Digital Commons Network^™

The Effect Of Mentorship And Social Events On Job Embeddedness And Intent To Stay In Emergency Department Nurses, Kacie L. Albertsen

DNP Projects

Background and Purpose: The COVID-19 pandemic has drastically impacted nurse retention. According to the Kentucky Nurses Association, 57% of surveyed Kentucky nurses are considering leaving their jobs. Best retention strategies are unclear. Job embeddedness (JE) and Intent to stay (ITS) are factors that influence retention. The purpose of this project is to increase JE and ITS at a level one emergency department (ED) by implementing evidence-based mentorship and social event interventions.

Methods: This study utilized a mixed-methods, one group pretest-posttest design. Mentorship pairs were matched by personality type using the Big Five Personality Test. Four mentorship discussion meetings and two …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Depression Management Among Primary Care Providers: Evaluation Of An Educational Intervention, Whitney Hunt

DNP Projects

Background: Nearly one-third of patients diagnosed with depression and prescribed an antidepressant medication will stop taking their medication within the first month. Timely follow-up care can improve medication adherence and symptoms for depressed patients on antidepressants however, most patients do not receive timely follow-up. Common system and provider-based barriers to timely follow-up include limited provider time, lack of training, and mental health stigma.

Objective: The purpose of this project was to assess provider attitudes, knowledge level, perceived barriers, and current depression management strategies in a primary care setting.

Methods: In this quasi-experimental one group pre/post-test study a survey was used …

Staff Perceptions Of Workplace Violence In The Emergency Department; Increasing Safety Awareness And Education, Marissa Hibbs

DNP Projects

Purpose: The purpose of this project was to evaluate nursing staff perceptions of safety and workplace violence and increase safety awareness and knowledge in the emergency department of a level 1 trauma center.

Methods: This study was a single site project that used a descriptive non-experimental survey design to evaluate staff perceptions on workplace violence and safety before and after educational intervention. The study was broken down into three parts. After obtaining IRB approval, an invitation to participate in the pre-survey was distributed via email in a private electronic unit-based list server. Then an educational intervention on workplace safety and …

Patient Characteristics And Telehealth Visits In A Hepatology Clinic, Maria E. Walters

DNP Projects

BACKGROUND: In an attempt to decrease significant no-show rates amongst telehealth patients in a Hepatology outpatient clinic, a clinic-specific intervention was executed, which was efficient in decreasing no-show rates, however could not continue to be financially supported.

PURPOSE: The purpose of this study was to evaluate correlations between demographic data and social determinants of health with patients who showed and did not show for their telehealth appointments, with an overall goal of determining if there is a need for targeted support for telehealth appointments to decrease no-show rates.

METHODS: Electronic health records of telehealth patients were reviewed in an …

Impact Of Physical Activity Vital Sign Screening On Physical Activity Counseling And Referrals In Primary Care, Anna Selepina

DNP Projects

Background/Purpose: Physical Activity Guidelines for Americans recommend 150-300 minutes of moderate-intensity physical activity each week for adults; however, half of the adults do not meet this goal, which leads to increased chronic health conditions and poor health outcomes. The physical activity vital sign (PAVS) screening tool is an evidence-based assessment tool associated with increased physical activity counseling, which can lead to increased physical activity and improved patient outcomes.

Objective: The purpose of this study was to examine the impact of PAVS screening on physical activity counseling and referrals in primary care.

Methods: This prospective study took place in a small …

Evaluating The Effect Of A Brief Mindfulness Intervention Designed To Reduce Compassion Fatigue On Staff Mindfulness, Catherine Siegel

DNP Projects

Background: Compassion fatigue is “stress resulting from exposure to a traumatized individual” and is described as “a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment” (Cocker & Joss, 2016, p. 1). Fifty-two percent of mental health workers are experiencing compassion fatigue (The Mental Health of Healthcare Workers in COVID-19, 2020). Behavioral health units have some of the highest turnover rates across hundreds of hospital systems (2019 NSI National Health Care Retention & RN Staffing Report, 2019). Compassion fatigue has been identified as a risk factor for turnover in nurses and statistics …

