Digital Commons Network^™

A Stronger Impact On Career Development For Early- And Mid-Career Faculty, Daniel A Gorelick, Jason Gertz, Kaitlin J Basham, Lindsey S Treviño

Faculty, Staff and Students Publications

Nuclear receptors are important in normal physiology and disease. Physicians and scientists who study nuclear receptors organize and attend conferences and symposia devoted to foundational and translational nuclear receptor research, but the field lacks a platform for early-stage investigators and aspiring leaders. In 2019, Zeynep Madak-Erdogan, Rebecca Riggins, and Matthew Sikora founded Nuclear Receptor (NR) Interdisciplinary Meeting for Progress And Collaboration Together (IMPACT, https://nrimpact.com), a collaborative group designed for early- and mid-career faculty who study nuclear receptors in any context or organism [1]. NR IMPACT addresses challenges for early- and mid-career faculty. Here, we review the progress of NR IMPACT …

Lecture: Impactful Women And Their Contributions In Ellensburg History, Julia Stringfellow

Library Scholarship

Julia Stringfellow, Professor and University Archivist at Central Washington University, will speak on “Impactful Women and Their Contributions in Ellensburg History.” The event is free, open to the public, but seating will be limited. About the Lecture

About the Lecture: Julia Stringfellow, Professor and University Archivist at Central Washington University, will share her research from a Sabbatical she took in 2023 that focused on Ellensburg and Central Washington University impactful women and their contributions. Women discussed in this lecture include the “mother of Ellensburg,” the wife of the first Ellensburg mayor, the first African American female minister of Ellensburg, and …

Addressing Weight Bias Among Pediatric Healthcare Clinical Staff., Kathyrn Kyler, Codi Cutburth, Gayla Goleman, Sarah Hampl, Amy R. Beck

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children with obesity may experience weight-based discrimination as a result of weight bias and stigma, which can have deleterious effects on their health and wellbeing, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Prior work has shown that weight bias occurs from healthcare workers caring for adults, but less is known about the prevalence of weight bias in the pediatric healthcare setting.

METHODS: We aimed to determine what proportion of pediatric healthcare professionals had attitudes of weight bias at our own institution by constructing a survey with questions from validated weight bias …

Housing And Children’S Social Care In England: Learning From Embedded Research, Thomas El-Hoss, Felicity Thomas, Felix Gradinger, Susanne Hughes

Peninsula Medical School

The UK housing crisis is having a detrimental impact on the lives of families. However, in England the links between housing and Children’s Social Care remain poorly understood. This paper draws upon 24 months of embedded research within Torbay Council, a Local Authority with comparatively high rates of children in care and acute housing challenges. It includes qualitative data from interviews/focus groups with parents (n = 66); Children’s Services professionals (n = 7), the housing department (n = 2); housing association (n = 2); and staff/volunteers from voluntary and community Sector organisations (n = 28). This study shows that housing …

Which Way? Experiences Of Aboriginal And Torres Strait Islander People Who Are Deaf Or Hard Of Hearing Attaining Supports To Meet Their Interwoven Socio-Cultural, Health And Disability-Related Needs And Aspirations Within The Context Of Australia’S National Disability Insurance Scheme, Jody Barney, Alexandra Devine, Damien Howard, Marie Huska, Hannah Lack, Yeokyung Kim, Yi Yang, George Disney, Peter Summers, Ashley Mcallister

Journal of the Australian Indigenous HealthInfoNet

The life experiences of Aboriginal and Torres Strait Islander people who are Deaf or Hard of Hearing are often more complex than for Aboriginal and Torres Strait Islander people who are hearing, or non-Aboriginal Australians who are Deaf or Hard of Hearing. In turn, this can make engaging with and benefiting from policies and programs such as Australia’s National Disability Insurance Scheme (NDIS) more complex, particularly for individuals living in remote settings. To understand more about these complexities, yarnings were held with 15 Aboriginal and Torres Strait Islander NDIS participants who are Deaf or Hard of Hearing living in rural …

An Integrative Review: The Incidence Of Transient Neurologic Symptoms With The Administration Of Intrathecal Lidocaine Or Bupivacaine, Ellen Brightweiser

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aims and Objectives: The aim of this integrative review is to analyze the effects of intrathecal administration of lidocaine and bupivacaine on transient neurologic symptoms (TNS).

