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Abstracts from the 33rd Conference and Annual Meeting Texas

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					             Abstracts from the 33rd Conference and Annual Meeting
                      Texas Society of Allied Health Professions
                                 September 23-24-2010

               TSAHP Keynote Presentation – September 23, 2010

Health Reform Passed: Is Our Workforce Ready?
José A. Pagán, University of North Texas Health Science Center

   It is now very likely that 32 million Americans will gain health insurance coverage. Although the
health reform bill partly addresses the need to increase the size of the health care workforce to
meet the growing need for care, it is unclear whether the country will be able to recruit and
prepare enough doctors, nurses and other health care professionals to serve all of these patients.
   After so much effort and debate, the inconvenient truth is that we are not ready for this
challenge. The U.S. health care system will not be able to provide high quality care to all
Americans unless there are dramatic improvements in the size and composition of our health
care workforce. Many providers are already challenged to meet the needs and demands of
patients in the current health care climate, especially primary care needs, such as physical exams
and flu shots. This problem will be particularly acute in Texas, California and Florida, where one
of every three uninsured Americans live. Further, given that a large portion of the uninsured
population are either young adults or immigrants, the need for doctors, nurses and other health
care professionals that are attuned to the specific health needs of these populations will be more
relevant than ever.
   All the potential benefits of health care reform will not be realized unless we address these
issues head on. How do we increase the number of primary care providers who are best
prepared to serve the newly insured? Given the high cost of a medical education, scholarships
and loan repayment programs can make primary care specialties much more attractive.
Increasing reimbursement rates for primary care services can also help to make primary care
more profitable. But even the best efforts to make primary care specialties more attractive to
medical students will not be enough to close the employment gap.
   The best solution is a mix of incentives that make primary care specialties more attractive to
medical students and recognize that some of the workforce shortage will need to be filled out by
other health care professionals. In many states, nurse practitioners and physician assistants
provide most of the services delivered by primary care or family physicians, including physical
exams, counseling and prescribing medications.
   The amount of education and preparation needed to become a nurse practitioner or a
physician assistant is typically less than to become a doctor; yet, no shortcuts are taken in
education and training.
   Many studies have shown that nurse practitioners and physician assistants provide similar—
and at times superior—quality of care. Costs associated with care delivered by a nurse
practitioner or a physician assistant are routinely lower, and when working collaboratively with
physicians in primary care settings, nurse practitioners and physician assistants facilitate efficient
case management of patients with chronic or complex health conditions.
   What hurdles do we face as a society if we want to adopt this paradigm shift?
   The first is public fear and erroneous perceptions about the role of different primary care
providers. Although I probably would not go to a nurse practitioner for brain surgery, I would be
perfectly happy to go to one for a routine check-up.
   The second barrier is political will. The health reform bill provides ample resources to reform
the U.S. health care system but does not ask any of the different workforce interest groups to do
more with less. Until we are ready to make some sensible sacrifices, we will not be able to
respond to the needs of all Americans.
               TSAHP Keynote Presentation – September 24, 2010

The Evolution of Simulation Education in Health Care
Steven D. Miller, South Texas College NAH

    An overview of the history of simulation use from simple skills models to today’s high fidelity
patient simulators will be presented. After my presentation, participants will be able to distinguish
between low fidelity, mid fidelity, and high fidelity patient simulators. Tips are based on the
development of the South Texas College Simulations Lab will be provided along with some of the
pitfalls to avoid, some of the “must haves”, and innovative ideas for the future.
                TSAHP 2009 Research Grant Award Presentations

An Investigation of Graduate Speech Pathology Students’ Clinical Self-Efficacy.
Rubini Pasupathy and Renee Bogschutz, Texas Tech University Health Sciences Center

Purpose and Objectives - The primary aim of this study was to investigate clinical self-efficacy
among graduate speech-language pathology students. Clinical self-efficacy is an individual’s
confidence in his or her ability to perform clinical skills successfully. In social learning theory,
Bandura proposes that human behavior, cognition and the environment interact and affect each
other. Specifically, this study investigates the relationship between clinical self-efficacy and
clinical performance as measured by clinical evaluations self-reported by students. Additionally,
this study provides information about clinical skills that are relatively easier or difficult to acquire
from the perspective of a student clinician.
     Methods - The subjects of this study consisted of a convenience sample of speech language
pathology graduate students at a Health Sciences Center located in the Southwestern part of the
United States. Data was collected from first (n = 29) and second (n = 33) year graduate students
in the spring 2010 semester. Graduate students completed a self-efficacy questionnaire wherein
each student rated his or her confidence to conduct various speech-language pathology clinical
tasks on a continuous ratio scale of 0 to 100. Students were also asked to report their current
clinical enrollment, current number of direct contact hours with clients, as well as their most
recent numeric clinical evaluation scores (formative clinic grades given by the training program).
    Major Findings - Preliminary analysis of data indicated that clinical self-efficacy for second
year graduate students was significantly higher (t46 = -4.19, P < .01) than the clinical self-efficacy
for first year graduate students. To further evaluate factors that contribute to a student’s clinical
self-efficacy, correlations were computed between clinical self-efficacy and number of direct
contact hours with clients, as well as reported numeric clinical evaluation scores. A significant
positive correlation coefficient was found between clinical self-efficacy and number of direct
contact hours with clients (r = 0.578, P < 0.01). Students who had more experience (contact
hours) were more efficacious about conducting clinical tasks. Additionally, a positive correlation
coefficient was found between clinical self-efficacy and self-reported clinical evaluation scores (r
= 0.516, P < 0.01). Students who had higher clinical scores were more efficacious about
conducting clinical tasks.
    Conclusions - Speech-language pathology clinical self-efficacy has not been widely studied. It
is critical that allied health training programs, such as speech-language pathology, periodically
assess clinical self-efficacy of their students and revise their clinical curriculum based on the data
collected from students. In the interest of fostering effective and productive speech language
pathologist, it is important to study the development and training of these clinicians.