Evaluating The Effect Of Electronic Health Record Patient Portal Use On Medication Adherence In Adults With Chronic Conditions, Jennifer Averbeck

DNP Projects

Background Medication non-adherence is prevalent among fifty percent of the United States population. This behavior leads to increased morbidity and mortality as well as increased healthcare costs for both the patient and the healthcare system. More than two-thirds of nonadherence exists in those aged over 65 years old who are diagnosed with Multiple Chronic Conditions (MCC). Several studies have researched and trialed interventions to improve rates of adherence, limit poor health outcomes, and decrease overall cost of care. The patient portal is an interactive tool which encourages participation of the patient in their healthcare management. Implementation of this tool has …

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 …

Evaluating Providers’ Knowledge, Attitudes, And Intentions Toward Utilizing First Post-Discharge Visit Checklist In Primary Care To Reduce Readmissions In Heart Failure Patients, Binu Bashyal

DNP Projects

Background and Significance: Heart failure (HF) affects approximately 6.2 million adults in the United States and 40 million people globally. HF is one of the leading causes of emergency department (ED) visits and hospitalizations in adults. Twenty percent of patients admitted for HF are readmitted within thirty days, and up to fifty percent are readmitted by six months. A First Post-Discharge Visit checklist could help mitigate the problem of readmission.

Purpose: The purpose of this DNP project was to evaluate primary care providers’ knowledge, attitudes, and intentions towards utilizing the First Post-Discharge Visit checklist to reduce hospital readmissions among …

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 …

Evaluation Of Patient And Clinical Staff Perceptions Of Screening For Social Needs In An Underserved Population, Alysha Greenwell

DNP Projects

Abstract

Background. Despite ample strong evidence linking social determinants of health (SDOH) and unmet social needs to higher healthcare costs and worse health outcomes across the lifespan, only 16% of healthcare practices screen their patients for social needs. Various barriers contribute to low screening rates, including uncertainty about best methods for screening, the amount of time it takes to screen, and lack of confidence in knowing what to do once needs have been identified. As movements toward value-based models of care change the healthcare landscape, healthcare systems must find practical and effective methods to effectively screen for social needs utilizing …

Improving Nursing Comfort In Relation To Difficult Conversations, Sarah Clifton

DNP Projects

Abstract

Background/Purpose

Conversations between care providers and patients are integral to medicine and are the most performed “procedure” (Luff et al., 2016). In Pediatric Intensive Care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs), children of all ages with diverse diagnoses and needs are treated for critical illnesses and traumatic events. Therefore, providers frequently have difficult conversations with patients and their families. Pediatric critical care nurses are often invited to participate in these discussions. However, their role during, and after, these conversations is not always clear. The goal of this project was to evaluate the impact of an educational …

Implementation Of A Death Anxiety Screening Protocol Specific To Patients With Advanced Cancer In An Outpatient Palliative Care Setting, Olivia M. Sasdi

DNP Projects

Abstract

Background: Recent studies have shown that upwards of 80% of patients with advanced cancer suffer from death anxiety resulting in increased physical and psychological suffering. Despite death anxiety’s ubiquitous nature and negative impact, the literature regarding this condition consistently indicates that it remains under-identified and undertreated in patients with advanced cancer. The “Death and Dying Distress Scale” (DADDS) is a clinically validated tool used to identify, measure, and guide effective treatment modalities for death anxiety specifically in patients with advanced cancer, but is scarcely used routinely in practice. Incorporating this screening tool to be used regularly could improve identification …

Effectiveness Of A Multimodal Educational Program In Increasing Understanding And Utilization Of Tele-Icu Resources By Critical Care Nurses: A Pilot Study, Olga Vulakh

DNP Projects

Background. Integration of tele-intensive care units (tele-ICUs) into healthcare systems is associated with improved patient outcomes and organizational performance. Inadequate bedside nurses’ knowledge about tele-ICU is associated with poor communication and lack of trust between bedside and tele-ICU teams. These problems might diminish tele-ICU’s ability to maximally impact patient outcomes.

