Under Washington State law, nurse delegation is a process in which a registered nurse, known as a nurse delegator, provides training and management for delegated care tasks to be performed by long-term care workers (LTCWs) within in-home or community-based care settings. State law requires that clients who receive care through nurse delegation must be in a stable and predictable condition (SPC). In our previous study, we determined that nurse delegators need more specific criteria than the definition in Washington State law to assess SPC. The purpose of this project is to provide additional clarification to the determination of SPC by developing an instrument for nurse delegators to use for comprehensive assessment of SPC and describing the instrument’s utility and applicability. Methods to reach those goals included: 1) reviewing published literature and policy reviews of federal and state-by-state laws on potential alternative definitions for SPC; 2) consultation with nurse delegation content experts (two Washington State Nurse Delegation Program Managers and a nurse researcher, whose work helped establish state regulations for nurse delegation in Washington State) regarding the clinical applicability of a SPC assessment instrument; 3) development of the instrument based on relevant clinical evaluation guidelines and instruments content expert feedback; and 4) collection and analysis (via phone interviews and qualitative content analysis, respectively) of feedback from nurse delegators on the utility and applicability of the developed instrument. We hypothesize that nurse delegators will view the instrument as a useful clinical resource for determining SPC within the nurse delegation process. The results of this study can be used to implement the instrument independently or in conjunction with other evaluation methods, as standardized practice to assess SPC and effectively meet this state requirement for clients to receive care under nurse delegation.

Insulin is a medication that requires training, safety, and care in administration due to potential serious outcomes if administered incorrectly. Under Washington State Law, long-term care workers (LTCW) are permitted to administer insulin in community-based and in-home care settings with the oversight of a nurse delegator, a registered nurse who is responsible for the nursing care of a client and supervises an unlicensed person to perform selected tasks for that client. The current model of training for LTCWs lacks a standardized method to assess their competency in administering insulin. The purpose of this research study is to explore methods of assessment to inform the development of a standardized, comprehensive tool for evaluating competency in insulin administration. The aims of this study are to determine the utility and feasibility of this tool. I developed the “Insulin Delegation: Competency Evaluation Tool” by researching methods of training and evaluation and through student-mentor collaboration. The tool incorporates entrustment scores, reflection, and competency-based education. Prior to testing, the tool was reviewed by content experts, including Washington State Nurse Delegation Program Managers and a nurse researcher who helped develop and evaluate nurse delegation regulations in Washington State. The tool was tested in the field by nurse delegators contracted with the Department of Social and Health Services to assess delegated LTCW competency of insulin administration. After that testing period, feedback on the utility and feasibility of the tool was obtained by an online survey with Likert-type scale and free-text items. I expect to find that the tool is effective in assessing competency in insulin administration and applicable to the workflow of nurse delegators. This tool has potential use as a standard resource for nurse delegation training and an ongoing safety and quality measure in community-based and in-home care practice.

Every year, approximately 18,000 children and adolescents are diagnosed with cancer in the United States, and many of these diagnosed children will have siblings. Some studies indicate that siblings suffer from high rates of post-traumatic stress reactions, school absenteeism, behavioral problems, and declines in academic performance. Preliminary results from “Parenting in the Face of Cancer: Non-ill Child and Parent Relationships" indicate that children have misconceptions about the cause of cancer and contagion. They are also reluctant to share their feelings and concerns with their parents, and wonder what their role is in helping their sibling with cancer. The aim of this study is to develop a children’s book to facilitate communication between parents and their non-ill children. We reviewed the published literature about the effects of cancer on school-age non-ill siblings, and conducted interviews with child life specialists who work in cancer care. We also analyzed interviews of school age (7-12 years) non-ill siblings of children with cancer. Analysis focused on sibling’s perspectives of what caused the cancer, contagion, worries and concerns, and the perceived availability of their parents. The siblings’ perspectives and misconceptions were used to develop a story that provides a simple description of cancer, addresses the siblings’ misconceptions and concerns, encourages them to share their feelings and concerns with their parents, and suggests ways they can play an active role in their sibling’s treatment. A future study will be designed to evaluate whether this interactive children’s book alone, or the book with a short nurse coaching session, will improve emotional and behavior outcomes in non-ill siblings of children with cancer.

A consequence of the rising opioid epidemic in the United States is the dramatic increase in the number of infants born with a drug dependency known as neonatal abstinence syndrome (NAS). Treating NAS often requires lengthy hospital admissions and presents a range of challenges to both nurses and mothers caring for these newborns. While the nurse-mother partnership carries great potential to improve treatment outcomes for the infants, it is frequently hindered by stigma and poor maternal engagement. The purpose of this study is to better understand the nursing and maternal-level factors that affect the nurse-mother relationship and to identify the needs of both parties to partner in infant caregiving. We collected data through surveys given to nurses and mothers at Swedish Medical Center First Hill and Ballard campuses. Data analysis of the nurse surveys focused on the relationships among knowledge and comfort with NAS, stigma, and compassion while analysis of the mother surveys focused on the relationship among trauma history, parenting confidence, and maternal engagement. We hypothesized that greater knowledge and comfort with NAS among nurses was associated with decreased stigma and increased compassion towards families affected by this syndrome. We also predicted that extensive trauma history and lack of parenting confidence was negatively associated with the mother's ability to engage with her infant. In creating a better understanding of the nurse-mother relationship, we hope to guide future research on developing interventions that will improve the nursing care and maternal engagement in families affected by NAS.

Childhood asthma accounts for 571,000 ER visits, 136,000 hospitalizations, and $10 billion in healthcare costs annually in the United States. Fewer than 50% of children with asthma are adherent to their treatment regimen, leading to worse health outcomes. The purpose of this study is to develop and test the usability and acceptability of the symptom monitoring and response module of the Child Asthma Management Program (CHAMP), a new web-based, tailored asthma shared management health application for 7 to 11-year-old children with persistent asthma and their parents. A user-friendly and visually engaging module was developed with content focused on asthma symptom identification, monitoring, and response. Using a human-centered design framework, dyads of children and parents were recruited to participate in two rounds of design and usability sessions with prototypes of the module. Additionally, dyads completed the Asthma Responsibility Questionnaire, CHAMP acceptability questionnaire, and a semi-structured interview following the sessions. Thematic analysis using an investigator-developed coding frame was used to code all interview data using ATLAS.ti software and quantitative data from the acceptability survey was transferred to SPSS 24 for analysis. Results from both design and usability sessions will inform final revisions to the module. The final version of this module will guide dyads in improving their asthma shared management. This module meets a considerable need for effective asthma management interventions and represents a step towards better tools for improved chronic disease management for pediatric patients.

There is currently a lack of research in how transgender adolescent populations are affected by sleep and depressive symptoms. Sleep is incredibly important for teens, and there are links between depression and negative sleep outcomes. The purpose of this study is to examine correlations between gender, depression, and sleep in adolescents. I am using all data from a previous study that was comparing sleep and obesity in 100 cis-gendered adolescents aged 12 to 18. I am using this data to determine if a significant correlation exists between gender, objective sleep measures including total sleep time, sleep onset, wake after sleep onset, sleep efficiency (measured via Actigraphy), and depressive symptoms (measured via Center for Epidemiologic Studies Depression Scale, with scores of 16 or higher considered positive for significant depressive symptoms). An ANOVA test is being used to analyze for a significant correlation between gender, mean sleep time in minutes, and the presence or absence of depressive symptoms. The analysis of this data determines whether or not gender has a role in sleep and depressive outcomes, thereby determining the need for a further study of sleep and depressive symptoms in transgender adolescent populations.