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Transforming Care: Elevating Oral Hygiene Compliance to Combat Nosocomial Aspiration Pneumonia in Adult Oncology Patients
Get PDFObjective Aspiration pneumonia is a preventable, yet common complication in oncology patients undergoing chemotherapy, steered by suboptimal compliance with oral hygiene protocols and elevated susceptibility due to mucosal barrier injuries. Despite its major impact on healthcare costs and morbidity, compliance with evidence-based practices remains inadequate. Aim This project aimed to decrease nosocomial aspiration pneumonia rates from 1.5% to 1.3% by enhancing oral hygiene compliance from 41% to 70% over a 12-week period. Methods Proposed interventions included implementing paired oral hygiene order sets into electronic medical records, once-per-shift cues, staggered patient education sessions, and staff education on standardized protocols. Pre-intervention data pinpointed gaps in adherence and education, while future metrics for assessment included compliance rates, mucosal barrier injuries, and pneumonia incidence. Results Baseline findings disclosed that 20% of patients had a lack of knowledge surrounding oral hygiene protocols. Barriers included inconsistent workflows, inadequate reminders, and a shortage of resources. Proposed interventions addressed these barriers to optimize compliance and decrease complications. Conclusions Although not implemented, the proposed interventions offer a foundation for enhancing oral hygiene compliance and decreasing the incidence of aspiration pneumonia. Future implementation and evaluation are required to measure their effectiveness and maintain long-term improvements in oncology care. Keywords aspiration pneumonia, nosocomial infection prevention, oncology care, oral hygiene, complianc
Reducing the Incidence of Nosocomial Aspiration Pneumonia in Adult Oncology Patients Through Improved Compliance with Oral Hygiene Protocols
Get PDFObjective: Oncology patients undergoing chemotherapy are at increased risk of mucosal barrier injuries and aspiration pneumonia, with current aspiration pneumonia rates exceeding target levels. Enhanced oral hygiene protocols and improved compliance have been shown to reduce these complications in this vulnerable population.
Context: The microsystem under review comprises six oncology units within Hospital A, a major medical center in California. Aspiration pneumonia, frequently linked to mucosal barrier injuries, poses a significant threat to patient safety and increases treatment costs and complications in oncology care. Recognizing the critical need to address this issue, an aspiration pneumonia task force has prioritized efforts to reduce nosocomial aspiration pneumonia rates across the oncology units.
Aim: By the end of fiscal year 2025, the project aims to reduce the incidence of aspiration pneumonia among adult oncology patients from 1.5% to 1.3% of total discharges—a 13.3% reduction. This goal will be achieved through targeted interventions to improve oral hygiene compliance, increase nursing awareness, and enhance patient education.
Methods: Due to project time constraints, interventions were not implemented; however, proposed strategies were presented to nursing quality leaders and the aspiration task force for future consideration. Recommended actions include standardizing oral hygiene order sets for neutropenic patients at risk for mucositis, mucosal barrier injuries, and aspiration pneumonia, clarifying nursing guidelines, and improving patient education. Two key measures were identified: an outcome measure tracking aspiration pneumonia rates and a process measure assessing oral hygiene compliance, both critical to evaluating intervention success.
Expected Results: Evidence from the literature supports the anticipated outcomes: increased patient awareness about oral hygiene, higher compliance with oral hygiene protocols for patients with paired order sets, and improved nursing adherence to standardized practices. Enhanced compliance is expected to lower rates of mucositis and mucosal barrier injuries, which, in turn, will reduce the incidence of aspiration pneumonia.
Conclusion: Root cause analysis and baseline data identified key drivers contributing to low oral hygiene compliance among neutropenic patients. Proposed interventions aim to standardize oral hygiene practices, refine nursing guidelines, and strengthen patient education, ultimately improving compliance and reducing aspiration pneumonia rates across six acute care oncology units. Sustainability measures include appointing oral care champions, conducting biannual patient questionnaires, and implementing monthly compliance audits.