Methods: A review of the literature was performed utilizing the following electronic databases: Ebsco, Medline, Pubmed, CINAHL Complete, and Cochrane Complete. Search results were critically appraised based on study method and design that aligned with this integrative review's guiding questions.

Results: The use of lidocaine is associated with an increased risk of TNS when compared to other local intrathecal medications. The specific etiology of TNS remains unknown. This review revealed several contributing factors to …

Coadministration Of Ketamine And Magnesium: An Integrative Review, Lauren Chiavetta

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Objective: The object of this integrative review was to investigate the analgesic benefit and side effect profile of the coadministration of ketamine and magnesium. Secondary goals were to provide an evidence-based recommendation on the ideal dosing, frequency, and order of administration of the medications. Methods: Relevant articles published between January 2001 and May 2019 were examined for quality, strength, and generalizability. Results: Beginning evidence suggests ketamine may interact with magnesium to provide synergistic NMDA receptor antagonism and analgesia. Evidence from animal studies proposes that order of administration may influence potency, with ketamine prior to magnesium producing better analgesia. Coadministration of …

The Implications Of Local Anesthetic Volume In Adductor Canal Blockade: An Integrative Review, Michaela Purcell

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Introduction: Maintaining patient safety is of utmost concern for anesthesia providers. The adductor canal block, a peripheral nerve block identified as a motor-sparing sensory block, may decrease fall risk and associated adverse outcomes seen in total knee arthroplasty patients following femoral nerve block. A large volume of local anesthetic administered in the adductor canal has been questioned due to concern about impaired quadriceps strength if volume extends beyond the adductor canal, causing an unintended femoral nerve block due to spread of local anesthetic into the femoral triangle.

Methods: A review of literature was performed on the following databases: PubMed, CINAHL …

Anesthetic Management In Eras Protocols For Total Knee And Total Hip Arthroplasty: An Integrative Review, Laura Oseka

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aims and objectives: The aim of this integrative review is to provide current, evidence-based anesthetic and analgesic recommendations for inclusion in an enhanced recovery after surgery (ERAS) protocol for patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).

Methods: Articles published between 2006 and December 2016 were critically appraised for validity, reliability, and rigor of study.

Results: The administration of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, and steroids result in shorter hospital length of stay (LOS) and decreased postoperative pain and opioid consumption. A spinal anesthetic block provides benefits over general anesthesia, such as decreased 30-day mortality rates, …

Dexmedetomidine As An Intrathecal Adjuvant For Subarachnoid Block For Women Undergoing Elective Cesarean Section: An Integrative Review, Mark Funk

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aims and Objectives: This integrative review aims to evaluate the safety and effectiveness of intrathecal dexmedetomidine as an adjunct to hyperbaric bupivacaine for elective cesarean sections using subarachnoid block (SAB).

Methods: A review of the literature was performed on the following databases: PubMed, CINAHL Complete, Google Scholar, and Cochrane Collection. Relevant research articles were critically evaluated and added to a literature matrix for synthesis.

Results: Intrathecal dexmedetomidine-5 mcg enhances the efficacy of intrathecal bupivacaine 0.75% by 24% in women undergoing elective cesarian sections using SAB. Intrathecal bupivacaine administered with 5 mcg dexmedetomidine produced a similar analgesic effect as intrathecal morphine …

Cuffed Verses Uncuffed Endotracheal Tubes For Pediatric Patients, Bryce Scott

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Pediatric airway management can present many challenges for anesthetists. One such challenge is whether to use a cuffed or uncuffed endotracheal tube (ETT) for pediatric patients younger than eight years. Practitioners have used uncuffed ETTs for smaller children due to the risk of cuffed ETTs causing airway mucosal injury which may lead to subglottic stenosis and stridor.1 In recent years, cuffed ETTs have been used more frequently in order to reduce tube exchanges, ventilation leak around the tube, unreliable end-tidal carbon dioxide (ETCO2) monitoring, and the risk of aspiration. The purpose of this evidence based practice analysis is to compare …

Target Receptors Of Cbd & Potential Clinical Implication(S): An Integrative Review, Teran A. Walford

