Digital Repository Masters Theses Spring 2026 Standardized Discharge Education and Psychological Risk Assessment in Pediatric Intensive Care Emma Johnson Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Johnson, E. 2026. Standardized Discharge Education and Psychological Risk Assessment in Pediatric Intensive Care. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Standardized Discharge Education and Psychological Risk Assessment in Pediatric Intensive Care Project Title by Emma Johnson Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 4/25/26 Ogden, UT Date Emma Johnson BSN, RN, MSN Student 4/25/26 Student Name, Credentials (electronic signature) Date 4/25/26 MSN Project Faculty (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 4/25/26 Date 1 Standardized Discharge Education and Psychological Risk Assessment in Pediatric Intensive Care Emma Johnson Annie Taylor Dee School of Nursing Weber State University Trish Gibbs MSN Project April 25th, 2026 2 Abstract Purposes/Aims: The purpose of this project is to implement standardized nursing-led discharge education and a psychological risk assessment protocol in a pediatric intensive care unit (PICU) to improve nurse confidence and overall consistency in delivering evidence-based discharge teaching. Rationale/Background: Children admitted to PICUs are at increased risk for long-term psychological complications. Despite this risk, discharge education practices are often inconsistent and lack structured psychological screening. Evidence supports the effectiveness of nurse-led discharge education and early assessment in improving patient and family outcomes. Methods: This quality improvement project uses the John Hopkins Evidence-Based Practice model as a guide in the development and implementation of a standardized discharge education protocol. Interventions include staff education, a psychological screening tool, a caregiver education brochure, and a pre- and post-implementation nurse confidence survey. The protocol will be implemented over six months in a PICU setting. Summative evaluation will compare preand post-survey results. Results: Anticipated results include increased nurse self-reported confidence and improved consistency in discharge education post intervention. Conclusions: A standardized nurse-led discharge and psychological screening protocol may improve discharge readiness and promote early identification of psychological concerns. Findings may inform future practice changes and support broader implementation across pediatrics situations. Keywords: pediatric intensive care, discharge education, nurse-led intervention, psychological screening. 3 Standardized Nursing-Led Discharge Education and Psychological Risk Assessment in the Pediatric Intensive Care Unit Pediatric intensive care unit (PICU) admissions present critical healthcare experiences that can have a lasting impact on children's psychological well-being beyond their physical recovery. Research suggests that children admitted to PICUs had lower IQ scores at 5 years, developed more total emotional and behavioral problems, and had worse memory (Ko et al., 2022). Families can leave unprepared for the psychological challenges that arise from hospitalization. Nurses are perfectly positioned to bridge this gap by providing structured education and psychosocial screening. However, the lack of standardized discharge education protocols in many PICUs leads to fluctuation and inconsistent practices. This project evaluates whether implementing a standardized nursing-led discharge education and psychological risk assessment protocol improves nurses’ self-reported confidence in delivering comprehensive, evidence-based discharge teaching. Statement of Problem As survival rates for critically ill children continue to improve, attention has shifted toward quality-of-life outcomes, such as psychological health post-discharge (de Sonnaville et al., 2022). Patients in the PICU face multiple stressors such as invasive procedures, sedation, mechanical ventilation, and separation from family members, all of which increase their risk of psychological trauma (Tang et al., 2024). Pediatric hospitalization, specifically in the ICU setting, has been associated with a higher risk of new-onset mental health diagnoses within 12 months of the acute episode (Daughtrey et al., 2024). Despite the well-documented risks, current discharge practices often employ a reactive approach, addressing psychological concerns only after symptoms have arisen (Demers et al., 4 2022). This leads to missed opportunities for prevention and early intervention. More proactive approaches like incorporating systematic psychological screening, psychoeducation for families, and early referral to support services have been shown to reduce trauma symptoms and improve long-term outcomes (Baker & Gledhill, 2017; Giummarra et al., 2018). Regarding nurses, incorporating psychological care into their training has presented several challenges. These challenges include time constraints, inconsistent guidelines, and limited training in psychological assessment (Leng et al., 2022). These barriers contribute to fragmented care and leave families vulnerable to preventable post-discharge complications. This project addresses these issues by implementing a structured, nurse-led protocol that standardizes discharge education and integrates a validated psychological screening tool. Significance of the Project This project holds significance for several reasons. First, it addresses a gap in post-PICU care by shifting from a reactive to a proactive approach in psychological support. Psychological interventions have been associated with lower rates of long-term trauma and anxiety in children (Scott et al., 2025). Second, standardized nurse-led