- Email: [email protected]
Evaluating the Quality of Interventions: Improving Pediatric Nursing Practice Through Research
Journal of Pediatric Nursing (2012) 27, 767–769
RESEARCH COMMENTARY COLUMN Column Editor: Becky J. Christian PhD, RN
Becky J. Christian PhD, RN
Evaluating the Quality of Interventions: Improving Pediatric Nursing Practice Through Research Becky J. Christian PhD, RN ⁎ University of Alabama at Birmingham, School of Nursing, Birmingham, AL
EVALUATING INTERVENTIONS DETERMINES not only the quality and effectiveness of programs on specific outcomes in real-world settings, but creates new knowledge about the impact of the intervention, thereby building upon and extending the evidence (Glascow & Linnan, 2008; Rohrbach, Grana, Sussman, & Valente, 2006). Quality improvement projects are designed to evaluate and test the effectiveness intervention programs by translating research into nursing practice (Polit & Beck, 2012). Through systematic evaluation, interventions are refined to improve the quality of the intervention program and, ultimately, to enhance pediatric nursing practice through improved care of children and their families. This dynamic interplay of research, theory, and practice undergirds the dialectic between nursing research, knowledge development, and nursing practice. In this way, evidence is substantiated and knowledge is developed resulting in improved nursing practice. Critical evaluation and testing of interventions are essential to determine their efficacy and effectiveness in improving outcomes that will enhance the care of children and their families (Christian, 2011). Testing and evaluation of best practices identified and developed through clinical experiences, provide critical evidence that is translated into practice for improving the quality of care (Christian, 2010a, 2010b). In this way, knowledge is developed and pediatric nursing practice is enhanced, resulting in improved quality of care. In this issue of the Journal of Pediatric Nursing, 15 articles highlight the importance of critical evaluation of interventions and quality improvement programs providing evidence for the ⁎ Corresponding author: Becky J. Christian, PhD, RN. E-mail address: [email protected]. 0882-5963/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2012.09.003
improving outcomes in pediatric nursing practice, as well as the care of children and their families:
Research and qual-
• An evaluation of a theory-based ity improvement model predicting parental accepprojects highlight tance (N=323 parents) of human the importance of papillomavirus (HPV) vaccine and intention to vaccinate their evaluating and testdaughters (9 to 18 years) was ing interventions to conducted using survey methods improve the quality (Reynolds & O'Connell, 2012). of pediatric nursing Factor analysis with principal practice. components analysis with a varimax rotation yielded seven factors that explained the major predictors. Parents who believed that their daughter was more susceptible to HPV and had more positive attitudes toward vaccination and were more likely to vaccinate their daughters. Age of the girls was found to be a significant predictor of vaccination status, with parents more likely to vaccinate older girls. • An evaluation of caregiver perspectives of unintentional injury risk of children (N=165, 3 to 12 years) with autism spectrum disorders (ASD) obtained through online survey indicated that children with ASD demonstrated increased rates of risk-taking behaviors as compared to peers, but were rarely rated as high risk for injury by their caregivers (Cavalari & Romanczyk, 2012). • A qualitative, phenomenological study explored caregiving experiences in Ireland of mothers (N=17 mothers) of children (N=20) with a variety of complex care needs (Nicholl & Begley, 2012). Based on data from 48 unstructured interviews and 11 diaries, mothers reported
768
•
•
•
•
•
•
•
four categories of caregiving (one of eight dimensions) that reflected a “no-choice” situation, but not the “burden” of caregiving described in the literature. Parent (N=21) and healthcare provider (N=5) satisfaction with pediatric ambulatory surgery was evaluated in a telephone follow-up survey by a pediatric nurse practitioner (PNP) (Kassmann, Docherty, Rice, Bailey, & Schweitzer, 2012). The evaluation of this practice change indicated that parents were satisfied with the telephone follow-up by the PNP and that this intervention was feasible. Healthcare providers were satisfied with the telephone follow-up, noting that it was a safe option and an effective use of staff and patient time. The use of undergraduate student nurses (N =10) as school nurses was evaluated in a 10-week practice improvement project combined with an undergraduate pediatric clinical educational experience focused on quantifying the activities related to the role of the school nurse in an elementary school (Rossman, Dood, & Squires, 2012). Students performed 400 hours of activities, including health assessment, health promotion and education to meet the health needs of the elementary school children and to learn about the role of the school nurse and children's health. A single case study design was employed to evaluate the use of non-nutritive sucking (NNS) to facilitate oral feeding in a term infant with feeding difficulties (Harding, Frank, Dungu, & Colton, 