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Translating the Evidence: Comprehensive Approaches for Head and Neck Cancer Prehabilitation
Full text linkHead and neck cancer survivors experience significant changes to their health, well-being, and ability to participate in daily life activities as a result of cancer treatment. Oftentimes, these patients are left to their own devices without concrete instructions or strategies to mitigate, much less prevent, the sequelae they experience. Likewise, interdisciplinary teams lack an evidence-based framework in which to provide comprehensive supportive care for patients with head and neck cancer. Despite acknowledgement within the occupational therapy profession of the chronic nature of survivorship (Baxter et al., 2017) and the national public health initiatives to prevent and reduce the impact of secondary chronic disease burden (American Occupational Therapy foundation, n.d.; National Center for Chronic Disease Prevention and Health Promotion (U.S.) et al., 2004), there remains a critical gap in preventative services in head and neck cancer populations regarding known side effects of cancer treatment (Berkowitz et al., 2018; Fang & Heckman, 2016; Rogers et al., 2011). Therefore, a review and critical appraisal of the existing evidence surrounding prehabilitation as a model of care and the role of occupational therapy with head and neck cancer survivors was indicated. The evidence review and critical appraisal, which took place in the fall of 2021, provided the underpinning for three knowledge translation projects.
The aims of this doctoral project are to increase awareness of head and neck cancer survivors’ needs and to share knowledge concerning evidence-based interventions and approaches to meet these needs. To accomplish these aims, I selected three different methods to translate knowledge. In the first project I sought to educate generalist practitioners and students in the context of a collaborative synchronous webinar series with the Minnesota Occupational Therapy Association about implications for practice. The second project involved a live webinar embedded within a semi-annual meeting of the Michigan Occupational Therapy Association Oncology Special Interest Section. Attendees in this project were assumed to have had at least minimal training or experience in oncology practice and included a range of practitioners and students. Attendees also participated in discussion pertaining to implementation. The third project was a scoping review article submitted to the interdisciplinary journal Archives of Physical Medicine and Rehabilitation. This article serves as a method to reach a wide audience in terms of discipline as well as geographic location.
Together, these three projects provided a variety of opportunities to increase knowledge about prehabilitation and occupational therapy approaches in the supportive care of head and neck cancer survivors. In light of the vast scope of this project, future refinements of the recommended model are expected. Additional information and input from other disciplines would serve the usability of the model well. Future planned projects include a poster presentation at the American Congress of Rehabilitative Medicine Annual Conference in the fall of 2022, in addition to a critical issues article in the American Journal of Occupational Therapy to provide a call to action for occupational therapy practitioners to take their place on the interdisciplinary team
Visual Perception and Reading Outcomes: The Occupational Therapy Practitioner’s Role
Full text linkThe number of students in the United States who fall below grade level reading proficiency is staggering (Grajo, 2019). The National Assessment of Education Progress (NAEP) reports that sixty- five percent of fourth graders and sixty- six percent of eighth graders are reading below grade level in America (NAE, 2019). Children with disabilities have even worse statistics regarding reading proficiency. The National Center for Learning Disabilities reports that eighty-five percent of students with specific learning disabilities fall below basic levels of literacy (Grajo, 2019). Literacy is defined as the ability to read, write, speak, and listen. (Schneck, 2019). Reading proficiency is required to participate in daily life occupations and engage in the community effectively (Grajo & Candler, 2017). Children who are not proficient in reading by third grade are more likely to do poorly in school, drop out in high school, and have higher rates of teenage pregnancy and incarceration (Hernandez, 2012).
