Through advancements in modern medicine, human beings worldwide are living longer. The increase in life expectancy creates a need for a more qualified and knowledgeable nursing workforce for the delivery of quality geriatric health care. Although nurses are the primary care providers for vulnerable older adults, they are generally not well trained or prepared in geriatric care. Therefore, the purpose of the project was to develop an education program aimed at improving nursing knowledge of geriatric care in the long-term care (LTC) setting. The goal of the project was to answer the research question: What impact would attendance in the program have on improving nursing geriatric knowledge, retention, and job satisfaction by project end? Guided by the advancing research and clinical practice through close collaboration (ARCC) model for evidence-based practice (EBP), the learning needs of nurses in the LTC setting were assessed. The 6-week education program was designed to provide education on the basics of geriatric care, pharmacology and aging, symptom evaluation, dementia care, and geriatric physical assessment. Project participants consisted of 8 nurses who volunteered to take part in the program. The program was evaluated using a pre-test and post-test method to examine nurse's knowledge before and after the education program. Using a paired t test, the results indicated a significant increase (p<.05) between the mean pre-test (3.75) and mean post-test (4.25) scores of nurse knowledge of geriatric care. The education program improved participant knowledge of geriatric care. Positive social change will be achieved with this scholarly project as nurses with greater knowledge gain confidence, strengthen decision making and clinical skills, and improve patient outcomes in the LTC setting.

The high turnover rate of graduate nurses is a challenge in the United States' hospitals because of high job dissatisfaction rates. The premature disaffiliation of the graduate nurses is costly for organizations and can significantly affect the quality and safety of patient care due to the inadequate supply of adequately prepared staff nurses, particularly in the long-term acute care hospitals. The purpose of the project was to decrease the turnover rate of graduate nurses in a long-term acute care setting from 40% to 20% through modification of the nurse residency program by applying an intervention based on Bauer and Erdogan's theory of organizational socialization. The intervention included provision of psychosocial and educational support to the graduate nurses in addition to the formal classroom learning and a preceptorship with experienced registered nurses. The project used a prospective descriptive design to examine whether the provision of psychosocial and educational support intervention to all newly hired graduate nurses for four weeks beyond the existing residency program would improve the nurses' perceptions on items of the Casey-Fink Graduate Nurse Experience Survey and decrease the turnover rate from 40% to 20%. Eighteen nurses completed the survey at eight weeks (the end of the existing residency program) and at 12 weeks (when four additional weeks of psychosocial and education support ended). The pretest and posttest survey results were compared using descriptive statistics. The graduate nurses' self-reported confidence level, job satisfaction level, and role transition experiences all improved after the intervention. The social change resulting from the project was positive residency learning experience for the graduate nurses that may result in better patient care, commitment to the organization, and retention of nurses.

Nurse recruitment is a challenge for long-term care (LTC) leaders. Some owners of LTC businesses lack knowledge of how to attract, market, and hire qualified nurses to help ensure success. The purpose of this multiple case study was to explore the methods and strategies LTC leaders used to recruit nurses. The target population consisted of leaders of 3 LTC facilities who were responsible for recruiting nurses. This selection was based on findings that organization leaders experienced a downsizing of more than 20% of their personnel. The conceptual framework was the motivation-hygiene theory. Working conditions were influenced by Herzberg's 2-factor principles of job dissatisfaction. I focused on analyzing the participant data, public documents, and performance outcomes that demonstrated the effectiveness of participant recruitment strategies. Data were collected from semistructured interviews. I compared the motivational hygiene theory factors that influenced employee job satisfaction and dissatisfaction identified with the conceptual framework and any new studies published since beginning my study. Results of data coding and analysis revealed 3 major themes: communicating job descriptions to new LTC recruits, hiring for nurse–position fit to address turnover, and making the position attractive by offering competitive wages and benefits. Successful recruiting strategies included ensuring nurse position fit, contacting qualified candidates, and work conditions designed to meet candidates' needs, expectations, and requirements. Results of this study might contribute to social change by providing recruitment strategies to ensure quality nursing services in LTC and strategies necessary to sustain business operations.