2012). The intervention in this case illustrates the success of a sequential, NNS program for transition to oral feeding. A comprehensive review of the evidence and recommendations related to pacifier usage in full-term infants was conducted evaluating the evidence and identifying the major benefits and risks of pacifier usage (Nelson, 2012). A critical evaluation of the evidence-based pediatric research literature focused on the use of distraction techniques for children undergoing procedures was employed to determine best practices and interventions to improve children's coping ability to inform clinical practice and research (Koller & Goldman, 2012). Child preferences and participation in healthcare decisions were found to be integral to the success of distraction as a coping strategy for children undergoing procedures. A quality improvement project was conducted over 2 years to evaluate the effectiveness of intervention strategies to reduce peripheral intravenous infiltration (PIV) and extravasation injuries on 15 inpatient units in a large, urban pediatric academic medical center (Tofani et al., 2012).The use of the PIV intervention bundle with standardized assessment of PIV sites every 60 minutes led to a significant decrease in grades 2–4 events initially; however, the results were not sustained over time. A cross-sectional descriptive study was used to describe the prevalence and severity of medical line entanglements among pediatric patients (N =486) in a freestanding children's hospital (Goodin, Ryan-Wenger, & Mullet,
B.J. Christian
•
•
•
•
•
2012). One-third of the children were found to be at-risk for adverse events and safety hazards due to medical line entanglements. The accuracy of the landmark technique for cannulation of the greater saphenous vein (GSV) near the medial malleolus was evaluated in a descriptive study of children (N=100, 3 to 16 years) (Germino, Gerard, & Flood, 2012). The GSV location varied significantly by child age and weight, with the traditional landmark rarely predicting the precise GSV location in children less than 10 years and in children weighing less than 40 kg. Thus, landmark techniques were not reliable in predicting the accurate location of the GSV. An evaluation of pediatric obesity care guidelines employed at freestanding children's hospitals (N=28) was conducted using survey methods to determine the preparedness of hospital systems and staff to provide safe care for children with severe obesity (Porter, Thrasher, & Krebs, 2012). Hospitals with bariatric surgery programs (n=7) were better prepared to care for severely obese children. To improve quality and safety, pediatric obesity care guidelines were developed and implemented at one freestanding children's hospital resulting in improved knowledge and communication among the multidisciplinary healthcare team. An evaluation of a pilot staff educational program to prevent and manage challenging behaviors of children with developmental disabilities at a pediatric hospital was conducted and staff (N=604) participated in an online survey (Johnson, Lashley, Stonek, & Bonjour, 2012). The performance improvement project demonstrated increased knowledge and decreased fear of working with children with developmental disabilities. A quality improvement project was conducted over 2 years to review the evidence regarding pain assessment tools, obtain feedback from a family advisory council, and compare the use of two pain assessment tools (e.g., Pediatric Pain Profile and the revised FLACC) as evaluated by nurses (n=126) and parents (n=24) regarding pain assessment in children who are cognitively impaired (Chen-Lim et al., 2012). Pain assessment by nurses and parents of children with cognitive impairments was improved with increased accuracy through the use of the revised FLACC. Policy change was implemented with the addition of the revised FLACC pain assessment to the pain policy. Post-implementation audit results were found to be inconsistent with the use of the revised FLACC pain assessment. Follow-up individual education was employed to improve the utilization of the assessment tool. A pilot study of children with obstructive sleep apnea syndrome (N =21) was conducted to investigate neurocognitive functioning in children with the use of positive airway pressure (PAP) therapy intervention (Yuan et al., 2012). Only 4 of the 21 children completed the full PAP treatment using PAP for five to seven nights per week, although they demonstrated improvement in memory
Research Commentary Column and motor speed. However, the small sample size in this study and the high dropout rate with few completing the intervention limit the ability to interpret the results of this study. These research and quality improvement projects highlight the importance of evaluating and testing interventions for translating outcomes to improve the quality of care for children and their families as well as pediatric nursing practice. However, it is essential to evaluate interventions and quality improvement projects to determine their effectiveness before changing practice. In this way, new evidence is established through research and evaluation, while knowledge is developed that will contribute to improving the quality of pediatric nursing care and enhancing the health of children and their families.
