Medicine and Health Sciences Commons^™

Improving Acute Pain Management: Development Of An Adult Dexmedetomidine Infusion Protocol, Timothy Denney

Doctor of Nursing Practice Projects

Studies have revealed over 80% of surgical patients experience acute postoperative pain: 75% of patients describe pain levels as moderate, severe, or extreme (Chou et al., 2016). Opioids continue to be the mainstay of most postoperative analgesia regimens (Tan, Law, & Gan, 2015). While effective for the treatment of severe pain, opioid use also prolongs length of hospital stay and places patients at greater risk for higher adjusted mean costs due to dose-related side effects. Multimodal analgesia is a concept that continues to gain momentum to improve perioperative analgesia while reducing the incidence of opioid-related adverse events (Buvanendran & Kroin, …

Integration Of Mental Heath Screening Protocol In Primary Care For Patients Who Have Experienced Traumatic Events, Karra N. Adams

Doctor of Nursing Practice Projects

Mental health status is not always assessed in patients involved in a physically traumatic event unless the patient expresses concern. Often times, orthopedic injuries are a result from a traumatic event. Routine mental health screening in the primary care orthopedic setting can help identify mental health care needs early so that adequate interventions can be implemented in a more effective manner. The goal of this project was to evaluate the feasibility of incorporating the use of a brief mental health screening tool in a primary care setting to assess the psychological needs of patients who have been involved in a …

Implementation Of Emergency Severity Index Training To Improve Accuracy Of Triage Levels, Erinn Hileman, Douglas Mckain

Doctor of Nursing Practice Projects

This quality improvement project was created to help increase knowledge of the Emergency Severity Index (ESI) in the Emergency Department (ED), a form of triage used to categorize patients by their acuity. Proper ESI use shortens the length of stay times, door to provider times and reduces the number of patients that leave without being seen.

The goal of this project was to develop an online learning module that would increase the nurses’ knowledge of triage to enhance triage accuracy. Nineteen (19) emergency department nurses were given a pretest, an ESI educational presentation, and a follow-up post-test.

Data analysis indicated …

Development And Evaluation Of A Malignant Hyperthermia Computer Based Learning Project, Andrew Miller

Doctor of Nursing Practice Projects

Malignant hyperthermia (MH) is a potentially fatal, inherited disorder of muscle hypermetabolism that occurs after a person is exposed to commonly used volatile anesthetic agents (sevoflurane, desflurane, isoflurane) and/or the depolarizing muscle relaxant, succinylcholine (Diu & Mancuso, 2012). The MH mortality rate has decreased from 80% in the 1960s to less than 5% in 2006 due to increased clinical awareness of manifestations, pathophysiology, and improvement in perioperative monitoring (Rosenberg, Pollock, Schiemann, Bulger, & Stowell, 2015). Therefore,continuing education of perioperative staff is an integral part of proper MH preparedness. Computer-based learning (CBL) modules have been shown to be efficient, inexpensive forms …

Increasing Utilization And Awareness Of An Existing Patient Portal Application, Amanda Graham, Jessica L. Schnebly

Doctor of Nursing Practice Projects

Patient portal applications (PPAs) are secure website or computer/mobile device applications that allow 24-hour access to a patient’s electronic health record (EHR). Patient portal applications are intended to improve quality and access to health care by engaging patients to be more active in managing and monitoring their health. A large Midwest multispecialty organization’s Follow My Healthpatient portal application (FMH app) is underutilized by patients and providers. While evidence supports the use of web-based patient portal applications, only 17% of this organization’s patients use the FMH app, and even less use its direct messaging capabilities.

