• A Brief Educational Intervention to Improve Culturally Appropriate Care in Hispanic Adults with Type 2 Diabetes Living in Texas

      Pacheco, Christy; Diaz, Gabriela Cassandra; Brown, Angela; Allison, Theresa (The University of Arizona., 2019)
      The purpose of this project was to utilize an online asynchronous educational webinar to increase the Texas Nurse Practitioners Association’s providers’ knowledge of teaching strategies and culturally appropriate education for Hispanic patients with type 2 diabetes. The incidence of type 2 diabetes in the Hispanic population in Texas is increasing with the Hispanic population being diagnosed disproportionately more. This is a cause for concern across the state of Texas due to its significant Hispanic population. Type 2 diabetes; if poorly managed, can have negative outcomes for the patient’s quality of life as well as a financial impact on the economy. Unsuccessfully managed glucose levels may result in debilitating outcomes, such as renal failure, stroke, loss of limbs, blindness, nerve damage, and possibly early death. The sample included 40 nurse practitioners’ who were members of the Texas Nurse Practitioner Association. This project included a pre-test and a post-test to evaluate the effectiveness and satisfaction of the webinar. This project ran for three weeks, during which time one reminder e-mail was distributed. Data was then compiled and analyzed using descriptive statistics. The results of the comparison showed that the presentation helped nurse practitioners by providing new cultural knowledge. There were barriers in the questionnaires because the pre-test and post-test were not linked, so there was no way to determine the knowledge learned by each individual participant. There were also technical problems regarding sound quality and speed of presentation. This study could serve as a foundation for further research on improving cultural education for providers who educate Hispanics with type 2 diabetes in Texas. Aggregate data and recommendations were given to the Texas Nurse Practitioner Association.
    • A Case Study of Art Museum Educational Programming for Persons with Dementia and their Care Partners

      Hochtritt, Lisa; Romero, David Reuel; Shin, Ryan; Kraus, Amanda (The University of Arizona., 2018)
      Persons diagnosed with dementia or with an intellectual disability and their care partners frequently are marginalized by society (Innes, Archibald, & Murphy, 2004). In the United States, the dementia community is growing because of an aging population and increasing numbers of persons with brain injuries (Hurd & Langa, 2013; Plassman et al., 2011). This qualitative case study investigated inclusive museum programming for persons with dementia (PWDs) and their care partners. It focused on participants from Tucson Museum of Art’s (TMA) Memories in the Making program (MIM) and examined: (1) museum and art education strategies, (2) the use of other disciplinary theories, and (3) how universal design influences the intellectually disabled museum visitor. Using a constructionist lens and single case study methodology, the investigation examined: 11 interviews from museum professionals, docents, artist/educators, and care partners; art pieces produced by the participants; and programming materials. The theoretical frameworks of Kübler-Ross (1974, 1969), Boss (2016, 2007, & 1999), and Schlossberg (1981) were used to analyze issues of grief, loss, and human development. The study findings affirmed that: (1) museum dementia programs strengthened the relationship between PWDs and the care partners, (2) shared experiences had a positive effect on both, (3) there is a need for effective educational strategies for visitors with intellectual disabilities, (4) environments of creativity and self-expression are needed, even when impediments exist. Results suggest that further investigations are warranted into how to strengthen, expand, and sustain museum and art educational programming for those members of the intellectual disability communities. Keywords: dementia, intellectual disabilities, care partners, museum educational programming, museum inclusion
    • A Catalog of Chamber Music Works for Cello in Trio, Quartet, and Quintet Formats from Colombian Composers Who Lived During the Late Nineteenth, Twentieth and Twenty-First Centuries

      Buchholz, Theodore; Mejía, Juan David; Alejo, Philip H.; Kantor, Timothy A. (The University of Arizona., 2020)
      When Nobel Prize-winning author Gabriel García Márquez was asked about magical realism, he replied that surrealism, the main component of magical realism, came from the reality of Latin America. It is in this same manner that the composers in this catalog have expressed their reality - through a chorus of many different sounds and rhythms distinct to Colombia. The purpose of this study is to discover and promote Colombian chamber music from 1880 to the present. This has been accomplished by researching trio, quartets, and quintets in which the cello is included as part of the ensemble. A comprehensive catalog of fifty-three composers and 126 chamber music works found while researching in Colombia are presented. Pertinent information on composers and their works, including instrumentation, publishers, and libraries where the compositions can be found, is included in this project. Finally, this study discusses four works from the catalog that serve as examples of the diversity of styles and wealth of repertoire existing in Colombia. Appendices to this research include a list of instrument abbreviations, as well as a list of publishers and libraries with their respective contact information. As significant research of Colombian chamber music, this catalog intends to introduce and facilitate these compositions, exposing and cultivating Latin American chamber music repertoire.
    • A Change in Forecast: A Preliminary Analysis of the Effects of a Brief Mindfulness Intervention on Elementary School Class Climate