Purpose. The purpose of this project was to create a multimodal educational program with the goal of improving knowledge, attitudes, and skills related to tele-ICU among critical care nurses and to assess the effect of the educational intervention on tele-ICU utilization among bedside nurses as evidenced by the number of …

Relationship Between Number Of Mechanical Ventilation Days Prior To Ecmo Initiation And Outcomes In Covid-19 Patients, Brittany Bergman

DNP Projects

Background: Since the start of the pandemic, there has been over 16,000 COVID-19 positive patients placed on Extracorporeal Membrane Oxygenation (ECMO). Little is known about the effect of long mechanical ventilation prior to ECMO initiation. Purpose: The first purpose of this project is to evaluate whether a longer mechanical ventilator time (ten or more days) prior to ECMO initiation is associated with increased mortality and longer total lengths of time on ECMO in patients with COVID-19, as opposed to being on a ventilator for under ten days prior to being placed on ECMO. The second purpose is to increase provider …

Evaluation Of A Discharge Clinic Implemented For Patients Without A Primary Care Provider Or Access To Their Primary Care Provider, Jessica Sass

DNP Projects

Background: Patients transitioning from an inpatient hospital stay to self-care responsibilities post-discharge are at risk for readmission resulting in increased cost and resource utilization. Care transition programs can result in cost avoidance and decreased resource utilization.

Purpose: The purposes of this project were to: (a) determine if implementation of a Discharge Clinic affected 30-day readmission rates in patients without a primary care provider, (b) ascertain if a visit by a paramedicine program paramedic impacted 30-day readmission rates in patients who missed their Discharge Clinic appointment, and (c) find out whether a second post-discharge phone call influenced 30-day readmission rates.

Method: …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

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 …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Lateral Spacing Of Subsurface Poultry Litter Bands: Effect On Gaseous Nitrogen Emissions, Nutrient Uptake, And Maize Yield, Jason R. Simmons

Theses and Dissertations--Plant and Soil Sciences

Poultry litter (PL) is traditionally applied to no-till maize (Zea mays L.) cropping systems by surface broadcast. Poultry litter is nutrient dense, and it has been repeatedly shown that surface applied PL nitrogen (N) is vulnerable to losses to the atmosphere and nearby water systems. An application method was developed by USDA-Agricultural Research Service scientists for banding poultry litter (PL) below the soil surface with minimal soil disturbance to reduce ammonia (NH₃) volatilization and surface run-off. It is well documented that subsurface applied poultry litter (PL) reduces N losses by ammonia (NH₃) volatilization; however, the …

Management And Characterization Of Root-Knot Nematode (Meloidogyne Spp.) In Kentucky High Tunnels, Victoria Bajek

Theses and Dissertations--Plant and Soil Sciences

Kentucky is one of the most active adopters of high tunnels in the United States. Across the state, high tunnel growers have reaped the benefits of greater marketable yields, season extension, and protection from harsh weather. However, the high tunnel environment has increased soil temperatures and intensive crop production which has the potential to encourage root-knot nematode (RKN; Meloidogyne spp.) infestations. The extent and distribution of RKN in Kentucky were previously unknown. Two on-farm trials in infested high tunnels were conducted to determine whether grafting with RKN-resistant tomato rootstock is a viable management strategy. A statewide soil census to determine …

Molecular Analysis Of Epigenetic Memory Of Stress Establishment And Long-Term Maintenance In A Perennial Woody Plant, Jia Wen Tan

Theses and Dissertations--Plant and Soil Sciences

Plants adapt to extreme environmental conditions through physiological adaptations, which are usually transient. Recent research has suggested that environmental conditions can activate a memory of stress that can result in a primed response to subsequent stress events. While the effect of priming has been observed in many plants, the underlying mechanisms are puzzling and seldom studied. A large body of research has been developed in the last decade linking response to stress, stress priming, and memory of stress with epigenetic mechanisms. This understanding of plant epigenetics has opened the door to the application of epigenetics to crop improvement, such as …

Language Matters: Evaluating How Linguistic And Visual Differences In Financial Documents Impact Financial Reporting In Hospitals, Alicia Irwin

Theses and Dissertations--Accountancy

Hospital financial assistance policies (FAPs) should inform uninsured and under-insured patients about options available to assist with their medical expenses. However, language and visual rhetoric variations in these documents may deter otherwise qualified patients from applying to programs meant to relieve their financial obligations. This project explores how visual rhetoric and linguistic differences such as tone and readability, in financial assistance policy documents may influence community benefit reporting in hospitals as a consequence of patient engagement in the application process.