The purpose of this project …

Assessing Palliative Care Needs In Residents With Alzheimer's, Emily Yarnell

Doctor of Nursing Practice Projects

Current evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans. …

Improving Acute Postoperative Pain Management For The Pediatric Patient: Guidelines On The Use Of Intravenous Dexmedetomidine, Jenna Winters

Doctor of Nursing Practice Projects

Inadequately treated surgical pain in children leads to risky complications, such as longer recovery times, infection, prolonged hospitalizations, readmissions, altered pain sensitivity, neurophysiological changes, and cognitive-behavioral abnormalities (Campbell, 2013; Ibrahim, Jones, Lai, & Tan, 2016). Review of the literature indicated intravenous dexmedetomidine, as an adjunct, may lead to improved outcomes and a reduction in postoperative pain in children undergoing surgical intervention. An evidenced-based educational presentation introduced intravenous dexmedetomidine in children to anesthesia professionals, pharmacy staff, and the pediatric care team at a tertiary care center. Concluding the educational presentation, participants completed a voluntary survey evaluating the effectiveness of the presentation. …

Hepatitis C Virus Screening And Treatment, Dani Loftus, Emily Machens, Crista Jamous

Doctor of Nursing Practice Projects

Hepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the …

Transitioning Pediatric Patients With Special Needs, Dimi Resch

Doctor of Nursing Practice Projects

Transitional care, which encompasses both the sending and receiving aspects, is essential for pediatric patients with complex care needs.A provider in a small, Midwest pediatric primary care clinic agrees with researchers that transitional guidelines are needed for consistency among pediatric and adult providers. This clinic currently has no process in place to guide the transition of patients with special needs. The primary goal of this project was to develop a communication tool that aids in the transition of patients with special needs into the adult primary care setting. The literature reviewed provided a variety of tools used to communicate healthcare …

Transition Of Care From Pediatrics To Adult Health Care, Heather Mahsman, Holly J. Henderson

Doctor of Nursing Practice Projects

Transition planning is essential for continuity of healthcare for adolescents approaching adulthood. Transition of care should start in early adolescence to help pediatric patients find and establish an adult healthcare provider. The purpose of this project was to assess and increase awareness of transition planning and assess the feasibility of instituting a transition program in a rural health pediatric clinic. Staff and providers were educated about transition of care planning and current recommendations from the American Academy of Pediatrics. Pre and post surveys were collected. Staff reported the program as beneficial to their patients and would like to see further …

Using “Remote” Training And Coaching To Increase Providers’ Skills For Working Effectively With Older Youth And Young Adults With Serious Mental Health Conditions, Janet S. Walker, Caitlin Baird

School of Social Work Faculty Publications and Presentations

Since about the turn of the century, a growing awareness of the poor outcomes resulting from “as usual” community mental health care has led to increasing efforts to implement programs and interventions with empirical evidence of effectiveness. However, these efforts have encountered numerous barriers, in particular the high cost of implementation, which has severely limited uptake and sustainment of empiricallysupported programs and interventions. Typically, the largest contributor to cost is the training and coaching required to ensure provider competence and fidelity to the intervention or program model. This paper describes a social innovation that aims to provide high-quality training and …

First Responders, Melissa Browning

A Midwestern Review: A Magazine of the Arts and Issues at DePauw University

No abstract provided.

Quantifying Expression Of Interneuron Subtype Markers For Dlx-2 Transfected Ng2 Cells, Timothy Nolan

Honors Scholar Theses

Neurons are a post-mitotic cell population, and therefore, they are not able to regenerate in vivo after a traumatic injury. Because inhibitory GABAergic interneurons and oligodendrocyte precursor cells (OPCs) are derived from the same precursor, recent studies have focused on transforming these OPCs into GABAergic neurons. However, there are different types of GABAergic interneurons that have different electrophysiological responses, which can lead to functional differences. The Nishiyama laboratory had already used a key gene in GABAergic interneuron and OPC differentiation, Distal-less homeobox 2 (Dlx-2), to transfect OPCs; early electrophysiology tests showed most of these transfected cells behaved like immature neurons, …