Acoustic Analysis of Neurogenic Speech and Language Disorders
James Dembowski, Texas Tech University Health Sciences Center

   Objective - Survivors of stroke frequently show communication deficits. These deficits may
take one of two primary forms. One form is difficulty finding the right words or sounds to express
a thought (aphasia). Alternatively, a speaker may know what she wishes to say but be unable to
move her speech articulators to the proper positions to make the correct sounds (apraxia). The
two types of deficit have different neurological bases, but may show strikingly similar perceptual
speech symptoms. Thus, it is often difficult to tell whether a given patient’s symptoms indicate
primarily a language deficit, a speech motor control deficit, or a combination of the two. Fine
grained acoustic analysis has been applied to these different groups of disordered speakers.
Research results suggest that groups may show subtle systematic differences in speech sound
characteristics. To date, this analysis has not been clinically applied to individual patients in order
to make differential diagnoses that contribute to the choice of therapeutic strategies. Additionally,
many practicing clinicians find the technical aspects of acoustic analysis intimidating, and resist
the use of acoustic analysis in clinical practice. This project aims to apply research findings to
selected individual patients, with a view toward determining whether their deficits are primarily
linguistic or motoric, and to facilitate therapeutic choices. One long term hope is that a few
selected measures may emerge that might be obtained easily by speech clinicians in clinic
settings, using micro-computer technology.
    Methods - Data are obtained from stoke survivors who have visited a speech-language clinic
for the purpose of evaluation and/or therapy. The data are drawn from acoustic recordings made
during routine assessments. Data also include results of standard behavioral speech diagnostic
procedures for aphasia and apraxia. From the recordings, a series of acoustic measures are
derived. These include such things as the spectral frequency distributions of selected sounds,
and fine grained temporal measures (such as the durations of selected consonants or vowels).
These measures are compared to published data from existing research studies to see whether
acoustic patterns appear more consistent with patterns of language deficits, or patterns
associated with motor control deficits. Data are also related to behavioral speech diagnostic
procedures.
    Results - Preliminary data from three speakers to date suggest that individual speakers may
show some distinct acoustic patterns similar to those found in groups with different types of motor
and language deficit. At least one speaker shows acoustic patterns that approximate normal
speech; this speaker seems to have a predominantly linguistic deficit. A second speaker shows
more variable acoustic patterns; this speaker appears to have a greater motor control deficit. A
third speaker shows severe disruptions in acoustic patterns related to speech rhythm. The study
is ongoing. Yet to be determined is whether some of these acoustic measures are more telling
than others. Discussion will focus on which, if any, acoustic measures may have practical
applications in clinical settings, and which may be obtained by speech clinicians with minimal
training in acoustic analysis.
                                        Presentations

Better Choices: A Sexual Health Peer Mentoring Program Targeting First-Generation
Freshmen Latina/o College/University Students of the South Texas Border Region.
Janis B. Feldman and Stephanie Rodriguez, The University of Texas – Pan American

    Latina adolescents of Mexican-American ethnicity, especially those 18 and 19 years of age,
have the highest rates of teen pregnancy of all Latinas in the United States. The teen birth rate
increased 5% between 2005 and 2007 and ¾ of these were to older teen ages 18 to 19.
Unplanned pregnancies cause multiple problems including drop out from universities and
colleges. Lack of sexual knowledge, binge drinking and date rape have led to unprotected sex
and unplanned pregnancies accounting for 5% drop out rate for women and 2% dropout for men
in the general freshmen population.
    Mexican-American adolescents who are first generation students in Texas colleges and
universities are a population who are at even greater risk for drop-out because of greater inability
to discuss sexuality openly with their parents, coming from an abstinence-only high school
education, being unable to handle the demands of a different type of educational system, and
family support systems that may not understand the complexities brought on by higher education
within a different culture. This program will focus on this particular student population entering the
University of Texas-Pan American, South Texas Community College, University of Texas-
Brownsville, Texas A & M International University-Laredo, Texas State Technical College, and
Laredo Community College located in the Lower Rio Grande Valley region of South Texas. While
centers of higher education may provide services to student parents, these services are usually
expensive and focus on after birth issues. The program proposes implementing the Better
Choices curriculum to give more attention to preventing unplanned pregnancies and increasing
retention rates.
    Primary participant students would undergo training through Planned Parenthood of Hidalgo
County to serve as sexual health peer trainers and mentors to the student population by
voluntarily participating in two-1 non-credit sexual health courses in two Saturday sessions during
both fall and spring semesters for two academic years. These sessions, plus semester long e-
learning, will include small group training using creative arts and activity centered learning
coupled with discussions/learning exercises developed for the Better Choices using the
curriculum CUIDATE, virtual meeting room in Second Life (http://secondlife.com) and course
sessions in Blackboard (http://www.blackboard.com/ ). Over the 10 week training period students
will twitter (http://twitter.com) issues of sexual and relational wellness to graduate student mentors
as part of their coursework. Graduate student mentors will be trained and monitored by program
directors and community family planning experts.
    During fall semesters, each class group of 18 primary target students will work together to plan
a sexual health fair event at each campus for spring 2011and 2012 semesters promoting peer
awareness building. During the all-day long campus fairs, an additional 800 students (secondary
participants at UTPA and other universities will gain knowledge about sexual and relational
wellness behaviors, contraceptive options, and accessibility. As student knowledge levels permit,
primary program students on campuses will offer peer support using Twitter on-line discussion
tools. Finally, a new Better Choices student lead organization will be developed that will foster
program sustainability.
Making the Connections: Environmental Degradation and Human Health
Catherine A. Faver, The University of Texas - Pan American
Aim of Project - During the past three decades one-third of the world’s resources have been
depleted, and contamination of the earth’s land, water, and air has both direct and indirect health
effects. Yet, because the connections between exploitation of the natural environment and human
health are complex and obscured by the media and private interests, these connections are often
left unexplored in the health sciences and human services curricula. The purpose of this
educational innovation is to illustrate the integration of curriculum content on health and the
environment by presenting a unit of study focusing on the connections among agricultural and
industrial practices, increasing rates of preventable diseases, world hunger in developing
countries, and degradation of the natural environment through air and water pollution, soil
erosion, and climate change. After exploring this particular set of complex connections and
identifying points of intervention to prevent negative health effects, students are prepared to
transfer this knowledge to analysis of other specific connections between the natural environment
and human health.
    Methods - This educational innovation relies on a combination of readings, videos, and
internet activities to facilitate students’ critical thinking about the multiple links among industrial
practices, governmental regulations, consumer demands, environmental degradation, increases
in preventable diseases, and perpetuation of hunger in developing countries. Each of these
factors can be regarded as the focal point to analyze connections to each of the other factors.
The results of these analyses reveal multiple points of intervention to change causal connections.
The analyses ask: Who are the decision makers (in each process)? What power do they have?
What changes are needed to positively affect health outcomes? How can these decision-makers
be influenced?
    Evaluation - In addition to making students aware of the connections between environmental
degradation and human health, this project achieves several important general learning
objectives:
     • Enhances critical thinking by drawing connections between disparate processes
     • Facilitates understanding of differential levels of power among key decision-makers
     • Empowers students with knowledge of multiple intervention points to facilitate change


