Medicine and Health Sciences Commons^™

Collaborative Human-Machine Interfaces For Mobile Manipulators., Shamsudeen Olawale Abubakar

Electronic Theses and Dissertations

The use of mobile manipulators in service industries as both agents in physical Human Robot Interaction (pHRI) and for social interactions has been on the increase in recent times due to necessities like compensating for workforce shortages and enabling safer and more efficient operations amongst other reasons. Collaborative robots, or co-bots, are robots that are developed for use with human interaction through direct contact or close proximity in a shared space with the human users. The work presented in this dissertation focuses on the design, implementation and analysis of components for the next-generation collaborative human machine interfaces (CHMI) needed for …

Perceived Social Support, Family Relationships, And Health-Related Quality Of Life Among Women With Breast Cancer In Jordan., Hedaya Rateb Hina

Electronic Theses and Dissertations

Introduction: Breast cancer is the most common cancer among Jordanian women. Perceived social support (PSS) and family relationships are strongly associated with positive psychosocial outcomes and health-related quality of life (HRQoL). This area was widely explored in Western countries, but little attention was devoted to investigate this area in Middle East region. Purpose: to investigate the interrelationships among PSS, family relationships, and HRQoL of women with breast cancer in Jordan using an exploratory cross-sectional design. Method: The contextual model of HRQoL designed by Ashing-Giwa (2005) provided the foundation for this study. A total of 140 women were …

Implementation Of A Risk Assessment Tool In The Cardiac Catheterization Laboratory To Identify High Bleeding Risk Patients On Dapt After Pci: A Quality Improvement Project., Ghulam Mughal

Doctor of Nursing Practice Papers

Bleeding is a risk among patients on dual antiplatelet therapy (DAPT) after the percutaneous intervention (PCI) in acute coronary syndrome (ACS). There is a need to accurately identify the patients with increased bleeding risk. Evidence shows that 1.7 cases bleed among 100 PCI patients, and 5% of patients are re-admitted for bleeding which increases subsequent death or MI within 60 days post-discharge bleeding. Evidence suggests that the internally and externally validated BLeeMACS bleeding risk instrument can be used to measure bleeding risk in this population. This quality improvement project aims to improve the awareness among healthcare providers of the bleeding …

Hair Toxicology Testing Among Children Evaluated For Physical Abuse: Evaluation Of A Practice Change., Ashley Dejarnette

Doctor of Nursing Practice Papers

Background: Despite a complete medical evaluation for child physical abuse, many suspected victims have indeterminant findings. The lack of a definitive diagnosis can impede child protection agencies’ ability to protect those children at high risk for abuse, leaving them vulnerable to subsequent injuries and potentially escalating violence by caregivers. Oftentimes, allegations of child physical abuse are accompanied by concerns for substance abuse by the caregiver as well. While we know that children living in homes where caregivers use illicit substances are at substantially higher risk for physical abuse, drug testing children for environmental exposure to illicit substances is not yet …

Using Simulation To Prepare Nursing Students To Care For Covid-19 Patients., Erika Keithley

Doctor of Nursing Practice Papers

Background: The COVID-19 pandemic has impacted the state, nation, and globe resulting in significant death and healthcare strain. To minimize risks associated with potential illness and educational interruptions, nursing students have often been prohibited from caring for COVID-19 patients during clinical experiences. Simulation-based education immerses students in a realistic clinical environment providing a safe learning environment for novice practitioners.

Purpose: The purpose of this project was to implement simulation-based education related to acute care of COVID-19 patients for pre-licensure nursing students. Project objectives included: (a) to educate nursing students on the care of COVID-19 patients; (b) to assess competency through …

Evaluation And Implementation Of A Video Intervention To Increase Adherence In A Rural Phase Ii Cardiac Rehabilitation Program., Holly Yahyawi

Doctor of Nursing Practice Papers

Background: In the U.S., heart disease affects over 30 million adults and is the leading cause of death. Cardiac rehabilitation (CR) decreases cardiac hospital readmissions, decreases the risk of additional cardiac events, and increases life expectancy. Environment: This project was implemented at a CR program which serves rural Indiana and Kentucky counties. Purpose: This QI project uses a Plan-Study-Do-Act framework to evaluate patient adherence to a rural CR program, implement a video intervention for patients, and measure patient’s perceptions. Procedures: CR patients watched four videos describing what CR is, what to expect at CR, CR benefits, and a patient CR …

