Digital Commons Network^™

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. …

Post Evaluation Of A Nurse Driven Early Mobility Program, Paula Halcomb

DNP Projects

The goal of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). The purpose of this study was to evaluate the effectiveness of a recently implemented nurse driven early mobility program (NDEMP) on patients in two Trauma Surgical Intensive Care Units at the University of Kentucky HealthCare (UKHC). Nursing staff are responsible for mobilizing patients to their maximum ability twice daily in addition to any therapy provided by Physical and Occupational Therapists. The study was an uncontrolled …

Evaluating Utilization Of An Early Mobility Protocol In An Adult Icu In The Veterans Administration System, Julie Duffy

DNP Projects

Purpose: To evaluate ICU staff’s adherence to a new progressive mobility protocol as part of a quality improvement project in an adult medical-surgical intensive care unit (ICU).

Background: Bedrest can lead to complications for hospitalized patients and current literature supports that mobility within the ICU is safe and feasible for critically ill patients. Current evidence based literature identifies barriers to patient mobilization which can be addressed through implementation of a mobility protocol. Utilization of mobility protocols is one way to improve quality of care and prevent common bedrest complications in the critically ill patient population.

Methods: Retrospective medical record reviews …

Comparison Of Pain Management Modalities In The Development Of Postoperative Respiratory Failure, Amanda Carney

DNP Projects

BACKGROUND: This paper outlines the steps taken for a quality improvement study that investigated the development of postoperative respiratory failure (PORF) at University of Kentucky Chandler Medical Center (UKCMC). The first paper describes the influence of an interprofessional education (IPE) pilot program on doctoral nursing students and the experiences gained while working on a process improvement project. The second paper is a literature review on predictors for PORF. The third paper is a case control study that investigated the effects of pain management modalities on the development of PORF.

OBJECTIVES: To outline the process for developing a practice improvement project. …

Evaluation Of The Healthy-Heart, Healthy-Brain Program, Sooksai Kaewbua

DNP Projects

Purpose: The purpose of this study was to evaluate the effects of a group-based, psychoeducational program on the knowledge of healthy diet and eating behaviors of adults with mental-health diagnoses in an inpatient psychiatric setting.

Background and Significance: In a given year, adults with mental-health diagnoses have a higher risk of mortality relative to the general population. Mortality from natural causes among individuals with mental-health disorders is similar to the leading causes of death found nationwide, including cardiovascular diseases. There is a growing body of evidence showing a relationship between the health of clients’ hearts and brains. Thus, it is …

A Gap Analysis On Vaccine Administration For Average And High-Risk Adults, Whitney Pack Metcalfe

DNP Projects

Background: Nationally adult immunization rates continue to fall below the current benchmark goals. It is estimated adult vaccinations range from 20 to 60 percent, depending on the vaccine. There are different vaccine schedules for those of average-risk compared to those with high-risk conditions. Providers are being encouraged to explore their administration of vaccines as preventable, communicable diseases continue to be seen. Objectives: In a primary care clinic, a gap analysis was conducted to: 1.) Determine adult immunization rates, 2.) Compare vaccine administration rates of the Tdap, PCV13, PPSV23, and influenza vaccines between average and high-risk adults, 3.) Determine if specific …

The Association Between High Flow Nasal Cannula Therapy And Intubation In Acute Respiratory Failure Patients, A Single Center Retrospective Analysis, Patrick Nolan

DNP Projects

Background: High flow nasal cannula therapy is becoming a more common therapy in the adult population. Multiple studies have been conducted on the potential benefits of this therapy such as increased patient tolerance of the therapy, improved secretion clearance and the ability for providers to deliver a greater range of FiO2 settings at a wider range of flow rates. With the increasing utility of this therapy, the research for best practices, setting (FiO2 and LPM) and duration of therapy to guide clinicians is lacking.

Aim: 1) Does high flow nasal cannula therapy reduce the need for intubation or re-intubation in …

Evaluation Of Oral Nutritional Supplement Use In Elderly Patients Admitted With Heart Failure, Geri L. Sipe

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effects of enhanced ordering privileges among registered dieticians (RD) on oral nutritional supplement (ONS) ordering frequency and prevalence of oral nutritional supplement use among elderly patients admitted with heart failure (HF).

METHODS: This study was a single facility, retrospective pre-post implementation evaluation of the impact of expanded ONS ordering privileges among elderly patients (age ≥ 65 years old) hospitalized with heart failure at Frankfort Regional Medical Center (FRMC). The sample consisted of 105 patients for the pre-evaluation period and 259 for the post-evaluation period.

RESULTS: There were …

Assessing Provider And Staff Knowledge Of Health Literacy And Satisfaction With A Health Literacy Assessment Tool In A Primary Care Practice, Whitney J. Lynn

DNP Projects

PURPOSE: The purpose of this quality improvement project was to assess provider and staff knowledge about health literacy. Specifically, the knowledge of health literacy and perceived importance, current usage, and benefits of the use of a health literacy assessment tool at a primary care clinic was evaluated pre-intervention. The perceived importance of health literacy as well as satisfaction with, frequency of use, and recommendation of the chosen health literacy assessment tool for future use was evaluated post-intervention.

