<p> This study explores the pervasiveness of job fatigue in Emergency Room nurses. It identifies factors that contribute to nurse burnout, including job dissatisfaction and workplace bullying, and explores strategies for assessing and reducing fatigue syndrome. As the literature suggests, there is a link between nurse burnout and patient safety. These findings are expected to help organizations develop strategies to reduce stress in the workplace and develop wellness programs. Upon using an interviewing process, the study found several themes that pointed to the key factors of increased ER nurse burnout, and provided several implications as to the changes that need to be made to improve the ER department environment. Some of the key findings included the need to hire more staff, make supervisors and management more approachable and available, and increasing support to ER nurses. Doing so will clearly help mitigate the problem of high stress levels among ER nurses and help to prevent the likelihood of burnout.</p>

<p>Caring relationships established between nurse managers and staff nurses promote positive work environments. However, research about staff nurses&rsquo; perceptions of nurse manager caring behaviors is limited. A 94-item Caring Assessment Tool-Administration (CAT-adm^&copy;) was developed to measure staff nurses&rsquo; perceptions of nurse managers&rsquo; caring behaviors; however, it lacked robust psychometric testing. This study was undertaken to establish the CAT-adm^&copy; survey as a reliable and valid tool to measure staff nurses&rsquo; perceptions of nurse managers&rsquo; caring behaviors. </p><p> The Quality-Caring Model^&reg; (QCM^&reg;) served as the theoretical framework. Specific aims were to 1) evaluate construct validity of the CAT-adm^&copy; survey by describing factors that account for variance in staff nurses' perceptions of nurse manager caring, 2) estimate internal consistency, and 3) conduct item reduction analysis. Four research questions were: 1) Will the factor structure of observed data fit an 8-factor solution? 2) What is the internal consistency reliability of the CAT- adm^&copy;? 3) What items can be reduced while maintaining an acceptable factor structure? and 4) What are staff nurses&rsquo; perceptions of nurse manager caring behaviors? </p><p> A cross-sectional descriptive design was used. A sample of 703 staff nurses from Midwestern, Midatlantic and Southern Regions of the U.S. completed the CAT-adm^&copy; survey electronically. Analysis included Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), univariate analysis, and descriptive statistics. CFA did not support an 8-factor solution. EFA supported a two-factor solution and demonstrated significant shared variance between the two factors. This shared variance supported a one-factor solution that could conceptually be labeled <i>Caring Behaviors</i>. Random selection reduced the scale to 25-items while maintaining a Cronbach&rsquo;s Alpha of .98. Using the new 25-item scale, the composite score mean of staff nurses&rsquo; perceptions of nurse manager caring behaviors indicated a moderately high level of caring. Suggestions for nursing administration, nurse manager practice, leadership, education and for future research were given. </p><p> The new 25-item CAT-adm^&copy; survey has acceptable reliability and validity. The 25-item CAT-adm^&copy; survey provides hospital administrators, nurse managers, and researchers with an instrument to collect valuable information about the caring behaviors used by nurse managers in relationship with staff nurses. </p>

<p> With a fast paced hectic environment, extensive work loads and decisions to make that affect countless lives, health administrators often experience high levels of stress. High stress levels can lead to burn out, negative work environment, poor inter-office relationships, reduced productivity and probable mental and emotional unease which can result in dismissal or quitting. </p><p> As employers are becoming increasingly aware that their businesses depend on the quality, efficiency and happiness of their employees, considerable efforts have been put into aiding them in reducing their stress and improving their well-being. Health-Hardiness Training Institute aims to utilize an all-encompassing approach that combines cognitive, behavioral and biophysical processes and change management training. With the tools taught by the Health-Hardiness Training Institute, healthcare managers will be better equipped to turn stressful circumstances into opportunities to thrive in.</p>

Saudi Arabia has witnessed rapid development in economic, cultural and social aspects since the discovery of oil a few decades ago. This development involves all the governmental sectors including national parks. The need for national parks has become inevitable. Asir National Park was established to provide recreational sites and to preserve the unique natural and cultural features of the park. Research evaluated the impact of human activities of logging, grazing, hunting, land development and elimination and negligence of traditional architecture on Asir National Park features. A questionnaire, interviews and field observations were conducted to investigate the impact of these activities on Asir National Park. Asir National Park suffers a great deal of pressures from human activities. The local population depends on the park as their source of livelihood and as a traditional habit. The study illustrates the most affected zones where action should be taken to preserve park features.

<p> Healthcare is in a state of continuous change. The estimated failure rates for organizational change of 70% to 80% also exist within American hospitals and physician offices. Change research suggests that failure is not found in the process, but in the lack of consideration for the people during the change. A best practice approach to changing healthcare practices is the redesign of care teams. The transition to high-performing care teams requires renewed skills and behaviors, the willingness and ability to continuously change, and the belief that it can be successful. Self-efficacy, the belief in one&rsquo;s abilities to perform a specific task or action, and group-efficacy, the belief in one&rsquo;s group&rsquo;s abilities to perform a specific task or action, have been used in research on individual health behaviors, and have not been studied with team work in the primary care setting. This cross-sectional, quantitative study explores the relationship between self-efficacy and group-efficacy, and their relationship to organizational change capacity in a primary care setting. Individuals with higher self-efficacy are likely to expend effort and persist at a task, and tolerate with adverse experiences. Teams of individuals with higher group-efficacy exhibit increased effort and perseverance to the group task, including a higher level of resilience to group experienced adversity. Both self-efficacy and group-efficacy are generative, providing opportunity to develop these as capabilities within primary care teams. Exploring these relationships provides insights for leveraging the limited and valued resources of primary healthcare in achieving successful change.</p>

