The growing opioid use epidemic in the United States affects all aspects of the population, including pregnant women. The fetus may have chronic exposure to opioids from the pregnant woman’s substance use or from addiction treatment with legally prescribed opioids such as methadone or buprenorphine. These fetuses are likely to go through withdrawal after birth when the supply of opioids from placental transfer is removed. This withdrawal is called neonatal abstinence syndrome (NAS) and often leads to prolonged hospitalization to treat the symptoms of withdrawal, including irritability, feeding intolerance and poor sleep. Studies have found that the mothers of these infants often feel judged by the nurses caring for their infants and they are unable to build a trusting therapeutic relationship due to stigma. Nursing curricula have limited content on substance use disorder; this leaves nursing students and future nurses unprepared to care for childbearing families affected by opioid use disorder. The purpose of the study is to explore the knowledge, attitudes, and beliefs of undergraduate nursing students about opioid use disorder in pregnancy and NAS. We will conduct an anonymous online survey to explore students’ perceptions of caring for mothers and infants affected by NAS. We will also examine student characteristics (demographics, personal or professional exposure to substance use) that may predict stigmatizing attitudes. Findings will inform development of educational materials and programs that can better prepare future nurses to care for this population. These educational tools may address stigma towards opioid use disorder, best practices in caring for infants with NAS, and promoting mothers’ engagement in the care for their infants while hospitalized.

Asthma is the most common chronic disease among children, affecting almost 10% of children in the US. Standard treatment for persistent asthma is inhaled daily corticosteroids to reduce airway inflammation. Adherence to these controller medications is poor, with less than 50% of children consistently using them. Poor adherence leads to worsened asthma control, causing increased symptoms, exacerbations, school absences, and decreased quality of life. Poor asthma control has also been associated with impaired family functioning. The purpose of this study was to analyze the relationships between quality of life, family functioning and asthma control among school-age children with asthma and their parents.  Thirty-three child-parent dyads (children ages 6-11 years) were enrolled in this study. Parents and children independently reported on asthma quality of life and the child’s asthma control. Additionally, parents reported on family functioning using the McMaster Family Assessment Device, which assesses numerous family functioning domains. Our hypothesis is that poor asthma control will be associated with impaired family function and decreased asthma quality of life and that parent and child reports of asthma quality of life will differ significantly. Results from this study will provide insight into new potential opportunities for nursing interventions for children with asthma and their families. 

About 75% of women experience sleep disturbances during pregnancy. Sleep problems during pregnancy are associated with prolonged labor, preterm birth, an increased risk for cesarean delivery, gestational hypertension, glucose intolerance, and depression. To our knowledge, no research has explored the experience of sleep difficulties in pregnant women of color, despite the evidence that racial and ethnic minorites have an increased risk for poor sleep quality. The purpose of this study is to describe the sleep experiences in pregnant women of color during the second half of their pregnancy and to examine the personal and systemic contexts for their sleep. We conducted qualitative semi-structured interviews with 10 women recruited from a local prenatal clinics. Questions explored the internal physical and emotional challenges as well as the external challenges to getting sufficient quality and quantity of sleep during pregnancy. We audio recorded interviews, transcribed verbatim, and analyzed data using qualitative description methodology. We expect that health disparities faced by women of color will be manifested as personal, enviromental, and systemic factors that contribute to their difficulty sleeping during pregnancy. Findings from this study will have implications for the design of culturally appropriate prenatal interventions to facilitate improved sleep for minority women. 

