<p> This study was the result of a quantitative methods research design, which assessed: athletic training services, injury prevention at the time of the study, and intervention protocols for high schools within the Gateway Athletic Conference (GAC). This study explored the impact of injuries and concussions on student athletes. The study also examined the types of athletic training facilities, resources for rehabilitation, and procedures for athletic training programs available at the high school level in the GAC. The study uncovered some significant findings between the groups who were surveyed. The participants surveyed represented athletic trainers, athletic directors, and coaches. There were differences in how these groups viewed emergency care procedures, injury policies, and protocols. The differences ranged from views of job descriptions, written policies and procedures for emergency transportation, reporting and submitting accident reports, and regular review of the effectiveness of athletic training services. The groups did agree on most legal duties and responsibilities, general policies and procedures, injury management protocol and procedures, training room facilities, and operation questions. Blood-borne pathogens were an area in which notable improvement is needed, and there were some concerns with some of the data reporting injury statistics. Overall, the participants agreed with one another, but there were some differences throughout the study, as reported in this dissertation.</p>

<p> American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products including n-3 dietary supplements. Argyris' ladder of inference theory provided the study framework to facilitate understanding physicians' decision criteria. Rich data collected and analyzed from 20 primary care physician interviews in Kentucky, Indiana, and Tennessee revealed physicians use similar decision criteria for drugs and n-3s. Three essential influencers of physician decisions included clinical evidence, personal experience, and cost. Other influencers were opinions of peers, pharmaceutical representatives, samples, direct-to-consumer advertising, and knowledge of dietary supplements. Study outcomes may inform pharmaceutical marketers regarding presentation of clinical evidence, cost emphasis, and pharmaceutical representative skills and may facilitate competitive advantage for n-3 marketers. The social benefit of this study is improved physician understanding of n-3s may result in more accurate and appropriate prescribing to augment positive health outcomes. </p>

<p> A severe and worsening nursing shortage exists in the United States. Increasing numbers of new graduate nurses are necessary to meet this demand. To address the concerns of increased nursing demand, leaders of nursing schools must ensure larger numbers of nursing students graduate. Prior to practicing as registered nurses in the United States, graduates of nursing schools must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Various companies, such as the Assessment Technologies Institute (ATI) and Kaplan have created NCLEX-RN predictor tests that report candidates&rsquo; chances of passing the NCLEX-RN. ATI created a test called the RN Comprehensive Predictor and Kaplan created an NCLEX-RN predictor examination called the Kaplan Readiness Test. Students with less than optimal scores on the predictor can remediate to improve their knowledge of nursing, critical thinking, and test-taking skills. The intent for the ATI RN Comprehensive Predictor and the Kaplan Readiness Test is to predict the probability of success on the NCLEX-RN. The focus of the quantitative study was the ability of the aforementioned examinations to predict both success and failure on the NCLEX-RN. The overall TEAS score did not have a significant relationship with NCLEX-RN results. However, the ATI TEAS Math score was significantly higher (<i>p</i> = .005) for students who passed the NCLEX-RN. Data analysis showed no significant relationship between the Kaplan NCLEX-RN Readiness Test and NCLEX-RN results (<i>p</i> > .05). A significant relationship between the ATI RN Comprehensive Predictor and the NCLEX-RN scores existed in both the total sample (<i>p</i> = .001) and the BSN subsample (<i> p</i> = .001). In the MSN student subsample, all 37 students passed the NCLEX on the first attempt.</p>