discharge teaching and follow-up significantly improve the timeliness of care, enhance patient safety, and help maintain low rates of readmission and clinical deterioration (AlZaher et al., 2023). Third, empowering nurses with standardized tools strengthens their role as leaders in patient-centered care and increases professional confidence and improves satisfaction with the discharge process (Thum et al., 2022). By targeting children aged 3–17 years who have been admitted to the PICU for at least 48 hours, this project addresses the crossroads of physical recovery, psychosocial health, and family-centered care. Implementing a standardized nursing-led discharge and psychological risk 5 assessment protocol can potentially reduce readmissions, improve long-term child development outcomes, and alleviate caregiver stress (Weiss et al., 2017). Ultimately, this project aims to advance nursing practice by demonstrating how structured nurse-driven interventions can improve continuity of care, support early intervention, and promote holistic recovery for patients in the PICU. Review of the Literature This literature review examined current evidence related to standardized nursing-led discharge education and psychological risk assessment protocols in PICUs. The purpose of the review was to identify effective strategies that enhance nurses’ ability to deliver comprehensive, evidence-based discharge teaching and incorporate early psychological screening for pediatric patients and their families. Framework The Johns Hopkins Evidence-Based Practice (JHEBP) was chosen to guide this project due to its nurse-driven approach, which promotes leadership, interdisciplinary collaboration, and systematic practice change. This model consists of three primary steps: practice question, evidence, and translation into practice (John Hopkins Medicine, 2025). First, a clearly defined practice question is developed to identify the clinical issue. Second, evidence is collected and critically appraised, drawing on the internal and external sources to ensure comprehensive evaluation. Finally, the translation phase concentrates on integrating evidence into practice through implementation, evaluation, and continuous improvement (Bissett, 2025). The JHEBP model supports sustainable, evidence-based change in nursing practice. The application of the JHEBP model to this project ensures a structured approach to addressing inconsistent PICU discharge education and the lack of standardized psychological screening. 6 During the practice question phase, the need for standardized PICU discharge education and psychological screening will be identified. An interdisciplinary team including nurses, physicians, social workers, and family representatives will be assembled in alignment with this model. The evidence phase will involve a comprehensive evaluation of both internal evidence (current unit culture, existing resources, and staff competency levels) and external evidence (published research on PICU discharge protocols and validated psychological screening tools) that will inform protocol development. This evidence will generate specific recommendations for the discharge protocol structure, integration of psychological screening, and nurse requirements. Finally, in the translation phase, a structured nurse-led discharge protocol will be developed and implemented. Continuous improvement efforts will be implemented after the protocol is created and implemented to ensure sustainability and effectiveness. The effectiveness of this practice change will be measured through a survey completed by nurses regarding the practical implementation of the new protocol and their confidence in completing it effectively. Strengths and Limitations The JHEBP model offers several strengths that make it a valuable framework for practice change. One of its primary strengths, and the main reason it was chosen, is that it is nurse-driven in nature. This empowers staff to take leadership roles in identifying and addressing clinical problems. The model’s clear three-step process provides a straightforward, systematic pathway for implementing change in clinical settings. Additionally, it emphasizes interdisciplinary collaboration and fosters engagement across disciplines, which enhances the likelihood of success and sustainable change (Melnyk & Fineout-Overholt, 2023). 7 Despite its strengths, the JHEBP model has limitations. Nurses have stated that actual adoption of evidence-based practice can be hindered by barriers such as limited time, lack of training, inconsistent organizational support, and staff resistance to change (Pitsillidou et al., 2023). These limitations are particularly relevant to this project, as introducing a standardized PICU discharge protocol will require dedicated time for staff training, leadership support, and ongoing monitoring to overcome potential resistance. Acknowledging these barriers will allow the project team to develop strategies to strengthen staff engagement, ensuring successful and sustainable practice change. Search Strategies A comprehensive literature search was conducted using CINAHL, PubMed/MEDLINE, Google Scholar, and Weber State University’s Stewart Library OneSearch and Advanced Search. Articles published between 2020 and 2025 were included to ensure relevance and recency. Search items included: "pediatric intensive care unit” or “PICU” AND “discharge teaching” or "discharge education” AND "psychological screening” or “trauma” AND “nurse-led” or “nursing intervention”. Several combinations of the keywords mentioned above were created to develop a broad search strategy to identify relevant literature on standardized nursing-led discharge protocols and psychological risk assessment in pediatric intensive care settings. Studies were