Digital Commons Network^™

Treatment At An Academic Medical Center Eliminates Survival Disparities For Appalachian Kentuckians With Pancreatic Ductal Adenocarcinoma, Emily Cassim, Hannah Mcdonald, Megan Harper, Quan Chen, Miranda Lin, Reema Patel, Michael Cavnar, Prakash Pandalai, Bin Huang, Pamela C. Hull, Joseph Kim, Erin Burke

Journal of Appalachian Health

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to …

Maternal Age And Inadequate Prenatal Care In West Virginia: A Project Watch Study, Madelin Gardner, Amna Umer, Brian Hendricks, Toni Marie Rudisill, Candice Lefeber, Collin John, Christa Lilly

Journal of Appalachian Health

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and infant. Teen age and advanced maternal age (AMA) are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC.

Purpose: This study sought to determine the potential association between maternal age (in groups, aged 20–24, 25–29, 30–34, 35–39, and >40) and inadequate PNC (visits).

Methods: West Virginia (WV) Project WATCH population-level data (May 2018–March 2022) were used for this study. Multiple logistic regressions were performed on inadequate PNC (less than 10 visits) with maternal age …

Ensuring Equitable Application Of Interventions To Vulnerable Subpopulations In The Kentucky Consortium For Accountable Health Communities (Kc-Ahc), Jing Li, Jessica M. Clouser, Akosua Adu, Aiko Weverka, Nikita Vundi, Terry D. Stratton, Mark V. Williams

Journal of Appalachian Health

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women.

Methods: Twenty-eight primary …

Decistifying Trans And Gender Diverse Inclusion In Library Work: A Literature Review, Stephen G. Krueger, Keahi Adolpho

Library Faculty and Staff Publications

This comprehensive review illuminates the current state of scholarly literature on trans and gender diverse inclusion in libraries, with the intention to provide a foundation and identify gaps for further research. Covering 50 works published between 2002 and 2023 in the areas of general inclusion, public libraries, academic libraries, experiences of library workers, archives, information behavior, and cataloging, we found that, with the exception of works on archives and cataloging, little scholarly literature goes beyond introductory talking points on basic information about trans and gender diverse people. We conclude with a call for much more in-depth research on this essential …

Adjustments To Social Work Practice During The Covid-19 Adjustments To Social Work Practice During The Covid-19 Pandemic In North Carolina: Effects On Burnout And Commitment Pandemic In North Carolina: Effects On Burnout And Commitment, Aaron Brown, Jayme E. Walters, Aubrey E. Jones, Lara Cates

Social Work Faculty Publications

Since the onset of the COVID-19 pandemic, the demand for social workers in the U.S. and abroad has increased. There is demand for more social workers in North Carolina due to ongoing and increasing mental health, substance use disorder, and child welfare needs. COVID-19 has taken a toll on the personal and professional lives of social workers, and research is needed to understand the pandemic’s effects on burnout and commitment among social workers. The present study sought to understand how the COVID-19 pandemic affected the personal and professional lives of social workers practicing in North Carolina and to determine how …

A Transdisciplinary Approach To Landscape Transformation Towards Perennial, Diverse, Circular Systems: Why And How, V. Picasso, C. Williams

IGC Proceedings (1997-2023)

Prevailing agricultural systems in the U.S. are dominated by intensification through annual crop monocultures and high amounts of external inputs. Increased yields per unit of land have resulted but many undesirable environmental, ecological, and socioeconomic outcomes have co-occurred. Lack of resilience within intensified agricultural systems is a factor in these outcomes. Redesign of agricultural systems and changes in federal policy are needed to better support resilience in agriculture. Redesign for greater resilience must encourage adoption of agricultural systems that are diverse, perennial, circular, and include forages. We developed a transdisciplinary framework within a project orientation with a focus on crops …

Creating An Educational Experience That Fosters Diversity And Inclusion, M. M. Kohmann

IGC Proceedings (1997-2023)

