Digital Commons Network^™

Implementation And Evaluation Of A Syphilis Screening Tool To Increase Patient Testing For Syphilis Among Adults 18 Years And Older In A Rural Primary Care Clinic, Valeria S. Wiggins

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) are an increasing epidemic in the United States (U.S.) that need immediate interventions to reverse the effects of syphilis on the sexual health of adults in rural populations. Many are unaware of the growing rate of syphilis and the overall impact it causes nationally. When syphilis is detected early, it can be easily treated and cured. Rural primary care providers are ideal candidates for implementing education, screening, testing, and treatment.

Purpose: The Doctor of Nursing Practice (DNP) project aims to increase the frequency of screening patients in rural primary care clinics for high-risk sexual behaviors. …

Implementing A Troponin Trending Toolkit In A Rural Emergency Department To Increase Provider Adherence To Troponin Trending Guidelines, Ace Beam

Doctor of Nursing Practice Projects

Background: Cardiac biomarkers are used for the diagnosis and risk stratification of patients with chest pain and suspected acute coronary syndrome (ACS) (Kamal, 2021). Cardiac troponin is the only biomarker recommended to be used for the diagnosis of acute myocardial infarction (AMI) at this time due to its superior sensitivity and accuracy (Kamal, 2021). Emergency departments routinely provide care for patients presenting with chest pain symptoms and should be prepared to utilize evidence-based guidelines for troponin trending to effectively evaluate these patients.

Purpose: The purpose of the DNP project was to improve emergency department healthcare provider compliance to evidence-based high-sensitivity …

Implementing The 4ds (Diet, Drinks, Drugs, And Dialysis) To Lower Hyperphosphatemia Among Outpatient Hemodialysis Patients, Morgan Atchison

Doctor of Nursing Practice Projects

Background: Hyperphosphatemia, also known as excess phosphate in the blood, is a problem that continually causes health issues for the outpatient hemodialysis population. Hyperphosphatemia yields multiple health comorbidities and can increase mortality (Rastogi et al., 2021).

Purpose: Hyperphosphatemia is directly correlated with end-stage renal disease (ESRD) (Goyal & Jialal, 2020). This project aimed to decrease the incidence of hyperphosphatemia in the chronic outpatient hemodialysis setting. The primary objective of this project was to increase adherence levels to diet, drinks, drugs, and dialysis (4Ds) in those receiving chronic outpatient hemodialysis in the pursuance of achieving and maintaining blood serum phosphorus levels …

Providing Education To Staff Members On Implementing Follow-Up Education At Discharge To Patients With Low Heart Scores, Daniel Burton

Doctor of Nursing Practice Projects

Background: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provides accreditation to hospitals, including “heart certification.” The facility was successful at meeting the four measures previously assigned to them. As a result, they were given four new measures. One of these standards is providing discharge education based on “heart scores.”. Only 35% of patients are receiving discharge/follow-up education at discharge from the emergency department (ED).

Purpose: The purpose of this study is to increase the number of patients receiving chest pain education and follow-up instructions in the ED as evidenced by the improvement in documentation of the interventions.

Methods: …

Clabsi’S: Reducing The Rates In An Urban Intensive Care Unit By Consistent Use Of The Central Line Maintenance Evaluation Tool (Clmet), Bridget Smith

Doctor of Nursing Practice Projects

Background: Quality improvement efforts from an urban facility have observed a need for staff education on the central line maintenance bundle and consistent surveillance with the Central Line Maintenance Evaluation Tool (CLMET).

Purpose: To address the practice gap of central line maintenance bundle usage at the bedside by utilizing the CLMET consistently.

Methods: A voluntary didactic program offered to staff and encouraging daily utilization of the CLMET that included real-time feedback by the supervisors.

Results: Pretest grade for the unit (n=13, 82.06) and the post-test grade (n=13, 86.33), which is + 4.27 points after education. Pre-implementation, January 1st through 31st, …

Project Ankle-Brachial Index: Implementation Of An Evidence-Based Peripheral Artery Disease Protocol, Melaney Banks

Doctor of Nursing Practice Projects

Background: Peripheral artery disease (PAD) is a narrowing or blocking of the arteries due to plaque buildup, which prevents oxygen, blood, and other nutrients from getting to the legs. When this buildup reaches a certain point, it becomes atherosclerosis, which is more prevalent in a smoker. Smoking intensifies the problem of plaque buildup if an individual already suffers from PAD. When an individual smokes, the nicotine causes the arteries to constrict and narrow, reducing blood flow further. The ankle-brachial index (ABI) is a simple, cost-effective diagnostic test to identify the presence of PAD which will improve patient outcomes.