<p> Hospital performance metrics are an indicator of leadership performance. However, there is inadequate research on whether physician or nonphysician chief executive officers (CEOs) perform better in the U.S. hospitals. The purpose of this study was to examine which type of leaders is better. Leadership trait, situational leadership, and leadership behavior theories constituted the theoretical foundation. The key research question examined the relationship between a hospital&rsquo;s outcomes, which in this study, included hospital net income, patient experience ratings, and mortality rates, and the type of CEO in that hospital: physician or non-physician. A quantitative, causal comparative design was used to answer this question. Three hypotheses were tested using multivariate analysis of variance. The dependent variable was hospital outcomes: hospital net income, patient experience ratings, and mortality rates. The independent variable was the type of hospital CEO: physician and nonphysician. Datasets from 2014-2015 were used, which were publically available on the websites of U.S. based hospitals, research organizations, and journals. A sample of 60 hospitals was drawn from U.S. non-federal, short-term, acute care hospitals, based on number of staffed beds (<i>n</i> = 60). No significant differences were found between nonphysician and physician CEOs on hospitals&rsquo; net income (<i>p</i> = .911), patient experience ratings <i>(p</i> = .166), or mortality rates (<i> p</i> = .636). Thus, the null hypotheses were retained. Findings suggest that physician and non-physician CEOs may produce similar outcomes in the hospitals they lead. Based on these findings, hospital boards can view CEO applicants equally when considering whom to hire and understanding U.S. hospital leadership.</p>

<p> Chronic disease plagues nearly 133 million Americans, approximately 45% of the population. Several techniques have arise to address this issue other than traditional medicine and alternative medicine is making substantial strides. With the gaining popularity of functional medicine (a subset), the growing need for alternative methods is apparent, especially in the city of Long Beach, California. Mint Health Functional Medicine Clinic aims to treat the source of chronic diseases within the adult population of Long Beach, rather than simply relieving symptoms. Institute of Functional Medicine board certified physicians will do so through a monthly membership, so patients may have a quality consultation and constant access to their providers and support staff for progress follow-up and questions. The mission is to help eliminate chronic disease incidence within the residents of Long Beach, in a non-traditional way.</p>

<p> High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities.</p>

<p> US asthma prevalence increased by five million in the last decade and health care spending for the disease increased from $53 billion to $56 billion. Children are more likely than adults to have an asthma attack and its estimated that 1-in-10 youth has asthma. Despite initiatives to promote adherence to practice guidelines, childhood asthma emergency room) visits, and hospitalizations remain steady while the number of asthma deaths have increased over a 17-year period. Preliminary studies find the majority of adolescents prefer smartphones as a means of education and guidance. A modified Technology Acceptance Model (TAM) survey was comprised of 15 statements that explored providers&rsquo; acceptance of smartphone applications (apps) as an adjunct strategy for management of asthma among adolescents in the outpatient setting. Current insight in adolescent asthma demonstrates multifaceted disparities in care stemming from biological and developmental transitions unique to adolescents. The quantitative, descriptive design of the project assessed two factors integral to the TAM related to provider acceptance and perception: 1) Perceived use (PU), and 2) Perceived ease of use (PEU). The survey sample consisted of 18 providers. Overwhelmingly, the majority of providers surveyed favored use of a smartphone app for adolescent asthma and believed apps had the potential to improve the quality of adolescent asthma management. Most participants agreed; smartphone apps might help accomplish benchmarks for adolescent asthma management. Numerous studies demonstrate adolescents&rsquo; preference for technological interventions for self-management of their asthma symptoms. The survey results reinforce the willingness of providers to accept asthma smartphone apps as a potential adjunct management strategy for adolescent asthma. Additional studies involving providers are required to further explore provider attitudes of acceptance and rejection relating to smartphone apps for chronic health conditions. </p>

<p> A nurse's use of evidence-based practice (EBP) is imperative if the goal is for quality and safe care that is safe. Patient quality care is directly correlated to the degree to which hospital nurses are active participants in decision making. Nurses possess the skills that should promote their presence in decision-making forums using evidence-based strategies. Both evidence-based practice (EBP) and participatory Shared Governance Models, independently, have been found to promote improved patient outcomes (Kramer &amp; Schmalenberg, 2004). Shared governance models include formal councils that address recruitment and retention, policy and procedure development, professional practice challenges, quality improvement initiatives and research opportunities. A nurses' Decisional Involvement (DI) and participation in a Shared Governance Council (SGC) may serve as a venue to best utilize Evidenced-Based Practice (EBP) skills with the overall goal of improving care outcomes. </p><p> The aim of this research was to determine the relationship of staff nurse engagement, DI and its impact on participation in a SGC and the relationship to EBP. A quantitative non-experimental correlational, on-line survey design was utilized. A total of 156 staff nurses from two (2) Magnet^&reg; recognized hospitals in the Northeastern region of the United States was studied.</p><p> Results revealed a significant positive relationship between participation in a SGC and staff nurse engagement, actual DI, age, years of experience and professional certification. Additionally, nurses that participated in a SGC had a significantly higher self-reported EBP implementation. Exploratory logistic analysis revealed EBP implementation, staff nurse engagement, full time work status and participation in IDRs were significant predictors of participation in a SGC. A multiple regression analysis resulted in EBP belief, staff nurse engagement, and participation in a SGC explaining 34.5% of the variability of predicting EBP implementation. The findings give beginning support to the importance of creating an infrastructure that fosters staff nurse engagement and participation in a SGC to promote EBP implementation.</p>