Nursing Commons^™

Assessment Of Nurses’ Views And Current Practice Of Trauma-Informed Pediatric Nursing Care: Oncology, Alesandra S. Conley

DNP Projects

Purpose: The purpose of this project is to: (i) assess and evaluate the awareness, knowledge and current practice trends of pediatric oncology nurses as they relate to pediatric trauma-informed care. Methods: A prospective, cross-sectional sample of convenience was used to assess pediatric nursing staff at the Kentucky Children’s Hospital. The survey used in this study was replicated from a previous study, “Nurses’ Views and Current Practice of Trauma-Informed Pediatric Nursing Care,” authored by Kassam-Adams et al., nurses and doctors affiliated with Children's Hospital of Philadelphia, University of Pennsylvania, Penn State Hershey Children's Hospital, Nemours Child Health System, Children's Hospital of …

Childhood Nutrition And Lifestyle In Owensboro, Kentucky, Mckenzie J. Mattingly

DNP Projects

According to the CDC, childhood obesity is now one of the leading health problems in the United States. Thirty-five percent of adults in the United States are obese. Kentucky is the 12th most obese state for adults. and the 7th most obese state for children. The State of Obesity: Better Policies for a Healthier America, states that Kentucky’s adult obesity rate is currently 31.6 percent. This is up from 21.7 percent in 2000 and 12.7 percent in 1990. Primary care providers must work to help prevent these numbers from continuing to climb. Since our population of children who are overweight …

Improving Nutritional Status In The Hematologic Oncology Population, Mary A. Malone

DNP Projects

Background: Patients undergoing treatment for both solid tumor and hematologic malignancies experience numerous symptoms that greatly affect their nutritional status. Malnutrition can have a negative impact on oncology patient outcomes. There is a reduced response to treatment, reduced survival and quality of life. Early and consistent interventions have proven beneficial in the oncology population.

Most hematologic cancer patients have good nutritional health. However, as their treatments intensify, side effects compared to their solid tumor counterparts can adversely affect nutrition. Interventions, consisting of total parenteral or enteral nutrition are initiated but only after oral intake has been impeded for 2-3 days. …

Examining The Relationship Between Type And Extent Of After-School Care Use And High Bmi In Children Ages 5-17, Morgan E.B. Chojnacki

DNP Projects

Objectives: The purpose of this study was to examine the relationship between body mass index (BMI) and after-school care use in school age children and adolescents in Kentucky. The specific aims of this study were to examine differences in BMI groups (high versus normal/low) by: a) type and b) extent of after-school care use.

Methods: Parents of children age 5-17 years were administered a 21-item survey which assessed the amount of time their children spent in specific types of after-school care. BMI of the child/adolescent participants were obtained at the time of the survey. High BMI was defined …

Dual Component Educational Program To Improve Medical-Surgical Nurses’ Knowledge And Self-Efficacy Of Severe Sepsis And Septic Shock, Duska S. Bethel

DNP Projects

Sepsis is manifested by a spectrum of clinical signs and symptoms that are produced by an immune response to an infection. The continuum of sepsis ranges from simple sepsis to septic shock and without timely and appropriate intervention leads to death. The purpose of this practice inquiry project is to implement a dual component educational program at Baptist Health Madisonville, a hospital part of the Baptist Healthcare System in Madisonville, Kentucky, and evaluate the changes in nurse knowledge and self-efficacy levels after they receive didactic and interactive education. The first manuscript is an integrative literature review of studies published between …

Delirium Screening Instrument Knowledge And Perception Among Cardiovascular Intensive Care Nurses, Brittany Lynn Dahl

DNP Projects

Background: Delirium is a serious condition that affects critically ill adult patients in the intensive care unit. Bedside nursing delirium measurements are considered a dependable source of information that can be used for clinical decision-making. Nurse education and assessment of perceptions is important when building a framework for successful delirium assessment. However, few data exist about nursing perceptions and practices associated with delirium screening instruments. The overall purpose of this project is to examine nurse perceptions and knowledge about delirium and delirium screening instruments at the University of Kentucky (UK) Hospital’s Cardiovascular Intensive Care Unit (CVICU).

