People living with HIV/AIDS (PLWHA) are 4 times more likely to have a diagnosis of depression than persons without HIV. The specific problem at a rural clinic in a southern region of the United States, was a lack of continuity in the Patient Health Questionnaire 9 (PHQ-9) screening procedures that made sure that PLWHA were screened, identified, and referred. Early identification and treatment can help patients cope with barriers that affect health outcomes. The purpose and goal of this project was to develop and implement an evidence-based depression screening protocol to improve clinical staff practices and adherence to the PHQ-9 guidelines thereby increasing the number of PLWHA who were diagnosed and treated for depression. The Iowa model of evidenced-based practice served as a guide for this project. An interdisciplinary team was assembled to develop protocols and staff training. This project compared clinic staff knowledge on depression through pre and posttests. Upon completion of staff training, the pretest had a M = 78.33 and SD = 11.146 and the posttest a M = 99.17 and a SD = 2.887. Results of a paired t test confirmed a statistically significant increase in knowledge with p < .000. Over a 4-week period, depression screenings at the study site went from 10% to 100%. Data showed that positive social change was realized when PLWHA began to get depression treatment because of proper screening, early interventions, and depression management. Although the project is designed for the PLWHA in the rural clinic, other primary care providers may find that an evidenced-based practice protocol can be useful to improve PHQ-9 depression-screening practices for patients in other clinical areas.

Retaining adult education students has been a growing concern. The new GED requirements have generated low completion rates for a free GED program in a 3-year period, in a non-profit agency in a Southeastern state. Instructors are concerned about this problem and need to understand the factors that are inhibiting adult learners from successfully attaining their GED. This qualitative research design was the most appropriate to answer the research questions to determine the experiences that caused the adult learners to not complete the program and identify potential educational strategies needed to improve retention. Sticht's functional context theory was the conceptual framework for this study. Fourteen adult learners previously enrolled in the free GED program participated in in-depth, individual interviews. Thematic analysis, NVivo and open coding were used to identify, describe, and interpret data. The findings indicated that lack of computer and typing skills, the conversion from paper and pencil to computerized testing, and the onset of temporary and personal and family obstacles were factors that contributed to learners not successfully completing the program. Reinstatement of tutors and mentors and providing the participants with a well-defined curriculum for the GED courses were potential solutions to improve retention. The overwhelming evidence from the participants also suggested that a curriculum for a professional development training for instructors facilitating the online courses is an educational strategy for a potential solution to the local problem. This project has the probability to produce social change because it provides GED instructors researched-based instruction to facilitate online courses effectively to improve retention.

Self-Efficacy and Select Characteristics in Nurses Who Respond to a Pediatric Emergency by Nancy McNeill MA, New York University, 1996 BS, New York University, 1987 Doctoral Project Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education Walden University June 2016 Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses' self-confidence or if other factors were involved. The purpose of this study was to determine if there were relationships between nurses' self-efficacy in pediatric emergencies and their knowledge of pediatric emergency care, as well as their years of clinical experience, nursing education, pediatric life support certification, specialty certification, and caring for pediatric patients. In addition, the research questions guided the investigation to determine if any of the variables could predict nurses' self-efficacy in pediatric emergencies. The theoretical framework was based on Bandura's social learning theory, which incorporates the concept of self-efficacy, as well as Zimmerman's self-regulated learning theory. A quantitative correlational design was used with a convenience sample of 37 nurses. Self-efficacy was measured with the General Self-Efficacy Scale and knowledge was quantified using a 32-item researcher-developed instrument. The data were analyzed using multiple regression analysis and correlations. Results showed that none of the variables predicted self-efficacy; however, years of nursing education, pediatric life support certification, and clinical experience were all significantly related to knowledge. Based on the results, a 3-day educational program was developed to address pediatric emergency practice. The results of this study can direct positive social change by informing future nursing education and training efforts in order to improve the medical outcomes of pediatric patients.

