Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey results from 2013 revealed a need for improvement in nurse-patient communication at the unit level. In response, nursing administrators at an acute-care hospital asked bedside nurses to develop a protocol for bedside shift report according to best practices. The protocol was implemented in May 2014. Three months later, a postimplementation survey was distributed. Work from Lewin and Kotter theoretical concepts were used to evaluate this organizational change. The purpose of this study was to determine whether re-educating staff nurses on the bedside shift report protocol increased compliance with evidence-based practice performance standards for bedside shift reporting. In the initial phase of this project, a review of a 3-month postimplementation survey revealed consensus that bedside shift report had not been universally accepted and implemented. Based on these findings, a re-education program was developed and implemented. A 2-week post re-education survey elicited 89 respondents' perspectives on bedside shift report. Analysis of the survey results revealed that nurses had strong perceptions of this significant change to their practice. The re-education revealed that nurses could show commitment to performing daily bedside shift report if specific conditions are supported, such as nurses understanding that the process improves satisfaction levels, and if nurses' misconceptions are addressed. Social change of this magnitude indicated that the voices of bedside nurses must be heard. To make this goal a reality ongoing evaluation is required to promote patient safety, improve patient outcomes, and improve HCAHPS results related to nurse-patient communication. Positive social change results in this project impacting patients by providing a better quality of care in this facility.

The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, increase staff satisfaction, and increase compliance with best practices. The diffusion of innovation theory was used to bring about successful change among team members in the ICU. The Focus Plan, Do, Study, Act methodology was used to determine what improvements were needed in the ICU. The evaluation of the telemedicine unit demonstrated early signs of positive progress. Actual length of stay (3.25 days) from the hospital's telemedicine dashboard was less than the predicted length of stay (3.8 days), and adherence to best practice was at or above target (95%) when compared to all telemedicine units across the nation, as provided by the telemedicine dashboard. Implementing a telemedicine unit will bring about a transparency and standardization of Intensive Care services, leading to positive social change in the organization. This social change, combined with the success of the unit, can influence other non-academic healthcare institutions to pursue telemedicine technology.

In 2017, there were 4,949 persons diagnosed with human immunodeficiency virus (HIV), 116,944 persons living with HIV, and 2,044 acquired immunodeficiency syndrome (AIDS) cases in Florida. Of the 4,972 new HIV diagnoses in Florida, 60% were related to male-to-male sexual contact, 4% from intravenous drug use, 2% from male-to-male sexual contact and intravenous drug use, 33% from heterosexual sexual contact, and 1% from other sources. Guided by the health belief model (HBM), this qualitative study sought to understand the lived experiences of HIV positive adult men who have sex with men (MSM) living in Florida, regarding their preinfection perceptions of risk of contracting HIV. The HBM guided this study as it examined health-related decision making and has been used in previous HIV prevention studies. A purposive sample of 11 HIV positive, adult MSM, living in Florida, who were knowledgeable and willing to discuss their HIV perceptions and lived experiences, were interviewed. Data analysis procedures included coding and categorizing the data, validation of the codes, identification of patterns and themes, interpretation of the data, and member checks. Participants had a general knowledge of HIV, and 7 out of the 11 men recognized they were at risk for HIV due to engaging in unprotected sex and substance abuse practices. Seven participants reported having access to HIV prevention tools but that they did not access these tools. All participants reported receiving ongoing health care. Developing HIV prevention programs targeting those engaging in at risk behaviors has the potential to produce positive social change by increasing HIV prevention education, testing opportunities, and treatment options.

Accidents are the leading cause of death among children. Compliance with safety measures have been shown to reduce morbidity and mortality in children. However, Hispanic parents and children have not been adequately studied in the literature in regard to trauma and safety habits utilized. In this exploratory-descriptive study, a convenience sample of 48 Hispanic parents were questioned about their child's activities. The purpose was to determine what safety equipment was used during these activities and how often they were used. Responses to an English/Spanish questionnaire were summarized by frequencies and percentages. Findings suggested that these Hispanic children were at risk for injury due to a low percentage of children wearing the necessary protective equipment Therefore, education must stress consistent use of safety equipment if injuries are to be prevented.