Improving Pediatric Delirium Prevention To Decrease Pediatric Delirium Prevalence In The Pediatric Intensive Care Units., Kelsie Houchens

Doctor of Nursing Practice Papers

Background: Pediatric delirium has emerged as a common complication of childhood illness in the intensive care setting, with estimated delirium prevalence ranging from 15.9% to 65.6%. Critically ill pediatric patients in the ICU are at risk for pediatric delirium due to modifiable risk factors including mechanical ventilation, sedating medications, physical restraints, and nutrition. In 2019, the pediatric intensive care unit (PICU) in a Kentucky children’s hospital reported only 18 % of chart audits revealed that physicians activated the physician-directed pediatric ICUs Delirium Prevention and Treatment Order Set (DPTOS) on pediatric patients. A quality improvement (QI) project was developed to identify …

Evaluating Quality Of Life And Participant Satisfaction In A Cancer Support Community Yoga Program., Lauren Topp

Doctor of Nursing Practice Papers

Purpose: The purpose of this EBP project was to evaluate program processes and outcomes of an established cancer support community yoga program for persons impacted by cancer and explore the impact of the program on quality of life (QoL) in persons with cancer.

Design: This project was a quality improvement project with a pre-test/post-test design. QoL was explored through the EROTC QLQ C30 questionnaire. Descriptive and explorative methods were conducted through a survey of participants’ satisfaction with the yoga program. Feedback for future improvements around QoL services were provided.

Methods: Members of Gilda’s Club (440 persons) received an …

The Black Church, Social Media, And Vaccine Hesitancy: A Program Evaluation Of A Virtual Town Hall Meeting Intended To Educate, Empower And Expedite Covid-19 Vaccine Uptake Intent Among Black Americans., Nina Johnson

Doctor of Nursing Practice Papers

Background: Vaccines are among the most important public health interventions of the 20th century saving millions of lives each year. Notwithstanding, the United States has seen a growing resistance to vaccinations since the late 1990s. Vaccine hesitancy (VH) is a delay or decline to accept vaccines, despite the available of safe and effective vaccines (WHO, 2019). Combatting VH in Black communities is especially challenging, complex, and multifaceted due to an elevated sense of medical mistrust from persistent racial discrimination, injustices and medical malfeasance. The current coronavirus-19 disease (COVID-19) pandemic has further magnified the intersection of this structural racism, the associated …

Implementation And Evaluation Of A Quality Improvement Project To Increase Tdap Vaccination Rates For Primary Caregivers In The Neonatal Intensive Care Unit., Vickie Winner

Doctor of Nursing Practice Papers

Pertussis (whooping cough) is a highly contagious deadly disease for neonates. The Centers for Disease Control and Prevention (CDC) identifies primary caregivers (anyone caring for the infant in the home environment) as the most common source of neonatal pertussis. The CDC therefore recommends primary caregivers receive a booster tetanus, diphtheria, acellular pertussis (Tdap) vaccine to reduce the transmission of pertussis to neonates. The purpose of this quality improvement (QI) project is to implement and evaluate an intervention to increase Tdap vaccination rates among primary caregivers of NICU patients. The specific aims of this quality improvement project are to 1) implement …

Improving Patient Safety During The Emergency Department Discharge Process With The Use Of Two Patient Identifiers., Hannah English

Doctor of Nursing Practice Papers

Nurses are not always confirming two patient identifiers while conducting a patient discharge, resulting in patient identification errors. This problem has been shown to significantly affect patient safety and satisfaction, decreasing both when errors are made. These errors also have heavy financial and legal consequences on the affected facility and on the discharging nurses, warranting a need for improvement. The purpose of this quality improvement project was to decrease patient-identification errors at discharge by increasing nurse use of two patient-identifiers through the implementation of an education program. This ten-week program involved education sessions that presented evidence-based material specifically focused on …

Why Targeted Testing Matters: Evaluation Of A Practice Change In Pediatric Ingestion Screening., Emily Neal

Doctor of Nursing Practice Papers

Background: The drug epidemic is plaguing the United States and more Americans than ever have been identified to use illicit substances regularly, including while caring for children. The practice of obtaining a standard urine or serum drug screen is outdated and ineffective in determining if children have been exposed to illicit substances. Often these immunoassay drug screens are negative despite pediatric patients having symptomatic responses to illicit drug exposures. Immunoassay drug screens are not designed for testing in children who are often passively and directly exposed as bystanders to adult drug use in their environment. This means that a “negative” …

Protection Against Infection In Epidural Stimulation Implantation: A Program Evaluation., Yukishia Austin

Doctor of Nursing Practice Papers

Background: Spinal surgical site infection (SSI) is the third most common complication after spinal surgery. Complications of surgical site infection can increase hospital length of stay, associated health care costs, mortality, and produce unfavorable surgical outcomes (Janssen et al., 2019). The need to decrease the incidence of surgical site infections (SSis) is a primary concern for the Kentucky Spinal Cord Injury Research Center (KSCIRC) organization. To decrease the risk of infection with epidural spinal cord implantation, a pre-operative quality improvement plan was implemented for KSCIRC to follow.

