School of Nursing

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Addressing Human Trafficking in Pediatric Nursing Education: A Simulation-Based Approach to Improve Student Competence
(2026) Gladwell, Courtney; Simmons, Staci
Introduction: Human trafficking is a growing public health crisis, and pediatric nurses are in a unique position to identify and intervene in suspected cases. However, undergraduate nursing students often lack training and confidence in recognizing red flags of human trafficking in clinical settings. This quality improvement project aimed to enhance undergraduate nursing students’ knowledge and self-reported competency related to identifying and responding to human trafficking in pediatric healthcare settings. The project aligned with the American Association of Colleges of Nursing Essentials and supported integration of evidence-based content into the existing pediatric curriculum. Methods: An asynchronous, one-time educational presentation was developed and made available through the university’s learning management system (LMS) as a required activity in the pediatric nursing course. The simulation component used a rapid-cycle deliberate practice model to reinforce learning in a clinical scenario during scheduled pediatric clinical simulation days. Pre- and post- intervention surveys were administered using Qualtrics and measured student knowledge and self-reported competency using the Student Nurses’ Human Trafficking Education Assessment Tool (SNHTEAT). Results: Pre- and post- intervention survey data was analyzed to evaluate changes in students’ knowledge and confidence levels regarding the identification and management of pediatric human trafficking cases. A paired t-test was used to compare mean scores before and after the intervention. Discussion: This project demonstrated the feasibility and impact of integrating an educational module and simulation to prepare undergraduate nursing students to recognize and respond to pediatric human trafficking. The intervention resulted in improved knowledge and self-reported confidence among participants. These findings support future curricular integration of targeted human trafficking education within undergraduate nursing programs.
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.
Advance Care Planning in the African American Faith Community: Taking Fear out of the Conversation
(2024) Kirby, Michelle; Parker, Kim; Griffin, Kotaya
Introduction: Advance Care Planning (ACP) helps individuals decide about future care by reviewing their values, goals, and wishes. Conducting ACP education in the African American community's place of worship and enlisting the pastor's support is a way to develop trust among parishioners. This scholarly project seeks to increase understanding of advance care planning and encourage participants to complete advance directives. Methods: The project offered two educational sessions and administered pre- and post-survey questionnaires to assess readiness to discuss advance care planning and complete advance directive documents. Results: The readiness to sign official papers naming a person or group of people to make medical decisions and talk to their decision-maker about the kind of medical care they would want if they were very sick or near the end of life, was significantly greater post-survey than pre-survey. Readiness to talk to their doctor about the kind of medical care and sign official papers was significantly greater post-survey compared to pre-survey. The project rendered four completed advance directives representing 11% of participants. Conclusion: The educational intervention provided knowledge about advance care planning and supported further sessions in the African American church.
Advancing Oncologic Emergency Preparedness: A Clinical Simulation Approach for Advanced Practice Providers in Oncology
(2024) Hemstetter, Sarah
Introduction/Purpose: Orienting advanced practice providers (APPs) in oncology is challenged by the intricate subspecialty knowledge required and limited exposure to high-stakes clinical scenarios during onboarding. Despite theoretical education on oncologic emergencies, a gap exists between theoretical knowledge and clinical experience. This Doctor of Nursing Practice (DNP) project explored the utility of virtual clinical simulation to enhance the education and training of oncology APPs, focusing on identifying and managing oncologic emergencies to increase confidence and comfort among APPs. Methods: Utilizing an evidence-based practice approach, new to oncology providers engaged in virtual simulation scenarios at two different time points. Participants were tasked with identifying and managing oncologic emergencies. Objective data, including performance of critical interventions, was recorded for each participant to gauge improved competency. Subjective data, including participants self-reported comfort and self-efficacy was also recorded. Lastly, participants completed a simulation satisfaction survey. Results: Reported results encompassed differences in pre- and post-simulation self-reported knowledge and confidence scores. Completion of critical interventions in the first and subsequent simulation sessions was also analyzed. Results were analyzed using a combination of statistical methods including both non-parametric and parametric testing including one sample t-tests, wilcoxon signed rank test, and basic descriptive statistics. Discussion: The discussion focuses on the overall outcomes of the intervention and potential future implications for advancing oncologic emergency preparedness among APPs in oncology.