Purpose: This …

Implementing Hand Hygiene Protocol For Direct Care Staff In An Inpatient Psychiatric Facility To Improve Hand Hygiene Compliance, Juliet Mkpuechina

Doctor of Nursing Practice Projects

Background: Handwashing with soap and running water is one of the most effective ways to prevent diseases and infections spread through touch. Hand hygiene refers to handwashing with soap, water, and other disinfecting agents to prevent infection. According to Chassin et al. (2017), hand hygiene compliance reduces healthcare-associated infections (HAI). Studies show that an increase in handwashing compliance can be correlated to a decrease in healthcare-associated infections. Studies have proven that though it is challenging to link hand hygiene to a reduction in healthcare-associated infections directly to improved hand hygiene compliance, many hospitals have seen a decline in HAIs as …

Utilization Of Remap Conversation Tool To Improve Advance Care Completion In The Home-Based Palliative Care Community Setting, Gwendolyn Starkey

Doctor of Nursing Practice Projects

Background: The World Health Organization and the American Society of Clinical Oncology guidelines endorses mandatory communication skills training in care goals for seriously ill patients (Back et al., 2019). In one survey of primary care providers (PCP), 68% reported no formal training to discuss advance care planning (Comer et al., 2020). Advance care planning is essential to manage chronic conditions in our growing aging population to provide the best patient care. This manuscript aimed to discuss best practices and techniques in advance care planning and optimize skills to provide patient-centered care conversations that honor patient wishes, reduce unwanted hospitalizations, and …

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …

Utilizing Multimodal Communication Strategies To Improve Average Risk Women Veteran Patient Participation In Returning Colorectal Fecal Immunochemical Test Kits, Shuntae Hooten

Doctor of Nursing Practice Projects

Background: Cancer is one of the most dreadful diseases present in today’s world. It is responsible for millions of deaths worldwide. The disease is debilitating to one’s physical and emotional well-being. Cancer impacts not only the affected individual but also those close to them. When colorectal cancer is identified early via preventive screenings, it has a greater chance of responding to treatment, therefore, increasing the chances of survival. The fecal immunochemical test (FIT) kit plays a pivotal role in the early detection of colon cancer. Schreuders et al. (2016) revealed that FIT kits have better adherence, usability, and accuracy, citing …

Evaluation Of The Implementation Of The Munro Pressure Ulcer Risk Assessment Scale To Mitigate Pressure Ulcers In The Perioperative Setting, Sherry Lynn Grandison

Doctor of Nursing Practice Projects

Background: The process of implementing appropriate skin assessment and documentation throughout the patient’s operative experience assists in the early detection of pressure ulcers.

Purpose: This Doctor of Nursing Practice (DNP) project had two goals. The first was to determine a practical tool that would ensure that surgical nurses demonstrate competence and comply with the process of identifying compromised skin integrity, and the second goal was to effectively communicate the findings with other clinical team members.

Methods: The DNP project focused on the use of the Munro Pressure Ulcer Risk Scale Assessment Tool to identify pressure ulcers and to promote collaboration …

Increasing Medical-Surgical Nurses' Skills And Knowledge On Wound Assessment And Documentation Through An Educational Approach, Jewels Knight

Doctor of Nursing Practice Projects

Background: Hospital acquired pressure injury rates are increasing while other hospital acquired condition rates are decreasing. Pressure injuries are expensive and place patients at a higher risk of death. Accurate wound assessment and documentation to satisfy the present on admission indicator could positively affect hospital acquired pressure injury rates.

Purpose: The purpose of this process improvement project was to increase nurses’ skills and knowledge towards proper wound assessment and documentation and to increase nurses’ knowledge on why comprehensive skin assessments and documentation of the observations are important for positive patient outcomes.

Method: This project consisted of offering an educational …

Using The Cdc’S Healthcare Personnel And First Responders: How To Cope With Stress And Build Resilience During The Covid-19 Pandemic Education Resources To Reduce Burnout Of Intensive Care Nurses At An Urban Acute Care Hospital, Elizabeth Gilbert

Doctor of Nursing Practice Projects

Background: Nurse burnout is a serious problem, as documented by many studies. Burnout has been shown to lower quality of life, performance level, and organizational commitment while also increasing a nurses' desire to leave the job. Despite this knowledge, nurse burnout continues to be present, especially among nurses who work in intensive care units (ICUs). Hospitals need ICU nurses to care for critically ill patients; therefore, it is essential to educate ICU nurses on burnout and initiate measures to decrease burnout in this vulnerable population.

