Saudi Cultural Missions Theses & Dissertations
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Item Restricted Clinical Effects of Nasal High Airflow on Swallowing Physiology, Respiratory-Swallowing Patterning, and Temporal Measures in Advanced Stable Chronic Obstructive Pulmonary Disease(Northwestern University, 2024-05-04) Saadi, Raneh; Martin-Harris, Bonnie; Lee, Julia; Shaikh, HameedaNoninvasive respiratory support (NRS) treatments, which deliver mechanical positive pressure through the upper airway to assist with oxygenation and ventilation, have been rapidly expanding in recent years. This growth is attributed to the comparable physiologic benefits to invasive mechanical ventilation methods, while simultaneously mitigating the associated risks and complications. The pulmonary effects associated with the mechanisms of respiratory support are generally well understood, but the effects on swallowing movements and breathing and swallowing patterns remain unclear. This dissertation aims to a) assess existing evidence on the impact of various types of NRS on measures of swallowing function, airway protection, and respiratory-swallowing patterns, and b) examine the clinical effects of nasal high airflow oxygen therapy (HFNC), one form of NRS, on measures of swallowing physiology, respiratory-swallowing patterns, and temporal measures in patients with advanced, stable chronic obstructive pulmonary disease (COPD). Chapter 1 presents a systematic review and a summary of current evidence on the effects of NRS modalities on measures of swallowing function and respiratory-swallow patterns. Chapter 2 describes a detailed clinical investigation of the effects of HFNC on measures of swallowing physiology, airway protection, respiratory-swallowing patterns, and temporal measures in a cohort of patients with stable, advanced COPD. Findings from the systematic review (Chapter 1) revealed that NRS modalities had mixed effects on swallowing measures and respiratory-swallow patterns in both healthy adults and those with respiratory diseases. The results from Chapter 2 demonstrated that HFNC did not exert negative effects on swallowing physiology or airway protection. However, there were favorable effects on increasing optimal respiratory-swallowing patterns and prolonging durations of expiratory phase in cycles containing swallow. While this study is exploratory, these findings suggest that HFNC did not result in adverse effects in this cohort. In addition, these results emphasize the need for instrumental swallowing evaluation in patients requiring this respiratory intervention.29 0Item Restricted The Implementation of an Online Educational Program for Nurses: Increasing Knowledge About Dysphagia and Dysphagia Dietary Recommendations(Saudi Digital Library, 2023-08) Nagshabandi, Bedoor; Shune, SamanthaDiet modification has become a fundamental clinical tool for speech-language pathologists (SLPs) within dysphagia management, particularly for acutely ill patients. However, for dietary modifications to meet intervention goals of increased intake and prevention of negative health consequences, adherence is needed across healthcare professionals, including nurses. Previous literature has highlighted education as a key contributor to increased adherence. Further, the increased flexibility of online education may help mitigate barriers experienced by healthcare professionals to completing these trainings. The purpose of this study was to develop and pilot an online educational program about dysphagia and diet modification for inpatient nurses caring for patients experiencing dysphagia. The study also aimed to examine the feasibility of program implementation and participants’ overall perceptions of program impact. A total of four participants completed the program and subsequent surveys with three also participating in semi-structured interviews about their experience. Results showed a large effect in knowledge level change between baseline and directly after completing the program and between baseline and one month after completion. Additionally, most of the participants rated the educational program as “good” using the System Usability Scale. Four themes were generated based on the semi-structured interviews. First, participants described the positive benefits of the educational program on their knowledge and clinical practices. The second and third themes encompassed dysphagia-related training received in educational and work settings and what barriers exist to additional training. The fourth theme included insight into the relationships between nurses and SLPs and the positive effects of a strong relationship. Taken together, the quantitative and qualitative analyses supported improvement in participants’ knowledge levels, preliminarily supporting the program’s effectiveness. Results also showed good levels of acceptability and feasibility of the online program as a mode for training. By increasing knowledge about dysphagia management, implementing such a program in nursing training or continuing education may increase adherence to dietary recommendations. In doing so, such a program can lead to earlier identification and appropriate management of dysphagia, resulting in better treatment outcomes, including a reduction in the negative consequence of dysphagia, increased patient satisfaction, and improved quality of life.25 0