Nursing Commons^™

Identification Of Early Markers Of Occult Tissue Hypoperfusion In Patients With Multiple Trauma Injuries, Kathryn M. Moore

Theses and Dissertations--Nursing

Injury is a global health problem and in the United States is the leading cause of death for persons aged 1 – 44 years. The primary causes of trauma related death are head injury and hemorrhage; hemorrhagic shock is difficult to recognize in the first hours after trauma. Identification of specific and optimal criteria upon which to base effective triage decisions for trauma patients has been an elusive goal for decades.

The purpose of this dissertation was to identify measures available in the prehospital phase of care and in the Emergency Department that should be included for a more comprehensive …

Hearts In The Balance: The Impact Of Desired Versus Received Social Support Needs On Persons With Heart Failure, Melanie P. Schrader

Theses and Dissertations--Nursing

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender.

The purpose of this dissertation was to determine if there are gender differences in …

Psychological Distress And Cardiac Disease, Tracey Vitori

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications …

A Randomized Controlled Trial Of Anesthesia Guided By Bis Vs. Standard Care And Effects On Cognition, Zohn Centimole

Theses and Dissertations--Nursing

Postoperative cognitive dysfunction (POCD) occurs frequently in individuals undergoing major surgery with general anesthesia. POCD adversely affects morbidity and health-related quality of life. Derived electroencephalographic (EEG) monitoring is utilized to guide the anesthesia provider in titration of volatile anesthetics. POCD has been associated volatile anesthetic neurotoxicity. EEG monitors are known to reduce a patient’s total cumulative dose exposure to volatile anesthetics. There is currently little evidence to support utilization of EEG monitors as a guide to reduce the incidence of POCD.

The purpose of this dissertation was to develop and test a technique of general anesthesia, delivered by anesthesia providers …

Competitive Food Policy Implementation In Kentucky Schools, Paula Gisler

Theses and Dissertations--Nursing

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of …

Co-Morbid Symptoms Of Depression And Anxiety And Bio-Behavioral Response To Stress In Patients With Heart Failure, Abdullah S. Alhurani

Theses and Dissertations--Nursing

Heart failure (HF) is a major public health problem throughout the world. It accounts for one death certificate among nine in the United States. Heart failure and sudden death combined are responsible for the largest number of deaths in America. The total costs of HF in the United States are estimated to be $37 billion each year. Despite substantial medical and surgical advances related to treatment of HF, it remains a very costly condition with high mortality and morbidity rates. Although biological factors contribute to high morbidity and mortality in HF, there are many unexplored psychosocial factors that also likely …

Exploring Test Anxiety In Bsn Nursing Students, Annette Marie Keller

Graduate Theses/Dissertations

Test anxiety is a phenomenon that was identified through research in the domains of education and psychology during the 1950s – 1960s. As test anxiety and its effects have been identified and addressed in nursing programs, the same treatment modalities have been applied without evidence that nursing students experience test anxiety in the same manner as other students. The purpose of this study was to describe test anxiety as experienced by BSN nursing students using the sequential explanatory mixed methods design in an effort to gain insight into the anxiety experience of nursing students. A sample of 73 junior and …

Facilitating Person-Centered Care For People With Intellectual And Developmental Disabilities, Laure Bertille Ndeutchoua

Walden Dissertations and Doctoral Studies

The patient centered care (PCC) model is recommended by the Institute of Medicine for individuals with intellectual and developmental disabilities. The problem identified in this quality improvement (QI) project was that PCC practices had not been included in the training curriculum within the organization. Framed within the plan-do-study-act model of QI, the purpose of this project was to develop an educational initiative on PCC that included a curriculum plan, a pretest/posttest, a protocol, a revision of the training policy, and an implementation and evaluation plan. Drawing upon the evidence-based literature and using a team approach, a curriculum plan on PCC …

Evaluation Of Central Line Insertion Bundle Practices In A Trauma/Surgical Intensive Care Unit, Margaret A. Moore

