Digital Commons Network^™

The Impact Of Icu Telemedicine On Patient Outcomes In The Surgical Critical Care Setting: An Observational Study, Megan Steely

DNP Projects

Abstract

Background: In April 2020, the University of Kentucky (UK) implemented a division entitled the Enhanced Care through Advanced Technology Intensive Care Unit (eCAT ICU) to provide tele-critical care (TCC) services in all critical care areas at UK Healthcare. The eCAT ICU at UK HealthCare was the first TCC delivery system of its kind in the state of Kentucky. Use of TCC has been associated with improved patient outcomes and decreased costs.

Purpose: The purpose of this study was to analyze targeted outcomes in the surgical critical care population pre- and post-implementation of TCC at UK HealthCare. Specifically, the aims …

Social Media Use And Mental Health: An Educational Intervention To Reduce Depression And Anxiety In Adolescents, Natalie Catlett

DNP Projects

Background: Most adolescents spend a great deal of their time using various social media platforms. However, excessive and maladaptive social media use is correlated with worsening symptoms of depression and anxiety among adolescents.

Objective: This project aimed to determine whether an educational intervention could help decrease overall time spent using social media and improve mood and mental health outcomes among adolescents with depression or anxiety disorders.

Methods: This was a quasi-experiment with a pretest and posttest design. An educational intervention about the relationship between social media use and symptoms of depression and anxiety among adolescents and strategies to minimize risk …

Screening For Severe Mental Illness In A Correctional Setting Using The Brief Jail Mental Health Screening Tool, Stephanie Kohl

DNP Projects

Abstract

BACKGROUND: Prisoners who are detained in jails and detention centers have higher rates of Severe Mental Illness (SMI) compared to the general population. However, SMI is often unidentified in this population, largely due to lack of assessment using effective SMI screening tools and lack of knowledge among prison staff about the prevalence of SMI and the importance of identification in the correctional setting. Prisoners with SMI often act out violently against others and themselves. Current standard practice for SMI screening varies significantly across jails. Many jails use standard medical questionnaires which help obtain a brief medical history but often …

A Multifaceted Approach To Improving Sedation Practices In The Cardiovascular Intensive Care Unit, Casey Mingua

DNP Projects

Purpose: Sedation protocols have been positively correlated with improved patient outcomes in the intensive care unit (ICU). Therefore, healthcare leaders should direct efforts to improving protocol compliance through evidence-based strategies. The purpose of this study was to evaluate the impact of a multifaceted intervention, consisting of educational outreach, point of care (POC) reminders, and audit and feedback (A&F), on nurse compliance with an ICU sedation protocol. A secondary data analysis was performed to evaluate the impact of the intervention on patient outcomes.

Methods: This was a before/after comparative analysis. A Research Electronic Data Capture (REDCap) pre-survey (n=58) was distributed to …

Increasing Medicare Wellness Visit Participation In A Primary Care Clinic, Katherine Rodriguez-Guerrant

DNP Projects

Background: Medicare Wellness Visits (MWV) came into use in 2011 to provide Medicare patients and their providers a chance to create a 5 to 10 year plan to prevent illness, disease, and disability. These visits are often underutilized due to various barriers on both the provider and patient side.

Purpose: The purpose of this study is to assess provider barriers to conducting MWVs and provide an educational tool that will assist providers in increasing the number of MWVs conducted within this system.

Design: This is a descriptive, quasi-experimental study to assess provider barriers combined with a Quality improvement project that …

The Effect Of Relational Aggression Training On New Emergency Department Nurses, Mary Wethington

DNP Projects

BACKGROUND: Relational aggression (RA) in nursing is widespread. One group often at risk for exposure to RA is the newly licensed nurse. RA can lead to a negative work environment which can cause poor patient outcomes and high nurse turnover.

PURPOSE: The purpose of this study was to evaluate the effects of an educational program on RA in the emergency department with newly licensed registered nurses. This was conducted using one pre and two post surveys. The surveys evaluated the nurses’ knowledge of RA self-awareness before and six weeks after an educational session.

