Rainbow by wuyunyi


									Childhood Injury Prevention

      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
 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
  – About 2,200 children suffer fatal injuries.
  – About 38,000 children suffer injuries that require
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
       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
      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
      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:

Motor Vehicle Accidents/ Pedestrian
           Innovation Description:
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:
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
                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
 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:
 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:
 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
 This agency has funded more than forty
  research and prevention programs and
  evaluation grants.
        Research Based Knowledge and
           the Proposed Innovation:
 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:
 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
 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
         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
 Local parks and recreational areas provide
  free swimming lessons throughout the
 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
              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-
 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-
 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
 Qualified parents will be individually
  selected to participate in the pilot project as
  they sign-in.
         Implementation Plan for Work-
 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
            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
             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
  – 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
 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
 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
 In conjunction with follow-up telephone calls to
  selected agencies, this process will approximately
  take one month.
         Time, Fiscal and Personnel

 The estimated fiscal budget for the CIPP is
 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
 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
 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
         Evaluation Data Collection

A quiz will be given to participants at
 the end of each session with answers
 and rationale given by Nurse
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
 If the CIPP is successful, the innovation
  will be maintained.
 Financial support sources will need to be
 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
             Methods to Extend the
 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
 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
 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
 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

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!

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