Changes In Telehealth Usage Among Medicaid Beneficiaries With Mental Illnesses In A Rural State: An Analysis Of Kentucky Medicaid Dataset Over 5 Years (2018–2022), Chizimuzo T.C. Okoli, Tianyi Wang, Bassema Abufarsakh, Sarret Seng, Zainab Almogheer, Jarrah Al-Kayed, Pooja Bhattarai, Holly Stith, Andrew Makowski

Nursing Faculty Publications

Introduction: Accessing mental health care remains challenging for Medicaid beneficiaries with mental illnesses (MI) in rural settings. The COVID-19 pandemic prompted telehealth service expansion through temporary policy changes and shifts in health care delivery. Despite the increased availability of telehealth as a modality to address disparities in health care access, telehealth adoption and associated use are inadequately explored among Medicaid beneficiaries with MI in Kentucky.

Objective: To examine trends and factors associated with telehealth use by residence status among Kentucky Medicaid beneficiaries with MI.

Design: A retrospective analysis of Kentucky Medicaid claims data obtained from 174,354 beneficiaries aged 18 years …

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Establishing An Advanced Practice Provider-Led Transient Ischemic Attack Clinic: A Quality Improvement Initiative, Brittany A. Young

DNP Projects

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% …

Sepsis In Sight: Immersive Vr Simulation For Pediatric Training, Kelsey Wagler

DNP Projects

Abstract

Objectives: This project aimed to decrease the time required to administer antibiotics and fluid boluses to pediatric patients with sepsis by implementing a virtual reality (VR) simulation program. The initiative sought to enhance bedside nurses’ and pediatric residents’ knowledge, clinical reasoning, and confidence in sepsis assessment, early recognition, and evidence-based management. A secondary objective was to evaluate the effectiveness of VR simulation as an educational strategy for nurses in a high-acuity pediatric setting.

Design: This quality improvement project used a quasi-experimental design that incorporated a VR simulation intervention followed by a structured debriefing and targeted education session. Participants completed …

Stronger Together: Exploring The Impact Of Peer Support Meetings On Stress And Burnout In Ambulatory Nurse Managers, Sara Wellman

DNP Projects

Background

Nurse manager (NM) burnout is common and leads to decreased staff productivity, departmental effectiveness, and leadership capacity. This results in decreased staff morale, poor conflict management, and ineffective communication. Stress reduction and resilience programs have been shown to reduce burnout and enhance resilience in NMs, but more focus needs to be directed toward NMs who work in ambulatory settings.

Purpose

The aim of this project was to evaluate the effectiveness of a peer-to-peer resilience intervention in reducing stress and burnout among ambulatory nurse managers.

Methods

This project used a pre-test/post-test survey design and a convenience sample of ambulatory NMs. …

Innovative Strategies For Incorporating Clinical Experiences Into An Rn To Bsn Program, Angie Hensley, Jessica Rice, Brooke Kuns-Adkins

Nursing Faculty Publications

Curricula for Registered Nurse to Baccalaureate (RN to BSN) programs need to enhance nurse’s scope of practice, critical reasoning, and analytical skills. The purpose of this paper is to demonstrate how one RN to BSN program innovatively integrated clinical experiences into the curriculum.  Students enrolled in the RN to BSN program were required to complete 40 hours of an on-site practice experience that integrated classroom learning with direct clinical experiences incorporated into the Capstone course.

Adult Tobacco Product Use Patterns Across The Urban–Rural Continuum: The Longitudinal Population Assessment Of Tobacco And Health (Path) Study, 2016–2023, Jing Zhang, Shyanika W. Rose, Ellen J. Hahn, Megan E. Roberts, Bethany Shorey Fennell, Jenny E. Ozga, Seth Himelhoch, Saber Feizy, W. Jay Christian, Amanda Thaxton Wiggins, Melissa Abadi, Delvon T. Mattingly, Mary Kay Rayens

Nursing Faculty Publications

Purpose: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

Methods: Data from Waves 4–7 (2016–2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

Findings: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) …

Implementing A Competency-Based Cross-Training Program To Enhance Patient Flow, Jill E. Shanklin

DNP Projects

Objective: To evaluate the effect of a competency-based cross-training program on perinatal nurses’ preparedness to care for medical-surgical (med-surg) overflow patients and to support patient flow.

Design: Quality improvement project using a quasi-experimental pre–post design.

Setting: A 44-bed perinatal unit within a university-affiliated medical center in the United States.

Participants: Registered nurses employed in the perinatal unit for ≥6 months; 24 completed the preintervention survey and 28 completed the postintervention survey.

Interventions: A competency-based cross-training program consisting of e-learning modules, simulation-based competency validation, and structured policy and procedure review.

