Standardization of health care provider competencies for intrathecal access procedures.
Date
2014-11
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Attention Stats
Abstract
Introduction
This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures.Methods
A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge.Results
Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = -2.92, P = .013), performance-related overall anxiety (t = -2.132, P = .05) and administering intrathecal chemotherapy (t = -2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias.Conclusion
This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.Type
Department
Description
Provenance
Subjects
Citation
Permalink
Published Version (Please cite this version)
Publication Info
McLaughlin, Colleen A, Marilyn J Hockenberry, Joanne Kurtzberg, Rémi Hueckel, Paul L Martin and Sharron L Docherty (2014). Standardization of health care provider competencies for intrathecal access procedures. Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, 31(6). pp. 304–316. 10.1177/1043454214543019 Retrieved from https://hdl.handle.net/10161/24647.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Colleen A McLaughlin
Marilyn J Hockenberry
Dr. Marilyn Hockenberry, PhD, RN, PNP-BC, FAAN, is the Bessie Baker Professor of Nursing at Duke University School of Nursing. Dr. Hockenberry, a distinguished leader in pediatric oncology and evidence-based practices and outcomes, is actively involved in the School’s cancer-related research initiatives and teaches in the DNP program. She also serves as one of the 11 chairs of the Duke Institutional Review Board.
Before coming to Duke, she was Professor of Pediatrics in the Hematology/Oncology Division at Baylor College of Medicine. She also served as the nurse scientist for the hospital and director of the pediatric nurse practitioner program in the Texas Children’s Cancer Center at Texas Children’s Hospital (TCH) from 1994 to 2012. At TCH, she served as director of the Center for Research and Evidence-based Practice from 2002 to 2009 and director of the Evidence-based Outcomes Center from 2004 to 2009. Earlier in her career, she practiced as a hematology/oncology nurse practitioner at Duke University Medical Center and was a clinical associate in the Duke School of Nursing.
Dr. Hockenberry received her BSN from Capital University in Columbus, Ohio, the Master of Science degree from Texas Woman’s University in Houston and her Pediatric Nurse Practitioner certification through Children’s Hospital in Philadelphia. She earned a PhD in nursing with distinction from the Medical College of Georgia. Her research focuses on treatment-related side effects experienced by children who have cancer and is the recipient of numerous research grant awards. Her latest NIH funded research grant evaluates phenotypic and genotypic characteristics and their associations with symptom clusters experienced during treatment for childhood leukemia. She has authored more than 80 publications, and has served for the past 10 years as senior editor for the Wong Pediatric Nursing Textbooks published by Elsevier. She is a Fellow of the American Academy of Nursing. She was appointed as a member of the Children’s Oncology Group Scientific Council in February 2011. She received the 2011 Distinguished Nurse Researcher Award and the 2011 Journal of Pediatric Oncology Nursing Writing Award at the 35th national conference of the Association of Pediatric Hematology/Oncology Nurses.
Joanne Kurtzberg
Dr. Kurtzberg is an internationally renowned expert in pediatric hematology/oncology, pediatric blood and marrow transplantation, umbilical cord blood banking and transplantation, and novel applications of cord blood and birthing tissues in the emerging fields of cellular therapies and regenerative medicine. Dr. Kurtzberg serves as the Director of the Marcus Center for Cellular Cures (MC3), Director of the Pediatric Transplant and Cellular Therapy Program, Director of the Carolinas Cord Blood Bank, and Co-Director of the Stem Cell Transplant Laboratory at Duke University. The Carolinas Cord Blood Bank is an FDA licensed public cord blood bank distributing unrelated cord blood units for donors for hematopoietic stem cell transplantation (HSCT) through the CW Bill Young Cell Transplantation Program. The Robertson GMP Cell Manufacturing Laboratory supports manufacturing of RETHYMIC (BLA, Enzyvant, 2021), allogeneic cord tissue derived and bone marrow derived mesenchymal stromal cells (MSCs), and DUOC, a microglial/macrophage cell derived from cord blood.
Dr. Kurtzberg’s research in MC3 focuses on translational studies from bench to bedside, seeking to develop transformative clinical therapies using cells, tissues, molecules, genes, and biomaterials to treat diseases and injuries that currently lack effective treatments. Recent areas of investigation in MC3 include clinical trials investigating the safety and efficacy of autologous and allogeneic cord blood in children with neonatal brain injury – hypoxic ischemic encephalopathy (HIE), cerebral palsy (CP), and autism. Clinical trials testing allogeneic cord blood are also being conducted in adults with acute ischemic stroke. Clinical trials optimizing manufacturing and testing the safety and efficacy of cord tissue MSCs in children with autism, CP and HIE and adults with COVID-lung disease are underway. DUOC, given intrathecally, is under study in children with leukodystrophies and adults with primary progressive multiple sclerosis.