Does Working as a PT Tech Prepare Students for Success on Their First Clinical Rotation?
Michael Geelhoed and Gregory Ernst, The University of Texas Health Science Center at San
Antonio

   Purpose/Hypothesis - The purpose of our investigation was to determine whether students
who worked as a PT Technician or Aide prior to beginning the clinical phase of their PT education
performed better on their first clinical rotation compared to students who do not work as a PT
Technician or Aide. Our hypothesis was that students who worked as a PT Tech/Aide would have
higher scores on their visual analog scale (VAS) rating of their overall clinical performance at the
conclusion of their first clinical rotation compared to students who did not.
   Number of Subjects - A total of 38 students' clinical performance assessment tools were
analyzed. Twenty-seven of these students worked as a PT Tech/Aide prior to the clinical phase of
their PT education (Tech group). Eleven students who did not work as a PT Tech/Aide were
selected as the comparison group.
   Materials/Methods - All students began their first 9 week clinical rotation in May 2008. The
mean final VAS scores of their level of performance on the clinical rotation was calculated and the
Tech group and control group were compared using a one tailed t-test. The VAS score was
documented by the clinical instructor by placing a vertical hash mark on a 10cm line to rate their
level of performance on the first clinical rotation. The midpoint of the VAS was “meets
expectations for this level”, with “below expectations for this level” at the far left and “exceeds
expectations for this level” at the far right. “Meets expectations” was further defined as meaning
that the student’s overall performance is what is expected at this level of clinical and academic
experience.
    Results - The mean VAS score for the Tech group was higher, at 6.8cm while the mean VAS
for the comparison group was 5.9cm. However, this difference was not statistically significant
(p=.08).
Conclusions - Working as a PT Tech/Aide prior to beginning the clinical phase of PT education
gives students experience to practice basic patient interaction skills on real patients and we
hypothesized it would better prepare them to perform well on their first clinical rotation. However,
our data did not support this hypothesis, possibly due to a low power from a small sample size.
We are collecting the data for our subsequent class of PT students which will be completed in
August 2010, which may change our results given the larger sample size.


Create a Virtual Classroom: Maximize the Online Teaching Outcomes via Adobe Connect
Tiankai Wang, Texas State University-San Marcos

   Background and Goal. There are many advantages to teaching online. It provides both
instructors and students flexible schedules, offers the accessibility to the non-traditional students,
and expands the reach of education. However, there are also some challenges to teaching
online. One of the challenges is the lack of an encouraging learning environment. Many online
instructors only post the reading material and the PowerPoint slides online. In that case, the
online students cannot experience the in-class learning atmosphere, i.e. listening to the
instructor’s lecture and participating the class discussion. Some online students felt that they
were ignored by the instructors, and did not receive qualified education. My goal is to create and
maintain a classroom-like learning environment where the online students feel valued as
individuals, supported, and motivated to learn.
   Instructional Strategies. To provide a classroom-like learning experience to the online
students, I adopted Adobe Connect as the teaching platform.
   (1) I posted the lecture videos online. I recorded the lectures in my office after the campus
         lectures. In such, the lecture videos had better sound and video quality and I could add
         campus students’ questions and discussion in the videos.
   (2) During recording, I shared my computer desktop. Therefore, besides the PowerPoint
         slides, I could show them how to use software, how to access the online library, and
         other information which was plotted on the blackboard in the classroom.
   (3) During the online discussion time (required in the syllabus) and the office hours, I logged
         in Adobe Connect and turned on the video camera. The online students could talk with
         me face to face. I could even watch how the student used software on my computer
         screen when the student encountered problems.
   (4) Adobe Connect team rooms were set up to provide a method for better communication in
         online team work.
   Conclusion. The utilization of Adobe Connect creates a virtual classroom to the online
students. The online students loved this learning model. With the development of technology, the
online instructors could provide better education to the online students.



Using IT to Improve Business Processes in Speech and Hearing Center: A Case Study.
Damian Huerta, The University of Texas – Pan American

    The Speech and Hearing Center at the University of Texas- Pan American’s was founded in
1975. The center is setup as a service learning laboratory for students and is open to the public
to provide services at a reduced rate compared to private clinics, thus reflecting the teaching
characteristics of the center. Even though students are the primary clinicians, the faculty of the
department supervise all aspects of the program and provide leadership to students while they
interact with patients. Services include different kinds of speech-language evaluations and
audiological evaluation and therapies for mostly speech-language problems. These services all
incur a fee except for the speech-language and audiological screenings; both are provided by the
center free of charge. However, the bookkeeping processes were performed manually and were
not leveraging in computer technology. In turn, this created a delay for reconciling the revenue
accounts with the University’s system (Oracle). A MBA graduate business student was hired to
assess their business practices, possibly develop a business plan, and serve as their
advisor/consultant.
   Objectives and Methodology - The first step was to identify the problems that the clinic had in
recording its financial information that was done manually. There was not a formal process in
place to identify the income the clinic was generating from their services.
The second step was to interview the personnel in charge of recording the revenues and creating
the reconciliation document. The third step was to define a formal process to record the
revenues. Finally, the fourth step was the development of an interim software application for the
recording of the revenue and generating the supporting documentation to aid the account
reconciliation with the University’s system. This application will serve as a base for customized
software.
   Conclusion - The interim software application was developed and successfully implemented.
Also a software user manual was created so the administrative personnel can easily follow the
procedures without problems. The outcome of these actions resulted in the improvement of the
Operating Manual Procedures for the business performance of the clinic and the introduction of
customized computer technology to their business processes. The final effect of these changes
would facilitate a financial assessment of the clinic and it will serve as a base for their strategic
planning of making the clinic self-sufficient.