METHODS: This was a single-site, single-unit pretest …

Tobacco Use Screening And Cessation Counseling In Primary Care, Jacob A. Heil

DNP Projects

Abstract

BACKGROUND: Primary care providers (PCPs) are poised across healthcare settings to reduce the leading cause of preventable morbidity and mortality, cigarette smoking. However, their patients may not be screened for tobacco use and miss cessation counseling, thus increasing tobacco-related diseases, and incurring costs to healthcare payers.

PURPOSE: This project seeks to identify the documentation process in a new electronic health record (EHR), communicate efficacy barriers, administer an educational intervention regarding the new process for PCPs, and measure its impact on performance of tobacco use screening and cessation counseling.

METHODS: This project was a quasi-experimental, single center, pre- and post-interventional …

Activating The Patient: A Nurse Led Coaching Intervention To Engage Health Information Seeking Behaviors Using The Ideal Discharge Framework And Get Well Network, Korinne Callihan

DNP Projects

Background: Cardiovascular (CV) patients are often overwhelmed by the unexpected emergence of the health condition, volume of knowledge for self-care mastery and acceptance of the responsibility for self-care upon care transition to the home setting. Low health literacy levels have been linked to poor outcomes in CV patients, requiring investigation into appropriate methods for patient education. The Get Well Network (GWN), an interactive digital patient education care plan at UK HealthCare (UKHC), is underutilized in this patient population.

Purpose: the purpose of this study is to assess the effect of a nurse-to-patient coaching intervention using the IDEAL discharge framework from …

The Effects Of Cultural Competency Training On Providers Knowledge, Skills And Attitudes Towards The Latino Population, Jennifer L. Peppiatt

DNP Projects

Background: Providers in the United States (U.S.) healthcare system need to understand the cultural values, beliefs, and traditions of the growing Latino population. As a result, academic institutions are incorporating cultural competency training in their curricula. However, a noticeable knowledge gap exists for those currently practicing in the healthcare arena, impacting patient and provider satisfaction and healthcare outcomes.

Purpose: The purpose of the study was to obtain a baseline assessment of the cultural competence of a select group of Advanced Practice Providers (APPs) caring for the Latino population at the University of Kentucky and provide a targeted educational intervention, followed …

Countering Moral Distress In Ecmo Nurses With Case-Review Debriefings, Sherry D. Griggs

DNP Projects

Abstract

Background: Moral Distress occurs when nurses know the ethically correct action to take, but they are restrained from taking it. It is especially prevalent in nurses caring for critically ill patients, such as those on extra-corporeal membrane oxygenation (ECMO). Effectively addressing moral distress is crucial to the growth and health of the nursing profession, which is the cornerstone of quality and safety in healthcare.

Purpose: The purpose of this project was to evaluate the effectiveness of case-review debriefings on moral distress of ECMO nurses.

Conceptual Framework: Analysis of Moral Distress Process was utilized. This framework addresses moral distress …

Nurses' Knowledge Of Delirium In The Icu, Sara Hancock

DNP Projects

Abstract

Background: Delirium costs the healthcare system $38 to $152 billion dollars annually. Nurses have a unique opportunity as healthcare providers to assess for and identify delirium, but often fail to recognize delirium.

Purpose: The purpose of this DNP project was to determine the effect of implementing an educational intervention regarding delirium risk factors, symptoms, prevention strategies, and treatments, on the knowledge of nurses working in an intensive care unit.

Methods: This DNP project used a quasi-experimental pre-test post-test design. Participants completed a pre-test (Appendix A), an educational intervention (Appendix C & D), and a post-test (Appendix B). Pre-test …

Examining The Impact Of Patient De-Escalation Techniques Training On Nurses' Feeling Of Safety, Raymond O. Young

DNP Projects

Abstract

Purpose: To evaluate the effects of patient behavioral verbal de-escalation techniques training on bedside nurses’ feeling of safety in the presence of an aggressive patient, and nurses’ confidence level in their ability to successfully de-escalate aggressive patient behavior prior to the patient becoming violent. Objectives of this study were to demonstrate increased feelings of safety and security in the workplace among nurses receiving patient de-escalation training once the training was completed; to improve the overall perception of mental health status of nurses; to improve the job satisfaction and likelihood to stay in their current position; and to assess the …

Effect Of Anticipatory Guidance On Parental Knowledge And Anxiety Prior To Discharge Of Infant From The Neonatal Intensive Care Unit To Home, Stephanie Kelty

DNP Projects

Background: Lack of adequate parental education and discharge readiness from the Neonatal Intensive Care Unit (NICU) increases the risk for poor infant outcomes, hospital readmissions, postpartum depression, parental anxiety, and post-traumatic stress disorder. One component of parental readiness at discharge is receiving anticipatory guidance from a trusted healthcare provider prior to discharge.