In the past, Dr. Kurtzberg has developed novel chemotherapeutic drugs for acute leukemias, assays enumerating ALDH bright cells to predict cord blood unit potency, methods of cord blood expansion, potency assays for targeted cell and tissue based therapies. Dr. Kurtzberg currently holds several INDs for investigational clinical trials from the FDA. She has also trained numerous medical students, residents, clinical and post-doctoral fellows over the course of her career.
Remi M Hueckel
Dr. Rémi Hueckel is an Associate Professor and Director for the Pediatric Acute Care Nurse Practitioner Major in the MSN Program at the Duke University School of Nursing. Rémi is a member of the pediatric critical care nurse practitioner team and a leader in clinical education and simulation for nurses, residents, fellows and advanced practice nurses in pediatrics and pediatric critical care.
Dr. Hueckel's scholarly practice is influenced by her clinical experience and commitment to patient safety and high-quality team-based care. Her teaching philosophy is based on communication, teamwork, core competencies of inter-professional education (IPE) and the use of simulation to teach and improve patient safety. Using these as a framework for innovative learner-centered activities, Dr. Hueckel has influenced the clinical development of pre-licensure and advanced practice nurses as well as pre-clinical and graduate medical learners in the academic and ICU settings.
Through her scholarly practice in the PICU and role in academia, Dr. Hueckel has unique opportunities to facilitate discussions, foster partnerships, and create networks of PICU clinicians and educators. Similarly, her role as a clinician in academic practice along with faculty appointments both in the schools of medicine and nursing allows her the opportunity to influence care of critically ill children and impact the clinical and academic development of future pediatric & critical care colleagues.
Dr. Hueckel received her BSN from Purdue University. She earned an MSN degree as an Adult Nurse Practitioner and completed post-master’s certificates in the Family Nurse Practitioner and Acute Care Pediatric Nurse Practitioner specialties at Duke University. She is a 2011 graduate of the Duke DNP program. Dr. Hueckel is board certified by the American Nurses Credentialing Center as a Family Nurse Practitioner and as an Acute Care Pediatric Nurse Practitioner by the PNCB and was inducted as a Fellow in the American Association of Nurse Practitioners in 2011.
Paul Langlie Martin
For most of my career in Pediatric Hematology/Oncology I have focused on the use of stem cell transplant for the treatment of pediatric leukemias (ALL, AML, CML and JMML) and other non-malignant blood disorders, such as sickle cell disease, hemaphagocytic disorders, Wiskott-Aldrich, aplastic anemia, Diamond-Blackfan Anemia, as well as inherited metabolic diseases. In addition to focusing on determining the best use of stem cell transplants for these disorders, I have also been involved in clinical research investigating the prevention and treatment of transplant related morbidity, particularly veno-occlusive disease of the liver, infections and diffuse alveolar hemorrhage. As study chair for the Children's Oncology Group protocol 9904, I was involved in the development, implementation and analysis of a large, international frontline study of childhood acute lymphoblastic leukemia. Results from this study show that a significant number of children with certain favorable cytogenetic abnormalities in their leukemic cells and who have a rapid response to their initial chemotherapy can expect to have a >95% chance of cure when treated with relatively low intensity chemotherapy.
I have concentrated on providing high quality care for high risk leukemia patients who require high intensity therapies, such as stem cell transplant and immunotherapy. As a member of the Pediatric Transplant and Cellular Therapy Division I provide clinical care for these patients. As a member of various cooperative groups and local PI for several drug trials, I have worked to provide better care and more specific therapies for the toxicities associated with stem cell transplant.
I have also collaborated with the Pediatric Immunology Division to provide a life-saving therapy for a small group of patients with thymic dysfunction, which causes severe immunodeficiency. Our clinical team now provides support during these patients hospital admissions for donor thymus tissue implantation. We once again achieved a new record for the number of implanted patients during the 2022-2023 academic year.
Sharron Lee Docherty
Sharron Docherty, PhD, MSN, PNP, FAAN is Vice Dean for Research Affairs and Innovation and Executive Director of the Ruby L. Wilson Center for Nursing Science and Innovation at Duke University School of Nursing. An internationally recognized nurse scientist, pediatric nurse practitioner, mentor, and research leader, Dr. Docherty is the recipient of the 2025 Distinguished Researcher Award from the Southern Nursing Research Society, recognizing her outstanding contributions to nursing science and research excellence.
As Vice Dean, she leads and advances the School's research enterprise, fostering interdisciplinary collaboration, scientific innovation, and research excellence while supporting the development of the next generation of nurse scientists. Under her leadership, Duke University School of Nursing continues to expand its portfolio of federally funded research, interdisciplinary partnerships, and innovative programs that address complex healthcare challenges and improve health outcomes. She also has a secondary appointment as an Associate Professor in Pediatrics at Duke University School of Medicine, is an Associate of the Duke Initiative for Science & Society and is a member of the Duke Cancer Institute.
