Nursing Commons^™

The Effect Of An Acuity Adaptable Unit On Efficiency In Non-Critical Trauma Patients, Rebecca Charles

DNP Projects

Problem Statement: It was observed a large academic medical center is experiencing impeding congestion of non-critical care patients due to challenges with bed availability and high patient volumes. Delays in transferring patients to an appropriate level of care can impose safety risks and prolong length of stay. Implementation of an acuity adaptable unit may be a cost-effective approach to a growing problem.

Background: A fixed bed model limits the acuity of patients admitted to a specific space. Using the Iowa Model of Evidence Based Practice as the framework for design, moving to an acuity adaptable unit could facilitate patient …

Care Coordination Of The Geriatric Traumatic Fracture Patient: A Multimodal Approach To Pain Management, Alexandra Keough

DNP Projects

Introduction: Traumatic fractures are increasing in incidence across the country, particularly in the aging population. Geriatric patients who are admitted to the acute care setting for traumatic fractures are a unique population that require acute pain management, while also managing other comorbidities. While there are several guidelines on pain management for patients who are admitted to the acute care setting, there are no specific guidelines on the best practices to manage acute pain in the geriatric traumatic fracture population. Evidence supports a multimodal pain management strategy using pharmacologic and non-pharmacologic means as the best way to care for this population. …

A Multi-Faceted Intervention To Reduce Low Value Diagnostic Studies In A Medical Intensive Care Unit., Jessica Caicedo

DNP Projects

Routine daily chest x-rays (CXRs) and laboratory studies have been identified as low-value care practices that contribute to the rising cost of healthcare without improving quality or outcomes. There is a large body of evidence as well as recommendations from multiple professional organizations for providers to not order unnecessary daily or routine diagnostic studies. Rather, these should be ordered in an on-demand fashion as a response to a specific clinical query. Despite the strength of recommendations, practice remains variable across the U.S. The reasons for resistance to practice change as well as the most effective strategies for implementing sustainable change …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Home Point Of Care Inr Testing In Left Ventricular Assist Device Patients: A Clinical Evaluation, Emily Corsentino

DNP Projects

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design.

Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

Anxiety Screening In Children & Adolescents With Type 1 Diabetes Using The Gad-7 Tool, Allison B. Reynolds

DNP Projects

BACKGROUND: Children and adolescents with type 1 diabetes (T1DM) can encounter a variety of factors that affect proper management of their diabetes, including mental health. Youth with diabetes have significantly higher rates of depression, anxiety, and mental health problems compared to the general population. Anxiety is especially prevalent. PURPOSE: The objective of this project was to evaluate anxiety screening of children and adolescents with T1DM during their routine diabetes visits. Specifically, to assess for any trends in anxiety levels and patient characteristics including demographics, insulin regimen and A1C levels. METHODS: A cross- sectional, retrospective review of ambulatory electronic health records …

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 …

Evaluation Of A Spontaneous Breathing Trial Extubation Protocol On Patient Outcomes, Joshua Caldwell

DNP Projects

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between …

S.A.F.F.E.R. Airway Management: Evaluating The Effectiveness Of Checklist Implementation On Reducing Peri-Intubation Complications In An Air Medical Transport Service, Rachael M. Croley

DNP Projects

Background: Advanced airway management via endotracheal tube placement in the critically ill and injured is tenuous and presents a multitude of challenges that threaten patient safety. The potential for procedure-associated hypoxia, hypotension, and cardiac arrest during the peri-intubation period can be detrimental to overall patient outcomes. Purpose: The purpose of this project is to evaluate the effectiveness of the Standardized Airway Flow For Engineered Resuscitation (S.A.F.F.E.R.) checklist in reducing peri-intubation complications and provider perception of checklist implementation when performing advanced airway procedures.

Methods: A case-control analytical observational design study which included retrospective and prospective electronic medical record review to determine …

End-Of-Life Nursing Consortium To Improve The Gap In Palliative Care, Emma Kroger

DNP Projects

Abstract

Objective: The purpose of this project is to implement a palliative care education intervention with a pre- and post-survey to assess knowledge, emotional preparedness, and confidence in undergraduate nursing students at the University of Kentucky.

