Medicine and Health Sciences Commons^™

Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer

DNP Projects

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to …

Improving Nutrition Screening Practice In The Hospitalized Heart Failure Patient Population, Amanda J. Bourgeois

DNP Projects

Background: Heart Failure is a disease known to affect nearly 6.5 million adults in the United States. Characterized by recurrent hospitalizations, heart failure significantly contributes to morbidity, mortality, and healthcare costs in the United States and worldwide. Because malnutrition is prevalent in the heart failure population, healthcare providers must perform nutritional assessments on admission to intervene in the case of malnutrition, prevent deterioration, and improve patient prognosis. Without intervention and early identification of malnutrition, heart failure hospitalizations will remain a significant problem.

Purpose: The purpose of this study is to evaluate the effect of an evidence-based educational program for cardiac …

Ideal Body Weight And Body Fat Percentage Predict Relative Energy Deficiency In Sport (Red-S) Scores In Collegiate Athletes, Emily Norman

Theses and Dissertations--Nutrition and Food Systems

Background: Low energy availability (LEA) is the underlying cause of Relative Energy Deficiency in Sport (RED-S) which negatively affects athletes' physiological function, health, and performance. RED-S results from inadequate dietary intake to support energy expenditure for daily living, growth, and optimal performance. It occurs in both male and female athletes, with or without disordered eating. However, screening and diagnosis in athletes can be difficult. Objective: This study aims to identify strong predictors of RED-S and assess its prevalence in collegiate male and female athletes. Methods: A total of 270 NCAA athlete test points from mixed sports were evaluated for RED-S …

The Effects Of Extended Fructose Access On Relative Value And Demand For Fructose, Saccharin, And Ventral Tegmental Stimulation, Megan Halloran

Theses and Dissertations--Psychology

Globally, food addiction (FA) is a growing area of research and is largely attributed to the availability of foods that are both energy dense and high in fats and sugars. Further, it has been suggested, that sugar and fat, when consumed frequently, have properties similar to drugs of abuse. While the validity of FA is questioned, researchers have drawn parallels between substance use disorder (SUD) and FA. For example, sugar binge models emphasize craving, withdrawal and binging as primary components of FA, which are also hallmarks of SUD. Additionally, both natural rewards, like sugars, and drug rewards act on the …

Exploring The Distinction Between Support And Enabling In Families With Substance Use Disorder, Krystal N. King

Theses and Dissertations--Family Sciences

Substance use disorders (SUD) are a pervasive public health problem facing families in the United States. Although families are frequently urged to support loved ones who have SUD and cautioned against enabling them, there is a dearth of literature that distinguishes between supporting and enabling. Through qualitative interviews, this phenomenological study examined the experiences of eight parents with adult children with SUD who were currently in recovery. Five themes emerged from the data including: (a) living in despair, (b) addiction and recovery knowledge, (c) support group philosophy, (d) coping with addiction, and (e) differentiation. The results from this study suggest …

Prenatal Ethanol Exposure Impairs Performance On Spatial And Tactile Sequential Discrimination Task In Juvenile Rats, Caleb S. Bailey

Theses and Dissertations--Psychology

Fetal alcohol spectrum disorders (FASDs) are a set of cognitive and behavioral abnormalities that arise in ~5% of children who have been prenatally-exposed to alcohol. Prenatal alcohol exposure (PAE) can cause impairments in learning acquisition, working memory, response inhibition, and attentional-set shifting that result in exaggerated deficits in executive function and impairments in goal-seeking behavior. There are standard procedures used in rodent research to address some components of these deficits, but few procedures are sensitive enough to comprehensively assess such deficits. To address this issue in FASDs research techniques, we developed a procedure that requires prolonged executive function in a …

The Effect Of A Community Resiliency Model Education On Resilience, Psychological Empowerment, And Well-Being In Behavioral Health Nurses, Lorrie Smith-Esterle

DNP Projects

Background: Resilience, well-being, and psychological empowerment are associated with improvement in job satisfaction and nurse retention rates. The Community Resiliency Model (CRM) can promote emotional regulation, well-being, and create an internal state of balance in response to work-related stressors. Educating nurses on how to use CRM enables the recognition of changes in thoughts, emotions, sensations, and internal or external stimuli, which can promote resilience, well-being, and psychological empowerment.