      Eklund, Katie R.; Meyer, Lauren Nicole; Kirkpatrick, Jennifer B.; Sulkowski, Michael (The University of Arizona., 2018)
      In recent years, schools have begun seeking new ways to support students who are encountering barriers to success, specifically addressing academic and behavioral challenges that emerge in the classroom setting. Instruction in social-emotional learning (SEL) has emerged as a potential solution for students struggling with self- and social-awareness, relationship skills, self-management, and decision-making. The purpose of the current study was to evaluate the effects of a brief SEL-based mindfulness intervention on classroom climate and academic outcomes. Seven elementary school classrooms participated in a mindfulness program over a ten-week intervention period, and were matched with seven additional classrooms that acted as the control group. Teachers were trained to implement a two-minute mindfulness-based intervention that was delivered three times per day. Results indicated an increase in classroom satisfaction among students participating in the intervention. Students in both control and intervention classes demonstrated increases in friction and decreases in cohesion. Improvements in academic achievement were also observed. Both intervention and control teachers reported changes in classroom climate over time, specifically indicating decreases in friction. Further, there was a significant difference between intervention and control groups for cohesion; the intervention group had overall higher levels of cohesion. Practical implications, study limitations, and avenues for future research were considered.
    • A Clinical Decision Tool to Guide Prevention of Adult Postoperative Nausea and Vomiting during Ondansetron Shortages

      Carlisle, Heather L.; Hoch, Kristie; Bernal, Diana; Piotrowski, Kathleen A. (The University of Arizona., 2020)
      Nausea and vomiting frequently complicate recovery from anesthesia. Postoperative nausea and vomiting (PONV) are concerning to patients, with some patients fearing PONV more than postoperative pain. PONV remains a significant problem in anesthesia because of the multitude of consequences such as unexpected hospital admission, delayed recovery, and return to work of ambulatory patients, pulmonary aspiration, wound dehiscence, and dehydration. The antiemetic drug, ondansetron, is recognized as the standard of care in the prevention and treatment of PONV, but this medication is frequently on the national drug shortage list. The primary purpose of this Doctor of Nursing Practice (DNP) project was to develop an evidence-based clinical practice tool to guide PONV prevention practices during ondansetron shortages, to be used by anesthesia providers at a hospital in the Tucson area. The objectives for this project included exploring facility practices surrounding PONV prevention during ondansetron shortages, educating anesthesia providers on available alternative antiemetics during shortages, and evaluating the perceived usefulness of a clinical decision tool on PONV prevention practices. Lewin’s Change Theory and The Johns Hopkins Evidence-Based Practice (EBP) Model were utilized as the quality improvement, conceptual frameworks to facilitate translation of current evidence into best practices. Expert practitioners (N=7) were educated on the clinical decision tool modeled after the 2014 Society of Ambulatory Anesthesia (SAMBA) consensus guidelines. 100% of participants agreed or strongly agreed that the proposed clinical decision tool would enhance PONV prevention practices during ondansetron shortages. Project results were reported to the facility’s Director of Professional Practice and the anesthesia department’s chief Certified Registered Nurse Anesthetist (CRNA).
    • A Collaborative Investigation of Climate Change Adaptation for the Pyramid Lake Paiute Tribe

      Chief, Karletta; Chew, Edward Silvio Schuyler; Ramírez-Andreotta, Mónica; Crimmins, Michael; Scott, Christopher (The University of Arizona., 2020)
      This dissertation explores climate change impacts to the Pyramid Lake Paiute Tribe (PLPT) and considers how collaboration and community engagement with diverse stakeholder perspectives are critical for PLPT adaptation. The PLPT is a federally recognized tribe located at the Pyramid Lake Indian Reservation in the Truckee River Basin of what is now northern Nevada. The Pyramid Lake Paiute call themselves the Kooyooe Tukadu, or cui-ui eaters, reflecting their deep connection to the fish species of Pyramid Lake, which include the endangered cui-ui (Chasmistes cujus) and threatened Lahontan cutthroat trout (LCT, Oncorhynchus clarkii henshawi). The Kooyooe Tukadu are deeply connected – culturally, physically, and spiritually – to the Truckee River Basin, Pyramid Lake, the cui-ui, and the LCT, all of which are threatened by impacts of climate change. Designed and framed within an ongoing collaborative partnership between the PLPT Council and university researchers, this research has three key objectives: (1) develop community outreach strategies and tools for the PLPT that stimulate discussion of climate change issues; (2) engage PLPT departments and stakeholder groups to understand climate change impacts and vulnerability; and (3) explore how adaptation and Indigenous knowledge may enhance PLPT responses to climate change.Utilizing decolonizing and participatory action research methodologies, this study engaged community perspectives of climate change through a community centered workshop. Educational resources were developed to augment PLPT community members’ knowledge of how local climate affects the Pyramid Lake ecosystem. With PLPT oversight, interview questions were designed to identify climate change impacts and the role of planning and Indigenous knowledge in adaptation. This study engaged 31 PLPT department staff and stakeholders in interviews and focus groups. Their responses were organized into three main categories: climate change impacts and vulnerabilities; adaptation and planning; and Indigenous knowledge in climate change adaptation. Participants expressed concern about a wide range of climate change and environmental impacts. including water resource issues, cultural concerns, environmental change, management and operations, and impacts on individual livelihoods. Education, outreach, and community engagement were emphasized as potential solutions for adaptation planning. Planning emerged as an important category from the interviews and focus groups that encompassed seven themes: mismanagement, community engagement, funding issues, strategic plans, operations planning, ecosystem restoration, and PLPT governance. The role of Indigenous knowledge in PLPT adaptation was explored extensively through seven relevant themes: practices, knowledge & history, land, survival, colonization, intergenerational, and protection. The results of this study have direct relevance to PLPT efforts to understand and respond to climate change. This study may offer insight to tribal governments considering climate change research partnerships with university researchers. This study emphasizes accountability, PLPT autonomy over research design and data, empathy for participants, and respect for their contributions. This study’s careful approach to understanding how PLPT Indigenous knowledge might be included in adaptation efforts may provide guidance to other Indigenous communities. The conclusion offers a summary of the participants’ views on adaptation and Indigenous knowledge that the PLPT Council could consider for climate change action planning.
    • A Comparative Multi-Site Case Study of the Implementation and Impact of a Stock Inhaler Protocol in Two School Districts in Tucson, Arizona