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The purpose of this integrative review is to investigate the potential receptors of cannabidiol (CBD) in order to better understand any potential clinical implication(s) during administration of anesthesia and analgesia. A total of eight full-text review articles were included from multiple databases. All eight of the review articles were analyzed for evidence related to the target receptors of CBD. Analysis of the review articles focused on potential receptors and implications of CBD as it relates to anesthesia and analgesia. Two primary receptors were discovered, 5-HT1A and TRPV1. In total, 14 potential receptors of CBD have been identified resulting in multiple …

Anesthetic Management Of An Adult Brain-Dead Organ Donor: A Quality Improvement Project, Rebecca Vanwinkle

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Objective: Anesthesia plays a critical role in the management of an adult brain-dead donor. It is imperative that the anesthesia provider understand the pathophysiology of brain death and its subsequent effects on the body, hemodynamic maintenance, lung recruitment strategies, fluid and electrolyte balance, hormone replacement therapy, and the use of other pertinent medications. Failure to comprehend can result in improper management and may lead to the inability to recover and transplant organs. The purpose of this quality improvement project is to determine if an educational module to describe best practice for organ donation for certified registered nurse anesthesia providers (CRNA) …

Effects Of Dexmedetomidine On Postoperative Delirium In The Older Adult Population Undergoing Cardiothoracic Surgery: An Evidence-Based Practice Analysis, Mari Fischer Vazquez

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

A PICO question was developed to provide guidance for the research/literature review process. "In the greater than 60-year-old adult population undergoing cardiac or thoracic surgery with general anesthesia (P), does the use of intraoperative dexmedetomidine (I) affect the incidence of postoperative delirium (O) when compared to placebo (C)?" A literature search was conducted and completed by searching the following databases: PubMed, Scopus, MEDLINE Complete, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Academic Search Elite. Keywords used in the search strategy include dexmedetomidine, postoperative delirium, adult, geriatric, cardiopulmonary surgery, and thoracic surgery. Inclusion criteria were studies published in …

Preoperative Pre-Warming Versus No Preoperative Pre-Warming And Intraoperative Hypothermia: An Evidence-Based Practice Analysis, Heather J. Yancy

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Inadvertent perioperative hypothermia occurs in approximately 50% to 70%1 of all surgical patients, and is a risk for anyone undergoing general or neuraxial anesthesia, yet it can be prevented. Hypothermia is defined as a core body temperature of less than 36 degrees Celsius.1-10 Body temperature is regulated by the hypothalamus. Once anesthesia is induced, the body's ability to regulate temperature is reduced4 and the body's ability to produce heat is decreased. General and neuraxial anesthesia have a vasodilatory effect to the body, which causes a core-to-peripheral shift in body heat. This redistribution of heat contributes to 65%-81%4 of the total …

The Erector Spinae Plane Block For Improving Recovery After Spinal Surgery, Brooke Champane

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The literature was analyzed to determine the efficacy of ESP blocks on postoperative pain scores and postoperative total opioid consumption (TOC) in adults undergoing general anesthesia for posterior spinal surgery. Posterior spine procedures consisted of lumbar discectomies, laminoplasties, decompressions, single and multi-level fusions with and without instrumentation, and posterior internal fixation for fractures. Most studies compared the treatment (ESP block) group to the control group which consisted of no block, or a sham block performed with normal saline injection. One RCT performed in 2022, compared the ESP block group to the standard wound infiltration technique (control group) with equal doses …

The Safety And Efficacy Of Liposomal Bupivacaine Administration In Patients Undergoing Shoulder Arthroplasty: An Integrative Review, Sara Fouts

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The aim of this integrative review is to examine and report current evidence regarding the safety and efficacy of liposomal bupivacaine (LB) administration for post-operative analgesia in shoulder arthroplasty. The two administration methods examined are peri-neural and peri-articular infiltration. Articles published between 2008 and 2018 were critically appraised for validity, reliability, and rigor of study. The safety profile of subcutaneous and peri-neural administration of LB has been well documented by research. Risks of myotoxicity and neurotoxicity from LB administration are similar compared to Bupivacaine HCL when used at lower dosages (2.5-3 mg/kg). Evidence from animal studies show that peri-articular infiltration …

The Effect Of An Esmolol Infusion On Perioperative Opioid Use And Postoperative Pain Scores: An Integrative Review, Joey J. Chung

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Objective: The purpose of this integrative review is to investigate the effect of an esmolol infusion on perioperative opioid use and postoperative pain scores.

Methods: Articles published between 2012 and 2020 were examined and reviewed for quality, strength and relevance to the topic.