Demographic, intellectual, and individual diversity have been linked to increase in innovation, problem-solving, critical thinking, and economic gains. However, there are multiple challenges associated with recruiting, retaining, and advancing underrepresented groups in Science, Technology, Engineering, and Mathematics (STEM). Studies have indicated negative implicit bias against women and minorities in terms of their perceived competence, worthiness to be hired, and payment irrespective to their qualification. Additionally, lack of mentoring and access to personal capital often hinder students’ academic advancement in STEM. However, there have been multiple intentional, recent efforts to increase and foster diversity in sciences. Some of the most effective …

Barriers/Drivers Of Diverse Perennial Systems: Policy Recommendations, M. L. Krome, A. S. Finan, J. Obudzinski, N. Serrano

IGC Proceedings (1997-2023)

Despite growing documentation of perennial- and grass-based systems’ importance in addressing many ecological, infrastructural, farmer profitability, and climate concerns, these systems do not predominate on most United States farm and ranch lands. To better understand what impedes their wider adoption, we undertook four focus groups of diverse current and potential farmers using perennial systems. We were especially interested in how these farmers access, or don’t, insurance, credit, and federal programs, identifying patterns among farmers embracing more sustainable practices. Our virtual focus groups comprised 16 farmers in ten states, transecting climate zones and representing both rural and urban production systems and …

Feeds And Forages Intervention Strategies For Improved Livestock Nutrition And Productivity In The Northwest Highlands Of Vietnam, M. Atieno, T. B. N. Trần, V. T. Bùi, T. T. Mai, A. Duncan, S. Douxchamps, M. Peters

IGC Proceedings (1997-2023)

Livestock production in Vietnam is critical for livelihoods particularly for ethnic minorities in the Northwest Highlands (NWH). Improved livestock management and productivity can be achieved through better feed management and increased cultivation of improved forages, to meet animal nutrition demand. This study aimed at assessing feed intervention strategies to address context-specific feed-related challenges, mainly winter feed shortage in Mai Son district, Son La province, Vietnam. Feed interventions included promotion of improved forages (grasses and legumes) and capacity building on animal nutrition techniques including feed preservation, feed mix and feeding regimes for cattle and pigs. Willing farmers selected from a list …

Biophysical, Grazing-Season Management, And Animal Traits Effects On Individual Animal Performance Of Cow-Calf Systems: Insights From A Long-Term Experiment In The Us Western Great Plains, G. Irisarri, P. A. Cipriotti, L. Castro Sardiña, M. Mortenson, J. D. Derner

IGC Proceedings (1997-2023)

Beef grazing systems require information on management, biophysical, and individual animal influences on performance metrics. However, long-term controlled experiments are lacking to comprehensively ascertain these individual and likely interacting influences. We used a legacy data set from the USDA Agricultural Research Service where individual weight gains were determined from on and off weights of Hereford cows and calves grazing native northern mixed-grass prairie, during the June through September season, from 1975-2001 near Cheyenne, Wyoming, USA. The herd size varied from a minimum of 10 to a maximum of 48 pairs across years. Management (on and off grazing dates and stocking …

The Impact A Nurse Recruiter Has On Nursing Staff Shortages And Nurse Manager Satisfaction In An Acute Psychiatric Facility, Johna Arnett

DNP Projects

Abstract

Background: Nursing staff shortages have persisted for the last few decades. Strategies to resolve this enduring challenge continue to drive the creative efforts to attract and retain new staff. These shortages not only affect patient care but can also impact the satisfaction of nurse managers. Little information is available on the effects of a nurse recruiter role on nursing staff shortages as well as nurse manager satisfaction.