Main Outcome Measures: Self-reported comfort, …

Enhancing Tray Integrity: A Quality Improvement Project To Reduce Central Sterile Processing Defects, Ashley Conn

DNP Projects

Background: Instrument tray defects contribute to surgical delays, workflow disruptions, rework in sterile processing, inefficient instrument utilization, and patient safety risks.

Purpose: The purpose of this quality improvement project was to reduce orthopedic instrument tray defects through targeted education and standardized tray audits with double-check verification in a large academic medical center.

Methods: A quasi-experimental pre-post design was utilized to evaluate the impact of the intervention. Tray errors were captured using a standardized binary indicator. Staff satisfaction and confidence surveys were measured using Likert-scale surveys.

Results: Orthopedic trays were analyzed before (n=1,017) and after (n=941) implementation. Post-implementation, tray errors decreased …

Riddle Me Resilient: Investigating The Impact Of Riddle Based Class Openings On Student Resilience And Well-Being, Carolyn T. Brown

DNP Projects

Abstract

Background: Burnout among nurses and nursing students is a widespread and well‑documented problem that adversely affects professional performance and psychological well‑being. Resilience serves as a key protective factor, helping buffer the effects of academic stress and reducing burnout over time. Incorporating brief, low‑stakes cognitive challenges—such as a riddle—can help foster resilience.

Purpose: This project evaluated the impact of incorporating riddles into a wellness-focused course, Introduction to Mindfulness and Wellness, on resilience and well-being among undergraduate nursing students.

Methods: This project employed an Institutional Review Board approved pre-post survey design to measure the effect of an intervention focused on …

Evaluating The Implementation And Use Of A Standardized Screening Process To Increase Flu Vaccine Uptake In A Rural Health Primary Care Clinic, Mackenzie L. Pierce

DNP Projects

Background: Research has shown that an annual influenza vaccine is the most effective way to both prevent and reduce the risk of hospitalization and severe health complications of the flu. A yearly influenza vaccination is recommended for everyone age 6 moths and older.

Local Problem: Rural communities have lower rates of influenza vaccination which can be due in part to a lack of screening and education on vaccines and their importance. No process for influenza vaccine status screening existed at the project site prior to this project.

Methods: A quality-improvement project was conducted to evaluate the implementation of a standardized …

Evaluation Of A Nicotine Prevention Program In A Third Grade Classroom, Jennifer A. Pile

DNP Projects

Purpose: The purpose of this project was to increase knowledge of nicotine products and promote negative perceptions of nicotine use among third-grade students through early prevention education.

Background: Prevention is key and to prevent nicotine use, there must be an educational program with that aim in a much younger population. Third grade encompasses 8-, 9-, and 10-year-olds. This group is in the middle childhood stage and begin more complex thinking and problem-solving skills. There is physical and emotional development among this group.

Methods: This is a quasi-experimental study among third grade students in Breckinridge County Kentucky with pretest and …

Advancing Rural Health Equity Through Systematic Sdoh Screening- A Quality Improvement Initiative, Laura C. Combs

DNP Projects

Background: Social determinants of health (SDoH) significantly affect health outcomes and healthcare utilization, particularly in rural communities. In 2024, the Centers for Medicare & Medicaid Services mandated SDoH screenings in the inpatient setting, with recommendation to implement in rural clinics without specifying a standardized tool, resulting in inconsistent identification of needs, e.g., food insecurity, housing instability, mental health concerns, financial strain, and transportation barriers.

Purpose: This quality improvement initiative implemented a standardized SDoH screening tool in a rural outpatient clinic to evaluate changes in referral rates to community-based resources pre- and post-implementation and to improve patient reporting of social needs. …

Building Confidence And Team Communication: Implementation Of A Rapid Response In Situ Simulation Program In The Neonatal Intensive Care Unit, Janell F. Hacker

DNP Projects

Background: Neonatal code events are high-risk, low-frequency occurrences in the neonatal intensive care unit (NICU). Simulation-based training is used to support skill development, maintain competencies, and enhance team performance.

Purpose: The purpose was to determine if a multidisciplinary, high-fidelity, rapid response in situ simulation program would impact confidence and communication among frontline healthcare providers during neonatal code events.

Methods: A quasi-experimental, pretest-posttest study was conducted in a 90-bed Level IV NICU. A multidisciplinary, high-fidelity in situ rapid response simulation program was implemented over a 3-month period for frontline NICU healthcare providers. Pre- and post-surveys assessed perceptions of role clarity, …

Implementation Of A Cardiomems Screening Tool To Increase Provider Awareness And Referrals In Eligible Patients, Monica Rios

DNP Projects

Background: Heart failure affects over 6 million Americans and causes more than one million hospitalizations annually. CardioMEMS, a remote pulmonary artery pressure monitoring device, effectively reduces hospitalizations, yet its use remains limited due to provider and system barriers. The purpose was to increase CardioMEMS referrals for eligible heart failure patients through targeted provider education and a standardized screening tool.