Purpose: The goals of this study are to explore nurse burnout in the medical intensive …

The Effectiveness Of A Virtual Shared Medical Appointment On Opioid Safety Education Participation In The Veteran Population Within A Va Health Care System, Jana Falkner

Doctor of Nursing Practice Projects

Background: From 2019 to 2021, there has been an increase in opioid prescribing, leading to the current death rate of 136 Americans per day from an opioid overdose (Centers for Disease Control and Prevention [CDC], 2021). In response to these shocking statistics, a Veterans Administration (VA) health care system initiated a face-to-face interdisciplinary opioid safety shared medical appointment (SMA). Although the face-to-face Opioid Safety SMA was successful in increasing opioid safety awareness, participation, and attendance for the SMA have declined over the last year.

Purpose: The purpose of the DNP project was to improve attendance for veterans participating in the …

Reducing Hospital Readmissions Through A Standardized Heart Failure Educational Program For Community Based Nurse Case Managers, Greta Abernathy

Doctor of Nursing Practice Projects

Background: Heart failure is a high-risk health condition that impacts a patient's heart, causing it to pump at a weaker pace than a healthier person's heart (Mayo Clinic, 2020). Associated with frequent hospital admissions, heart failure affects millions of Americans in the United States (Fleg, 2018) and results in repeated readmissions, costing thousands of dollars per admission and decreased quality of life.

Purpose: This DNP project aims to implement an evidence-based educational model of care for nurse case managers within a community setting focused on Heart Failure (HF) that will improve the heart failure patient's ability to self-manage their disease …

The Use Of The Centers For Disease Control (Cdc) Outpatient Antibiotic Stewardship Program To Reduce Unnecessary Antibiotic Prescriptions Written For Sinusitis In A Rural Urgent Care Clinic Setting, Melanie Maddox

Doctor of Nursing Practice Projects

Background: The discovery of antibiotics has been a significant success in fighting bacterial infections. According to the Centers for Disease Control (CDC), in 2018, inappropriate prescribing of antibiotics contributed to antibiotic-resistant conditions, which led to 2 million infections, and has killed about 23,000 Americans annually (Chaney, 2018: CDC, 2019). By 2050, 10 million people are expected to die globally due to bacterial resistance, with the cost potentially reaching $100 trillion (WHO, 2019).

Purpose: The purpose of the DNP Project is to decrease unnecessary antibiotic prescriptions for the diagnosis of sinusitis in a rural urgent care clinic and increase provider awareness …

A Multi-Modal Strategy To Activate Pronation For Acute Respiratory Distress Syndrome Patients, Meredith Mccrorie

Doctor of Nursing Practice Projects

Background: Acute Respiratory Distress Syndrome (ARDS) is an acute pulmonary process that compromises the health of patients in the Intensive Care Unit (ICU). ARDS can progress to irreversible fibrosis causing the lungs to become noncompliant, adversely affecting ventilation or gas exchange (Buckley et al., 2019). An ARDS diagnosis accounts for 30-40% mortality rate which is an improvement from 60% in the last two decades. The clinical course of this disease is highlighted by Acute Hypoxic Respiratory Failure (AHRF) evidenced by chest radiographs revealing bilateral dense consolidations. Manual pronation of ARDS patients has shown an increase in alveolar function with end …

Utilizing Multimodal Education To Impact Provider Documentation Of Post-Anesthesia Evaluation In A Rural Hospital, Jennifer Coffman

Doctor of Nursing Practice Projects

Background: Hospital policy, Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC) require a post-anesthesia evaluation to be completed and documented no later than forty-eight hours following surgery or any other procedure requiring anesthesia. This evaluation is required any time general, regional, or monitored anesthesia has been administered to the patient and must be completed by a certified anesthesia provider. One rural hospital facility’s post-anesthesia documentation compliance has declined to 79%, compared to the previous quarter’s report of 95%.

Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve post-anesthesia documentation through a multimodal educational intervention. …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Implementation Of A Diabetes Self-Management Education Program In The Rural Health Care Setting To Improve Glycemic Control In The African American Adult Population, Patricia Jackson

Doctor of Nursing Practice Projects

Background: According to the Center for Disease Control (CDC), Type 2 Diabetes Mellitus (T2DM) is a significant epidemic health problem worldwide. Furthermore, with the generality of T2DM-associated complications increasing, individuals living with chronic diseases must be competent in self-management to prevent long-term complications (CDC, 2021). Therefore, this Project Investigator aims to decrease the reported home glycemic control and improve diabetes self-management education among African American individuals in rural healthcare using the DSMEP tool.

