Digital Commons Network^™

Enhancing Tray Integrity: A Quality Improvement Project To Reduce Central Sterile Processing Defects, Ashley Conn

DNP Projects

Background: Instrument tray defects contribute to surgical delays, workflow disruptions, rework in sterile processing, inefficient instrument utilization, and patient safety risks.

Purpose: The purpose of this quality improvement project was to reduce orthopedic instrument tray defects through targeted education and standardized tray audits with double-check verification in a large academic medical center.

Methods: A quasi-experimental pre-post design was utilized to evaluate the impact of the intervention. Tray errors were captured using a standardized binary indicator. Staff satisfaction and confidence surveys were measured using Likert-scale surveys.

Results: Orthopedic trays were analyzed before (n=1,017) and after (n=941) implementation. Post-implementation, tray errors decreased …

Riddle Me Resilient: Investigating The Impact Of Riddle Based Class Openings On Student Resilience And Well-Being, Carolyn T. Brown

DNP Projects

Abstract

Background: Burnout among nurses and nursing students is a widespread and well‑documented problem that adversely affects professional performance and psychological well‑being. Resilience serves as a key protective factor, helping buffer the effects of academic stress and reducing burnout over time. Incorporating brief, low‑stakes cognitive challenges—such as a riddle—can help foster resilience.

Purpose: This project evaluated the impact of incorporating riddles into a wellness-focused course, Introduction to Mindfulness and Wellness, on resilience and well-being among undergraduate nursing students.

Methods: This project employed an Institutional Review Board approved pre-post survey design to measure the effect of an intervention focused on …

Evaluating The Implementation And Use Of A Standardized Screening Process To Increase Flu Vaccine Uptake In A Rural Health Primary Care Clinic, Mackenzie L. Pierce

DNP Projects

Background: Research has shown that an annual influenza vaccine is the most effective way to both prevent and reduce the risk of hospitalization and severe health complications of the flu. A yearly influenza vaccination is recommended for everyone age 6 moths and older.

Local Problem: Rural communities have lower rates of influenza vaccination which can be due in part to a lack of screening and education on vaccines and their importance. No process for influenza vaccine status screening existed at the project site prior to this project.

Methods: A quality-improvement project was conducted to evaluate the implementation of a standardized …

Unintentional Medication Discrepancies In Outpatient Cardiac Procedures: Identifying Modifiable Barriers, Julie M. Turner

DNP Projects

Background: Medication reconciliation (MR) reduces medication errors during care transitions; however, unintentional medication discrepancies (UMDs) remain common due to variable practices and lack of standardization. Patients undergoing elective cardiac procedures are particularly vulnerable given complex medication regimens.

Purpose: This quality improvement project evaluated implementation of a Medication Reconciliation Barrier Identification Checklist (MRBIC) in the cardiac catheterization laboratory to identify patient, staff, and system-level contributors to UMDs.

Methods: A quasi-experimental pre–post design was conducted at a large academic medical center. During a six-week intervention, nurses and providers completed the MRBIC during pre-procedure MR. Barrier scores were compared with …

Advancing Rural Health Equity Through Systematic Sdoh Screening- A Quality Improvement Initiative, Laura C. Combs

DNP Projects

Background: Social determinants of health (SDoH) significantly affect health outcomes and healthcare utilization, particularly in rural communities. In 2024, the Centers for Medicare & Medicaid Services mandated SDoH screenings in the inpatient setting, with recommendation to implement in rural clinics without specifying a standardized tool, resulting in inconsistent identification of needs, e.g., food insecurity, housing instability, mental health concerns, financial strain, and transportation barriers.

Purpose: This quality improvement initiative implemented a standardized SDoH screening tool in a rural outpatient clinic to evaluate changes in referral rates to community-based resources pre- and post-implementation and to improve patient reporting of social needs. …

Building Confidence And Team Communication: Implementation Of A Rapid Response In Situ Simulation Program In The Neonatal Intensive Care Unit, Janell F. Hacker

DNP Projects

Background: Neonatal code events are high-risk, low-frequency occurrences in the neonatal intensive care unit (NICU). Simulation-based training is used to support skill development, maintain competencies, and enhance team performance.