Local Problem: Kentucky experiences higher heart failure hospitalization rates than the national average, contributing to prolonged hospital stays and rising healthcare costs.

Methods: A pre—post quasi-experimental study was conducted at an academic medical center. Baseline chart review of 47 patients evaluated …

Improving Compliance With Preoperative Antibiotic Protocols For Cardiac Implanted Electronic Devices: A Quality Improvement Project, James Kaup

DNP Projects

Abstract

Background

Cardiac implantable electronic device infections remain a serious complication of permanent pacemaker implantation despite evidence-based infection prevention guidelines.

Local Problem

An academic electrophysiology laboratory identified inconsistent guideline-concordant antibiotic selection despite consistently high compliance with recommended antibiotic timing.

Methods

A nurse-led, quasi-experimental pre-post quality improvement project evaluated implementation of a standardized preoperative antibiotic prophylaxis protocol. Data from 36 permanent pacemaker implantations (16 pre-intervention, 20 postintervention) were analyzed.

Interventions

The intervention included a standardized antibiotic protocol, multidisciplinary staff education, and performance feedback.

Results

Guideline-concordant antibiotic selection improved from 37.5% to 95.0% (χ² = 11.27, P = .001). Antibiotic timing remained …

Correlates Of Recovery Capital Among Women In Jails: Leveraging A Dimensional Recovery Framework, Amanda Fallin-Bennett, Martha Tillson, Jaxin Annett, Hartley Feld, Michele Staton

Nursing Faculty Publications

Background: Recovery capital encompasses internal and external factors that support recovery from substance use disorder, such as employment, social support, and physical and mental health. There is a need for more research on recovery capital among women who are incarcerated, who often face complex barriers to recovery, such as poverty, unemployment, and histories of trauma.

Methods: Women (N ¼ 900) were recruited from Kentucky jails as part of the broader NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) cooperative project. Measures from baseline interviews (during incarceration) were selected in alignment with the Substance Abuse Mental Health Service Administration (SAMHSA)’s four …

“Being Treated As The Expert:” A Blueprint For A Community Advisory Board Approach To Elevate The Voice Of People With Living Experience With Substance Use In Academic Research, Trevor Moffitt, Survivors Union Of The Bluegrass, Bryson Henson, April M. Young, Sharon L. Walsh, Rachel Vickers-Smith, Junior Cruz, Jeremy Byard, Brook West, Amanda Fallin-Bennett

Nursing Faculty Publications

Introduction: Researchers have traditionally engaged Community Advisory Boards (CABs) to meaningfully involve community members in the research process. However, CABs are often formed only after a grant is funded, leading to criticisms of functioning merely as “ethical approvers.” For substance use researchers, the inclusion of people with living experience (PWLE; current experience with drug use) across all stages of research is especially important as they have historically been the experts in the needs of their community.   Methods: In response to this need for community engagement in research, the University of Kentucky, in partnership with a local recovery community center (RCC; …

Coalition Building And Citizen Science For Radon Risk Reduction, Stacy Stanifer, Kathy Rademacher, Whitney Sedio, Naomi Cheek, David Gross, Caitlyn Curtis, Amanda Thaxton-Wiggins, Mary Kay Rayens, Ellen J. Hahn

Nursing Faculty Publications

We evaluated the implementation of local coalitions led in partnership with citizen scientists, community-based organizations, and public libraries in four rural communities to lower exposure to radon in the home. The objectives were to (1) describe the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) of four radon coalitions, and (2) compare RE-AIM factors among citizen scientists who participated in the coalitions and those who did not. A larger community-engaged research project embedded coalition building using a citizen science approach. Three of the four coalitions focused on health and wellness more broadly (18–34 members); one focused solely on radon (10 members). Coalition membership and activities varied …

Evaluation Of A Tobacco Treatment Specialist Training Program Targeted To Behavioral Health Professionals, Chizimuzo T. C. Okoli, Sarret Seng, Bassema Abu Farsakh, Emily Koyagi, Heather Beck, Audrey Darville

Nursing Faculty Publications

Tobacco use remains disproportionately high among adults living with mental illnesses (MIs), contributing to excess morbidity and mortality, particularly in high-burden states such as Kentucky. Behavioral healthcare providers are well-positioned to address this disparity but often lack formal training in evidence-based tobacco treatment. Tobacco Treatment Specialist (TTS) training provides healthcare providers with skills to deliver evidence-based tobacco treatment; however, traditional TTS training models often rely on synchronous, in-person or live virtual formats, which may limit accessibility for some healthcare workforces. Asynchronous, web-based delivery models may reduce these barriers. This study evaluates a targeted, asynchronous TTS training program designed for providers …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review, Angela J. Occidental, Inga M. Zadvinskis, Jacqueline Hoying