Purpose: The purpose of the DNP project was to implement and assess the Diabetes Self-Management Education Program (DSMEP) effect on African American individuals in the rural health …

Stroke Care: Achieving Recommended Door To Computed Tomography Times In Ambulatory Patients Presenting To The Emergency Department Of A Rural Hospital Through The Application Of American Stroke Association Guidelines, Ricardo Paitz

Doctor of Nursing Practice Projects

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP …

Utilization Of Staff Education To Improve The Management Of Aggression And Violence In The Rural Inpatient Psychiatric Setting, Clara Ugwuibe-Ogunseye

Doctor of Nursing Practice Projects

Background: Workplace violence (WPV) is a global concern and an occupational hazard faced by healthcare professionals worldwide. Aggression and violence can result in serious injury to the patient, healthcare professional, other patients, or visitors and cause stress to healthcare workers, and increase work absences (Picot, 2021).

Purpose: This DNP process improvement project aim was to utilize an educational training program on violence risk assessment, therapeutic communication, and verbal de-escalation techniques, to improve the confidence of mental health nursing staff in using early intervention to manage aggressive, violent patients. This education and early intervention reduced rates of aggression and violence escalation, …

Reducing Admissions Of Adult Congestive Heart Failure Patients In The Acute Care Setting, Jamekia Calhoun

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a clinical diagnosis that affects about 1 to 2% of the population worldwide. Poor education regarding self-care behaviors after discharge has contributed to increased readmissions after acute hospitalization. Hospital readmissions cost is approximately one hundred thousand dollars. This increase in cost has forced the Centers for Medicare and Medicaid Service (CMS) to place penalties on organizations with high readmission rates. The organization may be penalized for increases in readmission rates by decreasing the percentage of the combined total Medicare payments received from the CMS (Centers for Medicare and Medicaid Services [CMS], 2021)

Purpose: …

Implementation And Evaluation Of A Post-Op Coronary Artery Bypass Graft Extubation Checklist To Reduce Prolonged Intubation In The Intensive Care Unit, Melissa Bailey

Doctor of Nursing Practice Projects

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project.

Purpose: This DNP project aims to …

The Apoe Ε4 Allele Association With Cholesterol Related Phenotypes In The Mexican American Population, Stephanie Lozano

Theses and Dissertations

Diseases linked to high cholesterol have been well studied and several diseases-associated candidate genes have been suggested. Among these, the apolipoprotein E gene (APOE) gene associated with lipid metabolism and lipid-related traits was reported in the non-Hispanic population. There are three types of alleles APOE ε2, ε3, and ε4. The APOE ε4 allele has been identified as a biomarker for Alzheimer’s disease (AD) and cardiovascular disease (CVD). In recent years, there have been limited studies regarding the association between the APOE gene and hypercholesterolemia in the Mexican American population. Therefore, the aim of this study is to investigate …

Modelo De Predicción De La Demencia En Adultos Mayores De 60 Años [Dementia Prediction Model In Adults Over 60 Years Old], Maria Del Pilar Santacruz-Ortega, Maria Fernanda Cobo-Charry, Bertha Lucia Avendaño-Prieto, Silvia Mejia-Arango

School of Medicine Publications

In order to determine the contribution of the sociodemographic, psychosocial and health variables to a prediction model of dementia in the elderly population, a secondary analysis was carried out with the data from the “Health, Well-being and Aging. Bogotá, 2012”, with 2000 men and women over 60 years of age from urban and rural areas of Bogotá. To select the sample, a probabilistic, multistage, conglomerate and stratified sampling was carried out, based on the 2005 National Census. The SABE questionnaire adapted for Colombia was used. According to the level of measurement of each variable and the distribution of the data, …

Location-Specific Cutaneous Electrical Stimulation Of The Footsole Modulates Corticospinal Excitability To The Plantarflexors And Dorsiflexors During Standing, Gagan Gill, Davis A. Forman, Joanna E. Reeves, Janet L. Taylor, Leah R. Bent

Research outputs 2022 to 2026

Non-noxious electrical stimulation to distinct locations of the foot sole evokes location-specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival …

How Does Parents' Social Support Impact Children's Health Practice? Examining A Mediating Role Of Health Knowledge, Paulin Tay Straughan, Chengwei Xu

