<p> Millions of women are diagnosed with breast cancer every year in the United States. In San Bernardino County breast cancer rates are increasing each year among Asian American women. It is considered to be the second leading cause of death compared to other cancers among Asian women. In the Inland Empire, there is a lack of health services aimed specifically at Asian Americans. The foundation aspires to be culturally competent and bring breast cancer awareness to all women. Through an expansive service that includes a navigation program lead by breast cancer survivors, outreach to local health care institutions for breast cancer screenings, as well as offering mental health counseling and seminars to help women and their families cope with their diagnosis as well as post-treatment care. The Breast Cancer Foundation for Asian American Women (BCFAAW) is a not-for-profit organization that aims to provide education, support, and advocacy for the Asian community throughout the Inland Empire. </p><p>

<p> Assistive technology may delay cognitively impaired elders&rsquo; need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah&rsquo;s 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer&rsquo;s or other dementia by 2037. Data were collected from a focus group of 10 seniors at a senior center in a large mid-Atlantic city, as well as survey data from with 5 family members of the cognitively impaired elderly and 16 technology developers from an engineering society. These data were coded according to the thematic content analysis and causal layered analysis. The future triangle analysis served as a second layer of analysis. Findings indicated that the most desirable outcome for 2037 is that of the &ldquo;happy retiree,&rdquo; characterized by flourishing cultural and financial opportunities, and the least desirable is that of the &ldquo;struggling pensioner&rdquo; characterized by monetary gains of the social elite at the expense of the poor and working class. The most expected outcome, though, is the &ldquo;caring robot&rdquo; that is characterized by the use of technology and artificial intelligence to promote equitable social and health care benefits to aging citizens. Positive social change may be achieved through recommendations to state, local, and national policy makers that support the improvement in the elders' well-being, the delay of hospitalization, and greater support for the duties of family members, and greater caretaker independence.</p><p>

<p> The purpose of this research was to identify common adaptations family members make and to identify areas where additional nursing interventions or support might be helpful for families. A qualitative approach using descriptive case studies was applied to study the recipients and their families. The Roy Adaptation Model (RAM) was used as a framework to collect data and to analyze it. The RAM was used to analyze various stimuli and how the family and recipient made adaptations within the four conceptualized areas of the RAM model. Structured interviews were conducted to collect the data. The demographic data and structured interview data was processed with thematic analysis. Data was arranged into categories and then themes after reflection. Recommendations on adaptions families experience and how nursing could contribute to positive adaptations were discussed. Family Transplant Syndrome was identified as a name for common characteristics shared by all the family cases.</p><p>

<p> There exists a blatant need in the Gateway City region of Los Angeles County to serve the Hispanic population in their caregiving needs. In serving a prominently Hispanic population, La Paz Home Care Agency will be distinctive as it will present specialty, expertise, and cultural sensitivity to clients&rsquo; home health and caregiving needs. As with national trends, there exists a growing demand for home health providers in the Los Angeles County and Orange County metropolitan region. Home health care services allow a person with special needs stay in their home as they are getting older, are chronically ill, recovering from surgery, or are disabled. Laz Paz Home Health Agency will meet the growing demand for caregiver services by providing services like bathing, dressing, meal preparation, assistance with self-care such as grooming, using the toilet, assisting with ambulation, transfer, light housekeeping, laundry, errands, medication reminders, escorting to appointments, hobby engagement, and supervision for someone with dementia or Alzheimer&rsquo;s disease. In this business plan a detailed account of La Paz Home Care&rsquo;s competitive environment, aims, and operations will be covered in detail.</p><p>

<p> Within the 21^st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. The materials were found to be clear, accurate, and easy to read by the medical assistants. Four MAs, who worked at the clinical setting, participated in the educational program that taught them to use the toolkit developed for this project. To evaluate the effects of the educational program for the MAs, the results of the pre and posttests were scored and showed that MAs had significantly increased their knowledge of teaching diabetes and obesity self-management for African Americans (pretest mean score 80, posttest mean score 93). An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing education in diabetes and obesity. Positive social change may result as the African American patients who receive education from medical assistants at the clinical site improve their self-management skills to prevent diabetes and obesity or the complications of the disease.</p><p>