Our Healthcare Future: College Success for Students Seeking Entrance to Rigorous
Healthcare Programs
Wayne K. Williams, Monica Alaniz, and Melba Trevino, South Texas College

   Goals and Objectives -
    1) To present an innovative approach in preparing prospective healthcare students for the
    realities and expectations of rigorous healthcare educational programs.
    2) To correlate the pilot program to student persistence, commitment, retention, comfort, and
    success in the rigorous selective entrance healthcare programs at STC.
    3) To interact and network with educators in varied educational and occupational healthcare
    facilities and institutions in addressing appropriate preparation of potential healthcare
    students.
    4) To present and discuss the initial findings of the College Success for Healthcare pilot
    program, and to present the plan for longitudinal research.
    Program Description - This pilot program at South Texas College’s Nursing & Allied Health
division, exists in a newly developed College Success for Healthcare course, that presents timely,
specific, accurate, didactic and experiential curriculum to students at the college, who have
declared a major in the division, to improve student awareness, decision making ability, comfort,
persistence and success in the rigorous, selective entrance healthcare programs.
    Summary of Information - In order to address the significant difference between selective
entrance healthcare academic programs and the prerequisites required for those programs, this
pilot college success class has been introduced at South Texas College at three of the five
campuses where the programs are offered. Although the expected level of academic
achievement require to be selected for one of these programs is generally quite high, the actual
academic effort, commitment and dedication of time and resources necessary to remain enrolled
is frequently unexpected and overwhelming to students. As a result, more students find
themselves dismissed from healthcare programs simply because they rely on what for them has
been the "academic" status quo.
    The College Success for Healthcare class (CS4H) provides students with a realistic level of
academic and discipline specific curriculum so that they are adequately prepared for the rigors of
healthcare education, and aware of the responsibilities and expectations of the healthcare
professions, as early in their academic journey as possible.
    This endeavor has been strongly supported and motivated by the eleven Program Chairs and
Dean of the division of Nursing and Allied Health at South Texas College, as well as the general
College Success Program Chair and the Dean of the Developmental Studies division.
Briefly, the pilot class, College Success for Healthcare continues to cover the basic academic
skills required for any student to be successful, but additionally exposes students to student life at
the healthcare campus. Classes and instructors are scheduled at the NAH campus so that
students have access and exposure to instructors, students and facilities of each of the division's
eleven programs.
    Program presentations and experiential skills lab give potential students a "Real Life"
perspective. Interaction with students already in the rigorous programs brings to life the “actual
expectations” of each program, and the necessary level of commitment required of any student
who is selected to become a full participant in one of these difficult programs.
    As a result of this pilot and the accompanying research project being carried out by the
Research and Analytical Services department at South Texas College, it is expressed that
students who participate in the pilot program will evidence a higher level of commitment,
retention, comfort, and success in the rigorous selective entrance healthcare programs at STC.


Clinical Learning for the Health Sciences in Rural Africa
Jack Runyan, The University of Texas – Pan American

    The University of Texas Pan American (UTPA) Mission Statement pledges a commitment to
the higher education of an international and multicultural society. Likewise, the Mission of the
UTPA College of Health Sciences & Human Services (COHSHS) upholds a holistic and
multidisciplinary approach to meet the educational needs of the students and the human services
needs of the diverse global community that they serve. Dr. Bruce Reed, Dean of the COHSHS,
has called attention to “hands-on, field-based learning and experiences” in achieving these
objectives.
    Uganda is a land-locked independent, democratic republic in Central Africa. In the 1970’s
through 1985 the country suffered under brutal military regimes, resulting in the loss of nearly
one-quarter of the inhabitants, mostly male. Although currently safe and at peace, retribution of
social services and health care within the culture have been sluggish at best. Infant mortality is
ten times that of the United States. Life expectancy for adults is 52 years of age. Infectious
disease, including malaria and HIV, are the leading causes of death. Morbidity and mortality is
largely a consequence of a struggling infrastructure within the remote, rustic villages that
accommodate more than 85% of the population. Rural residents endure the absence of basic
necessities such as electricity (or any power resource), running water (or sewer), basic
transportation (or roads) and, perhaps most importantly…, access to primary health care
services.
   This presentation is a proposal for UTPA and COHSHS to sponsor an annual Study Abroad
learning experience in Uganda. The discussion will address the roles that each COHSHS clinical
discipline can fill. The journey will present unique learning opportunities for Rehabilitation
Services, Pharmacy, Social Work, Occupational Therapy, Laboratory Sciences, Advanced
Practice Nursing and Physician Assistant. This experience can offer students rare exposure to
primitive surroundings with limited resources. They will be confronted with ‘real-life’ situations
that will test their aptitude for compromise, innovation, communication, clinical skills and crucial
decision making. Clearly, the curriculum embraces the international perspective(s) of the UTPA
and COHSHS Missions as a hands-on, field-based learning experience.
    The Lodoi Foundation teaching hospital and clinic in Kanjinama, Uganda will serve as the host
facility. Students of similar fields of study from Kampala (Uganda) University and Muslim
University of Uganda will share the educational experience. Travel arrangements,
accommodations, safety concerns, liability issues, anticipated costs and other pertinent concerns
will be discussed in the presentation.
The Comparison of Blood Pressure, Body mass Index, and Acanthosis Nigricans in Texas
School-aged Children: A Multidisciplinary Study.
Debra Otto, The University of Texas – Pan American

   The purpose of this retrospective quantitative study was to examine the relationships among
acanthosis nigricans (AN), body mass index (BMI), blood pressure (BP), school grade, and
gender in children attend elementary school in South West Texas. Data were collected by
attending school district nurses. Researchers reviewed 7,026 previously collected records from a
state mandated public school health screening program in elementary school grades 3,5,7, and 9,
conducted by school nurses. Of the 7,026 records, 6,867 were included for the secondary
analysis. A logistic regression analysis was carried out with the AN marker as the dependant
variable and school grade, gender, BMI, and BP as the independent variables. The results of the
study suggest that a direct relationship exists between the AN marker, BMI, and BP in school
aged children. Further study is warranted based on the number of school aged children who are
now found to be obese.
                                   Poster Presentations

Advance Directives in Teaching Legal and Ethical Issues
Bruce R. Niebuhr, The University of Texas Medical Branch