Purpose: The purpose of this project is to assess how implementing a designated nurse recruiter impacts nursing staff shortages and nurse manager satisfaction in an acute psychiatric facility. This project examines two …

Utilizing The Stop-Bang Questionnaire To Assess Risk Of Obstructive Sleep Apnea In Hospitalized Patients With Heart Failure To Facilitate Sleep Medicine Referrals Upon Discharge, Chelsea Mitchell

DNP Projects

Background: Obstructive sleep apnea (OSA) is the most common sleep-breathing disorder. Undiagnosed OSA is highly prevalent in the population, especially in those with heart failure. OSA and heart failure combined create a negative feedback loop that can lead to poor clinical outcomes. Unfortunately, many cardiac patients are never screened for OSA.

Purpose: The purpose of this project is to improve screening rates for OSA via the STOP-Bang questionnaire and establish an efficient and effective process for referrals to sleep medicine for heart failure patients screening high-risk.

Methods: The design was a quality improvement project with pre- and post-testing and a …

Extracting Social Network Model Parameters From Social Science Literature, Isaac Batts

Theses and Dissertations--Computer Science

When looking at computer modeling of social situations, much of the social science literature does not include ready-to-use statistics or parameters to be included in a social model. I explore studies related to speaking about racism (and other forms of bias), and interventions designed to diminish the occurrence of biased behavior, and use those readings to synthesize plausible parameters for a social computer model.

Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer

DNP Projects

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to …

Improving Knowledge, Confidence, And Competency Among Icu Nurses Concerning The Benefits Of Using The Uk Ventilator Separation Protocol, Brittany Monroe

DNP Projects

Background: The trauma intensive care unit (ICU) at University of Kentucky (UK) Healthcare uses a ventilator separation protocol which provides specific guidelines on the successful weaning of patients from mechanical ventilation. However, many of the nurses are not aware of this protocol as formal education is not included in their orientation or training. This lack of knowledge can lead to risks such as increased patient morbidity, mortality, ICU length of stay, and healthcare-related costs. Research shows that using structured mechanical ventilator weaning tools in the ICU can shorten the duration of mechanical ventilation, which in turn, lowers these associated risks. …

The Impact Of Lung Cancer Screening Education On Knowledge And Screening Rates In A Kentucky Cancer Survivorship Clinic, Alexandra Isler

DNP Projects

Background: Lung cancer is a significant problem in Kentucky, which ranks fourth in the nation in adults who currently smoke. Early detection, through lung cancer screening, can prevent untimely deaths. Several barriers to screening exist including lack of knowledge and awareness among patients regarding lung cancer screening. By increasing knowledge, at risk patients can take the necessary steps to decrease incidence of late stage diagnoses.

Purpose: The purpose of this project was to evaluate patients’ knowledge of lung cancer screening and referral and screening rates before and after one-on-one patient education.

Methods: This was a quality improvement project that used …

“Your Legs Don’T Look All That Good” An Analysis Of Impoliteness And Politeness In Individuals With Traumatic Brain Injuries In The Workplace, Grace Kozal

Theses and Dissertations--Communication Sciences and Disorders

Background: Social communication disorders are a common outcome from traumatic brain injury (TBI). This social communication disorder can be seen through impolite speech acts during conversation. While politeness is a social norm for workplace discourse, instances of impoliteness may have poor consequences. This research explores the use of impoliteness in persons with TBI within computer generated work-based conditions.

Methods: Language samples from the Voicemail Elicitation Task (VET) and Feedback/Advice Spoken Task (FAST) were transcribed word-for-word. Transcripts from all 62 participants were coded for impoliteness using a developed Impoliteness Codebook and were analyzed to identify significant differences in the number of …

Autism In Agricultural Education: A Case Study Of An Adolescent With Autism Spectrum Disorder And Their Parent On Career And Technical Education, Grace Miller

Theses and Dissertations--Community & Leadership Development

Autism spectrum disorder (ASD) is a unique and often misunderstood diagnosis. Little is known about the experiences of adolescents with ASD. As students with ASD graduate high school, many are under- and unemployed. Career and technical education (CTE) in U.S. schools is intended to prepare all students for careers post-secondary. Agricultural education is one of the predominate career clusters within CTE. This qualitative single case study sought to create a platform for both a student and their parent to share their experiences in agricultural education and CTE. Participants were an adolescent with ASD who had taken at least one year …