Purpose: The purpose was to determine if a multidisciplinary, high-fidelity, rapid response in situ simulation program would impact confidence and communication among frontline healthcare providers during neonatal code events.

Methods: A quasi-experimental, pretest-posttest study was conducted in a 90-bed Level IV NICU. A multidisciplinary, high-fidelity in situ rapid response simulation program was implemented over a 3-month period for frontline NICU healthcare providers. Pre- and post-surveys assessed perceptions of role clarity, …

Improving Compliance With Preoperative Antibiotic Protocols For Cardiac Implanted Electronic Devices: A Quality Improvement Project, James Kaup

DNP Projects

Abstract

Background

Cardiac implantable electronic device infections remain a serious complication of permanent pacemaker implantation despite evidence-based infection prevention guidelines.

Local Problem

An academic electrophysiology laboratory identified inconsistent guideline-concordant antibiotic selection despite consistently high compliance with recommended antibiotic timing.

Methods

A nurse-led, quasi-experimental pre-post quality improvement project evaluated implementation of a standardized preoperative antibiotic prophylaxis protocol. Data from 36 permanent pacemaker implantations (16 pre-intervention, 20 postintervention) were analyzed.

Interventions

The intervention included a standardized antibiotic protocol, multidisciplinary staff education, and performance feedback.

Results

Guideline-concordant antibiotic selection improved from 37.5% to 95.0% (χ² = 11.27, P = .001). Antibiotic timing remained …

Effects Of Student And School Technology Adoption On Student Reading Achievement In The United States: The Case Of Pisa 2018, Mikah J. Hughes

Theses and Dissertations--Educational, School, and Counseling Psychology

This study examined the relationship between student and school-level information and communication technology (ICT) factors and reading achievement using data from the Programme for International Student Assessment (PISA) 2018 in the United States. In an increasingly digital world, reading and information literacy are essential skills, yet significant gaps in digital competencies persist. This study investigated how ICT access, use, and perceptions relate to reading achievement in the context of student and school background factors.

A two-level hierarchical linear modeling (HLM) framework was employed to account for the nested structure of students within schools. The sample included approximately 4,000 students across …

Characterization And Antimicrobial Activity Of Lignin-Derived Compounds In Ground Hurd Tissue Of Cannabis Sativa L. (Hemp) Cultivars, Jourdan E. Lakes, Anjam Sadik, Robert C. Pearce, Barbara L. Knutson, Stephen E. Rankin, Bert C. Lynn, Michael D. Flythe

Chemistry Faculty Publications

Objectives: Characterize lignin-derived compounds from the hurd of 10 fiber/grain Cannabis sativa L. cultivars and investigate the antimicrobial activity of select compounds on the wasteful ruminant bacterium, Acetoanaerobium sticklandii SR.   Methods: Hurd was processed using an aqueous ethanol solvent system and analyzed via GC-MS to identify and characterize lignin derivatives. Antimicrobial activity of the hurd and three monomers was assessed using solid (hurd) and liquid medium (monomers) bioassays against SR.   Results: 27 compounds were identified, most as monomers but a few were dimers, ethylated derivatives, and organic acids. There were approximately equal G- and S-units with substantially fewer H-units. Several …

Analytical Commentary And Performer's Guide To Carlos R. Martinez's Four Pieces For Trombone, Bailey Jean Hardy-Price

Theses and Dissertations--Music

Musicians with hearing loss are documented in prominent figures, such as Ludwig van Beethoven. In the age of developing medical technology, hearing aids can turn the course for many musicians. Music can serve as an audio medium for this journey.

