s emergency room. Transportation will be provided free to these field trips by the hospital’s transportation services. Research Based Knowledge and the Proposed Innovation Congress passed the Injury Prevention Act in 1986, authorizing and funding what has come to be the National Center for Injury Prevention and Control as the lead agency for injury control research and prevention programs. This agency has funded more than forty research and prevention programs and evaluation grants. Research Based Knowledge and the Proposed Innovation: continued A study was conducted by Kendrick & Clamp (1998) to assess the effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on safe practices at home. The intervention increased safe behavior and use of safety equipment. Research Based Knowledge and the Proposed Innovation: continued Another study was conducted by Kendrick, Marsh, Fielding & Miller (1999), to assess the effectiveness of safety advice at child health surveillance consultations, provision of low cost safety equipment to families, home safety checks, and first aid training on frequency and severity of unintentional injuries in children at home. A systematic review of the effectiveness of counseling parents by physicians showed reduced hazards and improved safety behavior. Feasibility of Implementation in Work Setting A CIPP could be easily implemented in a community clinic. The CIPP Guidelines, parent questionnaires, applications, donation request letter, and CIPP educational checklist will be formulated by the Nurse Practitioner. Videos, brochures, supplies and equipment will be provided by the community clinic Feasibility of Implementation in Work Setting The fire station and emergency department field trip will be coordinated by the Nurse Practitioner. The main concern is locating a CPR and First Aid Instructor to provide free certification to the parents. Other concerns are obtaining donations by district drug representatives and other agencies. The program will need donations of syrup of ipecac, poison control refrigerator magnets, infant/toddler car seats, first aid kits and lifesaver jackets. Feasibility of Implementation in Work Setting Staff meetings will be conducted prior to the beginning of the CIPP and once a week during the course of the program. One front/back office assistant will be involved in the program. He or she will be assigned to provide program information, applications, questionnaire (Pretest) and consent to parents as they sign into the clinic. The CIPP assistant will code and red flag participant medical records. Consistency with Organization, Community Culture and Resources Cultural norms, poor knowledge of English, and socioeconomic status may affect parents by impeding them to become educated in childhood preventable injuries. Many parents don’t know where or who to ask. The majority of parents in this community don’t speak English and don’t know when or how to call EMS “911”. Parents will feel more comfortable in asking the nurse practitioner questions related to childhood preventable injuries and first aid measures during life threatening situations The CIPP may be consistent with the organization and community culture and resources. Community Resources There are many resources throughout the community. Local parks and recreational areas provide free swimming lessons throughout the summer. There are community hospitals that provide free infant car seats to mothers that deliver their babies at there facility. Other community clinics provide free infant car seats to families in need. Research Support This section provides quantitative and qualitative research studies that are analyzed and considered important bases of support for the CIPP. Research Support Merrell, Driscoll, Degutis, & Renshaw (2002) conducted a quantitative correlational research study. Purpose: To examine the frequency and location of pediatric pedestrian injuries and to evaluate the outcome of 5 injury prevention interventions. Interventions: – (1) traffic safety education – (2) school busing – (3) a safe driving campaign – (4) decentralization of public housing projects – (5) an increase in traffic-related tickets Results: Child pedestrian motor vehicle collisions decreased from 118 in 1993 to forty-three in 1999 Research Support Gielen, et al, (2002) conducted a quantitative quasi- experimental research study. Purpose: Evaluate the impact of a combination of injury prevention services delivered through a pediatric resident clinic. Intervention: A total of 122 parents with small children were enrolled. Parents in the standard intervention group received safety counseling and referral to the CSC from their pediatrician. Parents in the enhanced intervention group received the standard services plus a home safety visit. Results: Families who visited the CSC compared with those who did not had a significantly greater number of safety practices (34% vs. 17%) Research Support Hendrickson (2003) conducted a qualitative ground theory research study Purpose: To identify how injury prevention programs can become an accepted public safety influence and to address real life parental concerns. Intervention: Parent interview which offered a unique perspective on pediatric injury. Results: 3 main themes emerged from the analysis (1) sources of parental concern for children's safety, (2) private versus public safety influences (3) behaviors making children vulnerable to injury. Understanding the preinjury event from the patient's or family's perspective can improve strategies for intervention. Implementation Plan The primary objective of the CIPP is to educate parents of potential injury risks and emergency intervention strategies. The CIPP will be implemented according to set policies and procedures, Rogers’ Diffusion of Innovations planned change model, community clinic’s policy and departmental resources. Implementation Plan for Work- Setting A program presentation will be provided to the clinic’s Administrative and Medical personnel for their approval. If the CIPP is acceptable to both Administrative and Medical personnel, the Clinic Director will submit the proposal to the Medical Director for approval Implementation Plan for Work- Setting Upon approval of the CIPP, two volunteers will be sought within the clinic. A Nurse Practitioner willing to educate the parents involved and a front/back office assistant, willing to register qualified parents. Qualified parents will be individually selected to participate in the pilot project as they sign-in. Implementation Plan for Work- Setting A small informational packet will be given to each participant. Brief overview about the program, a consent, questionnaire which will include the Pretest to assess knowledge of childhood injury prevention strategies and emergency interventions. A brief description about the program will be given by the CIPP assistant. Implementation Plan and Principles of Planned Change Rogers’ Diffusion of Innovations identifies 5 steps in his change model. His 5 steps details how an individual or decision-making unit passes from first knowledge of an innovation to confirmation of the decision to adopt or reject a new idea Participants may initially adopt a proposal but later discontinue it, or the reverse, they may initially reject it but adopt it at a late time. Roger’s Five Steps to