Exploring The Individual Impact An Appalachian Higher Education Institution Had On Fostering Solidarity, Capacity, And Agency Of Female Appalachian Students Seeking To Improve The Quality Of Life For Themselves And Their Appalachian Communities., Analiese Mitchell

Theses and Dissertations--Community & Leadership Development

Appalachian women navigating higher education encounter multifaceted challenges, often confronting marginalization and a lack of representation within academic spaces. This study investigates the experiences of female Appalachian students at Mountain University in Kentucky, aiming to shed light on their journey and the university's impact on their lives and communities. Drawing on qualitative data from interviews, the research explores themes of solidarity, capacity, agency, and Quality of Life. Findings reveal a robust sense of solidarity among Appalachian peers and faculty, fostering a supportive environment conducive to personal and academic growth. Participants express opportunities to engage with their communities positively, contributing to …

Division Of Labor And Relationship Satisfaction: Examining The Mediating Role Of Self Esteem, Ellen Keith

Theses and Dissertations--Family Sciences

As a result of feminist movements, rejections of gender roles, and changing economic conditions, profound changes have occurred within the structure of American families. This study delves into the intricate dynamics of divisions of household labor (DoL), self-esteem, and relationship satisfaction within the context of contemporary relationships. Drawing on data from the Panel Analysis of Intimate Relationships and Family Dynamics (Pairfam), this study tested five hypotheses, and investigates how perceptions of fairness in DoL tasks influence self-esteem and relationship satisfaction. Significant associations were found between reported share of DoL and indicated fairness of DoL, indicated fairness of DoL and relationship …

Music For The People: Comparing Public Funding Models For Popular Music In Atlanta, Glasgow, And Toronto, Heather Mcdonald

Theses and Dissertations--Arts Administration

This dissertation explores the complex landscape of public funding policies for popular music across three cities: Atlanta, Glasgow, and Toronto. Through comparative case studies and qualitative research methods, this work explores the varying approaches each city takes towards funding popular music, including the social, economic, and political environments in which these funding policies have developed.

Through document reviews and interviews with key stakeholders, the dissertation highlights the differences in how public funding for popular music is approached in Glasgow, Atlanta, and Toronto and the broader context of how these policies were created. Using Multiple Streams Approach, the Five Streams Confluence …

Reducing Nursing Documentation Burden: Evaluation Of An Electronic Health Record Optimization Plan, Jessica Collins

DNP Projects

Background: UK HealthCare transitioned to a new enterprise electronic health record (EHR) system, offered by Epic Systems Corporation, in June 2021. Approximately 2,000 inpatient nurses use the EpicCare Inpatient Module in the 1,086 licensed bed facilities. Compared to other academic medical centers, UK HealthCare nurses take more time documenting in this EHR inpatient module’s Basic Assessment Flowsheet (documentation burden) and have a longer delay between assessment and documentation (timeliness) potentially contributing to nursing dissatisfaction with using this new EHR.

Purpose: The purpose of this project was to evaluate the effectiveness of a phase of the Epic Nurse Well-Being Project, a …

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Improving Black Maternal Outcomes In Christian County, Ky: A Social Marketing Approach To Perinatal Provider Change, Ariel A. Arthur

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound …

The Effect Of An Intervention To Improve Screening For Opioid Use In Patients With Post Traumatic Stress Disorder, Tammy Swartz

DNP Projects

Background: Rates of post-traumatic stress disorder (PTSD) were reported to be higher during COVID-19 than during any other epidemic in history. Patients diagnosed with PTSD are at an increased risk of experiencing opioid use disorder (OUD). Early detection, prevention, and treatment are essential to prevent OUD.

Purpose: The purpose of this project was to determine if education aimed at increasing nurses’ knowledge increased patient screenings for OUD.