Active voluntary euthanasia is one of the most controversial issues in the nursing and legal systems today. The purpose of this study was to explore hospice nurses' attitudes on active voluntary euthanasia (AVE). One hundred useable questionnaires were collected, for a response rate of 33%. The questionnaires included demographic data, four vignettes which described a patient care situation and possible responses to AVE, questions on awareness of organizations and legislation that promote legalization of AVE, and questions on adequate pain relief. The findings revealed fifty - three percent of the nurses supported AVE. Eighty - three per cent of the nurses would not administer the medication that would cause death. Also, there were significant relationships between the nurses' age, religion and educational level and their responses.

The purpose of the study was to identify NANDA-I, NOC, and NIC linkages based on a clinical reasoning model to capture accurate nursing care plans for patients with Congestive Heart Failure. A retrospective descriptive design was used to address the research questions. Data were obtained from the records of patients discharged for one year with the medical diagnoses of CHF (DRG 127) from an Iowa community hospital. A total of 272 inpatient records were analyzed to describe the frequency and percentage of NANDA-I diagnosis, NIC interventions, and NOC outcomes for patients with CHF. The top ten NANDA-I diagnoses associated with NOC outcomes and NIC interventions were identified. The results were compared with published NNN linkages. Knowledge Deficit (NANDA- I) -Knowledge: Treatment Regimen (NOC)-Teaching Procedure/Treatment (NIC) (N=94) and Cardiac Output Alteration (NANDA-I) - Cardiac Pump Effectiveness (NOC)-Cardiac Care (NIC) (N=83) were the top two NNN linkages for CHF. In addition, using means, SD, and t-tests, the effectiveness of NIC interventions was examined by comparing admission and discharge NOC scores. The top ten NOC outcomes scores showed significant differences between mean score on admission and discharge (p value < .0001). All of top ten NOC-NIC linkages showed significant results in terms of effectiveness (p value

It is estimated there are approximately 8.5 million migrant workers in the U.S. The migrant workers are employed in low paying manual labor jobs. Most of the migrant workers are undocumented and are in the U.S. illegally. Many of the migrants are not familiar with available health services and are unable to pay for health care. Lack of primary, preventive health care affects the migrant population as well as public health in general. Accessing health care is the first step in primary, preventive care. In order to understand what barriers affect accessing health care, research into access of health care and barriers encountered will benefit all. The first purpose of this study was to research if migrant workers were accessing health care and the reasons for accessing health care. The second purpose was to identify barriers preventing access of health care. The findings revealed that 74% of the sample (n = 50) have accessed health care in the last year. Only 24% of the sample had received a general check up leaving a majority without preventive care. The study showed that 40% have a regular medical provider. This means that 60% may not have a regular medical provider to give preventive care. The barriers encountered were language, waiting for an appointment, unavailable clinic times, out of pocket expense and lack of full communication between the clinic staff and the patient. Statistical analysis included frequencies, cross tabulation of 2 variables using chi square to test for significance. Fisher's Exact test was used for validation of chi square where there were low cell counts. The study revealed a significant relationship between the length of stay in the U.S. and having insurance as well as knowledge of available clinics. Recommendations for improving access include establishment of a community-based health center and a mobile clinic. Required cultural training for all health providers would facilitate culturally competent care / A Thesis submitted to the College of Nursing in partial fulfillment of the requirements for the degree of Master of Science. / Degree Awarded: Fall Semester, 2006. / Date of Defense: October 26, 2006. / Barriers, Healthcare, Migrant, Latino / Includes bibliographical references. / Mary Beth Zeni, Professor Directing Thesis; Sally Karioth, Committee Member; Katherine Mason, Committee Member; Eunice Warren, Committee Member.

The care of patients with pain associated with rheumatoid arthritis is challenging and requires a systemic approach to assessment and treatment. This study aimed to explore with female patients, caregivers, and nurses, their perceptions of pain and pain management in adult patients with rheumatoid arthritis in Ratchaburi Province, Thailand. The study involved 10 female patients, 12 caregivers, and 10 nurses. Grounded theory was used as the methodology. Each participant was interviewed for at least one hour for biographical data, and experiences of pain and pain management of rheumatoid arthritis. Interviewing was audiotaped for verbatim transcription. A manual method of thematic analysis was used to find codes and categories, and to generate a grounded theory. The results showed that patients, caregivers, and nurses perceived pain and the effects of the pain of rheumatoid arthritis in terms of degeneration, and the need for intimacy and vigilance respectively. Patients expressed their negativity to pain as dejection, and they acknowledged their solicitude and receptivity towards care. Caregivers and nurses felt close understanding and connectedness respectively. Patients emphasised attribution, and nurses focused on the difficulties associated with chronicity. Pain management was in terms of physical, mental, and spiritual dimensions for all participants.

