<p> More than one third of all Americans are obese, causing a myriad of health ailments that put excessive strains upon the U.S. healthcare system. It is estimated that medical costs attributed to these health complications such as heart disease, stroke and diabetes, are nearly $150 billion dollars. These statistics, along with the increasing amount of older adults due to the aging Baby Boomer generation, will only continue to increase these costs. Fitness initiatives are instrumental in lowering the rates of obesity and increasing overall health and wellness for these individuals. </p><p> Long Beach Mobile Fitness, LLC will provide on-site athletic training services to assisted living communities and business districts that provide adapted CrossFit techniques, along with other athletic training programming to clients within the City of Long Beach and the surrounding areas. Low start-up and monthly costs, along with the ease of transporting a mobile gym facility, allows Long Beach Mobile Fitness, LLC the flexibility to provide fitness programming to a wide range of clientele with ease.</p><p>

<p>ABSTRACT The current increase in the population of older adults has created a high demand for more informal caregivers. Informal caregivers complain of many problems in providing care including psychological stresses and anxieties, as well as physical, emotional, financial, and other social burdens. The purpose of this phenomenological study was to understand and describe the essence of the lived experiences of informal caregivers. The study was also intended to make health professionals and policy makers aware of such problems. The study adopted a qualitative methodology and a hermeneutical phenomenological design. Purposeful sampling was used in selecting participants with informal caregiving experience. Eleven informal caregivers were interviewed via telephone for data collection. Data was analyzed using Nvivo 11 for the identification and description of patterns and themes from the perspectives of participants. Eight themes that emerged from data analysis were: (a) Gender, many females engaging in caregiving, (b) Caregivers feeling stressful, (c) Love played a crucial role in caregiving, (d) Need for training for caregivers, (e) Being cared for by loved family members, (f) Impacts on job performance, (g) Living arrangements between caregiver and care receiver, and (h) Lack of support from family, community or state agencies. The conclusions focused on the need for support to informal caregivers such as caregiver training, adult day care services, care leave or respite care, increased access to services, care payments, and expansion in the informal caregiver workforce.

<p> The rigors of labor and childbirth are incredibly demanding on the mother's body physically, emotionally, and psychology. Most new mothers deliver in a hospital setting where they are discharged after approximately two days. However, the mother's health and well-being does not improve that drastically within those two days of post-delivery recovery. Common struggles that new mothers face include postpartum depression, intimate partner violence, mood and body changes, as well as nutrition and sleep deprivation. Therefore, it is not only important to be attentive to the newborn but to the mother's recuperation as she adjusts to postnatal life. While there are many options for new mothers to deliver their baby through hospitals or birth centers, there is a lack of postnatal care facilities in comparison. </p><p> Pamper Partum, LLC is a private company with an organizational mission to offer quality service and care that eases the transition to motherhood, to empower a new mother through education and community support, and to reduce any preventable risks associated with the postnatal period. Pamper Partum, LLC is an all-inclusive healthcare facility that provides services such as breastfeeding assistance, peer-support groups, private counseling, nutrition, general health care, and 24/7 infant monitoring in a state-of-the-art nursery. Pamper Partum, LLC will seek to be the first postnatal care facility that serves Orange County.</p><p>

<p> The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner&rsquo;s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.</p><p>

<p> Access to safe abortion care has been linked to better maternal and child health outcomes (Sedgh et al., 2012) and identified as essential for advancing women&rsquo;s economic and social equality (Lang, 2013; Bengsch, 2015). Around the world, nurses, including nurse practitioners (NPs) and certified nurse midwives (CNMs), are integral members of the health care teams that provide care to women considering or electing to have an abortion. Evidence supports NPs and CNMs as safe and effective providers of comprehensive early abortion care, and acceptable to patients (Barnard, Kim, Park, &amp; Ngo, 2015; Kallner et al., 2015; Weitz et al., 2013). </p><p> Currently in the United States (US), almost one million women have an induced abortion each year (Jones &amp; Jerman, 2017). National abortion data reveal significant disparities in rates, and inequities in access (Jerman, Jones, &amp; Onda, 2016). An inconsistent legal and regulatory landscape precludes NPs and CNMs from providing comprehensive abortion care in many states, including some where there are few providers. Vermont and New Hampshire comprise two of the four states where laws and practice regulations allow NPs and CNMs to perform aspiration abortion, and across New England. These advanced practice nurses (APRNs) are extensively involved in providing and managing the care of women undergoing medication abortion. </p><p> Little literature describes nurses&rsquo; experiences providing comprehensive early abortion care around the world, including in the US. The aim of this qualitative, exploratory, descriptive research study was to explore the experiences of NPs and CNMs who provide comprehensive early abortion care in New England. Data were collected through in-person individual interviews with seven NPs and one NP/CNM. Providing comprehensive early abortion care was generally a positive experience for most participants, though it did include challenges. Critical influences to becoming an NP or CNM who provided comprehensive early abortion care included the era in which participants came of age, values of their family of origin, exposure to feminism, reproductive rights and social justice during emerging adulthood, having a role model or mentor, and a personal experience of having an abortion were. Support at every level from interpersonal to societal was found to be a key enabling or constraining factor. Laws and regulations at the societal level were also noted to facilitate or impede abortion care provision by NPs and CNMs in the study. Finally, participants offered words of wisdom to others considering providing comprehensive early abortion care that ranged from clinical pearls to inspirational statements. They were universally encouraging in recommending this as a service to incorporate into clinical practice. This study has a number of implications for the future including the need for further research on NPs and CNMs experiences providing early abortion care in other regions of the US, and to remove state legislative and regulations that constrain practice for clinicians in this area of reproductive health care.</p><p>