      Gerald, Lynn; Snyder, Aimee; Taren, Douglas; Cutshaw, Christina; Clemens, Conrad; Contreras, Ricardo (The University of Arizona., 2018)
      A stock inhaler protocol for schools has been recommended as an important safety net for students who do not have access to personal quick-relief medication. The implementation process and impacts of the stock inhaler protocol in public school systems are not well defined in the literature. This comparative case study assesses the processes and impacts of stock inhaler implementations in two low-income, majority Hispanic public school districts in Tucson, Arizona. The implementation and impact assessments used simple quantitative usage data and extensive narrative data from meeting notes, email correspondences, and in-depth interviews to evaluate the implementation processes and impacts from the 2013-2017 school years. Legal and practical concerns were the primary barriers to stock inhaler adoption at the district level and implementation at the school level. The recognition of the students’ needs and lack of resources; challenges of care without quick-relief medications; supports from external asthma experts; and supports from a centralized district health services leadership were identified as facilitators of adoption and implementation. The stock inhalers were used in the majority of the schools included in the evaluation. The stock inhalers were favored by all interviewed stakeholders (n=78), except for one caretaker and one adolescent. School health staff reported that the stock inhalers improved school-based respiratory care; reduced time, opportunity, and resource losses; reduced psychological distress related to unexpected respiratory distress; provided a tool used to improve family/student respiratory care and asthma management; and allowed family/student reliance of the school’s stock inhaler. The improved school-based respiratory care; reduced psychological distress; and reduced time, opportunity, and resource losses were the most cited benefits of the stock inhalers. Stock inhaler protocols can provide reliable and immediate access to quick-relief medication for any individual who experiences respiratory distress at schools, dependent on the design of the protocol. Stock inhaler protocols can improve efficiency and effectiveness of school-based respiratory care when barriers to access and implementation are reduced. External stock inhaler supports – including supportive state laws, expert knowledge to adapt the protocol to fit the needs of the district/school, and provision of necessary medication and delivery device – can reduce barriers to adoption and implementation.
    • A Comparative Study of Vladimir Leyetchkiss's 1985 Piano Transcription of Igor Stravinsky’s Le Sacre du printemps

      Woods, Rex; Linder, Daniel; Dong, Minjun; Knosp, Suzanne; Cockrell, Thomas (The University of Arizona., 2020)
      Vladimir Leyetchkiss was a pianist, composer, and teacher born in Russia on August 8, 1934. It was Leyetchkiss’s love for transcriptions that led him to study with Heinrich Neuhaus. His passion for writing and playing piano transcriptions was fueled by his strong interest in orchestral music and conducting. His transcription work was facilitated by his impressive technique as well as his ability to produce an orchestral sound at the piano. He transcribed numerous orchestral works for the piano including Trois nocturnes by Debussy, L’Apprenti sorcier by Dukas, Tasso: Lamento et Trionfo by Liszt, symphonies of Taneyey and Prokofiev, and most notably, Igor Stravinsky’s Le Sacre du printemps. This study shows that Leyetchkiss’s piano transcription of Le Sacre du printemps is superior to three existing transcriptions of the same work by other composers, because of its fidelity to the original orchestral score. The three existing transcriptions are: Le Sacre du printemps for Piano Four Hands by Igor Stravinsky; The Rite of Spring: Complete Ballet for Piano Solo by Sam Raphling; “The Rite of Spring: An Original Solo Piano Transcription of Stravinsky's 1913 Ballet with Annotations and Historical Notes” by William Norman Fried. Leyetchkiss’s piano transcription not only includes as many elements and voices as possible from the orchestral score but is also practical and accessible for the performer. Studying and performing this repertoire is a rewarding process for pianistic and musical growth. A comparative analysis of these four transcriptions will follow a brief history of the development of the piano transcription (Chapter 2), and an introduction to Stravinsky’s Le Sacre du printemps (Chapter 3). Chapter 3 includes comparison of selected passages from five representative sections of Le Sacre du printemps: “The Augurs of Spring,” “The Ritual of Abduction,” and “Dance of the Earth” from Part I and “Naming and Honoring of the Chosen One” and “Sacrificial Dance (The Chosen One)” from Part II.
    • A Compassion Fatigue Education Presentation for Medical-Surgical Nurses