References Cavalari, R. N. S., & Romanczyk, R. G. (2012). Caregiver perspectives on unintentional injury risk in children with an autism spectrum disorder. Journal of Pediatric Nursing, 27, 632–641. Chen-Lim, M. L., Zarnowsky, C., Green, R., Shaffer, S., Holtzer, B., & Ely, E. (2012). Optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process. Journal of Pediatric Nursing, 27, 750–759. Christian, B. J. (2010). Research commentary—Educational interventions: Essential strategies for pediatric nursing practice and research. Journal of Pediatric Nursing, 25, 589–591. Christian, B. J. (2010). Discovering the power of research: Improving the quality of pediatric nursing care. Journal of Pediatric Nursing, 25, 229–230. Christian, B. J. (2011). Evaluating educational programs in pediatric nursing: Translating research outcomes to improve practice. Journal of Pediatric Nursing, 26, 383–384. Germino, K. W., Gerard, J. M., & Flood, R. G. (2012). Greater saphenous vein location in a pediatric population. Journal of Pediatric Nursing, 27, 626–631. Glascow, R. E., & Linnan, L. A. (2008). Evaluations of theory-based interventions. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research and practice (pp. 487–508). (4th ed.). San Francisco: Jossey-Bass.
769 Goodin, H. J., Ryan-Wenger, N. A., & Mullet, J. (2012). Pediatric medical line safety: The prevalence and severity of medical line entanglements. Journal of Pediatric Nursing, 27, 725–733. Harding, C., Frank, L., Dungu, C., & Colton, N. (2012). The use of nonnutritive sucking to facilitate oral feeding in a term infant: A single case study. Journal of Pediatric Nursing, 27, 700–706. Johnson, N. L., Lashley, J., Stonek, A. V., & Bonjour, A. (2012). Children with developmental disabilities at a pediatric hospital: Staff education to prevent and manage challenging behaviors. Journal of Pediatric Nursing, 27, 742–749. Kassmann, B. P., Docherty, S. L., Rice, H. E., Bailey, D. E., & Schweitzer, M. (2012). Telephone follow-up for pediatric ambulatory surgery: Parent and provider satisfaction. Journal of Pediatric Nursing, 27, 715–724. Koller, D., & Goldman, R. D. (2012). Distraction techniques for children undergoing procedures: A critical review of pediatric research. Journal of Pediatric Nursing, 27, 652–681. Nelson, A. M. (2012). A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of Pediatric Nursing, 27, 690–699. Nicholl, H. M., & Begley, C. M. (2012). Explicating caregiving by mothers of children with complex needs in Ireland: A phenomenological study. Journal of Pediatric Nursing, 27, 642–651. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott Williams & Wilkins. Porter, R. M., Thrasher, J., & Krebs, N. F. (2012). Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness. Journal of Pediatric Nursing, 27, 707–714. Reynolds, D., & O'Connell, K. A. (2012). Testing a model for parental acceptance of human papillomavirus vaccine in 9- to 18-year-old girls: A theory-guided study. Journal of Pediatric Nursing, 27, 614–625. Rohrbach, L. A., Grana, R., Sussman, S., & Valente, T. W. (2006). Type II translation: Transporting prevention interventions from research to real-world settings. Evaluation & the Health Professions, 29, 302–333. Rossman, C. L., Dood, F. V., & Squires, D. A. (2012). Student nurses as school nurse extenders. Journal of Pediatric Nursing, 27, 734–741. Tofani, B. F., Rineair, S. A., Gosdin, C. H., Pilcher, P. M., McGee, S., Varadarajan, K. R., et al. (2012). Quality improvement project to reduce infiltration and extravasation events in a pediatric hospital. Journal of Pediatric Nursing, 27, 682–689. Yuan, H. C., Sohn, E. Y., Abouezzeddine, T., Mahrer, N. E., Barber, B. A., Keens, T. G., et al. (2012). Neurocognitive functioning in children with obstructive sleep apnea syndrome: A pilot study of positive airway pressure therapy. Journal of Pediatric Nursing, 27, 607–613.