Journal of Appalachian Health

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …

The Impact Of A Geriatric Trauma Unit On Patient Outcomes, Shannon E. Johnson

DNP Projects

Abstract

Background: Traumatic injuries in the geriatric (> 65) patient population can have devastating effects. Only a small percentage of these patients return to independent ambulation and living. As the population continues to age and life expectancy continues to increase, the incidence of traumatic injuries in geriatric patients will continue to increase. Geriatric friendly hospital wards in several disciplines have been shown to reduce length of stay and improve patient outcomes. However, there has been no research surrounding geriatric trauma wards specifically.

Purpose: The purpose of this quality improvement project was to evaluate the impact of admitting geriatric trauma patients …

Improving End-Of-Life Care: A Nursing Education Initiative, Spring C. Kingsley

DNP Projects

Background: This study addresses the gap in education and training for medical intensive care unit (MICU) nurses regarding the care of hospice patients. The traditional medical model of healthcare prioritizes illness treatment, often leading to inadequate end-of-life support and increased hospitalization during patients' final days. The rise of in-hospital hospice programs, or scatter-bed hospice models, highlights the need for nurses to enhance their skills in providing end-of-life compassionate care. The MICU at the University of Kentucky’s Chandler Hospital serves as a focal point for this initiative, given its role in caring for critically ill patients who require hospice attention.

Purpose: …

A Comprehensive Exploration Of Stress And Depressive Symptoms In Farm Populations, Julie C. Derringer

Theses and Dissertations--Nursing

High rates of depression and suicide continue to be a concern, despite four decades of growing research into the mental health of farmers. Most farmers have an awareness of a need for improved mental health, but a lack of knowledge persists. As agricultural production demands increase and the number of family farms decreases, the stress placed upon farmers to support the food chain is higher than ever. Understanding the association between farm demands and resources among farmers is key for the development and implementation of programs to decrease occupational stress and depressive symptoms to improve mental health outcomes across farming …

“What We Say Matters”: Reducing Drug Use Stigmatization By Healthcare Professionals Through A Narrative-Based Awareness Campaign, Adam M. Traugott

DNP Projects

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma …

A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox

DNP Projects

Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.

Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …

Evaluating The Efficacy Of A Progressive Mobility Protocol Among Adult Icu Patients, Clayton Chroust

DNP Projects

Background: Many intensive care unit (ICU) patients are critically ill and require ventilator support, and they often do not receive any progressive mobility interventions until after they are liberated from the ventilator or receive transfer orders out of the ICU. Current literature suggests that patients in the ICU face deconditioning, increased ventilator days, development of deep vein thrombosis, pressure ulcers, pulmonary embolism, muscular atrophy, and increased days in the ICU which can be attributed to a lack of mobility. Current evidence-based research identifies that utilization of a progressive mobility protocol is one way to improve patient outcomes and reduce …

Implementation Of A Process To Improve Compliance With A Nurse Driven Foley Catheter Removal Protocol In Nursing Staff Of A Medicine Intensive Care Unit, Kendall L. Pfister

DNP Projects

Background: Catheter associated urinary tract infections (CAUTI) are the most prevalent healthcare acquired infection (HAI) in the acute care setting. Unfortunately, CAUTIs can lead to high morbidity and mortality rates, longer length of stay (LOS) and increased healthcare costs. Unfortunately, in critically ill patients which often suffer multi-organ failure/injury, there remains an increased risk for infection and poor outcomes.

Purpose: The purpose of this project is to increase medical intensive care unit (MICU) nursing staffs’ knowledge of existing nurse driven indwelling urinary catheter removal protocol and to implement an electronic medical record (EMR) prompt for removal of unnecessary urinary catheters …

Utilizing Integrative Medicine Services For Yoga To Reduce Cancer Related Fatigue, Leah R. Yeager

DNP Projects

Background: Cancer related fatigue (CRF) is one of the most prevalent and distressing side effects experienced by individuals undergoing cancer treatment. In fact, many patients report CRF as more debilitating than pain itself. CRF is characterized by persistent, severe exhaustion that is not alleviated by sleep and is not linked to prior exertion. Despite its widespread impact, the options available to manage CRF are limited, typically including practices like good sleep hygiene, balanced nutrition, mindfulness, and supplements. Integrative medicine, particularly yoga, has emerged as a promising intervention for reducing CRF. However, yoga is underutilized as a therapeutic approach to combat …