Embryonic Lethality Of Cranial Neural Crest Deletion Of Cdc73, Lilia Shen

Honors Scholar Theses

Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a disease characterized by parathyroid tumors, renal cysts or tumors, uterine tumors, and ossifying jaw fibromas. The cause of this syndrome is linked to a tumor suppressor gene called Cdc73, which encodes the protein product parafibromin. The loss of proper expression of Cdc73/parafibromin is implicated in the development of the tumors typical of HPT-JT, although the exact mechanisms of tumorigenesis are unclear. In particular, not much is understood about the development of ossifying fibromas (OF) of the jaw in this syndrome. OF is a benign bone neoplasm that can affect the mandible and …

Assessment Of Magnetic Resonance Imaging Safety: Allied Health Professional Clinical Competence, Tiffany Houser

Electronic Theses and Dissertations

Magnetic resonance imaging is a major advancement in the diagnostic imaging field. Most patients can tolerate an MRI however, there are some who are unable to complete a lengthy scan while lying completely still without sedatives or anesthesia. Non-MRI healthcare providers are trained to use equipment that is “unsafe” in the MRI suite due to the strong magnetic field. Staff who are not fully knowledgeable and trained in MRI safety measures can endanger staff and patients.

The purpose of this study was to determine the knowledge level of non-MRI healthcare providers regarding safety risks associated with MRI and to determine …

When Process Becomes Processing: Managing Instructor Response To Student Disclosure Of Trauma In The Composition Classroom, Kelci Barton

Electronic Theses and Dissertations

In first-year composition courses, there are three aspects of teaching that are researched well so far: disclosure of trauma in student writing, instructor feedback, and emotional labor. The disclosure of trauma is almost completely unavoidable in first-year composition. We encounter an issue with instructor feedback; how do we provide feedback to student writing, like grammar and mechanics, when the student has disclosed trauma in the writing? Additionally, we can build off this with emotional labor, which already occurs consistently in teaching but is heightened in this instance. When providing feedback to a student who has disclosed trauma, this can be …

The Sensoryfun! Toolkit: A Bilingual Resource For Parents & Caregivers, Nicolette D'Esposito, Yvette Lozano, Natalie Carrillo, Sarah Pashby

Occupational Therapy | MSOT Capstone Projects

A sensory diet is an occupational therapy (OT) intervention strategy. Sensory diets are specifically designed to meet a child's sensory integration needs. Sensory diets are not standardized among practitioners and there are a limited number of resources available for individuals that do not have a clinical background. The lack of easy to understand resources for parents and caregivers creates several barriers for occupational therapists working with families with children experiencing sensory processing difficulties. One barrier is that there are few resources available in Spanish. The purpose of this project was to develop a resource for parents and caregivers using educational …

Physiological Responses Of Adults With Sensory Over-Responsiveness, Catherine Anne Datu, Nicholas Wing Or, Megan Melody Valentine, Megan Jeanne Velcich

Occupational Therapy | MSOT Capstone Projects

The purpose of this research study is to identify if there are physiological response patterns associated with self-reported sensory over-responsiveness (SOR) in typical adults. SOR is the most common sensory modulation disorder and negatively affects the daily experiences of those that report SOR. The first phase of the study consisted of phone interviews where participants were screened for any potential characteristics that could affect physiological function. Then, the SRQ and AASP were used in conjunction to identify low and high SOR, typical adults. The last phase utilized the Sensory Challenge Protocol, which is both standardized and randomized, to expose participants …

Effects Of Sertraline Treatment For Young Children With Fragile X Syndrome: Family Perspectives Via Case Studies, Tracy P. Ye, Decerie A. Mendoza, Elena A. Javier, Martina C. Dualan

Occupational Therapy | MSOT Capstone Projects

Current research on children with Fragile X Syndrome (FXS) lacks inclusion of qualitative outcomes on the child’s daily occupational performance. Standardized measurements are frequently utilized and provide useful information, however, can be less sensitive to change (Berry Kravis et al., 2013) and miss capturing family perspectives and improvements within meaningful occupations. This research incorporates family perspectives via semi-structured interviews to promote an in-depth understanding about FXS and its impact on child and family occupations in addition to standardized assessment scores through in-depth case study analysis. This study used a mixed method research design examining four male participants who were given …