DNP Projects

Central venous catheters, also known as central lines, serve an essential role in critical care settings across the globe. However, these lines put patients at an increased risk for hospital-acquired infections in the form of central line-associated bloodstream infections (CLABSI). In an effort to prevent these infections, evidence-based nursing interventions in the form of insertion and maintenance bundle are undertaken. It is the focus of this practice inquiry project to evaluate nurse adherence to central line insertion bundles before and after implementation of routine reporting of adherence rates within an ICU. The evaluation will provide insight to the degree of …

Assessment Of Obesity Management In A Primary Care Setting, Katie Diffenderfer

DNP Projects

Purpose: The purpose of this study was to evaluate the current practices related to obesity in the primary care setting in University of Kentucky’s Healthcare System. The specific aims were to: 1) Determine the proportion of obese patients who had an ICD-9/10 diagnosis code for obesity, 2) Determine the proportion of obese patients who received interventions related to their obesity, 3) Determine whether obesity diagnosis and interventions varied based on patient demographics, and 4) Compare actual obesity interventions to those outlined in the clinical practice guidelines.

Methods: A retrospective chart review of male and female patients between the ages of …

Improving The Identification, Delivery Of Care, And Outcomes Of Hospital-Acquired Sepsis, Nicholas James Welker

DNP Projects

Sepsis syndromes that develop among a hospital inpatient population can be difficult to differentiate from other disease processes that share systemic inflammatory response syndromes. A bedside nurse-driven screening process was developed at Baptist Health Lexington to aid with early sepsis identification and foster prompt goal-directed therapy. This retrospective study of 26 patients identified over a 6 month period measures intensive care length of stay, mortality, and sepsis severity. Exclusion criteria were pregnancy and Do Not Resuscitate orders.

Screening compliance was poor at 23.1 percent (n=6). Complete compliance with goal directed therapy was 7.7 percent, though some components of therapy such …

Evaluating Provider Knowledge Of The Hpv Vaccine In Kentucky, Madeline A. Wilson

DNP Projects

According to the CDC, about 79 million Americans are currently infected with Human papillomavirus (HPV) with an additional 14 million infected annually, most of which are teenagers and young adults. Of these 14 million newly diagnosed cases, approximately 27,000 are diagnosed with a cancer caused by HPV. Kentucky’s HPV vaccination initiation and completion rates are below national estimates.

In 2013, Kentucky’s vaccine completion rate for girls age 13 to 17 was 26.8 percent compared to United States completion rate of 37.6 percent. Kentucky vaccine completion rate for boys age 13 to 17 was 19 percent compared to a United States …

Effect Of Enteral Feeding Timing In Septic Shock Patients, Shane D. Slone

DNP Projects

The goal of this research project was to identify the effect of the timing of enteral nutrition (EN) initiation timing on in-hospital mortality, ICU LOS and hospital LOS among patients with septic shock requiring norepinephrine. The study design was a cross-sectional analysis of retrospective electronic health record data. Patients who had received norepinephrine for septic shock were divided into early EN initiation (within 48 hours of ICU admission) and late EN initiation (Greater than or equal to 48 hours after ICU admission) groups. 680 subjects were included; 469 in the early group and 211 in the late group. Demographics, comorbidities, …

An Evaluation Of Childhood Overweight And Obesity Screening And Management In The Primary Care Setting, Stephanie Horning

DNP Projects

Background-In Kentucky, 19.7% of children ages 6-11 years old are obese ("Center for Disease Control and Prevention (CDC)," 2013). Approximately 50% of these children will become obese adults (Lazarou & Kouta, 2010). It is imperative that interventions are initiated to normalize weight in childhood to offset the long term physical and psychosocial risks associated with obesity.

Purpose-The purpose of this gap analysis was to evaluate the screening and management of childhood overweight and obesity in one of Norton’s healthcare primary care setting.