      Reel, Sally; Vintapatr, Pauline; Wung, Shu-Fen; Bouchard, Lindsay (The University of Arizona., 2022)
      Purpose: This quality improvement project aimed to increase awareness of compassion fatigue, its’ signs and symptoms, and self-care strategies in medical-surgical nurses at a local hospital in Oakland, California.Background: Medical-surgical nurses is the single largest specialty that deals with a high number of complex patients and tasks which can cause a higher risk of becoming compassion fatigued. Interventions such as education on compassion fatigue and self-care can help increase awareness of this problem and may decrease the risk of compassion fatigue in nurses. Methods: This project used a comparative design including a retrospective pre-test focusing on nurses working in a medical-surgical unit to measure perception of learning. Demographic data and baseline Professional Quality of Life Scores were obtained. Participants then viewed an education presentation on compassion fatigue, signs and symptoms, risks, and self-care strategies. Results: Professional quality of life scores showed moderate levels of compassion satisfaction, burnout, and secondary traumatic stress within this group of 21 participants. Pre and post mean results were statistically significant indicating participants felt they had a growth in learning after viewing the education presentation. Conclusion: Education on compassion fatigue was beneficial in providing awareness of compassion fatigue, the signs and symptoms of compassion fatigue, and strategies to decrease the risk of compassion fatigue for medical-surgical nurses at a local hospital.
    • A Comprehensive Analysis of Simple Verbs in Persian

      Karimi, Simin; Nabors, Rana Nicole; Harley, Heidi; Henderson, Robert (The University of Arizona., 2019)
      This dissertation is an analysis of the internal construction of simple verbs in Persian within the Distributed Morphology (DM) framework. Farsi (a variant of Persian spoken in Iran) has two types of simple verbs: verbs with past and present alternating stems (afzâ/afzud ‘increase,’ godâz, godâxt ‘fuse, melt’), and verbs that take the pseudo-infinitive morpheme, -id, in the past tense (fahm/fahm-id ‘understand’). Either verb type may causativize with the morphological causative affix, -ân-, (fahm-id/fahmând ‘understand/make understand’). This work, argues for a unified analysis of simple verbs, in which an acategorical root combines with a verbalizer to form a verbal stem. In the past tense, this verbalizer can be either null or overt. I show (in chapter 2) that the null verbalizer triggers alternations to the final phoneme of the root, and that this alternation is systematic. This is a unique and up-to-date analysis of these alternating past/present stems and one that is supported by evidence from synchronic and diachronic language change. In chapter 3, I argue against a mono-morphemic analysis of the pseudo-infinitive morpheme and claim this affix is in fact composed of an overt verbalizer, -i-, and the voiced version of the past tense affix, -d. In chapter four, I propose that the causative affix, -ân-, is a root attaching little-v. Following Folli and Harley’s (2002, 2004) ‘flavor of v’ analysis, I claim that the causative affix is blocked in verbs that take a vDO flavor during numeration. Verbs that specify a vDO flavor in their structure are verbs that have certain restrictions on their agent, which do not permit subject demotion. The restrictions on the external arguments of these verbs is specified in the feature bundle in little-v. When Vocabulary Items (VI) compete for insertion in the structure, the VIs that are overspecified for the terminal node are blocked from insertion; hence, the blocking of the causative little-v, -ân-, from these verbs. This work not only provides a comprehensive list of simple verbs in Persian which includes their archaic, formal forms and the current colloquial forms, but also makes exciting predictions about the direction of verb changes over time, as simple verbs are being replaced with complex predicates (CPrs) in the language.
    • A Conductor’s Guide and a New Edition of Christoph Graupner's Wo Gehet Jesus Hin?, GWV 1119/39

      Chamberlain, Bruce B.; Brobeck, John T.; Seal, Kevin Michael; Woods, Rex A. (The University of Arizona., 2020)
      Christoph Graupner (1683-1760) was Kapellmeister for the court in Darmstadt, Germany for nearly fifty years. In this position he composed over 1400 church cantatas. Original manuscripts exist from which to produce a new performance edition of Graupner's Wo gehet Jesus hin?, GWV 1119/39. This edition incorporates current understanding of historically- appropriate performance practices by consulting the considerable scholarly literature pertaining to late Baroque performance practices in general and, more specifically, performance practices in eighteenth-century Darmstadt. This document provides a guide for conductors to explore this music, focusing on Graupner's life, the development of the German Protestant Church Cantata and Graupner's contributions to the genre, and analysis of the work itself. Special areas of emphasis will be the following practices affecting performance: conditions at the Darmstadt court, issues of tuning and pitch, the size of the ensemble, the difference between modern and historical instruments, the composition of the basso continuo group, and the challenges of realizing a keyboard part.
    • A Critical Analysis of Written and Pictorial Representations in Picturebooks about Koreans in the United States

