Digital Commons Network^™

“Letting Kids Be Kids”: Youth Voice And Activism To Reform Foster Care And Promote “Normalcy”, Bernard P. Perlmutter

Books and Book Chapters

In this chapter, I examine stories that foster care youth tell to legislatures, courts, policymakers, and the public to influence policy decisions. The stories told by these children are analogized to victim truth testimony, analyzed as a therapeutic, procedural, and developmental process, and examined as a catalyst for systemic accountability and change. Youth stories take different forms and appear in different media: testimony in legislatures, courts, research surveys or studies; opinion editorials and interviews in newspapers or blog posts; digital stories on YouTube; and artistic expression. Lawyers often serve as conduits for youth storytelling, translating their clients’ stories to the …

Self-Compassion : What Meaning And Role Does It Play In The Lives Of Women Who Experience Anxiety And Depression In The Perinatal Period, Cindy Cranswick

Theses

With one in five Australian women suffering from perinatal anxiety and depression, there is a constant need for a greater understanding of the lived experience of motherhood. This research investigated the role and meaning of self-compassion in the lives of women in the perinatal period who experience anxiety, depression and psychological distress. There is a growing body of evidence to support findings that self-compassion is an important source of emotional and psychological well-being, but little evidence on the potential role it plays in the lives of women in the perinatal period. A qualitative approach was chosen to undertake this research …

Mobile Learning In Early Childhood Education: A School-University Partnership Model, Serena Davie

Theses

Mobile learning (mLearning) devices are ideal for 21st century learning. mLearning devices are light and, therefore, mobile so that young children can use them anywhere. Examples of mLearning devices are tablet computers, programmable robots such as Bee-Bots and robotic Lego. The term 21st century learning is used around the world and includes the skills of collaboration, communication, new literacy, creativity, critical thinking, and problem-solving. New literacy has emerged because of new technologies and being literate in the 21st century now includes being digitally literate. However, mLearning is not widely used in early childhood education despite the fact that schools are …

Examining The Role Of Emotional Intelligence In The Work And Life Balance Of Foster Care Workers, Pamela Applewhite Applewhite

Walden Dissertations and Doctoral Studies

Foster care workers are an important part of the social service system, as they are the first line of support for children without families or who have been subjected to tragic events leading to their need for foster care. Foster care workers often experience work-life boundary issues due to the emotional nature of their work. The purpose of this quantitative study was to examine the relationship between (a) emotional intelligence and absenteeism and (b) emotional intelligence and work-life balance with foster care workers. Data was collected from foster care workers in the state of South Carolina employed with the Department …

Recidivism Rates Among Juveniles With Mental Illness, Kia Chevon Russell

Walden Dissertations and Doctoral Studies

Treating mental illness is imperative to help reduce criminal justice involvement within the juvenile population. Receiving mental health care will help decrease the likelihood for youth to reoffend, ultimately reducing recidivism rates. Past studies showed there are risk factors associated with juveniles and recidivism; however, very few studies have examined what factors are prevalent after services have been received. The purpose of this study was to identify factors that increase the risk of recidivism among juveniles who have received psychiatric stabilization in Harris County, Texas. Risk factors that were assessed included age, gender, ethnicity, and criminal offense. The psychodynamic perspective …

Methods , Systems , And Devices Relating To Robotic Surgical Devices , End Effectors , And Controllers, Shane M. Farritor, Thomas Frederick, Joe Bartels, Eric Markvicka, Jack Mondry

Department of Mechanical and Materials Engineering: Faculty Publications

The various embodiments disclosed herein relate to improved robotic surgical systems, including robotic surgical devices having improved arm components and/or bio metric sensors, contact detection systems for robotic surgical devices, gross positioning systems and devices for use in robotic surgical systems, and improved external controllers and consoles.

A Legal Study On The Internal Control System For Direction Of Legislation In Korea, Sungbum Kwon

Maurer Theses and Dissertations

The concept of internal control began in accounting professional groups, gradually expanded to the administrative control and the risk management from accounting control, and became an important area that cannot be excluded from the operation of the public companies in the U.S.

When the Enron scandal struck the credibility of the stock market in the U.S. in 2001, the authorities implemented reformative measures including the SOX enactment to protect investors. Although there has been a controversy over this legislation since the enactment of the SOX, it appears that the U.S. capital market has been restoring confidence with the efforts of …

Birds Of A Feather: Patterns Of Judicial Decision-Making At The International Court Of Justice, 1946-2015, Kai-Chih Chang

Maurer Theses and Dissertations

The technical legal expertise of the International Court of Justice (ICJ), the principal judicial organ of the United Nations, is rarely questioned. However, from its inception critics have questioned its partiality by drawing attention to apparent extrajudicial influences on its decisions. While there has been no lack of research assessing the ICJ judges’ voting behavior, methodological limitations of prior research designs have stymied empirical assessments of the extent and nature of extrajudicial factors’ influence over the ICJ judges’ voting behaviors. This dissertation challenges previous research concluding that political and military alignments have no effect on judicial decision-making. In contrast to …