Results: Evidence suggests that an intraoperative esmolol infusion can decrease intraoperative and postoperative opioid consumption, as well as decrease postoperative pain scores.

Incorporating Dexamethasone With Local Anesthetics In Single-Shot Nerve Blocks: An Integrative Review, Kyle G. Hilsabeck

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Prolonging the duration of analgesia in single-shot nerve blocks (SNBs) continues to be a problem in regional anesthesia. Both IV and perineural dexamethasone have proven to be effective in prolonging the duration of analgesia in SNBs.

Objective: The purpose of this integrative review was to determine how IV and perineural dexamethasone effect duration of analgesia, pain scores, opioid consumption, and complications in patients undergoing SNB.

Methods: An integrative review that included 12 peer-reviewed randomized-controlled trials (RCTs) and one meta-analysis was performed.

Results: The results of the integrative review found that perineural dexamethasone prolonged the duration of analgesia, reduced pain scores, …

Intraoperative Lidocaine Infusion For Multimodal Pain Management In Gastrointestinal Surgeries: An Evidence-Based Practice Analysis, Shelby Sullivan

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

A population, intervention, comparison, and outcome (PICO) question was used to provide the key concepts of my search strategy. "In (P) patients undergoing gastrointestinal surgeries, what is the effect of using (I) a continuous lidocaine infusion (C) compared to normal saline (O) on the severity of postoperative pain scores?"

Indications For Hepa Filter Use In Patients Undergoing General Anesthesia With A Breathing Device: An Integrative Review, Tara Dickey

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aim and Purpose: This integrative literature review aims to provide evidence-based recommendations for high-efficiency particulate air (HEPA) filter use within the anesthesia breathing circuit. The purpose of the recommendations is to reduce the risk of pathogen transmission to patients undergoing general anesthesia with a breathing device.

Methods: Relevant literature was critically appraised for validity and reliability. A matrix was utilized for data extraction, allowing themes to be generated as well as for categorizing findings and limitations. Inclusion criteria were current recommendations guiding filter use within the anesthesia breathing machine, indication for filter use, placement within the respiratory circuit, and recommended …

Effectiveness Of Inhaled Albuterol Delivery Methods In Adult Intubated Patients: An Integrative Review, Anthony Heidtbrink

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The purpose of this integrative review is to critically appraise the available literature related to effectiveness of albuterol delivery methods for the intubated patient undergoing general anesthesia and to make recommendations for practice. Methods of albuterol delivery commonly utilized by anesthesia providers, such as attaching a metered dose inhaler to an endotracheal tube adapter, have not been proven to reliably deliver albuterol to target tissues. The use of an in-line chambered spacer in conjunction with a metered dose inhaler improves the anesthetist's ability to reliably deliver albuterol to target tissues and achieve measurable reductions in airway resistance. Additionally, a novel …

Intraoperative Hypotension Management For Microvascular Reconstruction Surgery Using Free Tissue Transfer: An Integrative Review, Lyndsie Lafleur

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Introduction: Anesthetic management for free flap surgery contributes to flap survival, as hypotension is an independent predictor of flap loss. The optimal blood pressure range is unknown and there are no standardized guidelines available in this area. The aim of this integrative review was to provide evidence-based recommendations for hypotension management during microvascular free flap reconstruction surgery. Methods: Articles evaluating anesthetic related predictors of flap survival were critically appraised for validity, reliability, and rigor of study. Results: Current practice favors the use of fluids over vasopressors, supported by animal studies and anecdotal evidence. Clinical data demonstrated vasopressor use does not …

The Mallampati Test Versus The Upper Lip Bite Test In Predicting Difficult Intubation, Chance Buttars

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The accurate assessment of the airway is one of the most important skills an anesthesia practitioner should perfect. A difficult intubation is often defined as a Cormack Lehane (CL) grade of III or IV in adult patients. The reported frequency of difficult intubation or CL grade III and IV is 12.35% and 9% in those undergoing a general anesthetic.¹ Several assessments and scoring systems are used by anesthesia providers with the goal of identifying a potentially difficult intubation.