RESEARCH COMMENTARY COLUMN Column Editor: Becky J. Christian PhD, RN
Becky J. Christian PhD, RN
Evaluating the Quality of Interventions: Improving Pediatric Nursing Practice Through Research Becky J. Christian PhD, RN ⁎ University of Alabama at Birmingham, School of Nursing, Birmingham, AL
EVALUATING INTERVENTIONS DETERMINES not only the quality and effectiveness of programs on specific outcomes in real-world settings, but creates new knowledge about the impact of the intervention, thereby building upon and extending the evidence (Glascow & Linnan, 2008; Rohrbach, Grana, Sussman, & Valente, 2006). Quality improvement projects are designed to evaluate and test the effectiveness intervention programs by translating research into nursing practice (Polit & Beck, 2012). Through systematic evaluation, interventions are refined to improve the quality of the intervention program and, ultimately, to enhance pediatric nursing practice through improved care of children and their families. This dynamic interplay of research, theory, and practice undergirds the dialectic between nursing research, knowledge development, and nursing practice. In this way, evidence is substantiated and knowledge is developed resulting in improved nursing practice. Critical evaluation and testing of interventions are essential to determine their efficacy and effectiveness in improving outcomes that will enhance the care of children and their families (Christian, 2011). Testing and evaluation of best practices identified and developed through clinical experiences, provide critical evidence that is translated into practice for improving the quality of care (Christian, 2010a, 2010b). In this way, knowledge is developed and pediatric nursing practice is enhanced, resulting in improved quality of care. In this issue of the Journal of Pediatric Nursing, 15 articles highlight the importance of critical evaluation of interventions and quality improvement programs providing evidence for the ⁎ Corresponding author: Becky J. Christian, PhD, RN. E-mail address: [email protected]. 0882-5963/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2012.09.003
improving outcomes in pediatric nursing practice, as well as the care of children and their families:
Research and qual-
• An evaluation of a theory-based ity improvement model predicting parental accepprojects highlight tance (N=323 parents) of human the importance of papillomavirus (HPV) vaccine and intention to vaccinate their evaluating and testdaughters (9 to 18 years) was ing interventions to conducted using survey methods improve the quality (Reynolds & O'Connell, 2012). of pediatric nursing Factor analysis with principal practice. components analysis with a varimax rotation yielded seven factors that explained the major predictors. Parents who believed that their daughter was more susceptible to HPV and had more positive attitudes toward vaccination and were more likely to vaccinate their daughters. Age of the girls was found to be a significant predictor of vaccination status, with parents more likely to vaccinate older girls. • An evaluation of caregiver perspectives of unintentional injury risk of children (N=165, 3 to 12 years) with autism spectrum disorders (ASD) obtained through online survey indicated that children with ASD demonstrated increased rates of risk-taking behaviors as compared to peers, but were rarely rated as high risk for injury by their caregivers (Cavalari & Romanczyk, 2012). • A qualitative, phenomenological study explored caregiving experiences in Ireland of mothers (N=17 mothers) of children (N=20) with a variety of complex care needs (Nicholl & Begley, 2012). Based on data from 48 unstructured interviews and 11 diaries, mothers reported
768
•
•
•
•
•
•
•
four categories of caregiving (one of eight dimensions) that reflected a “no-choice” situation, but not the “burden” of caregiving described in the literature. Parent (N=21) and healthcare provider (N=5) satisfaction with pediatric ambulatory surgery was evaluated in a telephone follow-up survey by a pediatric nurse practitioner (PNP) (Kassmann, Docherty, Rice, Bailey, & Schweitzer, 2012). The evaluation of this practice change indicated that parents were satisfied with the telephone follow-up by the PNP and that this intervention was feasible. Healthcare providers were satisfied with the telephone follow-up, noting that it was a safe option and an effective use of staff and patient time. The use of undergraduate student nurses (N =10) as school nurses was evaluated in a 10-week practice improvement project combined with an undergraduate pediatric clinical educational experience focused on quantifying the activities related to the role of the school nurse in an elementary school (Rossman, Dood, & Squires, 2012). Students performed 400 hours of activities, including health assessment, health promotion and education to meet the health needs of the elementary school children and to learn about the role of the school nurse and children's health. A single case study design was employed to evaluate the use of non-nutritive sucking (NNS) to facilitate oral feeding in a term infant with feeding difficulties (Harding, Frank, Dungu, & Colton, 2012). The intervention in this case illustrates the success of a