Digital Commons Network^™

Remote Blood Pressure Monitoring Program: Program Evaluation., Brittany Walker

Doctor of Nursing Practice Papers

The prevalence of hypertension is high at the local, state, and national levels. In 2021, 39% of Kentucky adults were diagnosed with high blood pressure (CDC, 2021). Primary care providers are utilizing remote blood pressure monitoring (RBPM) to assist with the management of hypertension. Literature reveals that remote BP monitoring alone, without the use of other interventions such as counseling and education, may not effectively control blood pressure (Uhlig K, et al, 2013). This project evaluated the RBPM program utilized at a federally qualified health center in Louisville, KY. Patient engagement within the RBPM program includes BP measurement, communication with …

Exploring The Lived Experiences Of Dysphoric Milk Ejection Reflex During Postpartum Breastfeeding: A Phenomenological Study, Stephanie Herr, Jessica Devido, Richard Zoucha, Jill Demirci

Electronic Theses and Dissertations

This study sought to explore the lived experiences of Dysphoric Milk Ejection Reflex (D-MER) during postpartum breastfeeding. A phenomenological method based on Giorgi’s phenomenological underpinnings was used. The setting for this study was virtual interviews in a secure online platform. The sample consisted of 13 participants, self-identifying as experiencing D-MER. Semi-structured interviews, with thematic analysis of transcription were conducted. Four major themes were identified: 1) Breastfeeding concessions and toleration; 2) Something does not feel “normal”; 3) I remember a feeling like this before 4) This is real, and recognition is validating. Conclusions were that women of this study value the …

Exploring The Influence Of Postnatal Depression On Neonatal Care Practices Among Mothers In Western Kenya: A Qualitative Study, Florence Achieng, Alloys K’Oloo, Hellen Barsosio, Simon Kariuki, Helen Nabwera

Obstetrics and Gynaecology, East Africa

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality.

Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya.

Design: A cross-sectional study.

Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale.

Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to …

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Hands-Only Cpr Education In Tarrant County, Courtnee C. Cross

Electronic Theses and Dissertations

The purpose of this project was to identify the impact of in-person, hands-only CPR education for community members on their confidence and ability in performing CPR. Bystander-initiated CPR is an important aspect in the survival and outcomes of those that experience a cardiac arrest in the community. The hands-only CPR method was developed to help increase bystander-initiated CPR and improve outcomes for those experiencing a cardiac arrest at home. This project was quasi-experimental, using pretest and posttest data. Community members took the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) before and after the hands-only CPR education video to determine how the …

Mindfulness Training To Reduce Perceived Stress Among Manufacturing Employees: An Evidence-Based Project, Ijeoma Okoro

Doctor of Nursing Practice Projects

Background: Stress, a state of emotional or physical tension, is experienced by individuals for various reasons. The American Psychological Association identifies money, work, and the economy as the most frequently cited sources of stress. Workers in manufacturing settings are particularly susceptible to increased levels of perceived stress due to the demanding nature of their work. To reduce stress levels, some manufacturing companies have begun implementing different interventions, including mindfulness-based stress reduction.

Objectives: The aim of this project was to implement a weekly 30-minute mindfulness training program over six weeks to reduce perceived stress levels among manufacturing employees at a company …

A Practice-Based Inquiry Into The Correlation Between Nursing Retention Rates And Resiliency, Kelly J. Watson

Electronic Theses and Dissertations

Nurses are the frontline in the security of the United States. Their wellbeing and retention in the workforce is of the utmost of importance. Nurses are leaving at increasing levels with just over 27% turnover rates across the nation in 2021. Organizations are experiencing increasing fiscal losses and the average loss for a nurse leaving is just over $46,000. The prioritization of nurses’ wellbeing and taking steps to address policy that promotes the sustainability of this very valuable workforce has the potential to pay high dividends for nurses individually, the security of the nation, and the good of the organization. …

Care Transition Assessment Redesign In The Acute Care Setting, Darla M. Johnston

Electronic Theses and Dissertations

There is a gap in case management professional practice with a lack of consistent, research-based transition evaluation (TE) tools available and used in practice. An evidence-based case management TE is necessary to develop a holistic and comprehensive discharge plan for hospitalized patients. Updating and implementing an evidence-based case management TE would positively impact the transition of care and promote improved health outcomes including a reduction in readmissions. This quality improvement project used a quantitative nonexperimental, interventional pretest-posttest design. Kirkpatrick’s multidimensional knowledge attitudes assessment (KAP) education evaluation model was used to assess (1) the influence an educational offering on evidence-based assessment …

Implementing An Integrated Psychology, Social Services, And Pediatric Diabetes Clinic, Joan P. Totka, Jacquelyn Smith, Sandra Brown, Maharaj Singh, Elaine Parton, Dawn Cvecko, Heather Fortin, Peter M. Wolfgram

College of Nursing Faculty Research and Publications

Objective:

Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families.

