<p><strong> Objective:</strong> The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers.</p> <p><strong> Methods: </strong>A search strategy was developed to identify primary studies published between 2000-2010.<strong> </strong>Studies were obtained from multiple electronic databases, supplemented by checking the reference lists of included articles and background papers. Two independent reviewers screened studies for relevance, assessed methodological quality and extracted data from relevant studies using standardized tools. Disagreements were resolved through consensus.</p> <p><strong> Results: </strong>The search identified 92, 548 titles related to KT interventions. After duplicate articles were removed 64, 391 were imported into Distiller SR of which 345 articles were deemed potentially relevant on double title and abstract review. Of the 345 articles, 30 met all relevance criteria on full text screen and after revisions to the inclusion criteria, 6 studies of moderate quality were included in this review.</p> <p>KT interventions tested in the systematic review included organization change, provider reminders, education, financial incentives and feedback. Interventions tested in the five primary studies ranged from; educational sessions; dissemination channels including print, CD-ROM and Internet; technical assistance and staff training; and web-based services such as databases, information services, registries of pre-processed research evidence and tailored targeted messaging.</p> <p>KT strategies shown to be less effective included access to registries of pre-processed research evidence or print materials. Simple or single KT interventions were shown in some circumstances to be as effective as multifaceted ones including organizational change, provider reminders and tailored targeted messaging. While knowledge brokering did not have a significant effect generally, results suggest that it did have a positive effect on organizations with low research culture.</p> <p><strong> Conclusion:</strong> KT research in public health is in early stages. Single interventions can be effective. Researchers and practitioners must pay attention to contextual factors.</p> / Master of Science in Nursing (MSN)

In this study, systematic reflection in professional practice is seen as a dynamic process towards socio-political action, negating a navel-gazing critique. Positioned within nursing, the pioneering narrative inquiry approach will be highly valuable in medicine, education and other health fields. When I embarked on this study, research to guide me in homeless health care was limited and there is, even yet, insufficient evidence to demonstrate the effectiveness of advanced nursing practice in England particularly with homeless people. Through its reflexive narrative nature that research gap is addressed in a profound journey that illuminates my transformation over a three year period of being and becoming a Specialist Public Health Nurse (homelessness). The methodology draws dynamically on an eclectic, philosophical framework which includes reflective practice/guidance, narrative inquiry, hermeneutics, aesthetics, critical social science theory, storytelling, performance-ethnography and ancient wisdom. The Six Dialogical Movements (Johns, 2009) provides coherence to the twenty-one practice experiences that adequately marked my transformation towards my practice vision. I used the Being Available Template (Johns, 2009) as a reflexive framework which became the metaphoric net of my practice, showing where and how homeless people fall through the net of care, and my role in weaving a stronger net. I also drew on the work of Belenky et al's (1986) voice perspectives to show empowerment in my specialist role. Within the narrative, each story illuminates complexity and brings new knowledge about homeless health care. The study tangibly links childhood trauma to adult homelessness; it illuminates suffering in homelessness, showing where and how mainstream health professionals contribute to suffering when they do not grasp their role within the net, perpetuating homelessness. Appreciating precarious engagement in four quadrants: health services, homeless services, the homeless person and my SPHN role, is a concept that illuminates the precariousness of the net. The study concludes with a SPHN Homeless Health Care Model. Towards an ensuing social action through dialogue, I use the term 'audiencing' rather than transferability of findings. Hearing stories from 'street to boardroom' - making the invisible visible - has been profound in health services as evidenced in the narrative.

Methicillin-resistant Staphylococcus aureus (MRSA) is a problem nationally and affects many people from all walks of life. Community associated MRSA is often ignored and not viewed as significant, thus there is a lack of education on the topic. One area that is at a particular risk for the transmission of Community Associated MRSA is physical activity centers. Education in these areas could improve the knowledge of community acquired MRSA among employees and decrease the likelihood of infection at physical activity centers. In this study a pre-test was given. After the pre-test an educational powerpoint on MRSA was presented and then the participants were given a post-test to complete. The goal of this study was to determine if the staff’s knowledge and opinions of MRSA would change after being educated on the topic.