<p> The implementation of telehealth applications is resource intensive and fraught with challenges unique to the people and places involved. The use of telehealth to provide clinical care to patients, educate patients and providers, and conduct research studies to advance medical science has been shown to positively affect issues of access and the quality of care. Previous research has focused on the use of specific technologies, known barriers to adoption and diffusion, and the general efficacy of these applications. Few studies have researched the role champions play in the deployment and operation of telehealth networks. The researcher proposed conducting an interpretative phenomenological analysis (IPA) of clinicians, educators and technical professionals within a successful telehealth network to determine the lived experiences that identify them as champions in the field. </p><p> Three research questions were studied: 1) What do telehealth champions believe to be the human elements necessary to advance telehealth systems?; 2) How do these telehealth champions explain their empowerment during the creation and use of telehealth networks?; and 3) How do these champions use shared processes and experiences to help spur engagement? Semi-structured interviews with 16 champions from the three disciplines were conducted to explore their lived experiences as part of a telehealth network. Seven champion themes&mdash;<i>modern pioneers; champion teams; agents of change; knowledge brokers; supported by management; advocates, not champions; and well-prepared visionaries</i>&mdash;emerged from the iterative review and analysis of data. Findings suggest that telehealth champions are not born but instead created. They are modern pioneers who function as part of innovative telehealth teams. Champions also serve as agents of change who utilize their knowledge of disruptive technologies to advocate for improvement in established healthcare systems. They are problem solvers who serve as resources for their colleagues, organizations and collaborative networks. Telehealth champions channel the universal goals of improving patient care and expanding healthcare access to overcome adoption barriers. Applying the ideals of what it means to be champions and how they overcome barriers to new telehealth applications could prove to be very beneficial for those tasked with developing new networks. </p>

<p> Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors in the context of full-range leadership theory. This theory distinguishes between transformational, transactional, and passive/avoidant behaviors of the program director from the perspectives of both leader and follower. This study also examined leadership outcomes. </p><p> Data were collected via an electronic survey (Multifactor Leadership Questionnaire) administered to PA program directors and other members in the same academic unit. The survey was deployed to 82 academic units. The response rates for completed MLQ surveys were 43.2% (54) for program directors and 24.6% (228) for others associated with the PA academic unit. </p><p> The results of this study indicated that program directors use transformational leadership factors frequently in the execution of their responsibilities, and those program directors perceive favorable outcomes with these behaviors. However, discrepancies existed between leader perceptions and the perceptions of individuals in the same academic unit in regards to leadership and outcomes, with program directors having more favorable perceptions. This research provides a foundation for future study of the PA program director and contributes towards professional development efforts and the measurement of associated outcomes.</p>

<p> In recent years, nursing faculty incivility has been a searing topic of research. Nursing research included studies on incivility among nursing students, incivility between nursing students and nursing faculty, and incivility in the clinical setting. However, literature specifically on nursing faculty incivility was limited. This descriptive, quantitative study examined perceived levels of workplace incivility among nursing faculty members. The sample (<i> n</i> = 257) consisted of nursing faculty members employed at community colleges in North Carolina. The methodology included a non-experimental, online survey design using Martin and Hine's (2005) <i>Uncivil Workplace Behavior Questionaire</i>and a demographics survey. Data analysis included use of descriptive and inferential statistics. Findings revealed three themes (a) the description of workplace incivility among nursing faculty aligned with Bandura's (1977) social learning theory and Andersson and Pearson's (1999) incivility spiral; (b) workplace incivility among nursing faculty existed in the community college setting; and (c) most demographic factors did not influence the extent to which faculty members perceived uncivil behaviors among their peers. However, there were four exceptions: hostility and full-time employment, hostility and salary range, privacy invasion and ethnicity, and uncivil behaviors and the number of years of full-time teaching. Implications for nursing education included turning conflict into problem-solving and collaboration, and cultivating climates of civility and cultures of openness, inclusion, and social connectedness.</p>

<p> This study investigated the presence and roles of Child Life Specialists (CLSs) in camps for children coping with chronic illnesses and conditions. The current research project surveyed 118 camp coordinators and directors regarding their awareness of CLSs as well as the presence and roles of these professionals at their camps. Additionally, 61 Certified Child Life Specialists (CCLSs) were surveyed about their main responsibilities at camp and subjective beliefs regarding the effects of camp on children's health related quality of life (HRQoL). Further areas explored in this research included the applicability of Child Life education and training in the camp environment, Child Life motivations for joining the camp community, and CCLSs' previous experiences in this setting both as campers and counselors. Results indicated that the majority of camp coordinators and directors were aware of CLSs prior to this study as well as indicated that CLSs had worked at their camp. This subset of participants was also significantly more likely to be interested in bringing a CLS or additional specialists to their camp. Further results indicated that CLSs hold a wide range of roles and responsibilities in the camp setting, both paid and volunteer-based. All CCLSs indicated that they felt attending camp had positive effects upon children's HRQoL, particularly in the areas of psychosocial development and coping, as further illustrated by first-hand anecdotes from their time at camp.</p>

