<p> Cultural beliefs on healthcare in the 21st century by the African immigrants in the United States have contributed to the severity of illnesses in their communities. The results of this research identified the healthcare barriers experienced by members of the Bronx Ghanaian Immigrant Muslim Community (BGIMC) in New York City. The purpose of this research was to investigate the influence of education, immigration status, health insurance status, and cultural beliefs on the BGIMC members' perceived access and willingness to use healthcare services for various ailments. A sample of 156 male and female members of the BGIMC completed the survey questionnaire. The study was grounded in the conceptual frameworks of critical theory and complexity theory. The results of logistic and linear multiple regressions indicated that those with insurance were 9 times more likely to report that they had access to healthcare than those who did not have insurance. Additionally, those with health insurance were almost 7 times more likely to report using healthcare services in the past 12 months. Results of the multiple linear regressions indicated that immigration status, health insurance status, and education levels did not predict willingness to use healthcare when an arm was broken, nor did they predict willingness to use healthcare for a severe fever. However, immigration status, health insurance status, and education levels did predict willingness to use healthcare when experiencing dizziness. Understanding the social and cultural factors related to use of health care services will lead to tailored health insurance and access initiatives for the BGIMC; this increased understanding will also promote positive social change in their community and serve as a model for other African communities in the United States.</p>

<p> The purpose of this research was to examine the link between obesity and stroke rates among African Americans and Hispanics/Latinos. Secondary data set was utilized to test the hypotheses of this study. Previous studies have indicated that the link between obesity and stroke is environment, poor nutrition, and socioeconomic status. Increasing health awareness about obesity and stroke prevention by having health fairs can promote a healthier lifestyle in the community. The study aimed to determine the causes of obesity and stroke among African Americans and Hispanics/Latinos in the underserved population. This research was intended to examine the risk factors that can lead to obesity and stroke among this population. The findings of this research concluded the acceptance of both hypotheses that in the underserved population, obesity and stroke rates are higher in the rural areas; and African American and Hispanic/Latino men have a higher risk of being obese and having higher risk of stroke. </p>

<p> The purpose of the hermeneutic phenomenological study was to explore the perceptions and lived-experience of work-life balance of oncology nurses living the Houston Metropolitan area. The two theories used to advance the study were work-family conflict and role stress theory. A single research question guided the study: <i>How do oncology nurses perceive and describe the lived-experience of work-life balance?</i> Twelve oncology nurses were interviewed to identify perceptions of work-life balance, understand from the nurses&rsquo; perspectives of the contribution of oncology work environment to work-life balance, to describe the experience of work-life balance, and to identify personal strategies that help the nurses achieve work-life balance. The study revealed nine major themes: (a) work-life balance is described as managing time between work and home; (b) time management and emotional demand are challenges oncology nurses face in achieving work-life balance; (c) the oncology work-environment creates challenges for nurses achieving work-life balance; (d) work-life imbalance creates negative effects for the nurse, the workplace, and the patient; (e) nurses had considered leaving oncology or the current nursing workplace because of work-life balance issues; (f) successful work-life balance has positive outcomes for employees and the workplace employer; (g) A nurses&rsquo; lifestyle and demographic factors contributes to successful work-life balance; (h) an organization&rsquo;s benefits and resources contribute to successful work-life balance; and (i) self-care is a strategy nurses find useful for obtaining and maintaining work-life balance and self-care is important to psychosocial health. Recommendations include providing more staff recognition opportunities, providing more work-life balance resources, performing work-life balance nursing needs assessment, developing work-life balance programs, developing work-life balance champions, developing nurse caregiver programs, and improving marketing and communication regarding work-life benefits and programs. Education recommendations include educating staff about available work-life balance and self-care programs, increasing the amount of and access to oncology related educational opportunities, incorporating work-life balance and self-care in nursing educational programs, and providing time management learning opportunities designed specifically to address managing critically ill patients and high acuity. Finally, a recommendation for nursing practice is developing strategies that include flexible work schedules and self-scheduling.</p>

