Thesis (M.P.H.)--University of Michigan, 1945.

<p> Identifying the primary barriers that block initial employment of newly licensed nurses is essential to smooth transition to the workforce. Enrollment in nursing education has increased and schools have added programs, but newly licensed nurses struggle to gain initial employment. This qualitative e-Delphi study solicits feedback from nurse employers through a series of three surveys. The surveys were delivered and returned electronically. They were distributed to 33 volunteer nursing participants who are responsible for hiring and evaluating nurse performance in the workplace. The average response rate was 46%. The identified skill gaps in newly prepared nurses are communication, critical thinking, organization, and professionalism. These skill deficits result in delayed initial employability and prolonged orientation times.</p><p>

<p> The purpose of the study was to examine the effect of the Autonomous Student Experiences (ASE), a specific course component of OAE programming, on promoting youth developmental outcomes, including youth autonomy and positive youth development (PYD). The ASE component in this study was carried out as the &ldquo;Final Expedition,&rdquo; where students traveled as a group with limited supervision from instructors. Three outdoor courses offered by Northwest Outward Bound School were selected with 25 subjects in total. </p><p> This study used a mixed-method quantitative and qualitative research design to explain and interpret the effect of ASE on youth autonomy and PYD. A questionnaire was developed to collect quantitative data measured by three scales, including Noom&rsquo;s (1999) Adolescent Autonomy Questionnaire, Lerner et al.&rsquo;s (2005) Positive Youth Development Short Form Measurement, and Characteristics of the ASE scale adapted from Sibthorp&rsquo;s Characteristics of the Experience Scale (2000). This questionnaire was administered three times throughout the course, including the first day of course, the day before the ASE, and after participants finished the ASE. Qualitative data were collected using semi-structured interviews. These one-on-one phone interviews were conducted with selected participants about two weeks after they returned home from their field experiences. </p><p> Findings from the quantitative data analysis showed that the overall OAE program can be effective in facilitating adolescents&rsquo; levels of youth autonomy and PYD. ASE may afford the opportunity for &ldquo;learning reinforcement&rdquo;, refers to a chance for adolescents to reinforce developmental outcomes that have evolved early on during the course. However, the differences in adolescents&rsquo; youth autonomy and PYD levels before and after completing the ASE course component did not reach a statistical significance. Higher levels of autonomy were associated more with adolescents who played follower roles in the ASE compared to those who played leadership roles. Findings from the qualitative data further shed light on the underlying mechanisms for linking ASE with youth developmental outcomes.</p><p>

<p> The purpose of this study was to assess changes in after-school time spent performing sedentary behavior (SB), light intensity physical activity (LPA), and moderate to vigorous-intensity physical activity (MVPA) among elementary school children in response to the introduction of stand-biased desks in the classroom. Thirty-one 6^th grade participants randomly assigned by their teacher to a traditional (CON) or stand-biased (INT) desk provided complete accelerometer data. After-school PA and SB were measured on four consecutive weekdays at baseline and 10-weeks. Wilcoxon Rank Sum Tests were used to detect significant differences (p&lt;0.10) in changes in the proportion of after-school wear time performing SB and PA between groups. Results suggested no significant differences in changes in after-school time performing SB (p=0.770), LPA (p=0.740), or MVPA (p=0.470). Significant differences in the change in moderate PA (INT: -1.4%; CON: -0.2%, p=0.093) were detected. Stand-biased desks were not detrimental to children&rsquo;s after-school PA and SB.</p><p>

The allegation that students in hospital schools of nursing were exploited has not been adequately supported by research. This examination of the financial relationship between Worcester Hahnemann Hospital (WHH) and Worcester Hahnemann Hospital School of Nursing (WHHSON), from the school's founding in 1900 until both hospital and school closed in 1989, begins to fill this gap in the history of nursing education. The study explores the effects of historical events on WHHSON while focusing on the development of the educational program and the financial relationship between school and hospital. Classic and contemporary writings about nursing and nursing education, including the work of Dock and Nutting (1907), Robb (1907), Goldmark (1923), Nutting (1926), Burgess (1934), Brown (1948), Stewart (1950), Kalisch and Kalisch (1995), and Donahue (1996) were sources of contextual material. The WHHSON archives, a rich source containing letters, brochures, annual reports, yearbooks, newspaper clippings and photographs, was the primary source of data on WHH and WHHSON. The study follows Stewart's (1950) chronology of nursing education until 1932. From 1933–1989 the chronology is based on national economic events which impacted nursing education. Chapters move from the general to the particular, beginning with contextual events, continuing with developments in nursing and nursing education, and finally relating this material to developments at WHH and WHHSON. The study found that the relationship between the students and the hospital was more complex than one of simple exploitation. While WHH depended on the cheap labor of student nurses to balance its budget in the early years, students received a good education, achieved entry into nursing practice, and fulfillment of basic human needs. The hospital consistently funded educational improvements mandated by accreditation standards for WHHSON. In later years these costs were covered by insurance reimbursements and by shifting educational expenses to students. The study concluded that not only one hospital, but the whole health care system in the Worcester area was subsidized by the labor of student nurses in a relationship characterized by dependency, enmeshment, symbiosis, and synergy.

