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Description
Objective
A needs assessment identified a nursing knowledge gap of chemotherapy-induced neurotoxicity (CIN) symptoms as a significant factor in delayed recognition of patients' neurologic decline. The quality improvement (QI) project aimed to increase nursing comfort levels and knowledge related to screening for CIN in hospitalized pediatric hematology, oncology, and bone marrow transplant (Heme/Onc/BMT) patients.
Methods
Nursing CIN education and pre- and post-education assessment questions were created using best practice parameters to screen and monitor CIN in Heme/Onc/BMT pediatric patients. Pre- and post-surveys included a valid Likert-type scale to assess comfort levels using neurotoxicity screening tools (NST) followed by knowledge-based formative assessments. ASU IRB and hospital QI board standards were maintained.
Results
Heme/Onc/BMT nurses (n=37) participated. The most frequent pre-education comfort level was three or somewhat comfortable (n=13). Most frequent post-education comfort level is four or very comfortable (n=21). The two-tailed Wilcoxon signed rank test for pre- and post-education comfort levels was significant based on an alpha value of .05 and p < .001.
Conclusion
Nursing comfort and knowledge of screening for CIN increased. Early recognition of CIN will improve outcomes for high-risk hospitalized Heme/Onc/BMT pediatric patients.
ContributorsBest, Brianne (Author) / Bucci, Aimee (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27
Description
According to The Joint Commission, most sentinel events in healthcare can be attributed to errors in communication. Thousands of medical students in the United States lack adequate communication training. Current literature illustrated that communication skills training programs increase confidence and communication skills of medical students and residents. These programs vary in techniques, with many including lectures and role play exercises. This project aimed to improve outcomes at a forensic facility in Arizona by utilizing a student role play intervention and lecture. Outcomes were measured utilizing developed pre- and post-intervention surveys. The surveys included a validated tool which measured four communication skill categories. A convenience sample consisted of pre-medical interns who participated in the project. The small sample size (four) led to descriptive statistics utilization to provide preliminary data. Prior to the intervention, communication skill average scores were as follows: listening (15), giving and getting feedback (12), sending clear messages (13.75), and handling emotional interactions (11.5). Post-intervention, the average scores for the communication skills were as follows: listening (18.25), giving and getting feedback (13), sending clear messages (16), and handling emotional interactions (12.75). Average scores for each category showed an increase after the implementation of the intervention. The survey was completed for four (100%) of participants, and 75 percent of participants stated they felt more confident with utilizing communication skills in their internship. A communication skills training program can enhance communication skills of medical trainees by providing structured support. Further research is needed on effective techniques to train medical trainees.
ContributorsIliescu, Michelle (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Background: Workplace violence (WV) is a significant problem in healthcare that affects the nurses' physical and mental health and impacts patient care. This is costing healthcare organizations millions of dollars for damage control as there is a lack of prevention. Hence, this evidence-based practice project uses the theory of planned behavior and nursing process discipline theory to explore the effectiveness of screening patients for violence.
Method: After an aggregate IRB approval, a violence screening tool with high sensitivity and specificity, Broset Violence Checklist (BVC), was implemented twice daily and as needed for 15 days with 275 adult patients in a neurology/telemetry unit to help identify patients at high-risk for violence. All interventions and procedures were based on established policies, not the BVC score.
Results: A generalized estimating approach with a logit link and linear regression was used for data analysis. Of the 1504 BVC screenings completed, 43 violent incidents were reported, with interventions recorded in 106 (7.1%) screenings. Patients with a BVC score of <2 required an intervention 16 times (1.2%), and BVC score of >2 required an intervention 90 times (54.2%), OR= 17.95 (95% CI: 3.55 to 90.84), p< 0.001.
Discussions: Total BVC score, male gender, and older age were highly predictive of violence. Also, as the BVC score increased above 1, additional interventions were utilized.
Conclusion: The BVC has value, indicating that patients who score above 1 can pose enough threat to require an intervention. Thus, uncovering risks and identifying the potential for violence is essential to diminishing harm and WV.
ContributorsSilwal, Sadikshya (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-05-01
Description
Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight and health. Primary care providers (PCP) have limited knowledge of current evidence in obesity treatment. The project guides the form of tools to help identify the patients' self-efficacy, change readiness, and insurance reimbursement.