Aim: The aim of this project is to address the gap in palliative care education by increasing professional knowledge, emotional preparedness, and confidence levels in regards to palliative care of future nurses at the University of Kentucky.

Background: The terms “hospice” and “palliative” are often used interchangeably in the healthcare setting. However, palliative care focuses on symptom management in all stages of acute, chronic, …

Sustainability Of A Dnp Qi Project On Bmi Screening And Weight Management Documentation In Primary Care, Assal Moori Shir Mohammadi

DNP Projects

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited.

Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of …

Evaluating The Effect Of An Electronic Health Record Patient Portal On The Management Of Hypertension, Ashley Hall

DNP Projects

Background: Hypertension is the leading cause of cardiovascular disease and affects individuals globally, nationally, and locally. Consequences of uncontrolled hypertension include atherosclerosis, heart failure, stroke, and renal disease. The electronic health portal is a patient-specific, interactive tool that has been shown to promote adherence to provider recommendations and improve chronic disease management.

Purpose: The purpose of this project was to determine the effects of education via an electronic healthcare portal on the blood pressure management of adults at a primary care clinic in a small town in Kentucky.

Methods: This study was a one-group pre/post intervention designed to evaluate provider …

Population Assessment To Determine The Eligibility For Birth Center Care At University Of Kentucky Midwife Clinic, Dolores Polito

DNP Projects

Background: The COVID-19 crisis prompted patients to inquire about their options to avoid going to the hospital for birth. Outside of the hospital, birth center care has been identified as an evidence-based model for healthy women during pregnancy and birth, but it is not available in Kentucky.

Purpose The purpose of this study was to determine if there are women eligible for birth center care who have been part of a nurse midwifery service and given birth in a large, academic, tertiary care setting.

Methods: A retrospective chart review was used for this study. It involved a collection of …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Evaluating The Sustainability Of A Colorectal Cancer Screening Improvement Intervention, Kimberly Bastin

DNP Projects

Background: Sustainability is a domain or characteristic of quality in healthcare that is not just about what may be delivered to patients today, but what can continue to be delivered to patients in the long term. Evidenced based interventions and quality improvement (QI) initiatives have led to major advancements in health care and have become expected in every clinical setting. Despite the amount of QI work taking place, there is limited evaluation of the sustainability of initially successful quality improvement efforts and a lack of evidence supporting best strategies and measures to ensure that improvement of goals and outcomes are …

The Effect Of Multimethodological Emotional Intelligence Training On Emotional Intelligence Levels In Nurses At An Academic Medical Center, Chad Eldridge

DNP Projects

Background: Stress levels associated with the nursing career can be amplified by hostile social environments in the workplace, horizontal aggression, lack of leadership support, and poor communication. This can lead to poor retention rates and increased burnout.

Conversely, supportive work environments positively influence nursing sensitive quality indicators such as patient satisfaction, nosocomial infections, patient falls, pressure ulcers, and medication errors. Strong relationships enhance workplace social capital leading to an increased sense of belonging, strengthened mental health, and improved job satisfaction ratings.

Executive nurse leaders can promote an empowering environment dedicated to the physical, mental, and social well-being of their staff …

Improving Tobacco Cessation Counseling Documentation In The Primary Care Setting, Brittany Roher

DNP Projects

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation …

The Association Between Polygyny Statuses Of Currently Married And In-Union Women And Attitude Towards Intimate Partner Violence Against Women In Ghana, Dorcas Adewale, Nutifaga Eugene Yaw Dey, Kenneth Owusu Ansah, Henry Ofori Duah, Pascal Agbadi

College of Nursing Faculty Research and Publications

Polygyny is a common family structure in sub-Saharan African countries. Previous studies have documented that women in this family structure have favourable attitudes towards intimate partner violence (IPV). Nevertheless, there is limited recent research concerning this association in Ghana. This study sought to investigate the association between polygynous statuses and endorsement of IPV among Ghanaian reproductive-aged married and in-union women while controlling for covariates. The study used the nationally representative data from the 2017/2018 Ghana Multiple Indicator Cluster Survey. The sample comprised 7800 married/in-union women aged 15–49. Data analyses included tests of association and multivariable modelling using binary logistic …

