Development of a Program Proposal for a Nitrous Oxide Program in Pediatrics

Development of a Program Proposal for a Nitrous Oxide Program in Pediatrics by Sarah Oleson MSN, Walden University, 2013 BSN, University of Wisconsin-Green Bay, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Abstract When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child’s response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having an excellent safety profile in the pediatric population while providing an almost pain and anxiety free procedure. The program proposal will be used to improve pain and anxiety management for pediatric patients requiring procedures such as intravenous access, venipuncture, voiding cystourethrograms, lumbar puncture, bone marrow biopsy, port-a-cath access, PICC line insertion, dressing changes, chest tubes, and wound care. Key stakeholders and content experts were brought together to create the nitrous oxide program proposal which included a new practice guideline, a comprehensive policy and procedure for nitrous oxide administration, and an education plan. The program proposal included other key components necessary for a safe and efficient program such as a pre-assessment to determine if the child is a candidate, monitoring and documentation of nitrous oxide administration, and education for the child/parent(s). The nitrous oxide program for pediatrics was designed as a minimal sedation method to minimize procedural pain, fear, and anxiety in children where medical procedures are a necessary part of treatment.When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child’s response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having an excellent safety profile in the pediatric population while providing an almost pain and anxiety free procedure. The program proposal will be used to improve pain and anxiety management for pediatric patients requiring procedures such as intravenous access, venipuncture, voiding cystourethrograms, lumbar puncture, bone marrow biopsy, port-a-cath access, PICC line insertion, dressing changes, chest tubes, and wound care. Key stakeholders and content experts were brought together to create the nitrous oxide program proposal which included a new practice guideline, a comprehensive policy and procedure for nitrous oxide administration, and an education plan. The program proposal included other key components necessary for a safe and efficient program such as a pre-assessment to determine if the child is a candidate, monitoring and documentation of nitrous oxide administration, and education for the child/parent(s). The nitrous oxide program for pediatrics was designed as a minimal sedation method to minimize procedural pain, fear, and anxiety in children where medical procedures are a necessary part of treatment. Development of a Program Proposal for a Nitrous Oxide Program in Pediatrics by Sarah Oleson MSN, Walden University, 2013 BSN, University of Wisconsin-Green Bay, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Dedication I dedicate this project to my husband, Kevin, for his unconditional support while I continued my studies. Also, for proofreading my papers even though he knew nothing about the topics. To my children, Kamden and Haleigh, who are the best children a mother could ask for. Their smiles and hugs kept me going. I have no doubt that without their love and support through my doctorate studies; I would not be where I am today. I also dedicate this work to my parents, Jerry and Cindy, who have taught me perseverance and that I can do anything I set my mind on. Acknowledgement The last 18 months has been an intense learning experience both academically and personally. This project has had a big impact on me, and I want to thank everyone involved who has supported and guided me through this journey. I would like to express my gratitude to my project committee, Dr. Oscar Lee, Dr. Catherine Garner, and Dr. Francisca Farrar. Your guidance, contributions, and feedback at each level of my project have been invaluable. I would also like to thank the pediatric leaders, Kim Kostichka RN, Lori Vertz, RN, and Drs. Taylor and Ament for all of your help and guidance in completing my work and for helping me grow as a scholar, practitioner, and a leader. Your continued support and encouragement has been priceless. I am indebted to the knowledge and expertise you each provided as I developed my work. A very special thanks goes out to my practicum mentor and Executive Director of Pediatrics, Heidi Warpinski MS, RN, CPNP, for her willingness to help with this project and for her continued enthusiasm and support. I am entirely grateful for all the teamwork, dedication, and support from the pediatric leaders that was needed to complete my work and for guiding me every step of the way.