Purpose: The purpose of this project was to evaluate evaluate the effect of a resiliency education using the Community Resiliency Model (CRM) on resilience, psychological empowerment, and well-being of behavioral health nurses. …

Assessing 4-H And Its Circle Of Courage In A Psychiatric Residential Treatment Facility: A Case Study, Elizabeth Steering

Theses and Dissertations--Family Sciences

This 4-H case study takes place in a psychiatric residential treatment facility (PRTF) in Kentucky. The PRTF provides clinical services to youth that are not able to be safely maintained in their homes due to having demonstrated unsafe or harmful behaviors. Youth admitted to the PRTF stay for an average of three to six months while they receive intensive therapeutic and psychiatric care as well as medical treatment and public schooling. The current case study incorporates programming from 4-H, which is the youth development program of the Cooperative Extension System (CES) and the National Institute of Food and Agriculture (NIFA), …

Calcium Imaging Of Central Amygdala Activity After Fentanyl Escalation, Samantha Malone

Theses and Dissertations--Psychology

Evidence suggests that rats given long access (LgA) sessions to self-administer (SA) opioids escalate their intake, while also showing greater withdrawal severity and drug-induced reinstatement compared to rats maintained on short access (ShA) daily SA sessions. Little is known about the neural changes that occur during opioid escalation that may impact withdrawal and relapse. Past work examining opioid SA using ShA sessions in rodents has identified the central amygdala (CeA) as an area of interest that becomes hyperactive in acute withdrawal and may be involved in the incubation of craving that occurs after protracted withdrawal. However, these studies have not …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

An Examination Of Three Transitional Events In The Substance Misuse Trajectories Of Women With Criminal Legal System Involvement, Martha Tillson

Theses and Dissertations--Sociology

Research has consistently demonstrated that criminal legal system (CLS)-involved women are distinct from men in initiation and course of drug use, with important differences on biological, environmental, and sociocultural levels. Thus, the unique pathways and transitions into and out of drug use for women with CLS involvement are critical to consider from a research perspective, but also from a need to develop and support evidence-based, women-centered services in correctional contexts. This dissertation project uses a three-paper format to investigate three aims: (1) to understand CLS-involved women’s initiations to injection drug use and their experiences providing injection initiation assistance (IIA) to …

The Role Of Organizational Leaders In Employee Self-Care: A Change Management Approach, Olivia Dawn Honaker

DSW Capstone Projects

Although literature demonstrates that helping professionals have had high levels of stress and burnout for decades, the COVID-19 pandemic has only exacerbated the issue. The already burdened healthcare workers, now facing increased workloads, long hours, and high-level exposure to trauma, have created an urgency to address this significant risk to helping professionals. The current capstone will bring awareness to organizational leaders regarding the importance of employee self-care and the benefits of implementing employee self-care programs. First, a systematic literature review will examine self-care in helping professions and explore how organizational leaders operationalize employee self-care programs. In addition, the capstone aims …

A Content Analysis Of Reddit Comments Discussing Fibroadenoma Appraisal And Decision Making, Hayley Marie Kay Stahl

Theses and Dissertations--Communication

Though fibroadenomas are clinically benign in most cases, clinical research suggests that these lesions can cause diagnosis-related physical health complications and psychological distress. However, this research is limited and should be investigated further. Thus, this study aimed to explore how patients appraise their fibroadenoma diagnosis uncertainty. Additionally, this study sought to determine if a correlation existed between appraisal and decision making as well as identify the factors that influence the most common treatment decision: removal. Data was retrieved from Reddit discussions for a content analysis. These discussions were then qualitatively analyzed using codebooks associated with this study’s research questions. Findings …

The Use Of A Pediatric Palliative And Hospice Education Module To Enhance The Knowledge And Practice Of Emergency Room Providers, Morgan Garrett

DNP Projects

Background: Palliative and hospice care resources are underutilized in pediatric patients with chronic and life-limiting illnesses. One contributing factor is the lack of formalized education for medical providers regarding the differences and scope of palliative and hospice care models. Without adequate education about these services, providers are not able to effectively utilize otherwise available resources to provide holistic care.

Purpose: The purpose of this study was to assess the current perception of knowledge among providers pertaining to pediatric palliative and hospice care. The study investigated improvements in educational outcomes in ten categories after participation in a web-based training. A secondary …

Promotion Of Early Recognition Of Depression To Improve Health Related Quality Of Life In Pediatric Oncology Patients, Jennifer Blankenship

DNP Projects

Background: Depression and anxiety are serious complications of cancer and deemed a challenging diagnosis due to the symptoms of depression mimicking common side effects of chemotherapy and radiation. Signs/symptoms frequently are underrecognized thus appropriate treatment is delayed, compromising the health-related quality of life (HRQOL) for pediatric oncology patients.