Methodology: A baseline chart audit was performed to determine the number of patients seen in the emergency department with PTSD who also were evaluated for OUD. Two hundred and forty emergency department registered …

Implementation Of An Evidence-Based Bundle To Educate Nurses In The Care Of Adult Post-Transplant Diabetes Mellitus Patients, Christine Slaughter

DNP Projects

Background: After solid organ transplantation, between 10-40% of patients develop post-transplant diabetes mellitus (PTDM) due to the immunosuppression regimen, infection, stress response and pain. Hyperglycemia events are common and managing glycemic targets is critical to decrease the likelihood of graft failure and mortality.

Purpose: To determine the impact of an evidenced-based bundle education strategy on the perceived confidence/knowledge of nurses and on their documentation compliance in the care of adult solid organ post-transplant diabetes mellitus patients.

Methods: A single group, pretest-posttest design was implemented to evaluate the effectiveness of the electronic educational program on the nurses perceived confidence/knowledge regarding glycemic …

Implementation Of An Education Intervention Aimed At Intensive Care Unit Providers To Improve Knowledge Of And Screening For Cognitive Impairment Related To Post-Intensive Care Syndrome, Terry Harrod

DNP Projects

Abstract

Background: Post intensive care syndrome is a condition that can lead to a range of physical,

cognitive, and psychiatric issues and is frequently undiagnosed. Educating Nurse Practitioners,

Physician Assistants, and Physician Fellows who work in the ICU about post intensive care

syndrome and a cognitive screening tool like the MoCA can significantly enhance their

understanding and ability to diagnose a component of this syndrome.

Purpose: The purpose of this project was to evaluate the effect of an educational intervention

regarding post intensive care syndrome among ICU nurse practitioners, physician assistants, and

physician fellows treating patients within the ICU.

Methodology: …

The Effects Of An Educational Intervention On Nursing Knowledge Of Post-Operative Care Of Patients After Minimally Invasive Esophagectomy Surgery, Kelli Curry

DNP Projects

Abstract

Background: Minimally invasive esophagectomy surgery is commonly performed by thoracic surgeons on patients with esophageal cancer. The post-operative care of these patients is meticulous and follows a protocol developed by the thoracic surgeons at the University of Kentucky. At UK Chandler Medical Center, concerns have been raised regarding nurses’ lack of education of the protocol, and therefore decreased implementation. Increasing nursing knowledge pertaining to this protocol by performing educational in-services periodically and standardizing and implementing formal education as part of nursing orientation will decrease the knowledge gap and improve patient outcomes and increase utilization of the post-operative protocol.

Purpose: …

The Effect Of An Educational Intervention On Early Mobility Compliance In Oncology Nurses, Jonathan A. Hacker

DNP Projects

Background: Geriatric adult patients admitted into acute care hospital settings are at risk of functional decline in their capacity for activities of daily living and independent ambulation. Many of these patients fail to achieve pre-hospitalization levels of function and continue to decline, requiring additional support and care after discharge. Current literature supports early mobilization and ambulation during hospitalization. However, ambulation and patient mobilization has been shown to be the most missed item of nursing care. There is a gap in literature and patient outcome data regarding the impact of early mobilization on medical-surgical patient populations.

Purpose: The purpose of this …

New Crew Nights: The Impact Of A Nurse Leader Led Mentorship Series On Perceived Competency In The Novice Nurse, Taylor C. Bergman

DNP Projects

Abstract

Background and Purpose: Nursing leaders across the United States are seeking to recruit and retain new graduate nurses as a national nursing shortage widens at an alarming pace. Healthcare systems are tasked to strengthen the skill set of novice nurses as they seek to meet the care needs of acutely ill patients and rebuild a skilled workforce for future years. This study evaluated the impact of a four-part mentorship series for novice nurses on perceived strengths in competency, communication, wellbeing, and teamwork.

Methods: In this quality improvement project with pre-intervention/post-intervention assessment, a sample (n=14) of medical surgical nurses with …