Factors Associated With Covid-19 Vaccine Hesitancy In South Central Appalachia, Florence M. Weierbach, Rebecca Adkins Fletcher, Ingrid E. Luffman, Cynthia Meyer, Janet M. Keener, Manik Ahuja, Hadii M. Mamudu

Journal of Appalachian Health

Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall …

Hospital Adhering To The Ten Steps To Successful Breastfeeding Predicts Exclusive Breastfeeding In Latinx Mothers., Ana Linares, Diana Cartagena, Marialda Moreira Christoffel

Nursing Faculty Publications

Introduction: Assessing how well a hospital adheres to the Ten Steps to Successful Breastfeeding is the key to outlining necessary modifications in mother breastfeeding support. This study aimed to assess Latinx mothers’ perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding and its influence on exclusive breastfeeding (EBF) rates at hospital discharge.

Methods: Secondary analysis of two longitudinal studies. The combined sample (N = 74) of Latinx pregnant women residing in the US. We modified, translated, and evaluated reliability of the Questionnaire for the Breastfeeding Mother (QBFM), which was applied to evaluate mothers’ …

Effectiveness Of Individualized Counseling On The Duration Of Exclusive Breastfeeding: Study Protocol For A Multicenter, Randomized, Parallel, And Open Clinical Trial., Mariana Torreglosa Ruiz, Elisa Da Conceição Rodrigues, Karine Emanuelle Peixoto Oliveira Da Silva, Cynthya Viana De Resende, Michele Curcino Cavalcanti, Luciano Marques Dos Santos, Monika Wernet, Ana Letícia Monteiro Gomes, Marialda Moreira Christoffel, Maria Beatriz Guimarães Raponi, Jéssica Aparecida Da Silva, Jacqueline Faria De Oliveira, Divanice Contim, Ana Linares

Nursing Faculty Publications

BACKGROUND: Despite the benefits of breastfeeding, early weaning is a reality, so less than 50% of children worldwide and in Brazil are on exclusive breastfeeding in the sixth month of life. A strategy to counteract this scenario is breastfeeding counseling. This study aims to verify the effectiveness of individualized counseling by nurses trained in breastfeeding counseling, on the duration of exclusive breastfeeding, compared to standard care.

METHODS: Multicenter, randomized, parallel, and open clinical trial, with primiparous women aged over 18 years, hospitalized in rooming-in wards at participating centers and hemodynamically stable, aware, and oriented, who had a single-fetus pregnancy and …

Review Of Storytelling In Queer Appalachia: Imagining The Unspeakable Other, Sandra L. Cotton Dnp, Rn, Anp-Bc, Fnap, Laurie A. Theeke Phd, James Messer

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of residents of Appalachia. Improving the health in the region of Appalachia means knowing our people as they live and thrive in communities. The book reviewed here, Storytelling in Queer Appalachia: Imagining the Unspeakable Other (Edited by Glasby, Gradin, and Ryerson), is a must read for people who wish to gain insight on the real experience of being queer in Appalachia.

Advocating For Comprehensive Sex Education In Kentucky, Kylie Higgins

Lewis Honors College Thesis Collection

Legislation surrounding sexual education, comprehensive sexual education in particular, has always been a point of controversy. Recently however, this controversy has been brought to the forefront of political debates and media coverage. With sexual education, and the repercussions of a lack thereof, being such a timely issue, this thesis project will explore the current written literature to create an evidence-based presentation to educate future nurses on the issue and their role in promoting the implementation of comprehensive education in schools and providing it in the clinical setting. Comprehensive sex education is medically accurate, age appropriate, evidence based, and LGBTQIA+ inclusive, …

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, …

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 …

Implementing An Educational Intervention Aimed At Nursing Staff To Improve Patient Hand Hygiene, Bonita Moore

DNP Projects

Abstract

Background/Purpose: Healthcare organizations are responsible for ensuring that healthcare workers adhere to effective hand hygiene (HH) protocols, and ample research exists on the best methods for monitoring and encouraging compliance. Despite the importance of HH for infection prevention, there has been little focus on patient hand hygiene (PHH). The purpose of this pilot project was to focus on improving nursing staff’s knowledge and attitudes about PHH with the expectation of showing a correlation between these factors and an increase in the performance PHH.

Methods: The project used a quasi-experimental study that took place on one hospital unit at …

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 …

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 …

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: …

Impact Of A Parent Education Program On Parents Of Children With Complex Congenital Heart Disease Prior To Discharge Home, Laura Elkhoury

DNP Projects

Abstract

Background and Purpose: Children with complex medical needs, such as children with complex congenital heart disease, are at risk for hospital readmission, morbidity, and mortality related to disease complications. Parents must be adequately prepared to care for their children following hospital discharge to prevent hospital readmission and complications. This study seeks to evaluate the impact of an education intervention on parental knowledge and stress related to caring for their child with complex medical needs.