Research shows that one of the major contributors for an extended stay in a long-term care facility is lack of knowledge regarding goals for rehabilitation after being discharged from an acute care facility. It is important to determine patients’ levels of engagement because individuals who are actively involved in discharge planning and rehabilitation goals are able to manage their ongoing care more effectively, which results in increased quality of life. The data was collected using a survey method and the instrument used was the Patient Activation Measure or PAM which is a highly accurate and reliable tool. The 22 question survey was used to determine the level of patient activation among patients who are currently receiving rehabilitation services at a rehabilitation or long-term care facility. Determining the level of engagement in patients receiving rehabilitation services will provide health care providers insight into the how willing patients are to be engaged in their own care. A total of 11 surveys were completed by patients varying age, gender, and length of stay. Each patient was currently receiving rehabilitation services at National Healthcare Corporation of Johnson City or John M. Reed Health and Rehabilitation Facility in Limestone.

As the Hispanic population continues to grow in the United States, especially in the South, it is critical for healthcare workers to provide culturally competent care as required by certain laws. The Latina experience is of significant importance due to the role Latina mothers play in their families and communities. It is necessary to understand the perspective of this population and the experience of the Latina mother in regards to healthcare; specifically, how have language barriers hindered care, what perceptions of bias or discrimination have been encountered, and how do these factors influence their healthcare decisions and outcomes. Research has been conducted that identifies language and bias as barriers to access; however, further research is necessary to identify how these barriers influence a Latina mother’s perception of the healthcare system with an emphasis placed on East Tennessee. Therefore, it is critical for more studies to be conducted in order to identify what public health officials can change in order to provide equal access to this significant demographic.

This study was designed to create a high-risk fall profile for a specific Appalachian community. Data were obtained from 1,598 individuals with fall-related injuries who had been had been evaluated at a Level 1 Trauma center in Northeast Tennessee throughout 2011 and 2012, ages of individuals were 18 to 85 years. Data collected included: age, gender, county of fall, site of fall, type of fall, number of co-morbidities, season of fall, and time of day of fall. Results showed differences in criteria for categorizing individuals at high risk of falls, as well as data that had not appeared in the literature such as high-risk counties, a new high-risk age range, and the specific type of fall occurring. Tailored interventions should be created to fit the needs of this at risk community.

This research study was designed to improve the quality of health care received by the Hispanic population in northeast Tennessee. After reviewing past research, it is evident that the Hispanic population reports a lower level of health care satisfaction and a greater number of health disparities. Although attempts to reconcile this problem have included implementing regulations and guidelines on the cultural competency of and the provision of language services by health care providers, no measurable improvement has been noted. To positively impact this pervasive problem, the focus must shift away from how health care agencies can affect health care for Hispanics, and toward how health care providers can improve patient care. It is the responsibility of health care providers to provide quality care to all patients, regardless of their culture, race, or language. By interviewing three primary care nurse practitioners who serve a large Hispanic population in northeast Tennessee, it became evident that even with a language aide present, barriers to caring for this population still exist, although these barriers are not unsurmountable. Through years of experience, these providers have developed skills that have improved communication with, and health-related outcomes of, Hispanic patients, but this type of care should not be impacted by nurse practitioner turnover. Each provider agreed that nursing students’ education and opportunities to work with diverse populations while in basic nursing education programs must be improved, so that when students graduate, they can become part of the solution to this ongoing problem.

In today's competitive home health industry, productivity has become a major concern, and establishing productivity expectations is necessary for survival. Productivity can be described as a relationship between the outputs produced by an organization and the inputs provided to create the outputs. This means that the outputs consist of the number of home visits performed and the inputs consist of the time, supplies, mileage, and administrative support necessary for producing home visits. In order to have a complete understanding of productivity, one must understand the importance of examining significant service delivery factors that are unique to the home health industry. This study focuses on two such factors: nursing employment and patient care and service. The nursing employment quality indicators include the nursing personnel functions such as orientation programs. home health nursing experience, educational preparation, and staff development. The patient care and service quality indicators include activities that are related to direct and indirect patient care such as the actual home visit; geographic area, travel time; amount of time required to admit a patient. caseload expectations. time it takes to complete paperwork requirements; staffing; and follow-up with doctors, other home health team members, and other service providers. This observational cross-sectional study was conducted among Kentucky Medicare and Medicaid certified home health agencies belonging to the Kentucky Home health Association. The necessary data to determine average daily registered nursing patient visits productivity for home health agencies by organizational type was obtained from information in the Kentucky Semi-Annual Home Health Services Report 1991-2. The statistical technique, one-way analysis of variance, was used to analyze whether there were differences in the patient visit productivity outcomes for the home health registered nurses. No significant differences were found. The second part of this study involved surveying the study population to determine the effect that overall average daily registered nursing patient visits productivity had on nursing employment and patient care and service quality indicators. The survey instrument was subjected to a peer review evaluation team process to improve its validity before administration. The questionnaires were mailed to the study population during March 1993. The questionnaire return rate was 63.86%. Results of the survey were demonstrated in regular frequency distribution tables. The questionnaire results demonstrated that in some of the nursing employment and patient care and service areas for quality indicators, differences may exist. Some of the home health organizational types place more emphasis in some quality areas than in others. For example, hospital-based home health agencies allow more time for orientation and in-service training, have more home health experienced registered nurses, provide more time for paperwork completion, and allow more time for follow-up activities.