Carlos R. Martinez (b. 1978) is an active composer and pianist commissioned to create a piece that explores the journey of hearing loss in a musician. Martinez’s Four Pieces for Trombone and Piano illustrate a musician’s discovery of their hearing loss, its consequences, and joy in implementing the use of a hearing aid. The detailed discussion of the composer and …

Investigation Of Succinylated Zwitterionic Polyethylenimine/Dna Complexes: Performance In Serum, Internalization, And Intracellular Fate, Levi Lampe

Theses and Dissertations--Chemical and Materials Engineering

Gene therapy has promised to revolutionize medicine since the earliest clinical trials, but a lack of delivery methods that are both safe and efficient has hampered progress. Gene therapy with viral vectors is effective at delivering nucleic acids to cells, but is associated with dangerous immunogenic responses and cancer-causing insertions into the genome. Viral vectors are also among the most prohibitively costly therapeutics in medicine. Polymeric vectors avoid these dangers and are made from inexpensive, off-the- shelf materials, but have been hindered by poor efficiency compared to viral vectors.

A benchmark polymer for in vitro nucleic acid delivery has been …

Scrolling, Searching, And Self-Diagnosing: Examining How Social Media Influences Self- Diagnosis And Shapes Mental Health Literacy, Conceptualization, And Identity Development, Sara Elaine Hamilton

DSW Capstone Projects

This capstone examines the influence of social media on the growing issue of self-diagnosis of mental health disorders through three scholarly works: a systematic literature review (SLR), a conceptual paper, and practice application paper. Accessibility, anonymity, and social isolation are identified as contributing factors of self-diagnosis, as individuals increasingly prioritize convenience over traditional help-seeking methods. Research suggests that self-diagnosis is influenced by misinformation and reinforced by validation and a sense of belonging, leading individuals to internalize mental health disorders as part of their identity. Findings further indicate that social media plays a significant role in the dissemination of misinformation about …

Effect Of Substrate Dispersion Method And Particle Size On In Vitro Digestibility, Gas Production Kinetics And Composition, And Fermentation Characteristics In Different Feed Types, Luiz C. O. Sousa, Ellem M. A. Matos, Ronald J. Trotta, Edenio Detmann, David L. Harmon

Animal and Food Sciences Faculty Publications

Our objective was to evaluate the influence of substrate dispersion method and particle size on in vitro digestibility, gas production kinetics and composition, and fermentation characteristics of different feed types. Alfalfa hay, tall fescue hay, ground corn, soybean meal, and a total mixed ration (TMR) were used as substrates. Treatments were designed according to a 2 × 2 × 5 factorial arrangement: two substrate dispersion methods (loose substrate and in filter bags), two particle sizes (1 mm and 2 mm), and five feeds. Filter bags decreased (P ≤ 0.001) digestibility and gas production compared with loose samples. Filter bags decreased …

Menstrual Cycle Phase Effects On Alcohol-Impaired Driving Performance And Risk Awareness, Annie K. Griffith

Theses and Dissertations--Psychology

Growing evidence indicates that risky behavior among women is elevated during the late follicular phase of the menstrual cycle, likely due to increased estradiol levels. Furthermore, alcohol-induced impairment of women’s inhibitory control is significantly greater during the late versus early follicular phase. Consequently, cycle phase may influence outcomes of poor inhibitory control while intoxicated, such as alcohol-impaired driving. Alcohol-impaired driving risk manifests in two ways: risk-taking while driving, and risk awareness regarding the decision to drive. This dissertation tested the hypothesis that alcohol-induced increases in driver risk-taking and decreases in risk awareness would be exacerbated during the late versus early …

The Relationship Between Estradiol And Progesterone Concentration Levels, Alcohol Consumption, And Inhibitory Control, Layne Elizabeth Robinson B.S.