Methods: The study design is a quasi-experimental, nonequivalent control pre-test/post-test design. The pre-test was administered prior to the educational intervention, with the post-test …

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 …

The Impact Of A Blood Pressure Reduction Program In Optimizing Control Of Hypertension Amongst Adult Females In An Outpatient Ambulatory Clinic, Brooke Englert

DNP Projects

Background: Hypertension (HTN) is a public health problem that, when well-controlled, can significantly reduce the risk of stroke, coronary heart disease, heart failure and death. Effective patient-provider communication strongly incentivizes an improvement in medical outcomes. Communication with patients can often be effectively delegated to other clinical staff, such as registered nurses (RNs) or clinical service technicians (CSTs) (Tavakoly Sany, Behzhad, Ferns & Peyman, 2020).

Purpose: Given the increased risk of all-cause and cardiovascular disease mortality of uncontrolled HTN, the purpose of this study was to implement and evaluate a standardized, evidence-based practice intervention via communication between APRN providers and patients …

An Interprofessional Collaboration To Increase Total Enteral Nutrition In Critically Ill Patients On Vasopressor Agents In Cvicu, Priyanka Shah

DNP Projects

Background: Delayed enteral nutrition (EN) in critically ill patients increases the risk of complications and poor outcomes. The 2016 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (S.C.C.M.) evidence-based guideline recommends initiating EN within 24-48 hours of Intensive Care Unit (ICU) admission once resuscitation and hemodynamically stability have been achieved. The evidence-based guideline notes that critically ill patients on low-dose vasopressors can be started on EN with close monitoring.

Purpose: This interprofessional project aims to increase the amount of EN delivered to all qualifying Cardiovascular Intensive Care Unit (CVICU) patients who are at risk …

Evaluation Of Universal Depression Screening In A Pediatric Diabetes Outpatient Clinic With The Integration Of A Depression Screening Tool Into An Electronic Health Record, Jenna Westberry

DNP Projects

Background: Depression is a significant problem for adolescents with chronic health conditions. Prevalence rates are two to three times higher in adolescents with diabetes compared to adolescents without diabetes (Badescu et al., 2016). Routine depression screening is not transpiring at rates and frequency recommended by the American Diabetes Association for this population. Implementing use of the Patient Health Questionnaire for all adolescents over the age of twelve years with Type 1 & Type 2 Diabetes Mellitus during routine health visits may improve early identification and diagnosis of depression and improve long-term health outcomes.

Purpose: The goal of this project was …

Effectiveness Of Self-Care Education On The Perceived Quality Of Life In Adults With A Tracheostomy, Elizabeth A. Bonnet

DNP Projects

Background: A tracheostomy is an operative procedure performed to create a stable surgical airway for patients with respiratory compromise due to a variety of clinical reasons. Living with a tracheostomy has tremendous impact on the patient as they experience alterations in their ability to eat, speak, breathe normally, and care for themselves. There is also a potential negative impact to their quality of life. Under ideal circumstances, the tracheostomy is a planned event and education is given to the patient prior to the procedure in an effort to lessen the impact and prepare them to cope with the expected life …

Improving Readmission Rates Through Warm Handoffs For Low Health Literacy Patients, Stephanie D. Poonawala

DNP Projects

Preventable readmissions are a significant cost burden to hospitals and healthcare systems and are associated with overutilization of healthcare services, suboptimal health outcomes, and reduced quality-adjusted life years (QALYs) for patients. Low health literacy is an independent patient risk factor for preventable readmissions following hospital discharge. Improving transitional care practices through targeted and timely communication with community-based healthcare providers, within the framework of Naylor’s Transitional Care Model, may reduce readmission rates for patients with low health literacy. An experimental pilot study was conducted on a standard medical-surgical unit to assess local levels of low health literacy among sepsis patients utilizing …

Evaluating Kentucky Advanced Practice Registered Nurses’ Confidence, Comfort, And Knowledge Levels Regarding Dermatology Care After A Web-Based Video Training, Victoria Hayden

DNP Projects

Background: It can take an average of 38.9 days to see dermatology from referral to initial appointment. As a result, delays in diagnosis and treatment of life-threatening conditions such as malignant melanoma could occur. Primary care providers frequently refer patients for benign conditions that can be appropriately managed in the primary care setting; often due to lack of knowledge or confidence in their clinical management skills. Educational resources equip providers with the knowledge and tools to feel confident in their management of various skin conditions in a primary care setting. Purpose: The purpose of this project was to …

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 …

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 …

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 …