Methods:

Using the Iowa Model of implementation, we redesigned the “Regular Engagement And Connection for Health” (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social …

High Fructose Corn Syrup And Sugar Substitutes: Hemoglobin A1c Implications In Diabetes?, Rachelle S. Glover

Doctoral Dissertations and Projects

Diabetes mellitus type 2 (DMt2) is an increasing health concern of epidemic proportion in the United States. High fructose corn syrup (HFCS) and artificial sweeteners (AS) have been implicated as contributory factors to DMt2. This project seeks to demonstrate elimination of daily consumption of HFCS and AS in DMt2 patients can contribute to lower hemoglobin A1C (HgbA1C) levels by comparing two groups of patients receiving two differing diabetes education programs. A reduction of HgbA1C levels by 0.2-0.5% is expected in DMt2 patients instructed to eliminate HFCS and AS, and no change is expected in HgbA1C levels in DMt2 patients receiving …

Factors Determining Commitment To Health-Promoting Behavior During Covid-19, Dheni Koerniawan, Sanny Frisca

Jurnal Keperawatan Indonesia

Forming new behaviors during the COVID-19 pandemic required individual commitment. Based on Pender’s health promotion model (HPM), factors affecting commitment to new behaviors include benefit perception, barriers, self-efficacy, related activities, as well as interpersonal and situational influences. This study aims to determine the determinant factors that affected commitment to health-promoting behavior and habits during the COVID-19 pandemic. This study randomly assigned online questionnaires to 186 people in Palembang. The instruments used in this study were developed by the author based on Pender’s HPM. Path analysis with the SEM-PLS approach was used to analyze determinant factors of community commitment. The results …

The Impact Of Stress On The Work Performance Of Covid-19 Isolation Room Nurses At Hospitals In Timor, Antonius Rino Vanchapo, Anggorowati Anggorowati, Ni Made Merlin

Jurnal Keperawatan Indonesia

The incidence of Corona Virus Disease (COVID-19) in East Nusa Tenggara has increased tremendously since April 2020. This has caused nurses to experience anxiety and stress due to fears of a shortage of special COVID-19 inpatient rooms. This study aimed to analyze the correlation between stress and the work performance of the COVID-19 isolation room nurses in mainland Timor. This cross-sectional study involved 278 nurses who worked in the COVID-19 isolation rooms of three hospitals on Timor Island. The Depression Anxiety Stress Scales (DASS-42) and the Nurse Work Performance Sheet were applied to obtain the data. The results demonstrated that …

Evaluating The Need For Return-To-Learn Concussion Protocols In High School Student-Athletes: An Integrative Review, William David Midgette

Doctoral Dissertations and Projects

Over a million high school students are estimated to sustain at least one sports-related concussion annually. Unfortunately, over a third of these student-athletes suffer from post-concussion syndrome, which leads to the question of whether student-athletes are allowed proper time to heal after a concussion or if more can be done to optimize concussion recovery. Proper and optimal recovery post-concussion encompasses both physical and cognitive rest. While concussion management has traditionally focused on the physical aspects of recovery, emphasis has shifted to the cognitive impacts of concussions. There is literature to support that cognitive rest is vitally important, if not equally …

Perceptions Of Covid-19 And The Use Of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study, Khushi S. Patel, Cynthia F. Corbett Phd, Rn, Faan, Elizabeth M. Combs, Sara B. Donevant, Margaret J. Selph, Lynette M. Gibson, Robin Dawson Phd, Rn, Cpnp-Pc, Amit P. Sheth, Ronda G. Hughes

Publications

BACKGROUND: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care.

OBJECTIVE: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents' perceptions of and suggestions for …

Faith And Information To Treat Hypertension, Tiffany Bell

Student Scholarly Projects

Practice Problem: The prevalence of stroke and hypertension (HTN) in African Americans in the United States is among the highest in the world (American Heart Association, n.d.) with cultural norms as a contributing factor.

PICOT: The PICOT question that guided this project was in African American adults (>18 y/o) (P), how does a faith-based hypertension management program (I), compared to standard hypertension management (C), affect blood pressure measurements (O) within an 8-week timeframe (T)?