Occupational therapy practitioners can help children with reading difficulties through visual perception interventions. Visual Perception is a complex process of taking in visual stimuli and organizing and interpreting it for higher cognitive functions. Visual perception skills can impact a child’s ability to read and participate in the academic environment (Schneck,2019). A large percentage of learning that occurs in the school is through our vision. Occupational therapy practitioners in the school setting help students participate in the school environment with academic and non-academic performance including social skills, literacy, math, self-help, recess, participation in extracurricular activities, pre-vocational and vocational skills, transportation and more (AOTA, 2020). This project will provide occupational therapy practitioners knowledge of an evidence-based practice intervention for addressing reading improvement for children that will increase their participation in the academic environment
Improving Student Concentration Through Caregiver Education
Full text linkThis action research was conducted in a primary classroom at a Montessori school. Using caregiver education that focused on the importance of limiting screen time, it aimed to increase student concentration during the work cycles. The research collected data through pre and post caregiver attitude scales and questionnaires as well as concentration and observation logs during the morning work cycles. Utilizing both qualitative and quantitative research methods, the data revealed a successful intervention with an increase in student concentration. This study can serve as a framework for future research projects that look at how caregiver education, focusing on different topics, can positively impact a child’s development. This study provided evidence that intentional caregiver education, that both informs and helps build a strong school-family relationship, can support the students’ concentration levels and therefore their development and success in the classroom
The Effect of Antiracist Children’s Literature on Developing Racial Awareness in Early Childhood
Full text linkIn this study, I asked the question, “What effect will antiracist children’s literature have on a white, homeschooled, 5-year-old child’s developing awareness of race and racial issues?” Over the course of four weeks, my child and I read and discussed antiracist children’s literature, and then I recorded my child’s signs of developing racial awareness using qualitative and quantitative data tools. In analysis of this data, I discovered that my child’s developing awareness focused more heavily on race and the understanding of skin tones than on racial issues such as a sense of equality. This finding aligns with early child developmental expectations that a child at age five typically relates better to concrete concepts before understanding abstract concepts. I concluded that antiracist work in early childhood, using children’s literature as a conduit, normalizes critical racial conversations and is an important part of a larger social justice education movement. Further recommendations for research include following my child’s developing racial awareness into the second plane of development (ages 6-9) and expanding this study into other early childhood educational settings to obtain more data for analysis
The Effects of Cognitively Engaging Exercise on Children’s Executive Functioning
Full text linkThis study examines the effect of combining vigorous exercise with cognitively engaging games on children’s executive functioning skills such as self-direction, engagement, and focus. Over four weeks, the research took place in a Montessori early childhood classroom with 17 children ages 2.6 to 6. The four-week study included a one-week baseline week to collect initial data on the capabilities of self-direction and comprehensive data on energy levels and engagement. The children participated in a 14-minute movement activity with 7 minutes of vigorous exercise and 7 minutes of cognitive-engaging games. The researcher used both quantitative and qualitative data tools to examine the effects on children’s ability to independently choose an activity, engage, and focus during the morning. The increased movement and cognitive exercise positively impacted children’s executive functioning skills. Future recommendations would include extending the intervention to study further if productivity continued to increase as the children had more days to engage in the exercises. Based on the data gathered in this action research, I recommend that teachers provide an opportunity for children aged three to six to participate in a short morning gathering where they can engage in vigorous movement and a cognitively engaging game
Improving Wellness Services for Community Dwelling Older Adults Through Education on Team Collaboration
Full text linkThe number of older adults in the U.S. is estimated to reach 1 billion by 2030 (United States Census Bureau, 2018). As individuals, they ma experience changes in our health. Some common disabilities experienced by older adults over 65 years old include vision loss, risk of falls, hearing difficulties, cognitive impairments, reduced independence, and difficulties with self-care tasks, all of which can create barriers to independent living (U.S. Census Bureau, 2018). Many older adults also experience chronic disease and complex health needs that can be difficult to manage independently while living in the community. To support healthy aging and good quality of life in older adulthood it is important to engage in health and wellness programs such as fall prevention, and other health education programs to promote positive health behaviors and improved outcomes. To improve service delivery and maximize time and resources, interventions and education for older adults should be targeted to increase older adults’ health and wellness knowledge and to facilitate positive health behavior change
Supporting Diversity, Inclusion and Equity Efforts in a Professional Organization
Full text linkIntroduction: Most of the occupational therapy profession identifies as white, female practitioners. The lack of diversity in the profession must be addressed on a national and state level. Occupational therapy state associations can contribute to the closing of the gap between cultural humility and cultural competence in occupational therapy education. State associations provide students and practitioners with resources, education, and opportunities for professional development. Current DEI literature promotes the use of the transformative adult learning in continuing education to increase the self-awareness of practitioners and improve patient-centered care. Transformative adult learning theory aligns closely with diversity, inclusion, and equity principles. Continuing education (CE) is vital to the occupational therapy profession because it reinforces best practices. There is minimal evidence in the literature that identifies best practices to promote DEI principles in OT continuing education.
Purpose: This capstone project aimed to incorporate DEI principles into a non-profit occupational therapy professional organization to increase cultural humility practices within the organization and specifically in CE offerings.
Approach: This quality improvement project consisted of several project activities. The project focused on educating the Minnesota Occupational Therapy Association board members on DEI principles and providing recommendations to improve the MOTA membership experience.
Outcomes: An outcome from the project activities included a lack of understanding on how to translate DEI practices into practice from both the board members and MOTA members. Furthermore, the professional development of MOTA to needs to provide members with opportunities for self-assessment and reflection regarding DEI.