Asthma affects over 6 million children in the United States. Asthma management requires a high level of executive functioning and self-regulation, including attention, planning, problem solving, and self-control. Executive functioning deficits, therefore, may impair asthma management capacity. Therefore, the purpose of this study is to describe the executive functioning of school aged children with asthma. The executive functioning of 33 children ages 6 to 11 years with asthma was tested using the National Institute of Health Toolbox Cognition Battery. The battery assessed numerous executive functioning processes, including attention, inhibition, shifting, episodic memory, working memory, processing speed, receptive vocabulary, and language. Compared to the reference sample, children in this study exhibited significantly lower age-adjusted scores in attention and inhibition t(33) = 93.06, p = 0.001, shifting t(33) = 92.64, p = 0.003, and processing speed t(30) = 82.37, p = 001. They scored significantly higher in receptive vocabulary t(33) = 113.76, p = 0.000, and language t(30) = 119.80, p = 0.000. This study revealed significant differences in the executive functioning of school aged children with asthma, specifically deficits in attention, inhibition, and shifting. These functions can be instrumental in the consistent use of controller medications and as a result impact the effectiveness of asthma management. Implications of these findings may include developing asthma management strategies within the capacity of the child. Future studies should explore the possible causes for executive functioning deficits as well as interventions that align with the executive functioning capacity of school aged children with asthma.

Throughout the United States, children and adults are forced to engage in sexual acts and use illicit drugs against their will, in what many would call modern day slavery, commercial sexual exploitation, or sex trafficking. Victims are controlled through coercion, force, fraud, physical and sexual violence and they endure many emotional and physical consequences. Approximately 80% of victims access healthcare during their time of exploitation for health reasons such as acute injuries, sexually transmitted infections, and mental illnesses, such as depression, anxiety, trauma, and suicidal ideation. The emergency department (ED) is the frontline to these patients. To date, little is known about nurses' confidence or competence in identifying or caring for this vulnerable population in Seattle, WA. The aim of this study is to examine what current practices exist at emergency departments in three, large referral hospitals in Seattle to identify victims, and to assess facility and nurse readiness for improved identification. Nine ED nurses in Seattle were interviewed to gain insight into how they currently identify trafficking victims, their opinion of the acceptability of existing screening questions (compiled from nationwide piloted studies) in their ED setting, and whether they felt such a standardized screening tool may be effective in identifying victims and improving subsequent care. Through transcription of audio interviews, nurses’ responses were analyzed and coded for common themes. Improved identification of trafficking victims by nurses and other frontline health workers in emergency settings may lead to more efficient and effective linking with vital support services and resources to assist them in safely exiting the sex trafficking industry. Results from this study will be shared with the participating hospitals, as well as public health officials and stakeholder organizations in order to improve awareness of sex trafficking, victims, and provision of necessary care and resources to support this vulnerable population.

Worldwide, there are currently more than 50 million people living with dementia and this number is projected to exceed 135 million by 2050. Unfortunately, negative stereotypes and misconceptions about dementia continue to exist, which can result in harm, isolation, and stigma towards those living with dementia. Dementia Friends is an anti-stigma and educational campaign that trains volunteers called “champions” to host informational sessions out in the community. During these sessions, champions educate local community members about the impact of dementia and what they can do to help. These community members are known as a “dementia friend” and are encouraged to help those with dementia live welll. Although Washington state is the fourteenth state to adopt the Dementia Friends program from the United Kingdom, limited research is available about the effectiveness of the program. This study seeks to evaluate the effectiveness of the Dementia Friends program in training the champions in Seattle and Yakima by comparing pre-training and post-training questionnaires. Results from this study will guide the expansion of the Dementia Friends program in other cities. Online questionnaires were distributed to 15 champions before and after the training session via RedCap. In order to assess the champions’ attitudes, perceptions, and experiences about dementia, participants were given 20 subjective statements about dementia and a 7-point Likert scale to assess the degree to which participants agree or disagree with each statement. We anticipate that Dementia Friends will be effective in educating community members and reducing misconceptions regarding dementia. If efficacious, we recommend Dementia Friends to be adopted across Washington to de-stigmatize dementia by educating community members.

Sleep in hospitalized children is disrupted by numerous factors including loud noises, light, assessments, medication administrations, and being away from their usual sleep routine and setting. Inadequate sleep can increase behavioral problems, increase stress, and increase length of stay. The goal of this project is to evaluate if an evidence-based sleep hygiene protocol in the Psychiatric and Behavioral Mental Health Unit at Seattle Children's Hospital promotes better sleep for the patients. The sleep hygiene protocol, a guided routine done prior to bedtime, is derived from a literature review on sleep routines in school aged children. A retrospective chart review will be conducted of seven patients from the unit ages 5-9 who use the sleep hygiene protocol. Data will include usage of sleep medication, hours asleep, and nighttime behavioral problems from before and after implementation of the sleep hygiene protocol. I am focusing on the effectiveness of the newly edited sleep hygiene protocol. Results from this study will be used to refine the sleep hygiene protocol so that it can be widely implemented in the PBMU and other units of the hospital. 