      Short, Kathy G.; Lee, En Hye; Combs, Mary Carol; Gilmore, Perry (The University of Arizona., 2020)
      This study explores cultural representations of Korea through a critical content analysis of 29 picturebooks that portray Korean communities and families in the U.S. Framed within the postcolonial theories with a particular lens of othering, the study examines written and pictorial representations of Korean people and culture in the U.S. to unpack the issues of othering, power structure of East and West, Self/Other dichotomy, and resistance of Eurocentric dominant narratives embedded in stories of Korean communities in children’s picturebooks published in the U.S. Critical content analysis is employed as a research methodology in this study to investigate the following research questions: How is Korean culture represented in these picturebooks? How do representations of Korean culture interplay within words and pictures? How do representations of Korean culture shift and/or transform in accordance with the publishing years of picturebooks? How do social, historical, cultural, and political contexts of publishing years interplay with the representations of Korean culture in words and pictures? One of the most significant findings in this study is that the dichotomized opposition brought about by unfair comparisons between Korea and U.S. is both explicitly and implicitly embedded in written and visual representations. It is interpreted through the lens of Orientalism that the unbalanced representations of East/West are rooted in an underlying Western sense of cultural superiority intertwined with power and domination. When it comes to the issues of cultural authenticity, lack of understanding of current socio-cultural contexts and absence of cultural fluidity in cultural representations are critiqued to warn the danger of single story and perpetuation of othering. Postcolonial resistance is also found in cultural representations. As cultural mediators, cultural objects/practices reflect Korean cultural identity illuminating the voices of Koreans in the U.S. The study discovers that these representations function as a form of postcolonial resistance of the Western dominant narratives and hegemonic gaze. Through a postcolonial lens, this critical content analysis further inspects Korean children’s cultural positioning and analyzes the relationship between the dearth of diverse racial characters in Korean children’s socialization and the assimilationist ideology or Eurocentric construction of Self/Other. Finally addressed in the study are socio-economic/political/cultural shifts in Korea reflected in picturebooks. From a postcolonial perspective, the changes in patterns of narratives and representations in picturebooks shed light on the hope of breaking down the binaries of East/West, the hope of resisting the Eurocentric lens of making the other, and the hope of moving from representing to re-presenting cultures.
    • A Cultural and Environmental History of Paricutin: Volcano in a Cornfield

      Beezley, William H.; Perrott, Claire; Jenkins, Jennifer L.; Gosner, Kevin M.; Vetter, Jeremy A. (The University of Arizona., 2020)
      A volcano grew out of a cornfield in Michoacán, Mexico in 1943, completely transforming the landscape and local people’s lives. Immediately following the news of this new volcano named Parícutin, observers flocked to the area. Within the first two years of activity, the volcano grew to about 1,400 feet, covered two villages with lava, and blanketed three villages with ash. The volcano gained attention because of its sudden appearance and mild eruptions that observers could closely watch, making it the first volcano in modern times that scientists could study from its birth. Different groups including locals, scientists, artists, journalists, and tourists, had distinct interactions with the volcano that reflect a profound national cultural examination. This study focuses on how visitors and locals interpreted and experienced the volcano. Recorded in written and visual documents, these various perceptions turned Parícutin into a symbol of national identity, or mexicanidad. The inhabitants of the area, who were mainly of Purépecha descent, rationalized it as a punishment for sinful behavior. Meanwhile, the national government exploited it as a scientific phenomenon and an opportunity to insert their idea of mexicanidad into the socially isolated Purépecha highlands. In their accounts of Parícutin, outsiders gave voice to popular ideas about the volcano, but silenced the role of villagers outside of the initial eruption and evacuation stories. Visual sources including photographs and artwork reveal a more comprehensive history of the volcano, one that incorporates people excluded from the written record. This research not only contributes to the scholarship on Mexican national identity, but it also acts as a microhistory for how a community reacts to changes in landscape. In a world with increasing environmental uncertainty, that is most harmful for marginalized communities, this work looks at how culture influences reactions to natural disasters and vice-versa.
    • A Deleuzian Approach to Critical Literacy through Global Children’s Literature

      Short, Kathy G.; Kim, Hee Young; Yaden, David B.; Brochin, Carol (The University of Arizona., 2020)
      This dissertation joins in a discussion of promoting critical literacy through children’s literature. Founded on Deleuze and Guattari’s theories, it examines preservice teachers’ responses to global children’s literature. The purpose of this study is to explore the ways of adapting Deleuzian theories into critical reading and literacy and how global children’s literature creates the space for critical literacy. For this study, I designed reading and response strategies that reflect Deleuze and Guattari’s theories, through which preservice teachers responded to global children’s literature. This dissertation answers questions of how preservice teachers responded to sociopolitical context, language use, and collectivity, which are three characteristics of Deleuze’s conception of ‘Minor’ literature and are present in global children’s literature and how they engaged with nonrepresentational visual responses as a Deleuzian literacy engagement. For three semesters, a combined total of sixty-three preservice teachers participated who were enrolled in a children’ss literature course in an undergraduate teacher education program. Result of this study showed that reading global children’s books through a Deleuzian lens created shifts in preservice teachers’ stabilized notions of politics and language. Global children’s literature includes political contexts that are different from preservice teachers’ lived experiences. Global children’s literature also present other languages than English and different language uses from normalized English. Focusing discussions on the differences in politics and language reveals how preservice teachers’ perspectives are stabilized and normalized in the territorialized power structure. Preservice teachers also developed the notion of becoming. Deleuzian reading facilitated discussions about collective identity and how they become others. Nonrepresentational visual response provided new experience of creation. Analysis of preservice teachers’ engagement showed that collectivity and creation could be ways of implementing the notion of becoming as an effective practice for critical literacy. Through this study, I investigated Deleuzian theories and global children’s literature in pursuing critical literacy. This dissertation demonstrated a literacy practice in which preservice teachers read global books through Deleuzian lens. Developing literacy practices of creating difference and becoming could be useful additions to critical literacy. Global children’s literature would be an effective conduit to this new approach.
    • A Descriptive Grammar of Kalinago

