<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> Nursing programs have embraced distance learning in their curricula, but discussion is ongoing about course assignments and grading criteria to increase examination scores in nursing distance learning courses. Because course examinations are a predictor of success on the postgraduate licensing examination (NCLEX-RN), the purpose of this study was to determine whether differences existed in student examination scores between nursing distance learning courses with and without points aligned to assignments. The theoretical framework was Knowles&rsquo;s theory of andragogy, which highlights adults&rsquo; motivation and self-direction to succeed. The quantitative causal comparative study included a convenience sample of 164 students to compare archival data of 4 examination scores between 2 nursing distance-learning courses. Data analysis included an independent-groups one-tailed <i> t</i> test. No significant differences were found between the 2 courses, suggesting that students do not achieve higher examination scores with course points aligned with course assignments. Nursing administrators and faculty in nursing programs with a distance learning component will benefit from the findings of this study. Findings may be used to draft, revise, and implement assignment criteria and point alignment for nursing distance learning courses. Social change will occur when nursing distance learning faculty use problem-solving and critical thinking assignments, including case studies, discussion boards, group assignments, concept mapping and NCLEX-RN style testing in each nursing distance learning course. Because point alignment to course assignments do not significantly improve examination scores, implementation of problem-solving and critical thinking assignments is necessary to promote student learning and examination success.</p>

<p> Waiters who serve alcoholic beverages at the majority of bars and restaurants in the United States are apt to serve alcohol to patrons who are visually intoxicated, notwithstanding laws prohibiting such service. Adverse effects of this practice include patron injuries, deaths, and law violations resulting in fines, incarceration, and lawsuits. Waiters not effectively trained to practice responsible alcohol retailing practices put patrons and others at risk of harm from alcohol related injuries or death. The problem is that the perceptions and attitudes of waiters who serve alcohol regarding self-learning as a strategy to prevent patron intoxication are not known; the purpose of this qualitative case study was to explore these perceptions. The study utilized in-depth semi-structured interviews with 23 waiters who utilized a self-learning tool about preventing patron intoxication. The waiters perceived that this self-learning tool was a good training solution, that it would be beneficial if implemented, that the tool could be used to improve public safety, and that its specific data on patron behavior and BAC levels were helpful. The participants also indicated that there would be challenges to implementing such a tool, including the waiters&rsquo; assertiveness and social aptness. As a whole, the researcher recommended that this tool be implemented across the country to improve waiter knowledge and patron safety. For future research, the researcher recommended that the study be expanded to include the perceptions of waiters across the country, the perceptions of those who underwent this training more than a year ago, and that the learning tool be adapted for different learning styles.</p>

<p> Estudiar c&oacute;mo las mujeres ejercen el liderazgo educativo es necesario para reconocer su influencia y poder de transformaci&oacute;n en los diversos escenarios laborales. Al analizar los contextos en los cuales se manifiesta su liderazgo se pueden delinear oportunidades para la adaptaci&oacute;n transdisciplinaria en el campo de la salud. </p><p> El enfoque de esta investigaci&oacute;n gir&oacute; en torno a la trayectoria profesional de Judith Danielsen de Lugo, una mujer, educadora en salud y profesora que ocup&oacute; m&uacute;ltiples puestos de liderazgo en Puerto Rico a partir de la d&eacute;cada de los 50. Con tal fin, se indag&oacute; respecto a: c&oacute;mo las acciones de su trayectoria profesional la caracterizan como l&iacute;der al ejercer las dimensiones del liderazgo educativo; los elementos hist&oacute;ricos, sociales y culturales que se desarrollaron a lo largo de su trayectoria profesional; sus contribuciones a la pr&aacute;ctica profesional de la Educaci&oacute;n en Salud y los desaf&iacute;os y cuestionamientos que se plantean con su liderazgo educativo para el desarrollo y el avance de la salud p&uacute;blica en Puerto Rico. </p><p> La investigaci&oacute;n se fundament&oacute; en los est&aacute;ndares de liderazgo educativo establecidos en el 2011 por el <i>Educational Leadership Constituent Council</i> [ELCC]. Estos consisten de las siguientes dimensiones: la did&aacute;ctica, la comunitaria, la administrativa, la pol&iacute;tica, la estrat&eacute;gica y la &eacute;tica. Se adopt&oacute; el m&eacute;todo cualitativo y un dise&ntilde;o biogr&aacute;fico para llevar a cabo la investigaci&oacute;n. Los hallazgos se desprenden del an&aacute;lisis de las entrevistas semi-estructuradas con personas que conocieron a Judith Danielsen de Lugo en vida y en contextos profesionales y del an&aacute;lisis de documentos. Posteriormente, se efectu&oacute; un an&aacute;lisis de contenido de la informaci&oacute;n obtenida. </p><p> Mediante esta investigaci&oacute;n se concluy&oacute; que Judith Danielsen de Lugo desarroll&oacute; acciones profesionales vinculadas a todas las dimensiones que componen el liderazgo educativo. Con sus ejecutorias se ejemplifica que el liderazgo educativo incide y puede ser ejercido exitosamente en m&uacute;ltiples contextos laborales y a nivel transdisciplinario. Por consiguiente, se brindan recomendaciones para la pr&aacute;ctica efectiva del liderazgo educativo y para el desarrollo de investigaciones futuras.</p>