Research Collection School of Social Sciences

Background: Many existing studies have found that social support and health knowledge positively affect an individual's health status. However, it is still unclear how parents’ social support and health knowledge influence their children’s obesity. The present study hypothesizes that parents’ health knowledge has a mediating effect on the relationship between social support and children’s health practice regarding weight management. Methods: To test the hypothesis, we conducted a questionnaire survey in Singapore and collected a nationally representative sample of 1488 household responses. Structural equation modeling (SEM) via Stata was used to examine the indirect effects of parents’ social support on children’s …

Association Of Rare Apoe Missense Variants V236e And R251g With Risk Of Alzheimer Disease, Yann Le Guen, Michael E Belloy, Benjamin Grenier-Boley, Itziar De Rojas, Atahualpa Castillo-Morales, Iris Jansen, Aude Nicolas, Céline Bellenguez, Carolina Dalmasso, Fahri Küçükali, Sarah J Eger, Katrine Laura Rasmussen, Jesper Qvist Thomassen, Jean-François Deleuze, Zihuai He, Valerio Napolioni, Philippe Amouyel, Frank Jessen, Patrick G Kehoe, Cornelia Van Duijn, Magda Tsolaki, Pascual Sánchez-Juan, Kristel Sleegers, Martin Ingelsson, Giacomina Rossi, Mikko Hiltunen, Rebecca Sims, Wiesje M Van Der Flier, Alfredo Ramirez, Ole A Andreassen, Ruth Frikke-Schmidt, Julie Williams, Agustín Ruiz, Jean-Charles Lambert, Michael D Greicius, Members Of The Eadb, Gr@Ace, Degesco, Demgene, Gerad, And Eadi Groups, Beatrice Arosio, Luisa Benussi, Anne Boland, Barbara Borroni, Paolo Caffarra, Delphine Daian, Antonio Daniele, Stéphanie Debette, Carole Dufouil, Emrah Düzel, Daniela Galimberti, Vilmantas Giedraitis, Timo Grimmer, Caroline Graff, Edna Grünblatt, Olivier Hanon, Lucrezia Hausner, Stefanie Heilmann-Heimbach, Henne Holstege, Jakub Hort, Deckert Jürgen, Teemu Kuulasmaa, Aad Van Der Lugt, Carlo Masullo, Patrizia Mecocci, Shima Mehrabian, Alexandre De Mendonça, Susanne Moebus, Benedetta Nacmias, Gael Nicolas, Robert Olaso, Goran Papenberg, Lucilla Parnetti, Florence Pasquier, Oliver Peters, Yolande A L Pijnenburg, Julius Popp, Innocenzo Rainero, Inez Ramakers, Steffi Riedel-Heller, Nikolaos Scarmeas, Philip Scheltens, Norbert Scherbaum, Anja Schneider, Davide Seripa, Hilkka Soininen, Vincenzo Solfrizzi, Gianfranco Spalletta, Alessio Squassina, John Van Swieten, Thomas J Tegos, Lucio Tremolizzo, Frans Verhey, Martin Vyhnalek, Jens Wiltfang, Mercè Boada, Pablo García-González, Raquel Puerta, Luis M Real, Victoria Álvarez, María J Bullido, Jordi Clarimon, José María García-Alberca, Pablo Mir, Fermin Moreno, Pau Pastor, Gerard Piñol-Ripoll, Laura Molina-Porcel, Jordi Pérez-Tur, Eloy Rodríguez-Rodríguez, Jose Luís Royo, Raquel Sánchez-Valle, Martin Dichgans, Dan Rujescu

Faculty, Staff and Students Publications

IMPORTANCE: The APOE ε2 and APOE ε4 alleles are the strongest protective and risk-increasing, respectively, genetic variants for late-onset Alzheimer disease (AD). However, the mechanisms linking APOE to AD-particularly the apoE protein's role in AD pathogenesis and how this is affected by APOE variants-remain poorly understood. Identifying missense variants in addition to APOE ε2 and APOE ε4 could provide critical new insights, but given the low frequency of additional missense variants, AD genetic cohorts have previously been too small to interrogate this question robustly.

OBJECTIVE: To determine whether rare missense variants on APOE are associated with AD risk.

DESIGN, SETTING, …

Uni Schedule Of Classes: Policies And Procedures, Summer 2022, University Of Northern Iowa

UNI Schedule of Classes

A listing and schedule of the courses being taught as well as policies and procedures concerning attending classes at the University of Northern Iowa.