Medicine and Health Sciences Commons^™

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 …

Provider And Staff Education Surrounding Universal Hcv Screening And Linkage To Care In An Ambulatory Care Setting, Lauren Clifford

DNP Projects

Abstract

Background: In the United States, it is estimated that there are more than 2 million cases of Hepatitis C (HCV), with over 66,000 new cases since 2020 However, an estimated 75% of those with HCV go undiagnosed and less than 35% receive treatment within a year of diagnosis. In 2018, UK Healthcare (UKHC) implemented a universal HCV screening method using a Best Practice Advisory (BPA) for anyone 18 and older who presented to the Emergency Department and had labs ordered. Patients who screened positive were then referred to outpatient clinics for HCV treatment. Approximately ten percent of positive patients …

Factors Associated With Covid-19 Vaccine Hesitancy In South Central Appalachia, Florence M. Weierbach, Rebecca Adkins Fletcher, Ingrid E. Luffman, Cynthia Meyer, Janet M. Keener, Manik Ahuja, Hadii M. Mamudu

Journal of Appalachian Health

Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall …

Advocating For Comprehensive Sex Education In Kentucky, Kylie Higgins

Lewis Honors College Thesis Collection

Legislation surrounding sexual education, comprehensive sexual education in particular, has always been a point of controversy. Recently however, this controversy has been brought to the forefront of political debates and media coverage. With sexual education, and the repercussions of a lack thereof, being such a timely issue, this thesis project will explore the current written literature to create an evidence-based presentation to educate future nurses on the issue and their role in promoting the implementation of comprehensive education in schools and providing it in the clinical setting. Comprehensive sex education is medically accurate, age appropriate, evidence based, and LGBTQIA+ inclusive, …

Addressing The Inpatient Penicillin Allergy And Antibiotic Stewardship: The Effect Of Education On Compliance Rates Of The Nurse Driven Penicillin Allergy Assessment Tool, Alexandria Bassler

DNP Projects

Background: Penicillin allergies are the most frequently reported drug allergy but less than 1% of the total population has a true immune-mediated allergy. Patients who are labeled as having a penicillin allergy may receive drugs that are less effective, more costly, and more toxic. The nurse driven penicillin allergy assessment tool strives to increase penicillin allergy de-labeling rates by pharmacists and providers.

Objective: The purposes of this study were to (1) perform a retrospective and prospective chart review to determine compliance rates with the nurse driven penicillin allergy assessment tool, (2) provide an education module on antibiotic stewardship …

The Effect Of An Educational Handout On Knowledge, Awareness And Attitudes Of Pre-Exposure Prophylaxis (Prep) Among Participants At A Needle And Syringe Exchange Site, Mckenzie Buckel

DNP Projects

Background: In 2018, the total number of HIV cases in the United States was 1.2 million. Almost 186,500 of these cases were attributed to intravenous drug use. With the adherence to pre-exposure prophylaxis (PrEP) there is approximately a 49% decrease in the rates of HIV among people who inject drugs and the most significant barrier to PrEP among this population is a lack of awareness and knowledge.

Objective: The purpose of this study was to determine participants’ of a needle and syringe exchange site knowledge, awareness and attitudes of PrEP after reviewing an educational handout about PrEP.

Methods: A quasi …

Electronic Cigarettes And Young Adults: Use Of Screening Tools And Provider Knowledge, Kayla Erin Chelf

DNP Projects

Background: Electronic Cigarette (e-cigarette) use is now more common than traditional cigarette use in adolescents and young adults (Dinardo & Rome, 2019). There is concern that the lack of screening for use and knowledge about the health consequences of e-cigarette use is driving this growth.

Objective: The purposes of this project were to (1) assess baseline e-cigarette knowledge and screening practices from healthcare professionals, and (2) evaluate changes in knowledge after delivery of an educational intervention about e-cigarettes.

Methods: In this quasi-experimental study a seven-question survey on screening practice and knowledge concerning e-cigarettes in young adults was posted on the …

Knowledge & Attitudes Towards Pediatric Pain With Needle-Based Procedures In The Emergency Department Setting, Charlstyn Paige Brown

DNP Projects

PURPOSE: By the time a child enters kindergarten, they may have faced as many as thirty-three vaccine-related injections. Throughout these experiences, parents and patients associated pain and fear regarding the administration of multiple vaccines concurrently to a child has played a role in vaccine hesitancy and refusal. Parents and patients experience associated fear and pain regarding the administration of multiple concurrent scheduled vaccines, thus leading to vaccination hesitancy and refusal. In addition to scheduled immunizations, there is also the possibility of unexpected needle-based procedures taking place when emergencies arise. The purpose of the study is to explore the current …

Exploration Of Vaccination Attitudes Among Parents And Caregivers In A Rural Appalachian Health Clinic, Radwa Omar, Karen Hande, Natasha Mcclure

Journal of Appalachian Health

At a rural Appalachian health clinic in Kentucky, 20% of patients under 18 years were not up to date with the CDC-recommended immunization schedule. Reasons parents or caregivers chose to delay or refuse their child’s immunizations were explored using the Caregiver Vaccination Attitude Scale. High levels of trust in the healthcare provider and self-reported vaccine knowledge highlight opportunities for rural healthcare providers to apply evidence-based communication strategies to address vaccine hesitancy and promote the safety and health of the entire community.

