Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Heidi Monroe, PhD, MSN, RN, CPN
Heidi Monroe, PhD, MSN, RN, CPN
Antwinett O. Lee, EdD, MSN-CNS, RN|
Background and Significance: Drowning can lead to irreversible brain injury (Restrepo et al., 2017). Drowning survivors may rely on machines for breathing, feeding tubes for nutrition, a variety of medications, and require frequent hospitalizations. In the United States (US), there are widely recognized disparities among pediatric drowning victims (Denny et al., 2019). Risk factors that increase drowning risk include (a) ages 12-36 months; (b) male gender; (c) medical conditions such as epilepsy and autism; and (d) certain cultural and (e) religious practices (Denny et al., 2019). In Washington State, unintentional drowning is the fourth leading cause of injury-related death in children ages 1 through 4, the second leading cause of injury-related death in children ages 5 through 9, and a leading cause of injury-related death for adolescents and young adults (Sabel et al., 2013). The mean hospital stay is 4.11 days with an average cost of $41,694 (Umapathi et al., 2020).
Problem and Purpose Statement: There are coordinated efforts to act upon the risk factors associated with an increased drowning risk by integrating community safety measures and educational initiatives. Seattle Children’s Hospital (SCH) coordinates drowning prevention efforts via the Washington State Drowning Prevention Network (DPN). The purpose of this program evaluation was to describe how the DPN implements drowning prevention strategies. The aims of this project were to (a) describe the activities and programs led by the DPN; (b) describe how the activities are coordinated; (c) describe the target population and perceived challenges reaching the target population; and (d) describe the perceived strengths, limitations, and opportunities of the network.
Methods: The theoretical framework selected for the program evaluation was the CDC’s Framework for Program Evaluation in Public Health (CDC, 1999). The framework incorporates six steps (a) engage stakeholders; (b) describe the program; (c) focus evaluation design; (d) gather credible evidence; (e) justify conclusions; and (f) ensure use and share findings. The program evaluation was conducted in a stepwise fashion to enhance credibility and facilitate a systematic approach using the six-step approach.
Convenience sampling was used to recruit participants. The injury prevention representative sent an invitation to participate in an online survey using the network’s email distribution list (N=280). Three separate surveys were used to conduct the program evaluation. The first cohort completed a survey regarding the network at large and was intended for active network members. The second cohort completed a survey regarding previous April Pool’s Day activities. The survey was intended for individuals who have been involved in the activity. The third cohort completed a survey regarding the Life Jacket Loaner Program sites. It was intended to be completed by those involved in the program, such as the loaner board site representatives.
The program evaluation utilized a mixed-methods approach. Results from Microsoft Forms surveys were used to perform the data analysis. The surveys included close-ended questions with unordered questions (e.g., multiple choice, polar interrogative, and select all that apply) and open-ended questions (e.g., free text response). Descriptive statistics were used to summarize the quantitative data. Data was summarized categorically in the form of tables and bar charts and numerically in the form of percentages and frequencies. Content analysis was used to review the qualitative data. The analysis included decontextualization, recontextualization, categorization, and thematic analysis (Bengtsson, 2016). To maintain trustworthiness, each stage was reviewed at least twice by the project lead and the second reviewer. Microsoft Word tables were used to visualize how the raw data led to the suggested categories and themes. Investigator triangulation was used to increase rigor.
Results/Outcomes: The quantitative data offered varying results, which may have been due to unsuitable question selection and a low response rate. The low response rate was attributed to utilizing convenience sampling based on an email distribution list, competing work-related priorities such as addressing time-sensitive issues related to the COVID-19 pandemic, change in network participation, or lack of interest. Despite the limitations, the quantitative data analysis helped substantiate the results from the qualitative data. The qualitative data analysis indicated that there are strengths, limitations, and opportunities existing within the network. Seven themes emerged from the results of the qualitative data analysis: (a) reaching the target (21.2%); (b) establishing a foundation (19.8%); (c) staying connected (17.3%); (d) sharing approaches (11.6%); (e) acquiring more resources (11.1%); (f) shaping the system (9.7%); and (g) generating visibility (9.7%). Potential limitations of the qualitative analysis included researcher bias and uncertainty from the respondent. The results suggested that there were respondents who were not sure how to answer certain questions or prompts (12.6%). To minimize researcher bias, investigator triangulation was used. Ultimately, the mixed methods approach provided a rich understanding of the network’s current state. Recommendations presented to the network were generated based on the combination of qualitative and quantitative data analyses. The recommendations were to (a) continue biannual meetings; (b) identify annual goals; (c) define the target population; (d) launch working groups; (e) expand social media use; (g) address the lack of resources; (h) explore the Life Jacket Loaner Board Program; (i) redefine the network.
Sustainability: The network meetings are central to ongoing collaboration among its members. The project lead will present the results of and recommendations to the network via the biannual network meeting. The injury prevention representative is a member of the network leadership and employed by the lead organization, Seattle Children’s Hospital. She is involved in coordinating the network meetings and sending quarterly emails. Additionally, she was the second reviewer for the qualitative data analysis and participated in finalizing recommendations. To support project sustainability, the injury prevention representative is a member of the network’s leadership team and plans to integrate the results and recommendations into future actions and approaches led by the network.
Implications for Practice: The program evaluation was the first evaluation of the network and provides a cost-effective starting point for improving current initiatives and identifying the necessary steps to optimize statewide drowning prevention interventions. The results and recommendations can be used to encourage a statewide model that expands collaboration among its members and existing partnerships. It may be used to spearhead high yield drowning prevention initiatives such as advocating for policy reform, expanding data surveillance, and integrating technological platforms into interventions led by the network.
Bengtsson, M. (2016, January). How to plan and perform a qualitative study using content analysis. NursingPlus Open, 2: 8-14. https://doi.org/10.1016/j.npls.2016.01.001
Centers for Disease Control and Prevention. (1999). Framework for program evaluation in public health. MMWR;48 (No. RR-11). US Department of Health and Human Services. https://www.cdc.gov/mmwr/PDF/rr/rr4811.pdf
Denny, S.A., Quan, L., Gilchrist, J., McCallin, T., Shenoi, R., Yusuf, S., Hoffman, B., Weiss, J., & the Council on Injury, Violence, and Poison Prevention. (2019, March 15). Prevention of drowning. Pediatrics, 143(5), Article e20190850. https://doi.org/10.1542/peds.2019-0850
Restrepo, C.S., Ortiz, C., Singh, A.K., & Sannananja, B. (2017, June 19). Near-drowning: epidemiology, pathophysiology and imaging findings. Journal of Trauma and Care, 3(3): 1026. ISSN: 2573-1246
Sabel, J. (2013, August 30). Drowning. Washington State Department of Health. https://www.doh.wa.gov/Portals/1/Documents/1500/IV-DRN2013.pdf
Umapathi, K.K., Thavamani, A., Dhanpalreddy, H., Khatana, J., & Roy, A. (2020). Incidence trends and predictors of in-hospital mortality in drowning in children and adolescents in the United States: A national inpatient database analysis. Clinical Pediatrics, 59(2), 134-141. https://doi.org/10.1177/0009922819886871
Courtney, Amanda A., "Describing Drowning Prevention Strategies via the Washington State Drowning Prevention Network: A Program Evaluation" (2022). Doctor of Nursing Practice (DNP) Scholarly Projects. 40.