Methods: Expedited IRB approval was obtained, allowing for data analysis from completed de-identified screenings, surveys, and medical records gathered between September 2022 and April 2023. Screenings including Weight Efficacy, Lifestyle long-form (WEL-LF), and Stages Of Change Readiness And Treatment Eagerness Scale In Overweight And Obesity (SOCRATES-OO) were used to assess the effectiveness of the treatment plan. Russwurm and Larrabee's model for evidence-based practice change was chosen for the project's framework. The provider was given a guide for obesity management with tips for billing insurance. A convenience sample of eight patients met with the providers over three months as part of their obesity management treatment plan.
Results: The pre and post-screenings collected from the remaining participants (n=8) showed no statistical differences. However, the satisfaction and feedback survey from patients (n=8), provider (n=1), and office staff (n=4) showed improved quality of care and greater confidence in the provider's part in initiating and managing their patient's chronic obesity.
Conclusion: Improving PCPs' knowledge of Obesity treatment improves patient care. Expanding this project to a larger scale and disseminating the information can impact patients' lives positively.
Keywords: Obesity; self-efficacy; readiness for change; stages of change; primary care, Weight Efficacy Lifestyle questionnaires
ContributorsBrock-Andersen, Marian (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Nonadherence to psychiatric medications was identified as an issue worldwide and in a non-profit organization for women recovering from substance use disorders (SUD) in the southwestern United States. Non-adherence is associated with increased hospitalizations and relapse. A literature review indicated that motivational interviewing (MI) was an evidence-based intervention for increasing psychiatric medication adherence in women recovering from SUD. This project aimed to assess if training the organization staff on MI, would impact their beliefs, knowledge, and comfort of using MI on their clients with non-adherence. The Theory of Planned Behavior is the underlying principle of the project. A recruitment flyer was sent to the organization via email, and interested staff attended the training on the basics of MI via a PowerPoint presentation through video conferencing. Pre-, post-, and one-month follow-up questionnaires were provided to assess participants' knowledge, familiarity, and comfort with MI. The questionnaires consisted of the reliable/validated Beliefs About Medication questionnaire (BMQ) and questions about MI. Participants were deidentified for data collection. A Friedman's test and descriptive statistics were used for analysis. 17 staff participated; five one-month follow-ups were completed. Participants believed medication was more beneficial than harmful and necessary for improvement-nonsignificant: Friedman test p = .179. Upon follow-up, 40% reported being comfortable using MI while 60% reported they had not used MI yet. MI training may improve staff comfort and ability to address medication nonadherence. A larger sample may lead to significant and generalizable results.
ContributorsDarko-Amoako, Princess (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Loneliness and depression in older adults are under-recognized public health concerns that increase risks for all-cause mortality, medical morbidity, and rising healthcare costs. This quality improvement project assessed whether smartphone Mindfulness software mitigated self-reported feelings of loneliness and depression among community-dwelling older adults. Nine participants aged 65 and older, living at home, experiencing loneliness or depression, and owning a smartphone were recruited using newsletters and fliers. A short demographics questionnaire and two valid and reliable instruments, namely the University of California Los Angeles Loneliness Scale (UCLA V3) and Geriatric Depression Scale (GDS), were used in pre-intervention and four weeks post-intervention. Participants downloaded the UCLA Mindful app on their smartphones after attending a 20-minute Mindfulness education at a local church banquet room. Participants used the UCLA Mindful software twice weekly for ten minutes for four weeks. Of the nine participants, three completed the study. A two-tailed paired sample t-test and descriptive analysis were used to evaluate the efficacy of the UCLA Mindful smartphone software. The results of the two-tailed paired sample t-test were not statistically significant for the UCLA V3 Loneliness scale (p=.220) and GDS (p=.208) due to the small sample size. Although the results were negligible, participants nevertheless reported favorable impacts. Future research with a larger sample size is encouraged.
ContributorsMurdock, J. Kristine (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Problem Statement: The onset of the COVID-19 pandemic led to intense challenges for health care providers. Outpatient primary care practices rapidly moved from in-person practice to video-conferencing telehealth appointments. This shift requires study, particularly how this has impacted the lived experience of providers.