The retention of adult learners in rural educational settings throughout the United States is challenging for adult education instructors. Adult learners in rural areas encounter internal and external barriers, including lack of self-efficacy and minimal transportation. Research exists regarding the retention of adult learners, but little is known about the barriers to persistence among adult learners in rural areas, or the motivations experienced by students and instructors. The purpose of this qualitative case study was to identify perceived barriers to retention at a rural adult learning center in Georgia and to provide suggestions to improve adult education and literacy initiatives. Knowles' theory of andragogy was used to guide this investigation. The research questions examined instructors' and students' perceived and experienced barriers, motivations, and recommendations for better strategies. Responses were recorded from semistructured interviews with 3 instructors and 9 adult students who represented the various levels of Adult Basic Education or General Educational Development within the rural setting. Data were coded and sorted by themes using inductive thematic analysis. The participants' detailed narratives indicated that situational hardships were a perceived barrier and personal investment was a motivator. Based on participants' recommendations to improve time management and incorporate technology-based instruction, a professional development training program for learning center instructors was created. The training may promote positive social change by providing research based techniques, which may increase retention and graduation rates at the local site.

To offset the cost and meet the demand for high quality nursing graduates, adjunct faculty members are hired to educate students in the practice settings. Adjunct faculty may not have access to the resources allocated to full-time faculty and may not feel empowered to provide the most effective educational experiences for the students. The purpose of this quantitative study was to measure factors that influence empowerment in adjunct faculty members teaching in an associate degree nursing program at a community college located in the Midwestern United States. The study also examined whether there is a difference in the empowerment of novice faculty, defined as instructors who were employed 2 years or less at this institution, and expert faculty who were classified based on their employment 3 years or more. Kanter's theory of structural empowerment and Knowles's principles of adult learning provided the theoretical base for the study. The Conditions of Work Effectiveness Questionnaire-II, which was designed to measure 4 empowerment factors of the workplace, was administered to a convenience sample of 53 adjunct faculty members (20 novice and 33 expert faculty). The Mann-Whitney U test found no significant difference in total survey scores between novice and expert adjunct faculty members. The mean subscale scores identified that limited access to information and support were the 2 factors most influencing empowerment in this sample. Based on the results, a faculty development/mentoring program was developed to provide the adjunct faculty with the resources needed for empowerment. Future research on other factors associated with faculty effectiveness should be explored. Social change can occur by empowering the adjunct faculty members, thereby improving the quality of education afforded to nursing students in this associate degree nursing program.

Nursing programs have embraced distance learning in their curricula, but discussion is ongoing about course assignments and grading criteria to increase examination scores in nursing distance learning courses. Because course examinations are a predictor of success on the postgraduate licensing examination (NCLEX-RN), the purpose of this study was to determine whether differences existed in student examination scores between nursing distance learning courses with and without points aligned to assignments. The theoretical framework was Knowles's theory of andragogy, which highlights adults' motivation and self-direction to succeed. The quantitative causal comparative study included a convenience sample of 164 students to compare archival data of 4 examination scores between 2 nursing distance-learning courses. Data analysis included an independent-groups one-tailed t test. No significant differences were found between the 2 courses, suggesting that students do not achieve higher examination scores with course points aligned with course assignments. Nursing administrators and faculty in nursing programs with a distance learning component will benefit from the findings of this study. Findings may be used to draft, revise, and implement assignment criteria and point alignment for nursing distance learning courses. Social change will occur when nursing distance learning faculty use problem-solving and critical thinking assignments, including case studies, discussion boards, group assignments, concept mapping and NCLEX-RN style testing in each nursing distance learning course. Because point alignment to course assignments do not significantly improve examination scores, implementation of problem-solving and critical thinking assignments is necessary to promote student learning and examination success.

MyMathLab, an online interactive and educational system by Pearson Publisher, was implemented in 2 lower-level, traditional in-seat algebra courses to provide supplemental, instructional support to students in the fall of 2015 at the college under study. After the first year of use, no significant change in student success was reported, although more students passed intermediate algebra without first taking elementary algebra. The problem addressed in this study was that student results suggested there might be benefits to using MyMathLab that should be investigated. Knowles' theory of andragogy was used in this qualitative case study to gather perceptions of 7 2016-2017 faculty selected through stratified purposeful sampling. The research questions explored the benefits and challenges of using MyMathLab to support students in understanding math concepts and the effect on classroom time for instruction. The 3 major themes that resulted from analysis of the data collected through semistructured interviews were additional practice, immediate feedback, and ownership. Student data were used to triangulate and substantiate the findings. The resulting project was a professional development program for faculty using available resources in MyMathLab. Formative and summative evaluations were recommended to collect feedback from participants. The project contributes to positive social change by increasing faculty confidence in using the product to improve student success and increase student graduation rates. The findings of this study may also contribute to positive social change by supporting existing results from previous studies on the use of digital technology in traditional, in-seat math courses.