   The purpose of this qualitative research study is to describe 1) the use of advance directives in
teaching legal and ethical issues in health care and 2) summarize student experiences in writing
their own advance directives. The study was approved by the university Institutional Review
Board. As a requirement of a course in legal and issues, physician assistant students wrote their
own advance medical directives. Ribbens (2008) presents a case study of a comotose patient
who had indicated that he would not want intubation. In the present study, the students’ own
advance directives, not a case study, were used to investigate relevant legal and ethical issues.
The students were not required to submit their directives to the faculty nor share them with their
classmates. The students were required to describe what the experience meant to them, such as
describing emotional responses, reactions of family members, or surprising points of law. The
students were predominantly in the early ‘20s in age and few had previously either prepared their
own advance directives or assisted a family member. Preliminary content analysis extracted the
themes of 1) an emotional response to the exercise, 2) resistance of family members to
participation in the exercise and 3) a willingness to discuss advance directives with patients and
families. The students overwhelming considered the exercise to be valuable. Applicability of the
exercise for various health professions is discussed.
   Reference - Ribbens, E. (2008). Treating E: A Medical Ethics Case Study. National Center for
Case Study Teaching in Science. Retrieved from
http://www.sciencecases.org/treating_ed/treating_ed.asp


Asthma: Implementation of Updated Guidelines for Physicians & Other Providers
Amanda M. Rodriguez, The University of Texas – Pan American

    This seminar was prepared and presented to a medical staff of a local physician group by a
fourth year pharmacy student. This endeavor was to fulfill requirements for an advanced
specialty problems course. The presentation included: pathophysiology, epidemiology, asthma
triggers and management, in addition to step-wise assessment and treatment as per 2007
Asthma Guidelines and 2009 Statement Update. Assessment of severity and control and
consequently appropriate pharmacotherapy selection was the emphasis of the presentation. The
power point presentation also included video of an asthma patient with severe persistent asthma
in severe distress. A case presentation was utilized for application of guideline parameters,
proper assessment, and treatment. Participants including physicians, nurse practitioners, and
physician assistants, were surveyed to assess applicability to practice, the speaker overall, and
the speakers command of the knowledge.
Our Healthcare Future: College Success for Students Seeking Entrance to Rigorous
Healthcare Programs
Wayne K. Williams, Monica Alaniz, and Melba Trevino, South Texas College

Goals and Objectives -
    1) To present an innovative approach in preparing prospective healthcare students for the
    realities and expectations of rigorous healthcare educational programs.
    2) To correlate the pilot program to student persistence, commitment, retention, comfort, and
    success in the rigorous selective entrance healthcare programs at STC.
    3) To interact and network with educators in varied educational and occupational healthcare
    facilities and institutions in addressing appropriate preparation of potential healthcare
    students.
    4) To present and discuss the initial findings of the College Success for Healthcare pilot
    program, and to present the plan for longitudinal research.
    This pilot program at South Texas College’s Nursing & Allied Health division, exists in a newly
developed College Success for Healthcare course, that presents timely, specific, accurate,
didactic and experiential curriculum to students at the college, who have declared a major in the
division, to improve student awareness, decision making ability, comfort, persistence and success
in the rigorous, selective entrance healthcare programs.
    Summary of Information - In order to address the significant difference between selective
entrance healthcare academic programs and the prerequisites required for those programs, this
pilot college success class has been introduced at South Texas College at three of the five
campuses where the programs are offered. Although the expected level of academic
achievement require to be selected for one of these programs is generally quite high, the actual
academic effort, commitment and dedication of time and resources necessary to remain enrolled
is frequently unexpected and overwhelming to students. As a result, more students find
themselves dismissed from healthcare programs simply because they rely on what for them has
been the "academic" status quo.
    The College Success for Healthcare class (CS4H) provides students with a realistic level of
academic and discipline specific curriculum so that they are adequately prepared for the rigors of
healthcare education, and aware of the responsibilities and expectations of the healthcare
professions, as early in their academic journey as possible.
    This endeavor has been strongly supported and motivated by the eleven Program Chairs and
Dean of the division of Nursing and Allied Health at South Texas College, as well as the general
College Success Program Chair and the Dean of the Developmental Studies division. Briefly, the
pilot class, College Success for Healthcare continues to cover the basic academic skills required
for any student to be successful, but additionally exposes students to student life at the
healthcare campus. Classes and instructors are scheduled at the NAH campus so that students
have access and exposure to instructors, students and facilities of each of the division's eleven
programs. Program presentations and experiential skills lab give potential students a "Real Life"
perspective. Interaction with students already in the rigorous programs brings to life the “actual
expectations” of each program, and the necessary level of commitment required of any student
who is selected to become a full participant in one of these difficult programs.
    As a result of this pilot and the accompanying research project being carried out by the
Research and Analytical Services department at South Texas College, it is expressed that
students who participate in the pilot program will evidence a higher level of commitment,
retention, comfort, and success in the rigorous selective entrance healthcare programs at STC.
Depression Education Websites: A Focus on Language and Readability
Patricia L. Gonzales, The University of Texas Pan American

    Objectives - The objectives of this study were to develop a process to evaluate depression
education websites in terms of language availability and readability and to determine which
website, if any, would best meet the needs of patients served at a clinic located in the Rio Grande
Valley.
    Methods - Five internet search engines (AOL, GOOGLE, Yahoo, MSN and Netscape) were
used to identify depression education websites for evaluation. “Depression” was the search term
used. A literature review of relevant website evaluation studies was conducted to develop an
initial list of evaluation criteria for this study. This list was then modified to reflect the specific
objectives of this study and the demographics of the clinic population. The following criteria were
used: 1) disease manifestation 2) depression epidemiology, 3) pathology, 4) causes, 5) treatment
options, 6) ease of website navigation, 7) content readability, and 8) Spanish availability.
Websites were scored 1 point for each criterion met, with a maximum total score of 8 points.
‘Ease of website navigation’ was determined using a similar process as in previous studies. Links
needed to be active, appropriate and connect seamlessly to relevant pages. The Flesch-Kincaid
grading system was employed to determine content readability’ and the cut off was set at a 6th
grade reading level.
    Results - Seventy-five websites resulted from the 5 search engines. All duplicates, blogs,
sites on unrelated topics, and foreign sites were eliminated leaving 16 websites for evaluation. Of
the 16 websites evaluated, none received a perfect score. Only 4 were available in Spanish and
only 1 was written at a 6th grade reading level. The top four websites included: www.depression-
screening.org, Wikipedia.org, health.msn.com, and www.nimh.nih/gov/health. Both the
depression-screening.org and nimh websites met the majority of the objectives of the study. Both
are available in Spanish and easy to navigate however both are written at a 12th grade reading
level, well above the literacy level of the clinic population in the Rio Grande Valley. The
health.msn.com website is the only site that is written at a 6th grade reading level but it does not
contain information on epidemiology and pathology of depression.
   Conclusion - Depression education websites have the potential to provide valuable information
to patients seeking answers about symptoms and treatments. However, many patients with low
health literacy may have difficulty understanding medical information and navigating through the
wealth of information on the world wide web. As evidenced by the results of this evaluation, very
few websites are available in Spanish and at a reading level that most could understand.