<p> The purpose of the proposed qualitative phenomenological research study was to determine the lived experiences of emergency department nurses involved in family presence during resuscitation events. The phenomenological research study added to the current knowledge about family presence during resuscitation by examining an emergency department nurse&rsquo;s past experiences with family presence during resuscitation and the impact they have on their decision to allow family presence in future events. The information can assist health care leaders in understanding the perceptions of emergency department nurses regarding family presence and assist in developing guidelines regarding family presence during resuscitation. The data collected also helped to identify factors which influence the nurse&rsquo;s feelings about the practice and to overcome resistance to the practice.</p>

<p> Congestive heart failure (CHF) afflicts millions of Americans, and accounts for the largest share of rehospitalization of patients. Readmission rates for CHF patients have been high for more than a decade, resulting in unfavorable outcomes for patients and hospitals. One potential solution element is telemonitoring in the home. Allowing cardiologists to monitor patients with chronic diseases remotely has been shown to reduce hospital readmissions. This observational research (OR) study was based on anonymous secondary data from a CardioNet telemonitoring study conducted by a community teaching hospital in New England. The study was designed to answer the research question of whether telemonitoring can predict an imminent heart failure episode and, upon initiation of an intervention, reduce the number of hospital readmissions. The OR study also reported the effect telemonitoring had on the number of emergency department visits, medication changes, home healthcare visits, and visits to cardiologists or primary care physicians. The study did not have a sufficient number of participants to gain statistical power, but it highlighted the opportunity to learn more about the population of CHF patients in the community. The study also identified an opportunity for the use of mobile healthcare devices, big data, and analytics. </p>

<p> Without exception, healthcare systems in the Sub-Saharan Africa, including Ghana, face many challenges. Difficulties in Ghana&rsquo;s healthcare system stem from many factors, but the most notable one is professional migration, which has crippled the former British colony since 1980. Statistical data demonstrate the yearly migration of healthcare workers from Ghana and its impact on healthcare services (the doctor/nurse population ratio). This study used a quantitative multiple regression research method to examine and empirically analyze the relationship between healthcare workers, technological innovations, and changes in healthcare services in Ghana from 1990 to 2010. The main result was that technological innovations had a significant impact on healthcare services in Ghana during the observed period. Also, regional disparities in the number of medical doctors and nurses were largely explained by the degree of urbanization and economic development. Therefore, the pooled regression analysis from the panel data consistently showed that technological innovations significantly impacted the healthcare system in Ghana during the observed period. However, the numerical impact of the technological innovation coefficients was relatively lower in Ghana during the observed period.</p>

<p> The need for an adjunctive and alternative program at Alternative, Community, and Correctional Schools and Services (ACCESS) schools is critical to better serve the youth of Orange County. The purpose of this project was to write a grant proposal seeking funds to develop a program that will explore the use of active treatment approaches: healthy diet and exercise as an alternative or adjunct to the use of psychotropic medications among adolescents identified at risk for mental health problems. The proposed program if funded will introduce active approaches to improve the student's self-regulation and level of mental health functioning. The program will involve a nutritional, well balanced diet integrated into their daily life along with daily exercise and a weekly outdoor engagement outing. If funded, this program would result in the adolescent's ability to overcome their mental health challenges holistically, attaining self-sufficiency without pharmacotherapeutic treatment. Submission of this grant is not required for this thesis project.</p>