Purpose/Objectives: This study aimed to evaluate the effectiveness of provider-led anticipatory guidance to enhance parents’ knowledge regarding high-risk infant behaviors and decrease anxiety related to caring for their high-risk infant after NICU discharge. Additionally, this study aimed to assess parental opinions about the value of anticipatory guidance sessions. …

Promotion Of Early Recognition Of Depression To Improve Health Related Quality Of Life In Pediatric Oncology Patients, Jennifer Blankenship

DNP Projects

Background: Depression and anxiety are serious complications of cancer and deemed a challenging diagnosis due to the symptoms of depression mimicking common side effects of chemotherapy and radiation. Signs/symptoms frequently are underrecognized thus appropriate treatment is delayed, compromising the health-related quality of life (HRQOL) for pediatric oncology patients.

Purpose: Analyze existing physician and Advanced Practice Provider (APP) clinical practice regarding depression, via a pre- and post-survey and educational PowerPoint on the use of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to promote early recognition of depression.

Methods: A prospective, single-arm, study was completed in the Kentucky Children’s …

Increasing Confidence Of Nurses In Giving And Receiving Constructive Performance Feedback, Savanna Carroll

DNP Projects

Background: Nursing peer review is a process of reviewing standard nursing practice in an organization and comparing a nurse’s own practice to that standard. Nursing peer review contributes to the professional practice environment by assuring standard practice and competence, maintaining a culture of accountability, and maintaining psychological safety.

Purpose: The purpose of this project was to design and implement an educational intervention and simulation activity to prepare nurses to have constructive conversations with peers regarding work performance. Evaluation of the intervention would yield increased confidence and competence of nursing staff in giving constructive performance peer feedback.

Conceptual Framework: Bandura’s Social …

Back To Basics: Re-Envisioning Job Satisfaction Through Social Work-Strengths-Based Leadership, Mary Mcdaniel

DSW Capstone Projects

Social work job satisfaction is a pressing concern, becoming even more dire, in times of depleted social work workforces like experienced in Kentucky in 2021 or during an overall depleted workforce like experienced nationally due to The Great Resignation labor trend of 2022. Over recent years, it has become evident social workers and social service workers are less willing to settle for employment experiences and work environments of high stress, exhaustion, and frustration. Instead, social workers’ work expectations are changing, with social workers looking for positive work experiences such as workplaces which promote wellness, self-care, work-life balance, flexibility, and professional …

Oxidative Damage To Brain Cells Underlies: (I) Resistance To Radiation And Increased Tumor Cell Growth In Glioblastoma; (Ii) Apoe Allele Status And Pentose Phosphate Pathway Proteins In Alzheimer Disease Mouse Models, Nicole Rummel

Theses and Dissertations--Chemistry

Oxidative phosphorylation occurs within the inner mitochondrial membrane producing ATP for the cell’s energy needs. The Electron Transport Chain carries out the transfer of electrons from electron carriers through a series of proteins to form a proton gradient across the inner mitochondrial membrane. This gradient acts as the energy source needed to put a phosphate onto ADP and form ATP. With the large amounts of free electrons and oxygen within the mitochondria, an inevitable by-product of free radicals in the form of superoxide are produced. Superoxide (O^-̇₂) is a reactive radical that can react further to …

Development Of Fluorescence Based Approaches To Understand Astrocyte Biology In The Context Of Nicotine And Nicotinic Receptor Activity, Surya P. Aryal

Theses and Dissertations--Chemistry

Smoking and tobacco use (STU) is a major global health problem and worldwide more than six million people die due to tobacco related diseases each year. Although majority of smokers try to quit smoking several times in their life, traditional therapeutic approaches, which focus only on neuronal cells, have a very low success rate. Understanding the effect of nicotine on glial cells, synaptic communication and blood vasculature in the brain can provide further insights on the neurobiology of substance abuse and can potentially help to design better therapeutic approaches. Glial cells are non-excitable cells in the brain which do not …