Methods-The electronic medical records of 35 children aged 10 to 11, who had BMIs > 85 …

Preceptor Progam For New Graduate Nurses, Althea Louise Webster

Walden Dissertations and Doctoral Studies

The transition from student to new graduate nurse is a difficult conversion. The challenges of the new graduate are the demanding workload, lack of clinical skills, and incivility from staff nurses and unfamiliar institutional cultures. More than 40% of new graduate nurses report making medication errors and feel unprepared to recognize and intervene in life-threatening complications that keep the patient safe from harm. Preceptorship is a clinical instructive model in which a professional relationship provides new graduate nurses with access to a clinical expert and role model within a preset time frame. The goal of the program was to evaluate …

An Obesity Needs Assessment With African American Adults In Central Virginia, Nicole Michelle Brown

Walden Dissertations and Doctoral Studies

The risk for obesity is especially prevalent among African American adults in Central Virginia, who have one of the highest rates of obesity in the nation. Efforts to address obesity in African American adults through diet, weight reduction, and increased physical activity in settings such as schools, worksites, healthcare organizations, churches, and communities, are among the initiatives of Healthy People 2020. The objective of this project, conducted with 91 African American adults (33 females and 58 males) in central Virginia, was to complete a community needs assessment that related to obesity among members of an African American church. The needs …

Nurse Practitioners' Attitudes Toward Nonpharmacological Interventions For Individuals Diagnosed With Clinical Depression, Joseph Ocran

Walden Dissertations and Doctoral Studies

Depression negatively impacts the American economy, and there is a shortage of physicians to provide treatment. Nurse practitioners are viable alternatives to provide high-quality treatment of depression. The project's purpose was to describe nurse practitioners' attitudes toward nonpharmacological interventions to treat clinical depression. Attitude theory provided the theoretical framework. The American Psychiatric Association's guidelines for treating major depression provided the conceptual framework. The project used a quantitative nonexperimental descriptive survey research design. A purposeful sample of 63 nurse practitioners was obtained from members of the American Association of Nurse Practitioners. Data were collected through an online survey that included questions …

Student Reflections Of Psychiatric/Mental Health: Using Journals And Creative Expressions, Melinda Hermanns, Barbara K. Haas

Nursing Faculty Publications and Presentations

Second semester undergraduate nursing students in their psychiatric/mental health clinical rotation express an array of emotions as they frequently view the setting as foreign. Two assignments, reflective journaling and a form of expression were incorporated into clinical to provide students an opportunity to reflect and convey their thoughts and feelings concerning their clinical experiences. Thematic analysis was used to analyze 10 journals and 10 art forms with a written description. Two content themes emerged: A Change in Perspective and Insight. Exemplars of the students’ perspectives are provided. As evidenced by students’ submissions, reflective journaling and creative expression can be an …

Attitudes Of Mental Health Care Professionals Toward The Provision Of Tobacco Dependence Treatment In The Transition To A Smoke-Free Mental Health Unit: An Exploratory Mixed Method Study., Jane Chambers

Theses

Smoking rates among people with a mental illness have not declined and remain a significant and preventable risk factor contributing to increased morbidity and reduced life expectancy. This study aimed to measure commitment, thus underlying attitude of mental health professionals towards provision of tobacco dependence treatment and enablers and barriers to implementing routine tobacco dependence treatment and smoke-free policy in an acute inpatient mental health setting.

A convenience sample of health professionals from an acute inpatient mental health unit were surveyed. This exploratory mixed method study included the Tobacco Treatment Commitment Scale (TTCS), smoking status, the Fagerstrom Test for Nicotine …

Empowering Midwives In The United Arab Emirates, Grace Edwards, Philidah Seda

School of Nursing & Midwifery, East Africa

Considerable efforts have been made to increase women’s access to quality midwifery care around the world. The World Health Organization (WHO) identifies midwives as ‘the most appropriate and cost effective healthcare professional to provide care in normal pregnancy and childbirth’ (WHO 2009). A growing body of evidence demonstrates that midwifery care is associated with more efficient use of resources and improved outcomes when provided by midwives who are educated, trained, licensed, and regulated. A recent Cochrane review revealed many benefits of midwifery care, including reduction in the use of regional analgesia, fewer episiotomies, fewer instrumental births, and women feeling more …