Programmed Intermittent Epidural Bolus for Labor Analgesia in a Critical Access Hospital

Klunder, Laraine. Programmed intermittent epidural bolus for labor analgesia in a critical access hospital. Unpublished Doctor of Nursing Practice Scholarly Project, University of Northern Colorado, 2021. With over two-thirds of women in the United States receiving neuraxial analgesia or anesthesia to ease the pain of labor and delivery, advances in epidural technology can potentially influence the childbirth experience. Continuous epidural infusion (CEI) with patient-controlled epidural analgesia (PCEA) has been the mainstay for delivering epidural labor analgesia for the past two decades; however, programmed intermittent epidural bolus (PIEB) is making its debut as a promising new technology to improve labor analgesia. Literature suggests delivery of programmed boluses of dilute local anesthetic with or without opioid at regularly spaced intervals may result in lower local anesthetic utilization while maintaining or improving analgesia quality and maternal satisfaction and minimizing motor blockade. The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to develop and plan for translation of an evidence-based clinical practice protocol for PIEB for labor analgesia in a critical access hospital. The clinical practice protocol incorporated findings from an integrated literature review. Planning for implementation of the clinical practice protocol consisted of a before-and-after without control design to measure the effect of PIEB with PCEA modality for labor analgesia (after group) on analgesia quality, local anesthetic utilization, and prevalence of motor blockade compared to the CEI with PCEA modality (before group). The plan for translation includes the provision of staff education about protocol implementation. Lastly, structure, process, outcomes, and balancing measures were identified to evaluate translation of the practice change. Statistical analysis using SAS software was used where applicable

Culturally Responsive Educational Leadership: A Qualitative Study of Indigenous Innovations

This qualitative study of culturally responsive educational leadership (CREL) explores noteworthy cases of system-wide innovation spanning decades through interviews with seven education professionals active within Indigenous movements and organizations driving Native Hawaiian education and the revitalization of Hawaiian language and culture. The research focus includes the Na Honua Mauli Ola Guidelines (and Pathways) for Culturally Healthy and Responsive Learning Environments, along with the preceding Kumu Honua Mauli Ola Philosophy Statement. Interviewees, all with direct connections to these innovations, illuminate their local and global significance through personal accounts of their development and implementation. The study’s uniquely situated methodology yields rich data for systems-level analysis of these innovative cases of CREL and related work addressing persistent inequities for historically underserved students in the singularly unique environment, education system and socio-cultural context of Hawai‘i. A transformative leadership centered theoretical framework guides data analyses striving for a more complete process-oriented understanding, organizationally and operationally, of effective system-wide CREL practice (across all levels of the P-20 continuum and among various organizational types) in an uncommonly diverse community, as demonstrated in these cases of Indigenous innovation exemplifying CREL in Hawai‘i

Thomas Nast: the Father of Modern Political Cartoons

Drawing a New History of Political Cartooning Fiona Deans Halloran, a history teacher at Rowland Hall-St. Mark\u27s School in Salt Lake City, surveys the life and career of Thomas Nast, the famed nineteenth-century political cartoonist. Nast was born in Bavaria on September 27, 1840, and ...

Fabrication of low optical losses Al2O3 layer used for Er3+-doped integrated optical amplifiers

Al2O3 is commonly used as host material for Er3+-doped integrated optical amplifiers. In this paper, a Graeco-Latin square is used in DC reactive magnetron sputtering deposition experiment in order to get low optical losses Al2O3 layer. By reasonable selection and careful arrangement of experimental parameters, an optimal combination of deposition parameters is obtained via statistic analysis with the fewest experimental runs. The result forms the base for the further fabrication of Er3+-doped Al2O3 layer. The Graeco-Latin square experiment can also be used to investigate the influence of each parameter on the deposition rate of Al2O3 layer

Jayhawkers: The Civil War Brigade of James Henry Lane

Seeking the Real Jayhawkers This book recounts the exploits of the Kansas regiments and their eccentric commander, James H. Lane, during the early months of the Civil War. The focus is on the Third, Fourth, and Fifth Volunteers, which made up the core of Lane\u27s Brigade. The author,...

Lincoln and Douglas: The Debates That Defined America

Those Famous Debates Allen C. Guelzo is the author of several books focusing on Jonathan Edwards and American theology and numerous works on the Civil War era, including Lincoln\u27s Emancipation Proclamation (2004) and Abraham Lincoln: Redeemer President (1999). He combines th...