Through her work, Dr. Docherty is strengthening Duke Nursing's research capacity, expanding collaborative partnerships across Duke and beyond, and accelerating the translation of scientific discoveries into improved health outcomes, healthcare delivery, and policy. Her work is guided by a commitment to health equity, scientific innovation, patient- and family-centered care, and ensuring that research meaningfully improves the lives of individuals, families, and communities.
Dr. Docherty's research has transformed understanding of how healthcare systems can better support children, adolescents, young adults, and families experiencing serious chronic and life-limiting conditions. Her work has advanced innovative care models, symptom management strategies, care coordination approaches, and decision-making interventions that improve quality of life across the illness trajectory, from diagnosis through end of life.
Areas of Expertise
• Pediatric and adolescent health
• Serious illness and palliative care
• Family caregiving and decision-making
• Care coordination and care transitions
• Chronic illness management
• Patient- and family-centered care
• Health equity
• Nursing science and innovation
• Research leadership and workforce development
• Qualitative, mixed-methods and multidimensional data integration
• Intervention development and testing
• Healthcare delivery and care models
Research and Scholarly Impact
Dr. Docherty's research focuses on improving outcomes for children, adolescents, young adults, and families undergoing treatment for chronic, complex, and life-limiting conditions. She studies how healthcare teams and systems can improve symptom management, communication, care coordination, and decision-making across the continuum of care. Her scholarship has helped shape evidence-based approaches and nurse-led models of care that improve both patient and family experiences and long-term health outcomes.
A central focus of her work has been developing and evaluating innovative models of care that address the physical, emotional, social, and behavioral challenges associated with serious illness. Her research has contributed to improving care delivery for patients with complex healthcare needs while strengthening support for family caregivers and healthcare professionals.
Dr. Docherty is recognized for methodological expertise in qualitative research, mixed-methods diverse data integration techniques, trajectory science, visualization methodologies for complex data exploration, and intervention development and testing. These approaches have enabled her to generate new insights into patient and family experiences and develop interventions that improve care, quality of life, and health outcomes.
Dr. Docherty's research and mentorship activities are supported through numerous federally funded initiatives, including grants from the National Institutes of Health. She serves as a research mentor for Duke's Clinical and Translational Science Awards (CTSA) K12 Program, helping develop the next generation of clinical and translational scientists. She also contributes to NIH-supported research focused on palliative care, care transitions, social determinants of health, and innovative models of care that improve outcomes for patients and families across the lifespan. Her leadership on these initiatives reflects a sustained commitment to advancing nursing science, interdisciplinary collaboration, and research workforce development.
Her work spans pediatric health, cancer care, palliative care, critical care, chronic illness, care transitions, and health services research. Through interdisciplinary partnerships, she continues to advance innovative approaches to healthcare delivery and population health improvement.
Leadership and Academic Administration
As Vice Dean for Research Affairs and Innovation and Executive Director of the Ruby L. Wilson Center for Nursing Science and Innovation, Dr. Docherty provides strategic leadership for the Duke University School of Nursing's research mission. She works to strengthen research infrastructure, expand interdisciplinary scientific collaboration, increase research funding, support faculty development, and promote innovation that advances nursing science and improves health outcomes. Dr. Docherty has leveraged her research expertise as a national leader through her frequent service as an NIH study section reviewer. In 2026, she was appointed as a standing member on the newly formed National Standing Committee on the State of Nursing Science.
Honors and Distinctions
Dr. Docherty is a Fellow of the American Academy of Nursing and is widely recognized for her contributions to nursing science, pediatric health, palliative care research, mentoring, and interdisciplinary collaboration. Her scholarship has influenced clinical practice, healthcare delivery, and research approaches designed to improve outcomes for children, adolescents, young adults, and families facing serious and chronic illness.
Her contributions to nursing science, research leadership, and mentorship have been recognized through honors and awards, including:
• Distinguished Researcher Award, Southern Nursing Research Society (2025)
• Outstanding Nurse Scientist Award, Council for the Advancement of Nursing Science (2022)
• International Nurse research hall of Fame, Sigma Theta Tau International Honor Society of Nursing (2021)
• Distinguished Contributions to Nursing Science Award, Duke University School of Nursing (2020)
• Mid-Career Research Award, Southern Nursing Research Society (2014)
• Fellow, American Academy of Nursing (2013)
• Donna Wong Pediatric Nursing Writers Award, Pediatric Nursing (2008)
Media and Speaking Topics
• Future of nursing research
• Research innovation and scientific discovery
• Pediatric and adolescent health
• Serious illness and palliative care
• Family caregiving and decision-making
• Care transitions and care coordination
• Health equity
• Patient- and family-centered care
• Interdisciplinary science
• Translating research into practice
• Research workforce development
• Mentorship and academic leadership
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.