Theses and Dissertations--Psychology

Alcohol use is increasing among women, with estimates for binge drinking having risen to levels similar to those seen in men. Despite this trend, sex differences regarding mechanisms of alcohol consumption have seldom been investigated. Our group and others have found evidence to suggest that ovarian sex hormones are associated with alcohol consumption and mechanisms that might be related to alcohol consumption, such as executive function deficits. The current study sought to extend this prior research in a larger sample with higher drinking rates and more rigorous methods, and to explore inhibitory control associations with drinking. Across the two samples …

Patient Perspectives Of Psychotherapy Duration And Treatment Outcomes, Doug Terrill

Theses and Dissertations--Psychology

The duration of psychotherapeutic treatment is a longstanding and clinically consequential question in psychotherapy research. Premature dropout from therapy is common, indicating some patients do not receive adequate benefit. On the other hand, some patients remain in treatment beyond the point at which they receive significant benefit, which may delay care for those on patient waitlists. Researchers have proposed two contemporary models of the relation between treatment duration and symptom improvement; 1) the dose-effect (DE) model, which posits that patients improve at similar rates following a negatively accelerated symptom curve, suggesting treatment should end when sessions no longer provide significant …

Numerical Modeling Of Multi-Scale Jet Feedback In Seyfert Galaxies, Julianne Goddard

Theses and Dissertations--Physics and Astronomy

We present a suite of high-resolution cosmological zoom-in simulations investigating the impact of mechanical and thermal feedback from low-luminosity jets launched from supermassive black holes (SMBHs) on Seyfert galaxy evolution from early cosmic times to the present (z ≤ 10). Our models follow the formation of central galaxies within identical dark matter halos of logMhalo/M⊙ ∼ 11.8 at z = 0, seeded with ∼ 10^6M⊙ SMBHs at z ∼ 9.1 and z ∼ 3.7. Feedback from active galactic nuclei (AGN) is implemented in the form of bipolar jets launched along the SMBH spin axis, with jet powers spanning Ljet ∼ …

“Being Treated As The Expert:” A Blueprint For A Community Advisory Board Approach To Elevate The Voice Of People With Living Experience With Substance Use In Academic Research, Trevor Moffitt, Survivors Union Of The Bluegrass, Bryson Henson, April M. Young, Sharon L. Walsh, Rachel Vickers-Smith, Junior Cruz, Jeremy Byard, Brook West, Amanda Fallin-Bennett

Nursing Faculty Publications

Introduction: Researchers have traditionally engaged Community Advisory Boards (CABs) to meaningfully involve community members in the research process. However, CABs are often formed only after a grant is funded, leading to criticisms of functioning merely as “ethical approvers.” For substance use researchers, the inclusion of people with living experience (PWLE; current experience with drug use) across all stages of research is especially important as they have historically been the experts in the needs of their community.   Methods: In response to this need for community engagement in research, the University of Kentucky, in partnership with a local recovery community center (RCC; …

Coalition Building And Citizen Science For Radon Risk Reduction, Stacy Stanifer, Kathy Rademacher, Whitney Sedio, Naomi Cheek, David Gross, Caitlyn Curtis, Amanda Thaxton-Wiggins, Mary Kay Rayens, Ellen J. Hahn

Nursing Faculty Publications

We evaluated the implementation of local coalitions led in partnership with citizen scientists, community-based organizations, and public libraries in four rural communities to lower exposure to radon in the home. The objectives were to (1) describe the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) of four radon coalitions, and (2) compare RE-AIM factors among citizen scientists who participated in the coalitions and those who did not. A larger community-engaged research project embedded coalition building using a citizen science approach. Three of the four coalitions focused on health and wellness more broadly (18–34 members); one focused solely on radon (10 members). Coalition membership and activities varied …

The Impossible Motherhood: Education Accompanying Mothers (Peidu Mama) And Transnational Migration In China’S Global Era, Jingxue Zhang Dr.