Increasing Staff Compliance With Routine Hcv Screening And Improving Linkage To Care Among Patients Testing Hepatitis C Positive In The Emergency Department, Carson G. Swartz

DNP Projects

Background: Hepatitis C virus (HCV) is a blood-borne pathogen that can cause severe liver disease, cancer, and death and is a significant source of morbidity and mortality in the United States. Several academic medical centers including University of Kentucky Healthcare have implemented routine HCV screening for patients presenting to the emergency department (ED) and have discovered a large viral burden amongst patients who are often symptomatic.

Purpose: The purpose of this doctoral project is to increase staff compliance, confidence, and education regarding the HCV screening process in an urban, Level I emergency department, as well as to evaluate whether an …

Workplace Lactation Support And Breastfeeding Practices In Employed Mothers, Robin Ray

Theses and Dissertations--Nursing

Low rates of breastfeeding are a global public health issue. Despite national and international health agency recommendations for breastfeeding until infants are six months of age when solid foods are introduced and continued breastfeeding until 12 months of age or older, many mothers in the United States discontinue breastfeeding at an early age. Return to work after childbirth is one of the leading contributing factors to early cessation of breastfeeding in employed mothers. Understanding the association between individual and organizational factors and breastfeeding practices in employed mothers is essential for the development, implementation, and evaluation of programs and policies to …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Seeking Care At Free Episodic Health Care Clinics In Appalachia, Malerie Lazar, Sandra Thomas, Lisa Davenport

Journal of Appalachian Health

Background: People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers.

Purpose: A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, …

Associations Between Psychosocial Stressors, Genes, And Cardiovascular Disease In At-Risk Adults, Kaitlin Voigts Key

Theses and Dissertations--Nursing

Psychosocial stressors have a significant adverse impact on cardiovascular health. While better medical treatments and increased emphasis on healthy lifestyle have improved cardiovascular health for many in the United States over the past 50 years, there are persistent inequities in cardiovascular disease (CVD) rates, with the highest rates among populations burdened by chronic exposure to psychosocial stressors such as discrimination and anxiety, among others. Genetic factors may interact with these stressors further influencing the rates of CVD in these populations. The purpose of this dissertation is to examine associations among psychosocial stressors and other CVD risk factors, and the influence …

Residential Radon Exposure, Its Contribution To Lung Cancer, And Social Determinants Of Radon Testing, Stacy Stanifer

Theses and Dissertations--Nursing

Lung cancer is a highly preventable form of cancer. Cigarette smoking is the leading cause of lung cancer followed by radon gas exposure and exposure to secondhand smoke. Kentucky leads the nation in both incidence and mortality from lung cancer. Tobacco use in Kentucky continues to be a major public health concern as nearly one-quarter of adults report current tobacco use and just over one-third of Kentucky homes with children lack rules which prohibit smoking in the home. Radon, a colorless, odorless radioactive gas, occurs naturally from the decay of uranium found in rocks and soil and is harmful when …

Tobacco Use And Nicotine Withdrawal Among Patients With Mental Illness, Yazan Daher Al-Mrayat

Theses and Dissertations--Nursing

People with mental illness (MI) are disproportionately affected by tobacco use compared to the general population. In fact, it is estimated that people with MI consume approximately 44% of cigarettes smoked in the United States. Moreover, the MI population is at greater risk for the negative social, economic, and health consequences associated with tobacco use and are reported to have 25-year shorter life expectancies than the general population. The impact of tobacco use is further noticeable among patients with MI who require psychiatric hospitalization. Quitting smoking in this population has been linked to fewer discharges against medical advice, better quality …

Depressive Symptoms Among Farm Women Aged 50 And Older, Cheryl Dean Witt

Theses and Dissertations--Nursing

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer.

Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to …

Patient-Centered Medical Homes In Community Oncology Practices: Changes In Spending And Care Quality Associated With The Come Home Experience, Teresa M. Waters, Cameron M. Kaplan, Ilana Graetz, Mary M. Price, Laura A. Stevens, Barbara L. Mcaneny

Health Management and Policy Faculty Publications

PURPOSE:

We examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality.