The number of adult learners has grown significantly since World War II, and workplace environments have expanded to embrace many new areas of expertise and knowledge. The expectations of these learners in terms of the courses offered by career universities have become increasingly diverse. University personnel need to find ways that optimize and align courses offered with those expectations. The purpose of this correlational study was to understand the relationships between outcome variables in adult education programs and students' perceptions of the quality of their educational programs. Five historically tracked variables were examined: program GPA, job placement rate, program completion rate, Net Promoter Scores, and student satisfaction. The study was underpinned by 3 andragogical areas as understood through the lenses of Mezirow and Knowles: adult student perceptions of educational experiences (as measured through student-completed evaluations), adult learner motivation, and content and curriculum design. The research question addressed relationships between and among the 5 variables for each of the 14 specialized MBA programs at a career university in the northwestern United States. Data for 400 adult students from the years 2008 to 2014 were used. Spearman's Rho correlations revealed no consistently significant relationships between the variables. Other metrics may be more useful to assess the overall effectiveness of programs. Possible future research can explore different variables so that university staff will have better data to address the demands of adult students, which will contribute to their educational and social wellbeing and to the needs of their present and future employers.

Many postsecondary institutions face challenges when veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) enroll in college and become student-veterans. Staff and faculty may need to better understand how to accommodate these student-veterans as they transition from military to student life. The purpose of this study was to explore the perspectives of 3 groups at a Texas community college regarding classroom accommodations for student-veterans with PTSD or TBI: (a) student-veterans with PTSD or TBI, (b) the faculty, and (c) the disability counselors. Schlossberg's theory assessing an individual's assets and abilities in transition was the conceptual framework for this study. The research questions asked about the perspectives of student-veterans with PTSD or TBI, the faculty, and the disability services staff. A case study design was used, and inclusion criteria included 5 enrolled student-veterans with a PTSD or TBI diagnosis, 5 faculty members who have taught student-veterans, and 3 Disability Resource Center (DRC) staff at the community college. Semi-structured interview questions aligned with the research questions and data were analyzed for credibility, reliability, interpretation, and themes related to classroom accommodations. Findings from the study revealed student participants felt more could be done to accommodate student-veterans. Faculty participants expressed concerns regarding a lack of training related to accommodations. DRC participants reported reluctance from some student-veterans to use accommodations. Findings contribute to positive social change by identifying gaps in practices and by aiding staff and faculty with professional development to better provide accommodations for student-veterans with PTSD or TBI.

The enrollment of college students in the United States who are classified as adult learners will continue to grow, bringing new challenges to degree programs. Multiple studies have provided insight into how best to teach these learners. However, to maximize learning, institutions must now consider strategies that merge adult learning principles with the integration of technology and students' personal and professional networks. Connectivism, based largely on the work of Siemens, and andragogy, based on Knowles, provided the conceptual framework that guided this basic qualitative interpretive study that examined how instructors experience and interpret the characteristics of connectivism (autonomy, openness, diversity, and connectedness) and their impact on students' learning. Ten instructors teaching adult learners were recruited using the LinkedIn social media tool. Data were coded using categories based on the four characteristics of connectivism, and a thematic analysis of the data generated four themes: fostering self-direction and student decision to learn (autonomy); teacher disposition, sharing experience, and effective dialogue (openness); depth or variation of experience, outside resources, and learning from others (diversity); and encouraging engagement, collaboration, and learning for engagement (interactivity/connectedness). This work may be useful to faculty and administrators needing to develop strategies to incorporate andragogical strategies with new learning technologies to contribute to positive social change by better meeting the needs of adult learners.