Nursing Commons^™

A Standardized Approach To Awakening And Breathing Trials, Maureen Awuor Abongo

Dissertations

Abstract

Problem: Mechanical ventilation with sedation, are crucial co-therapies for the critically ill. Risks of both, known as Ventilator Associated Events( VAEs), can worsen outcomes. Performing Spontaneous Awakening Trials (SATs), with Spontaneous Breathing Trials(SBTs), is a targeted evidence-based strategy in reducing VAE rates. The Intensive Care Unit (ICU) lacked a coordinated approach to operationalizing SATs with SBTs.

Methods: An observational retrospective study involving a review of VAE and patient data for corresponding months in years before, and after an improvement strategy application, and making comparisons. The multimodal strategy includes filling out checklists outlining criteria for performing a SAT with …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Using Debriefing For Meaningful Learning With Screen-Based Simulation, Kristina Dreifuerst, Cynthia S. Bradley, Brandon K. Johnson

College of Nursing Faculty Research and Publications

Background

COVID-19 has led to increased use of screen-based simulation. However, the importance of including a robust debriefing as a component of these simulations is often neglected.

Problem

Failing to include debriefing with screen-based simulation could negatively impact student learning outcomes.

Approach

Debriefing, including recollection, discussion to reveal understanding, feedback and reflection, is a process of helping learners make sense of learned content and knowledge as it is applied to the patient care experience. Debriefing for Meaningful Learning (DML) is an evidence-based method derived from theory, which can be easily incorporated into screen-based simulation to augment the clinical learning experience. …

Mental Health Concerns Of Frontline Registered Nurses Associated With The Covid-19 Pandemic, Julie Ingle

Dissertations

Problem

COVID-19 caused local healthcare facilities to admit patients with COVID-19 at increasing rates, critically overloading healthcare system resources. Caregiver-related stress associated with the COVID-19 pandemic placed frontline registered nurses (RNs) at risk for mental health consequences (Havlioglu & Demir, 2020; Shechter et al.,2020).

Methods

This quality improvement project used a descriptive design to administer a collection of validated instruments assessing anxiety, depression, posttraumatic stress disorder (PTSD), and demographics. A purposive sample of RNs were recruited from the COVID-19 units in a local hospital, and the survey was distributed via email.

Results

During the implementation period (April 4, 2021-May 15, …

Proactive Text Messaging For Public Health Surveillance During The Covid-19 Pandemic, Daria Kester

Dissertations

Problem

The Department of Public Health (DPH) of a suburban Midwestern county considers surveillance and control of COVID-19 to be sub-optimal, resulting in part from difficulties with completing case and contact interviews.

Methods

To increase the success rate of case investigation, proactive messaging using short message media (SMS) alerts is used in a quality improvement initiative based on the PDSA framework. Participants are sent text message alerts prior to receiving a call from a DPH case investigator. Results are recorded in a statewide database.

Results

Individuals who received text messages prior to receiving a case investigation interview phone call were …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

Attitudes Toward Sars-Cov-2 In Frontline Healthcare Workers And First Responders, Michelle Tiffany Arrington

Dissertations

Problem: To date, little evidence exists to understand attitudes of SARS-CoV-2 in frontline healthcare workers (HCW) and first responders (FR), related to best practices in mitigating virus spread. The purpose of this project was to assess attitudes toward COVID-19 in young adults, ages 18-44 years old, who are frontline workers related to their adherence to PPE guidelines, social distancing, hand hygiene, community exposures, and vaccinations.

Methods: A descriptive survey design using five-point Likert scale questions and 26 open-ended questions and was implemented one-year after onset of the pandemic. A purposive sample working in a large, urban, Midwest metropolitan area was …

Mental Health Effects Of The Covid-19 Pandemic On Older Adults, Elizabeth Kerr

Dissertations

Problem: Significant psychological effects such as anxiety, depression, stress, and loneliness are shown to affect the older adult population, aged 65 years and older. The social isolation and disconnectedness related to the COVID-19 pandemic potentially worsens anxious and depressive feelings, increasing the risk for adverse outcomes in the high-risk older adult population. This project aimed to identify older adults at risk for acute, situational mental health issues associated with the pandemic.