Setting: The project took place at the University of Louisville's Kentucky Spinal Cord …

Improving Communication And Teamwork Among Emergency Department Nursing Staff., Phoebe Girgis

Doctor of Nursing Practice Papers

Background: Emergency Department (ED) nurses are experiencing a rise in patient visits, staffing shortages, lower levels of job satisfaction, higher nurse to patient ratios, increased acuity for trauma patients, and increased psychiatric admissions. Tension, frustration, and breakdowns in communication are among reasons for lateral violence among emergency nursing staff.

Setting: This evidence-based practice project took place at a level one trauma academic medical center in the Southeastern region of the United States. Emergency Psychiatric Services (EPS) is a subunit within the ED which has a capacity of 24 patients for psychiatric services. The main ED, Medical ED (MED), or the …

Program Evaluation: Assessing The Effectiveness Of Diabetes Group Education Utilizing The Diabetes Knowledge Test., Aminata Gueye

Doctor of Nursing Practice Papers

Background: Diabetes Mellitus (DM) is the 7th leading cause of death in the United States (HHS ODPHP, 2019). It is also the leading cause of chronic disease complications such as adult-onset blindness, kidney failure, and lower-limb amputations (HHS ODPHP, 2019). It is recommended that all people with diabetes should participate in diabetes self-management education (ADA, 2018). Purpose: The purpose of this DNP project is to evaluate the effectiveness of diabetes group education by assessing participants’ knowledge utilizing the diabetes knowledge test (DKT) at an outpatient diabetes care center in Louisville KY. The evidence from the literature review supports the importance …

The Implementation Of A Standardized Car Safety Seat Discharge Teaching To Improve Self-Efficacy In Neonatal Intensive Care Unit Nurses., Madeline Sass

Doctor of Nursing Practice Papers

Background: There is a lack of standardization for car safety seat education to caregivers before hospital discharge. Nationally, 59% of motor vehicle accident deaths occur because the car seat is misused (Greenwall, 2015). The American Academy of Pediatrics (1999) states this is a gap in care because all caregivers need to receive proper car safety seat instruction before discharge. Purpose: This quality improvement project aimed to increase nursing self-efficacy and compliance of registered nurses (RNs) by implementing a standardized CSS discharge intervention. Methods: RNs on the unit were educated with a 7-minute presentation video titled “Car Seat Safety: Discharge Teaching” …

Increasing Extubation Awareness During Interdisciplinary Rounds With A Rounding Tool In The Pediatric Intensive Care Unit (Picu)., Lilly Giang

Doctor of Nursing Practice Papers

Purpose: Prolonged duration of mechanical ventilation and endotracheal tube intubation are associated with longer length of stay and increases risk for infection by about 3% per day when mechanically ventilated (Mirzarahimi et al., 2020). Evidence suggests that the use of a rounding tool during interdisciplinary rounds improves clinical outcomes, reduce duration of mechanical ventilation, and decrease length of stay in the PICU. The aim of the project was to measure registered nurses and PICU providers perception of the extubation prompts and determine if the extubation prompts decrease duration of mechanical ventilation and length of stay. Methods: After extensive review of …

Improving Pneumonia Immunization Rates Among Adult Residents Of A Long-Term Care Facility., Salma Hegazi

Doctor of Nursing Practice Papers

Background: Pneumonia is a significant cause of morbidity and mortality in long-term care facility (LTCF) residents (Stamm et al., 2020). Vaccination of LTCF residents is a reasonable prevention strategy, (Andre et al., 2018; Centers for Medicare & Medicaid Services, 2020; Kaiser Family Foundation, 2019). Improving immunization rates among LTCF residents remains to be a challenge (Rehm et al., 2012; Stamm et al., 2020).

Purpose: The purpose of this quality improvement (Q.I.) project is to improve the pneumococcal pneumonia immunization rates at an LTCF in Louisville, KY.