One out of every two-hundred schoolchildren lives with type 1 diabetes. Type 1 diabetes is a chronic illness that requires monitoring blood glucose, calculating insulin needs, meal planning, and monitoring for and treating hypoglycemia and hyperglycemia. Effective coordination of care between school nurses, health care providers, parents, children, and school staff is critical to promote diabetes control and prevent adverse health outcomes. The purpose of our project is to describe parent and school nurse perceptions of care coordination in the care of children with type 1 diabetes. Our project is part of a larger project that aims to identify facilitators and barriers to effective care coordination in Washington state schools. Focus groups were conducted with parents of type 1 diabetics in urban and rural settings throughout the state that represent the diversity of resources and school nurses across the region. We recorded, transcribed, categorized, and analyzed verbal and written responses to identify themes. Our preliminary findings suggest that parents and nurses identify inadequate communication between school nurses, parents, and providers, and difficulties organizing care as a significant barrier to effective care coordination. Strong communication and involvement between all parties contributes to successful care coordination. Results from the larger project will be used to develop a care coordination model to inform interventions to improve the care of children with type 1 diabetes in schools.

Elevated intermuscular fat (IMF) is an indicator of metabolic syndrome and triggers the development of chronic diseases such as diabetes and heart diseases. Metabolic syndrome (MetS) includes insulin resistance, hypertension, dyslipidemia, hypercholesterolemia and abdominal adiposity. A leading hypothesis linking IMF to MetS is because skeletal muscle is the primary site of glucose metabolism. This function is impeded by the presence of IMF due to limited microvasculature perfusion to the muscle. Cancer treatment increases the ratio of intermuscular fat to skeletal muscle (IMF:SM), which indicates an investigation of IMF is warranted in patients treated for cancer. The purpose of this study to investigate the relationship between IMF, diabetes and hypertension in patients treated for cancer. We will perform a secondary analysis to examine IMF composition by magnetic resonance imaging (MRI) leveraging existing data in 143 cancer patients with stage A heart failure. This will inform us of the association between intermuscular fat, hypertension and insulin resistance in cancer patients, which is the first study to investigate this research question. Further study is needed to determine whether increased IMF in cancer patients leads to increased risk of MetS or diabetes. Furthermore, this line of work will inform future research into lifestyle interventions capable of reducing intermuscular fat, which has implications for the development of MetS in individuals treated for cancer.

Everyone dying at home requires help from a care partner (CP). For most people, these CPs are family members and friends who help their loved ones with daily tasks, medications, and comfort measures. Those who engage hospice services also benefit from the support of experienced medical/social service teams. By definition, the focus of hospice care is on a family unit, although currently there are no broadly disseminated systematic methods for assessing the needs of CPs or offering preventative interventions. My mentors, Dr. Sadak's team, conducted a pragmatic trial of assessing CP needs in hospice by adapting "Managing Your Loved One's Health" (MYLOH), a 29-item self-report measure of CP activation: readiness, knowledge, skills for meeting their care recipient's healthcare needs and maintain personal wellness for use in hospice. I reviewed and thematically coded: 1. Video interviews with RN case managers and administrators, 2. Researcher's field notes, and 3. All other documented communication between the research and the hospice teams; created a timeline and documented the rationale for adaptations that were made in MYLOH. Methods: A Sample of N=50 CP of people receiving hospice care; N=14 RN Case Managers; N=6 Hospice Administrators. MYLOH and several other brief CP assessment measures were administered by RN case managers to CPs on baseline, week 4, and week 12. Measures were used as a guide for conducting CP/Patient needs assessment, and to plan and assess effectiveness of interventions. Case managers took process notes and offered feedback via video-recorded interviews with the research team. Adaptations to MYLOH were made based on this iterative feedback. MYLOH-Hospice is a 12-item measure that is a useful tool for guiding assessment and interventions for CPs in hospice, it has strong face validity and acceptability, but is found to be too long for iterative routine use.