limited to peer-reviewed articles involving pediatric populations, nurse-led intervention, or standardized education models. The selected literature comprised quantitative, qualitative, mixed-methods studies, systematic reviews, and quality improvement initiatives. Synthesis of the Literature Increased Psychiatric Risk Post-PICU Admission 8 The literature presents strong evidence that children who are admitted to PICUs are at exceedingly high risk for the development of psychiatric disorders after discharge which highlights the need for systematic assessment and intervention strategies (Ko et al., 2022; Rennick et al., 2025). Ko et al. (2022) evaluated long-term psychological outcomes following admission to a PICU, revealing that 10 to 30% of children manifested clinically significant psychological symptoms at three to six months follow-up. Anxiety disorders and post-traumatic stress symptoms were the common disorders in this study. The research suggested that exposure to invasive procedures, duration of hospital stays, and critical illness were associated with the development of pediatric post-intensive care syndrome (Tippayawong & Chaiyakulsil, 2022). Recognizing the potential long-term psychological effects of intensive care, subsequent research has been conducted to examine the relationship between PICU stays and long-term mental health. For example, Daughtrey et al. (2024) reviewed a national database investigating the occurrence of mental health disorders after pediatric hospital admissions, explaining that children admitted to intensive care units manifested considerably higher subsequent mental health diagnoses compared to general pediatric admissions. Rennick et al. (2025) reported three-year follow-up findings from the Caring Intensively Study, a mixed-methods examination of children's psychological and behavioral responses after PICU hospitalization, which highlighted that children consistently scored higher than their typically developing peers on standardized depression and anxiety scales after discharge. Further, the study revealed that the PICU environment had lasting impacts on both child and family mental health with behavioral issues persisting years after discharge. The consequences of PICU admission extend beyond psychological symptoms. Researchers have also explored the impact PICU admission has on cognitive function and 9 development. de Sonnaville et al. (2022) conducted a systematic meta-analysis of intelligence outcomes in PICU survivors, finding additional cognitive consequences that compound the psychiatric risks. These include developmental delays and learning difficulties that further emphasize the vulnerability of this population to long-term psychological morbidity. Nurse-led Discharge Teaching is Effective The efficacy of nurse-led discharge instruction and follow-up interventions plays a critical role in improving patient outcomes and increasing the effectiveness of healthcare provision (AlZaher et al., 2023; Carlton & Yagiela, 2024). AlZaher et al. (2023) conducted a quality improvement project that implemented a nurse-implemented follow-up service for newly discharged patients from the PICU. Implementation of the follow-up service significantly improved the timeliness of care and patient safety, while helping maintain low readmission and clinical deterioration rates. This intervention has also been shown to reduce delays in post-discharge monitoring and has the potential to reduce readmissions. Carlton and Yagiela (2024) emphasized that nurse-implemented interventions in the PICU have resulted in greater consistency and effectiveness in improving family outcomes compared to physician-implemented or multidisciplinary interventions, particularly when protocols are standardized and systematically implemented. The authors noted that nurses' consistent presence during hospitalization and discharge planning put them in an optimal position to deliver comprehensive education and successfully implement psychological screening. Psychological Risk Screening Can Improve Outcomes 10 Early psychosocial screening for children following PICU admission is critical for identifying patients at high risk for long-term emotional and behavioral difficulties. Children discharged from the PICU frequently exhibit symptoms such as anxiety, post-traumatic stress, and deficits in adaptive functioning, highlighting the need for psychological assessment (Abdelmageed et al., 2025). In one prospective cohort study, children who underwent structured psychosocial evaluation post hospitalization were found to have measurable impairments in psychosocial and adaptive behavior function up to six months post-discharge, demonstrating the need for early identification and intervention strategies (Abdelmageed et al., 2025). In pediatric populations battling cancer, early psychological screening followed by targeted interventions has been shown to improve outcomes, reducing the likelihood of persistent emotional and behavioral difficulties (Yu et al., 2023). Additionally, studies of children admitted to PICUs for critical illnesses such as septic shock have shown that risk factors for post-traumatic stress disorder can be identified early, emphasizing the utility of proactive screening protocols to guide follow-up care and mitigate long-term psychological morbidity (Burcher et al., 2024). Moreover, Tang et al. (2025) performed a scoping review of post-traumatic stress disorder in children after discharge from pediatric intensive care units, identifying a high prevalence of symptoms and multiple contributing factors. The review also highlighted significant variability in assessment methods highlighting the need for more structured psychological screening approaches. All together these findings support the