The Effects Of Preoperative Carbohydrate Loading On Postoperative Nausea And Vomiting: An Integrative Review, Jennifer Meyer

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Background: Postoperative nausea and vomiting (PONV) is a very common problem among surgical patients. Despite improved methods of risk identification, the incidence of PONV remains as high as 20-40%. It can increase hospital length of stay and greatly reduce patient satisfaction. The purpose of this integrative review is to examine the effects of both oral and IV preoperative carbohydrate loading on the incidence of postoperative nausea and vomiting in surgical patients. Methods: A review the literature was completed by searching for the terms related to preoperative carbohydrate loading and PONV. Results: Twenty studies met the criteria and were analyzed for …

Iv Ketamine Infusions For The Treatment Of Depression: An Evidence Based Practice Analysis, Sergio A. Quinones

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

According to the World Health Organization, major depressive disorder (MDD) is a mental health condition which affects a significant portion of the worldwide population and is projected to become the leading cause of disability by 2020. There are several treatment options for the diagnosis of depression, with the most popular being antidepressant drugs such as the selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs); and electroconvulsive therapy (ECT). The significant drawbacks to the current treatments are the extended timeframe required for drugs to reach therapeutic efficacy and resistance to ECT over time. These disadvantages can lead to increased risk …

The Perceived Levels Of Stress And Anxiety In Student Nurse Anesthetists During A Pandemic: A Descriptive Cross-Sectional Study, Bryant A. Gaudreau

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Background and Significance: Limited research exists regarding Student Registered Nurse Anesthetists' (SRNAs') perceptions of stress and anxiety during a pandemic such as the COVID-19 outbreak. Clinical effects of stress and anxiety have been shown to be detrimental to the active learning process in students.

Purpose: To explore the differences in stress and anxiety among three different cohorts of SRNAs in a nurse anesthesia program during the COVID-19 pandemic.

Methods: Purposive sampling was utilized to select SRNAs who were full-time second or third-year nurse anesthesia students from a Midwestern nurse anesthesia program actively enrolled during the COVID-19 pandemic. Surveys were sent …

Conventional Epidural Versus Dural Puncture Epidural For Labor Analgesia: An Evidence Based Practice Analysis, Andee Pauley

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Purpose Statement: The purpose of this evidence based practice analysis (EBPA) is to provide evidence-based recommendations for lumbar epidural techniques for labor analgesia in adult women in active labor (parturients) with uncomplicated pregnancy.

Methodology: A population, intervention, comparison, and outcome (PICO) question was established to guide a review of the current literature. The PICO question used to afford structure and direct analysis was: In (P) adult women in active labor with uncomplicated pregnancy, what is the effect of (D) dural puncture epidural (C) compared to conventional epidural on (O) time to adequate analgesia, presence of asymmetric block and incidence of …

Ondansetron Administration Prior To Subarachnoid Block In Cesarean Section: An Evidence Based Practice Analysis, Jeremy Bustamante

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Subarachnoid block (SAB) is a preferred regional technique utilized by many institutions for caesarean section. A sensory block height of T5 is necessary for a successful caesarean under SAB. Unfortunately, side effects often emerge related to the physiological changes as a result of sympathetic nervous system inhibition. Current research suggests up to 55%-90% of parturients experience extended block height resulting in hypotension and bradycardia.There is a reduction in cardiac output due to a decrease in systemic vascular resistance and venous pooling. Similarly, the shift of cardiac autonomic balance toward parasympathetic stimulation causes bradycardia and activation of left ventricular mechanoreceptors due …

Prioritizing Wellness In A Multi-Site New Graduate Nurse Residency Program, Andrea Wilkins Howard, Kristie Richardson, Abby Jones, Julianne Rella, Amalia Acevedo-Sanic, Klaria Turnbull, Halea Caudill, James C. Gay, Sophia Bannis, Jennifer Fruitticher, Amy Ross, Belinda Chambers, Stephanie Robinson, Catherine Palmer

Group: American Nurses Credentialing Center (ANCC)

New Graduate Registered Nurse (NGRN) burn-out is an increasing, but not well studied phenomena (Xie et al., 2021). Purpose: The purpose of the study is to determine if prioritizing wellness in a newly built, multi-site,12-month, nurse residency program will increase retention and decrease early NGRN burn-out. Relevance: Nurse wellbeing is imperative to address. The pandemic has shown addressing mental health in all workplaces is necessary, but in healthcare this is especially true. NGRN do not have the tools to properly care for themselves and need ongoing, evolving and varied strategies to be effective. Strategy: The site is a fifteen-hospital healthcare …