<p> Seventy-eight percent of emergency department (ED) patients do not thoroughly understand their discharge instructions prior to leaving the hospital (Engel, Heisler, Smith, Robinson, Forman, &amp; Ubel, 2009). The chaotic nature of the emergency department and the necessity of discharging patients in a rapid manner create significant challenges in the communication process between health care providers and the patient. The aim of this quality assessment study was to evaluate the patient's understanding of the emergency department discharge instructions and motivation to use an online health information website. This was a descriptive cross-sectional quantitative study, conducted from March-June, 2012, in a 52-bed emergency department facility in an urban setting which randomly surveyed 100 adult patients at the time of discharge from the emergency department. The majority of the participants did not or was not completely sure if they understood the discharge instructions. The Pearson chi-square <i>r</i> = 0.43,p &lt; .001 was statistically significant and indicated a reasonable difference between the preferred method of learning and understanding of the ED discharge instructions. Cramer's V was 0.302 with a significance of .01 and indicated a reasonable association between the preferred method of learning and understanding the ED discharge instructions. Motivation to use a health information website, indicated a central tendency mean of 3.02, and a standard deviation of 1.56, (0 is not motivated and 5 is very motivated). There was a relationship between motivation and the use of the online website and a quantitative prediction could be made for anticipatory guidance in clinical practice. A five question survey was completed by 45 ED staff members in October, 2012. Thirty-five or 76.1% of the ED staff was motivated to discuss the online website with the patient and family and make a change in their practice. The results indicated that when patients are discharged from the ED having care instructions and other information available electronically or online could provide a better understanding of their condition. The ability for patients to understand their medical condition through a visual or audio learning process could increase their level of understanding and adherence to the discharge instructions. </p>

<p> Though hepatitis B virus infection is vaccine preventable, it remains a leading cause of serious liver disease including cirrhosis and hepatocellular carcinoma. With more than 2 million individuals living in the United States chronically infected, increasing the adult vaccination rate, currently estimated at only 26.3% based on large patient self-report surveys, is a public health imperative. Primary care visits represent an opportunity to assess hepatitis B risk and vaccination status, and to administer vaccine. </p><p> The purpose of the study was to determine the factors that affect primary care physician recommendation and delivery of hepatitis B vaccine as part of routine adult care, and measure vaccination rate in the primary care setting. A survey was developed, validated and completed online by a random sample of 319 physicians who provide routine primary care for >100 adult patients each month. Adult hepatitis B vaccination rate was calculated based on physician-reported caseload and number of vaccinations administered over a 6 month period. In addition to practice descriptors, 24 survey items assessed physician knowledge, attitudes and practices related to vaccination rate. </p><p> Statistical analyses were conducted using SPSS software. The median and mean vaccination rates were 3.3% and 9.4%, respectively. Vaccination rates were highest among physicians practicing medicine for &lt;10 years, in private hospital settings located in urban areas. Vaccination significantly correlated (<i>p</i>&lt;.05) with routine assessment of hepatitis B risk, guidelines-based vaccination, and distribution of patient education materials. Focusing on history of intravenous drug use as the key indication for vaccination and concerns regarding related liability were found to be barriers to vaccination. Forward multiple linear regression analysis generated a model that predicted 26% of variance in vaccination rate, which suggested that physicians who have integrated risk assessment, discussion of vaccination rationale with patients, and vaccine delivery into their routine primary care practices exhibit higher vaccination rates. </p><p> The results suggest that adult hepatitis B vaccination rates may be increased through physician education that reinforces identification of CHB risk factors other than intravenous drug use and clarifies the limited nature of vaccine injury liability, as well as health policies that incentivize vaccination in the primary care setting.</p>

<p> Healthcare today is constantly transforming as hospital systems are challenged to maximize productivity and value. Factors such as occupational stress, difficult working conditions, unresolved conflict, lack of leadership, and increased complexity of healthcare foster disruptive and uncivil behavior and directly impact work performance, patient safety, and the physical well-being of those providing or supporting the care given to patients. The objectives of this study were to: 1. assess the prevalence of incivility within a large metropolitan healthcare organization, 2. determine differences in the frequency of incivility within select occupational groups, and 3. examine the relation between incivility and productivity, organizational commitment, job satisfaction, and workplace stress. The study was a cross-sectional, correlation design, using survey methodology. Data were collected from employees working in one organization consisting of an acute care facility, outpatient centers, and ambulatory locations. The study population included direct and non-direct patient care job categories and physicians.</p>