Keywords: aspiration pneumonia, mucosal barrier injuries, mucositis, oral hygiene compliance, oral saline rinses, oncology department, education, standardized oral hygiene order set
Healing Words: The Power of Patient-Centered Communication in Bedside Reports
Get PDFObjective In the healthcare setting, using language that is not patient-centered can result in lower patient satisfaction, increased miscommunication, and heightened anxiety for patients. Hospital A currently lacks education on the use of patient-centered language within the peripartum mesosystem, despite being required to conduct bedside reports. Hospital A is an urban tertiary hospital in San Francisco, whose peripartum mesosystem is divided into two levels with a total of 35 beds. Aim The project aimed to increase patient satisfaction by implementing patient-centered language during bedside reports for peripartum nurses from 70% to 80% during labor and delivery (L&D) to postpartum (PP) patient transfer between October 28 and November 15. Methods The project implements a patient-centered language guide supported by literature reviews and designated the words in the guide for the maternity unit based on personal observation, and educated both L&D and PP nurses on the guide. The primary outcome evaluated was the nurse’s understanding of the patient-centered language. Results Results show that more than 50% of L&D nurses said they were very familiar with the patient-centered language tool and always purposefully used it with patients after education. 96.5% of nurses believe that using patient-centered language promotes trust between patients and nurses. Survey responses show major challenges of using patient-centered language in practice, including time constraints and patient’s cultural or language differences. Conclusion Effective education about patient-centered language helps nurses understand what it is, encourages patient-nurse trust, and facilitates bedside reports
Climate- and Land-use Change Impacts on Ecosystem Services provided by Prairie Pothole Wetlands
Get PDFPrairie pothole wetlands are a type of depressional, isolated wetland that can be found in the glaciated landscape of the mid-central United States and portions of southern Canada, also referred to as the Prairie Pothole Region (PPR). The region is consistently recognized for its historic production and support of migratory waterfowl populations among other types of mammals and invertebrates largely due to the variability in pothole wetlands water levels and vegetative structure. Isolated from other waterbodies and lacking surface water connections, the hydrology of prairie pothole wetlands is influenced by the region’s continental climate. Historically, the region receives much of water inputs from springtime snowmelt and precipitation events. However, under different emission scenarios, global climate change could increase the temperature of the region between 0.8 to 8.4 °C and lead to increased precipitation patterns. Coupled with historic and continued land-use change and wetland drainage in support of agricultural production, the hydrology of prairie potholes is likely to change. Changing hydrologic conditions are likely to have larger ramifications on ecosystem services provided by these wetlands, including the ability to buffer against flood events and the ability to maintain habitat and nursery populations, specifically for migratory waterfowl. As prairie potholes lack federal protections under the Clean Water Act, continued implementation of voluntary conservation programs is needed to conserve the remaining pothole wetlands and the services they provide. Opportunities to enhance voluntary conservation efforts should consider climate simulation models to identify high risk areas and seek to incentivize conservation in these locations
ACCESSIBLE TECHNOLOGY FOR ALL: A CONTENT ANALYSIS OF UX DESIGN IN MOBILE WEBSITES AND APPLICATIONS
Get PDFMore and more, digital technologies are becoming the fabric of everyday life, imbuing almost every aspect of modern society. With an increasing reliance on technology to complete essential tasks for school, work, communication, health, finance, and more, there remain barriers to accessing these tools. These barriers are not just represented by the digital divide, the haves and have-nots, but in the myriad ways in which the technologies we use every day are difficult to use, complex, or simply inaccessible. This research study investigates the factors that impact the accessibility of technology, specifically for individuals with either temporary, situational, or permanent disabilities. Further, this study identifies ways to enhance user experience (UX) design and to reduce the barriers that render technology inaccessible to segments of the population. As part of this study, design frameworks, including human-centered design, multimodality, and Universal Design principles are presented in conjunction with Web Content Accessibility Guidelines (WCAG) to build out an inclusive and accessible approach to UX design and evaluation.
This dissertation is organized into three chapters: Chapter I: Statement of the Problem; Chapter II: Review of the Literature; Chapter III: Methodology. These chapters are followed by journal articles (Appendices A and B) that describe the research for this study.
Article 1 (Appendix A) examines the barriers people experience when using technology. The article presents the different access modalities people adopt when using technology and the types of barriers they experience. Theoretical frameworks and accessibility guidelines are discussed and integrated into a checklist to build awareness of accessibility considerations for not only UX designers and software developers, but also for anyone interested in better understanding accessible design. This article was prepared for submission to the Journal of User Experience.