Purpose: This project aims to explore primary care provider satisfaction with telehealth in the wake of the COVID-19 pandemic.
Methods: A point-in-time survey was administered to primary care providers at a large university health system. Participants were recruited at a monthly provider meeting and invited to complete an anonymous online survey. Satisfaction with video-conferencing patient visits was explored via Likert scale and write-in responses. Providers highlighted specific complaints, problems, and successes that impacted their practice and patients. Aggregate health data from this organization was also obtained for comparison. Statistical analysis was performed and recommendations made for future practice.
Findings: The provider experience of telehealth was overwhelmingly positive. 85% (n=11) of providers agreed or strongly agreed that telehealth allows them to manage their patients effectively. Lack of physical exam findings was the most commonly cited concern (n=9). 100% (n=13) of providers would like to continue seeing patients via telehealth in the future.
Conclusion: Videoconferencing appointments in university health primary care promote high provider satisfaction. Future policies and innovations should support the use of a telehealth platform.
ContributorsMcKernan, M. Katherine (Author) / Nunez, Diane (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of the leading causes of patients' ability to maintain peritoneal dialysis. Evidence suggests that enhanced patient education on infection control practices beyond standard education effectively reduces peritonitis incidents.
Methods: Enhanced education on infection control practices was delivered to 18 peritoneal dialysis patients in Southern Arizona through the application of determinants of the Health Belief Model utilizing the principles of the ADKAR framework. Data analysis will be available through facility-specific quality metrics of decreased peritonitis and modality loss episodes. Each of these measures is to have data compared to pre/post-intervention.
Results: All participants in the study were able to sustain peritoneal dialysis as their renal replacement therapy. Of the 18 participants, one patient episode of peritonitis occurred three months before the intervention, and zero episodes were reported during the first three months of monthly infection control education. Facility-specific peritonitis and modality loss measures are not available until after project publication.
Conclusion: To decrease peritonitis rates and modality loss, the intervention will continue for eight to 12 months to determine success. More time is needed to determine if patients adhere to monthly infection control practices taught during enhanced education.
ContributorsSchneeweis, A. Danielle (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Signal transduction networks comprising protein-protein interactions (PPIs) mediate homeostatic, diseased, and therapeutic cellular responses. Mapping these networks has primarily focused on identifying interactors, but less is known about the interaction affinity, rates of interaction or their regulation. To better understand the extent of the annotated human interactome, I first examined > 2500 protein interactions within the B cell receptor (BCR) signaling pathway using a current, cutting-edge bioluminescence-based platform called “NanoBRET” that is capable of analyzing transient and stable interactions in high throughput. Eighty-three percent (83%) of the detected interactions have not been previously reported, indicating that much of the BCR pathway is still unexplored. Unfortunately, NanoBRET, as with all other high throughput methods, cannot determine binding kinetics or affinities. To address this shortcoming, I developed a hybrid platform that characterizes > 400 PPIs quantitatively and simultaneously in < 1 hour by combining the high throughput and flexible nature of nucleic programmable protein arrays (NAPPA) with the quantitative abilities of surface plasmon resonance imaging (SPRi). NAPPA-SPRi was then used to study the kinetics and affinities of > 12,000 PPIs in the BCR signaling pathway, revealing unique kinetic mechanisms that are employed by proteins, phosphorylation and activation states to regulate PPIs. In one example, activation of the GTPase RAC1 with nonhydrolyzable GTP-γS minimally affected its binding affinities with phosphorylated proteins but increased, on average, its on- and off-rates by 4 orders of magnitude for one-third of its interactions. In contrast, this phenomenon occurred with virtually all unphosphorylated proteins. The majority of the interactions (85%) were novel, sharing 40% of the same interactions as NanoBRET as well as detecting 55% more interactions than NanoBRET. In addition, I further validated four novel interactions identified by NAPPA-SPRi using SDS-PAGE migration and Western blot analyses. In one case, we have the first evidence of a direct enzyme-substrate interaction between two well-known proto-oncogenes that are abnormally regulated in > 30% of cancers, PI3K and MYC. Herein, PI3K is demonstrated to phosphorylate MYC at serine 62, a phosphosite that increases the stability of MYC. This study provides valuable insight into how PPIs, phosphorylation, and GTPase activation regulate the BCR signal transduction pathway. In addition, these methods could be applied toward understanding other signaling pathways, pathogen-host interactions, and the effect of protein mutations on protein interactions.