Methods: A review of each residents' medical record to obtain immunization status, evaluating the …

Implementation Of A Newborn Skin Care Routine To Decrease Diaper Dermatitis., Shelia Kingsley

Doctor of Nursing Practice Papers

Background: Diaper dermatitis (DD) is an acute, inflammatory reaction of the skin, and is one of the most common skin problems in infancy. Diaper care procedures should aim at supporting skin barrier function to reduce the incidence of diaper dermatitis. Evidence indicates that providing appropriate skin care practices can be effective in preventing skin redness and breakdown. Purpose: To create an evidence-based skin care guideline that would improve consistency in care, decrease skin breakdown and standardize workflow. Methods: A Neonatal Skin Assessment Report was created and used to review pre- and postintervention Neonatal Skin Condition Score (NCSC) © assessment scores. …

Incorporating A Caregiver Support Group For Parents Of Children Diagnosed With Type 1 Diabetes Mellitus (T1dm)., Molly Recktenwald

Doctor of Nursing Practice Papers

Background: Learning to live with a chronic illness can be one of the most stressful times for a child and family. A new diagnosis of Type 1 Diabetes Mellitus (T1DM) consists of overwhelming amounts of education, and at the time of a new diagnosis, caregivers can experience extreme emotions, including depression and anxiety. Parent support groups have been shown to validate and alleviate parents’ emotions surrounding the diagnosis. Purpose: The purpose of this project was to initiate a support group for parents and caregivers of children diagnosed with new-onset T1DM that can be maintained and expanded in the future to …

Integrating Mhealth In A Virtual Prenatal Class To Promote Behavior Modification In Pregnant Women., Brittney Corniel

Doctor of Nursing Practice Papers

Background: Occurrences of pre-term births are disparagingly higher among women from vulnerable populations. Prenatal classes provide healthcare professionals an opportunity to educate pregnant women about mitigating their risk factors for perinatal complications.

Purpose: To introduce the use of pregnancy mobile applications in a prenatal class to assist women in obtaining optimal maternal health for fetal development.

Methods: A pre/post-test design was used to explore the relationship between increased mobile health (mHealth) use and achievement of health behavior goals. The project intervention included a 15-minute PowerPoint presentation about optimal use and effectiveness of mobile apps in pregnancy, pregnancy health behaviors, and …

Implementation Of Sensory Modulation For De-Escalation On An Adolescent, Female Psychiatric Inpatient Unit., Heather Scott

Doctor of Nursing Practice Papers

Background: Epidemiological data suggested high rates of aggressive incidents involving adolescent patients occurred on inpatient psychiatric mental health units. To mitigate these incidents, mental health staff utilized de-escalation techniques to help alleviate distress, yet the data suggested many occurrences resulted in a seclusion or restraint event. Consequently, national healthcare entities and mental health organizations have advocated for eliminating seclusion and restraint practices due to their potential for re-traumatization, injury, or death.

Purpose: This evidence-based project aimed to increase nurses' self-efficacy when utilizing sensory modulation as a de-escalation technique for aggressive behavior to reduce the seclusion/restraint rate.

Methods: Mental health staff …

Development And Implementation Of A School Nurse Staffing Model: A Policy Change Proposal., Jillian Champion

Doctor of Nursing Practice Papers

Background: School nurses play a vital role in the success of students. Having a school nurse is associated with improved attendance, management of chronic student conditions, and graduation rates. Public schools in Kentucky, and across the nation, face huge budget issues, and often, school nurse jobs are cut. With limited staff, school districts must find efficient ways to staff school nurses to meet student needs. The National Association of School Nurses (NASN) argue for staffing school nurses based on social determinants of health, along with medical complexity of students. In 2021, only one staffing model had been published with measurable …

Implementation Of A Quality Improvement (Qi) Intervention To Increase Influenza Vaccination Uptake In A Pediatric Primary Care Setting., Lisa Gaines

Doctor of Nursing Practice Papers

Background: Internal and external evidence demonstrates that there is a suboptimal uptake of influenza vaccination (flu vaccine) in all settings, despite national objectives to achieve 80%- 90% immunization rates across all populations. In 2002, the Advisory Committee on Immunization Practices (ACIP) issued a recommendation that all children 6 months of age and older be immunized annually with the influenza vaccine. Despite these recommendations, influenza vaccination is not required for school entry in the Commonwealth of Kentucky and immunization rates continue to fall below local, state, and national targets. Being considered an optional vaccine leaves the decision to vaccinate (or not) …

