Indiana University-Purdue University Indianapolis (IUPUI) / Pharmacogenetic testing has the potential to improve pain management through addressing wide interindividual variations in responses to pharmacogenetically actionable opioids, ultimately decreasing costly adverse drug effects and improving responses to these medications. A recent review of pharmacogenomics in the nursing literature highlighted the need for nurses to more fully embrace the burgeoning field of pharmacogenomics in nursing research, clinical practice, and education. Despite the promise of pharmacogenetic testing, significant challenges exist for evaluating outcomes related to its implementation, including oversimplification of medication exposure, the complexity of patients' clinical profiles, and the characteristics of healthcare contexts in which medications are prescribed. A better understanding of these challenges could enhance the assessment and documentation of the benefits of pharmacogenetic testing in guiding opioid therapies. This dissertation is intended to address the challenges of evaluating outcomes of pharmacogenetic testing implementation and the need for nurses to lead pharmacogenomic-related research. The dissertation purpose was to advance the sciences of nursing, pain management, and pharmacogenomics through the development of a typology of common patterns of medication exposure to known pharmacogenetically actionable opioids (codeine & tramadol). A qualitative, person-oriented approach was used to retrospectively analyze six months of electronic health record and pharmacogenotype data in 30 underserved adult patients. An overarching typology with eight groups of patients that had one of five opioid prescription patterns (singular, episodic, switching, sustained, or multiplex) and one of three types of medical emphasis of care (pain, comorbidities, or both) were identified. This typology consisted of a description of multiple common patterns that compare and contrast salient factors of exposure and the emphasis of why individuals were seeking care. Furthermore, in an aggregate descriptive analysis evaluating key clinical profile factors, these patients had complex medical histories, extensive healthcare utilization, and experienced significant polypharmacy. These findings can aid in addressing challenges related to the implementation of pharmacogenetic testing in clinical practice and point to ways in which nurses can take the lead in pharmacogenomics research. Findings also provide a foundation for future studies aimed at developing medication exposure measures to capture its dynamic nature and identifying and tailoring interventions in this population.

Whoonga is a relatively new addition into the drug market. The need for this study was prompted by the devastating effects this new arrival has had in the lives of young people addicted to it. The purpose of this study was to investigate the effects of whoonga on the learning of affected youth in Kwa-Dabeka Township. This study adopted a qualitative method and employed a phenomenological approach to explore the experiences of participants with regard to whoonga use and their learning. Data was collected through purposive sampling. Interviews were conducted, using semi-structured and unstructured questions with the help of an interview guide. Observations were also conducted to collect more data. This was done in the classroom during teaching and learning, as well as outside the classroom during recess. The study employed a social learning theoretical framework on the experiences of participants with regard to the use of whoonga. Four participants from one high school in Kwa-Dabeka Township were involved in the study. Themes that emerged from the study were that all the participants were totally ignorant of what they were getting themselves into before they started using whoonga. Peer pressure, coupled with curiosity made their decision to use whoonga easy. Challenges that participants face now on daily basis are far beyond their young age. The findings have indicated that learning is a situation of near impossibility for the participants. The findings have also depicted a picture of young people who are trapped in a vicious cycle of one of life‟s harshest living conditions in terms of their encounters with parents, school and the communities they come from. Despite their hopes for a brighter future one day, participants see no end in sight for their suffering at the hands of this unforgiving, destructive drug at this point in time. / Educational Studies / M. Ed. (Socio-Education)

Whoonga is a relatively new addition into the drug market. The need for this study was prompted by the devastating effects this new arrival has had in the lives of young people addicted to it. The purpose of this study was to investigate the effects of whoonga on the learning of affected youth in Kwa-Dabeka Township. This study adopted a qualitative method and employed a phenomenological approach to explore the experiences of participants with regard to whoonga use and their learning. Data was collected through purposive sampling. Interviews were conducted, using semi-structured and unstructured questions with the help of an interview guide. Observations were also conducted to collect more data. This was done in the classroom during teaching and learning, as well as outside the classroom during recess. The study employed a social learning theoretical framework on the experiences of participants with regard to the use of whoonga. Four participants from one high school in Kwa-Dabeka Township were involved in the study. Themes that emerged from the study were that all the participants were totally ignorant of what they were getting themselves into before they started using whoonga. Peer pressure, coupled with curiosity made their decision to use whoonga easy. Challenges that participants face now on daily basis are far beyond their young age. The findings have indicated that learning is a situation of near impossibility for the participants. The findings have also depicted a picture of young people who are trapped in a vicious cycle of one of life‟s harshest living conditions in terms of their encounters with parents, school and the communities they come from. Despite their hopes for a brighter future one day, participants see no end in sight for their suffering at the hands of this unforgiving, destructive drug at this point in time. / Educational Studies / M. Ed. (Socio-Education)