The Efficacy And Safety Of Intraoperative Acute Normovolaemic Haemodilution In Complex Spine Surgery In A Private Surgical Facility In Ghana, Irene Wulff, Henry Ofori Duah, Audrey Oteng-Yeboah, Henry O. Tutu, Kwadwo P. Yankey, Aba S. Essel, Harry Akoto, Oheneba Boachie-Adjei

College of Nursing Faculty Research and Publications

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. 
Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in Ghana
Patients: Seventy-six patients who underwent complex spine deformity surgery
Interventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.
Main Outcome …

Systematic Review Of Family Engagement Interventions In Neonatal, Paediatric, And Adult Icus, Natalie S. Mcandrew, Teresa Jerofke-Owen, Christine A. Fortney, Breanna Hetland, Deena K. Costa, Jill L. Guttormson, Eric Harding

College of Nursing Faculty Research and Publications

Aims and objectives

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings.

Background

Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited.

Search strategy

Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well‐being of the patient or family in neonatal, paediatric, or adult …

New Neurologic Deficit And Recovery Rates In The Treatment Of Complex Pediatric Spine Deformities Exceeding 100 Degrees Or Treated By Vertebral Column Resection (Vcr), Oheneba Boachie-Adjei, Henry Ofori Duah, Kwadwo P. Yankey, Lawrence G. Lenke, Paul Sponseller, Daniel J. Sucato, Amer F. Samdani, Peter Newton, Suken Shah, Mark A. Erickson, Harry Akoto, Brenda Sides, Munish Gupta, Fox Pediatric Spinal Deformity Study

College of Nursing Faculty Research and Publications

Study design

Prospective multicenter international observational study.

Objective

To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery.

Summary of background data

The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis.

Method

The FOX pediatric …

Postoperative Pulmonary Complications In Complex Pediatric And Adult Spine Deformity: A Retrospective Review Of Consecutive Patients Treated At A Single Site In West Africa, Irene Wulff, Henry Ofori Duah, Henry O. Tutu, Gerhard Ofori-Amankwah, Kawdwo P. Yankey, Mabel Adobea Owiredu, Halima Bidemi Yahaya, Harry Akoto, Audrey Oteng-Yeboah, Oheneba Boachie-Adjei, Focos Spine Research Group

College of Nursing Faculty Research and Publications

Study Design: Retrospective review of consecutive series. Objectives: This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Methods: Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. Results: The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A …

Surgical Management Of Complex Post-Tuberculous Kyphosis Among African Patients: Clinical And Radiographic Outcomes For A Consecutive Series Treated At A Single Institution In West Africa, Ali M. Maziad, Owoicho Adogwa, Henry Ofori Duah, Kawdwo P. Yankey, Derrick Nyantakyi Owusu, Arthur Sackeyfio, Mabel Adobea Owiredu, Tyler Wilps, Gerhard Ofori-Amankwah, Franklin Coleman, Harry Akoto, Irene Wulff, Oheneba Boachie-Adjei, Focos Spine Research Group

College of Nursing Faculty Research and Publications

Study design Retrospective review of consecutive series. Objective To assess the clinical and radiographic outcomes after surgical management of post-tuberculous kyphosis. Summary of background data Post-tuberculous (TB) kyphosis can lead to progressive pulmonary and neurological deterioration. Surgery is indicated to decompress neural elements and correct the spine deformity. Although posterior vertebral column resection (PVCR) has been established as the treatment of choice for severe TB kyphosis, there is paucity of studies on the clinical outcomes among patients treated in West Africa. Methods Clinical and radiographic data of 57 patients (pts) who underwent surgical correction of post-TB kyphosis at a single …

If Not Otitis Externa...Then What?, Elizabeth A. Flasch, Sadia Ansari, Timothy Martin