Synthesis And In Situ Characterization Of Intercalated Transition Metal Oxide Nanomaterials Investigated For Novel Cathode Applications, Ahamed Ullah

Theses and Dissertations--Chemistry

To develop an effective battery cathode material that can be useful for future batteries, the thermal stability and ion diffusion dynamics need to be well understood. In situ transmission electron microscopy (TEM) is a popular and proven technique to study the evolution of local structures during the dynamic processes in the cathode materials. This dissertation will demonstrate the application of high-resolution imaging and in situ heating and biasing in the TEM to study the structure and composition, morphology change, and ion diffusion in the cathode materials.

The three chapters in this dissertation will be focused on the two cathode materials: …

Nicotine And Cotinine: Microbial Modulators Of The Immune Response, Jourdan Lakes

Theses and Dissertations--Chemistry

The consumption of tobacco products is a known contributor to a variety of health conditions and disease pathologies including cardiovascular and lung diseases. In addition to these well-known pathological effects of tobacco use, it has been established recently that tobacco consumption as well as nicotine consumption alone results in distinct, dysbiotic perturbations to the enteric microflora of the gastrointestinal tract. Previous research into the intestinal microbiome has demonstrated that these microbes are active contributors to the maintenance of a homeostatic and tolerogenic environment within the host. In fact, the presence of our enteric microflora is necessary for the proper development …

The Design And Synthesis Of New Organic Dithiols For Environmental Applications, Shashika Nadishani Bandara

Theses and Dissertations--Chemistry

A thiol molecule, 2,6-pyridinediamidoethanethiol (PB9), was synthesized based on the pyridine-2,6-dicarboxamide scaffold with appended cysteamine groups. PB9 acts as an effective chelator for Pb(II) due to multiple binding sites (N₃S₂) through irreversible binding precipitating Pb(II). Removal of aqueous Pb(II) from solution was demonstrated by exploring the effects of time, initial PB9:Pb(II) ratios, pH, exposure time, and solution temperature. After 15 min the Pb(II) concentrations were reduced from 50.00 ppm to 0.30 ppm (99.4%) and 0.25 ppm (99.5%) for PB9:Pb ratios of 1:1 and 2:1, respectively. Removal of > 93% Pb(II) was observed over multiple pH values with …

Cell-Engineered Vesicles For Therapeutic Delivery And Immunomodulatory Applications, Khaga Neupane

Theses and Dissertations--Chemistry

Development of a new kind of drug delivery system (DDS) that could efficiently deliver therapeutics to the cell of interest would allow us to accomplish cell-specific drug delivery while eliminating systemic toxicity. Although nanocarriers including endogenously released extracellular vesicles (EEVs), liposomes, and small molecules seem to be promising drug delivery systems, biological challenges persist for their use in clinical applications. Here, we demonstrate nanovesicles engineered by fragmenting cellular membranes can be exploited as versatile DDSs for therapeutics delivery as well as immunomodulatory functions. Cell-engineered vesicles were produced by cavitating cells using nitrogen gas at high pressure followed by serial centrifugation. …

The Role Of Organizational Leaders In Employee Self-Care: A Change Management Approach, Olivia Dawn Honaker

DSW Capstone Projects

Although literature demonstrates that helping professionals have had high levels of stress and burnout for decades, the COVID-19 pandemic has only exacerbated the issue. The already burdened healthcare workers, now facing increased workloads, long hours, and high-level exposure to trauma, have created an urgency to address this significant risk to helping professionals. The current capstone will bring awareness to organizational leaders regarding the importance of employee self-care and the benefits of implementing employee self-care programs. First, a systematic literature review will examine self-care in helping professions and explore how organizational leaders operationalize employee self-care programs. In addition, the capstone aims …

Bolstering Leadership Engagement To Community Coalition Work In Rural Appalachia, Melissa Slone

DSW Capstone Projects

Rural Appalachian communities are overwhelmed with high cancer rates, diabetes, disabilities, and substance use disorder. The challenges in addressing these increase when you factor in workforce shortages and limited funding. The literature documents the effectiveness of coalitions in addressing healthcare challenges within communities. The need is for leaders to reduce their hesitancy to engage in community coalition efforts and increase awareness of the impact community coalitions can have on addressing rural populations' health and well-being needs.