<p> Universal developmental screening during pediatric well child care detects early delays in development and is a critical gateway to early intervention for young children at risk for Autism Spectrum Disorders (ASD). Developmental screening practices are highly variable, and few studies have examined screening utilization for children at risk for ASD. Currently, a two to four year gap exists between first recognition of concern and referral for diagnostic evaluation of ASD. The purpose of the current study was to examine the influence of developmental screening practices on timing of ASD diagnoses in the state of New Hampshire through health care administrative claims data from the New Hampshire Comprehensive Health Care Information System. The study examined differences in mean age of ASD diagnosis for a sample of 144 children who were born between January 2007 and December 2010 who received or did not receive universal screening during well child care, as well as those who received screening at multiple time points and those who received screening at one time point. Further, the study examined the association between gender, geographic region and provider type on age at diagnosis of ASD. The data suggested no significant differences in mean age of ASD diagnosis for children who received a standardized developmental screening during well-child care and those who did not. Statistically significant differences in mean age of diagnosis were found between children who were screened at one time point and children who were screened at more than one time point. Children screened at more than one time point were diagnosed later than those screened at one time point. Geographic region was a significant predictor on age of ASD diagnosis accounting for approximately 31% of the variance. Continued efforts to measure screening practices through use of administrative claims data may increase utilization and improve access to intervention for young children at risk for ASD.</p>

<p> Learning to provide emergency care alone and with others in the clinical environment imposes unexplored stresses on novice caregivers. It is unclear whether this stress inhibits or promotes performance and learning. Many academic health professions programs incorporate simulation as a method for teaching patient care emergencies. This study employed a modified switching replications design to explore the relationships and differences between psychological, physiological, and performance measures in health professions students who participated in acutely stressful health care simulation scenarios. Twenty-seven volunteer participants recruited from nursing, medicine, pharmacy, physical therapy, occupational therapy and speech therapy were assigned to teams in either a simulation treatment or a control group. Teams participated in two simulations scenarios where a fallen patient required assistance. Subjects in the simulation treatment groups received a standardized training module called the First Five Minutes^&reg; between simulation experiences. Mean heart rate, maximal mean heart rate, salivary alpha amylase levels, and salivary cortisol levels were compared at intervals before, during, and after each simulation scenario. Psychological stress was evaluated using the Stressor Appraisal Scale (SAS). Team performance during scenarios was scored by independent evaluators using an skills checklist adapted from a standardized commercially available training module, The First Five Minutes&trade;. Performance scores improved in both groups during the second simulation. Mean performance scores of the simulation intervention teams (<i>M</i> = 14.1, <i> SD</i> = 1.43) were significantly higher (<i>t</i> = 4.54, <i> p</i> &lt; .01) than the performance scores of the control teams (<i> M</i> = 10.6, <i>SD</i> = .96). Psychological and physiological measures did not significantly predict performance. Psychological and physiological indicators were reactive to the simulations across time, but did not differ significantly between the control and simulation intervention groups. This investigation explored the multi-dimensional nature of stress (psychological and physiological) that health professions students experience while learning. Simulation intervention did significantly improve group performance, but did not mitigate individual participant stress. Future research should include study with teams of working professionals to determine whether performance and stress measures differ with experience and expertise.</p>

<p> Two six-week research studies in two different geriatric facilities were conducted on how art making affects the anxiety levels, depression levels, and symptomology of geriatric patients with a diagnosis of COPD. There were 10 participants total between the two studies, all with varying stages of COPD and different symptoms of depression and anxiety.</p><p> The participants attended a one-hour creative arts therapy group once a week for six weeks. During each week, a different art directive was presented with new materials and new themes. Through pre- and post- self assessments each group, research showed how these art materials, discussions, and directives affected their medical and emotional symptoms. Research demonstrated how medical and emotional symptoms are intertwined, often greatly affecting one another. Providing art directives and group support, this study provided ways to observe how affecting one symptoms may possibly benefit other underlying symptoms and even a person's well-being as a whole.</p>