Methods: A descriptive study design was used. Telephone interviews were conducted to explore effects of the COVID-19 pandemic on mental health responses in older adults. A convenience sample …

Youth Sports In A Pandemic Age, Robert Bohnert

Dissertations

Abstract

Problem: Youth sporting events is a public health concern as infected youth with coronavirus disease 2019 may unknowingly spread the virus, as many show little to no symptoms (Zimmerman & Nigel, 2020). This project aimed to identify level of adherence to posted Youth Sports Guidelines, which were designed to mitigate the spread of virus at youth sporting events.

Methods: An observational descriptive design was utilized. Two observers tallied guideline violations by participants and spectators at six high-contact (basketball) and six low-contact (swimming) public high school youth sporting events.

Results: A total of 726 youth sport participants and 139 …

Social Wellbeing And Quality Of Life Of People Living With Disorders Of Sex Development And Sex Re-Assignment In Nigeria: A Qualitative Phenomenological Study, Abdurrahman Muhammad Sani, Ismaila Arzika Mungadi, Ismi Arif Ismail, Mohd Mursyid Arshad, Kim Lam Soh

The Qualitative Report

Disorders of sex development is a complex interaction between biological, psychological, social, and cultural factors, making it necessary for the multidisciplinary team to decide on the individualized patient basis. The characteristics of the individual patient, family and the social background are taken into consideration in order to derive maximum benefit. In developing countries, many people living with disorders of sex development faced serious psychological and social traumas such as marginalization, rejection, isolation, feeling of sadness, feeling of uncertainty, and feeling of shame. Therefore, this study explores the social wellbeing and quality of life of people with disorders of sex development …

Covid-19 And The Impact On Rural And Black Church Congregants: Results Of The C-M-C Project, Lovoria B. Williams, Anita F. Fernander, Tofial Azam, Maria L. Gomez, Junghee Kang, Cassidy L. Moody, Hannah Bowman, Nancy E. Schoenberg

Nursing Faculty Publications

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory …

Health Disparities And Covid-19 Pandemic: Increasing Clinical Research Participation Among African Americans, Kashica J. Webber-Ritchey, Abbi D. Lane-Cordova

Journal of Health Disparities Research and Practice

Health disparities in African Americans is a persistent issue. Higher rates and severity of the novel coronavirus-19 [COVID-19] among African Americans only widens health disparities. Effective COVID-19 treatment options are imperative, requiring representation of African Americans in clinical research. However, low participation and under-representation of African Americans is complex in nature. This article describes health disparities, the impact of COVID-19, and participation in clinical research among African Americans. We offer strategies for researchers to enhance the inclusion of African Americans. We also offer strategies in conducting clinical research during COVID-19.

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

Doctor of Nursing Practice Papers

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

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

Stream Sediment Monitoring In Morehead Kentucky, Kristopher Krolikowski, Jen O'Keefe

2021 Celebration of Student Scholarship - Oral Presentations

Sediment loads in stream systems play a big role in how overall runoff behaves. Streams naturally transport sediment at various ratios depending on precipitation. When vegetation is removed in upstream environments, sediment loads on streams increase. Sudden increases of sediments in streams can cause many issues, such as flooding or stream re-direction. In Morehead, KY, large-scale logging operations on the ridge above Knapp Avenue and on the ridge above the north end of Allen Avenue have caused increased sediment load in a small stream called Oxley Branch. This stream flows south parallel to Knapp Avenue and along the eastern property …

Efficacy Of Programmed Intermittent Epidural Boluses For Labor Analgesia, Keisha Joyce

Nurse Anesthesia Student Research Posters

Programmed intermittent epidural bolus (PIEB) is an automated method of administering epidural local analgesia with or without opioids. Fixed boluses at scheduled intervals can be utilized as an alternative to a continuous epidural infusion (CEI) alone or as a background administration with a PCEA technique. The purpose of this research project is to provide education regarding PIEB and investigate the benefits and challenges of implementing this new technique into practice.