Severe traumatic brain injury (TBI) is a pervasive and devastating condition, often resulting in permanent alterations in cognition, behavior, and personality. As such, survivors of severe TBI usually rely on the assistance of caregivers to navigate situations of daily living throughout their life span. Spouses of individuals with TBI have been shown to experience greater levels of burden than parental caregivers of TBI survivors (Kreutzer et al., 1994; Mauss-Clum & Ryan, 1981) and subsequently rates of divorce and separation have been documented within the research literature to be high (Thomsen, 1984; Wood et al., 2005). Although marital breakdown has been frequently studied, research on marital satisfaction and coping within long-term marriages where one spouse has survived a severe TBI remains insufficient. The purpose of this study was to provide a descriptive analysis of long-term spousal caregivers of individuals with severe TBI. First, demographic variables of caregiving spouses of individuals with severe TBI, who remained married at least 10 years post injury, were described and comparisons to other spousal caregiver samples were addressed. Second, the relationship between marital adjustment and demographic variables, coping, and quality of life was examined. Finally, an analysis of primary stressors was conducted to better understand the caregiving spouses' continued experience of stressors. Twenty-one spousal caregivers who remained married for at least 10 years post injury to their spouse who sustained a severe TBI participated in the study. Analyses revealed that spouses had remained married an average of 19 years post-injury and in general were mildly dissatisfied within their marriages. Furthermore, marital adjustment (Dyadic Adjustment Scale total score) of long-term spousal caregivers of severe TBI was not significantly different than spousal caregivers of individuals with chronic illness. Higher marital satisfaction scores were associated with higher endorsement of emotion-focused coping strategies and greater mental health quality of life. In addition, marital satisfaction was positively associated with the longevity of the marital relationship, the age of the spouse at the time of the injury, and the length of the marriage at the time when the injury was sustained. As expected, higher scores of marital satisfaction were associated with higher levels of mental health quality of life. There were no significant relationships between physical health quality of life and marital satisfaction. An analysis of primary stressors show that long-term caregiving spouses continue to report similar types of stressors as indicated in the research literature from caregiving spouses during the first 5 to 8 years post injury. Findings were discussed in relation to implications for practice and additional research.

This qualitative study used narrative analysis of interviews with 10 older lesbians (aged 55 and over) who have made a financial commitment to live in a continuous care retirement center (CCRC) specializing in lesbian, gay, bisexual and transgender (LGBT) care. The specific aims were to: 1. Describe what has impacted older lesbians' decisions to live in an LGBT-specific CCRC. 2. Describe factors that both positively and negatively impact older lesbians' perceptions of elder care. The study combined two qualitative strategies (across-case, thematic analysis and narrative analysis) and used a convenience sample. Themes identified in across-case analysis were interpreted in the context of patterns in the narrative analysis. Categories, topics and subtopics were organized temporally. This within and across case strategy facilitated the ability to view the whole as well as individual and identify salient themes and representative stories across cases. Stories of past negative experiences with family (resulting from the participants' sexual orientation) as well as past positive experiences within the gay community were widespread across cases. Presently, the participants are caring for older heterosexual family members and realizing that in their lesbian friendship circles they have experienced this type of care and support and not in their biological family relationships. Additionally, they are increasingly aware of their own aging and realizing that at some point they might not be able to support themselves and each other in ways that preserve their dignity and prevent discrimination, as they generally can now. The participants' past experiences (as well as expectations stemming from them) coupled with present experiences and realizations, have led to the decision to live in an LGBT CCRC. They have concluded that the only way to be assured of dignity and respect in elder care is to decide on the LGBT CCRC. Positive perceptions regarding the decision to live in this elder care option were straightforward and directly reflected the findings for Aim I. It is important to understand older lesbians' elder care decision making because continued lack of knowledge may potentially undermine optimal care delivery of elder lesbians across settings.