      Warner, Natasha; Josephs, Keisha Marie; Zepeda, Ofelia; Ussishkin, Adam (The University of Arizona., 2019)
      This dissertation is a descriptive grammar of Kalinago, a dormant Arawakan language that was spoken in the Caribbean area, primarily the Lesser Antilles. It is closely related to Garifuna a language currently spoken in Central America and Lokono, an endangered language spoken in South America. Chapter 1 provides a historical background of the Kalinago people, as well as an explanation of historical written documentation about the Kalinago language. Chapter 2 uses a historical linguistic approach to determine the phonetic inventory of the language from written documentation and related languages. Through this approach, I determine the existence of an aspiration distinction in stops, a voiceless alveolo-palatal fricative, as well as an aspirated nasal. Chapter 3 describes some of the more common Kalinago morphemes and argues that Kalinago is a middle voice marking language. In Chapter 4, the syntactic features of the language are explained, highlighting a possible VSO sentence structure and the organization of comparative phrases. Finally, Chapter 5 examines the role of linguistics in language revitalization and how it can be applied to revive and revitalize the Kalinago language.
    • A Descriptive Study of Palliative Care Team Use in the Intensive Care Unit

      McRee, Laura; Andrade, Aaron; Reed, Pamela; Baldwin, Carolina (The University of Arizona., 2019)
      Objective: The cost of an ICU stay is over two and a half times more expensive than a regular inpatient admission, taxing healthcare systems nationwide (Barrett, Smith, Exlixhauser, Honigman, & Pines, 2014). Palliative care consults can lead to decreased costs by facilitating de-escalation of care, limiting futile treatments, and decreasing total length of stay (Enguidanos, Housen, Penido, Mejia, & Miller, 2014). The purpose of this descriptive study is to review the medical records of patients admitted to the ICU with pre-existing advance directives and to whether goals of care discussion occurred, signified by the initial palliative care consult visit date, so that care could be guided towards the goals pre-described. Methods: This retrospective chart review was conducted to identify the total number of adult patients admitted to the ICU at a level one trauma, stroke, and academic healthcare facility in Scottsdale, Arizona from January 1, 2017 to December 31, 2017 with pre-existing advance directives.  It will also identify whether or not a palliative care consult was ordered, and if so, how long after admission the goals of care discussion occurs, signified by the initial palliative care visit date.  Finally, it will assess the discharge disposition of these patients.  Findings: One hundred forty-two patients that met inclusion criteria for 2017 had a pre-existing DNR status. Of those 142 patients, 40 had a documented palliative care consultation order. Zero patients had a palliative care initial visit date on the day of or one day after admission. Five patients had a palliative care initial visit date of 2 to 3 days after admission, and three patients had a palliative care initial visit date of 4 to 5 days after admission. Finally, there were 5 patients that had a palliative care initial visit date that occurred more than 5 days after admission. Of the 40 patients that received a palliative care consult, 10 expired. Of those patients discharged to the morgue, 10 received a palliative care consultation, and 4 did not. Conclusion: A gap in care is present in those admitted to the ICU with a pre-existing DNR status because 71% of patients admitted to the ICU with a pre-existing DNR status did not receive a palliative care consultation. Four patients with a pre-existing DNR status died in the ICU without receiving a palliative care consultation. A palliative care consultation would ensure that all healthcare providers are in alignment with the patient and their family regarding the healthcare goals and treatment plan. The results and information obtained from this project can be used to guide quality improvement projects championed by the AGACNP aimed at creating a protocol requiring a palliative care consultation to be ordered within 24 hours of admission to the ICU in those with a pre-existing DNR status so that goals and plan of care can be in alignment.
    • A Diabetes Educational Intervention to Improve Self-Management (A Quality Improvement Project)

      Daly, Patricia; Harper, Brooke; Prettyman, Allen; Poedel, Robin (The University of Arizona., 2021)
      Purpose: This DNP quality improvement project aimed to assess the feasibility and usability of educational videos to improve diabetic patients' knowledge of diabetes self-management.Background: Diabetes prevalence is growing and accounts for 20% of chronic diseases in the US, with 34.2 million people (10.5% of the population) diagnosed in 2018. Severe comorbidities are associated with inadequate management of diabetes, prompting a focus on diabetes self-management education. Diabetes self-management education benefits non-insulin-dependent diabetic patients by lowering hemoglobin A1c (HbA1c) levels up to 0.5%-2%. Methods: The Health Behavior Model helped develop the education and motivate patients to change to benefit their health. The Model for Improvement helped guide the project design, set goals, identify accomplishments, measure improvements, and select the change that resulted in improvement. A pretest/post-test quantitative design was used with an evidence-based diabetes self-management educational intervention. The project measured knowledge changes from baseline on diet, confidence, and intention to change. The post-test measured the participant's understanding and the effectiveness of the intervention. Results: Six participants completed both the pretest and the post-test. Demographic data demonstrated the average age of the patients was 57.8 years (range 56-65, SD= 1.5), with 17% male and 83% female. 83% (SD=0.37) of participants reported they never received any diabetes education. The Wilcoxon-signed rank test with a p-value of 0.05 for statistical significance was used to measure the change in knowledge and confidence of the following: I feel fearful about my future health, I know what healthy carbohydrates are, Fresh fish are a great way to incorporate protein into my diet, I feel confident I can manage my diabetes through diet, and Proteins affect my blood sugar minimally. Comparing the change in the questions mentioned above indicated a statistically significant difference with a p-value = 0.00902 Conclusions: APRNs can facilitate patient education to support preventative medicine rather than reactive medicine. Results from this project indicate that this educational intervention can increase knowledge and self-efficacy for diabetes self-management. This project can be utilized to benefit the health and well-being of patients, increase best practices, and help promote patient autonomy and self-efficacy.
    • A Digital Intervention to Educate Primary Care Providers to Perform Clinical Skin Examination for Melanoma in Underserved Patients

