Honors Theses and Capstones

Date of Award

Spring 2022

Project Type

Senior Honors Thesis

College or School



Department of Nursing

Program or Major


Degree Name

Bachelor of Science

First Advisor

Kathleen Kiley

Second Advisor

Anne Meginniss

Third Advisor

Kerry Nolte



Background: Pediatric psychiatric emergencies have been recognized as a national crisis in the United States (Roman et al., 2018). Emergency department (ED) visits for pediatric behavioral health (BH) conditions rose 31% from April 2020 to October 2020 (Bartek et al., 2021). This increase in ED visits for BH concerns, matched with overwhelmed inpatient psychiatric treatment centers and lacking community support programs, has resulted in an increase in BH ED boarders (Bartek et al., 2021). This population of patients who remain in the ED while awaiting placement at a psychiatric care program are at risk for prolonged boarding durations in the stimulating and chaotic ED environment, which has the potential to increase levels of anxiety and agitation (Lelonek et al., 2018). Current literature states that structured daily routines promote a sense of safety and that the use of visible daily schedules can decrease anxiety and episodes of behavioral escalation (ENA, 2021; Gerson et al., 2021).

Methods: The purpose of this single site quality improvement project was to increase the implementation of daily schedules for BH patients 12-years-old and younger who were boarding in the ED for BH concerns. Daily census of ED BH boarders 12-years-old or younger and whether a schedule was in place was recorded daily at 9am during the five-day study period. Utilizing survey methodology, a seven-item survey with a unique respondent identifier including one open response question was distributed at end of shift to nursing staff who cared for BH patients to gain understanding of the process of daily schedule implementation.

Results: Schedule implementation varied by day throughout the week. The majority of respondents were not aware of the modifiable, templated daily schedules located on the internal ED nursing webpage. Survey respondents largely identified the use of a daily schedule as having a positive impact on the patient’s day, despite trouble with consistent schedule adherence by the patient being identified as a barrier to consistent implementation.

Conclusion: ED visits for BH concerns continue to occur at high rates as seen during the height of the pandemic. The use of daily schedules, as supported by the literature, should be utilized for this population of patients requiring a more structured and consistent environment. More research and further studies need to be conducted that provide strategies for schedule implementation and adherence, as well as additional recommendations for clinical practice that can be utilized to improve the ED boarding process and help prevent episodes of agitation and behavioral escalation from occurring.

Available for download on Friday, May 17, 2024