implementation of structured, psychological screening at the point of PICU discharge, enabling early identification, intervention, and improved post-discharge outcomes. Summary of Literature Review Findings and Application to the Project 11 The literature review highlights the critical role nurses play in bridging the gap between patients and post-PICU care. The evidence supports the development and implementation of standardized nursing-led discharge education to improve both nurse confidence and patient outcomes, ultimately advancing family-centered care in pediatric critical care settings. Project Plan and Implementation This section describes the proposed plan to implement a standardized, nursing-led discharge education and psychological risk assessment protocol in a PICU. The project plan uses findings from the literature review and is guided by the Johns Hopkins Evidence-Based Practice (JHEBP) model. This specific model was chosen as it emphasizes nurse-led change, interdisciplinary collaboration, and systematic translation of evidence into clinical practice (Dang, 2022). The goal of this implementation plan is to address gaps in discharge education and the lack of routine psychological screening for pediatric patients following PICU hospitalization. The proposed intervention is designed to promote consistency in discharge practices, enhance nurse confidence, and improve family preparedness for post-discharge psychological challenges. Plan and Implementation Process The proposed project will take place in a pediatric intensive care unit within an acute care hospital setting. The PICU provides high-acuity, life-sustaining care to pediatric patients aged 3–17 years and frequently manages prolonged hospitalizations that place patients at increased risk for psychological distress following discharge. The target population for this project will include pediatric patients admitted to the PICU for a minimum of 48 hours who are preparing for discharge to home or a lower level of care, as well as their caregivers. Implementation of the project will follow a structured, phased approach consistent with the translation phase of the JHEBP model. The project will begin with a comprehensive review 12 of existing PICU discharge practices and the identification of gaps in psychological education and screening. Evidence from the literature will guide the development of a standardized discharge education protocol that integrates a revised version of the Child and Adolescent Trauma Screen (CATS) tool (Sachser et al., 2017). This protocol will be designed to fit within existing discharge workflows to promote sustainability. Approval to proceed will be obtained from the proper channels per the JHEBP model. The translation process will include staff education, protocol rollout, and ongoing support. PICU nurses will receive targeted education on the purpose and use of the standardized discharge protocol, trauma-informed discharge teaching strategies, and administration of the psychological risk screening tool. Education sessions will be developed in collaboration with nursing educators and will emphasize the nurse’s role in early identification of psychological risk and family-centered discharge planning. Once education is completed, the standardized protocol will be introduced into clinical practice. Nurses will be responsible for delivering structured discharge education, completing the psychological screening prior to discharge, and communicating identified concerns to appropriate interdisciplinary team members. Ongoing coaching and feedback will be incorporated to support consistent implementation and address barriers as they arise. This process aligns with the JHEBP model, which emphasizes reflection in achieving best practice. Evaluation of the project’s effectiveness will be incorporated throughout the implementation process. Pre-implementation surveys will be administered to the PICU nurses to assess baseline confidence and perceived competence regarding current discharge education practices. Following implementation, the same survey will be distributed to evaluate changes in nurse confidence, understanding of risks, and satisfaction with the discharge education process. 13 Comparison of the pre- and post-survey results will be used to determine the success of the intervention on nurses’ self-reported ability to deliver standardized discharge education and perform the screening. Dissemination of project results will occur through multiple channels to promote transparency, shared learning, and sustainability. Findings will be presented to PICU nursing leadership and interdisciplinary stakeholders through staff meetings and internal reports. Results will also be shared via email to peers and faculty. Sharing findings aligns with the JHEBP model’s emphasis on spreading evidence-based innovations to improve clinical practice. Interdisciplinary Team Successful implementation of the standardized discharge education and psychological risk assessment protocol will require collaboration among an interdisciplinary healthcare team. The JHEBP model emphasizes that interdisciplinary engagement is essential for effectively translating evidence into practice, particularly in complex care environments such as the PICU (Dang, 2022). Each team member will contribute specialized expertise to ensure comprehensive, patient and family-centered care. PICU Registered Nurses. PICU RNs will serve as the primary leaders and implementers of the project. Consistent with the nurse-driven focus of the JHEBP model, nurses will be responsible for delivering standardized discharge education, administering the psychological risk screening tool, charting results, and communicating findings to the interdisciplinary team (Dang, 2022). Nurses are uniquely