Families living on welfare in low-income impoverished neighborhoods encounter multiple barriers that need mitigating before seeking work to reach self-sufficiency. Many welfare recipients' self-sufficiency barriers are unnoticeable to caseworkers due to lack of data sharing to assess clients' needs through information technology processes. The purpose of this exploratory descriptive phenomenological qualitative study was to understand welfare recipients' viewpoints on socioeconomic barriers to living self-sufficiently and gain perspectives from human services caseworkers and technical resources on data sharing issues that impact recipients' ability to live independently from government assistance. Data collection and observational field notes resulted from in-depth interviews of 11 participants to capture welfare recipients' lived experience on human services barriers to achieve self-sufficiency, as well as, caseworker and technical resources views on welfare systems data sharing issues. The analysis of semistructured interviews revealed that welfare systems data sharing is an enhancement needed to help caseworkers identify and mitigate welfare recipients' self-sufficiency barriers. The common assessment framework model provided a contextual view to exploring research questions to elicit participants' perceptions of data sharing in welfare systems processes. The data analysis showed that the lack of data sharing impacts caseworkers' ability to assist recipients with self-sufficiency barriers. Results indicated the need for caseworkers to use data sharing to understand client's socioeconomic barriers and to make effective decisions to lead them to self-sufficiency. The impact on positive social change is using automated data sharing to identify and mitigate recipients' barriers to self-sufficiency.

Colleges and universities face some retention problems for female adult learners over the age of 25 who face technical requirements in higher education courses. However, little is known about how technology influences the experiences of female adult learners. The purpose of this basic qualitative study was to identify how female adult learners over the age of 25 perceived the technical demands of the courses in their degree programs and how they coped with those demands. The conceptual frameworks for the study were the adult learning theory, which focuses on self-directed learning, and the transactional distance theory. Participants for this study were 12 female adult learners who reside in Tennessee who have been enrolled in undergraduate and graduate courses and were over the age of 25. Data sources included face-to-face and phone interviews. Data were analyzed using open coding to identify patterns and themes. The findings of this study indicated that participants were influenced by the technical demands they faced. Participants attributed the extent of success in their courses to the level of technical competence they possessed during their time as students. Participants used individual coping strategies in their courses as well as resources provided by the institutions they attended. This study contributes to positive social change because it provides information that higher education institutions can use to both increase retention and help female adult learners succeed during their higher education careers.

Breast cancer is a widespread public health issue in the United States which affects all women. Although mammography is a proven screening tool, screening rates vary widely. Self-reported health status may play a role in how women perceive their risks for developing breast cancer, which may affect mammography use. The purpose of this cross-sectional survey study was to assess the association between self-reported health status and perceived risk for developing breast cancer, as well as perceived barriers towards mammography screening and use. Social action theory, which holds that social and the psychological factors influence health behaviors, served as the theoretical foundation of the study. A convenience sample of 309 African American, non-Hispanic White, and Hispanic women, aged 30+, was recruited to participate in the study. Linear and logistic regression analyses revealed the model including all variables were significance between self-reported health status, demographic characteristics, and the dependent variables perceived risk of breast cancer, receipt of a mammogram in the last 2 years, and barriers (personal, economic, and health). However, self-reported health status was not a significant individual predictor in any of the analyses, and the null hypotheses for the research questions were not rejected. This study may promote positive social change by providing information on the necessity of interdisciplinary and interrelated educational and intervention approaches to address the challenges of women from diverse populations receiving regular mammograms.

Teachers integrate technology to make the learning environment interactive and appealing to students. The purpose of this qualitative case study was to explore perceptions of teachers at one high school working to integrate technology into instruction following participation in professional development. Guided by Dewey's constructivist theory and Mishra and Koehler's technological pedagogical content knowledge model, this study explored teachers' perceptions of pedagogy and technology integration following participation in professional development and the strategies they used to overcome barriers to integrating technology. Twelve purposefully selected high school teachers from English, social studies, mathematics, science, electives, health education, and special education provided triangulated data in the form of interviews, lesson plans, and classroom observations. Through the qualitative coding and analysis process, emergent themes were developed. Teachers suggested that professional development for technology integration should benefit the learning environment, be relevant to course content so that teachers can make connections to real-world learning experiences, and that there should be consistent follow-up training. Findings suggested that teachers have limited access to hardware and software and lack time to develop technology-rich lesson plans, and students lack technical skills. The implications for this study include that district and school administrators should plan and implement relevant professional development, assess the needs of teachers through effective communication, and identify additional resources or training to help teachers who struggle to integrate technology.