Visual rhetoric and design, as well as linguistic style variation can have a profound impact on program utilization and financial …

Social Ties Across Audit Offices And Audit Quality, Wenyin Li

Theses and Dissertations--Accountancy

This dissertation explores the audit consequences of social ties across audit offices. Although recent studies have demonstrated the importance of auditors’ social ties in auditor performance, little is known about the role of social ties across audit offices in facilitating knowledge sharing within audit firms and their impact on audit quality. To fill this gap, this study employs the Facebook Social Connectedness Index to capture social ties across audit offices within the same audit firm. Drawing upon the organizational learning literature and social network literature, I predict and find that audit office-level social ties improve audit quality. In addition, the …

Development Of Polymeric Sorbents As Reusable Filtration Systems For Remediation Of Pfas Contaminated Water, E. Molly Frazar

Theses and Dissertations--Chemical and Materials Engineering

Decades of use of per- and polyfluoroalkyl substances (PFAS) in a multitude of consumer and industry-based products have led to a devastating amount of soil and water contamination. Although these chemicals and compounds possess advantageous qualities – such as that of PFAS in the role of fire-fighting foams that have no doubt saved countless lives and homes, we must take responsibility for the anthropogenic hazards that threaten our global health. This entails being able to cost-effectively remediate problems created in the past from overuse of toxic substances that could negatively impact our future, and in this case, the future of …

Developing And Modeling Tunable Nanofiltration And Functionalized Membranes For The Separation Of Organics And Inorganics From Water: Per- And Polyfluoroalkyl Substances, Lanthanides, And More, Francisco Cecil Leniz-Pizarro

Theses and Dissertations--Chemical and Materials Engineering

In a world where clean water predictability is challenged by both global warming and the contamination of our natural resources, it is our responsibility to advance water separation technologies into more efficient processes and to lessen their environmental footprint. Pore and surface functionalization of membranes can enhance the separation of ions from water and even help overcome intrinsic challenges that some current separation technologies possess. If we begin with a complete fundamental understanding of the nanoscale interactions that occur in the process of separating ions from water, then we can engineer new functionalized composite membranes to provide alternative processes keeping …

Leveraging Cell-Substrate Adhesion And Cell Migratory Properties In Skeletal Muscle Constructs And Cancer Metastasis Assays, Lauren E. Mehanna

Theses and Dissertations--Chemical and Materials Engineering

Volumetric muscle loss (VML) remains one of the few skeletal muscle injuries without a reliable and repeatable treatment. In large volume muscle injuries, muscle fibers as well as the surrounding connective tissue are damaged, preventing therapeutic muscle stem cells, called myogenic progenitor cells (MPCs), from reaching the injury site and initiating repair. There is a clinical need to rapidly fabricate in vitro muscle tissue constructs that mimic the native tissue organization, with aligned myotubes, for insertion and integration at the patient’s injury site. In this dissertation, we utilize the MPC’s natural propensity to close gaps across an injury site to …

Secondary Traumatic Stress Is An Occupational Hazard For Pet Hospice Support Staff: Psychoeducational Support Groups Provide The Cure, Kari Hayden

DSW Capstone Projects

There are three separate yet interrelated products presented in this final capstone product. The completed product is focused on pet hospice veterinary support staff and the need for an evidence-based social work intervention to combat secondary traumatic stress. This capstone uses the andragogical approach to adult learning theory as the foundation to construct a psychoeducational peer support group specific to this population. Implications for clinical social work in veterinary medicine are presented within this project.

The first scholarly product presented is the Systematic Literature Review (SLR). The SLR utilizes a scoping review process in an attempt to locate prior research …