Evaluation Of The Effectiveness Of Emergency Department Through-Put Based On Provider Type In A Critical Access Hospital, Deanna Faye Dingus Hamilton

DNP Projects

Abstract

Purpose: To evaluate effectiveness and timeliness of through-put in the emergency department based on provider type in a rural critical access hospital in eastern Kentucky.

Design: A retrospective, observational review was conducted at a small critical access hospital. Descriptive statistics including Mann Whitney and Chi square were performed to evaluate significance.

Methods: Pre-intervention 552 charts were abstracted and 1656 post-intervention charts were abstracted. Arrival time to triage, triage to provider and provider to disposition times in minutes were collected. A prospective survey regarding comfort level with performing advanced practice skills was given to the advanced providers who were working …

Promotion Of Most Forms Through Education About Importance Of Advance Care Planning In Seriously Ill Patients, Nidhi More

DNP Projects

Abstract

Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population.

Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria …

Improving Multidisciplinary Adherence To A Daily Goals Checklist In The Icu: A Quality Improvement Initiative, Chelsea Mccarty

DNP Projects

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve …

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

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 …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

The Impact Of A Change In Leadership, Taylor Collins

DNP Projects

Abstract

Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after …

Evaluation Of A Spontaneous Breathing Trial Extubation Protocol On Patient Outcomes, Joshua Caldwell

DNP Projects

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between …

Sustainability Of A Dnp Qi Project On Bmi Screening And Weight Management Documentation In Primary Care, Assal Moori Shir Mohammadi

DNP Projects

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited.

Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of …

Evaluating The Effect Of An Electronic Health Record Patient Portal On The Management Of Hypertension, Ashley Hall

DNP Projects

Background: Hypertension is the leading cause of cardiovascular disease and affects individuals globally, nationally, and locally. Consequences of uncontrolled hypertension include atherosclerosis, heart failure, stroke, and renal disease. The electronic health portal is a patient-specific, interactive tool that has been shown to promote adherence to provider recommendations and improve chronic disease management.

Purpose: The purpose of this project was to determine the effects of education via an electronic healthcare portal on the blood pressure management of adults at a primary care clinic in a small town in Kentucky.

Methods: This study was a one-group pre/post intervention designed to evaluate provider …

Positive Reflective Journaling As A Tool For Managing Stress And Promoting A Healthy Work Environment In Nursing Academia, Roxanne Gall

DNP Projects

Abstract

Background: Teaching and nursing are consistently cited as the two occupations that work under the highest levels of occupational stress. Positive Reflective Journaling may be a tool that helps to manage stress and influence a healthy work environment in academic nursing settings.

Purpose: The purpose of this study was to investigate whether Positive Reflective Journaling could be used as an adjunct to reduce stress and support a healthy working environment in

nursing academia.

Methodology: Eighty-six faculty and staff from a University based School of Nursing were invited to participate in the study. A positive reflective journaling exercise was evaluated …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Evaluating The Sustainability Of A Colorectal Cancer Screening Improvement Intervention, Kimberly Bastin

DNP Projects

Background: Sustainability is a domain or characteristic of quality in healthcare that is not just about what may be delivered to patients today, but what can continue to be delivered to patients in the long term. Evidenced based interventions and quality improvement (QI) initiatives have led to major advancements in health care and have become expected in every clinical setting. Despite the amount of QI work taking place, there is limited evaluation of the sustainability of initially successful quality improvement efforts and a lack of evidence supporting best strategies and measures to ensure that improvement of goals and outcomes are …

The Effect Of Multimethodological Emotional Intelligence Training On Emotional Intelligence Levels In Nurses At An Academic Medical Center, Chad Eldridge

DNP Projects

Background: Stress levels associated with the nursing career can be amplified by hostile social environments in the workplace, horizontal aggression, lack of leadership support, and poor communication. This can lead to poor retention rates and increased burnout.

Conversely, supportive work environments positively influence nursing sensitive quality indicators such as patient satisfaction, nosocomial infections, patient falls, pressure ulcers, and medication errors. Strong relationships enhance workplace social capital leading to an increased sense of belonging, strengthened mental health, and improved job satisfaction ratings.

Executive nurse leaders can promote an empowering environment dedicated to the physical, mental, and social well-being of their staff …

Improving Tobacco Cessation Counseling Documentation In The Primary Care Setting, Brittany Roher

DNP Projects

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation …

Incorporation Of Summer Annual Mixtures Into Grazing Systems In Kentucky, Kelly Marie Mercier

Theses and Dissertations--Plant and Soil Sciences

Utilizing summer annual grass-legume forage mixtures has the potential to improve forage yield and nutritive characteristics, and/or animal performance during times when cool-season pasture growth is limited by high temperatures. Legumes can utilize atmospheric nitrogen, which can increase crude protein and forage digestibility in mixtures. As nitrogen application generally improves both the yield and nutritive characteristics of summer annual forages, but can have a negative effect on legume competitiveness, nitrogen fertilizer recommendations for legume-containing summer annual mixtures are not well established.