Sepsis is associated with high mortality and morbidity. Immediate recognition and treatment is crucial to prevent complications that can be highly detrimental and cause a significant impact on the U.S. healthcare economy. Numerous studies have been conducted to improve patient outcomes and lower healthcare costs from sepsis and septic shock. Many of these studies were focused on exploring healthcare providers' knowledge and compliance to the Surviving Sepsis Campaign (SSC) guidelines. This study aimed to explore and identify barriers to the implementation of the sepsis bundles and strategies to enhance healthcare providers' adherence to these bundles. A systematic review of articles was conducted using the ACE Star Model of Knowledge Transformation. Studies such as randomized controlled trials (RTC's), systematic reviews, retrospective studies, and prospective observational studies conducted in Intensive Care Units (ICUs) within the past 10 years were utilized, guided by the American Association of Critical Care Nurses' (AACN's) grading system. Sources of evidence were obtained from PubMed, CINAHL, and GoogleScholar. The results of this study are aimed at helping support the evidence-based clinical practice among providers caring for patients with sepsis and septic shock in an ICU setting using evidence-based guidelines. The results of this study provide an opportunity for healthcare systems to relieve financial burdens from sepsis and thus contribute to pos

Abstract Tuberculosis (TB) is the leading cause of death from a single infectious disease. Unfortunately, 4.1 million cases were missed in 2017 globally, and Nigeria contributes 9% of the missing TB cases. At least 73% of the estimated TB cases in Nigeria were not reported in 2017 to the National TB Program (NTP); therefore, the true burden of TB was not certain, and this affected planning for prevention and control of TB. This quantitative secondary data analysis (NTP Lagos TB Inventory study database) guided by the integrated behavioral model assessed TB underreporting based on the TB reporting process in Nigeria. Chi-square and binomial logistic regression were used to assess the association between TB underreporting and the characteristics of health facilities (HFs), health workers' (HWs) awareness, barriers to TB reporting, and patient-related factors. The results indicate at least 60% of all HFs underreported TB, with an average of 7.4% underreporting between HFs records and TB program reports. There was a statistically significant association between NTP nonengaged health facilities (χ2 (1) = 20.547, p <.05), HWs' awareness of TB reporting (χ2 (1) = 6.576, p <.05), and barriers for TB reporting (χ2 (1) = 4.106, p < .05) with TB underreporting. The following patient factors were statistically significant predictors of TB underreporting with over 50% increased odds, p<0.05: previously treated, extrapulmonary, unknown TB site, HIV negative, and HIV unknown. This study supports social change through NTPs ensuring the establishment of a coordinating mechanism for TB reporting within and between HFs and supply of TB reporting tools to all HFs to know the true burden of TB for better planning and monitoring of quality care for TB patients.

Background: As the number of older adults in Thailand continues to increase, along with increased incidence of surgical intervention that causes pain, the quality of pain care in older adults is needed. Nurses are primarily responsible for assessing and managing pain in older adults (Jose Closs, 2008; Prowse, 2007). The use of evidence-based practices (EBPs) improves quality of care and saves healthcare cost. However, in Thailand where empirical study of using EBP related to pain in older adults is limited, research to understand how Thai nurses use EBP acute pain in older adults is needed.Purpose:The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Thai nurses on using EBP for assessing and managing acute pain in postoperative older adults.Method:A descriptive exploratory survey was conducted in 8 mid and large-size hospitals in Thailand. The Acute Pain EBP Questionnaire (APEBPQ) (Suwanraj, 2009) was distributed to 240 Thai nurses. 236 questionnaires were returned with the response rate of 98.3 percent. Open-ended questions related to barriers and facilitators of using EBPs were coded to identify major themes. MANOVA was performed to explore the differences between years of nursing experience on perceived barriers and facilitatorsResultsThe majority of participants are female (96.8%) with mean age 35.5 years (range=23-54). Thai nurses reported using 51/53 recommendations from EBPG Acute Pain most of the time/always (95%). Using an equianalgesic table (1.80±1.16) and assessing MMSE in older adults with postoperative pain (1.74±1.15) were occasionally used. Research reports published in English was the greatest barriers. Nurses perceived greatest support from a Head ward than other colleagues. Nurses with 11-20 years of nursing experience had higher reported barriers than those with 1-10 years of nursing experience.Practice Implications: This study will provide important information on barriers and facilitators of using EBPs related to pain assessment and pain management in Thailand. The results of the study will be used to develop strategies to promote the use of EBPs acute pain among Thai nurses who provide nursing care for postoperative older adults.