An algorithm to guide the transition of care for the heart failure patient: A quality improvement project
Lang-Coleman, Kristen; Carter, Patricia
Purpose:The increase in hospital re-admission rates is a national concern. Patients aged 65 years and olderwith chronic health conditions, such as heart failure (HF), have high rates of 30-day hospitalreadmissions. This issue was observed in a palliative care organization, whereby a traditionalhospital discharge model was followed. A gap in the literature was using a nurse practitioner(NP)-led transition of care model (TCM) to tackle this problem. A DNP scholarly project wasimplemented with the aim of decreasing hospital readmissions for HF patients.Methods:A NP-led TCM was designed, which included a quality tool to manage HF patients after beingdischarged home. A pre-test/post-test design was utilized to compare hospital readmission datafollowing use of the NP-led TCM model. Feasibility and efficacy of the tool were also assessed.Results:Following the implementation of the NP-led TCM, hospital readmission rates for HF patientsdecreased to zero. Findings also supported the tool’s efficacy.Discussion:Compared to a traditional hospital discharge model, the NP-led TCM reduced hospital re-admission rates for HF patients. Findings from this project can add to the current body ofevidence regarding strategies to mitigate hospital re-admission rates for elderly patients withchronic conditions. As a result, hospitals will be more likely to receive quality incentives andprevent reimbursement penalties associated with readmissions and the lives of this vulnerablepopulation may be improved.
An Antibiotic Stewardship Program for Sinusitis in an Urgent Care Setting: A Quality Improvement Project for Advanced Practice Providers
Slattery, Meagan; Simmons, Staci; Gosnell, Jason
Introduction: Sinusitis is commonly diagnosed in the urgent care setting. According to evidence-based practice guidelines, most cases do not require antibiotics. Current clinical practice guidelines support a target antibiotic prescribing rate of less than 12% for upper respiratory infections, such as sinusitis. Inappropriate antibiotic usage can cause adverse effects, ranging from mild rashes and gastrointestinal distress to life threatening antibiotic resistance and colitis. In the chosen network for this project, 56.9% of patients received antibiotics when diagnosed with sinusitis between April and September 2023. Methods: All non-physician advanced practice providers (APPs) within the urgent care network were invited to view an educational PowerPoint presentation regarding current evidence-based practice guidelines for sinusitis. Participation in the intervention was voluntary and anonymous. Post-intervention prescribing patterns were evaluated to determine the efficacy of the intervention. Results: The results of the intervention demonstrated a statistically significant reduction in antibiotics prescribed by APPs for the diagnosis of sinusitis. The antibiotic prescribing rate improved to 46.3% during the six-week period following the educational intervention, a reduction of 10.6%. Conclusion: While this quality improvement project did not achieve the desired antibiotic prescribing rate of 12%, the educational intervention was effective at lowering the overall rate of antibiotics prescribed for sinusitis. Limitations include a short follow-up period and the voluntary nature of participation in the educational intervention.
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.
Antibiotic Stewardship in Urinary Tract Infection Therapy
Shelton, Deanna; Graves, Ann; O'Dea, Douglas; Glenn, Christina; University of Alabama Tuscaloosa
Introduction: Urinary tract infections (UTI) are common reasons women are treated in the primary care settings. But UTI therapy often does not follow the most current evidence-based clinical practice guidelines (CPG). Antibiotic stewardship for primary care providers (PCP) is recommended by the Centers for Disease Control and Infectious Diseases Society of America. It is important to analyze clinic level antibiotic stewardship for appropriate antibiotic therapy for UTI. Review of Evidence: Research supports four main elements of outpatient antibiotics stewardship: commitment, action for policy and practice, tracking and reporting, and education and expertise. When PCP monitor prescribing practices within a clinic, data can be gathered, and feedback given that allows for assessment of prescribing practices and education to reinforce the use of evidence-based CPGs. These practices can help improve discernment related to antibiotic stewardship. Implementation plan: A gap analysis was conducted to review current, internal data related to antibiotics prescribed for UTI therapy. A comparison of current data to CPG determined the percentage of prescriptions that align with CPG. A two-fold intervention consisted of 1.) Education of PCP on the CPG related to UTI therapy; 2.) Implementation into practice of the CPG related to UTI therapy. Evaluation: Pre and post intervention chart review data compared effectiveness of the practice change education. Conclusion: The percentage of providers that more closely followed CPG related to antibiotics in UTI therapy did increase.