Two experiments were conducted to determine the feasibility of utilizing summer annual mixtures in Kentucky, USA. The first experiment …

Investigation Of Multidrug Efflux Transporter Acrb In Escherichia Coli: Assembly, Degradation And Dynamics, Prasangi Irosha Rajapaksha

Theses and Dissertations--Chemistry

The Resistant Nodulation Division (RND) super family member, tripartite AcrA-AcrB-TolC efflux pump, is a major contributor in conferring multidrug-resistance in Escherichia coli. The structure of the pump complex, and drug translocation by functional rotation mechanism have been widely studied. Despite of all these data, the dynamics of the assembly process of the pump and AcrB during functional rotation in the process of drug efflux remains poorly understood. My thesis focuses on understanding the pump assembly process, dynamics of AcrB in functional rotation mechanism, and also investigate the mechanism of degradation of AcrB facilitated by a C-terminal ssrA tag.

In the …

Probing The Assembly, Functional Relevance, And Dynamics Of Acra In Multi Drug Efflux In Escherichia Coli, Isoiza Ojo

Theses and Dissertations--Chemistry

Efflux pumps and low permeability of the outer membrane of gram-negative bacteria are major culprits in drug resistance. The most studied of these multidrug efflux pumps is the AcrAB-TolC, a complex of three proteins, the inner membrane transporter AcrB, the periplasmic adaptor AcrA and outer membrane factor TolC. This pump exports a wide range of molecules such as dyes, detergents, and antibiotics out of the bacteria system into the external environment. AcrB and TolC exist as obligate trimers, but the structure of AcrA during the assembly process is not well defined. My research aims to explore the functional and structural …

Physiological Stress Responding During Negative Memory Recollection And The Habitual Use Of Psychological Coping Strategies, Kyle P. Rawn

Theses and Dissertations--Psychology

Coping represents an important process for stress: how effectively one copes dictates how a person experiences stress. However, research has not yet examined how a person’s long-term coping habits are related to their physiological stress responding during a particular situation. The current study addresses this through examination of skin conductance level (SCL) trajectories and coping tendencies (i.e. habitual use of coping strategies) during an autobiographical interview. 167 college students completed questionnaires assessing their demographics and their frequency of use for fourteen coping strategies. SCL was collected while participants recalled and discussed a negative family memory from their childhood. Multilevel modeling …

Religious Beliefs And Behaviors As Predictors Of Substance Use In First-Year College Students: A Longitudinal Study, Hannah B. Mcgee

Theses and Dissertations--Psychology

Substance use is prevalent on college campuses (e.g., Douglas et al., 1997) and can create significant negative consequences (Kodjo & Klein, 2002; NIAAA, 2006). Research suggests that religious beliefs and religious behaviors interact to predict risky substance use in first-year undergraduate students, such that students with religious beliefs but no corresponding behaviors are at risk for significant alcohol use and related problems (Brechting et al., 2010; Cole et al., 2020). However, these studies have only been cross-sectional in nature.

The current study assessed longitudinally if the interaction of religious beliefs/behaviors influenced first-year undergraduate student substance use across the early adjustment …

The Role Of Alexithymia And Affective Lability In Disordered Eating Behaviors, Anna Marie Lilia Ortiz

Theses and Dissertations--Psychology

Affective distress may influence eating disorder behaviors in multiple ways. Affective lability refers to the tendency to experience frequent and striking fluctuations in mood. There is considerable evidence that it predicts eating disorder symptoms. Further, alexithymia is characterized by difficulties identifying and describing feelings and an externally oriented thinking style. Alexithymia has also been implicated in the development and maintenance of eating disorders. To date, these risk factors have been studied separately. Given the evidence that both alexithymia and affective lability are affective components associated with eating disordered behaviors, it may be important to examine possible relationships among alexithymia, affective …

A Test Of The “Teachable Moment” Heuristic’S Relevance For Understanding Cancer Survivors’ Health Behavior Motivation And Performance: A Cross-Sectional Study, Gabriella Puleo

Theses and Dissertations--Psychology

Cancer diagnosis has potential to motivate health behavior changes to promote better health outcomes. The Teachable Moment Heuristic is a parsimonious, transtheoretical framework for understanding the conditions under which behavior change might occur, with constructs that include affective, cognitive, and social factors. This exploratory study aimed to measure the three primary constructs of the Teachable Moment, evaluate the extent to which they are associated with cancer survivors’ motivation to adopt favorable health behaviors, and explore their potential as a model for health behavior performance. Participants (n = 93) in this cross-sectional study were adult breast, prostate, colorectal, lung, and …

Parent School Involvement, Student School Engagement, And Academic Achievement In Children Adopted From Foster Care By Lesbian And Gay Parents, Cassandra P. Vazquez