<p> Despite concerted efforts to improve the process of shift-to-shift hand-off report (SHR), challenges and barriers continue to threaten the integrity of information shared between nurses. Research studies have demonstrated that vulnerabilities in SHR have been associated with clinical practice demographic factors, lack of a standardized process and tools, and differences in perceived value of SHR. </p><p> A quantitative, descriptive, cross-sectional study was conducted to identify nurse perception of SHR processes, factors that influence nurse perception of SHR, and nurse perception of bedside shift report (BSR) versus alternative SHR methods. Participants included a convenience sample of registered nursing students (n=49) enrolled in RN-BSN or MSN programs at a private southwestern Pennsylvania university. Descriptive statistics, ANOVA, and two independent t-Tests were used to analyze data collected from the Handover Evaluation Scale. </p><p> Study results revealed there was no statistically significant difference between nurse perception of SHR processes, demographic factors that influence SHR, and the locality of SHR (BSR). In addition, the majority of nurses identified a reluctance to change current practice of conducting the SHR process. There was no identified association between nurse perception of the quality of information (<i>p</i>=.22), interaction and support (<i>p</i>=.96), or efficiency (<i>p</i>=.17) of SHR. </p><p> As nurses are key stakeholders in the transfer of crucial up-to-date patient care information, nurse perception of the SHR needs to be further examined and evaluated to improve patient care outcomes. Quality assurance measures are the hallmark of standardized processes to ensure the delivery of safe and effective care.</p><p>

<p> <b>Background:</b> Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. </p><p> <b>Purpose:</b> The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services&rsquo;, Joint Commission on Accreditation of Healthcare Organization&rsquo;s, and other professional healthcare organizations&rsquo; guidelines for nurses&rsquo; knowledge of evidence-based discharge practices; determine level of nurses&rsquo; knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. </p><p> <b>Theoretical Framework:</b> The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. </p><p> <b>Methods:</b> Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired <i>t</i> test. An online demographic survey and pre- and posttest surveys were administered to determine nurses&rsquo; knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired <i>t</i> tests. </p><p> <b>Results:</b> A statistically significant difference was found in the pre-posttest survey responses for question 5 (<i>p</i> = 0.046 Wilcoxon; <i>p</i> = 0.041<i>t</i> test), and question 13 (<i>p</i> = 0.022 Wilcoxon; <i>p</i> = 0.018 <i> t</i> test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. </p><p> <b>Conclusion:</b> A standardized diabetic discharge guideline incorporated into the hospital&rsquo;s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses&rsquo; adherence results in effective nursing practices and an informed patient population. </p><p>

<p> Healthcare spending in the United States has reached an all-time high in recent years, with an estimated $3.2 trillion spent, without any significant impact on patient outcomes because of this excessive spending. Whether the excess be attributed to over-utilization, fee-for-service payment methodology or medical errors, there is an immediate need to mitigate these issues and greatly reduce healthcare costs. </p><p> Epic Systems Corporation has developed a widely-adopted health management software that provides functionality to accomplish such goals. It applies a fully-integrated methodology to all of its different applications that support different healthcare business and clinical functions. Epic is a leader in the health management software industry. </p><p> ALLTAP Solutions, LLC provides high quality, efficient custom solutions to its clients, by applying healthcare industry expertise and Epic technical knowledge to increase efficiency and reduce costs. The market analysis that is to be presented will provide an overview of the target market, key players, the demand for these services and growth potential.</p><p>

<p> Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans&rsquo; perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans&rsquo; perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population&rsquo;s perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans&rsquo; participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi&rsquo;s strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans&rsquo; health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines&rsquo; answers on the PDHRA. An understanding of the study&rsquo;s findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.</p><p>

<p> The purpose of this qualitative study was to investigate the influence of the athletic health care team on urban secondary school student-athlete physical health, academic engagement, and academic success. Limited and inconsistent research had been identified that linked student-athlete physical health to academic engagement and success at the time of research. In question is how the presence of an athletic health care team influenced student-athlete health, academic engagement, and academic success. A qualitative intrinsic case study using a face-to-face responsive interview model was deployed for data collection. The population was identified as all student-athletes, coaches, and parents/guardians involved with one urban secondary school district athletic program. Five male student-athletes, two male and one female parent, and three male coaches voluntarily participated in the research study. Data analysis occurred through an iterative process beginning with manual transcription of audio recordings into a Microsoft Word document that was uploaded into the NVIVO 11 computer-assisted qualitative data analysis software for organizing further coding and theme development. A conceptually clustered matrix was further used for data analysis to help identify themes among student-athletes, their parents, and coaches to triangulate responses. The athletic health care team in this research study was found to directly influence student-athlete health, have a minimal influence on academic engagement, but have indirect influence on academic success according to participants. The athletic trainer was the key athletic health care team member contributing to student-athlete physical health, while coach was identified as most dominant figure on academic engagement, with coaches and parents being most powerful on academic success. Additional research is needed to fully understand the collaboration between athletic health services and general health services for the secondary school student-athlete. The variability between health care programing offers an opportunity for standardization that can be replicated and then studied across different settings, such as rural versus urban, or among diverse socioeconomic groups. Future research collaboration between health care and education is also needed specifically in the area of athletic health care team implementation at the secondary school level to fully understand the positive educational impacts that may be achieved. Extending health services beyond than the traditional student and into the extracurricular environment may be a powerful tool that offers additional academic engagement and success opportunities.</p><p>