Antibiotic Stewardship Initiative for Treatment of Upper Respiratory Infections: Why Is This Needed in Primary Care Settings?
(2026) Thornton, L. Heather; Welch, Teresa
Introduction/Purpose: Inappropriate antibiotic prescribing for upper respiratory infections (URIs) remains a persistent issue in outpatient primary care, contributing to antimicrobial resistance and avoidable adverse outcomes. This quality improvement (QI) project aimed to reduce unnecessary antibiotic use by implementing a targeted stewardship intervention aligned with evidence-based standards and national guidelines. Methods: The project was conducted in a single outpatient clinic following Institutional Review Board (IRB) approval. A multi-phase intervention included provider education, patient-facing materials, and pre- and post-intervention chart reviews. Surveys administered via a validated platform assessed provider knowledge and attitudes. Data was stored securely on UA Box, with all personal health information de-identified. Quantitative prescribing metrics and qualitative survey responses were analyzed using thematic coding frameworks. Results: The intervention significantly reduced antibiotic prescribing, while provider surveys showed positive but non‑significant shifts in knowledge and perceived barriers. No meaningful correlations emerged due to the small sample. Qualitative feedback emphasized prescribing‑awareness tools, patient education materials, and consistent stewardship messaging. Discussion: The intervention significantly reduced inappropriate antibiotic prescribing, while provider surveys showed positive but non‑significant improvements in knowledge and perceived barriers. No meaningful correlations emerged, likely due to the very small sample. Qualitative feedback emphasized prescribing‑awareness tools, strong support for patient education materials, and the need for consistent stewardship messaging to sustain improvements.
Antihypertensive Education to Improve Patient Outcomes: A Quality Improvement Project
McKerrocher, Paul; Hines, Cheryl B.; Jennings, Whitney; University of Alabama Tuscaloosa
Introduction/Purpose The purpose of this quality improvement project was to improve compliance with the 2014 American College of Cardiologists/ American Heart Association (ACC/AHA) Joint Task Force Clinical Practice Guidelines recommendation regarding the continuation of prescribed antihypertensive medications throughout the perioperative period by implementing a patient education initiative, which used the teach-back method of instruction, and evaluated the effectiveness of the education as evidenced by the incidence of patients presenting for their endoscopy procedures with hypertension requiring pharmacological intervention, procedure delay, or procedure cancellation. Methods Data was collected from patients’ electronic health records (EHR) using a retrospective cohort design. The preintervention group consisted of data from all endoscopy patients with the diagnosis of hypertension and taking at least one prescribed antihypertensive medication, and having procedures during the six weeks prior to implementation of the 2014 ACC/AHA Joint Task Force Clinical Practice Guidelines. The post intervention group consisted of data from all endoscopy patients with the diagnosis of hypertension and taking at least one prescribed antihypertensive medication, and having procedures during the six weeks following implementation of the guidelines. Results A chi squared analysis was utilized to compare the data from preintervention and postintervention groups regarding the incidence of hypertension significant enough to require pharmacological intervention, case delay, or case cancellation, both before and after Antihypertensive Education to Improve Patient Outcomes: A Quality Improvement Project 4 implementation of the education intervention. The P-value was also calculated using the chi squared analysis, X^2 (1, N=1044) =7.71, p= .00548. No incidence of case delay or cancellation were experienced in either test group. A 70.5% decrease was experienced in the incidence of patients requiring pharmacological intervention during the 6 weeks period when patients were provided the antihypertensive patient teaching via the teach-back method, compared to the previous 6 weeks. The calculated P-value was .00548, indicating a statistically significant improvement. Conclusion The statistically significant decrease in the incidence of patients requiring pharmacological intervention for hypertension supported the need for permanent inclusion of the antihypertensive patient teaching, via the teach-back method, in the preoperative procedures at the project site. The GI clinic has continued to include this patient teaching method in their preoperative patient contacts after completion of the project.