Recommendations: MOTA as an organization should include DEI practices in CE that identify one’s own cultural preferences, learn about cultural fluency and cultural humility practices, and provide continuing education events in which participants leave with a set of action steps to implement in practice from a DEI lens
Assistive Technology and Older Adults: Education to Support Evidence-Based Practice
Full text linkBackground: In 2020 there were over 54 million older adults in the U.S. (USCB, 2020). Nearly 90% of these older adults intend to live in their homes and communities for as long as possible (AARP, 2011) although nearly 40% of individuals 65+ report having at least one disability (USCB, 2014). Community partner LiveLife Therapy Solutions (LLTS) seeks to provide assistive technology (AT) services to community-dwelling individuals of all ages, supporting their independence. They have recently branched out into the aging sector. Continued education can aid practitioners in use of evidence-based practice (EBP) to support older adults (Stetler et al., 2014).
Purpose: The purpose of this capstone project was to use education to aid interdisciplinary practitioners in use of EBP relating to the support of community-dwelling older adults through use of AT.
Methods: After a review of evidence-based literature, nine educational modules were created. Five of the nine modules were presented to LLTS consultants using a combination of synchronous and asynchronous methods. The effectiveness of the education was then determined based upon analysis of pre/posttests.
Results: Participants (n=16) rated education highly and education-specific learning was seen during pretest/posttest comparison. Greater changes in practitioner confidence were seen after synchronous presentation than asynchronous. Areas of key learning, proposed future topic areas, and suggestions for improvement were also identified.
Implications: Findings supported that education, especially when synchronous, can help support learning and EBP. Continuing education can be used to support professionals at LLTS and beyond in the field of AT and older adults, but more research is needed on AT use with older adults
Screening and Early Recognition of Sepsis in Home Hospital and Home Care Patients
Full text linkProblem Statement: In 2018, septicemia was the number one diagnosis for hospital inpatient stays for ages 65-74 in the United States (Agency for Healthcare Research and Quality, 2018). Most hospital admissions due to sepsis come from the community- as many as 87% (Rhee et al., 2017). People over 65 are 13 times more likely to end up hospitalized due to sepsis (Sepsis Alliance, n.d.). Sepsis in Home Hospital Care (HHC) and Home Care (HC) patients is prevalent because these patients are typically over 65. HC and the HHC program within the project site have noted a rise in hospital readmissions due to sepsis. HC nurses do not always identify early sepsis signs and symptoms due to a gap in sepsis knowledge. Early recognition and prompt action can improve outcomes and decrease unnecessary hospitalizations in HHC patients.
Purpose: This quality improvement (QI) project aimed to provide sepsis education and sepsis screening tool training to HC nurses. The training was intended to increase HC nurses’ ability to identify early sepsis signs and symptoms, improve patient outcomes, and decrease hospital readmissions related to sepsis.
Methods: A QI project provided sepsis education to 114 HC nurses who completed pre, post, and 5-week follow-up questionnaires that measured staff knowledge of sepsis\u27s early signs and symptoms. Education occurred over two mandatory HC nursing staff quarterly meetings, and data collection occurred before and after the meetings.
Results: Due to various intervening factors, only three HC nurses completed the pre-sepsis knowledge assessment; only 1 (33%) completed the post-sepsis assessment. This participant did not complete the 5-week knowledge retention assessment. The post-sepsis knowledge assessment score (10 out of 16) was one point lower than the pre-sepsis knowledge assessment score (11 out of 16). 5 HC nurses completed the 5-week sepsis knowledge retention assessment. The average score ranged from 10 to 15 (62.5% to 93.7%) out of 16.
Conclusion: The implementation of sepsis education for HC nurses successfully educated 114 HC nurses; however, participation in the sepsis knowledge assessments was very poor. As a result of poor participation, a conclusion cannot be drawn as to whether or not sepsis education was directly related to increasing HC nursing sepsis knowledge
Lived Experiences of Mixed-Race Children of Deaf Adults
Full text linkThe purpose of this phenomenological qualitative exploratory study was to examine the impact of Deaf culture upbringing on mixed-race children raised in the United States. The data was obtained through virtual semi structured focus groups with ten mixed-race children of Deaf adults (Codas) over the age of eighteen years old, and an anonymous survey with the phenomenological analysis of participants’ experiences growing up as a mixed-race child of a Deaf adult. Growing up mixed-race as a Coda revealed four overarching themes of lived experiences such as: intersectionality of a mixed-race Coda, parental culture transmission, hearing family members, and managing intersecting identities as a mixed-race Coda. Findings from this study expand on the critical mixed-race studies research by connecting parental disability socialization with their child’s mixed-race identity, stemming from generational factors. Additionally, data from this study has important clinical and future research implication