positioned to assess family readiness for discharge and identify early signs of psychological distress due to their constant presence at the bedside (Scott et al., 2022) Nurse Managers and Educators. Nurse managers and nurse educators will support the project by facilitating staff education, ensuring access to resources, and reinforcing adherence to 14 the standardized protocol. Their leadership will be critical to promoting staff engagement and addressing implementation barriers. Leadership support is a crucial component of successful evidence-based practice implementation, as well it is associated with enhanced nurse participation and the sustainability of practice change (Dang, 2022). PICU Physicians and Advanced Practice Providers. PICU physicians and advanced practice providers will collaborate with nursing staff to support integration of psychological considerations into the overall discharge plan. When psychological risk is identified through screening, providers will assist with clinical decision-making, referrals, and follow-up planning. Interdisciplinary communication between nurses and providers supports shared accountability and aligns with JHEBP principles for collaborative care delivery. Social Workers and Case Managers. Social workers and case managers will play a key role in addressing psychosocial needs identified during discharge planning. They will assist with coordination of care, referral to mental health services, and linkage to community resources. Early involvement of social work supports continuity of care and reduces barriers to accessing psychological support services after discharge, which is essential for families transitioning from the PICU setting. Behavioral Health and Psychology Services. Behavioral health professionals, including psychologists or child life specialists, will provide consultation for patients identified as high risk for psychological distress. Their involvement will support trauma-informed care practices, assist with referrals, and contribute to staff education regarding psychological recovery following critical illness. Patients and Caregivers. Patients and caregivers will be active participants in the discharge education and screening process. Caregivers will receive standardized education 15 regarding potential psychological responses following PICU hospitalization, warning signs to monitor at home, and available support resources. Engaging families as partners in care promotes shared decision-making, improves discharge preparedness, and enhances adherence to follow-up recommendations, all of which are critical to improving post-discharge outcomes. Description and Development of Project Deliverables The project deliverables are designed to support consistent implementation of the standardized nursing-led discharge education and psychological risk assessment protocol in the PICU. Each deliverable aligns with evidence identified in the literature review and follows the translation phase of the Johns Hopkins Evidence-Based Practice (JHEBP) model. The deliverables include a staff lesson plan, staff education PowerPoint, caregiver education brochure, and evaluation instruments to assess nurse confidence. Staff Development Lesson Plan Nurse discharge screening education plan (See Appendix A) will be developed to provide focused instruction on the administration, interpretation, and documentation of the psychological risk screening tool. This deliverable will include a step-by-step lesson plan, including time, demonstration, and a breakout session for hands-on learning. Staff Education PowerPoint A staff education PowerPoint presentation (See Appendix B) will be developed to introduce PICU nurses to the standardized discharge education and psychological risk assessment protocol. The presentation will include an overview of the psychological risks associated with PICU hospitalization, the rationale for standardized discharge education and anticipated outcomes. This PowerPoint will be used during scheduled education sessions and 16 sent through email to ensure consistent distribution of information. The presentation will also serve as an ongoing reference tool for new staff orientation. Caregiver Education Brochure A caregiver education brochure (See Appendix C) will be created to support family education during the discharge process. The brochure will be written in clear, simple language and will outline common psychological responses following PICU hospitalization, signs and symptoms caregivers should monitor, and guidance on when and how to seek additional support. The brochure will be provided to caregivers during discharge teaching to reinforce verbal education and promote family preparedness. Staff Survey A staff survey (See Appendix D) will be developed to evaluate nurse confidence, perceived usability of the standardized discharge protocol, and satisfaction with the discharge education process. The survey will be administered pre- and post-implementation to assess changes in self-reported confidence and perceived effectiveness of the intervention. Use of the same pre- and post-surveys allows one to see the difference after proper education easily. Revised CATS Tool A revised CATS screening tool (Appendix F) was created as an age appropriate tool to assess pediatric patients. There are two slightly different versions of this tool based on the age of the child and who is filling out the form (caregiver or patient). This tool and the scoring will help guide the nurse as to what intervention the patient requires and who from the interdisciplinary team to involve. Timeline 17 The proposed implementation of the standardized nursing-led discharge education and psychological risk assessment protocol will occur over a six-month period using a structured, phased