<p> This study investigated the relationships between birth order, personality, mental toughness, and performance as they relate to trained collegiate athletes in the sports of Men's and Women's Basketball. There were three variables measured: personality, mental toughness, and performance. There were 238 participants in this study: 149 females and 89 males. All participants were NCAA collegiate basketball players. Participants' ages ranged from 18 to 24. Participants were administered the NEO Five Factor Inventory questionnaire to assess personality, while mental toughness was assessed using the Mental Toughness Scale (Madrigal &amp; Hamill, 2013). To measure performance, statistics were obtained from the 2013-14 collegiate regular season and computed into an overall performance score (Ramos-Villagrasa &amp; Navarro, 2013). Correlational analyses were conducted to determine the relationships between birth order, personality, mental toughness, performance score, and performance statistics. Based on past research, it was hypothesized that middleborns would score the highest in mental toughness while firstborns would score higher than lastborns (who will score the lowest). Hypotheses for the big five traits were as follows: Openness: middleborns would score the highest, followed by lastborns, then firstborns. Conscientiousness: firstborns would score the highest, then middleborns, then lastborns. Extroversion: middleborns would score the highest, then firstborns, and finally lastborns. Agreeableness: lastborns and middleborns would not differ, but would both score higher than firstborns. Neuroticism: lastborns would score highest, followed by firstborns, then middleborns. It was hypothesized that high conscientiousness and extroversion, along with low neuroticism would indicate higher mental toughness, while other big five traits would not factor into determining mental toughness. Higher mental toughness scores were hypothesized to result in higher performance scores. Middleborns were hypothesized to have the highest performance scores, followed by firstborns, and finally lastborns. The results of this study did not support any of the hypotheses regarding birth order. The results did support the hypothesis that high conscientiousness and extroversion, along with low neuroticism would predict higher mental toughness. The results also partially supported the hypothesis that higher mental toughness would yield higher performance scores.</p>

<p> This study took place at a Wake Technical Community College, a multi-campus institution in Raleigh, North Carolina. An evaluation of the return on investment in high fidelity simulation used by an associate degree of nursing program was conducted with valid and reliable instruments. The study demonstrated that comparable student outcomes are attainable when traditional clinical study is replaced with high fidelity simulation curriculum. Limited clinical practice space justifies the spread of simulation in college health science programs. North Carolina Administrative Code permits community colleges to replace 25% of traditional clinical with simulation. The lack of research on the cost effectiveness of high fidelity simulation has been cited as a barrier to its diffusion. Sound research demonstrating performance-based and patient-centric outcomes can provide governing bodies with evidence supporting the diffusion of high fidelity education.</p>