Evaluation Of Depression Screening Practices In Comorbid Patients In The Primary Care Setting, Kristyn L. Clark

DNP Projects

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% …

Evaluation Of Screening Practices For Alcohol Use In Primary Care, Tiffany Centers

DNP Projects

Purpose: The purpose of this practice inquiry project was to examine current screening practices for alcohol misuse within a primary care clinic. The United States Preventive Services Task Force (USPSTF) guidelines state that alcohol misuse screening should be performed on adults aged 18 years or older using one of three standardized screening tools: Alcohol Use Disorders Identification Test (AUDIT), the abbreviated AUDIT-Consumption (AUDIT-C), or a single-question screening. If indicated, providers should provide a brief intervention and/or referral to treatment through the process known as SBIRT (screening, brief intervention, referral to treatment).

Methods: A retrospective chart review was conducted …

The Effect Of Trauma-Informed Care Training On The Knowledge And Awareness Of Medical Professionals At Kentucky Children’S Hospital, Laura Broughton

DNP Projects

Background: Many children who present to the hospital require treatments and procedures in their medical care that can be potentially emotionally traumatic for themselves and their families. Medical professionals caring for these children may also experience emotional trauma symptoms related to their work. A trauma-informed care approach to medical care may help to lessen these negative consequences in both patients and medical professionals. Purpose: The objective of this study was to assess the effectiveness of a one-hour training on trauma-informed care to nurses at Kentucky Children’s Hospital. Methods: Nurses participated in a one-hour interactive seminar and completed pre- and post-measures …

A Process Improvement Project To Increase Diabetic Retinopathy Screening Rates As Evidenced By Formal Documentation, Michelle Renae Campbell

DNP Projects

Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …

The Effect Of Transition Readiness Interventions On Adolescents With Diabetes When Transitioning From Pediatric To Adult Clinic, Kimberly Walker

DNP Projects

PURPOSE: The purpose of this study was to initiate a transition readiness program which uses motivational interviewing at the Pediatric Endocrinology Clinic located within the UK HealthCare Kentucky Clinic. An evaluation of this program was conducted by assessing participant outcomes related to readiness for transitioning.

METHODS: This study was a quasi-experimental one group pretest posttest design to assess the effectiveness of transition readiness interventions on adolescent readiness and confidence in transition of care at the Pediatric Endocrinology Clinic located at the Kentucky Clinic. The sample consisted of 14 patients.

RESULTS: No statistical significance was found in the TRAQ tool and …

Implementing A Patient Hand-Hygiene Protocol To Decrease Clostridium Difficile Infections In The Acute Care Setting, Lydia S. Mendez

DNP Projects

PURPOSE: The purpose of this study was to develop and implement a patient hand hygiene protocol (PHHP) to improve patient outcomes, specifically to decrease the rates of clostridium difficile infections (CDI) at Norton Hospital (NH) and Norton Audubon Hospital (NAH) in Louisville, Kentucky.

METHODS: This was a multi-center, quasi-experimental study that implemented a PHHP on three units at two hospitals in the Norton Healthcare system. The sample consisted of 159 patients in the pre-intervention period and 18 patients in the intervention period. A retrospective records review was performed to analyze specific demographic variables.

RESULTS: No differences in age and gender …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

The Impact Of Nursing Staff Adherence With Chlorhexidine Gluconate Bathing On Intensive Care Unit Patient Outcomes, Tara M. Jones

DNP Projects

Purpose: The purpose of this study is to evaluate nursing staff adherence to a chlorhexidine gluconate (CHG) bathing protocol in the intensive care unit at Norton Brownsboro Hospital.

Methods: This study utilized a single-site, quasi-experimental, retrospective electronic medical record review format. The sample consisted of 200 patient records post CHG bathing protocol initiation from the Norton Brownsboro Hospital Intensive Care Unit during the period of March, 2015 to May, 2017.

Results: The sample was divided into adherent and non-adherent groups. No significant differences in age, sex, race, ICU length of stay (LOS), BMI, or mortality scores, presence of indwelling medical …

Effect Of A Parent Empowerment Program On Length Of Stay And Parental Stress In The Neonatal Intensive Care Unit, Holly L. Nieves

DNP Projects

PURPOSE: Research surrounding topics in the Neonatal Intensive Care Unit have long been focused on mortality and morbidity of this population. However, consideration of the parent-infant relationship and subsequently adverse outcomes that could be formed during the intensive care stay should be examined. Parent empowerment programs in the NICU have been shown to decrease length of stay, parental stress, and depression. The purpose of this study was to evaluate the impact of the COPE for HOPE parent empowerment program on length of stay, parental stress, maternal depression, and parent satisfaction in the Neonatal Intensive Care Unit with parents of infants …