Article 2 (Appendix B) presents original research, a content analysis of 48 websites and applications (apps), following predefined user journeys to access, navigate, and interact with each website and app on a mobile device. The selected websites and apps were organized into four categories: Instruction, Messaging, Products & Commerce, and Transportation as these reflect categories of essential and daily tasks for most people and often require the use of technology. This article was prepared for submission to the journal Ergonomics
AN EXPLORATION OF ADULT CHILDREN’S ATTACHMENT TO THEIR PARENTS ACROSS TWO CULTURAL GROUPS: INDIANS IN INDIA AND INDIANS WHO IMMIGRATED TO THE UNITED STATES
Get PDFTypically, attachment theory has been studied and explored with western populations. Individuals seeking mental health treatment within the United States include western and nonwestern cultural groups and research, theories and interventions that apply to diverse populations are necessary. Attachment relationships are often a part of, or reasons for clients to seek therapy either overtly or covertly, thus allowing research on attachment to better inform treatment plans and practice. An attachment relationship between a parent and child can be influenced by several factors and may change over the course of development, but little is known about this process among Indians who reside in India and Indians who immigrated to the United States. Through exploratory semi-structured interviews, the present study aimed to explore the change and maintenance of attachment relationships from childhood to adulthood from perspectives and narratives of the adult child population. Further, the study aimed to identify the factors that contribute to the change or maintenance of these relationships over time. This study focused on cross cultural differences between Indians in India and Indian migrants living in the United States, to identify between and within group differences. Hypothesized factors such as immigration, religion, career decisions as well as newly identified factors that participants shared were synthesized and analyzed using thematic analysis. Common themes (factors) that impact attachment relationships were identified through data analysis. These themes included immigration experiences, religion, family values, and the impact of siblings on an attachment relationship. An important finding in the study was that individualism and collectivism were not concrete concepts to each group as each participant’s narratives provided insight into how the sample group and population at large may not be entirely individualistic or collectivistic, allowing for a cohesion in values and preferences. The findings from the present study have potential to contribute to future studies on factors impacting attachment relationships, and also provide more insight for clinicians to develop interventions that focus on the impact of family systems, acculturation, migration, religion, communication and other factors on an attachment relationship. Also, the study’s findings are intended to further support clinical interventions and providers to accurately recognize the cultural variations between the two groups, and better serve the two groups in clinical settings
Making Us Matter Workbook: Combating Anti-Blackness and White Supremacy: And Other Conversations About Racism in Schools
Get PDFThe Making Us Matter Workbook was designed to inspire communities to initiate and organize a small Clapback Collective that is well-informed and has developed a collective strategy to deal with racism and anti-Blackness in the culture and curriculum of their educational institutions. The author aims to help students and educators develop understanding, utilize tools, and employ strategies needed to effectively combat anti-blackness and racial injustice in their schools. This multi-media resource serves as both syllabus and workbook by providing structure, source material, exercises, discussion questions, and vocabulary needed to turn this knowledge into a comprehensive and collective plan toward educational liberation
Quiet Quitting or Just Tired as Hell?: Embracing the Challenging Reality of Work-Life Balance as a Black Woman in Academia
Get PDFQuiet quitting is a phenomenon that has swept the globe as result of burnout and apathy in the work environment. The result of deeper issues causes some employees to disengage in the professional environment. After reflection, there was a personal realization that quiet quitting was not my issue, but instead I was tired of the juggling act required for maintaining a healthy work-life balance in academia. Three practical approaches to implement when explicitly and intentionally dealing with the challenge of work-life balance in academia, particularly as a Black woman are (1) learning to say no, (2) establishing healthy boundaries, and (3) engaging in enjoyable work. Recognizing the need for healthy work-life balance begins with reflection and honest self-assessment
Black Teacher, Black Mommy: Co-Conspirators for Equity in American Public Schools
Get PDFThis narrative piece is a reflection of one Black mother’s experience with navigating the public education system in a large city in the United States. The author explores the humbling and often powerless moments she feels as an educator with over 21 years of experience, yet also as a first-time mother of a Black girl. She discusses the impactful Black teachers and other co-conspirators who helped to advocate for her and her daughter, Aya, during their schooling journey thus far. She concludes by referring back to her own father’s text, which outlines a framework for transformational education for Black children and families
Creating whole inclusive worlds: The impact of social media usage on Black gender expansive millennials’ experiences of social support and identity development processes
Get PDFThis qualitative study explored the processes of finding community and developing one’s own intersectional racial and gender identity through the social media (SM) experiences of 8 Black gender expansive (GE) adults located around the United States. Using Interpretative Phenomenological Analysis (IPA) methodology and an intersectional theoretical framework, the research questions guiding the study were: “What is the relationship between Black gender expansive people, social media, and community?” and “What is the relationship between Black gender expansive people, social media, and identity development?” The researcher’s findings from in-depth interviews with participants included three major themes: A) Positive Resilience-Supporting Experiences on SM, B) “Don’t Read the Comments”: Negative Experiences on SM, and C) Intersectional Identity Development IRL (In Real Life) and on SM. An analysis of these findings, implications for practice, and suggestions for future research are discussed