sequential, NNS program for transition to oral feeding. A comprehensive review of the evidence and recommendations related to pacifier usage in full-term infants was conducted evaluating the evidence and identifying the major benefits and risks of pacifier usage (Nelson, 2012). A critical evaluation of the evidence-based pediatric research literature focused on the use of distraction techniques for children undergoing procedures was employed to determine best practices and interventions to improve children's coping ability to inform clinical practice and research (Koller & Goldman, 2012). Child preferences and participation in healthcare decisions were found to be integral to the success of distraction as a coping strategy for children undergoing procedures. A quality improvement project was conducted over 2 years to evaluate the effectiveness of intervention strategies to reduce peripheral intravenous infiltration (PIV) and extravasation injuries on 15 inpatient units in a large, urban pediatric academic medical center (Tofani et al., 2012).The use of the PIV intervention bundle with standardized assessment of PIV sites every 60 minutes led to a significant decrease in grades 2–4 events initially; however, the results were not sustained over time. A cross-sectional descriptive study was used to describe the prevalence and severity of medical line entanglements among pediatric patients (N =486) in a freestanding children's hospital (Goodin, Ryan-Wenger, & Mullet,
B.J. Christian
•
•
•
•
•
2012). One-third of the children were found to be at-risk for adverse events and safety hazards due to medical line entanglements. The accuracy of the landmark technique for cannulation of the greater saphenous vein (GSV) near the medial malleolus was evaluated in a descriptive study of children (N=100, 3 to 16 years) (Germino, Gerard, & Flood, 2012). The GSV location varied significantly by child age and weight, with the traditional landmark rarely predicting the precise GSV location in children less than 10 years and in children weighing less than 40 kg. Thus, landmark techniques were not reliable in predicting the accurate location of the GSV. An evaluation of pediatric obesity care guidelines employed at freestanding children's hospitals (N=28) was conducted using survey methods to determine the preparedness of hospital systems and staff to provide safe care for children with severe obesity (Porter, Thrasher, & Krebs, 2012). Hospitals with bariatric surgery programs (n=7) were better prepared to care for severely obese children. To improve quality and safety, pediatric obesity care guidelines were developed and implemented at one freestanding children's hospital resulting in improved knowledge and communication among the multidisciplinary healthcare team. An evaluation of a pilot staff educational program to prevent and manage challenging behaviors of children with developmental disabilities at a pediatric hospital was conducted and staff (N=604) participated in an online survey (Johnson, Lashley, Stonek, & Bonjour, 2012). The performance improvement project demonstrated increased knowledge and decreased fear of working with children with developmental disabilities. A quality improvement project was conducted over 2 years to review the evidence regarding pain assessment tools, obtain feedback from a family advisory council, and compare the use of two pain assessment tools (e.g., Pediatric Pain Profile and the revised FLACC) as evaluated by nurses (n=126) and parents (n=24) regarding pain assessment in children who are cognitively impaired (Chen-Lim et al., 2012). Pain assessment by nurses and parents of children with cognitive impairments was improved with increased accuracy through the use of the revised FLACC. Policy change was implemented with the addition of the revised FLACC pain assessment to the pain policy. Post-implementation audit results were found to be inconsistent with the use of the revised FLACC pain assessment. Follow-up individual education was employed to improve the utilization of the assessment tool. A pilot study of children with obstructive sleep apnea syndrome (N =21) was conducted to investigate neurocognitive functioning in children with the use of positive airway pressure (PAP) therapy intervention (Yuan et al., 2012). Only 4 of the 21 children completed the full PAP treatment using PAP for five to seven nights per week, although they demonstrated improvement in memory
Research Commentary Column and motor speed. However, the small sample size in this study and the high dropout rate with few completing the intervention limit the ability to interpret the results of this study. These research and quality improvement projects highlight the importance of evaluating and testing interventions for translating outcomes to improve the quality of care for children and their families as well as pediatric nursing practice. However, it is essential to evaluate interventions and quality improvement projects to determine their effectiveness before changing practice. In this way, new evidence is established through research and evaluation, while knowledge is developed that will contribute to improving the quality of pediatric nursing care and enhancing the health of children and their families.