A Sensory-Based Program To Enhance Occupational Performance For Dementia, Ivy Annahi Torres-Flores, Jacob Gantan, Heather Anne August, Naomi Grace Wong

Occupational Therapy | MSOT Capstone Projects

Dementia is a neurological disease, causing behavioral and cognitive symptoms, that progressively impairs an individual’s ability to engage in meaningful activities. Progressive deterioration associated with dementia impacts occupational performance and independence and quality of life. Sensory based interventions, such as drumming groups, have been hypothesized to be a non-pharmacological intervention for individuals with dementia. The purpose of this study was to analyze the effects of a sensory based intervention program, in this case participation in a drumming group, on functional engagement during self-feeding for individuals with dementia. Researchers gathered data over the course of two days using the Functional Behavior …

Autism And Occupation: Video Modeling For Maker Activities, Hannah Gibeson, Kelly Yerby, Molly Smith, Brittany Yung

Occupational Therapy | MSOT Capstone Projects

Understanding the lived experiences of individuals with Autism Spectrum Disorder (ASD) using video modeling (VM) while engaging in Maker activities is an essential part of occupational therapy research. Participants in this study were four individuals with ASD recruited from a project-based studio located in San Rafael, CA, and one staff member. The qualitative portion of this study analyzed the lived experiences and perspectives of the individuals with ASD and their service provider through qualitative semi-structured interview methods. The quantitative portion of this study analyzed the effectiveness of VM for Maker activities during the activity of making a box using a …

The Impact Of Fall Efficacy On Occupational Performance In Community-Dwelling Older Adults, Michelle Fong, Araya Moua, Erin Denola, Merit Franklin

Occupational Therapy | MSOT Capstone Projects

Falls are a major health concern in the older adult (OA) population. While there is research on falls and their prevention, research on how low fall efficacy (FE) impacts the occupational engagement of the OA population is limited. FE is defined as the confidence a person has in his/her ability to complete a task without falling (Tinetti & Powell, 1993). A qualitative study was conducted using a phenomenological approach to explore the lived experiences of OAs with low FE and the impact on occupational performance. Participants who scored ≤ 6 on the Modified Fall Efficacy Scale (MFES) engaged in a …

Exploratory Application Of A Sensory Activity Schedule In Head Start Preschool, Marian Perez, Elaine Wong, Michelle Perryman

Occupational Therapy | MSOT Capstone Projects

Objective: The objective of this research is to determine whether the implementation of sensory activity schedule in a preschool classroom can increase the on-task behaviors of the students.

Methods: Three students were recruited to participate in a quantitative multiple single subject design with qualitative follow-up study. The participants performed sensorimotor activities before circle time and were monitored for frequency of their off-task behavior using a time sampling frequency data collection. Afterwards, the head teacher was interviewed to discuss the experience.

Results: Off-task behavior decreased from baseline on all three children, which supports the efficacy of sensory activity schedule in reducing …

Occupational Responses Of Older Adults Following Partner Loss, Carol Huang, Jane Song, Peter Behr, Stephanie Sterner

Occupational Therapy | MSOT Capstone Projects

Spousal loss has been frequently identified as a life stressor that can greatly impede one’s ability to age at home. The purpose of this study is to identify the occupational changes that commonly result after this event and their impacts on one’s ability to age in place. This study utilized a qualitative phenomenological research design. Eight participants were recruited from an educational program for older adults and were interviewed using a semi-structured interview format. Researchers transcribed and coded all interviews to determine emergent themes. Two major categories of themes were found: occupational and intrinsic responses. The areas of occupation that …