PATIENTS AND METHODS:

We compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for …

The Effect Of A School Nurse Intervention Program On Student Absenteeism In Jefferson County Public Schools: A Pilot Study, Eva Stone

DNP Projects

Background: School attendance has a significant impact on student achievement. In early grades, students who miss 10% or more of school are considered chronically absent and at risk to be behind in reading. High school students with similar attendance patterns are less likely to enroll and stay in college after graduation. Evidence shows that the presence of school nurses can result in improved school attendance.
Purpose: The purpose of this pilot project was to implement a targeted school nurse intervention at an elementary, middle and high school in Jefferson County. The intervention included assessment by a registered nurse for children …

Provider Adherence To National Heart, Lung, And Blood Institute’S Guidelines On Screening, Diagnosis, And Treatment Of Hypercholesterolemia In The Pediatric Population Aged 9-11 Years, Alanna Cox

DNP Projects

Purpose: High cholesterol levels have been directly linked to atherosclerosis, which is a leading cause of cardiovascular disease (CVD). Risk factors that accelerate the development of atherosclerosis, such as high cholesterol can begin in childhood. The purpose of this project was to evaluate provider adherence to the National Heart, Lung, and Blood Institute’s (NHLBI) Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, specifically the guidelines on universal lipid screening in children aged 9-11 years. The objectives were: 1) determine the rate of lipid screening in children 9-11 years old; 2) determine the number of children who …

Evaluation Of Emergency Department Use By Adult Patients With Established Primary Care Provider, Sherry Tolentino

DNP Projects

BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only …

Assessment Of Alcohol Withdrawal Syndrome Incidence And Identification Of Other Correlating Risk Factors In Patients Admitted Through The Emergency Department, Hannah Young

DNP Projects

PURPOSE: The purpose of this project was to measure adherence rates to the current alcohol use screening process, and identification of correlations of alcohol use and outcomes in patients admitted to Norton Hospital, via the emergency department.

METHODS: The study design is a retrospective descriptive evaluation, of adherence to the current alcohol use screening process, and associations among age, gender, ethnicity, length of stay, number of ICU days, restraint use days, level of care at admission (ICU, TCU, LLM/tele, MS), incidence of AWS/DTs, and activation of the CIWA protocol among the adult inpatient population of Norton Hospital’s downtown campus, admitted …

Impact Of Education On Provider Knowledge And Screening Practices Related To Childhood Obesity, Natalie B. Fulk

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effect of a provider education program on BMI screening practices and provider knowledge related to childhood obesity by implementing an educational intervention to advanced practice providers in a primary care clinic setting.

METHODS: A pretest/posttest design was used to examine changes in provider knowledge about BMI screening practices in children and adolescents, and lifestyle recommendations after a brief educational intervention was provided. A retrospective chart review was used to assess the screening and management practices for an elevated BMI percentile and provider documentation of lifestyle recommendations.

RESULTS: A total of …

A Retrospective Comparative Analysis On The Effectiveness Of Pharmacologic Weight Loss, Emily Dunn

DNP Projects

PURPOSE:Obesity costs the U.S. roughly $147 billion in health care spending annually. There has been a call for healthcare providers to initiate all possible weight loss interventions. One treatment strategy not used to its fullest potential is that of prescribing antiobesity medications. The purpose of this project was to examine and evaluate the effectiveness of three common weight loss medications used in the treatment of obesity, including discussion and recommendations.

METHODS: This project was a single-center retrospective study comparing three different groups of patients seen at a rural weight loss clinic. The sample consisted of 84 patients seen between September …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

Reproductive Autonomy: The Context Of Pregnancy Intention, A Global To Local Approach, Hartley C. Feld

Theses and Dissertations--Nursing

Globally, in low and middle-income countries 4 out of every 10 pregnancies is reported to be unintended. Having an unintended pregnancy increases the risk of maternal and infant morbidity and mortality, preterm birth, low birth weight, and decreases rates of breast-feeding. The United States (U.S.) consistently has some of the highest rates of preterm birth, infant and maternal mortality of all high-income countries and 45% of all pregnancies in the U.S. are reported to be unintended. The etiology of these outcomes and their relationship to pregnancy intention are complex and multifactorial, but we know this disproportionately effects women living in …

Social Determinants Of Health And Disparities In Outcomes Related To Cardiovascular Health In Vulnerable Populations, Jennifer L. Miller

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

The Use Of Magnets As Patient Appointment Reminders And Hpv Vaccination Rates, Hayden Kelley

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a patient reminder alert system implemented at a public health department in rural Indiana in an attempt to increase the facility’s human papillomavirus (HPV) vaccination rates.

METHODS: This study was a secondary data analysis utilizing the Children and Hoosiers Immunization Registry Program (CHIRP) database to compare HPV vaccination rates before and after the implementation of an HPV magnet reminder program. The sample consisted of 122 adolescents; 31 patients for the pre-implementation period, July 1, 2015- June 30, 2016 and 91patients for the post-implementation period, July 1, 2016- Jan …