Purpose: Analyze existing physician and Advanced Practice Provider (APP) clinical practice regarding depression, via a pre- and post-survey and educational PowerPoint on the use of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to promote early recognition of depression.

Methods: A prospective, single-arm, study was completed in the Kentucky Children’s …

Associations Of Sexual Satisfaction, Relationship Quality, And Cognitive Functioning Within Intimate Relationships In Older Adulthood, Allison G. Smith

Theses and Dissertations--Family Sciences

The roles of sexual satisfaction, relationship quality, and cognitive functioning within older adults (N = 538) intimate relationships are assessed at two timepoints over an 11-year timeframe. Longitudinal data from 63 older adults are assessed through a path modeling approach to examine how sexual satisfaction and relationship quality change throughout older adulthood. Cross-sectional data for 538 older adults are utilized to examine the association between cognitive health and sexual satisfaction/relationship quality. Qualitative data from 125 older adults are utilized to understand how older adults describe their intimate relationships. Results from path models demonstrate that one’s degree of sexual satisfaction …

Implementation Of Farmers Markets In Bell County, Kentucky, Rachael Schmetzer

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This proposal addresses the link between food insecurity and obesity through the implementation of farmers markets in Bell County, Kentucky as a way to increase access and consumption of fruits and vegetables in this rural, low-income community.

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

The Impact Of Covid-19 On Collaboration And Turnover Among State Health Leadership, Kaylee Gouge

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background/Objectives: State Health Officials (SHOs), the physician-leaders of state public health departments in the US, have long been indicated as potential peacemakers between the fields of medicine and public health. However, the average term length of SHOs has declined in recent years. Meanwhile, the COVID-19 pandemic has increased public visibility of state public health departments and their leadership. Some have hypothesized that the political strain of the pandemic has further accelerated SHO turnover, compromising their leadership efficacy. Contrarily, others have suggested that the pandemic would force public health and organized medicine into closer collaborative alignment through a common enemy. …

Other People’S Families: How Social Ties Shape Entrance Into The Medical Profession, Lillian Sims

Theses and Dissertations--Educational Policy Studies and Evaluation

Not enough members of low-income, rural, and minoritized populations are successfully prepared for and recruited into medical school, exacerbating issues of unequal access to healthcare and limiting access to the profession. While a multitude of factors contribute to this problem, early social exposure to others in a field can act as a key contributor to career interest and a key advantage for entering the profession. Meanwhile, students without early social exposure to healthcare may take unconventional paths to medical school or may struggle to fit into the unique culture of medicine when they do enter training, especially if they belong …

Unboxing The Japanese Sojourning Mom’S Pediatric-Going Experience: A Phenomenlogical Study Of Culturally And Linguistically Appropriate Health Services, Carolyn Oldham

Theses and Dissertations--Education Sciences

This study explores how twelve former Lexington-area Japanese sojourning mothers define culturally and linguistically appropriate services and how culture, gender and language shaped their health care beliefs, behaviors and experiences in pediatric settings. It is a naturalistic, pragmatic line of inquiry born in collaboration with Japanese sojourning moms across cups of matcha 末茶 and mugicha 麦茶. Framed by constructivist and intersectionality research lenses, this phenomenological study seeks to understand how study participants perceived the cultural and linguistic appropriateness of their interactions with Lexington-area pediatric offices and to begin to ascertain the meanings they created based on their subjective experiences. Its …

Stress, Burnout, And Well-Being In New Veterinary Graduates: Evaluating A Pilot Online Professional Development Program, Addie Rose Reinhard

Theses and Dissertations--Community & Leadership Development

Suicide, stress, and burnout are occurring at high rates among veterinary professionals, and the transition from student to practicing veterinarian has been shown to be a particularly stressful time. The aim of this study was to evaluate an online professional development program for new veterinary graduates incorporating peer social support and training in professional skills important for success in the transition to practice. In this mixed methods study, the program was evaluated qualitatively with focus group data and quantitatively by assessing knowledge gained and levels of stress, burnout, social support, and well-being. Seven new veterinary graduates participated in the program, …

Psychological Distress And Relationship Satisfaction Among Survivors Of Sexual Violence, Alyssa Campbell

Theses and Dissertations--Family Sciences

The World Health Organization (WHO; 2002) has indicated that sexual violence is a serious public health concern, and both the WHO and the United Nations (UN) have declared that violence against women, in particular, is a profound violation of human rights (UN General Assembly, 1993; WHO, 2017). Although the systemic and negative impact of trauma on family and intimate relationships have been well documented, the empirical literature regarding the effects of adult sexual trauma on relationship satisfaction is less robust. These studies are designed to address this gap and will do so with analyses centered on an understudied population: the …