Enhancing the Practice of Pharmacy in the Rio Grande Valley by Offering Blood Pressure
Screenings by Trained Technicians
Tarah Garza, The University of Texas – Pan American

    The Hispanic population is one of the fastest growing ethnic groups in the country. According
to Texas state census data, they will be the majority ethnic group by the year 2025. The Rio
Grande Valley is home to many a dense population of Hispanics. This area of Texas has a large
number of people living below the poverty level, and consequently it is an area of low health
literacy. The number one cause of death in Hispanics is due to cardiovascular events. The
combination of all these facts calls for action by all members of the health care community.
    Pharmacists are in a prime position to offer patient’s blood pressure screenings and other
health care services. They are easily accessible and trusted by many of their patients. Current
PharmD programs include physical assessment as part of the curriculum. By providing free
blood pressure screenings pharmacists can help monitor patient’s blood pressure and screen for
heart disease. They can help explain what hypertension is and the dangers associated with it.
Pharmacists can provide valuable resources and educate them on clinics available to low income
individuals. By adding manual blood pressure readings to a pharmacy setting this can help in
developing patient pharmacist relationships and even result in patients being more compliant with
their medications and life style modifications.
    A blood pressure clinic was set up at a local independent pharmacy in Weslaco, TX by a
PharmD student on a community pharmacy rotation. The purpose of setting up this clinic was to
train the technicians on how to manually check a patient’s blood pressure. This served to give
the technicians better job satisfaction and to offer a valuable service to the community. In
training the technicians, they were given a presentation on hypertension based on the JNC 7
Guidelines and current literature. They also were taught the proper technique of handling the
appropriate equipment used to manually check a blood pressure. They were given information on
patient screening questions as well as cuff size and a protocol to follow if they have a patient with
a high reading. Since this service has been offered many patients are being made aware that
they have elevated blood pressure and are very receptive to the information and resources
provided to them.


Genograms as Threat Appeals: Promoting Patient Efficacy
Betty Bowles, Midwestern State University

     Over 96% of Americans acknowledge the importance of knowing family medical history, but
only 30% have attempted to gather it. The genogram is the best and most inexpensive genomic
tool available.
    Persuasive health risk messages that gain compliance by arousing fear are called fear
appeals. The Extended Parallel Process Model (EPPM) contends that for fear appeals to be
successful, the individual must perceive the threat is serious, that he is personally susceptible to
it, that the recommended response will control the threat, and that he is capable of making the
recommended response. If perceptions of threat exceed perceptions of efficacy, the individual
will shift into fear control and respond to and cope with the fear, not the danger, through
defensive avoidance, denial or reactance. The fear appeal backfires.
     This research study introduced health genograms as fear appeals in motivating intent to
perform health promotion and disease prevention behaviors. It validated the use of the EPPM
and its Risk Behavior Diagnosis (RBD) Scale in determining dominance of threat or efficacy.
Volunteers with a family history of cardiovascular disease completed surveys based on the RBD
scale before and after completing health genograms. Results indicated that those in most need
of behavior changes have the most fear and are thus in fear control rather than threat control.
Fear appeals are not appropriate for them unless accompanied by vigorous efficacy-building
strategies. Nurse educators must teach interventions to build patient efficacy in order to avert a
fear control response and message rejection.


Learning by Doing: Student Researchers Examine Mexican-American Elders’ Perceptions
of Independence and Quality of Life
Angela E. Scoggin, The University of Texas – Pan American and H.K. Yuen, Medical University
of South Carolina.

   All students in an introductory occupational therapy research course at the University of Texas-
Pan American, over a period of four years, participated in a series of learning activities that
enabled them to contribute to the implementation of a research project of significance to the Rio
Grande Valley. The purpose of the investigation was to examine perceptions of independence
and quality of life of a group of Mexican-American elders. Through a series of learning activities
the students discussed the research design, completed the IRB application, developed interview
questions, and translated the questions into Spanish and back into English. Results of these
activities were then compared to the actual IRB-approved design and interview questions. Once
students understood the research design and had practiced interviewing methods, each student
completed an interview according to the project protocol. The student identified an individual 65
years of age or older, who lived in the Rio Grande Valley, described himself/herself as Mexican-
American, and was not related to the interviewer. The student interviewer obtained informed
consent and conducted one interview with the participant. The student offered to let the
participant listen to the tape or view the interview notes and correct or delete information.
    The data collection instrument consisted of a series of open-ended questions related to the
meaning of independence to the individual and the individual’s actual perceived level of
independence, based on a previous study in another part of the country (Yuen, Gibson, Yao, &
Mitcham, 2007). Additional questions at the end of the interview related to the individual’s
reflections on their lives and advice for the next generation. Participants were interviewed in
English or Spanish, depending on the choice of the participant and the language proficiency of
the student interviewer. A total of 51 interviews were audiotaped and transcribed. Interviews
were audiotaped unless the participant preferred otherwise, in which case the student interviewer
took notes during the interview. The interview data were coded so that confidentiality of
participants was maintained. The coded interview data were presented and discussed in class so
that the student interviewers could participate in the process of naturalistic data analysis.
    Participating in a research project, with the structured guidance of the instructor, provided the
students with the opportunity to learn about and experience each step of the process at an early
stage of their research development, while making an actual contribution to a research project.
    Reference - Yuen, HK, Gibson, RW, Yau, MK, & Mitcham, MD. (2007). Actions and personal
attributes of community-dwelling older adults to maintain independence. Physical and
Occupational in Geriatrics, 25(3), 35-53


A Novel Approach to Addressing Geriatrics in the Clinical Laboratory Science Curriculum.
Cheryl Burns, Linda Smith, and Shirlyn McKenzie, The University of Texas Health Science Center
at San Antonio