Sexually active young men are at high risk of contracting HPV and developing genital warts and penile/anal cancers. They contribute significantly to the incidence of HPV in women. The HPV vaccine, Gardasil, was approved in 2009 for use in preventing HPV 6 and 11 in young males ages 9 to 26. Knowledge and awareness of the virus and the vaccine is limited among young men. Promoting education and prevention measures regarding HPV and reducing personal risks to HPV is significant in narrowing the gap between acquisition of the HPV virus and cancer sequelae. A correlational design utilizing cross-sectional survey methodology was used for this study. Seventy participants completed a HPV vaccine survey at a university in Southwestern United States. The survey measured their knowledge and acceptance of the HPV vaccine and their intention to be vaccinated. Male participants were likely to accept or consent to receive the vaccine however they reported low intent to actually get the HPV vaccine. Acceptance of the vaccine was greater among minorities and participants who reported regular doctor visits. Knowledge of HPV and HPV prevention was low. Young men may benefit from HPV vaccine educational marketing strategies that include enhancing their communication skills on HPV, the HPV vaccine and reducing risky sex behaviors.

Purpose &lt;br&gt;The purpose of this study was to provide an understanding of the self-perceived physiological and psychosocial needs of persons living in communities which have been exposed to environmental contamination, and to provide an understanding of how forensic nurses can be utilized in these communities. &lt;br&gt;Background &lt;br&gt;This study was conducted to provide an opportunity for forensic nurses to advance their profession by finding ways that they can move beyond their traditional roles. Dixon and Dixon's Integrative Environmental Health Model was the theoretical framework. &lt;br&gt;Research Design &lt;br&gt;This cross-sectional triangulated study used quantitative and qualitative methods. The Community Environmental Health and Rights Assessment Tool (CEHRAT) was used to elicit quantifiable responses. One-on-one qualitative interviews were then conducted. &lt;br&gt;Participants and Data Collection and Analysis &lt;br&gt;Questionnaires were completed by 198 participants (109 from Ellenville, New York, and 89 from South Plainfield, New Jersey). For the qualitative phase, six residents were interviewed. &lt;br&gt;All persons who completed the questionnaire received a $5 gift card and an environmental resource pamphlet. The quantitative data was analyzed using SPSS. The qualitative data was managed with Weft QDA. &lt;br&gt;Results &lt;br&gt;The majority of participants in each community were `Somewhat satisfied' with the environmental information they receive (32.4% for Ellenville and 53.5% for South Plainfield). Two-thirds of the respondents in both communities said they know little or nothing about environmental contamination in their community. Over ninety-six percent of respondents indicated that they would trust nurses to provide environmental information if the nurses were experienced in such matters. Over ninety-eight percent of respondents stated they would trust forensic nurses. Eighty-five percent of respondents wanted educational information so they could protect themselves from contamination. The qualitative data revealed themes that buttressed the quantitative results: a lack of knowledge; the negative impact of politics, economics, and personal finances on remediating contamination; the need for outside help; and the belief that nurses can help affected communities by providing education, treatment, and investigation. &lt;br&gt;Conclusions &lt;br&gt;Forensic nurses can benefit communities that have been environmentally contaminated. In addition to advancing their profession, forensic nurses can be catalysts for change. / School of Nursing / Nursing / PhD / Dissertation