Objectives: The aims of …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

Pediatric Asthma Telemonitoring: Literature, Theory, And Application To Practice, Erin Christine Shankel

DNP Projects

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of …

Medication Adherence And Intervention To Create Success In Hypertensive African Americans In A Rural Setting, Laneita Davis

DNP Projects

Hypertension is a chronic disease that has been a major problem in the African American community for decades. Although numerous research studies have examined interventions to combat this disease, there has been very little research published that focused on African Americans with hypertension in a rural setting. Rural residents experience many difficulties in accessing healthcare services. This difficult access is a disadvantage that results in higher morbidity and mortality rates compared to those of their urban counterparts. Being from a small town in Mississippi, I have witnessed first hand the many barriers that are encountered. Individuals who live in a …

Pediatric Obesity: Taking Advantage Of Well-Child Visits For Early Identification, James E. Gelement

DNP Projects

Background: Pediatric obesity has reached epidemic levels in the United States and the burden of early identification and prevention lies with Primary Care Providers. With this burden comes the responsibility of increased documentation in order for patients to obtain the appropriate counseling, treatment, and referrals.

Objective: The objective of this study is to identify missed opportunities to identify pediatric patients that meet the criteria for overweight or obesity during well-child visits within a primary care practice.

Method: A retrospective chart review of 100 randomly selected patients born between 9/1/2001 and 9/1/2010 that have received a well-child visit between 1/1/2010 and …

Assessing Provider Adherence To An Emergency Contraception Guideline In Reproductive Age Women, Amber E. Davis

DNP Projects

Purpose: To determine current provider adherence to the 2010 ACOG Emergency Contraception (EC) guidelines, specifically by assessing provider EC counseling with patients at well-woman annual exam visits or during contraceptive counseling visits. A second aim of this study is to identify provider facilitators and barriers of EC discussion with patients.

Methods: Using a retrospective design, 90 medical records of patients presenting to a university clinic within the previous year were reviewed for the discussion of EC during annual exams or contraceptive counseling. Forty-five medical records were reviewed prior to implementation of the Ambulatory Electronic Health Record (AEHR) and forty-five medical …

Role Of The "Tobacco Free Teens" Mobile Application In Adolescent Smoking, Juawanna L. Schuller

DNP Projects

Adolescent tobacco use rates have plateaued. Tobacco use education is not mandatory in all states, yet schools remain a good opportunity to reach this population. School nurses should be able to identify components of effective tobacco use prevention education programs and learn to overcome barriers to implementation of these programs. The "Tobacco Free Teens" mobile application is a novel tool that may decrease adolescent tobacco use rates. A pilot study found that the Tobacco Free Teens mobile application was satisfactory to most participants but appealed to girls more than boys. Further research is needed to determine the effectiveness of this …

Post-Laminectomy Back Pain: Understanding The Progress From Acute To Chronic Pain State, James Derek Calhoun

DNP Projects

In the United States, 74.6% of patients who have lumbar laminectomy surgery have residual low back pain (Hussain & Erdek, 2014) and overall costs of low back pain may reach up to $200 billion per year (Carey & Frebuger 2013). To further address this problem, a study was conducted to determine if treatment in a chronic pain clinic could result in a reduction in the development of a chronic pain state for adult patients who have had lumbar laminectomy surgeries. A convenience sample of 50 patients was selected from the Interventional Pain Associates clinic at the University of Kentucky. Records …

Primary Stroke Prevention: 3-Hydroxy-3-Methyl-Glutaryl-Coenzyme A (Hmg-Coa) Reductase Inhibitor (Statin) Use In The Diabetic Patient, Amy L. Hatcher

DNP Projects

Purpose: The primary objective for this retrospective chart review was to evaluate provider adherence to the 2011 AHA/ASA Primary Stroke Prevention guideline of prescribing a statin to all diabetic patients for primary prevention of stroke, regardless of dyslipidemia. A second aim of this study is to identify provider facilitators and barriers to prescribing a statin therapy for primary prevention.

Methods: Using a retrospective study design, a random sample of 100 medical records of diabetic patients presenting to a university women’s health clinic within the previous year were reviewed for statin use and rationale.