The US Census Bureau projects that by 2030 there will be at least 69 million individuals 65 years
of age or older. Few clinical laboratory science (CLS) programs have formally dealt with geriatric
healthcare topics, yet graduates must be prepared to address the health care issues of this
population. Shrinking resources, packed curricula, and a lack of faculty with expertise in
geriatrics present problems with adding another new course. To address this problem, we invited
several geriatric experts from other allied health disciplines to help design a symposium covering
a number of age-related health topics for CLS students. The resulting three hour symposium
focused on the physiology, psychology, and demography of aging; specimen collection; changes
in, and interpretation of geriatric laboratory test data; economic implications; and medical
necessity. A video on communication skills was included. Student course evaluations averaged
4.6 on a 5-point Likert scale. The post-test scores on an aging quiz increased by 29.9% over pre-
test scores. Students’ comments were very positive. They found the overview of aging
interesting and the communication techniques for working with the elderly and other healthcare
professionals helpful even for their personal lives. In addition, students made a number of
recommendations for other topics to be included. This symposium will be expanded for CLS and
will form a template for development of an interdisciplinary geriatrics course in the School of
Health Professions.
Teaching Students in Entry-level Physical Therapist Educational Programs to Write
Comprehensive Goals in Geriatrics and Neurology
Jason Boyd Hardage, Texas State University - San Marcos

    Purpose - The purpose of this project is to develop a model, “Rise and Shine,” for writing
comprehensive goals in geriatrics and neurology for students in entry-level physical therapist
educational programs. Students typically have difficulty formulating comprehensive goals in these
practice areas, in which the patient/client often has difficulty with multiple mobility tasks. For
example, a student may write an appropriate goal for ambulation but neglect bed mobility and
transfers. The "Rise and Shine" model provides a framework for systematically addressing both
basic and instrumental activities of daily living. In the model, the student is asked to consider,
from the perspective of the patient/client, all of the mobility tasks that the patient/client performs in
a typical day in sequence, starting when he or she first awakens. Therefore, the day starts with
bed mobility to come to a sitting position at the edge of the bed, followed by a sit-to-stand transfer
to arise from the bed and ambulation to the restroom for toileting, bathing, dressing, and
grooming. Next, the patient/client must ambulate to the kitchen to prepare breakfast, which might
involve dynamic standing balance while reaching for objects of various weights at surfaces of
different heights. Other mobility tasks in the home can then be considered in a similar manner.
For community mobility, the patient/client might need to negotiate steps to exit the home,
negotiate uneven terrain to reach the vehicle, and perform a car transfer to enter and exit the
vehicle. Then, he or she might need to negotiate additional types of terrain, negotiate curbs, and
cross streets at crosswalks in a safe amount of time. In addition to mobility tasks, comprehensive
goals must also address any needs for equipment; patient/client, family, and caregiver education;
and ongoing exercise; these areas are represented by the "Es" in "rise and shine." Thus, the
"Rise and Shine" model helps students generate a comprehensive set of goals by considering the
day's sequence of activities from the point of view of the patient/client.
    Methods - I created the model based on my clinical experience as a physical therapist with
expertise in geriatrics and neurology in response to my perception of the need for such a tool in
the classroom. I have refined the model through multiple iterations, have found it to be useful, and
am now ready to undertake a research project to evaluate its impact on the quality of students'
goals. The project will feature a pretest/posttest design in which a panel of expert clinicians and
academicians evaluate the quality of students' goals written for a particular
patient/client scenario before and after the model is presented in the classroom. Student-centered
measures, such as confidence in goal-writing ability, will also be included. To my knowledge, no
similar model exists in the literature.
    Conclusions - The model provides a framework for writing comprehensive goals, which in turn
assist in the formulation of the plan of care and highlight the need for interventions to progress
the patient/client to higher-level activities that are needed for community mobility.
TTUHSC Masters of Rehabilitation Counseling Prep Program: A Model for Professionals
Returning to the Academic Environment
Katherine L. Byers and Evans H. Spears, Texas Tech University Health Sciences Center

   There is a shortage of qualified rehabilitation counselors in the United States State/Federal
Rehabilitation Programs. The problem centers on both the rate of new counselors entering the
profession not meeting the rate of those retiring and the need for currently employed rehabilitation
counselors to obtain a master’s degree to keep their job. This dilemma stems from the
Comprehensive System of Personnel Development (CSPD) movement. This is a national
mandate requiring all states to develop a system to ensure all state vocational rehabilitation (VR)
counselors are qualified. For most states, this equates to the need to have a master’s degree in
rehabilitation counseling or a closely related field. The CSPD mandate may pose a problem for
many presently employed rehabilitation counselors in that they may not have the undergraduate
grade point average (GPA) necessary for admittance into master’s-level rehabilitation counseling
programs and/or have other circumstances that hinder their return to school.
   The TTUHSC MRC Prep Program is intended as an option for students who are unable to
gain admittance to a MRC program or have been away from academia for an extended period of
time and are fearful of returning to school. The program allows these students to enter the MRC
Program as provisionary students and take specialized courses designed to prepare them for
master level work. Previous GPA is not considered when admitting students into the Prep
Program; however, other existing admission criteria still need to be met. Performance in the Prep
Program will determine continuation into the MRC program. This program is beneficial not only to
those that are currently employed as rehabilitation counselors, but the myriad of other non-
traditional students who desire to return to school after a prolonged absence.
   The MRC Prep Program is a social action pilot program aimed to meet the needs of not only
the profession and field, but also of a population that has been placed in a difficult position. This
presentation will cover the format and content of the program as well as data collected in relation
to academic performance. Data includes comparisons of prep program students to traditional
students in the areas of GPA, exam scores, attrition rates, and participation scores.