approach. Prior to implementation, several preparatory steps have already been completed, such as a comprehensive needs assessment of current PICU discharge practices, an extensive literature review to identify evidence-based interventions, and consultation with key stakeholders such as PICU nursing leadership and interdisciplinary team members. Approval to proceed with the project has been obtained from the appropriate unit leadership to ensure organizational support and feasibility. The timeline (see Appendix E) is designed to support systematic preparation, staff education, implementation, and evaluation. This phased approach allows adequate time for nurse engagement, training, feedback, and refinement of the protocol to promote successful adoption and sustainability. During months 1-2, preparatory activities will begin. These activities will include finalizing all project deliverables, coordinating with nursing leadership and interdisciplinary stakeholders, and distributing baseline staff surveys to assess current discharge education practices and nurse confidence. This phase will establish readiness for implementation and provide baseline data for future comparison. Month 3 will focus on staff education and training. PICU nurses will participate in structured education sessions using the previously mentioned deliverables. Education will emphasize the rationale for the change, communication strategies, proper use of the psychological screening tool, and expectations for protocol adherence. During this phase, there will be opportunities for discussion and clarification to support engagement and understanding. During months 4-5, the standardized discharge education and assessment protocol will be implemented into clinical practice. Nurses will begin using the protocol with eligible patients and 18 families, including the distribution of the Caregiver Education brochure during discharge teaching. Ongoing support, informal coaching, and feedback will be provided throughout this period to reinforce correct use of the protocol, address barriers, and promote consistency across shifts and providers. Month 6 will be dedicated to evaluation and follow-up. Post-implementation staff surveys will be administered to assess changes in nurse confidence, perceived usability, and satisfaction with the discharge education process. Evaluation findings will be analyzed and summarized for presentation to PICU leadership, along with recommendations for sustained implementation and future quality improvement initiatives. Overall, the six-month phased timeline allows for sufficient time for education, clinical integration, and evaluation of the standardized discharge protocol. This approach supports nurse engagement, promotes consistent adoption of evidence-based practices, and facilitates sustainable improvement in discharge education and risk screening for PICU patients and their families. Project Evaluation The effectiveness of the standardized nursing-led discharge education and psychological risk assessment protocol will be evaluated using both formative and summative evaluation methods. These approaches will allow the project team to monitor implementation progress, identify barriers, and measure outcomes related to nurse confidence and protocol utilization. Formative evaluation will occur throughout the implementation phase to assess the adoption process and identify any challenges staff encounter. This will begin during months four and five, when informal feedback will be gathered from PICU nurses through brief check-ins, staff huddles, and direct observation of the discharge process. This ongoing feedback will aid in 19 timely adjustments, clarify screening procedures, and reinforce educational content. Additionally, documentation audits may be conducted to determine whether standardized discharge education and the revised CATS screening tool are consistently used. Summative evaluation will occur at the end of the six-month implementation period. The primary outcome measure will be changes in nurse self-reported confidence and perceived competence in delivering discharge education and conducting psychological risk screening. A structured pre- and post-implementation survey will be administered to PICU nurses using the same instrument for both data collection points. The survey will assess confidence in discharge teaching, perceived usability of the protocol, and satisfaction with the discharge process. Survey responses will be analyzed using descriptive statistics to compare pre- and post-implementation scores. Changes in mean confidence levels and perceived competence will be examined to determine the impact of the intervention. Together, these formative and summative evaluation strategies will provide a comprehensive assessment of both the implementation process and the effectiveness of the standardized discharge protocol. The results will guide recommendations for sustaining or expanding the intervention within the PICU setting. Ethical Considerations Several ethical principles will guide the implementation of this project, including respect for persons, beneficence, nonmaleficence, and justice. Due to this project focusing on practice improvement rather than human subjects research, it is anticipated to be classified as a quality improvement or evidence-based practice initiative. Institutional approval will be obtained in accordance with the organization’s policies, which may include review by nursing leadership to confirm the project’s status. 