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

Understanding Perspectives Of Clinical And Non-Clinical Healthcare Administrators On Culture And Diversity In The Healthcare Workplace, Katherine Counts

Theses and Dissertations--Community & Leadership Development

The racial and ethnic composition of the U.S. population is becoming increasingly more diverse. The 2010 U.S. Census reported a 29% increase in minority groups other than non-Hispanic Whites. In response to these changing demographics, healthcare organizations have struggled to keep pace with these trends in their hiring of a diverse staff. Healthcare leaders appear to be lagging in their efforts to make adequate changes to increase diversity in their organizations. What factors may be contributing to this inequity? One possible explanation is a limited knowledge of healthcare leaders regarding culture and diversity within the workplace. To this end, this …

The Impact Of A Change In Leadership, Taylor Collins

DNP Projects

Abstract

Background: Unmitigated stress in nursing results in moral distress, burnout, turnover and poor patient outcomes. Authentic leaders can improve the nurses’ work environment and satisfaction by improving communication and implementing supportive measures.

Purpose: The purpose of this study was to determine whether a change in executive leadership at BSW Grapevine Medical Center reduced nursing job stress as evidenced by improved nurse satisfaction, nurse retention, nurse engagement, patient satisfaction and care outcomes.

Conceptual Framework: Watson’s Theory of Human Caring

Design: This study is a quantitative, descriptive retrospective measurement of two points in time, before and after …

Risk Factors For Workplace Sexual Harassment In Female Truck Drivers, Kimberly Marie Riddle

Theses and Dissertations--Nursing

Sexual harassment is one of the most common forms of workplace violence in the United States. Sexual harassment is defined as unwanted verbal and physical behaviors of a sexual nature (e.g., physical advances, requests for sexual favors, inappropriate sexist or sexual comments or jokes, pornography, or other unwanted conduct) that creates an uncomfortable working environment or interferes with the employee’s job responsibilities. In general, it is estimated that nearly one in every two women have experienced sexual harassment at the workplace over their lifetime. In male-dominated occupations, such as truck driving, law enforcement, firefighting, and construction, females may have a …

Exploring Health And Risk Information Seeking In The Context Of Covid-19: Testing The Comprehensive Model Of Information Seeking And Risk Information Seeking And Processing Model As Competing Explanatory Models, Xianlin Jin

Theses and Dissertations--Communication

Facing a pandemic caused by a novel coronavirus (COVID-19), the public feels uncertainty and fear. To cope with the pandemic and reduce uncertainty, the public needs accurate and prompt information. By theoretically and empirically comparing the Comprehensive Model of Information Seeking (CMIS) and the Risk Information Seeking and Processing Model (RISP), this dissertation aims to unpack the core mechanism of health and risk information seeking. Built on the two models, the author proposed an Integrated Model and explored which variables are the significant predictors of health and risk information seeking.

The author recruited 729 adult participants and analyzed 394 completed …

A Multiple Goals Perspective On Burnout Disclosure And Support Among Attending Physicians, Alison N. Buckley

Theses and Dissertations--Communication

Burnout is a common experience among physicians and has been identified as a precursor to substance abuse and suicide ideation. When not addressed, burnout can have many negative personal, relational and professional consequences. Research about the burnout experience is limited due to the taboo nature of the topic. The present study used a multiple goals theoretical perspective to examine how physicians disclose burnout in order to access social support. Attending physicians from various specialties (N = 30) participated in one-on-one interviews and were asked to discuss their burnout experience, conversational goals during burnout disclosure, catalysts and barriers for disclosure, and …

Religious Beliefs And Behaviors As Predictors Of Substance Use In First-Year College Students: A Longitudinal Study, Hannah B. Mcgee

Theses and Dissertations--Psychology

Substance use is prevalent on college campuses (e.g., Douglas et al., 1997) and can create significant negative consequences (Kodjo & Klein, 2002; NIAAA, 2006). Research suggests that religious beliefs and religious behaviors interact to predict risky substance use in first-year undergraduate students, such that students with religious beliefs but no corresponding behaviors are at risk for significant alcohol use and related problems (Brechting et al., 2010; Cole et al., 2020). However, these studies have only been cross-sectional in nature.

The current study assessed longitudinally if the interaction of religious beliefs/behaviors influenced first-year undergraduate student substance use across the early adjustment …