Theses and Dissertations--Gender and Women's Studies

This dissertation examines transnational educational relocation as a gendered project of future making through the figure of Chinese educational accompanying mothers, or peidu mama, in Chiang Mai, Thailand, and the Greater Los Angeles area in the United States. It investigates how educational migration is organized through the intersection of affective governance, moralized motherhood, and unequal global conditions. It seeks to answer how transnational educational motherhood is represented in state-endorsed media and public discourse; how women narrate and justify educational relocation while negotiating the morally unstable label of peidu mama; how aspiration, risk, and the idea of “a better …

Regulating Galaxy Growth: Ionized Gas Conditions, Star Formation Histories, And Environmental Effects, Shweta Jain

University of Kentucky Doctoral Dissertations

Understanding galaxy formation and evolution requires tracing how baryons cycle between stars, gas, and the interstellar medium (ISM) across cosmic time. The efficiency of star formation, the buildup of metals, and the regulation of gas inflows and outflows are governed by evolving physical conditions within galaxies and their environments. My thesis investigates how the ionized ISM, star formation histories, and environmental processes have shaped galaxy evolution over the past ∼ 12 Gyr. The primary focus of this work is the evolution of the physical conditions of ionized gas in galaxies, including gas-phase metallicity and ionization state. Using new and archival …

Phonics And Friends: A Critical Multimodal Discourse Analysis Of Popular Teacher Influencers' Content, Zachary T. Milford

University of Kentucky Doctoral Dissertations

This critical multimodal discourse analysis examined how five teacher-influencers aligned with the Science of Reading (SoR) movement performed authority, constructed discourses, and used affective and semiotic resources in viral TikTok videos about reading instruction. Drawing on Kress and van Leeuwen's (2001) multimodal social semiotics, Fairclough's (1992) critical discourse analysis, Foucault's (1977, 1982) theorizations of power, Papacharissi's (2014) theory of affective publics, Ong's (1982) secondary orality, and Taussig's (1993) mimesis and alterity, this interpretive, qualitative, multiple-case study analyzed fifty viral TikTok videos and four semi-structured interviews with teacher-influencers. Data were analyzed through within-case and within-mode coding, cross-modal analysis, and cross-case analysis …

Multiscale Modeling Of The Thermomechanical Behavior Of Polymeric And Molecular Organic Semiconductors, Kehinde H. Fagbohungbe

University of Kentucky Doctoral Dissertations

Organic semiconductors, derived from π-conjugated polymers and molecules, enable the development of deformable, stretchable and flexible electronics due to their tunable redox, optical, electronic and mechanical properties. However, an informed understanding of how multi-scale morphological characteristics of the polymeric and molecular semiconductors influence bulk properties that contribute to electronic and optical performance, especially under operational thermal and mechanical stresses, remains incomplete. This lack of understanding poses a challenge to scalability and commercialization of organic electronics. This dissertation develops and deploys computational modeling approaches, particularly atomistic molecular dynamics (MD) simulations, to investigate the multiscale morphological behavior of these synthetic semiconducting materials …

Technology-Facilitated Violence And Abuse: Portrayals And Perceptions, Christina S. Walker

University of Kentucky Doctoral Dissertations

In the past, intimate partner violence (IPV) was primarily perpetrated in person. However, due to new mediated communication technologies and capabilities like social media and artificial intelligence (AI), perpetrators can use this technology for various purposes including subjecting others to violence, harassment, and abuse. Such violence can be a form of IPV and is referred to as technology-facilitated violence and abuse (TFVA). TFVA is becoming increasingly prevalent and is encountered by a staggering percent of women. Furthermore, unlike traditional forms of IPV, even men are subjected to TFVA at increasing and disproportionate rates, particularly male teens.

In the current state …

The Power Of A Picture: Building Visual Depictions Of The Eppm Bolstering Sunscreen Application Motivation, Ansley M. George

University of Kentucky Doctoral Dissertations

This study investigates visual depictions of efficacy skin cancer health risk messages. Using Witte's Extended Parallel Processing Model (EPPM) and existing literature on fear appeals and visual persuasion as a theoretical framework, the study aims to explore how self and response efficacy imagery impacts individuals' perceptions of health risk messages in the context of skin cancer prevention when emphasizing specific principles of design. Formative research was employed via qualitative photo sorts and participants were exposed to an assortment of images depicting efficacy in the context of skin cancer prevention where they discussed why they felt they were or were not …

Adolescent Relationships With Digital Actors And Their Influence In A Classroom Setting: An Interpretive Case Study, Kerry A. Hancock

Theses and Dissertations--Curriculum and Instruction

In this post-COVID-19 society students are strongly influenced by their use of digital text and electronic devices. The assumption of the study was that if students spend time with devices and digital text that it might be possible for them to develop relationships with the non-human actors that exist as part of the learning environments in schools. This  interpretive case study rooted, in Posthumanist ideology, used Latour’s Actor Network Theory to approach data collection.

A comparative approach was adopted for this interpretive case study research and data were collected in three stages: initial classroom observation and analysis to determine the …

Industry To Classroom: The Role Of Academic Program Consultants In Building Self-Efficacy Among Occupation-Based Career And Technical Education Teachers, Erica L. Settelen

Theses and Dissertations--Educational Leadership Studies

Occupation-based career and technical education (CTE) teachers bring industry expertise to secondary classrooms but often begin teaching without traditional pedagogical preparation or familiarity with public school systems. In Kentucky’s New Teacher Institute (NTI), academic program consultants (APCs) provide program-area support to strengthen induction. Using the framework of self-efficacy and guided by Ivankova’s mixed methods action research (MMAR) framework, this study examined how occupation-based CTE teachers perceived APC engagement during induction and how APC-created asynchronous supports were experienced.

In the Reconnaissance Phase, a sequential Quantitative → Qualitative design included an initial survey followed by interviews. Survey results indicated midrange familiarity with …

Recruitment Messaging, Authenticity, And Representation: A Mixed Methods Action Research Study In A Public School System, Chavis A. Sims

Theses and Dissertations--Educational Leadership Studies

This study employed a Mixed Methods Action Research (MMAR) design to examine recruitment communication within a public school system facing persistent underrepresentation of minority educators.  Recruitment prototypes were developed in collaboration with district leadership and evaluated in a formative pilot involving 15 educators who provided Likert-scale ratings and written feedback on clarity, cultural relevance, persuasiveness, and engagement.  Quantitative findings indicated that messaging emphasizing professional purpose and pathways into teaching was perceived as clear and engaging.  In contrast, cultural relevance consistently received the lowest ratings across prototypes.  Qualitative responses revealed that reliance on non-local and AI-generated imagery weakened perceived authenticity and …

Perceptions Of Sport Psychology Efforts And Access In Women's Wheelchair Basketball, Lindsay C. Cohen

Theses and Dissertations--Kinesiology and Health Promotion

As the field of sport psychology grows, services and training programs must evolve to properly serve the evolution of athletes seeking care. This could mean discovering new measures, testing different types of interventions, or developing programs that can better accommodate specific populations that are looking for sport psychology services. One such population is para athletes, and although they have expressed interest in learning more about the field of sport psychology and how to implement mental skills efficiently, athletes have reported a lack of access to sport psychology services and sport psychology consultants (SPCs) (Dieffenbach et al., 2009). The purpose of …

Unveiling The Shadows: An Exploratory Study On Ghostwriting, Gray Markets, And The Ethics Of Contract Cheating, Micah Crawford

Theses and Dissertations--Educational Policy Studies and Evaluation

Contract cheating has become an increasingly complex challenge for higher education, particularly as digital platforms, global academic labor markets, and generative artificial intelligence reshape the production and detection of academic work. While much of the existing literature examines contract cheating from the perspectives of students, faculty, and institutions, less attention has been given to the individuals who produce ghostwritten academic work. This dissertation addresses that gap by exploring how shadow scholars understand their roles, ethical boundaries, and participation within the academic integrity ecosystem.

Using an exploratory qualitative design, this study draws on twelve semi-structured narrative interviews with six freelance academic …