Addressing Bullying Behavior in Pediatric Patients Using a Clinical Practice Guideline

Addressing Bullying Behavior in Pediatric Patients Using a Clinical Practice Guideline by Barnitta Latricia Moses MS, University of Maryland, 2009 BS, University of Maryland, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2019 Abstract Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner’s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in the pediatric clinical site. Using a literature search, a CPG was developed with evidence that included 6 recommendations ranging from clinical assessment and screening to advocacy. The CPG was then evaluated by 4 expert panelists using the AGREE II tool. Panelists included 2 pediatric medical doctors, 1 pediatric school nurse, and 1 mental health nurse practitioner. The panel evaluation results revealed a score of 81 out of a possible 100, where a score of 71 was the standard for acceptable results for the 6 recommendations. Results from the expert panel were used to modify the CPG, after which the guideline was presented to the panel for final approval. One final recommendation of the panel was to include a provision for referral and follow up for children identified with bullying. The finalized CPG was presented to the medical director of the pediatric clinic for implementation. The implications of theChildhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner’s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in the pediatric clinical site. Using a literature search, a CPG was developed with evidence that included 6 recommendations ranging from clinical assessment and screening to advocacy. The CPG was then evaluated by 4 expert panelists using the AGREE II tool. Panelists included 2 pediatric medical doctors, 1 pediatric school nurse, and 1 mental health nurse practitioner. The panel evaluation results revealed a score of 81 out of a possible 100, where a score of 71 was the standard for acceptable results for the 6 recommendations. Results from the expert panel were used to modify the CPG, after which the guideline was presented to the panel for final approval. One final recommendation of the panel was to include a provision for referral and follow up for children identified with bullying. The finalized CPG was presented to the medical director of the pediatric clinic for implementation. The implications of the project for positive social change include decreased variations in clinical practice, early detection and intervention of bullying, improved effectiveness and quality of care, and decreased costly and preventable adverse events. Addressing Bullying Behavior in Pediatric Patients Using a Clinical Practice Guideline by Barnitta Latricia Moses MS, University of Maryland, 2009 BS, University of Maryland, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2019 Dedication I dedicate this project to my husband, Mannie Moses, and my children, Jennifer, Jackson, and Janine Moses. Without them, none of this would have meaning. I thank my family for always being in my corner. I would be remiss if I did not also give honor to my Lord and Savior, Jesus Christ.