Evidence: The integration of motivational interviewing with therapeutic lifestyle changes along with HTN education using a community-based participatory approach delivered in the …

Intervention For Treating Sarcopenia Among Older Residents In A Skilled Nursing Facility, David A. Hernandez, Susan E. Hueck, Donna-Marie Phyllis Lanton

Journal of Social, Behavioral, and Health Sciences

The incidence of sarcopenia, a geriatric syndrome characterized by the progressive and generalized loss of muscle quantity or quality, increases with age and is associated with adverse health and quality of life outcomes. A 12-week strength training intervention program (STIP) was designed to improve measures of muscle mass, muscle strength, physical performance, and quality of life in elderly patients with sarcopenia. Data were collected on these measures at 4-week intervals over 12 weeks. Results showed that the STIP was an effective intervention for reducing the characteristics associated with sarcopenia. Significant gains were made in muscle mass, grip strength, balance, gait …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Attention-Deficit Hyperactivity Disorder: Improving Outcomes Through Early Identification, Tina Lusk

Dissertations

Problem: Failure to identify and treat attention-deficit hyperactivity disorder (ADHD) is associated with academic underachievement, social difficulties, negative physical and mental health effects. Evidence suggests approximately 3% of a broad-based population sample and roughly 13% of an at-risk population are undiagnosed despite significant symptomology (Downey & Zun, 2018; Madsen et al., 2018; Okumura et al., 2019). The United States (U.S.) has no structured screening system for ADHD. Consequently, children receive no referral for diagnosis or treatment to mitigate its effects.

Methods: The Institute for Healthcare Improvement (IHI) Model for Evidence-Based Practice using the Plan Do Study Act (PDSA) cycle guided …

Is Heart Health As Simple As Gut Microbiota?, Elizabeth A. Moxley

Faculty Articles, Papers, and Other Scholarship

The current mortality statistics for cardiovascular disease (CVD) in the United States (US) and on a global scale are staggering. CVD is responsible for approximately 31% of global deaths,¹ and approximately 25% of adults in the United States (US) have CVD.² The American Heart Association has identified eight primary measures for improving and maintaining cardiovascular health: Life’s Essential 8.³ However, a lesser recognized measure that has a profound effect on cardiovascular health has recently emerged,^4-5 that of the gut microbiome. The link between cardiovascular health and diet is not merely due to essential nutrients found in …

Nonpharmacologic Measures To Maintain Or Increase Bone Density In Patients At Risk For Osteoporosis: An Integrative Review, Katie Saporsky

Doctoral Dissertations and Projects

Osteoporosis is a major phenomenon, impacting a large proportion of the population of the United States. Effective prevention and mitigation strategies for this condition and its related complications are necessary to promote health and well-being for the aging population. Current pharmacologic agents used to combat osteoporosis bring the risk of adverse effects, resulting in poor patient adherence. Nonpharmacologic methodologies, specifically weight-bearing exercise, targeted nutrition, and whole-body vibration, have proven to be successful in increasing bone mineral density and mitigating the risk of osteoporosis and its related complications. Implementing these methodologies results in increasing bone mineral density, strength, and well-being.

Kangaroo Care Impact On Maternal Health: An Integrative Review, Alexis Ann Lawson

Doctoral Dissertations and Projects

Health care should progress and change as the needs of the population change. As light is shed on the mothers’ experiences during the postpartum period, there is an increasing need to find and implement evidence-based interventions to promote their health and wellness. As a vulnerable population, postpartum women require appropriate treatments and interventions to avoid postpartum complications. Three key themes of postpartum health and well-being that directly and significantly impact mothers are postpartum depression, maternal and infant attachment, and exclusive breastfeeding. This integrative review addressed the correlation between each of these themes and how kangaroo care, upright skin-to-skin contact, impacts …

Prenatal Educational Strategies To Increase The Duration Of Breastfeeding: An Integrative Review, Kayla Caryl Carter

Doctoral Dissertations and Projects

Although breastfeeding is the best source of nutrition for infants, many women in the United States of America do not breastfeed their infants. Infants should be breastfed for the first 6 months of life. Not only does this benefit the baby, but the mother as well. While prenatal education has been linked with improvements in breastfeeding rates, little research has been completed on which educational strategies are most effective. The purpose of this integrative review is to determine effective prenatal educational strategies for increasing the duration of breastfeeding. The strategies reviewed were single methods, multiple methods, and education with continued …

Does A Telehealth Education Program Improve Lifestyle Behaviors Of Individuals With Prediabetes?, Loretta A. Richardson

Doctoral Dissertations and Projects

Chronic conditions are a considerable burden on the healthcare system, and one that is becoming increasingly prevalent is diabetes. Prediabetes is a condition that has become more common and diagnosed in many patients before an actual diagnosis of diabetes. Healthcare professionals strive to empower individuals to make lifestyle changes to prevent diabetes from occurring by informing individuals on how to manage prediabetes. For individuals that do not make the necessary changes to lower their hemoglobin A1c to below the standards of less than 5.6%, a diagnosis of diabetes occurs. It is estimated that five per 1000 individuals are diagnosed with …

Intention To Change Lifestyle Behaviors In 10- To 14-Year-Old Children With Obesity., Mallory Swanson

Doctor of Nursing Practice Papers

Background: Pediatric obesity is a multifaceted disease that affects 19.7% of children. Obesity increases the risk of long-term health morbidity and costs billions of dollars annually for the United States healthcare system.