Assessing Provider Adherence to Music Therapy in Parturients Undergoing Awake Cesarean Section: A Quality Improvement Project
Matson, Nikola
Low patient satisfaction with cesarean section (C/S) birth is a widely documented phenomenon which carries substantial risk for compromised health. Music therapy is a technique that can reduce stress and improve satisfaction when applied intraoperatively. Methods: The Kosucu et al. (2017) survey instrument was adapted for the research. The survey was administered pre- and post- intervention of an educational offering. Data was collected on the presumed impact of music therapy on patient mood, stress, anxiety, and pain and on practitioner implementation of music therapy. Results: A paired sample t test showed a statistically significant increase in the practitioner’s presumption of positive impact on mood, stress, anxiety, and pain between the pre and post survey scores. The paired sample t test showed no statistically significant increase in the practitioner’s adherence to music therapy between the pre and post survey scores. Discussion: The results of this study indicate a clear statistical correlation between music therapy education and presumptive positive impact of music therapy on mood, stress, anxiety, and pain. The study also cites reasons for not implementing music therapy. These include lack of time; concerns about increased workload; and lack of institutional support. Music therapy represents a low cost, low risk method of improving patient outcomes. Therefore, additional study is warranted with respect to effective educational techniques, institutional attitudes, and removing obstacles to implementation in the operating environment.
Assessing Stakeholder’s Attitudes and Perceptions Towards Treatment of Opioid Use Disorders in the Justice-Involved
Sullivan-Congden, Scott M.; Hooper, Gwendolyn; Martin, Wendy; University of Alabama Tuscaloosa
Purpose–Examine stakeholder perceptions and readiness for change regarding implementing an evidence-based treatment improvement protocol for opioid use disorder in Justice-Involved individuals residing within a state prison system. Methods–A one-time electronic survey was distributed to stakeholders using Qualtrics©. Data were analyzed using SPSS 27.0, and results tabulated. Results–The data increased understanding of stakeholder perceptions of current treatment protocols for opioid use disorder, demonstrating the need for focused education.Conclusions–Currently utilized in the system under examination are traditional evidence-based practices. The ideal future state is the replacement of older treatment practices with newer evidence-based protocols in the treatment of opioid use disorder. Internal data has now been gathered, via electronic survey, into the current stakeholder appraisal of the therapeutic benefits of OUD treatment. The data supports the need for stakeholder OUD disease and treatment education to affect a future practice change.Clinical Implications–Offering current evidence-based practice in treating OUD, a chronic illness, can improve patient outcomes. Increased understanding of barriers to providing the best evidence-based protocols is necessary for current and future practice. The research data suggests education helps navigate change. Beneficial interventions increase outcomes, decrease levels of mortality and morbidity, and increase social determinants of health.
Attitudes Toward Suicide and Self-Harm in the Detention Environment: An Educational Intervention for Nursing
Krüg, Michael Stephen
Suicide is a significant public health threat and a leading cause of death in U.S. detention facilities. Detention suicide rates are estimated to be three times greater than in the general population, and suicide is ranked as the number one cause of preventable death among all persons in custody. Nurses are routinely challenged with assessing suicidal detainees, and the attitudes toward suicide and self-harm can positively or negatively influence the outcomes of detention suicide prevention programs. Methods: The Attitudes Toward Prisoners Who Self-Harm (APSH) Scale was administered to nurses (n=21) working in a large U.S. Immigration and Customs Enforcement detention facility to determine current attitudes toward detained non-citizens related to self-harm and suicide. A 30-minute instructional education intervention regarding suicide risk evaluation was provided, followed by a communicative shared experience intervention between the nurses. A secondary survey was obtained 30 days after the training intervention to evaluate any change in nurses' attitudes, pre-intervention versus post-intervention. Results: A repeated measures design was utilized, and paired t-tests were used to evaluate the results from the two 5-point Likert surveys that were collected. The measures were processed with Intellectus Statistics software (Intellectus Statistics [Online computer software], 2023) to evaluate and determine any change in the nurses' attitudes.