20 Participation in staff surveys will be voluntary. Nurses will be informed of the project's purpose, the voluntary nature of the surveys, and their right to decline participation without affecting their employment status or performance evaluations. No individual identifiers will be collected on the surveys, and responses will be reported anonymously to protect participant confidentiality. Patient privacy and confidentiality will be maintained throughout the project. Any chart audits conducted for evaluation purposes will focus only on protocol adherence and will not include identifiable patient information. No patient names, medical record numbers, or identifying information will be included in reports or presentations. The project also reflects principles of social responsibility and equitable care. The standardized discharge education protocol is designed to provide consistent, non-discriminatory education and psychological screening to all eligible PICU patients and their families, regardless of socioeconomic status, cultural background, language, or diagnosis. Educational materials will be written in clear, family-friendly language, and interpreter services will be utilized as needed to ensure understanding. By prioritizing voluntary participation, confidentiality, equitable care, and objective evaluation, this project will remain within ethical standards while promoting improved psychological support and discharge education for PICU patients and their families. Discussion This project addresses the gap in standardized discharge education and psychological risk assessment for children leaving the PICU setting. The literature demonstrates that PICU admission is associated with increased risk for long-term psychological and cognitive complications, yet many units continue to rely on inconsistent or reactive discharge practices. Evidence supports the use of structured nurse-led interventions to improve discharge 21 preparedness, early psychological screening, and family-centered care. The proposed standardized discharge education and screening protocol aims to improve nurse confidence, promote consistent teaching practices, and support early identification of psychological risk factors. This discussion highlights dissemination strategies, the project's significance to nursing practice, potential implications, and recommendations for future development. Evidence-Based Solutions for Dissemination Dissemination of project findings is essential to promote knowledge translation and support sustainable practice change. Results from this project will be shared through multiple methods. Internally, findings will be presented to PICU nursing staff, nurse educators, and leadership through staff meetings and summary reports. These approaches encourage staff engagement and support the integration of successful practices into routine care. In addition, the project will be presented as a poster during the final MSN project presentation to faculty and peers. The poster presentation will allow for discussion, feedback, and knowledge exchange. If the intervention demonstrates positive outcomes, the protocol may also be adapted for use in other pediatric units or shared with interdisciplinary committees within the organization. Dissemination of results promotes the spread of effective interventions and supports continuous improvement in clinical care. Significance to the Advancement of Nursing Practice This project advances nursing practice by strengthening nurses' role in delivering comprehensive, patient-centered discharge education. A gap that is needed and that nurses are more than capable of filling. Nurses play a central role in coordinating care and preparing families for the transition from the hospital to home. Standardizing discharge promotes more 22 effective education, reduces practice variability, and higher nurse satisfaction (Patscheider, 2024). Additionally, the use of the Johns Hopkins Evidence-Based Practice model promotes interdisciplinary collaboration, and systematic translation of research into clinical practice (Bissett, 2025). This reinforces the importance of nursing leadership in improving care processes and patient outcomes. Implications This project has several potential strengths. First, a standardized discharge protocol promotes consistency in teaching practices, reducing variability among nurses and shifts. Second, the nurse-led design supports staff ownership of the intervention, hopefully increasing participation and sustainability. Third, integrating psychological screening into discharge planning supports early identification of at-risk patients and promotes timely referrals to support services. Despite these strengths, several limitations and barriers may affect implementation. Time constraints during the discharge process may limit nurses’ ability to complete additional screening tasks. Staff resistance to change, unfamiliarity with psychological screening tools, and competing clinical priorities may also affect adherence to the protocol. Additionally, the short six-month implementation period may limit the ability to observe long-term patient outcomes. To reduce these obstacles, the project includes structured staff education, ongoing support, and opportunities for feedback implementation. Integrating this new protocol into the existing workflow and keeping the screening tool brief and user-friendly may also improve feasibility. Leadership support and reinforcement of the protocol during staff meetings and huddles will be important for sustaining practice change. 