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The Benefits of Using Adult Learner Theory to Develop a Nursing Policy for Maintaining Skin Integrity around the VAD Site on a Pediatric Cardiac Unit

Background: Cardiac disease in children can vary from mild to severe. Children with severe cardiac disease can develop congestive heart failure and may need a heart transplant. The time congestive heart failure and transplant requires a bridge. The bridge between heart failure and heart transplant is managed with a ventricular assist device (VAD) as the bridge. The bridge-to-transplant is a vulnerable time for a child and requires comprehensive nursing care. In particular maintaining the skin integrity at the VAD insertion site is crucial. Implementing an evidence based nursing policy is a key component. The lack of a nursing policy to maintain VAD site skin integrity may jeopardize the child during the bridge-to-transplant phase.

Objective: The aim was to develop and implement a nursing policy to maintain VAD skin integrity on the pediatric cardiology unit by integrating adult learner theory in the nursing process.

Methods: The study design was a descriptive survey of the dressing change practice. There were three stages of the methodology. The first part was creating a policy, which incorporated the nurses’ suggestions for maintaining VAD skin integrity and identifying an acceptable process for dressing changes. The second part involved nurses identifying expert nurses as super users of the policy to facilitate the role out of the policy and dressing change process. The third part was a retrospective chart review to assess if the implementation and outcome of the new policy for dressing changes. The chart review identified 47 children with VAD from 2009 to 2014.

Results: From the review of the 47 charts, there was 100% compliance with the dressing change policy. Skin integrity around the VAD insertion site was maintained for the duration of the VAD. Incidentally, there were no VAD driveline related infections. There was no difference in outcomes based on the type of VAD.

Conclusion: A nursing policy, which incorporates adult learner theory, may contribute to better policy implementation and successful practice change to improve outcomes. Policy compliance may help to prevent VAD site infections and maintain skin integrity. Despite the finding from this small retrospective study, further research is needed to verify its findings.

IRB Protocol-30827 Exp 4/30/2017


Charleen Singh*, Noordeen Shoqirat, Shannon Feehan, Kristine M Taylor and MaryAlice M Gowen

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