ContributorsPetritis, Brianne Ogata (Author) / LaBaer, Joshua (Thesis advisor) / Lake, Douglas (Committee member) / Wang, Shaopeng (Committee member) / Arizona State University (Publisher)
Created2018
Description
Multicellular organisms use precise gene regulation, executed throughout development, to build and sustain various cell and tissue types. Post-transcriptional gene regulation is essential for metazoan development and acts on mRNA to determine its localization, stability, and translation. MicroRNAs (miRNAs) and RNA binding proteins (RBPs) are the principal effectors of post-transcriptional gene regulation and act by targeting the 3'untranslated regions (3'UTRs) of mRNA. MiRNAs are small non-coding RNAs that have the potential to regulate hundreds to thousands of genes and are dysregulated in many prevalent human diseases such as diabetes, Alzheimer's disease, Duchenne muscular dystrophy, and cancer. However, the precise contribution of miRNAs to the pathology of these diseases is not known.
MiRNA-based gene regulation occurs in a tissue-specific manner and is implemented by an interplay of poorly understood and complex mechanisms, which control both the presence of the miRNAs and their targets. As a consequence, the precise contributions of miRNAs to gene regulation are not well known. The research presented in this thesis systematically explores the targets and effects of miRNA-based gene regulation in cell lines and tissues.
I hypothesize that miRNAs have distinct tissue-specific roles that contribute to the gene expression differences seen across tissues. To address this hypothesis and expand our understanding of miRNA-based gene regulation, 1) I developed the human 3'UTRome v1, a resource for studying post-transcriptional gene regulation. Using this resource, I explored the targets of two cancer-associated miRNAs miR-221 and let-7c. I identified novel targets of both these miRNAs, which present potential mechanisms by which they contribute to cancer. 2) Identified in vivo, tissue-specific targets in the intestine and body muscle of the model organism Caenorhabditis elegans. The results from this study revealed that miRNAs regulate tissue homeostasis, and that alternative polyadenylation and miRNA expression patterns modulate miRNA targeting at the tissue-specific level. 3) Explored the functional relevance of miRNA targeting to tissue-specific gene expression, where I found that miRNAs contribute to the biogenesis of mRNAs, through alternative splicing, by regulating tissue-specific expression of splicing factors. These results expand our understanding of the mechanisms that guide miRNA targeting and its effects on tissue-specific gene expression.
MiRNA-based gene regulation occurs in a tissue-specific manner and is implemented by an interplay of poorly understood and complex mechanisms, which control both the presence of the miRNAs and their targets. As a consequence, the precise contributions of miRNAs to gene regulation are not well known. The research presented in this thesis systematically explores the targets and effects of miRNA-based gene regulation in cell lines and tissues.
I hypothesize that miRNAs have distinct tissue-specific roles that contribute to the gene expression differences seen across tissues. To address this hypothesis and expand our understanding of miRNA-based gene regulation, 1) I developed the human 3'UTRome v1, a resource for studying post-transcriptional gene regulation. Using this resource, I explored the targets of two cancer-associated miRNAs miR-221 and let-7c. I identified novel targets of both these miRNAs, which present potential mechanisms by which they contribute to cancer. 2) Identified in vivo, tissue-specific targets in the intestine and body muscle of the model organism Caenorhabditis elegans. The results from this study revealed that miRNAs regulate tissue homeostasis, and that alternative polyadenylation and miRNA expression patterns modulate miRNA targeting at the tissue-specific level. 3) Explored the functional relevance of miRNA targeting to tissue-specific gene expression, where I found that miRNAs contribute to the biogenesis of mRNAs, through alternative splicing, by regulating tissue-specific expression of splicing factors. These results expand our understanding of the mechanisms that guide miRNA targeting and its effects on tissue-specific gene expression.
ContributorsKotagama, Kasuen Indrajith Bandara (Author) / Mangone, Marco (Thesis advisor) / LaBaer, Joshua (Committee member) / Newbern, Jason (Committee member) / Rawls, Alan (Committee member) / Arizona State University (Publisher)
Created2019