References Cavalari, R. N. S., & Romanczyk, R. G. (2012). Caregiver perspectives on unintentional injury risk in children with an autism spectrum disorder. Journal of Pediatric Nursing, 27, 632–641. Chen-Lim, M. L., Zarnowsky, C., Green, R., Shaffer, S., Holtzer, B., & Ely, E. (2012). Optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process. Journal of Pediatric Nursing, 27, 750–759. Christian, B. J. (2010). Research commentary—Educational interventions: Essential strategies for pediatric nursing practice and research. Journal of Pediatric Nursing, 25, 589–591. Christian, B. J. (2010). Discovering the power of research: Improving the quality of pediatric nursing care. Journal of Pediatric Nursing, 25, 229–230. Christian, B. J. (2011). Evaluating educational programs in pediatric nursing: Translating research outcomes to improve practice. Journal of Pediatric Nursing, 26, 383–384. Germino, K. W., Gerard, J. M., & Flood, R. G. (2012). Greater saphenous vein location in a pediatric population. Journal of Pediatric Nursing, 27, 626–631. Glascow, R. E., & Linnan, L. A. (2008). Evaluations of theory-based interventions. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research and practice (pp. 487–508). (4th ed.). San Francisco: Jossey-Bass.
769 Goodin, H. J., Ryan-Wenger, N. A., & Mullet, J. (2012). Pediatric medical line safety: The prevalence and severity of medical line entanglements. Journal of Pediatric Nursing, 27, 725–733. Harding, C., Frank, L., Dungu, C., & Colton, N. (2012). The use of nonnutritive sucking to facilitate oral feeding in a term infant: A single case study. Journal of Pediatric Nursing, 27, 700–706. Johnson, N. L., Lashley, J., Stonek, A. V., & Bonjour, A. (2012). Children with developmental disabilities at a pediatric hospital: Staff education to prevent and manage challenging behaviors. Journal of Pediatric Nursing, 27, 742–749. Kassmann, B. P., Docherty, S. L., Rice, H. E., Bailey, D. E., & Schweitzer, M. (2012). Telephone follow-up for pediatric ambulatory surgery: Parent and provider satisfaction. Journal of Pediatric Nursing, 27, 715–724. Koller, D., & Goldman, R. D. (2012). Distraction techniques for children undergoing procedures: A critical review of pediatric research. Journal of Pediatric Nursing, 27, 652–681. Nelson, A. M. (2012). A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of Pediatric Nursing, 27, 690–699. Nicholl, H. M., & Begley, C. M. (2012). Explicating caregiving by mothers of children with complex needs in Ireland: A phenomenological study. Journal of Pediatric Nursing, 27, 642–651. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott Williams & Wilkins. Porter, R. M., Thrasher, J., & Krebs, N. F. (2012). Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness. Journal of Pediatric Nursing, 27, 707–714. Reynolds, D., & O'Connell, K. A. (2012). Testing a model for parental acceptance of human papillomavirus vaccine in 9- to 18-year-old girls: A theory-guided study. Journal of Pediatric Nursing, 27, 614–625. Rohrbach, L. A., Grana, R., Sussman, S., & Valente, T. W. (2006). Type II translation: Transporting prevention interventions from research to real-world settings. Evaluation & the Health Professions, 29, 302–333. Rossman, C. L., Dood, F. V., & Squires, D. A. (2012). Student nurses as school nurse extenders. Journal of Pediatric Nursing, 27, 734–741. Tofani, B. F., Rineair, S. A., Gosdin, C. H., Pilcher, P. M., McGee, S., Varadarajan, K. R., et al. (2012). Quality improvement project to reduce infiltration and extravasation events in a pediatric hospital. Journal of Pediatric Nursing, 27, 682–689. Yuan, H. C., Sohn, E. Y., Abouezzeddine, T., Mahrer, N. E., Barber, B. A., Keens, T. G., et al. (2012). Neurocognitive functioning in children with obstructive sleep apnea syndrome: A pilot study of positive airway pressure therapy. Journal of Pediatric Nursing, 27, 607–613.