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by the incoming fourth year dental students at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate and logistic regression analyses were conducted. The response rate was 97 percent. Some of the most frequently reported barriers included: patient's resistance to tobacco intervention services (96%), inadequate time available for tobacco intervention services (96%) and forgetting to give tobacco intervention advice (91%). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students could benefit from additional didactic training and enhanced clinical experience in order to facilitate effective intervention services in the dental school.

Inadequate cancer pain management is a global problem. The problem is particularly worse in developing countries where the majority of patients present with advanced stages of the disease. Nurses play an important role in cancer pain management because they spend the majority of their time with patients. The purpose of the study was to examine role of unit cultures on cancer pain management practices among nurses in Kenya. A focused ethnography was used to explore cancer pain management practices of two different units (general and private) within the same institution. Data were collected for four months in a national referral hospital in Nairobi, Kenya. Purposive sampling was used to recruit participants. A total of twenty five nurses and fourteen secondary participants (e.g., nurse managers) participated in this study. Data were collected through semi-structured interviews, observations, and document reviews. Content analysis was used to analyze the data. The study findings show that the unit culture plays a role in cancer pain management practices. For instance, nurses on the oncology unit prioritize pain while nurses on the private unit prioritize overall patient satisfaction. Nurses in both units do not conduct a comprehensive pain assessment and they do not use validated pain assessment tools. Facilitators, such as availability of analgesics and palliative care training, were helpful in managing cancer pain especially in the oncology unit. Barriers such as, negative attitudes towards opioids and doubting patients’ report of pain continue to hinder adequate cancer pain management in the private unit. Other barriers including lack of pain management policies, assessment tools, and workload, influence cancer pain management practices negatively in both units. Understanding the role of unit culture in nursing cancer pain management practices has important implications for policy and practice. Findings in this study show a divergence of the prevailing training of nurses on pain management and practice. Findings could be used to develop pain management policies and protocols for nurses to use as a guide in cancer pain management. Also, nurse managers could use this findings to improve practice for instance, training in cancer pain management could be expanded to include nurses in the private unit. In terms of research, studies could be done to capture patients’ perspectives regarding cancer pain management, or implementation studies could be carried out to alleviate the barriers identified. Lastly, tailored strategies aimed at changing the culture in a unit to enhance change in practice are needed.

Students with Autism Spectrum Disorder (ASD) are enrolling in colleges and universities at an increasing rate. Although there is greater attendance in PSE settings, the graduation rate of this population is below the standard average. Improved services to help these students achieve their college and university goals are needed. Disability service professionals provide services to these students, yet oftentimes are not prepared to do so. In an effort to take a step toward addressing this concern, the current study began the exploratory process of identifying whether services provided by campus disability resources centers (DRC) align with the best practices that enhance the success of students with ASD. The current study began by asking an expert panel consisting of disability service professionals to develop and agreed upon a list of (a) barriers in providing academic accommodation (b) individual and systemic barriers faced by the student, and (c) supports that can help reduce these barriers. The final instrument identified 34 barriers to providing academic accommodation, 47 systemic barriers, and 37 individual barriers students with ASD experience in PSE settings. Additionally, DRC counselors identified 45 supports and services that would help address the identified barriers. Results of the study were discussed in the context of the literature related to identifiable barriers that prevent success in PSE settings as well as supports and services that can best benefit student with ASD. Additionally, implications, limitations, and recommendations for future research were discussed.