METHODS: This project used surveys pre- and post-intervention at an urban primary care clinic in the southeastern United States from January to March …

An Evaluation Of Provider Adherence To Adult Sinusitis Quality Measures And Guideline, Caitlin A. Davidson

DNP Projects

Purpose

The purpose of this project is to evaluate adherence to Physician Quality Reporting System (PQRS) Measures #331 (delaying antibiotic treatment until at least seven days of symptoms) and #332 (prescribing amoxicillin or amoxicillin/clavulanate) on adult sinusitis treatment. Data was collected from patient encounters at the University of Kentucky College of Nursing Community Health Center (UKCONCHC) in Wilmore, Kentucky. To adhere to these quality measures would foster antibiotic stewardship. Further statistical analysis was completed to determine if gender or age bias was present in prescribing practices.

Methods

A retrospective chart audit was conducted to determine adherence to the quality measures. …

Safe Prescribing Of Combined Hormonal Contraceptives Using The U.S. Medical Eligibility Criteria For Contraceptive Use Guideline, Morgan E. Thomas

DNP Projects

Safe prescribing of combined hormonal contraceptives is important to prevent unplanned pregnancies and adverse effects including thrombotic events. Combined hormonal contraceptives can be taken safely but this relies on appropriate prescribing techniques by the healthcare provider. Prior to prescribing any type of contraception, health care providers should perform a risk assessment to anticipate and prevent patient complications. The Centers for Disease Control and Prevention created the United States Medical Eligibility Criteria (U.S. MEC) for contraceptive use guideline to help direct healthcare providers to assess patient risk factors, prescribe the safest form of contraception, and provide necessary teaching and follow-up. This …

Efficacy Of The Adherence To An Evidence-Based Early Mobilization Protocol On Patient Outcomes Post Thoracic Surgery, Blair Eberhardt

DNP Projects

Background: Immobilization is a commonly observed problem for adults in the intensive care unit (ICU) that may lead to ICU delirium, ICU associated weakness, increased length of hospital stay, and increased mortality¹⁷. Therefore, early mobilization has become an increasingly imperative priority regarding the treatment plan for patients in the ICU. Mobilization is often delayed or completed on a subjective provider basis due to scarcity of resources and outdated evidence-based knowledge⁷. This examination of adherence to an evidence-based protocol helps to assess efficiency of therapeutic outcomes regarding early ambulation of surgical thoracic patients in the critical care …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

Improving Screening For Alcohol Use Amongst Women In Primary Care, Sarah K. Bell

DNP Projects

Purpose: The purposes of this practice inquiry project were to examine the effect of the addition of a standardized screening tool (AUDIT-C) within the ambulatory electronic health record (AEHR) and the effect of an education session with primary care providers on documentation of alcohol screening and counseling within the AEHR. Furthermore, provider confidence with Screening, Brief Intervention, and Referral to Treatment (SBIRT) was compared before and after the educational session.

Methods: A quasi-experimental one-group pretest posttest design was utilized via chart review prior to and following the educational intervention for patients seen for an annual wellness exam. Data extracted included …

Implementing & Evaluating A Nurse-Led Educational Intervention For Bone Marrow Transplant Patients In The Acute Care Setting, Tia T. Wheatley

DNP Projects

Objective: The Bone Marrow Transplant (BMT) Basics Class is a nurse-led educational program dedicated to preparing patients and their caregivers of the treatment outline and self-care behaviors associated with receiving a BMT. The purpose of this project is to evaluate the effectiveness of this intervention in order to support the needs of the BMT patient and promote patient-centered care.

Study Design: Retrospective review to evaluate a quality improvement project.

Participants & Methods: As of July 2016, the BMT Basics Class became a standard of care at an NCI-designated academic cancer center in the southeastern United States. Between July 20, 2016 …

A Secondary Analysis Of Survey Data Evaluating The Lifelines Suicide Prevention Program Among Middle School Students, Nicki Sullivan

DNP Projects

PURPOSE: The purpose of this study was to evaluate student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School. Student feedback was examined by assessing students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and impressions of the educational presentation following participation in the Lifelines Suicide Prevention Program.

METHODS: In this secondary analysis, anonymous student responses (N=269) from a 2015 middle school survey were examined by using a mixed method design with the quantitative study measures being …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

The Use Of Magnets As Patient Appointment Reminders And Hpv Vaccination Rates, Hayden Kelley

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a patient reminder alert system implemented at a public health department in rural Indiana in an attempt to increase the facility’s human papillomavirus (HPV) vaccination rates.