Perceptions About Cognitive Enhancement Therapy Among Regional Mental Health Providers: A Mixed Methods Analysis, Adam A. Loose

DNP Projects

Cognitive Enhancement Therapy (CET) is a program, developed at the University of Pittsburgh, to improve cognitive deficits experienced by people diagnosed with schizophrenia. Since its implementation in various settings, CET has demonstrated positive outcomes for patients in many cognitive domains. This study took a mixed methods approach to assess the interest and knowledge of mental health providers at a regional level and a local mental health facility in particular, about beginning a CET program. The quantitative study obtained data from evaluations administered during two CET training events at a local mental health facility. Digitally recorded qualitative interviews were conducted with …

Assessing The Impact Timing Of Chemotherapy Education Has On A Patient's Ability To Self-Manage Common Side Effects, Deanna Anderson

DNP Projects

Purpose

A new diagnosis of cancer will often cause an individual to feel overwhelmed, confused and anxious (Kessels, 2003). Many patients often experience anxiety not only related to their cancer diagnosis but also in regards to the plausible side effects of chemotherapy (Greene, Nail, Fieler, Dudgeon, & Jones, 1994; Williams & Schreier, 2004). The purpose of this paper is to evaluate the association between timing of education provided to newly diagnosed patients undergoing chemotherapy for breast cancer and number of self-manageable triage calls to the oncologist’s office

Methods

A retrospective study design was conducted on newly diagnosed breast cancer patients …

A Retrospective Chart Review On The Effects Of Cam On Pain And/Or Anxiety In The Oncology And Bone Marrow Transplant Population, Cherry Nelson

DNP Projects

PURPOSE: The purpose of this study was to promote integrative medicine by evaluating the efficacy of Complementary Alternative Medicines (CAM) on pain and/or anxiety reduction in the oncology and bone marrow transplant population. The four modalities of CAM were massage, Jin Shin Jyutsu (JSJ), aromatherapy and narrative medicine.

METHODS: The design was a single center retrospective chart review, focusing on medications for pain and anxiety, self-reported pain levels, self-reported anxiety levels, chronicity of pain and acuity of pain prior to and after the CAM modality/s implementation.

RESULTS: Due to the lack of electronic documentation of massage, aromatherapy and narrative medicine, …

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

Evaluation Of A Primary Care Based Diabetes Education Program, Claire Pfister

DNP Projects

The improved management of diabetes is a critical clinical and economic challenge facing our healthcare system. Educating patients with diabetes to self-manage their disease is a vital component of diabetes care. The purpose of this DNP practice improvement project was to evaluate an innovative health care delivery method of individualized diabetes self-management education (DSME) in primary care. The approach combined individual DSME with a registered dietician and routine diabetes care with the primary care provider into one patient appointment. System data was reviewed to compare referral and attendance patterns of group and individual methods. Changes in clinical indicators of A1C, …

Exploring Barriers To Primary Care In The Lgbt Community, Desiree R. Price

DNP Projects

Purpose: The specific aim of this study was to identify the LGBT patient’s perspective of what factors could contribute to a more responsive primary care environment.

Methods: The study was a non-experimental, descriptive study utilizing an anonymous, internet based electronic survey. A survey/questionnaire tool, developed for the study, was disseminated among a social media site and a listserv for two organizations with strong connections to the LGBT community.

Results: Eighty-one responses were received. Participants: 60% identified as female, 95% were Caucasian, with 84% never having a Pap smear, and only 6.6% having recommended breast cancer screenings. The incidence of …

Evaluation Of An Enhanced Recovery After Surgery (Eras) Pathway In Two Hospitals, Jennifer A. Janes

DNP Projects

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Implementation Of A Screening Tool Protocol To Identify Patients With Unmet Palliative Care Needs And Improve Access To Palliative Care In The Icu, Katie Roach

DNP Projects

PURPOSE: The purpose of this study is to evaluate the use of a screening protocol for identifying patients with unmet palliative care needs, and improve access to these services in the intensive care units at Norton Hospital.

METHODS: This study was a single-site retrospective report of the impact of a palliative care screening protocol on palliative care use and quality metrics that correlated to access to palliative care services in the intensive care units at Norton Hospital. The sample consisted of 135 medical records of patients admitted during the study period, which spanned the timeframe between January 1, 2017 and …

Getting The Most Out Of Pediatric Screenings, Carly R. Oliver

DNP Projects

Purpose: The purpose of this study was to compare the results of the Ages and Stages Questionnaire to the Survey of Well-Being of Young Children to determine if they produced the same outcomes. The Survey of Well-Being of Young Children offers additional screening tools that address risk factors for child abuse, that the Ages and Stages does not include. This project also surveyed the caregivers completing the questionnaires to determine which questionnaire they found more beneficial.

Background and Significance: In the United States, approximately 15% of children ages 3 to 17 years of age have at least one developmental disability. …