The Effect Of An Educational Intervention On Nurses' Knowledge And Skills Related To The T-Piece Resuscitator., Christy Roe

Doctor of Nursing Practice Papers

Background: The t-piece resuscitator (TPR) is a device that provides respiratory support for neonates that has been shown to be safe and effective when used correctly. A recurring competency assessment for the TPR does not exist at the intervention site except for the biyearly Neonatal Resuscitation Program® checkoff. Nurses who are not competent and confident with the use of the t-piece resuscitator run the risk of not using it correctly when resuscitating a neonate and potentially causing harm. Methods: The Iowa Model of Evidence-Based Practice was used for this quality improvement project. A literature review was conducted to identify proper …

Effectiveness Of An Evidence Based Cognitive Behavioral Therapy Program (Creating Opportunities For Personal Empowerment [Cope]) To Improve Childhood Mental Health Outcomes In A Private School., Carlatesha Flippin

Doctor of Nursing Practice Papers

Background: When mental health issues are left untreated in children, there is an increased risk for poor school performance, substance abuse, and missing essential experiences in life. School-based cognitive-behavioral therapy programs improve negative emotions, increase student positive experiences, increase coping skills knowledge, and provide adequate resources for effective mental health management of symptoms. School-based -behavioral therapy programs improve childhood mental health outcomes and promote coping skills utilization amongst pediatric populations.

Purpose: To implement Creating Opportunities for Personal Empowerment (COPE) a cognitive behavioral therapy program in a private school-based setting to assist children in obtaining optimal mental health outcomes.

Methods: Seven …

An Interprofessional Approach To Holistic End-Of-Life., Andrew Aschbacher

Doctor of Nursing Practice Papers

Purpose: The goal of this Doctor of Nursing Practice (DNP) project was to develop and evaluate an evidence-based clinical practice guideline (EBP) for an interprofessional approach across four end-of-life care domains (1) ethnocentric spiritual wellbeing, (2) mental wellbeing, (3) symptom management, and (4) value-based goals of care. Design and Methods: The Iowa Model for the Development of Evidence-Based Practice guided the development of the practice guideline. A multi-phase literature review was conducted to establish and grade the best evidence. A two-phase evaluation plan was developed. The University of Louisville Institutional Review Board approved the project. Results: In evaluation phase one, …

Implementation Of An Evidence Based Quality Improvement Project To Improve Bathing Practices In The Neonatal Intensive Care Unit., Kimberly Johnson

Doctor of Nursing Practice Papers

Background: Conventional bathing practices in the NICU have shown to be a stressful, and even painful, activity for neonates and one that can negatively impact the developmental and physiological outcomes of premature infants. To negate these negative outcomes, and provide a positive experience for neonates and their parents, AWHONN recommends the implementation of immersion swaddle bathing [ISB] over conventional bathing practices, in premature infants and newborns. Purpose: The purpose of this quality improvement project was to implement and evaluate an evidence-based bathing practice in a Level III NICU that includes clinical practice guidelines and staff education. Methods: A live, education …

Developmentally Supportive Positioning In The Neonatal Intensive Care Unit., Taylor Morganti

Doctor of Nursing Practice Papers

Background: An estimated 15 million infants worldwide are born prematurely each year. These infants are at an increased risk of poor physical and neurodevelopment because of increased stress and inappropriate sensory stimuli experienced in the neonatal intensive care unit (NICU). The provision of developmentally supportive care can mitigate some of these noxious effects. By decreasing stress and conserving energy, developmentally supportive positioning can enhance sensory, motor, and neurodevelopment. Purpose: The purpose of this quality improvement project is to improve the positioning of premature neonates through an educational intervention and staff training on the importance of developmentally supportive positioning. Improved positioning …

Community-Based Wound Care Intervention Utilizing Non-Clinical Personnel In The Intravenous Drug Use Population., Jennifer Fox

Doctor of Nursing Practice Papers

Background: Wounds resulting from injection drug use can increase morbidity and mortality in intravenous drug users (IVDU) (Kerr, et al., 2004; Phillips, et al., 2012; Pieper, 2019). Lack of access to healthcare contributes to self-treatment, worsening wounds, and severe co-morbidities (Robinowitz et al., 2014). Needle exchange programs (NEP) offer clean injecting equipment and infectious disease testing. NEP employees have close contact and high rapport with this population (Robinowitz et al., 2014). NEP can be utilized to assess skin for infection and high-risk injecting behaviors contributing to wound development. Early detection of wounds through assessment and prevention through cleaner injecting behaviors …