23 Recommendations Several recommendations may improve the project and guide future development. First, extending the implementation period would allow for more comprehensive data collection and evaluation of patient and family outcomes. Future projects could include measures such as referral completion rates or incidence of post-discharge psychological symptoms. Second, expanding the protocol to include follow-up communication, such as post-discharge phone calls or outpatient screening, may further support families during the transition home. This would help further bridge the gap between the ICU-level care and at-home support. Finally, future studies could explore interdisciplinary approaches that integrate nursing, social work, psychology, and child life services to provide comprehensive post-PICU support. Conclusions Pediatric intensive care unit hospitalization places children and their families at a substantial risk for long-term psychological, emotional, and cognitive complications, yet discharge practices often remain inconsistent and solely focused on the child’s physical recovery. This project addressed the critical gap in standardized discharge education and routine psychological risk assessment for pediatric patients transitioning from the PICU to home or lower levels of care. Overall, this project illustrates the importance of addressing both physical and psychological recovery after critical illness. A standardized, nurse-driven discharge protocol has the potential to improve continuity of care, support early intervention, and enhance outcomes for this vulnerable population. The findings may also inform future quality improvement initiatives and encourage broader use of trauma-informed discharge practices in pediatric settings. 24 References Abdelmageed, R. I., Youssef, A. M., Magdy, S. M., Nasr, A. N., & Abdelaziz, A. W. (2025). Psychosocial and adaptive behavior functioning in children following pediatric intensive care unit hospitalization: Prospective cohort study. BMC Pediatrics, 25(1). https://doi.org/10.1186/s12887-025-06156-9 AlZaher, R. 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Yu, L., Mo, L., Liu, Y., & Huang, X. (2023). Screening for early warning of psychological crisis and intervention in children aged 8–18 years with cancer: A historical controlled trial. Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1156185 28 Appendix A Staff Development Lesson Plan Lesson Plan: Training PICU Nurses on Use of the Psychological Risk Assessment Tool Audience: PICU Registered Nurses Length: ~60 minutes 1. Welcome (5 minutes) ● Introduce instructor and purpose of training ● Review objectives and implementation timeline 2. PowerPoint Presentation (10 minutes) ● Psychological risks after PICU hospitalization ● Gaps in current discharge practices ● Benefits of early screening ● Expected outcomes of the new protocol 3. Teaching of Assessment Tool (15 minutes) ● Purpose of the tool ● When and how to administer ● Scoring and interpretation ● Documentation and referral process 4. Demonstration (10 minutes) 29 ● Instructor demonstrates tool use using a sample scenario ● Shows how to introduce, complete, and score the assessment 5. Breakout Sessions (15 minutes) ● Small groups practice using case scenarios ● Score results and discuss risk level ● Instructor provides guidance 6. Questions (5 minutes) ● Open Q&A ● Review key points ● Provide follow-up support information 30 Appendix B Presentation for Employee Education 31 32 33 34 35 Appendix C Unit Flyer/Infographic 36 37 Appendix D Pre and Post-Surveys Nurse Pre/Post Implementation Survey (To be taken anonymously through Google Forms) Instructions: Please rate your agreement with the following statements. Likert Scale: 1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree Pre & Post Survey Questions (Same Questions) 1. I feel confident providing discharge education related to psychological recovery after PICU hospitalization. 2. I understand the psychological risks children may face after PICU discharge. 3. I feel prepared to identify psychological risk factors prior to discharge. 4. I am comfortable discussing emotional and behavioral concerns with caregivers. 5. Discharge education in our PICU is delivered in a consistent manner. 6. I feel supported by my unit to address psychological needs during discharge planning. Post-Implementation Open-Ended Questions (Optional) 1. What aspects of the standardized discharge protocol were most helpful? 2. What barriers did you experience when implementing the protocol? 38 Appendix E Timeline Months 1–2: Preparation Phase ● Finalize all project deliverables (education materials, screening tools, surveys, brochure) ● Coordinate with nursing leadership and interdisciplinary stakeholders ● Confirm project approval and readiness for implementation ● Distribute baseline (pre-implementation) staff surveys to assess current practices and nurse confidence ● Review existing discharge processes and identify workflow considerations Months 3: Staff Education and Training ● Conduct structured education sessions for PICU nurses ● Introduce the standardized discharge education protocol and CATS psychological screening tool ● Provide training on trauma-informed communication strategies ● Clarify expectations for protocol use and documentation ● Allow time for discussion, questions, and staff feedback Months 4–5: Protocol Implementation ● Begin using the standardized discharge education and psychological risk assessment protocol with eligible patients and families ● Distribute the caregiver education brochure during discharge teaching ● Complete psychological screenings prior to discharge ● Provide ongoing coaching and support to staff ● Address barriers and reinforce correct protocol use 39 ● Promote consistency across shifts and providers Month 6: Evaluation and Follow-Up ● Administer post-implementation staff surveys ● Assess changes in nurse confidence, usability, and satisfaction ● Analyze survey data and summarize findings ● Prepare results for presentation to PICU leadership ● Develop recommendations for sustainability and future quality improvement initiatives 40 Appendix F Revised CATS Tool Ages 3-6 (Caregiver to fill out) 41 Revised CATS Tool Ages 7-17 (Caregiver or Patient)