<p> The purpose of this study was to increase the knowledge level and change self-reported behavioral intent among a sample of healthcare providers regarding safe sleep messaging. From 1995 through 2015 in New York City, an average of one infant died every week from unsafe sleeping conditions. One agency in New York City experienced four unsafe sleep infant deaths within two months in 2010. In 2011, the city provided case managers with training on infant safety. Before this training, up to six sleep-related infant deaths were reported annually. The following year, one sleep-related infant death occurred. None occurred during the second year subsequent to the training. Current literature demonstrates healthcare providers have considerable influence on safe sleep messaging. This current study utilized a similar educational training designed for healthcare providers working in an urban health facility.</p><p> A single group pre/post-test quasi-experimental design was delivered to 23 participants. The design incorporated an online educational intervention in order to increase healthcare provider&rsquo;s knowledge level and change their self-reported behavioral intent to educate parents and caregivers on the importance of safe sleep practices. Data were gathered at pre-test and post-test to assess changes.</p><p> Final analysis, using a repeated measures general linear model, was carried out on data from the twenty-three participants who returned completed pre- and post-class surveys. There was a statistically significant change in the overall 13-item composite score reflecting knowledge level and change the self-reported behavioral intent from pretest (M=6.13, SD=2.78) to post-test (M=8.78, SD=3.79) at the p &lt;.001 level. These findings support current literature recommendations for healthcare providers to incorporate the safe sleep message into their practice. Nonetheless, supplementary research is needed to conclude whether these results coincide with communities elsewhere and to examine the issues regarding knowledge and behavioral intent regarding safe sleep messaging.</p>

<p> The high incidence of medical and surgical errors in U.S. hospitals and clinics affects patients&rsquo; safety. Not enough is known about the relationship between physician characteristics and medical error rates. The purpose of this quantitative correlational study was to examine the relationship between selected physician characteristics and surgical errors in U.S. hospitals. The ecological model was used to understand personal and systemic factors that might be related to the incidence of surgical errors. Archived data from the National Practitioner Data Bank database of physician surgical errors were analyzed using bivariate and multivariate logistic regression analyses. Independent variables included physicians&rsquo; home state, state of license, field of license, age group, and graduation year group. The dependent variable was surgical medical errors. Physicians&rsquo; field of license and state of license were significantly associated with surgical error. Findings contribute to the knowledge base regarding the relationship between physician characteristics and surgical medical errors, and findings may be used to improve patient safety and medical care.</p>

<p> Sexuality education in public schools in the United States excludes a large population of students. These exclusions are due to a long history of legal and economic battles, as well as the politicized nature of adolescent sexuality. This critical interpretive inquiry explored the long history of sexuality education through the lens of economics, law, and psychological paradigms and examined the way in which each of these lenses furthered the exclusion of nonheterosexual males in curricula. Using a framework comprised of critical feminist theory, critical pedagogy, and queer theory, this manuscript provides an understanding of the social structures of sexuality education and how they continue to marginalize students labeled as &ldquo;other.&rdquo; Using critical discourse analysis, this study reviewed legal and political documents, state and private curricula, and works in the sociology and psychology fields. </p><p> The outcomes of interpretive research do not lend themselves to specific answers, but to a greater understanding of the experience of marginalized individuals and the structures in place that keep this experience intact. Through a critical review of current programming initiatives, recommendations are made to continue moving toward a more gender- and identity-inclusive sexuality education curriculum. These recommendations, which are grounded in current legal and economic requirements, include teacher certification requirements, implementation of the Advocates for Youth 3Rs curriculum, utilization of a rights-based approach to program design, and adoption of national sexuality education by the Department of Health and Human Services, rather than by the Department of Education.</p>

<p> Heart failure readmissions place a significant financial burden on the healthcare system. Stakeholders of this system have utilized many approaches to reduce the number and costs of heart failure readmissions, without significant improvement. The purpose of this practice improvement project was to determine whether education on the financial impact associated with readmissions improved a patient&rsquo;s measured quality of life, encouraged adherence to a therapeutic regimen, and thereby reduced readmission rates in Medicare and Medicaid patients diagnosed with heart failure. Theoretical support is derived from the theory of self-care of chronic illness, which recognizes the complex self-care processes a patient with chronic illness negotiates. The project used a quantitative methodology with a pre-test/post-test design. A convenience sample was enrolled of 10 Medicare and Medicaid patients who had recurrent heart failure readmissions. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to collect pre/ post-intervention data which was then analyzed by two-tailed paired t-test. There was no statistically significant difference from the intervention to determine any impact on the participant&rsquo;s measured quality of life (<i>p</i> = .953; &alpha; = .05). However, none of the participants were readmitted during the 30 day period of this project. The findings indicate heart failure patients acknowledge their financial constraints but quality of life is not as impacted by finances as anticipated. Polypharmacy and uncertainty with managing daily regimens during symptom exacerbation were the greatest concerns. It is recommended that heart failure patient education should be persistent and individualized to address the patient&rsquo;s unique needs. </p><p>