Results: Of the 100 diabetic patients sampled, …

Assessing Pediatric Nurses' Knowledge And Comfort Level With Recognition And Reporting Of Child Abuse, Andrea Sebastian

DNP Projects

Child abuse is a serious, yet preventable problem in the United States. Child abuse is defined in The Child Abuse Prevention and Treatment Act as “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation or an act or failure to act, which presents an imminent risk of serious harm” (United States Department of Health and Human Services [USDHHS], Children’s Bureau, Child Maltreatment 2009, 2010).

In 2010, there were an estimated 3.3 million referrals to Child Protective Services for the suspected abuse …

Implementation Of A Depression Screening Protocol Specific To Implantable Cardioverter Defibrillator Patients; A Quality Improvement Project, Kendra M. Kratzwald

DNP Projects

Background: Depression in patients with implantable cardioverter defibrillators (ICD) is a problem that has not been well addressed by providers. In 2012 the American Heart Association (AHA) released a scientific statement that recommended structured and routine depression screening of these patients. The AHA statement also recommended further research on depression screening instruments and their use with this population. Aims: 1.) To develop and implement an evidenced based depression screening protocol appropriate for patients with an ICD seen in an outpatient setting. 2.) Evaluate provider knowledge about depression screening (? Is this what you mean) and depression screening practices before and …

Emergency Nurses' Knowledge Of Pediatric Complaints, Kari J. Blackburn

DNP Projects

Each year there are more than 25 million pediatric emergency department (ED) visits, with 37-60% of the complaints being non-urgent (Brosseau, Hoffman, Nattinger, Flores, Zhang and Gorelick, 2007). Injury is the number one reason children present to the ED and is strongly associated with a complaint of pain (AHRQ, 2013). While pain is a high volume reason for visiting the ED, there are other presentation causes that may pose a high risk to pediatric patients. Nausea and vomiting is not typically viewed as a high risk complaint, yet there are some high risk etiologies resulting in nausea and vomiting that …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Final Dnp Capstone Report: Improving Adolescent Hpv Vaccination Rates, Jessica L. Murray

DNP Projects

Background: Human papillomavirus (HPV) vaccines have been shown to be effective against HPV types that are linked to cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Despite Advisory Committee on Immunization Practices (ACIP) recommendations that all 11-12 year old males and females in the U.S. should be vaccinated with the three-dose HPV vaccine series, vaccination rates remain low. In 2012, only 34.9% of adolescent females and 6.8% of adolescent males completed the series. Efforts to increase vaccination rates are needed, and healthcare providers have been shown to be an important part of the solution.

Purpose: This investigation was conducted to …

Assessing Blood Pressure Control In Primary Care, Ashley W. Guiliani

DNP Projects

Purpose: To evaluate provider adherence to JNC 7 by assessing documentation of blood pressure control and interventions in the absence of control in order to assist providers in reaching Healthy People 2020 goal of blood pressure control.

Methods: A retrospective chart review was conducted for patients with essential hypertension. Data collected included blood pressure, use of a home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three visits. A provider survey regarding provider barriers to blood pressure control was also completed.

Results: All surveyed providers were aware and …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

Evidence-Based Blood Conservation Education For Icu Nurses: A Pre And Post-Test Evaluation Of Nursing Knowledge, Stefanie M. Bull

DNP Projects

Purpose: The purpose of this evidence-based education project was (i) to evaluate baseline nursing knowledge of anemia, blood conservation and transfusion medicine, (ii) to identify current blood conservation practice and the nurse’s prior exposure to blood conservation education (iii) to determine the potential impact of evidence-based education on nursing knowledge, and (iv) to determine the impact of education on the nurse’s attitudes towards future implementation of blood conservation practices based on the nurse’s self report.