the Diffusion of Innovation (1) Knowledge: the decision-making unit is introduced to the innovation and begins to understand it. – The first step will be introduced when the innovation is presented to the clinic’s Administrative and Medical staff. (2) Persuasion: a favorable or unfavorable attitude toward the innovation forms. – Administrative and Medical staff may become favorable or unfavorable towards the innovation. Roger’s Five Steps to the Diffusion of Innovation (3) Decision: activities lead to a decision to adopt or reject the innovation. – If accepted by Administrative and Medical staff, the innovation will be submitted to the Medical Director. Step 1 through 3 of Rogers’ change model will once again take place. (4) Implementation: the innovation is put to use, and reinvention or alterations may occur. – The CIPP will be implemented, modifications will be made if any discrepancies occur. Roger’s Five Steps to the Diffusion of Innovation (5) Confirmation: The individual or decision-making unit seeks reinforcement that the decision was correct. – The CIPP will be evaluated once a week by participants. Considerable participant information will substantiate positive reinforcement on the CIPP. Two important aspects of successful planned change: Key people: Nurse Practitioner and the CIPP Assistant, must be interested in the innovation and committed to making it happen. Time, Fiscal and Personnel Resources Upon approval by the Medical Director, a CIPP presentation will be provided to all staff. Donation Request Letters will be sent to pharmaceutical companies, poison control centers, local community hospitals and recreational parks, California State Department of Children’s Services (CCS), Los Angeles County Department of Health Services (LAC/DHS), American Red Cross (ARC) and other community resource agencies. In conjunction with follow-up telephone calls to selected agencies, this process will approximately take one month. Time, Fiscal and Personnel Resources The estimated fiscal budget for the CIPP is $360. This amount includes $120 for the purchase of First Aid Kits and $240 for the purchase of snacks and small gifts to be offered during each parent group session Feasibility of the Implementation Plan and the Work-Setting The budget amount for the CIPP will be acquired from community fundraising events which will consist of health fairs and food sales. The Nurse Practitioner and the CIPP Assistant are both volunteers in this project. Video tapes, brochures, supplies and equipment will be provided by the community clinic. Feasibility of the Implementation Plan and the Work-Setting CPR and First Aid Classes will be provided free of charge by the ARC. Transportation to the emergency department and fire station field trip will be provided by the local community hospital’s transportation services without charge. The Nurse Practitioner will be responsible for the projects budget. Monitoring Methods for Implementation Plan Monitoring methods are included in the plan to ascertain that the investment for this project will not waste. Monitoring methods include formal and informal communication between all staff. Staff will have the opportunity to complete CIPP evaluation forms and voice their concerns about the project during weekly staff meetings. Participants will be encouraged to complete an evaluation at the end of each session and after each activity. Evaluation Plan: Outcome Measures A Pretest will be given to each participant at the beginning of the CIPP followed by a Posttest at the end of the program. The use of Pretest/Posttest proved to be reliable in measuring outcomes for the Think First For Kids Program (TTFK). The TTFK is a school based youth safety educational program. Educational concepts will be used from the (TTFK) curriculum as a guide. The CIPP curriculum and guidelines will be modified to parental education. Evaluation Data Collection Statistical data from before and after the project will be a component of the evaluation. Content analysis and frequency measures of the CIPP will be conducted by the Nurse Practitioner. The Nurse Practitioner will use content and nonparametric measures to analyze the data. Evaluative guides of parent safety knowledge and program indicators will be used to determine curricular and parent learning outcomes. Evaluation Data Collection A quiz will be given to participants at the end of each session with answers and rationale given by Nurse Practitioner. The quiz will not be included as part of the CIPP evaluation. Evaluation Data Collection Each session of the CIPP will be evaluated by all participants. A parent group weekly evaluation form will be completed by each parent at the end of each session. The Nurse Practitioner will present these evaluation forms to clinic staff during weekly staff meetings. Program modifications will be made based on participant and staff evaluations. Decision Making The CIPP will be discontinued or will continue based on the final evaluation outcomes according to parental knowledge. The CIPP will include methods to maintain, extend, or discontinue the innovation. Methods to Maintain the Innovation If the CIPP is successful, the innovation will be maintained. Financial support sources will need to be accessible. Donation request letters will be sent by the Nurse Practitioner to community resources: local pharmaceutical representatives, community hospitals, ARC, CCS, LAC/DHS and community leaders. Ongoing fundraiser events will be implemented. Methods to Extend the Innovation If the project is successful, the innovation will be extended. If the CIPP is successful it will expand into the community to target child day care centers, head start/pre-school programs and elementary schools. Grant monies will be sought through all available sources. One main source will be the CDC. Methods to Discontinue the Innovation if Unsuccessful If the project is unsuccessful, the Nurse Practitioner will submit in writing to the Medical Director a request to cease the CIPP. The Nurse Practitioner will review with clinic staff, medical and administrative personnel reasons why the CIPP failed. A letter will be issued to parents from the community clinic informing them of the program ending. Plan for Project Feedback in the Work-Setting The CIPP will be communicated to clinic staff through weekly staff meetings. The experience gained from this pilot project will be published in professional journals which will include Pediatrics and Nurse Practitioner journals and other journals related to Injury Prevention. The CIPP will also be presented to the CDC. Conclusion Teaching parents about safety and childhood injury prevention should begin as early as during prenatal visits with appropriate and validated curriculum and materials. Nurse Practitioners must seize the moment and educate parents about injury prevention. Conclusion Such efforts will facilitate the National Healthy People 2010 Objectives, as well as the Injury Prevention Position Statement of the Society of Pediatric Nursing (1998). Healthy lifestyles and injury prevention measures are essential to pave the way toward a healthy future for all children. Conclusion This project demonstrates that research is critical in supporting new and creative innovations to practice nursing to improve client outcomes. Let’s Keep Our Children Safe!