Research and Publications - School of Nursing

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Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight
(2017) Burton, Wanda Martin; Hernandez-Reif, Maria; Lian, Brad
As a widely used marker of health, birthweight has been a persistent racialized disparity with the low birthweight rate of Blacks in Alabama nearly doubling the national average. The purpose of this study was to examine the role of racial identity and acculturation on birthweight in a sample of Black women living in Alabama. Black women (n=72) in West Alabama were surveyed about the birthweight of their first born child. Correlation and multiple linear regression analyses were conducted. Racial identity was the only significant predictor of birthweight. Mothers with a strong racial identity reported having low birthweight babies less often than those who scored lower on racial identity. Further exploration of racial identity revealed self-image as the essential element that predicted birthweight. Birthweight increased 4.2 ounces for each additional degree of self-image. Results also indicated that birthweight decreased as mothers’ age increased, within the widely accepted optimal maternal age range 21 to 35. Results add to the existing body of literature in support of the positive effect racial identity has on health. Findings on age are congruent with the weathering hypothesis, which states that the health of Black women may begin to deteriorate in early adulthood possibly due to the strain of racism.
Analysis of Electrode Shift Effects on Wavelet Features Embedded in a Myoelectric Pattern Recognition System
(Taylor & Francis, 2014) Fontana, Juan M.; Chiu, Alan W. L.; University of Alabama Tuscaloosa; Louisiana Technical University; Rose Hulman Institute Technology
Myoelectric pattern recognition systems can translate muscle contractions into prosthesis commands; however, the lack of long-term robustness of such systems has resulted in low acceptability. Specifically, socket misalignment may cause disturbances related to electrodes shifting from their original recording location, which affects the myoelectric signals (MES) and produce degradation of the classification performance. In this work, the impact of such disturbances on wavelet features extracted from MES was evaluated in terms of classification accuracy. Additionally, two principal component analysis frameworks were studied to reduce the wavelet feature set. MES from seven able-body subjects and one subject with congenital transradial limb loss were studied. The electrode shifts were artificially introduced by recording signals during six sessions for each subject. A small drop in classification accuracy from 93.8% (no disturbances) to 88.3% (with disturbances) indicated that wavelet features were able to adapt to the variability introduced by electrode shift disturbances. The classification performance of the reduced feature set was significantly lower than the performance of the full wavelet feature set. The results observed in this study suggest that the effect of electrode shift disturbances on the MES can potentially be mitigated by using wavelet features embedded in a pattern recognition system.
Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes
(Lippincott Williams & Wilkins, 2019) Pimentel, Camilla B.; Mills, Whitney L.; Palmer, Jennifer A.; Dillon, Kristen; Sullivan, Jennifer L.; Wewiorski, Nancy J.; Snow, Andrea Lynn; Allen, Rebecca S.; Hopkins, Susan D.; Hartmann, Christine W.; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; US Department of Veterans Affairs; Veterans Health Administration (VHA); Providence VA Medical Center; Harvard University; Hebrew SeniorLife; VA Boston Healthcare System; Boston University; University of Alabama Tuscaloosa
Background: Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes. Problem: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research. Approach: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes. Conclusions: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.
Can Understanding Gut-Brain Axis Biopsychosocial Pathways Improve Clinical Reasoning?
(Elsevier, 2021) Ford, Shannon Hennessy; Hodges, Eric; Thoyre, Suzanne; Baker, Maureen; Bartlett, Robin; University of North Carolina; University of North Carolina Greensboro; University of North Carolina Chapel Hill; University of Alabama Tuscaloosa
Most nurse practitioners (NPs) practice in primary care settings. Cognitive tools to inform and advance NP understanding of biopsychosocial mechanisms can support early recognition, interdisciplinary collaboration, interventions, and prevention of negative outcomes. We describe the development of a model to support NP consideration of gut-brain axis evidence-based pathways, contributing variables, and related health outcomes. The model's outcomes are factors associated with homeostasis or disruption of biological, psychological, and social systems. This cognitive tool aims to support NP awareness of multidomain gut-brain axis relationships to consider with differential diagnoses and clinical treatment of the "whole body system." (C) 2021 Elsevier Inc. All rights reserved.