Battling Bullying: An Intervention to Improve Civility Among Nurses
(2025) Kafka, Kimberly; Welch, Teresa; Ascenzi, Judith
Introduction: Incivility among nurses in contemporary healthcare settings poses significant challenges impacting individuals, organizations, and patients alike, yet there is a lack of standardized, evidence-based interventions to address this issue. Existing literature advocates for the assessment of workplace incivility, continuous education, and cognitive rehearsal training. This project sought to evaluate whether a combination of e-learning and cognitive rehearsal training enhances the ability of first-year registered nurses to identify, recognize, and respond to incivility, while also promoting a culture of civility in the workplace. Methods: First-year pediatric critical care nurses at a nationally recognized Magnet®-designated children's hospital participated in a self-paced e-learning module, followed by a two-hour cognitive rehearsal session. The e-learning segment aimed to raise awareness of incivility and encourage effective communication. The cognitive rehearsal training involved role-playing structured scenarios, allowing participants to practice responses to typical uncivil behaviors utilizing evidence-based techniques. The Workplace Civility Index (WCI) was utilized to measure outcomes at three intervals including pre- and post-intervention and one-month post-intervention. Results: WCI scores demonstrated a significant improvement (p<.001) both post-intervention and at one-month post-intervention compared to pre-intervention measures. Participants also expressed a higher likelihood of directly addressing workplace issues (p<.001). Post-course evaluations revealed high levels of satisfaction and perceived usefulness of the training. Discussion: The results of this project indicate that integration of e-learning with cognitive rehearsal training effectively improves nurses' skills in recognizing and responding to incivility. The increased confidence in tackling workplace issues underscores the importance of structured training in fostering a positive workplace culture. These findings emphasize the necessity for ongoing educational initiatives to encourage civility within nursing practice. Incorporating such interventions into professional development programs may lead to healthier work environments and improved patient care. Future studies should investigate the long-term impacts and the potential for scalability across various healthcare contexts.
Beyond Body Mass Index: Waist Circumference vs. Body Mass Index in Identifying Cardiometabolic Risks
(2026) Lester, Brandi; Parker, Kim
Background: Body mass index is widely used to assess obesity; however, it does not account for fat distribution. Central adiposity, measured by waist circumference, is a stronger predictor of cardiometabolic risk. Despite guideline recommendations, WC is not routinely measured in primary care, which can lead to under-identification of at-risk patients. Methods: A quality improvement project was conducted in a rural primary care clinic in the southeastern United States. Adult patients (n = 50) underwent both BMI and WC measurements during routine visits. Patients were categorized using established clinical cutoffs (BMI ≥25 kg/m²; WC >35 inches for women and >40 inches for men). Descriptive statistics and comparative analyses were used to evaluate differences in risk classification. Results: Findings demonstrated that 68% of patients had both elevated BMI and WC, indicating combined general and central obesity. Notably, 4% of patients had a normal BMI but elevated WC, identifying cardiometabolic risk that would have been missed using BMI alone. Overall, the addition of WC improved identification of patients at increased cardiometabolic risk. Conclusions: Incorporating waist circumference measurement into routine primary care assessments enhances the identification of cardiometabolic risk beyond BMI alone. This low-cost, feasible intervention supports more accurate risk stratification and clinical decision-making.
Biological Perspectives: Adrenergic, Cholinergic, GABAergic, and Glutaminergic Receptor Function in the CNS
(Wiley, 2001) Keltner, Norman L.; Hogan, Beverly; Knight, Tamecka; Royals, Ann Lee
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.