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

Doctor of Nursing Practice Papers

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

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

Doctor of Nursing Practice Papers

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

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

Doctor of Nursing Practice Papers

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

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

Doctor of Nursing Practice Papers

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

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

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

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

Doctor of Nursing Practice Papers

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

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

Methods: Mental health staff …

Type I And Type Ii Diabetes Mellitus: Pathophysiology And Nursing Anesthesia Considerations, Megan Przybysz

Nursing Student Class Projects (Formerly MSN)

Diabetes Mellitus is prevalent across the globe, affecting more than 400 million people worldwide (Ogurtsova, 2017). Due to the high incidence of those affected, all healthcare providers will be responsible for the care of a diabetic patient, making it imperative that providers have a working knowledge of the pathophysiology of diabetes. This poster discusses the pathophysiology of type I and type II diabetes mellitus, as well as diabetes signs and symptoms and diagnostic criteria. There is also an examination of comorbidities associated with diabetes and how the pathophysiology of diabetes assists in the development of conditions such as autonomic neuropathy, …

Coccidioidomycosis (Valley Fever) Awareness, Kelly Dzialowski

Nursing Student Class Projects (Formerly MSN)

The overall purpose of this poster is to describe the fungal infection, Coccidioidomycosis, and bring awareness to this infection. The poster describes the history of the infection, pathophysiology, risk factors, and clinical presentation. Diagnosis, treatment, and complications of coccidioidomycosis are also addressed. The poster discusses the implications for nursing practice, information about the search for a vaccine, and comparisons of coccidioidomycosis and Covid-19. Finally, the conclusion discusses the key points within the poster and the importance of prompt and accurate diagnosis.

Cardiogenic Shock Pathophysiology, Bradley Closson

Nursing Student Class Projects (Formerly MSN)

Information detailing cardiogenic shock was developed into poster form. The definition and significance of cardiogenic shock were discussed. Pathophysiology and the importance of pathophysiological concepts of cardiogenic shock included. Treatment interventions and the implications for nursing care presented.

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

Doctor of Nursing Practice Papers

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

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

Doctor of Nursing Practice Papers

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

Acute Respiratory Distress Syndrome, Eric Boyer

Nursing Student Class Projects (Formerly MSN)

Acute respiratory distress syndrome (ARDS) is an inflammatory response that is accompanied by poor diffusion of oxygen across the alveolar-capillary membrane. Unfortunately, ARDS has a high mortality rate close to 43% when suffering from serve ARDS. ARDS cases in the United States range from 64.2 to 78.9 cases per 100,000 people. Early symptoms of ARDS are subtle and are common in many diseases processes. Such symptoms are tachycardia, tachypnea, and dyspnea. Late symptoms are right-sided heart failure, pulmonary hypertension, hypercarbia, and cyanosis. Common triggers of ARDS are sepsis, pulmonary insults such as pneumonia, pancreatitis, trauma, drug overdoses, and blood transfusions. …

Disseminated Intravascular Coagulation (Dic), Kahl Knapke

Nursing Student Class Projects (Formerly MSN)

Disseminated intravascular coagulation (DIC) is a rare medical emergency that can have profound and potentially life-threatening conditions. DIC has a hypercoagulability phase that simultaneously leads to a hypocoagulability phase due to depletion of clotting factors. DIC is secondary complication stemming from an underlying condition. Trauma, malignancy, severe infection, reaction to a transfusion, obstetric complications, etc. are a few conditions that are commonly linked to DIC. The primary method of treatment is early identification and resolving the underlying medical condition. The management of DIC requires nursing and medical staff with keen knowledge and understanding of precursor signs of DIC and the …

Gastroesophageal Reflux Disease, Kathryn Bland

Nursing Student Class Projects (Formerly MSN)

Gastroesophageal Reflux Disease is a very common disease, affecting at least 10% of people worldwide. Symptoms of the disease range from chest pain and chronic cough to acid reflux and laryngitis. It is a multifactorial disease. It can be caused by problems with the valve at the esophagogastric junction or improper pressure gradients between the stomach and esophagus. It can also be exacerbated by obesity, delayed gastric emptying and a hiatal sliding hernia. Nurses caring for these patients need to teach about prevention and treatment for the disease. Without treatment the disease can progress to Barrett’s esophagus and esophageal adenocarcinoma. …

Disseminated Intravascular Coagulation, Kahl Knapke

Nursing Student Class Projects (Formerly MSN)

Disseminated intravascular coagulation (DIC) is a rare medical emergency that can have profound and potentially life-threatening conditions. DIC has a hypercoagulability phase that simultaneously leads to a hypocoagulability phase due to depletion of clotting factors. DIC is a secondary complication stemming from an underlying condition. Trauma, malignancy, severe infection, reaction to a transfusion, obstetric complications, etc. are a few conditions that are commonly linked to DIC. The primary method of treatment is early identification and resolving the underlying medical condition. The management of DIC requires nursing and medical staff with keen knowledge and understanding of precursor signs of DIC and …

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

Doctor of Nursing Practice Papers

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