METHODS: This study was a secondary data analysis utilizing the Children and Hoosiers Immunization Registry Program (CHIRP) database to compare HPV vaccination rates before and after the implementation of an HPV magnet reminder program. The sample consisted of 122 adolescents; 31 patients for the pre-implementation period, July 1, 2015- June 30, 2016 and 91patients for the post-implementation period, July 1, 2016- Jan …

Evaluation Outcomes Of Delirium And Abrupt Discontinuation Of Psychiatric Medications Of The Adult Acute Care Patient, Latoya Lee

DNP Projects

PURPOSE: Delirium remains a common consequence of critical illness and is known to cause negative patient outcomes during an intensive care unit (ICU) stay. Hence, the purpose of this project is to evaluate the outcomes of patients taking psychiatric medications whose medications are abruptly discontinued upon admission to an ICU. Specifically, the outcomes of interest will be altered mental status, length of hospital stay, restraint use and mortality.

METHODS: A correlational analysis using a retrospective chart audit was conducted on 602 patients admitted to the Neurological/ Neurosurgical ICUs at the University of Kentucky Chandler Hospital from January 2015 to December …

Reducing Preoperative Anxiety In Adolescents Facing Spinal Fusion Surgery, Anna Gayle Parke

DNP Projects

Reducing preoperative anxiety for adolescents facing spinal fusion surgery for the treatment of scoliosis has significant implications for clinical practice and patient outcomes for this specific population. The reality of a pending surgery creates a difficult, uncomfortable, and exhausting state of being that can lead to increased postoperative pain, sleep disturbances, and maladaptive behaviors. This final capstone project inquiry report presents three manuscripts which focus on the reduction of preoperative anxiety in adolescents facing spinal fusion surgery. The first manuscript is a literature review examining current evidence related to preoperative anxiety, adolescents undergoing spinal fusion surgery, and teaching programs aimed …

Adult Acute Sinusitis Antimicrobial Stewardship Program In A Primary Care Setting, Katelyn M. Hellman

DNP Projects

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS.

PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic …

Family Rounds In The Medical Intensive Care Unit: An Intervention To Enhance Communication, Travis R. Klein

DNP Projects

Background: In the Intensive Care Unit (ICU) family member satisfaction is an important element of quality patient care. Families of ICU patients value communication with care providers and involvement in their relative’s care.

Objectives:

1. To determine if scheduled family rounds each day can improve the satisfaction and feelings of support with decision-making for family members of ICU patients?

2. Evaluate any associations between patient characteristics (hospital length of stay, ICU length of stay, and ventilator days) and family satisfaction?

Methods: This pilot project was conducted in a 12-bed medical ICU led by advanced practice nurses (APRN-MICU). Using the family …

Assessment Of Horizontal Violence And Healthy Work Environments Of Two Nursing Units, Rebekah Dailey

DNP Projects

PURPOSE: Horizontal Violence plagues the health of nursing work environments. In order to diminish this phenomenon and establish healthy work environments as established by the AACN, assessments must be completed to identify strengths and weaknesses and determine the proper interventions to employ. However, there is a lack of evidence in actionable interventions. The purpose of this project was to assess healthy work environments of two nursing units by examining horizontal violence, civility, teamwork, and satisfaction, and identify interventions to strengthen the health of the work environment.

METHODS: This study was a descriptive study using an electronic survey of two nursing …

Don’T Pull The Plug On Bioethics Mediation: The Use Of Mediation In Health Care Settings And End Of Life Situations, Amy Moorkamp

Journal of Dispute Resolution

A hefty decision, such as the life or death of a loved one, requires more than a few minutes of deliberation and a handful of outside consultations. Delicate, emotional, and potentially contentious medical decisions compel a structured, compassionate approach to produce quality and well-informed results. Due to the magnitude of the decision being made, as well as the abundance of other considerations, (emotional, religious, historic, financial, etc.) the case for a creative, problem-solving process of dispute resolution, such as mediation, is ripe.

This Comment will explore the use of mediation in bioethical disputes. In Part II, the Comment will give …

The Effects Of Coping Styles And Perceived Stress On Clinical Outcomes In Individuals With Moderate To Severe Brain Injury In A Post-Acute Rehabilitation Program, Leslie Perez

PCOM Psychology Dissertations

The present study investigated the effects of different coping styles used by individuals with moderate to severe brain injury on their clinical outcomes. Specifically, using self-report measures, this study evaluated the use of task-oriented, avoidance, and emotion-oriented coping and how these different styles influenced patients’ perceived stress and depression levels. In addition, task-oriented coping style has previously been deemed as a more adaptive way of dealing with life challenges. Hence, through a retrospective examination of archival records, this study also evaluated patients’ adjustment (i.e., observed mood lability and social contact), participation (i.e., observed ability to initiate tasks, interact with others, …

Increasing Renewable Oil Content And Utility, William Richard Serson

Theses and Dissertations--Plant and Soil Sciences

Since the dawn of agriculture man has been genetically modifying crop plants to increase yield, quality and utility. In addition to selective breeding and hybridization we can utilize mutant populations and biotechnology to have greater control over crop plant modification than ever before. Increasing the production of plant oils such as soybean oil as a renewable resource for food and fuel is valuable. Successful breeding for higher oil levels in soybean, however, usually results in reduced protein, a second valuable seed component. We show that by manipulating a highly active acyl-CoA: diacylglycerol acyltransferase (DGAT) the hydrocarbon flux to oil in …