Cancer Patients and Anxiety in the Pre-Surgical Ambulatory Setting
Scruggs, Susan S.; Collins-Yoder, Angela; Obringer, Kelley J.; University of Alabama Tuscaloosa
Introduction / Purpose: This primary research is aimed at identifying and scoring pre-procedural anxiety in cancer patients that undergo outpatient port placement. Identification of signs and symptoms of heightened levels of anxiety is common in the surgical setting. Determining a baseline level of anxiety in cancer patients can guide future studies and aid in determining proper protocols to plan for and treat anxiety in the outpatient setting. Hopefully, the future will consist of a routine anxiety score upon diagnosis and treatment options can be discussed early in the disease progress. Methods: Evaluation of anxiety levels will be assessed using the General Anxiety Disorder scale (GAD 7) as it is the most frequently used assessment tool for measuring anxiety levels in patients (Jordan, Shedden-Mora, & Löwe, 2017). The patients will be asked to self-score their anxiety levels upon arrival at the out-patient center on the morning of their port placement. The self_x0002_scoring assessment will provide useful data information to assist and guide the anesthesia clinician to properly evaluate and treat anxiety both pre-procedurally and intra-operatively. The anesthesia model selected for this evaluation will be limited to monitored anesthesia care (MAC)/ conscious sedation cases in the outpatient setting. Results: 5 Results after project completion revealed that 31.25% of participants scored ten or greater on the GAD 7 assessment tool used in pre-operative holding. Eleven males and twenty-one females participated in the study (N=32). A score of 10 or greater is considered significant and that anxiety is present (Jordan et al., 2017). The average age of the participants was 63 with a standard deviation of 11.9. The participants average weight in kilograms was 77.03. The anesthesia time in minutes from in the operating room until recovery hand-off in the post anesthesia care unit (PACU) averaged 57.19 minutes. Intravenous fentanyl average dose was 106.25 mcg and midazolam averaged 4.17 mg per participant. Of the participants that scored greater than 10 on the GAD 7 tool, 50% were males. Thusly, male cancer patients experienced heightened anxiety at a greater level of 45.4% whereas the female participants only reported heightened anxiety 23.8% of the time. The most prevalent cancer diagnosis in the convenience sample was lung cancer at a rate of 21.8%. Discussion: Surgery in an outpatient setting is quite common, it is also routine to be nervous or anxious on the day of the procedure. Generalized anxiety is a disorder that interferes with daily functioning and those that experience this phenomenon are overly concerned about routine matters such as health, finances, death, work related problems and inter-personal relationships. Symptoms can include excessive worry, intestinal issues, insomnia, irritability, exhaustion, trembling, muscle tension and aches, and can sometimes lead to more serious additional psychiatric issues (Mayo Clinic, 2018). 6 Based on the findings of the study this investigator recommends follow-up studies regarding anxiety recognition in patients diagnosed with cancer, and that early intervention and treatment options be discussed with patients and their caregivers. Future studies should aim at prevention of generalized anxiety disorders by treating anxiety with the initial diagnosis of cancer. Further studies should be aimed at prevention of anxiety in males that are facing cancer. This study finds that men experience anxiety at a much greater level than female patients and a larger study should be completed to confirm this finding. Additional studies should aim at treatment options and then after treatment do a repeat evaluation of anxiety levels with a proper scoring tool to evaluate and compare treatment modalities within this patient population . Expanding on existing studies should include males with anxiety when facing a cancer diagnosis, as well as statistical data on the quantitative data available for those that are being treated. Studies should be completed evaluating the use of anxiety evaluations for patients newly diagnosed with cancer and explore what treatment modalities provide the most appropriate relief for this patient population. Overall, further research should be done to expand on generalized anxiety disorders for cancer patients and anxiety evaluations should be considered as part of the full physical assessment for these patients. A gap in care exists between patient diagnosis of cancer and port placement for chemotherapy. Additional studies can be compiled to compare port placement surgery with tumor reduction or any surgery a cancer patient may face. Because cancer patients are diagnosed by routine findings on exam with their primary care physician, the referral process can be 7 overwhelming and rapid causing the diagnosis of anxiety to be of little importance. At times, this referral process to oncology, radiation, or surgery is rapid and necessary for proper treatment and best outcomes causes the patient to experience a myriad of emotional challenges. Anxiety is a commonly undiagnosed problem. Because nearly one-third of participants in this study reported significant anxiety, physicians should include an anxiety assessment as part of the clinical plan for cancer patients undergoing treatment. Proper recognition and consideration of anxiety issues will lead to better patient care and planning and provide a more wholistic plan of care for this patient population and the unique set of circumstances in which they find themselves.
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.

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