The purpose of this study was to understand the process of situational awareness (SA) in multi-casualty incidents (MCI). This study is significant because SA provides information on which critical decisions are made during emergency events. The literature concerning SA is mostly drawn from the domains of aviation, military operations and business and not nursing. Current conceptual and theoretical development is insufficient for application to the domain of MCI. MCI occur daily across the United States, yet a literature review revealed no studies involving SA in MCI. Limited issues that are possibly related to SA in MCI have been researched such as triage, scene safety and patient disposition, but none identify or integrate concepts important to SA. The lack of developed theory in this domain, let to a grounded theory approach to explore, identify and relate concepts that emerged from the data in order to uncover the process of SA. Interview transcripts from 15 emergency responders constituted the bulk of the data. Participants had various professional roles and diverse experiential levels. The data were managed using the software program NVivo 8. Findings suggested that ―establishing and maintaining control‖ of the scene was the core category, with other categories interacting with and being mediated by this core. Rescuers, given experiential and educational preparation responded to contextually-based situations. By appreciating the context and complexity of the event, rescuers handled information, managed resources, used roles and relationships and dealt with the emotional responses to the actions and interactions on the scene to establish and maintain control of the situation. By establishing and maintaining control, rescuers provided a relatively safe environment in which to provide emergency healthcare. The substantive theory, the ―Busby Theory of Situational Awareness in Multi-Casualty Incidents‖ resulted from this study. Future research should refine this model with eventual theory testing. This theory may prove beneficial in studying larger-scale events, such as mass-casualty situations and disasters and possibly different managerial hierarchies related to emergency response efforts. It should also serve as an educational tool for emergency responders and may prove helpful in the clinical practice of emergency responders from diverse disciplines.

The widespread use of pesticides by farmers, pest control operators and even the general public can pose significant risks to children's health. One particular pesticide, chlorpyrifos, was the most widely used pesticide in the United States with total use estimated at approximately 30 million pounds per year. Young children and the developing fetus are far more susceptible to the effects of pesticide exposure as a result of unusual exposure patterns and developmental immaturities. Transplacental transfer and lactational exposure are the pathways exclusive to the developing fetus and infant. Chlorpyrifos exposure is of special concern in this population because of its potential for disruption of normal brain function and cognitive development. The purpose of this study was to determine the concentration of chlorpyrifos in three different biological specimens: breast milk, plasma, and saliva. The research method employed for this study was a secondary analysis of existing samples collected for the purposes of a prior study. Based on specimen availability, there were a total of 26 subjects each for the lactating group and the non-lactating group. The lactation group had 26 matched breast milk, plasma and saliva samples and the non-lactation group had 26 matched plasma and saliva samples. The biological specimens were tested in the laboratory using an assay specific to chlorpyrifos. The Chlorpyrifos RaPID Assay was developed by Strategic Diagnostics, Inc and had a detection limit of 0.1 ng/ml (ppb) and a linear range of 0.22 to 3.0 ng/ml (ppb). Overall, for the lactation group, 25/26 samples were positive for chlorpyrifos with milk concentrations significantly higher than plasma or salivary concentrations. 19126 plasma samples were positive and 10/26 saliva samples were positive for chlorpyrifos. For the non-lactation group, 23/26 plasma samples were positive for chlorpyrifos and 16/26 saliva samples were positive. In addition, the plasma chlorpyrifos concentrations were significantly higher than salivary concentrations in the non-lactation group. Comparing the two groups, salivary chlorpyrifos concentrations were significantly higher in the lactation group. There is mounting evidence of pesticide contamination in the breast milk of lactating women. This study has contributed to this knowledge by documenting chlorpyrifos concentrations in breast milk, plasma, and saliva of lactating and non-lactating mothers. However, further research needs to be done to determine what these chemicals are doing to our children.