University Interdisciplinary Collaboration: Putting Prevention into Practice for Students
Engaging in Field Research in Remote Areas
Betty Bowles, Marty Gibson, and Lauren Jansen, Midwestern State University

Summary of Action Research -
    University Interdisciplinary Collaboration - Interdisciplinary collaboration is valued in the
university setting. Faculty in the Wilson School of Nursing at Midwestern State University
collaborated with the faculty of the School of Science and Mathematics to develop a Safety and
Emergency Plan and Health Promotion and Injury Prevention Handbook for student researchers
in a remote canyon known as the Devil’s Graveyard in the Big Bend of south Texas.
    Scientific Field Research in Remote Areas - Scientific field research can be a valuable
learning experience for university students. The Dalquest Desert Research Station provides a
rich laboratory for learning as well as unforgettable outdoor adventures which include magnificent
geological formations, springs, elevation changes and a vast array of plant and animal life.
Environmental conditions in this desert canyon are extreme and range from ice storms to
temperatures exceeding 115 degrees Fahrenheit. Electrical storms, flash floods and landslides
are common. Hazards also include stinging insects, poisonous spiders and snakes, mountain
lions, bears and wild javelinas. Because this site is 70 miles, or 3.5 hours, from the nearest town
and 100 miles from the nearest hospital, there was a need to apply the “Put Prevention into
Practice” philosophy to ensure the health and safety of university faculty and students engaging
in remote field research.
Updated Diabetes Pharmacotherapy Education Presentation by a Pharm D Student to
Primary Care Providers in the Rio Grande Valley.
Veronica I. Guerra and Yasar Tasnif, The University of Texas - Pan American

   Texas statistics show that approximately 1.8 million adult American were diagnosed with
diabetes in 2007. While these figures are alarming, they do not account for the almost 500,000
adults that are thought to be unaware that they have diabetes. Additionally, these figures do not
account for the children and adolescents that are both at risk for and already diagnosed with Type
2 Diabetes. Since obesity is a known risk factor of diabetes, and the epidemic of obesity is on
the rise, primary care providers are struggling to keep up the increased need for Diabetes
management of their patients. Fourth year professional PharmD students can fill a need in
providing updated Diabetes pharmacotherapy for both medical staff.
   This position was demonstrated in a conference provided to a large Rio Grande Valley
medical clinic staff in August of 2010. Preparation for the presentation was made through a
review of current literature including the Texas Diabetes Council Tool Kit, tertiary
pharmacotherapy literature, various primary literature papers and information garnered from
attendance at a July 2010 Diabetes Conference.
   The presentation included algorithms for pharmacotherapy as well as detailed explanations of
the various agents in current use. Each drug was presented to include mechanism of action, site
of action, indication, side effects, price and Texas Medicaid formulary inclusion or exclusion. A
question and answer segment served to augment drug information.
   Participants were surveyed regarding their opinion of the PharmD student’s knowledge of the
topic, preparation and presentation. The overall experience was of mutual benefit, as the student
gained a great deal subject knowledge, and presentation skills. The PharmD student worked with
various members of the Diabetes Team including a physician, and dietician. This endeavor also
helped to highlight the value of Pharmacist knowledge and place on the health care team.


Use of Role Simulation to Instruct Occupational Therapy Students about Psychiatric
Group Work
Tana Lynne Hadlock, and Celia Hope Schulz, The University of Texas- Pan American

    Objectives - The objective of this classroom approach was to use role simulation as a means
of instructing students in the psychosocial portion of OCCT 7401 about psychiatric group
treatment.
 Procedures - Students were assigned to dyads or triads for the purpose of planning two group
sessions that they would implement in the classroom on a particular day. One group session was
required to be for pediatric clients and the other group session was required to address the adult
population; the first group session was for practice only and ungraded, while the second group
session was graded by the instructor. Each dyad/ triad submitted a group treatment protocol for
each of their treatment sessions.
The remaining students in the classroom took on the role of group members receiving treatment.
In each group, specific roles and behaviors were assigned to some students by the instructor.
These roles varied in age from pediatric, adolescent, and adult to geriatric, and represented a
wide range of psychiatric diagnoses, such as Thought Disorders, Mood Disorders, Anxiety
Disorders, Eating Disorders, Personality Disorders, Substance Abuse Disorders, Autism and
other Pediatric Mental Health Disorders, and Cognitive Disorders, as well as violent behaviors.
The number of and difficulty/complexity of these specific roles were increased during the practice
sessions as students and group leaders became comfortable with their respective
roles/intervention approaches. During practice sessions, instructors would stop the group action
as needed to provide input to students on their approach.
Students presenting and implementing group treatment sessions were evaluated on choice and
justification for activity; organization/preparation of activity; presentation of activity to clients;
client-related skills; and protocol development.
   Findings/Evaluation - Student feedback about this activity as an instructional method was
generally positive. Excerpts from some of the student feedback about this technique will be
included as an illustration of student perspective on this approach.


Use of a Mneumonic Acronym as a Teaching Tool with Nursing Students and Allied
Healthcare Students
Vanessa Genung, Midwestern State University

    Purpose - To demonstrate the use of a mneumonic acronym as an effective teaching and
memory aid that assists students in encoding and recalling health information that is traditionally
difficult and confusing to understand and remember.
    Objectives/Aim - 1) To demonstrate the use of using a mneumonic or acronym as a memory
aid by using a specific learning activity example. 2) To assist learners in distinguishing between
depression, delirium, delusion, and dementia. 3) To assist learners to differentiate the stages of
decline observed in dementia.
    Method - Through a poster presentation, learners will view an outline entitled “Four Ds A-
FADING” where they will be delivered diagnostic information, in table form, using the same
reference criteria categories to be able to compare, contrast, and differentiate between
depression, delirium, delusion, and dementia. Additionally, learners will view an outline
distinguishing the specific signs and symptoms observed as an individual travels through the
progressive seven stages of dementia A-F-A-D-I-N-G.
    Conclusions - I designed this teaching and learning example and have found it to be an
effective teaching and memory tool for undergraduate students as well as graduate students. I
have used this technique to effectively disseminate this information to my students in several
healthcare related fields, most importantly: medical, nursing, social work, counseling, education,
and psychology.



Utilization of Diffusion-Simulation-Debriefing Framework (D-S-D) in Clinical: A Teaching
Strategy
Jayson T. Valerio, South Texas College

   The present U.S. health care system is becoming intricate as evidenced by advances in
technology, higher patient acuity, shorter lengths of stay in the hospitals, nursing staff shortages
and compound understanding of the human responses to illness. With this present reality, health
care professionals must adjust to these challenges in order to provide safe, prudent and quality
care to patients.
   Simulation is an effective strategy that provides an opportunity for nursing students to develop
and enhance their critical thinking skills in a safe and supportive environment.
   Objectives -
   1) Describe utilization of D-S-D framework in clinical simulation.
   2) Identify the elements involved in thoughtful practice as applied to the D-S-D framework.
   3) Describe the integration of debriefing process utilizing the clinical judgment model by
        Tanner.
   4) Describe the integration of D-S-D framework to the ADN program learning goals, NCLEX

				
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