Setting: The project was implemented in the Cardiovascular and Thoracic ICU (CVICU) at an 875-bed level-1 Trauma and Multi-Organ Transplant Center located in central Kentucky. …

Tobacco Treatment In College Students, Teresa H. Huber

DNP Projects

This study was conducted in a southeastern University to determine tobacco use status in a population of university students, student intention to quit, treatment options, use of student health service, and student’s degree of support of a tobacco-free policy. A major implication for practice is the need for college health providers to screen all students utilizing the USPHS Guidelines, as even light smokers may be vulnerable to nicotine addiction. However, the study found that a high proportion of the smokers were nondaily smokers who do not consider themselves as smokers and the vast majority of those were undergraduates. Thus, college …

Assessing Provider Knowledge And Attitude Towards Animal-Assisted Therapy As A Complementary Treatment For Children, Shannon Leigh Million

DNP Projects

Objective: The purpose of this project was to determine knowledge and attitudes of pediatric primary care providers working in a university outpatient clinic settings towards the use of animal-assisted therapy as a complementary treatment for children. This report also includes an integrative review of animal-assisted therapy in pediatric populations and a clinical practice guideline analysis regarding the use of equine facilitated learning with high risk children and adolescents in residential psychiatric treatment.

Methods: A survey tool was administered to the Department of Pediatrics at UK Healthcare.

Results: There were 41 respondents to the survey, 36 of which …

Trauma Resuscitation Team Program Evaluation, Lisa J. Fryman

DNP Projects

To evaluate the effectiveness of a newly implemented charge nurse-led trauma resuscitation team approach in the Trauma Intensive Care Unit (TICU). The approach was developed to improve patient throughput efficiency at a Level 1 Trauma Center. Measures of effectiveness include patient throughput efficiency, patient clinical outcomes, and financial impact. The implementation of the charge nurse-led trauma resuscitation team showed an improvement in efficiency of patient throughput without adversely affecting patient outcomes, and opening up critical resources for the next patient that arrives.

Screening For Sepsis: A Key Strategy For Early Identification And Management Of Septic Patients, Amy P. Fisher

DNP Projects

Background: Sepsis, defined as a systemic inflammatory response to infection, is a life-threatening medical condition that rapidly progresses from severe sepsis (characterized by signs of organ dysfunction) to septic shock with fluid-refractory hypotension. Adherence to the Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock have been associated with improved delivery of care and reduced mortality. Delays in recognition of sepsis has been identified as a barrier to achieving early goal-directed therapy targets.

Purpose: To determine if a sepsis screening protocol could facilitate earlier identification of patients with sepsis

Methods: A retrospective medical record review was …

The Effect Of Coaching On Nurse Manager Leadership Of Unit Based Performance Improvement: Exploratory Case Studies, Cynthia A. Baxter

DNP Projects

The nurse manager role has experienced an explosion of responsibilities and expectations over the last decade. As a result, competency and skill acquisition for the successful nurse manager has become the focus of many nurse managers, nurse executives, researchers and organizations. The three manuscripts contained in this final capstone report will explore the acquisition of nurse manager competency, propose coaching as a methodology for acceleration and improvement of nurse manager skill acquisition and describe the results of three case studies using coaching as an intervention to improve the performance improvement skill acquisition of nurse managers.

Military Tobacco Dependence Treatment: Implications Of Treatment Type On Abstinence And Weight Management Ability, Bradley A. Briscoe

DNP Projects

Military readiness, employer productivity and individual health are all significantly impacted by high rates of tobacco use. Current research, to date, suggests that use of brief, individually tailored behavioral modification strategies through group therapy may be most effective in smoking cessation. The objective of this Practice Inquiry Project was to explore aspects of tobacco use the U.S. military population and examine potential relationships between type of treatment, smoking abstinence, and maintenance of body weight (e.g. avoid weight gain) among those seeking tobacco use cessation. The findings of this project can provide guidance on enhancing current tobacco cessation efforts to enable …

Evaluation Of Depression Screening Practices For College Women In A Primary Care University Health Clinic, Sarah E. Lester

DNP Projects

Mental disorders, including depression, are increasing in frequency and intensity in the college student population. College-aged women appear to be particularly vulnerable to depression. Primary care providers play an important role in addressing this issue, as they are the principal health care contacts for more than 50% of patients with mental illnesses. Guidelines from the 2009 United States Preventative Services Task Force recommend screening all adults (age 18+) for depression in primary care when depression care supports are in place. However, current screening rates for depression in the primary care setting from are estimated at only 1.6 to 3.3% (United …