Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Leslie K. Scott

Clinical Mentor

Dr. Patricia Howard

Committee Member

Dr. Mollie Aleshire


Each year there are more than 25 million pediatric emergency department (ED) visits, with 37-60% of the complaints being non-urgent (Brosseau, Hoffman, Nattinger, Flores, Zhang and Gorelick, 2007). Injury is the number one reason children present to the ED and is strongly associated with a complaint of pain (AHRQ, 2013). While pain is a high volume reason for visiting the ED, there are other presentation causes that may pose a high risk to pediatric patients. Nausea and vomiting is not typically viewed as a high risk complaint, yet there are some high risk etiologies resulting in nausea and vomiting that require urgent intervention.

One high risk diagnosis that frequently presents with nausea and vomiting is the child with Medium-chain acyl-CoA dehydrogenase (MCADD) deficiency. These children need immediate care to avoid further clinical deterioration.

Pediatric emergency nurses in an academic setting need to be knowledgeable about a broad range of clinical issues. As mentioned previously a chief complaint of pain is encountered often in the ED. Despite the commonality of the complaint, evidence suggests that pediatric pain is often under-treated. Assessment of pediatric pain is an inherent aspect of pain management. Recognizing the need to understand how pediatric pain is assessed provides the framework for partial fulfillment of the capstone.

The first capstone manuscript is an integrative review regarding nursing knowledge of pediatric pain assessment in the acute care setting. The review begins with current practice recommendations and provides an overview of research from 2007-2014 regarding pediatric pain assessment, as well as knowledge and attitudes of nursing staff regarding this subject. It also includes current gaps in research and the need for additional study.

The second capstone manuscript highlights a 2013 investigation: “Emergency Nursing Knowledge of Pediatric Pain Assessment in the Acute Care Setting”. A survey with established reliability and validity (the PNKAS survey) was sent to all emergency nurses working at an academic medical center over a 3-week period. The results indicated that there is a knowledge deficit regarding pediatric pain assessment among ED nurses, regardless of increased experience or advanced degree. These findings provide an opportunity to change current emergency nursing practice.

The final capstone manuscript focuses on the high risk issue of nausea and vomiting in the child with MCADD. In the study setting, it was identified that emergency nurses needed education about the importance of this complaint, current guidelines for treatment, and initial management of these children. “Triage of the Pediatric Patient with Nausea and Vomiting” addressed the clinical presentation of MCADD and has been published in the Journal of Emergency Nursing (Blackburn, 2013).