Product One was a systematic review focused on research that examined agency leaders’ perspectives on community coalition involvement. The purpose of conducting the systematic …

Bolstering The Effectiveness Of Exposure-Response Prevention In The Treatment Of Obsessive-Compulsive Disorder: Using Self-Compassion As An Adjunctive Intervention, Whitney E. Dyer

DSW Capstone Projects

Individuals suffering with Obsessive-Compulsive Disorder (OCD) face many challenges receiving proper diagnostics and evidence-based treatment. Furthermore, Exposure-Response Prevention (ERP), the empirically supported gold standard approach for targeting OCD, presents its own challenges. Examining the influences of ERP treatment reluctance is paramount to bolstering the effectiveness of outcomes and safeguarding participant adherence and ultimate success. This Capstone highlights the overlooking of addressing shame within traditional ERP protocol and posits a practice application model that supports the adjunctive use of self-compassion, a potent antidote for shame, within the use of ERP. As treatment hesitation is an inhibitor to relief for OCD sufferers, …

Neuroleadership A New Burnout Prevention Strategy, Zakery David Sloan

DSW Capstone Projects

This capstone project examines the current state of burnout, prevention strategies, prevalence, and introduces neuroleadership as a new leadership theory to advance burnout prevention among the public human service population. Neuroleadership presents a new conceptualization of leadership practice and burnout prevention method by utilizing neuro-informed leadership practices. This new neuro-informed leadership strategy is explored throughout the three major products of this capstone project including a systematic literature review, conceptual paper, and practice application paper.

The first product completed was a systematic literature review. This literature review included a total of 13 articles which were used to answer the research question, …

Role Of Prior Knowledge In Timing Of Computer-Generated Feedback, Julie Faye Shirah

Theses and Dissertations--Psychology

Although often helpful, feedback sometimes has neutral or negative effects on learning (Hattie & Timperley, 2007; Kluger & DeNisi, 1996). For example, Fyfe and colleagues have found that the effects of feedback timing are moderated by students’ prior knowledge such that feedback has been useful for students with low prior knowledge, but has mixed effects on students with high prior knowledge (e.g., Fyfe et al., 2012; Fyfe, 2016). In this study, I extended Fyfe’s work by re-conceptualizing prior knowledge as knowledge of more familiar foundational concepts a learner brings to a learning task (Sidney & Alibali, 2017), which can be …

The Measurement Of Product Typicality In Design Research. A Basic And Applied Approach, Travis Kent

Theses and Dissertations--Psychology

The objective of this study was to examine the use of the cognitive construct of “typicality” to guide design decisions in the development of consumer products. Increasing products that will appeal to consumers, designers strive to balance novelty and familiarity. A potential way to thread this needle is to understand how “typical” a design is of its particular product category. The construct of typicality has been used by psychologists to understand how people create and represent categories. Objects that are more typical of a category are often associated with positive responses from observes (e.g., greater visual appeal, faster recognition). In …

Self-Monitoring And The Dsm-5 Section Iii Alternative Model Of Personality Disorder, Gillian Mccabe

Theses and Dissertations--Psychology

The Alternative Model of Personality Disorder (AMPD) was introduced in Section III (“Emerging Measures and Models”) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to address many of the challenges inherent to the categorical system of personality disorder diagnosis. According to the AMPD, personality disorders can be identified by the extent to which impairment in personality functioning (i.e., Criterion A) and pathological personality traits (Criterion B) are present. Researchers have divided over the distinction between Criterion A and Criterion B, with one side favoring the current AMPD conceptualization of personality traits and functioning as independent constructs and the …

Otavalan Women Weavers: Rethinking Gendered Labor And Crafts In Ecuador, Kaitlin Marie Zapel

Theses and Dissertations--Anthropology

This research focuses on the gendered labor of craft production and distribution of Otavaleños, an indigenous group in the Imbabura Valley in the Andes Mountains of Ecuador. Otavalans are often described as a society of weavers with strong gender divisions. Households typically function as units of production, with tasks ideally broken down along gender lines. Women are generally depicted as secondary workers who do not weave the textiles that make Otavalans famous; however, they are generally perceived as being responsible for selling these textiles in the market. This research argues that current gendered labor relations in Otavalan textile production can …