Doctor of Nursing Practice Program


Jason Williams
  • Committee Chair Name & Credentials:
    Karen Hande, PhD, DNP, ANP-BS, CNE, FAANP, ANEF


DNP Project Abstract

Screening for Acute Stress Reactions in Pediatric Trauma Patients

Pediatric trauma patients can develop acute stress reactions following a traumatic event. Nursing staff at one of the largest level I pediatric trauma centers in southern United States were not screening trauma patients due to a lack of knowledge regarding the STEPP screening tool, knowledge regarding acute stress reactions, and understanding of the STEPP screening tool. This was due to a lack of formal education provided to the staff. The purpose of this project was to increase knowledge of the STEPP tool and acute stress reactions among RNs after implementation of an education module from 7% achieving a score of 90 or greater pre-quiz to 60% achieving a score of 90 or greater post-quiz over a 6-week period. The objectives were to: improve nursing knowledge of ASR symptoms (via education module), increase nursing staff knowledge of the STEPP tool, and improve nursing staff understanding of STEPP tool screening procedures.

The PDSA cycle was used to assess if providing formal education to the nursing staff would increase staff's knowledge of the STEPP tool and acute stress reactions. Plan: Interview stakeholders to determine barriers to screening. Complete a retrospective chart review to assess current screening rates. Develop an education module centered around acute stress reactions and the STEPP tool. Create a pre and post quiz to measure nursing knowledge of ASR and the STEPP tool. Do: Record educational video and present to stakeholders for review. Load recording to organization's training system for the nurses to complete as part of their fourth quarter competencies. Study: Analyze pre and post quiz results six weeks into the fourth quarter to assess nursing knowledge. Act: Adopt education if 60% of RNs achieve a score of 90 or greater. Abandon education module if education is not the primary reason for failure to complete screenings. Repeat cycle to test new variables that may improve nursing knowledge.

During the first six weeks of the fourth quarter, 209 out of 617 registered nurses completed the education module. This is a completion rate of 34%. Pre-quiz score results showed 7% of nurses scored a 90 or greater. After completing the education module 92% of nurses scored a 90 or greater on the post quiz. Nursing knowledge increased by 1214% after implementation of the education module.

Implications for Practice
Implementation of education module to all registered nurses increased nursing knowledge of the STEPP tool and acute stress reactions. This project aligns with the American College of Surgeons requirement for level I pediatric trauma centers to have a protocol that identifies and refers patients at risk of development mental health problems. Trauma patients who screen positive will receive further evaluation by a mental health clinician. Patients are able to recieve care during their inpatient stay and assistance with locating resources in the community upon discharge.