College of Nursing Faculty Research and Publications

Ear pain is one of the most common presentations in urgent care, especially among pediatric patients. Further, acute otitis media (AOM) is the most common condition for which antibacterial agents are prescribed for children in the United States. Clinician visits make up 634 per 100 children during 2005-2006. It is imperative that clinicians differentiate AOM from new onset of otorrhea not due to acute otitis externa (AOE), the most common diagnoses made by clinicians with regional variations based on age and geography.1

The majority of AOE-related visits occur during the summer months (June through August); visits occur most commonly in …

Effectiveness Of Using A Simulation Combined With Online Learning Approach To Develop Discharge Teaching Skills, Marianne E. Weiss, Linda B. Piacentine, Lori Candela, Kathleen L. Bobay

College of Nursing Faculty Research and Publications

Background

Despite evidence of the impact of discharge teaching on patient outcomes, nursing students are poorly prepared in the pedagogical skills necessary for their role as patient and family educators in clinical practice. This study evaluated the effectiveness of simulation combined with online learning to improve nursing students’ discharge teaching skills.

Methods

The module included simulations before and after an online module on patient/family teaching for hospital discharge. Evaluation measures were student and independent rater evaluations using the Quality of Discharge Teaching Scale- Evaluation form (QDTS-E).

Results

Students (n=153) improved their performance on both content and delivery subscales of the …

When Pandemics Collide: The Impact Of Covid-19 On Childhood Obesity, Nancy T. Browne, Julia A. Snethen, Cindy Smith Greenberg, Marilyn Frenn, Jill F. Kilanowsky, Bonnie Gance-Cleveland, Pamela J. Burke, Linda Lewandowski

College of Nursing Faculty Research and Publications

• Children with obesity face increased biopsychosocial risks during COVID-19.

• Stress exacerbates inflammation and immune response in obesity and COVID-19.

• The COVID-19 pandemic has significantly interrupted children's daily routines.

• The health effects of the obesogenic environment are exacerbated by COVID-19.

• Access to timely, comprehensive healthcare is critical during COVID-19.

Youth And Parent Health-Related Quality Of Life And Association With Glycemic Outcomes In Preadolescents And Adolescents With Type 1 Diabetes, Joan P. Totka, Julia A. Snethen, Elizabeth D. Cox

College of Nursing Faculty Research and Publications

Introduction

We explored differences in Health-Related Quality of Life (HRQOL) and the youth's glycosylated hemoglobin (A1c) of preadolescent and adolescent youths with type 1 diabetes (T1D) by individual (age, sex, race) and family (socioeconomic status) factors, and associations between youths’ HRQOL, their parents’ HRQOL, and youth's A1c.

Method

Correlational secondary analysis of baseline data from a randomized controlled trial testing a developmental intervention for youths with T1D and their parents from two diabetes clinics.

Results

Better adolescent HRQOL was associated with better glycemic control. Better preadolescent HRQOL was associated with better parent HRQOL. Non-White adolescents had worse HRQOL than White …

An Engaged Community-Academic Partnership To Promote Positive Youth Development, Kristin Haglund, Angela Ortiz, Johanna De Los Santos, Mauricio Garnier-Villarreal, Ruth Ann Belknap

College of Nursing Faculty Research and Publications

In this paper, we discuss how we cultivated a sustainable community-academic partnership and describe how our community-based participatory research project, Bembé Drum and Dance, contributed to youth development. Bembé Drum and Dance is an Afro-Latino performing arts program based on the positive youth development theory. Thirteen children ages 9–13 participated in the ensemble. We used a multimethod descriptive design. Data were gathered using surveys, participant observation, and interviews. Increases in the Five Cs (competence, confidence, connection, character, and caring) were noted among youth, most notably in competence and confidence. Recognizing that the project belonged to the community and supporting this …

Intensive Care Unit Nurse: Could We Call A Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration In The Intensive Care Unit: The Struggle To Translate Evidence Into Practice, Natalie S. Mcandrew, Jill L. Guttormson, Sean Marks, Mary Rhodes, Jayshil Patel, Colleen Mccracken

College of Nursing Faculty Research and Publications

Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing …