University of North Carolina at Greensboro
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Improving Awareness and Knowledge of Local Anesthetic System Toxicity Amongst Labor and Delivery Nurses: Through Education, Simulation, and Cognitive Aids
Full text linkBackground: Local Anesthetic Systemic Toxicity (LAST) is a high-acuity, low-occurrence medical emergency caused by increased plasma concentrations of local anesthetics. When early signs and symptoms such as tinnitus, confusion, and tingling around the mouth go unidentified, symptoms can quickly progress to respiratory and cardiac arrest. Although LAST events are infrequent, they contribute to maternal morbidity and mortality. Purpose: This project aimed to provide traditional education and simulation to increase awareness, knowledge, and confidence in recognizing LAST and providing prompt treatment to laboring mothers. Methods: Labor and delivery nurses received a PowerPoint presentation and a scripted LAST simulation. The project used a mixed-method cross-sectional design to collect data to evaluate awareness, knowledge, and confidence following the implementation. Results: Thirty-two labor and delivery nurses participated in the implementation of this project, and fourteen of the thirty-two participants participated in the one-month follow-up surveys. Data collected by the pre-and post-surveys were analyzed using paired t-tests for two samples. All participants had increased awareness and knowledge of LAST, and most had increased confidence after the intervention. Conclusion: Results indicated that the intervention effectively increased awareness, knowledge, and confidence in identifying and managing a LAST event. By having more awareness, knowledge, and confidence in managing LAST, maternal morbidity and mortality should decrease during a LAST event. It is recommended that labor and delivery floors implement formal training along with simulation to create more awareness of LAST and to increase knowledge and confidence in managing a LAST event
Estimating homologous recombination rates across bacterial lineages and genomes
Full text linkThe study of bacteria has become increasingly important to agriculture, healthcare, and industry. However, the evolutionary forces that enable their unparalleled ability to adapt and persist in new environments have yet to be thoroughly determined. Due to their reproduction by binary fission, most evolutionary models consider bacteria to be clonally evolving. However, this ignores the contribution of genetic material from lateral genetic transfer (i.e. homologous recombination) which may be more impactful to their species and genomic evolution than mutation alone. Furthermore, tools developed to compare the impact of homologous recombination to mutation in bacteria are often based on strong assumptions and have been used to analyze only few species represented by few genomes. This, combined with a lack of standardization across methodologies and highly inconsistent measurements between studies makes determining the true impact of homologous recombination on bacterial evolution difficult. In this dissertation, I estimate the evolutionary impact of lateral genetic exchange via homologous recombination in 162 bacterial and one archaeal species under a unified framework based on Approximate Bayesian Computation (ABC). Using this data, I was able to map the evolution of recombination rate – as a trait – across many bacterial species represented by thousands of genomes, as well as estimate recombination rate variation on a gene-by-gene basis across bacterial chromosomes. Overall, this study provides insight into the diversity of recombination rates across bacterial species – a key step in understanding how homologous recombination plays a role in bacterial speciation, adaptation, evolution, and population diversity
Measuring and Reducing Noise Levels in the Operating Room during Induction and Emergence
Full text linkThis DNP project seeks to apply the existing evidence linking noise and workplace distractions to safety in the operative room and use an educational intervention to address knowledge deficits to change practice to reduce distractions during induction and emergence from anesthesia. Decibel monitors were placed in select operating rooms at the community hospital at two different times, two weeks before and two weeks after an educational intervention for perioperative staff. The resulting sound levels were predominately within the recommended governmental standards of noise. Mean sound levels before the intervention (57.8dB) and after the intervention (58.8dB) showed a statistically significant difference, potentially attributable to the time-sensitive nature of this project and lack of one-on-one communication with perioperative staff. These findings suggest alternative approaches to sound level reduction should be considered when educating perioperative personnel. Perioperative staff should remain vigilant with noise reduction techniques to reduce communication limitations during induction and emergence
Educational Intervention On Preinduction Ondansetron As Prophylaxis For Subarachnoid Block-Induced Shivering
Full text linkBackground: Post-anesthesia shivering affects 55% of patients who receive a subarachnoid block and increases the risk of cardiac complications. Ondansetron can reduce the incidence of shivering by 57% to 80% when administered before the block. However, anesthesia providers do not typically administer ondansetron before the block. Purpose: This project aimed to increase provider recognition of post-anesthesia shivering as a clinical problem, decrease the incidence of post-anesthesia shivering, and increase the administration of ondansetron before subarachnoid block using an educational intervention. Methods: The eight-week project used an educational intervention to change anesthesia providers' perceptions of the incidence and severity of post-anesthesia shivering and the safety and efficacy of ondansetron in preventing it. The providers' perceptions were assessed using a pre- and post-intervention survey and retrospective chart data. Results: The results showed a significant change in provider perceptions of ondansetron's efficacy and benefits. However, pre-subarachnoid block ondansetron administrations decreased after the intervention. It was not possible to quantitatively measure the incidence of shivering. Recommendations: Systemic changes at the project site, including stakeholder ownership and the operating room process, may be necessary to improve the quality of care further
Improving Knowledge, Recognition, and Management of Local Anesthetic Systemic Toxicity (LAST) in Labor and Delivery Nurses
Full text linkBackground: Local anesthetic systemic toxicity (LAST) is a high-impact, low-occurrence complication of administering local anesthesia, which can potentially be lethal to the patient if not recognized quickly. Purpose: This DNP project aims to provide education and increase awareness and proficiency in early recognition and management of a LAST event, specifically in labor and delivery nurses. Methods: A mixed-method design, including quantitative and qualitative methods. A quantitative method was used to evaluate recognition, knowledge, and confidence levels, and a qualitative method allows for an improved understanding of barriers to practice. Data were grouped into two categories. Group A comprised the entire sample of participants who completed the pre-intervention survey (n=22). Group B comprised the entire sample of participants who completed the post-intervention survey (n=22). Each group underwent statistical analysis using a two-sample T-test to determine statistical significance. Results: The average mean scores for knowledge and confidence increased across all categories. The education provided will be included in the annual competency training and orientation program for L&D nurses at this facility. Recommendations and Conclusions: It is recommended that LAST training be incorporated into the annual continuing education program. The results of this project have shown that knowledge and confidence improved for the L&D registered nurse
Advanced Care Planning Discussions and Documentation in Primary Care
Full text linkBackground: As the life spans of Americans are increasing, so is the number of people who are living longer with multiple chronic comorbid conditions. Advanced care planning is, therefore, important because it is a process that helps patients discuss and communicate their future treatment and end-of-life preferences with their providers if they lose their capacity to make decisions or communicate their wishes and preferences. Primary care settings are ideal for integrating advanced care planning into routine care and health maintenance. Purpose: This project aims to increase advanced care planning discussions and documentation in a primary care clinic through a workflow that identifies patients without advance directives and educates staff and providers about appropriately documenting and billing for advanced care planning discussions. Methods: Under the framework of the Transtheoretical Model, this quality improvement project implemented different interventions to increase advanced care planning discussion rates. A live PowerPoint presentation was conducted with the clinic staff on appropriately identifying patients without advance directives documents. Additionally, information was provided on how to document and bill advanced care planning discussions. Advanced care planning current procedural terminology code billing frequencies were tracked pre and post intervention over three months. Results: Descriptive statistics was used to analyze the data because it was small; this also meant there would be no hypothesis testing. Four providers participated, and the project resulted in a slight increase in advanced care planning billing codes post intervention compared to pre intervention. The pre intervention phase revealed 3 documented advanced care planning billing codes 99497. There was no documentation for billing code 99498. The post intervention phase had 5 documented billing codes, including 99497. Recommendations and Conclusion: The project identified that timing can be a barrier for providers in primary care clinics. As a result, this can affect the number of advanced care planning discussions and documentation conducted. A standardized system, such as utilizing support staff to engage in the advanced care planning process, can help increase those rates. Advanced care planning can increase revenue for primary care settings and the overall quality of care rendered during end-of-life
The life significance of undergraduate outdoor academic programs: Alumni perspectives
Full text linkUndergraduate outdoor academic programs have existed in the United States of America since the 1970s. These programs necessitate financial support, copious time from students and faculty, access to outdoor spaces, and specialized training for faculty, and so despite a strong academic tradition, these programs are challenging to justify to college administrators. Therefore, the purpose of this study was to explore the perceived life significance of experiences in an undergraduate outdoor academic program and if those experiences impacted graduates' careers. To address the gap in the literature, this study utilized a significant life experience theoretical framework and engaged alumni of three longstanding undergraduate outdoor academic programs via an Internet survey. The results indicate that respondents found their undergraduate outdoor academic program to be extremely impactful on their career whether their current work is in the outdoor industry or another field
Student choice and voice in physical education
Full text linkThe purpose of this study was twofold. First, to explore the teacher researchers’ (TR) previous experiences and evolving understanding of student choice and student voice initiatives. Second, this study also investigated the implementation of student voice practices and the connection of these practices to students’ understanding of social and emotional learning (SEL) skills. A qualitative case study design using participatory action research was appropriate for this study. Data was collected from student focus groups, individual interviews with the TR, journal reflections, student personal biographies, physical activity timelines, post-lesson reflections, and exit slips. Twenty-five ninth-grade students participated in the study. Five themes were drawn from the data: An Evolving Approach, Fun With Friends, I Can Choose What I Want to Do, Communication is Key, and Developing Competency. The findings of this study help provide a clearer understanding of how the TR’s experiences and efforts influenced student experiences with student voice. These findings help deepen our understanding of the steps needed to facilitate more authentic student voice pedagogies and enhance SEL in physical education (PE). The findings of this study will be made available to local school district officials, administrators, and PE faculty. Further inquiry into the perspectives of students and teachers' understanding of student voice initiatives and SEL will advance knowledge and add to the promising findings in the literature. This study can assist researchers and practitioners to further understanding of how student choice and SEL can be better implemented into future pedagogy practices to meaningfully influence teaching and learning in PE
Examining resiliency and grit in school psychologists with concerns to burnout
Full text linkResearchers have studied the effects of burnout on School Psychologists since the 1980s. Few studies exist that attempt to measure psychometric properties adjacent to, or that may contribute to burnout as measured by the Maslach Burnout Inventory. The purpose of this study was to investigate if two constructs, resiliency, and grit, may account for variability for each of the three subscales on the Maslach Burnout Inventory: emotional exhaustion, depersonalization, and personal accomplishment. This research could help to establish effective predictors of burnout for school psychologists before the effects of burnout begin to be felt. Participants (N = 77) were surveyed on age (M = 35.21) and years of experience (M = 8.80) which were used as control variables. The research questionnaire surveyed participants with The Connor-Davidson Resilience Scale and the Grit Scale and used multiple linear regression methods to predict the same participants results on the subscales of the Maslach Burnout Inventory. Results indicated both resilience (? = -0.22, p = .042) and grit (? = -0.25, p = .023) had significant, negative associations towards emotional exhaustion. Resilience also had a significant positive association (? = 0.31, p = .005) towards feelings of personal accomplishment. Implications for this research, limitations, and future directions were discussed
Utilizing the Constrained K-Means Algorithm and Pre-Class GitHub Contribution Statistics for Forming Student Teams
Full text linkIn modern software engineering education, team formation is crucial for mimicking real-world collaborative scenarios and boosting project-based learning outcomes. This paper introduces a simple, innovative, and universally adaptable method for forming student teams within a software engineering class. We utilize publicly available pre-class GitHub metrics as our input variables (e.g., number of commits, pull requests, code size, etc.). For team formation, the constrained k-means algorithm is employed. This algorithm embracesdomain-specific constraints, ensuring the resulting teams not only resonate with the inherent data clusters but also meet educational requirements. Preliminary results suggest that our methodology yields teams with a harmonious blend of skills, experiences, and collaborative potentials, thereby setting the stage for enhanced project success and enriched learning experiences. Quantitative analyses show that teams formed via our approach outperform both randomly assembled teams and student self-selected teams concerning project grades. Moreover, teams created using our method also display a reduced standard deviation in grades, suggesting a more consistent performance across the board