Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Martha K. Swartz


There is an overuse of oral antibiotics and acute care visits conducted to treat children with uncomplicated tympanostomy tube otorrhea (TTO), a condition easily identified by the child’s caregiver who can then independently initiate treatment with ototopical antibiotic drops (TAD). Yet, some caregivers seek urgent medical attention for children with TTO, which often results in mismanagement of the condition including the administration of oral antibiotics. This quality improvement initiative involved the development and implementation of an educational program for caregivers of children with tympanostomy tubes (TT). Resources for caregivers included a web-based instructional video, informational pocket-card, and a post-operative text reminder to educate, empower and improve the self-efficacy of caregivers of children with TTO to initiate treatment independently when clinically indicated. Fifty-eight caregivers were enrolled. Caregiver self-efficacy mean scores were analyzed (paired T-test) and significantly higher (p=<0.0001) after implementing the educational program when compared to pre-intervention scores on all 7 self-efficacy items measured. Caregivers were surveyed regarding their perception of the educational program, and the majority felt the resources were helpful and valuable for future use. Twenty-one percent of the patients experienced post-operative TTO; 100% of those caregivers reported initiating TAD, 58% of whom referred to the educational resources. Those who did not refer to the educational material all had children who had previous TTs. No children received oral antibiotics following tube placement related to TTO. Recommendations pertaining to scaling, sustainability and dissemination of the project are also presented.


This is an Open Access Thesis.

Open Access

This Article is Open Access