      Loescher, Lois J.; Diesner, Kyla; Stratton, Delaney; Flamm, Kristie L.; Bouchard, Lindsay A. (The University of Arizona., 2019)
      Background: Skin cancer is the most common cancer in the U.S. and melanoma is the deadliest type. Family nurse practitioners (FNPs) commonly work as primary care providers (PCPs) to care for underserved patients who are at risk of melanoma, but PCPs generally have a low knowledge of melanoma and low likelihood of performing clinical skin examination (CSE) for those patients. The U.S. Preventative Services Task Force recommends that PCPs conduct a thorough skin examination during patient examinations to aid in early detection of suspicious skin lesions. There is little information on how PCPs learn about CSE for melanoma or perform it in practice for their underserved patients. Purpose/Aims: To provide a digital video intervention to educate PCPs including FNPs, about CSE for melanoma in underserved patients. CSE was defined as melanoma risk assessment, head-to-toe skin examination, and skin lesion assessment. Aims were to determine whether scores improved postintervention for 1) CSE knowledge, motivation, and skills and 2) self-reported CSE in practice. Methods: This quality improvement (QI) project targeted a healthcare organization in Southern Arizona that served homeless, low income, Medicaid-eligible, Native American, migrant farmworkers, and rural populations. Recruited were 14 PCPs working in the organization’s six regional clinics. The Information-Motivation-Behavioral Skills (IMB) model guided the project. Participants completed an online pretest measuring CSE information (melanoma in underserved populations, risk factors), motivation (for conducting CSE), behavior skills (for CSE) and behavior change outcomes for CSE (number performed in practice). The intervention consisted of four brief videos previously tested for feasibility, each less than seven minutes long and delivered digitally. The videos covered melanoma in underserved populations and the CSE components. Participants completed an identical online posttest two weeks postintervention. Results: All data were self-reported and analyzed using descriptive statistics. Six PCPs recruited (42.9%) participated: all were FNPs with a mean age of 39.83 years and a mean of 3.33 years of primary care experience. Scores for information, motivation and behavioral skills all improved from pretest to posttest: the proportion of correct scores for information improved from 62.5% to 81.2%. Mean scores for motivation improved from 3.81 to 3.98 (1=strongly disagree, 5=strongly agree). Mean percent of correct responses for head-to-toe skin examination steps improved from 16.7% to 50%. Overall mean percent of correct answers for skin lesion assessment improved from 70.8% to 71.9%. The mean number of CSEs performed in practice increased from 1.33 to 9.50. Conclusion: The results show potential to provide a video intervention within this and other organizations to improve FNPs’ CSE skills and motivate FNPs to use those skills while caring for underserved patients. FNPs may need further instruction on skin lesion assessment. Future research directions include conducting a randomized controlled trial to determine the effect of the intervention on CSE outcomes and to further inform evidence-based practice for FNPs. Future directions considered by the organization are 1) showcasing the videos at upcoming provider meetings and 2) integrating the videos into PCP orientations. Future directions for education include securing continuing education credits for the intervention.
    • A Family Systems Approach to Sleep Patterns in Down Syndrome