The acute nervous system toxicity of organophosphate (OP) pesticides is well described. However, the reported long-term effects of OP pesticides on the nervous system are inconsistent. This inconsistency may be due to imprecise estimates of pesticide exposure, variability of central nervous system (CNS) and peripheral nervous system (PNS) assessment, small samples, and poor control of confounding. The primary goal of this research was to examine the association between long-term OP pesticide use on CNS and PNS function among pesticide applicators. An additional goal was to examine the association between high pesticide exposure events (HPEEs), which typically do not result in acute toxicity, and CNS function. Study participants were recruited from among applicators enrolled in the Agricultural Health Study (AHS) in Iowa and North Carolina. In 2006-2008, 701 male pesticide applicators completed a battery of neurobehavioral (NB) and neurological tests. Information about individual pesticide use was obtained from previous AHS interviews and a questionnaire administered during NB testing. Associations between pesticide use and neurological outcomes were estimated with linear and logistic regression models while controlling for covariates. When associations were examined between agent-specific pesticide use and nine NB tests, significantly poorer performance was observed on four tests and significantly better performance on five tests. Additionally, for some pesticides, we observed differential associations by state, suggesting that regional differences in pesticide practices may influence neurotoxicity. Overall, our results did not provide strong evidence that OP pesticide use was associated with adverse NB test performance. A history of at least one HPEE was reported by 23 percent of participants. Significant adverse associations were observed between HPEEs and two of the nine NB tests. Participants with HPEEs were, on average, 4.9 seconds slower on a test of visual scanning/processing, and 2.2 seconds slower on a test of visual scanning/motor speed. Overall, small but meaningful associations were observed between HPEEs and adverse CNS function. When associations were examined between pesticide use and PNS function, five of six neurological physical examination outcomes were associated with ever-use of one or more OP pesticides. Odds ratios ranged from 1.9 to 3.1. However, mostly null associations were observed between OP pesticide use and electrophysiological tests, hand strength, sway speed and vibrotactile threshold. This study provides some evidence that long-term exposure to OP pesticides is associated with impaired PNS function. In summary, our results suggest that exposure to a few individual OP pesticides as well as HPEEs may contribute to adverse neurological function. The observed exposure-effect associations were present after adjustment for confounding and were independent of past-diagnosed pesticide poisoning. We believe this research contributes important new evidence to an inconsistent literature. Reducing pesticide exposure and preventing HPEEs among pesticide applicators remain important public health goals.

The majority of the bridges in the United States are already reaching the years that the design process took into account when determining the time the structure would be functional. This means that many of the bridges in the nation are in need of increasing maintenance, and in some cases, major retrofitting. Researchers at Utah State University in conjunction with the Long-Term Bridge Performance (LTBP) Program, under the direction of the Federal Highway Administration’s (FHWA’s) Office of Infrastructure Research and Development, directed dynamic testing on the New Jersey Pilot Bridge, structure number 1618-150. The purpose of the LTBP Program is to monitor the nation’s highway bridges for a 20-year period to analyze and understand the behavior over time of the selected bridges and then promote the safety, mobility, longevity, and reliability on those bridges. In order to perform the monitoring of the bridge, ambient vibration analysis was selected for this structure, which was instrumented with an array of velocity transducers to record the response coming from the excitation. A finite element model was also created to compare the results from the ambient vibration testing. The results of this testing will be used with the LTBP Program to improve the knowledge of the bridge performance and foster the next generation of bridges and bridge management in the nation.

As part of the Federal Highway Administration's Long-Term Bridge Performance Program, Live Load and Dynamic tests were conducted. A long-term monitoring plan was developed and presented for the Utah Pilot Bridge based on Live Load and Dynamic tests. As one of seven pilot bridges, the Utah Pilot Bridge is one of the first bridges used to initiate the LTBP Program. A formal permit approval process, with the Utah Department of Transportation, was followed to gain permission to conduct the tests and install long-term instrumentation. Analysis provided good results for each test completed, with a summary of test results presented. A Finite Element Model was created and refined based off test data. Instrumentation was installed and checked to ensure quality data was streaming to the collection site.

Does the small business concern in this country have access to sufficient amounts of growth capital? For the past several years there has been much controversy concerning this question. Articles have been written both pro and con voicing opinions as to whether small businesses are being discriminated against in the acquisition of long-term loans to finance growth and business expansion. The majority of the written information on this subject appears to support the theory that too many small business firms are under-capitalized and the sources of long-term investment and growth funds are seriously limited to the small businessman.

Adolescents spend a large proportion of their everyday life in school, and schooling is vital for future success and well-being. One group that are in risk for reduced school success are children with disabilities or long-term illnesses. The aim of this study is to investigate whether the factors age, gender, self-perceived relationship with teachers, self-perceived relationship with peers and parental bonding can predict school engagement of students with self-reported long term health conditions and impairment. School engagement is defined as having three aspects, behavioral, emotional and cognitive. HBSC (Health behaviors in School Children) data from Sweden is used. The result shows that self-perceived relationship with teachers and age are related to all three components of school engagement, behavioral, emotional and cognitive in this study.  Self-perceived relationship with peers is related to emotional school engagement only. Gender is related to cognitive engagement. Parent bonding cannot predict any of the three aspects of school engagement. This study demonstrated that school environment, especially teachers, is important for the school engagement of students with long-term health condition and impairment. Dispite the inconsistent results with previous reseach which focus on typical functioning students, School and educators should focus on how to maintain and improve and promote school engagement of students with long-term health condition and impairment in mainstream school setting.