Theses and Dissertations--Psychology

Sparse research has examined academic outcomes of children adopted from foster care by lesbian and gay (LG) parents. Children who have experienced foster care are at greater risk for negative outcomes, but investment in academic achievement could help buffer potential adversity. Parent and student engagement with school peaks in middle childhood, so this may be an important period for understanding processes that influence academic achievement. This study explores how LG parents (N = 57) of school-aged children (Mage = 10.56 years) adopted from foster care in the U.S. involve themselves in their child’s school, how this involvement may …

Impact Of Ptsd On Hcv/Hiv Risk-Reduction Interventions Among Incarcerated Drug-Using Women In Rural Appalachia, Caitlyn Hood

Theses and Dissertations--Psychology

Justice-involved women in rural Appalachian Kentucky are a particularly vulnerable group in need of targeted risk-reduction interventions for hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Compared to women in the general U.S. population, justice-involved women in rural Appalachia report dramatically higher rates of HCV/HIV risk behaviors (e.g., injection drug use and risky sex), interpersonal violence (IV; e.g., physical, sexual, or emotional abuse), and posttraumatic stress disorder (PTSD). IV and PTSD may exacerbate rural Appalachian women’s risk for contracting and transmitting HIV/HCV, indicating a need to approach HCV/HIV risk-reduction interventions from a trauma-informed perspective.

Brief motivational interviewing and psychoeducation …

Producing Possibilities: Envisioning And Mediating Youth, Identities, And Futures In Central Appalachia, Tammy Lynn Clemons

Theses and Dissertations--Anthropology

This dissertation, based on anthropological research between 2015 and 2020, focuses on young people in different yet interconnected social contexts in Central Appalachia and how they envision, construct, and act upon possibilities for themselves and the region through multimodal cultural production processes like visual art, performance, and multisensory media. The research question focusing this project was: How do the social contexts of young Appalachians’ engagement in media consumption and production practices shape the possibilities they envision for themselves, others, and their region? I found that the specific contexts were less important than the interconnected mentoring conversations across sites and generations …

"Roses Remind Me Of Aleppo": Ironic Home, Beckoning States, And Memories Of Syrian Armenian Women In Yerevan, Armenia, Anahid Matossian

Theses and Dissertations--Anthropology

This project contributes to anthropologies of the state, (diasporic return) migration, belonging, home, and conflict, including genocide and war. It intervenes in the anthropology of home by focusing on both the social and physical aspects of home, its pain, joys, and ironies, and it speaks to the anthropology of genocide by showing how a population a century removed from a genocide uses it to interpret their experience. This dissertation also deals with state constructions of ideal citizen formation--one of obligation and devotion to the socially constructed ancestral homeland, where descendants who share an ethnic identity have a role to play …

Woman To Woman: Community And Belonging Among Lesbian And Queer Feminist Activists In Haifa, Israel, Lauren Copeland

Theses and Dissertations--Gender and Women's Studies

This dissertation focuses on experiences of belonging among lesbian and queer feminist activist women in the women-only organization Isha L’Isha. As the oldest feminist organization in Israel, Isha L’Isha was established in 1983 and has roots dating back to the 1970s. I spent one year (2017-2018) engaging in participant observation and conducting 40 interviews with current and former members of the group. Using Isha L’Isha as a lens through which to examine the multilayered ways in which gendered activism shapes experiences of belonging, this project centers the experiences and narratives of four women: Talma, Sophie, Amira, and Maya.

This work …

"My Gender Is Lesbian": Community Building And The Endurance Of The Lesbian In Queer Times, Adriana Sisko

Theses and Dissertations--Gender and Women's Studies

During 2016, the same year news of lesbian bar closures hit mainstream media, a small cluster of Tumblr users began to discuss a new gender and sexual identity, nonbinary lesbian, to describe those who identify both as nonbinary and as lesbian. Nonbinary lesbians stand at the crossroads of modern and postmodern identity constructs, engaging in contradictions and ambiguities for the sake of authentic self-expression. What does this demonstrate about the evolution of lesbian identity, particularly as lesbian bars continue to close around the United States? This dissertation explores this question by comparing and contrasting the discursive practices and strategies of …

Beyond Choice: An Intersectional Analysis Of Identity And Labor In Online Sex Work, Shawna F. Felkins

Theses and Dissertations--Gender and Women's Studies

This intersectional project seeks to understand the complex labor, social lives, and community building of online sex workers. Building on the work of foundational sex work researchers, this project utilizes in-depth interviews, a survey, social media posts, and published writing and research from online sex workers to understand how marginalization and identity impacts participation and success in online sex work. Providing analysis on how race, gender, class, and ability intersect in the digital sexual marketplace, this project critiques the rise of neoliberal feminism in sex work spaces that stems from the centering of white and otherwise privileged sex workers using …