Cancer is the second leading cause of death in the United States. Advanced treatment techniques and robust research have improved cancer survivorship. However, there is significant cancer treatment related morbidity and mortality with 30% of breast cancer patients presenting with heart failure symptoms that include trouble breathing, poor exercise tolerance, and fatigue. Therefore, research that aims to improve the lives of cancer survivors in this regard is needed. Excess body weight is a significant risk factor for both increased mortality in cancer patients and heart failure symptoms; however, it is unclear how fat is implicated. Intermuscular fat (IMF), fat that is located inside and between muscle groups, is a metabolically active tissue that competes with skeletal muscle for the use of oxygen, blood, and glucose. Elevated IMF has the strongest relationship with breast cancer mortality compared to any other measure of body composition. The purpose of my research is to describe differences in IMF accumulation during treatment in 143 patients receiving chemotherapy for cancer. Abdominal magnetic resonance imaging (MRI) will be used to determine total skeletal muscle, visceral fat, and IMF using Tomovision software. Images will compare total pixel surface area of each tissue to create a ratio of skeletal muscle to IMF at enrollment (0 mos) and end of study (24 mos). I hypothesize that the type of chemotherapy most strongly associated with weight loss will be linked with increased IMF during treatment. The study results will add to one aspect of a larger body of work that aims understand the mechanisms of IMF in cancer patients and its relation to cancer treatment-related symptoms. Future research should investigate interventions that aim to reduce IMF and monitor for reduced fatigue, less severe heart failure symptoms, and improved patient mortality.

Dementia impacts 4+ million older adults in the United States. The majority of patients with dementia (PWD) are cared for at home by family/friend care partners (CP). While this caregiving role can be highly meaningful, it is also a demanding responsibility. Resilience, or the ability to recover from stressful situations, has been shown to be protective for CP of PWD. There are three major models of resilience, describing resilience as: 1) an outcome, 2) a trait or 3) a process. Currently, there is no consensus on the best way to operationalize and measure resilience in the context of dementia caregiving. My project focuses on addressing this gap. My hypothesis is that: 1. Resilience in the context of dementia caregiving has specific characteristics, reflecting the complexity of caregiving; 2. CP likely over-estimate their resilience; 3. Resilience is a dynamic process related to positive functioning that fluctuates across time and situation, rather than a personality trait or outcome. 4. Optimal assessment will combine CP self-report with more objective, observable, or CP-reported behaviors. Our initial focus was understanding different approaches of defining and measuring resilience in CP of PWD. We used two data sources to code behaviors linked with resilience: 1. relevant literature; 2. 30 semi-structured interviews with CP of PWD evaluating resilience-related behaviors. We identified relevant behaviors and organized data from both sources using thematic coding. We used key identified behaviors to create a behavior-based model of CP resilience–Care Partner Resilience (CPR). Our hypotheses were confirmed. Our next steps are to validate CRP. Dementia is one of the major health conditions faced by the geriatric population, and CP burden from dementia can take a devastating toll the capacity to continue providing care. Thus, an accurate operational definition of resilience is essential in targeting interventions and developing long-term support tools for CP.

Probiotic bacteria grow on the intestinal lining and are essential for optimal digestive health. Understanding the optimal growth conditions for these probiotics is particularly important, since healthy probiotic populations in the gut have been shown to positively impact health in a number of ways. In order to determine the effect of pH and nutrient availability, the following methods were performed; first, probiotic growth was achieved by inoculating Sigma-Aldrich (MRS) and Luria-Bertani media (LBm) at different pH’s ranging from 2 to 7.5. For both MRS and LBm, live cultures of probiotics have been proven to grow successfully in both media while incubated at 37 degrees Celsius at the pH of +/- 6.2. The Bradford protein assay was used to determine protein concentration in samples of both media, and the tryptic digestion of the bacterial cultures were analyzed by liquid chromatography mass spectrometer. These findings will be reported, highlighting important differences in the proteomic data sets in relation to different environmental variables.