Purpose: The objective of this quality improvement project was to utilize the 5210 Healthy Children Campaign to facilitate behavior change in obese children. Potential outcomes include fostering health promotion and disease prevention, improving patient outcomes, decreasing morbidity and mortality, and easing the healthcare burden.

Methods: Intervention took place at Growing Kids Pediatrics and was conducted through four educational sessions involving the obese child and at least one caregiver. …

Utilizing Mhealth To Increase Follow-Up In Latinx Adults With Hyperlipidemia., Jessica Raymond Richards

Doctor of Nursing Practice Papers

Background: Management of hyperlipidemia (HLD) is crucial to the prevention and management of cardiovascular disease cardiovascular disease (CVD), a leading cause of death in the United States (US) and Latinx adults (Centers for Disease Control and Prevention (CDC), 2019). The main difficulty affecting monitoring of lipid levels in patients diagnosed with HLD is lack of adherence to follow-up appointments.

Purpose: The purpose of this Quality Improvement (QI) project is to evaluate the impact of culturally competent translated short message service (SMS) texts to increase adherence follow-up on a Latinx population served at the Kentucky Racing Services Health Center (KRSHC).

Intervention: …

Improving Post-Stroke Dysphagia Screening In The Intensive Care Unit., Chelsea Bills

Doctor of Nursing Practice Papers

Background: Dysphagia screening is a critical aspect in the care of patients experiencing acute stroke and dysphagia may often determine life or death following a stroke event. Inconsistent nurse dysphagia assessment and documentation were identified in the Medical/Surgical Intensive Care Unit project organization.

Purpose: The purpose of this project was to explore the impact of an educational program on stroke nurse dysphagia screening and nursing self-efficacy in the ICU.

Methods: Fifteen nurses completed a modified General Self-Efficacy Scale survey which measured nurse perceptions of change in their own self-efficacy to perform dysphagia screenings; dysphagia screening rates and rates of dysphagia …

The Use Of Two Nurses, Four Eyes On Skin Assessments To Reduce The Incidence Of Pressure Injuries In Medical-Surgical Patients, Tiffany Bass

Doctor of Nursing Practice Projects

Background: Hospital-acquired pressure injuries (HAPIs) adversely affect at-risk patient populations and hospital settings. HAPIs increase the risk of death in vulnerable patient populations (Wassel et al., 2020). In addition, HAPIs cost healthcare agencies $9 to $11 billion annually (Padula & Pronovost, 2018). Inconsistent completion and documentation of the patient’s skin assessments both upon admission and daily throughout their hospital stay are identified barriers to improving patient outcomes. Implementing a Two Nurses, Four Eyes on Skin Assessment model upon admission and daily during the patient’s stay will decrease the incidence of hospital-acquired pressure injuries.

Purpose: The purpose of this Doctor of …

An Unaddressed Role Of Nurses: Barriers In Promoting Reproductive Health In Pakistan: A Commentary Paper, Rabab Vadivala, Arisha Amin, Sahar Jessani, Sara Hudani

Journal of Asian Midwives (JAM)

Reproductive health has a significant impact on a person’s overall wellbeing. Despite this, it is not given major attention. Many people are still unaware of the importance of reproductive health, and one reason for this is the often-overlooked role of nurses in sexual and reproductive health. Nurses, midwives and lady health visitors are the healthcare professionals that play a pivotal role in promoting reproductive health. However, due to several factors, such as burnout among nurses and a lack of educational preparedness, this role of nurses remains unaddressed. This article discusses the general determinants that contribute to the underutilization of nurses …

Implementation Of A Nurse-Driven Early Mobility Protocol In Critical Care To Reduce Intensive Care Unit Acquired Weakness (Icuaw), Wendy Key

Doctor of Nursing Practice Projects

Background: Intensive care unit acquired muscle weakness (ICUAW) is a syndrome of general weakness that occurs while a patient has a critical illness. Almost half of all ICU patients develop ICUAW. The most common occurrence of ICUAW is seen in patients diagnosed with prolonged mechanical ventilation, severe sepsis, or difficulty weaning from mechanical ventilation (MV). Bedrest is the number one risk factor for the development of ICUAW and the elderly are at higher risk. The best treatment for ICUAW is early mobility which has shown positive effects for decreasing ventilator days and intensive care unit (ICU) length of stay (LOS). …