      Edgin, Jamie O.; Romero, Andrea J.; Khosla, Payal; Taylor, Angela R. (The University of Arizona., 2019)
      Down syndrome (DS) is one of the most common genetic conditions that manifests in a physical, behavioral, mental, emotional, and neurocognitive manner (Bittles, Bower, Hussain, & Glasson, 2006; Bull & the Committee on Genetics, 2011). In terms of physical health, individuals with DS are at a higher risk for congenital heart defects, hypothyroidism, gastrointestinal issues, and sleep problems (Bittles et al., 2006; Carter, McCaughey, Annaz, & Hill, 2009). Of particular importance, is the 30% to 80% prevalence rate of obstructive sleep apnea syndrome (OSAS) in DS (Dyken et al., 2003; Shott et al., 2006). OSAS as well as other sleep disturbances have been linked to neurocognitive and developmental delays among individuals with DS (Breslin et al., 2014; Edgin et al., 2015). A limitation to previous work in DS is evaluating sleep and its impact on development from a family systems perspective. The family’s interconnectedness, cohesiveness, and self-stability characteristics may play a role in sleep and development for individuals with intellectual disability. The three studies presented in this dissertation examined the multiple ways in which sleep effects all members of the family in addition to infant development in a longitudinal sample of infants with and without DS from 6-months to 24-months of age. In Study 1, we investigated work schedules among parents of 18-month-old infants with DS and typically developing (TD) along with its impact on infant sleep quality and quantity. There were no significant differences in work schedules and total number of hours worked per week between parents in both groups. However, infants with DS displayed significantly less sleep time, greater fragmentation index, poorer sleep efficiency, and more time waking up after sleep onset (WASO). We found group differences in nights per week spent co-sleeping and parents’ perceptions regarding the importance of a consistent bedtime routine. When assessing employment schedules, regardless of group, parents who were unemployed were more likely to indicate having an exact bedtime routine for their infant followed by parents with standard and nonstandard work schedules. Parenting stress was significantly higher among parents with a standard work schedule followed by parents with a nonstandard work schedule and unemployed. Finally, we found infant WASO to be highest in the nonstandard work schedule group and unemployed for families with and without DS, respectively. These results highlight the importance of assessing parental work schedules to better understand infant sleep patterns and family functioning. The findings from Study 1 indicate that sleep deficits begin to emerge as early as 18-months among infants with DS. In Study 2, we investigated a specific sleep practice - co-sleeping - and its association with sleep efficiency and daytime regulation among infants with and without DS at 18-months-old. Results indicated that while co-sleeping all of the night is more common among TD infants (approximately 26%), the most common type of co-sleeping for infants with DS was the second part of the night (almost 18%). Infants with DS not only displayed significantly poorer sleep efficiency but also higher scores on the depression/withdrawal subscale of the Infant-Toddler Social and Emotional Assessment (ITSEA) and lower adaptive behavior scores, both signifying delays in socio-emotional outcomes. Co-sleeping frequency was not correlated to sleep efficiency and any of the daytime regulation variables. Nonetheless, these findings suggest a need to assess co-sleeping behaviors in further detail and determine its impact on other sleep parameters and developmental outcomes in children at risk for sleep problems. In the first study, one of the prominent findings involved differing sleep practices between groups, specifically co-sleeping behavior and parents’ perceptions surrounding a bedtime routine. The second study addressed co-sleeping patterns and daytime regulation; therefore, in Study 3 we evaluated the associations between bedtime routine consistency, daytime functioning, and overall sleep quality, relationships not previously studied in this population from 6- to 24-months of age. Findings indicated that parents engaged in a consistent bedtime routine with their infant and their perception of the importance of the routine on their infant’s development increased with time. Growth curve models showed that a consistent bedtime routine was related to less externalizing behavior and fewer vocalizations particularly in the TD group and a 10-point difference in adaptive behavior scores with each assessed time point and longer sleep times regardless of group. Significant group differences were found such that infants with DS displayed less internalizing behavior and poor sleep efficiency compared to TD infants. The results highlight the impact of a consistent bedtime routine for all children, typical and atypical. Altogether, the three papers provide insight into sleep practices that, to our knowledge, have not been studied in the DS population. We note how parent-level factors such as works schedules, decision to co-sleep, and implementing a consistent bedtime routine impact infant sleep behavior. The last study proposes a strength-based approach not deficit-based approach to studying atypical development. Future work should further investigate different factors influencing infant sleep and development while also considering parental sleep behavior to obtain a holistic assessment of sleep among families with DS.
    • A Feasibility Study Assessing the Safety and Benefits of Seated Sun-Style Tai Chi among Individuals with Multiple Sclerosis

      Taylor-Piliae, Ruth E.; Taylor, Emily; Loescher, Lois; Pace, Thaddeus; Hom, Sharon (The University of Arizona., 2019)
      Background: An estimated 80% of individuals with multiple sclerosis (MS) do not meet daily physical activity recommendations. Low-impact physical activity that can be performed seated, such as Tai Chi, may be especially beneficial for individuals with MS having greater disability burden. Tai Chi is rooted in traditional Chinese medicine, and standing forms have been studied among individuals with MS. Methods: A quasi-experimental, single group pretest-posttest study was used to explore the effects of the Tai Chi intervention on personal (physical function, exercise self-efficacy, MS-related symptoms), behavioral (physical activity, exercise habits, exercise planning, exercise goal setting), and environmental factors (social support), using Bandura’s Social Cognitive Theory as the theoretical framework. Results: This study enrolled 25 individuals with MS in seated Sun-Style Tai Chi classes for one hour, twice weekly, over 12 weeks. Study retention was 88%, class attendance was 75%, and study satisfaction was 86.4%. No serious adverse events occurred during the classes. MS-related symptoms were measured every four weeks over a 16-week period. While this Tai Chi intervention study was not powered to detect significant differences in personal, behavioral, or environmental factors, there were significant improvements at eight-weeks in depression (p=.006), 95% CI [-6.37, -1.07], and anxiety scores (p=.028), 95% CI [-5.16, -0.30], and significant improvements at 12-weeks in depression (p=.002), 95% CI [-6.47, -1.39] and exercise goals scores (p=0.015). Improvements in scores were non-significant for fatigue (p=.099), lower extremity function (p=.922), exercise self-efficacy (p=.295), subjective physical activity (p=.118), and sub scores of social support from family and friends including family participation (p=.516), family rewards (p=.210), and friend participation (p=.349). Pain intensity (p=0.849) and pain interference (p=0.882) scores increased at four weeks and trended down as the study progressed. Exercise planning (p=.116) and upper extremity function scores (p=.176) decreased at 12 weeks. Conclusion: This study filled an important gap in our knowledge of potential benefits of physical activity among individuals with MS by determining adherence, feasibility, and safety for future research assessing the use of sun-style seated Tai Chi among individuals with MS.