Date of Graduation

Spring 5-21-2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Population Health Leadership

First Advisor

Dr. Francine Serafin-Dickson, DNP, MBA, BSN, CNL

Second Advisor

Dr. Nancy Selix, DNP, FNP-C, CNM, CNL



Problem: The National Center on Shaken Baby Syndrome reports that 1,300 abusive head trauma (AHT) cases occur in the USA each year, a quarter of which are fatal. Injuries are caused by impact, shaking, or both and result in intracranial and spinal damage, retinal hemorrhages, fractures of the ribs and other bones. AHT case rates in the community involved in this project had a 22% increase of AHT from 2018 to 2019.

Context: A practice improvement project involved the implementation of an AHT educational program targeted at parents/caregiversreceiving care services at a children’s hospital pediatric well-child clinic located in Fresno, California.

Interventions:The project was a quality improvement project and was framed by Lazarus and Folkman’s Stress Theory. The intervention utilized the Period of PURPLE Crying (PPC) educational tool as the basis of an AHT prevention education program to increase parental/caregiver knowledge of AHT and decrease the AHT incidence rate among children less than 36 months of age. Parents/caregivers completed a pre-knowledge survey before exposure to the intervention entailing an educational program and completed a post-knowledge survey after viewing the video and completing a Q &A session with the nurse educator.

Measures: Pre and post-knowledge survey scores were measured and compared using SPSS v24 for analysis. A matched sample t-test was conducted to determine if the participants experienced a significant improvement in knowledge of AHT and coping skills after exposure to the intervention.

Results:A total of N=61 parents attended the educational session and completed a pre-and post-knowledge survey. On a scale of 13 to 65 possible points, the average pre-test knowledge score was 43.1, and the average post-test knowledge score was 47.0 points. Although the degree of change was variable between questions, a matched pair t-test determined that the increase in cumulative scores was highly significant t=8.45, p=.001. In addition, the trend in the 12-month incidence rates of reported AHT cases demonstrated a three-fold decline from 10.97 per 1,000 children before October 2020 to 2.99 per 1,000 children in the 3 months after the intervention.

Conclusions: The educational intervention was found to be effective in significantly increasing knowledge of AHT and understanding coping skills. The AHT incidence rate dramatically declined during the post-intervention period. Evidence-based outcomes justify the integration of preventative education as part of services delivered to new parents/caregivers at this children’s hospital pediatric well-child clinic.

Dissemination:The plan for disseminating the final project will consider a variety of venues, including: (1) share findings with executive leadership of the children’s hospital in Fresno, California for their consideration to offer educational training to parents/caregivers of newborn and young children; (2) publish the final project paper in the USF Project Repository archive of curated documents which allows DNP graduates to share academic work products with the scholarly consumer communities; and (3) present a poster at the 37th Annual San Diego International Conference on Child and Family Maltreatment in January 2022.