The development of a self-directed learning module for rural emergency nurses on pediatric diabetic ketoacidosis

Background: Newfoundland and Labrador has a high incidence of type 1 diabetes and diabetic ketoacidosis (DKA) is a complication of type 1 diabetes. A clinical practice guideline was developed for the treatment of pediatric diabetic ketoacidosis (DKA) to standardize care in all Emergency Departments and improve patient outcomes. Rural emergency nurses are requires to maintain their competency and acquire new knowledge as stated by the Association of Registered Nurses of Newfoundland and Labrador (ARNNL). Purpose: The purpose of this practicum was to develop a self-learning module for rural emergency nurses to increase their knowledge and understanding of the clinical practise guideline to assess, treat, and prevent pediatric ketoacidosis. Methods: Two methodologies were used in this practicum. A review of the literature and consultations with key stakeholders were completed. Results: The self-learning module created was composed of three units and focused on the learning needs of rural emergency nurses in the areas of assessment, treatment, and prevention of pediatric DKA. Conclusion: The goal of the practicum was to increase rural emergency nurses’ knowledge and implementation of the clinical practice guideline when assessing and treating children and families experiencing DKA to improve patient outcomes. A planned evaluation of the self-learning module will be conducted following dissemination of the module throughout the rural Emergency Departments.

The development and preliminary testing of an instrument to measure the perceived economic burden of a subtype of arrhythmogenic right ventricular cardiomyopathy (ARVC) on patients and families in Newfoundland

The goal of this thesis was to develop, construct, and validate the Perceived Economic Burden scale to quantitatively measure the burden associated with a subtype Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in families from the island of Newfoundland. An original 76 item self-administered survey was designed using content from existing literature as well as themes from qualitative research conducted by our team and distributed to individuals of families known to be at risk for the disease. A response rate of 37.2% (n = 64) was achieved between December 2013 and May 2014. Tests for data quality, Likert scale assumptions and scale reliability were conducted and provided preliminary evidence of the psychometric properties of the final constructed perceived economic burden of ARVC scale comprising 62 items in five sections. Findings indicated that being an affected male was a significant predictor of increased perceived economic burden in the majority of economic burden measures. Affected males also reported an increased likelihood of going on disability and difficulty obtaining insurance. Affected females also had an increased perceived financial burden. Preliminary results suggest that a perceived economic burden exists within the ARVC population in Newfoundland.

Development of calix[4]arene-functionalized microcantilever array sensing system for the rapid, sensitive and simultaneous detection of metal ions in aqueous solutions

The work described in this thesis was conducted with the aim of: 1) investigating the binding capabilities of calix[4]arene-functionalized microcantilevers towards specific metal ions and 2) developing a new16-microcantilever array sensing system for the rapid, and simultaneous detection of metal ions in fresh water. Part I of this thesis reports on the use of three new bimodal calix[4]arenes (methoxy, ethoxy and crown) as potential host/guest sensing layers for detecting selected ions in dilute aqueous solutions using single microcantilever experimental system. In this work it was shown that modifying the upper rim of the calix[4]arenes with a thioacetate end group allow calix[4]arenes to self-assemble on Au(111) forming complete highly ordered monolayers. It was also found that incubating the microcantilevers coated with 5 nm of Inconel and 40 nm of Au for 1 h in a 1.0 M solution of calix[4]arene produced the highest sensitivity. Methoxy-functionalized microcantilevers showed a definite preference for Ca²⁺ ions over other cationic guests and were able to detect trace concentration as low as 10⁻¹² M in aqueous solutions. Microcantilevers modified with ethoxy calix[4]arene displayed their highest sensitivity towards Sr²⁺ and to a lesser extent Ca²⁺ ions. Crown calix[4]arene-modified microcantilevers were however found to bind selectively towards Cs⁺ ions. In addition, the counter anion was also found to contribute to the deflection. For example methoxy calix[4]arene-modified microcantilever was found to be more sensitive to CaCl₂ over other water-soluble calcium salts such as Ca(NO₃)₂ , CaBr₂ and CaI₂. These findings suggest that the response of calix[4]arene-modified microcantilevers should be attributed to the target ionic species as a whole instead of only considering the specific cation and/or anion. Part II presents the development of a 16-microcantilever sensor setup. The implementation of this system involved the creation of data analysis software that incorporates data from the motorized actuator and a two-axis photosensitive detector to obtain the deflection signal originating from each individual microcantilever in the array. The system was shown to be capable of simultaneous measurements of multiple microcantilevers with different coatings. A functionalization unit was also developed that allows four microcantilevers in the array to be coated with an individual sensing layer one at the time. Because of the variability of the spring constants of different cantilevers within the array, results presented were quoted in units of surface stress unit in order to compare values between the microcantilevers in the array.

Development of a learning resource manual for nurses new to thoracic surgery

Background: Patients with lung and esophageal cancer often have surgery as a means of treatment. In Newfoundland and Labrador, patients with lung and esophageal issues are cared for on Six East, the General/Thoracic Surgery unit at St. Clare’s Mercy Hospital. These patients frequently require chest tubes, which are managed and assessed by Registered Nurses (RNs) on the unit. For nurses new to thoracic surgery, fulfilling their new role and caring for chest tube systems can be daunting. Purpose: The purpose of this practicum project was to develop a learning resource manual for nurses who are new to thoracic surgery. Via self-directed learning, the manual can increase the knowledge and self-efficacy of nurses who are caring for thoracic surgery clients and assessing chest tube systems. Methods: An informal needs assessment, integrated literature review, and several consultations via in-person interviews were conducted. Results: Based on the findings from these methodologies, Knowles’ Adult Learning Theory, and Benner’s Novice to Expert Model, a learning resource manual was created. The manual was divided into chapters covering various aspects of patient and chest tube system care and assessment. Conclusion: For the purpose of this practicum project, no evaluation was conducted. However, a plan for future evaluation of the learning resource manual has been developed to determine if the manual assisted with increasing the knowledge and self-efficacy of nurses new to thoracic surgery. “Test Your Knowledge” questions were included at the end of each chapter in the manual as well as case study scenarios to allow for participant self-evaluation.