Caring for an Unconscious Transgender Patient at the End of Life Ethical Considerations and Implications
(Lippincott Williams & Wilkins, 2021) Lippe, Megan; Eyer, Joshua C.; Rosa, William E.; McKinney, Robert; Patterson, Brianna; Matteo, Rebecca A.; Townsend, Haley; Halli-Tierney, Anne; University of Alabama Tuscaloosa; Memorial Sloan Kettering Cancer Center
Individuals who identify as transgender (trans) or other gender-diverse identities are highly marginalized populations within the United States health care system. Transgender individuals experience a broad range of health disparities leading to devastating health outcomes. Experiences with discrimination and biased care often result in a lack of trust in providers and reduced care seeking, yet providers frequently rely on communication with trans patients to build competence. Consequently, when a trans patient has restricted communication, whether due to biological or psychological reasons, their care can be further disrupted. The nursing code of ethics compels the provision of competent care to all patients, regardless of demographics or gender identity, including individuals with serious illness and injury. This article describes an approach to the provision of affirmative, trans-inclusive care in a palliative nursing context that integrates cultural humility and self-reflection into an established patient care framework. The approach is then applied to identify ethical dilemmas present in the case of a trans patient who arrived at a hospital in an unconscious state following serious injury. Nurses' use of the ethical approach when caring for seriously ill trans patients would represent important progress toward fostering a health care system that provides affirmative, trans-inclusive care.
Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma
(Taylor & Francis, 2023-10-11) Jaiswal, Jessica; Griffin, Marybec; LoSchiavo, Caleb; Cox, Amanda; Hascher, Kevin; Dunlap, Kandyce; Walters, Suzan; Burton, Wanda Martin; Grini, Benjamin; Mumba, Merci; Eaton, Ellen
Introduction Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. Methods Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. Conclusion To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.
A Comparative Analysis of Rural versus Urban Preschool Children's Sugar-Sweetened Beverage Consumption, Body Mass Index and Parent's Weight Status
(Sage, 2022) Montgomery, Michele; Johnson, Paige; Ewell, Patrick; University of Alabama Tuscaloosa
Background Childhood overweight and obesity continues to be a major public health concern, especially in minority, low-income, and rural populations. In order to develop health promotion interventions aimed at reducing obesity rates, there is a need to identify which populations have the highest rates of obesity and the risk factors associated with these high rates. Methods Data collected from low-income, preschool children and their parents in an urban community and a rural community in Alabama were analyzed and compared. Body Mass Index (BMI) was collected during school based health screenings, and information regarding parent's BMI and child's consumption of sugar-sweetened beverages (SSBs) were collected by parent report. Results Of the 363 children screened, 12.8% (15.2% rural and 11.9% urban) were considered overweight, and 15.8% (20.2% rural and 14.2% urban) of the sample was classified as obese. Rates of overweight and obesity for mothers were 27.6% (25.3% rural and 28.4% urban) and 48% (56.3% rural and 44.8% urban) respectively and 39.6% (53.3% rural and 34.4% urban) and 34.6% (28.3% rural and 36.9% urban) for fathers. Parents reported their child consumed 3.82 SSBs per day. Overall, mother's BMI, father's BMI and sugar-sweetened beverage consumption was positively associated with child's BMI. However, there were no significant interactions between the rural and urban groups. Conclusion Rates of overweight and obesity remain high in low-income, predominantly minority preschool children and their parents in two communities in Alabama. Consumption of SSBs, mother's BMI, and father's BMI are three factors impacting the weight status of low-income preschool children. These factors are significant in both rural and urban children.
A Comparison of the Biomechanical Performance of 3 Negative Pressure Wound Therapy Foams
(Lippincott Williams & Wilkins, 2022) Gibson, Daniel J.; University of Alabama Tuscaloosa
PURPOSE: The purpose of this study was to compare 3 foam dressings to (1) determine the biomechanical performance of existing negative pressure wound therapy (NPWT) foams and (2) to determine if a test foam is possibly suitable as an antimicrobial "white" foam alternative for use in NPWT. DESIGN: A comparison of mechanical performance of 3 foams used for vacuum-assisted NPWT. SUBJECTS AND SETTING: Preclinical laboratory study using an in vitro model. METHODS: The performance of a "white" foam (polyvinyl alcohol [PVA]), an antimicrobial "black" foam (polyurethane [PU]), and an antimicrobial white foam alternative (test PVA) were tested and compared using 3 mechanically relevant criteria. First, the fluid removal rate was measured for 72 hours. Next, the pressure input was compared to the pressure directly beneath the center of the foam. Finally, the spread of negative pressure beneath the foam was measured and compared. RESULTS: Significant differences were found in fluid removal rates; specifically, the PU foam removed fluids faster than the PVA and test PVA foams, and the currently available PVA foams performed similarly. Both the PU and test PVA foams were able to transmit the negative pressure through the center of the dressing, while the typical PVA foam began failing at 140 mm Hg, with 50% of the samples failing at 200 mm Hg. All PU replicate foams evenly distributed the pressure, while 47% to 60% of the test PVA foams and 7% of the typical PVA foams distributed pressures evenly. CONCLUSIONS: Study findings suggest that the test PVA foam does not mechanically interfere with NPWT and performs equivalently to currently used foams. These results suggest that the test PVA may be modified and incorporated into a vacuum-assisted NPWT device. In addition, the methods employed in these experiments provide a reproducible means to compare biomechanical compatibility of various NPWT foams, dressings, and subdrape devices.
COVID-19: Facts, Cultural Considerations, and Risk of Stigmatization
(Sage, 2020) Bruns, Debra Pettit; Kraguljac, Nina Vanessa; Bruns, Thomas R.; University of Alabama Tuscaloosa; University of Alabama Birmingham
Data on COVID-19 supports targeted social distancing could be an effective way to reduce morbidity and mortality, but could inadvertently increase stigma for affected populations. As health care providers we must be aware of the facts of COVID-19, cultural implications, and potential for stigmatization of populations affected by COVID-2019. It is important to consider the real economic impact related to lost workdays due to quarantine and social isolation efforts as well as travel restrictions that may negatively impact access to care and ability to pay for care. Efforts geared towards general education about the disease and the rationale for quarantine and public health information provided to the general public can reduce stigmatization. Countries who are successful at aggressive screening, early identification, patient isolation, contact tracing, quarantine, and infection control methods should also address the risk of stigmatization among populations and the negative effects which could occur. The cases of COVID-19 will continue to rise and the virus will be sustainable for future infections. Timely and appropriate public health interventions addressing cultural impact and risk for stigmatization along with proper screening, treatment, and follow up for affected individuals and close contacts can reduce the number of infections, serious illness, and deaths.
Developing the Supporting Choice Observational Tool (SCOT) A Formative Assessment Tool to Assist Nursing Home Staff in Realizing Resident Choice
(Slack, 2017) Palmer, Jennifer A.; Parker, Victoria A.; Burgess, James F.; Berlowitz, Dan; Snow, A. Lynn; Mitchell, Susan L.; Hartmann, Christine W.; Harvard University; Hebrew SeniorLife; Boston University; Harvard Medical School; University of Alabama Tuscaloosa
Quality of care in nursing homes has begun to address the importance of resident choice in daily life, yet there are no published tools to teach nursing home staff how to offer such choice. In the current study, a formative assessment tool was developed that can provide staff with detailed and concrete feedback on how to realize resident choice. The tool was created and refined through 22 hours of ethnographic observation in two Veterans Health Administration Community Living Centers (CLCs), 22 hours of developmental testing in two CLCs, review by a modified Delphi panel, and use of an algorithm to assess its logical structure. The resulting Supporting Choice Observational Tool (SCOT) documents how choice is or is not offered and is or is not enabled within a singular staff-resident interaction. SCOT findings could be used in clinical teaching, quality improvement, or research efforts intent on enhancing nursing home resident quality of life.
Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia
(Elsevier, 2015) Ford, Brianne; Snow, A. Lynn; Herr, Keela; Tripp-Reimer, Toni; University of Iowa; University of Alabama Tuscaloosa
Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (chi(2) = 19.167, p < .001). No significant differences were noted across ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample. (C) 2015 by the American Society for Pain Management Nursing
An exploratory study of a hands-on naloxone training for rural clinicians and staff
(Wiley, 2023) Cody, Shameka L.; Hines, Cheryl B.; Glenn, Christina J.; Sharp-Marbury, Rochelle; Newman, Sharlene; University of Alabama Tuscaloosa
IntroductionSince the COVID-19 pandemic, an increase in fentanyl-combined drugs has led to a surge in opioid overdose deaths in the United States. Higher opioid overdose mortality rates are problematic in rural communities, and there are few prevention, treatment, and recovery resources for individuals experiencing opioid use disorder. MethodThis exploratory project aimed to investigate a hands-on naloxone training for rural clinicians and staff. Rural clinicians and staff at two behavioral health centers were recruited to participate in a 30-min lecture and 30-min hands-on intranasal naloxone training using a low-fidelity mannequin. A pre-post opioid knowledge questionnaire, rubric based on the Substance Abuse and Mental Health Services Administration toolkit, and investigator-generated survey were used to evaluate opioid knowledge and response, demonstration of intranasal naloxone administration, and participants' perceptions of the training. Enrollment characteristics were summarized using descriptive statistics and paired t-tests were used to assess mean differences. ResultsOf the nine participants in the project, seven (87.5%) were female and six (75.0%) were Black. Four participants assumed a therapist role, attained a MS or MA degree, and had 5 or more years of experience working in healthcare. The total mean rubric score for all participants was 96.0 (SD = 8.8). No significant pre-post mean differences among opioid knowledge, overdose risk, and overdose response categories were found, all p > 0.05. However, post-intervention mean scores were slightly higher in all categories except overdose risk. Most participants (77.8%) responded that they felt comfortable handling an opioid situation and teaching the training to community members. Open-ended responses indicated that participants liked the demonstrations, examples used, hands-on nature of the training, and the presentation materials. ConclusionA hands-on naloxone training is beneficial for training rural clinicians and staff to respond to opioid overdose. This training may be a promising solution to reduce response time between recognition of opioid symptoms and administration of the life-saving medication, naloxone. Future studies should examine the efficacy of this training in larger samples with the inclusion of rural interdisciplinary teams, trusted community leaders, and family and friends of those impacted by opioid use disorder. Clinical relevanceThis innovative hands-on naloxone training is designed for rural clinicians and residents who are most likely to witness individuals experiencing opioid toxicity. The primary goal is to reduce response time between recognition of signs and symptoms and administration of the life-saving medication, Naloxone.
Fostering resilience and mental health support in a post COVID-19 environment
(Wiley, 2022) Horton, Abby Grammer; Mumba, Mercy N.; University of Alabama Tuscaloosa
From crisis management to multi-level interinstitutional partnerships: Development of the southeastern conference deans nursing coalition
(WB Saunders, 2023) Andrews, Jeannette O.; Niederhauser, Victoria; Sanford, Julie; Prevost, Suzanne; Porche, Demetrius; Heath, Janie; Jeffries, Pamela; Fahrenwald, Nancy; University of South Carolina Columbia; University of Tennessee Knoxville; University of Mississippi; University of Mississippi Medical Center; University of Alabama Tuscaloosa; Louisiana State University Health Sciences Center New Orleans; University of Kentucky; Vanderbilt University; Texas A&M University College Station
The Southeastern Conference (SEC) Nursing Dean's Coalition is a purposeful alliance organized to collaboratively address several challenges that arose during the COVID-19 pandemic. Over the last three years, this strategic team of academic leaders has evolved from a crisis response team to a multidimensional support team, leveraging both individual and collective strengths, to provide several benefits to the dean members, as well as other SEC nursing faculty members, students, and institutions. Participation has grown from the original 12 deans to engage a broader team of associate deans and nurse leaders in faculty development, research, service, and di-versity, equity, and inclusion. This article describes the origin, evolution, and outcomes of this coalition to date, as well as visions for the future.
Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress
(Taylor & Francis, 2022-10-13) Burton, Wanda Martin; Paschal, Angelica M.; Jaiswal, Jessica; Leeper, James D.; Birch, David A.
Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N=164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.
Gendered Racism: A Call for an Intersectional Approach
(Slack Journals, 2022) Burton, Wanda Martin
Inequities in social determinants of health (SDOH) contribute to health disparities that outweigh an individual’s ability to make healthy choices. SDOH refer to environmental conditions that affect a wide range of health, functioning, and quality of life outcomes and risks. They are complex, interdependent, and often grouped in five categories: economic stability, education access and quality, health care access and quality, neighborhood and the built environment, and social and community con- text. Within the social and community context, discrimination has increasingly received attention since the American Public Health Association established its National Campaign Against Racism (Jones, 2016a,b). Understanding, revealing, and redressing racism as a social and structural determinant of health may help eliminate racialized health disparities. Yet, for those who are at the inter- section of multiple oppressions, focusing on racism alone may not go far enough.
Innovative use of a flipped-classroom approach to teach fundamental nursing skills
(Elsevier, 2023) Wilson, Kimberly E.; Hobbs, Jill R.; University of Alabama Tuscaloosa
Prelicensure nursing students are required to master fundamental nursing skills. The COVID-19 pandemic created challenges in maintaining excellence while teaching skill acquisition. The purpose of this study was to evaluate skill validation scores and student satisfaction and self-confidence using a flipped classroom approach and a low-fidelity simulation model to innovatively teach skill acquisition. Researchers used a quasi-experimental method to compare skill validation scores of a control group and intervention group using independent samples t-test. Researchers also evaluated whether prelicensure nursing students had satisfaction and self-confidence with this teaching strategy. Findings suggested that skills validations scores were no different using a flipped-classroom approach than in-person instruction. Prelicensure nursing stu-dents were satisfied and self-confident following the implementation of this teaching strategy. This teaching strategy has the potential to decrease in-person clinical practice time, provide alternative opportunities for clinical make-up and remediation, and decrease cost. (c) 2022 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Integration of Health Information Technology and Promotion of Personhood in Family-Centered Dementia Care Intervention Trial
(Slack, 2021) Brown, Ellen L.; Ruggiano, Nicole; Roberts, Lisa; Clarke, Peter J.; Davis, Debra Lee; Agronin, Marc; Geldmacher, David S.; Hough, Monica Strauss; Munoz, Mariateresa (Teri) H.; Framil, C. Victoria; Yang, Xin; Florida International University; University of Alabama Tuscaloosa; University of Alabama Birmingham
Alzheimer's disease and related dementias (ADRD) often result in communication deficits that can lead to negative health outcomes as well as complications for caregiving and clinical care. Although augmentative and alternative communication (AAC) devices have demonstrated efficacy in assisting persons living with dementia (PLWD) in communicating, few devices offer customization for the person's care preferences (e.g., clothing, food, activities) or are designed for integration into clinical care and caregiving. To address this issue, our research team is developing a novel electronic AAC prototype with a touchscreen to promote communication and personhood for PLWD. The current article describes the development of this technology and uses the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement to describe the clinical trial that is planned to test its efficacy. TARGETS: PLWD and their care partners. INTERVENTION DESCRIPTION: Use of AAC Plus to promote communication and personhood for PLWD. MECHANISMS OF ACTION: AAC Plus will provide PLWD and care partners a way to communicate PLWD's daily preferences and provide clinical data for health care providers. OUTCOMES: Determine whether enhanced communication of daily preferences of PLWD will improve quality of life of PLWD and their care partners.
Integrity of Databases for Literature Searches in Nursing Avoiding Predatory Journals
(Lippincott Williams & Wilkins, 2021) Oermann, Marilyn H.; Wrigley, Jordan; Nicoll, Leslie H.; Ledbetter, Leila S.; Carter-Templeton, Heather; Edie, Alison H.; Duke University; University of Colorado Boulder; University of Alabama Tuscaloosa
The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.
Intraoperative Ketamine Administration for Enhanced Pain Management
(2024-07-02) Colin Tomblin
Introduction: Ketamine has been around for over 50 years in the United States and is now commonly used in anesthesia practice. When administered in subanesthetic doses, it is an effective alternative to opioid administration for postoperative pain control without the unwanted side effects of higher doses. Total joint arthroplasty is one of the most performed orthopedic surgeries and effective pain control is a must. The research evidence reflected lower pain scores in the immediate and early postoperative periods (6-24 hours) in patients who underwent total joint replacement surgeries and received intraoperative ketamine. Methods: The project design was a retrospective chart review using Cerner 1Chart of patients aged 40 to 65 years old who underwent total knee arthroplasty or total hip arthroplasty surgery. The postoperative pain scores of the patients who did and did not receive intraoperative ketamine were collected and analyzed pre and post educational intervention. Results: A total of 80 cases were analyzed with half being pre-educational intervention and 40 pos-educational intervention. A Chi-Square Test and t-test were performed on the data obtained from the retrospective chart review. There were no statistically significant differences in ketamine administration by CRNAs before and after the intervention (chi-square = .29, p = .59). There were no statistically significant differences in patient’s self-reported levels of pain based on the administration of ketamine (t(78) = 1.13, p = .26). Discussion: The overall sample size was relatively small, and more data could be collected over a longer time frame to be analyzed. Assessing and trending the postoperative pain scores over a 6–24-hour period could yield useful information.

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