<p> Healthcare management is an industry where skill sets are incremental, and Registered Nurses (RNs) must gain their clinical skills before they develop their management skills. Professional training for management-bound RNs seldom comprises more than a few disjointed days or weeklong development seminars, which is valuable but inadequate. The purpose of this original basic qualitative study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, was to explore the lived experiences of staff RNs who transitioned into the Clinical Nursing Supervisor (Nurse Manager) role within a small rural community hospital in North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: a lack of orientation to the new role; inconsistent expectations of the new role; the benefits of a formal program or structured orientation for the new role, and a need to focus the hospital administration on formal leadership orientation and succession planning. The evidence from this original basic qualitative study aligns with the published literature regarding the transition from a staff RN role into a nursing leadership role and supports making a proposal to the hospital&rsquo;s administration for a systems-oriented Clinical Nursing Supervisor training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced Clinical Nursing Supervisors, would ensure a smoother transition from the staff RN role into a Clinical Nursing Supervisor role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.</p><p>

No description available.

Individuals with heart failure (HF) are often readmitted within 30 days of discharge from the hospital. Telehealth has been developed to help manage HF during this critical period. However, association of telehealth with improved HF outcomes is still unclear. There is a need to identify the patients who benefit most from telehealth and explore factors that work in conjunction with telehealth to improve HF outcomes. Therefore the purpose of this study was to explore the patient characteristic factors that impact health status and healthcare utilization outcomes of patients with HF who use telehealth in a homecare setting. A descriptive, correlational study design using retrospective chart review was employed. The sample comprised Medicare patients admitted to a New England homecare agency, with HF as a diagnosis and had used telehealth from 2008 to 2010. OASIS and electronic documentation at the homecare agency served as data sources. Descriptive statistics, logistic and multiple regression analysis were used to analyze association of patient demographic, psychosocial status, and disease characteristics with HF outcomes of patients on telehealth. The sample size was 403, of whom 70% were over 75 years of age, 55% were female, and 94% were Caucasian. Number of nursing contacts ranged 1 to 26 with a median value of 10. There were 118 (29.3%) all-cause readmissions, 76 cardiac-related hospitalizations (18.9%), 17 cases with mortality (4.2%) and 52 (12.7%) abrupt terminations of telehealth. For patients with HF on telehealth, patient characteristics such as: anxiety, high number of medications, acute cardiac events, musculoskeletal, psychiatric and anemia type of co-morbidity were associated with high nursing utilization patterns; dyspnea, high number of medications, obesity, ACEI/ARB and beta-blockers were associated with hospitalizations; and renal, psychiatric and cancer type of co-morbidities and female gender were associated with unplanned termination of telehealth. Abrupt termination of telehealth was also found to be correlated with hospitalizations. The findings of this study contribute to our understanding of healthcare utilization by patients with heart failure on telehealth.

No description available.

<p> When the HITECH Act of 2009 set mandates for the transition from paper to electronic health records (EHRs), few realized the far-reaching impact this technological change would have on the entire healthcare environment. This dissertation examines the many facets of this adoption process by exploring perceptions, responses, and reactions of physicians and patients alike as they navigate through this transformative &ldquo;medicological environment.&rdquo; Characterized by influences from legal, political, governmental, medical, social, geographical, economic, and technological factors, this multi-faceted space reveals how a new medium for communication&mdash;the electronic message within secured health portals&mdash;transforms the way in which healthcare is managed and utilized today. </p><p> Multiple methods of observation, including oral histories, surveys, critical incident reports, and content analyses of data mined messages, together reveal the many challenges faced by patients and healthcare professionals alike as they attempt to adapt to this change while still maintaining (or improving upon) primary healthcare needs. As demonstrated by the varied responses from those living in rural and urban areas, it was found that each population approached the transition process from different vantage points. The early-adopting, urban physicians provided patient online communication simply because they felt patients expected it while rural physicians tended to resist the process, arguing that patients were media illiterate, lacked Internet access, and preferred face-to-face interactions. Others cited implementation costs and personnel training issues as a deterring factor. This provides insight into how such a new medium can affect user perceptions about online healthcare, including physician availability, online relationship factors, and overall patient care. Future research suggestions include expanded content analyses of the electronic messages themselves and follow-up, longitudinal research once implementation is more widespread. </p><p> As the Institute of Medicine (2008) states, all patients have the right to varied means of communicating with their physicians, including but not limited to online interactions. Evidence of a paradigmatic shift exists in physician training as well as patient expectations. The influence of online communication within secured health portals certainly has contributed towards this shift as more personalized, patient-centered care becomes a vital part of this ever-changing medicological environment.</p>