Nursings' lack of full professional status based on the criteria of autonomy coupled with the need for a more independent practitioner in today's complex health care system was the basis for this study. A comparison of senior nursing students from different educational programs was undertaken to determine if type of educational preparation was a predictor of professional autonomy. Schutzenhofer's (1988) Nursing Activity Scale (NAS) was used to measure and compare the level of professional autonomy of 306 senior nursing students who were within four weeks of graduation from nine nursing programs across Massachusetts. Further comparisons of students' professed autonomy as a function of demographic variables and students' perceptions of their level of participation in learning were compared. Thirty-six senior level nursing faculty were surveyed for identification of possible relationships between student and faculty scores on these variables. The majority of students surveyed (85%) scored in the high range of the autonomy scale, and the level of nursing education was not a predictor of the students' autonomy level. Variables that correlated with student autonomy levels were marriage, plans for earning an advanced nursing degree and perceived level of participation in learning. However, significant differences were found in student reported autonomy between schools at the associate degree level. Schools at the baccalaureate degree level did not differ significantly from each other. No clear relationship was found between student and faculty scores. More baccalaureate degree students reported their programs as having a more theoretical than practical focus, while the associate degree students perceived a more practical focus to their programs. Seventy-five percent of students from both programs planned to earn advanced nursing degrees. These findings have implications for nursing education. Increased opportunities for students to participate more fully in their educational process may facilitate the internalization of professional autonomy in nursing students. Such opportunities may ultimately provide the health care system with practitioners who possess the professional characteristics necessary for a more autonomous, successful practice.

<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> 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&rsquo;s theory of andragogy, which highlights adults&rsquo; 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 <i> t</i> 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.</p>

<p> Waiters who serve alcoholic beverages at the majority of bars and restaurants in the United States are apt to serve alcohol to patrons who are visually intoxicated, notwithstanding laws prohibiting such service. Adverse effects of this practice include patron injuries, deaths, and law violations resulting in fines, incarceration, and lawsuits. Waiters not effectively trained to practice responsible alcohol retailing practices put patrons and others at risk of harm from alcohol related injuries or death. The problem is that the perceptions and attitudes of waiters who serve alcohol regarding self-learning as a strategy to prevent patron intoxication are not known; the purpose of this qualitative case study was to explore these perceptions. The study utilized in-depth semi-structured interviews with 23 waiters who utilized a self-learning tool about preventing patron intoxication. The waiters perceived that this self-learning tool was a good training solution, that it would be beneficial if implemented, that the tool could be used to improve public safety, and that its specific data on patron behavior and BAC levels were helpful. The participants also indicated that there would be challenges to implementing such a tool, including the waiters&rsquo; assertiveness and social aptness. As a whole, the researcher recommended that this tool be implemented across the country to improve waiter knowledge and patron safety. For future research, the researcher recommended that the study be expanded to include the perceptions of waiters across the country, the perceptions of those who underwent this training more than a year ago, and that the learning tool be adapted for different learning styles.</p>

<p> Estudiar c&oacute;mo las mujeres ejercen el liderazgo educativo es necesario para reconocer su influencia y poder de transformaci&oacute;n en los diversos escenarios laborales. Al analizar los contextos en los cuales se manifiesta su liderazgo se pueden delinear oportunidades para la adaptaci&oacute;n transdisciplinaria en el campo de la salud. </p><p> El enfoque de esta investigaci&oacute;n gir&oacute; en torno a la trayectoria profesional de Judith Danielsen de Lugo, una mujer, educadora en salud y profesora que ocup&oacute; m&uacute;ltiples puestos de liderazgo en Puerto Rico a partir de la d&eacute;cada de los 50. Con tal fin, se indag&oacute; respecto a: c&oacute;mo las acciones de su trayectoria profesional la caracterizan como l&iacute;der al ejercer las dimensiones del liderazgo educativo; los elementos hist&oacute;ricos, sociales y culturales que se desarrollaron a lo largo de su trayectoria profesional; sus contribuciones a la pr&aacute;ctica profesional de la Educaci&oacute;n en Salud y los desaf&iacute;os y cuestionamientos que se plantean con su liderazgo educativo para el desarrollo y el avance de la salud p&uacute;blica en Puerto Rico. </p><p> La investigaci&oacute;n se fundament&oacute; en los est&aacute;ndares de liderazgo educativo establecidos en el 2011 por el <i>Educational Leadership Constituent Council</i> [ELCC]. Estos consisten de las siguientes dimensiones: la did&aacute;ctica, la comunitaria, la administrativa, la pol&iacute;tica, la estrat&eacute;gica y la &eacute;tica. Se adopt&oacute; el m&eacute;todo cualitativo y un dise&ntilde;o biogr&aacute;fico para llevar a cabo la investigaci&oacute;n. Los hallazgos se desprenden del an&aacute;lisis de las entrevistas semi-estructuradas con personas que conocieron a Judith Danielsen de Lugo en vida y en contextos profesionales y del an&aacute;lisis de documentos. Posteriormente, se efectu&oacute; un an&aacute;lisis de contenido de la informaci&oacute;n obtenida. </p><p> Mediante esta investigaci&oacute;n se concluy&oacute; que Judith Danielsen de Lugo desarroll&oacute; acciones profesionales vinculadas a todas las dimensiones que componen el liderazgo educativo. Con sus ejecutorias se ejemplifica que el liderazgo educativo incide y puede ser ejercido exitosamente en m&uacute;ltiples contextos laborales y a nivel transdisciplinario. Por consiguiente, se brindan recomendaciones para la pr&aacute;ctica efectiva del liderazgo educativo y para el desarrollo de investigaciones futuras.</p>