Dating For College Students In The San Francisco Bay Area, Justin Pring, Cristina Cummings, Gabriela Saucedo, Cathy Lynn Gonzales

Occupational Therapy | MSOT Capstone Projects

Dating is a widely practiced occupation by many individuals, especially the emerging adult, college student population. The primary objective of this research study was to develop a greater understanding of San Francisco (SF) Bay Area college students’ perception, practice, and occupational impact of dating. Phenomenological interviews were conducted with seven college students living in the SF Bay Area. Three themes emerged: the dating process, internal and external factors that influence dating, and personal growth from dating experiences. The data revealed that the emerging adult, college student population values dating and believes it can significantly impact their own development. However, this …

Veteran Wellness And Reintegration: Factors Contributing To Their Success In The Community, Melissa A. Escamilla

Theses and Dissertations

The purpose of the following study is to determine if there is a relationship between veteran wellness based on gender, discharge status, theatre of operations, substance use disorder, veteran self-efficacy, community reintegration post discharge, stigma and veteran physical and psychosocial factors. Military veteran wellness has been the focal point of service providers for ensuring post-discharge veterans' success. During the last decade there has been an increase in military veterans reintegrating into society with chronic ailments and undiagnosed conditions. The study examined 85 Texas veterans: (a) the relationship between veterans' substance abuse and their perception of stigma, (b) the relationship between …

Comparison Of Knowledge And Diagnostic Practices Relating To Autism Spectrum Disorder Between The United States And Mexico, Maria F. Valdez

Theses and Dissertations

The present study examined and compared the knowledge, screening, and diagnostic practices of health care practitioners from Mexico and the United States of America (U.S.) as they relate to autism spectrum disorder (ASD). The participants included 56 healthcare professionals from U.S. and 16 healthcare professionals from Mexico. Data was collected via an online survey. Overall, participants achieved a mean knowledge accuracy of 0.58 (SD = 0.13). The mean accuracy of knowledge in Mexico was 0.52 (SD = 0.13) and the mean accuracy of knowledge in the U.S. was 0.60 (SD = 0.13). Location, years of experience, patient contact, and comfort …

Re-Visioning Interprofessional Education In Virtual Worlds, Susan Toth-Cohen, Anne C. Smith

Department of Occupational Therapy Faculty Papers

From their inception, virtual worlds have attracted educators from many disciplines, and benefits for both students and educators for networking and immersive experience have been well documented. But, while virtual world education has engaged multiple disciplines to learn with, from, and about each other, the potential for innovation in interprofessional education (IPE) has not been fully realized. This paper outlines ways to re-vision IPE using a flexible learning framework to develop, implement, and enhance virtual world training programs.

Evaluation Of Cervical Spine Posture After Functional Therapy With Twin-Block Appliances: A Retrospective Cohort Study, Adeel Tahir Kamal, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Introduction: It has been postulated that a change in cervical posture occurs as a consequence of forward repositioning of the mandible. Therefore, the objective of this study was to compare the cervical spine posture between subjects with and without functional appliance therapy.
Methods: A retrospective cohort study was conducted with the use of pre- and post-functional therapy cephalograms of orthodontic patients. A total of 60 subjects was composed of 2 groups of 30 subjects each: those who underwent treatment with a twin-block (TB) functional appliance and a control group selected from the Bolton-Brush Growth Study. Three sagittal and 7 cervical …

Decreasing Unplanned Extubations By Taping Technique & Creating A Culture Of Safety, Karishma Rao, Beckie Palmer, Christopher R. Nitkin, Christian Anthony Schneider, Brandy Huitt, Molly Terhune, Ashley Orwick, Dianne Wilderson, Sarah Carboneau, Jenny Mckee, Kerrie A. Meinert, Eugenia K. Pallotto

Presentations

Describes strategies used to decrease the unplanned extubation rate in the Level IV neonatal intensive care unit to less than 1.0 event per 100 ventilator days by December 2018.