<p> This exploratory research increases knowledge and understanding of blame in the workplace. Attribution theory, moral philosophy, and social cognition provided a theoretical framework to understand individual blame determination as a precursor to understand systemic blame. Systemic blame is informed by complex systems theory and research on "no blame" cultures in a healthcare setting. </p><p> Interpretive description, supported by applied thematic analysis, provided the methodological framework for this qualitative study. The 17 senior leaders interviewed for this research study were selected through purposive sampling, and individually had an average 28 years of experience in healthcare. The semi-structured interviews were designed to gather experiences and stories that informed the participants' perspectives on blame in the workplace. </p><p> Constant comparative thematic analysis of the data resulted in four main findings. First, blame is prevalent in the workplace. Second, blame begets blame through a vicious cycle of blame. In this cycle there is often unwarranted blame. Blame feels bad, which results in fear of blame and avoidance of blame. One way to avoid blame is to blame someone else. This positive reinforcing feedback loop of blame creates a culture of blame. Third, a culture of blame includes characteristics of risk aversion and mistrust. Risk aversion decreases innovation, and mistrust decreases transparent communication. Fourth, blame has an inverse relationship to accountability, where less blame may result in more accountability. These findings both confirm and contradict the current literature. The resulting conclusion is blame is not a game.</p>

<p> For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.</p>

<p> Diabetes is one of the most prevalent diseases in America, and the associated costs place a heavy burden on our health care system. This study was undertaken to provide information on emergency service utilization and hospitalization among people with diabetes in the United States. The hypotheses were that adults with diabetes visit the emergency department (ED) more than those without diabetes, that persons with diabetes who present in the ED are hospitalized more than those without diabetes and that more patients with diabetes present in the ED within 1 week of hospital discharge than those without diabetes. To test these hypotheses, secondary data from the 2010 National Hospital Ambulatory Medical Care Survey was analyzed. The results indicate that adults with diabetes did utilize the ED more than those without diabetes, and that patients with diabetes were admitted to the hospital through the ED more than those without diabetes. Furthermore, persons with diabetes presented within 1 week of hospital discharge more than those without diabetes.</p>

<p> The objective of the study was to validate the assumption that respondents who self-identified as white, were more likely to be enrolled in a Medicare Advantage HMO Plan and underutilize health care services when compared to their non-white counterparts.</p><p> The results showed that the majority of the respondents in the stratified population of Medicare eligible respondents were categorized as White, 11,271 out of 15,297, and 42% reported being enrolled in a Medicare Advantage HMO Plan. A total of 3,685 of the White respondents on Medicare Advantage HMO Plans indicated they were in "Good" or better health, which was 78% of all White respondents in this population. The mean number of times that White respondents were seen by an MD (Figure 2) fell within the same range of 5-6 times for the majority of the Race/Ethnic groups. The mean number of hospital stays for Whites and the other Race/Ethnic groups ranged from 1.86-1.92 within the same 12 month period, with the exception of Pacific Islanders.</p>

<p> Evidence suggests that there is a link between higher than average rates of depressive symptoms and student participation in athletics. Various factors many student athletes face typically contribute to depression and depressive symptoms among this population. Such factors include balancing roles, sustaining injuries, overtraining, joining a new team, striving to achieve perfection, experiencing a sense of split identities, and even age and gender, among others. The literature suggests that due to the factors surrounding student athletes' roles, individuals in this population are more likely to experience symptoms of depression, including feelings of hopelessness and emotional problems, than their non-athlete counterparts. The literature also examines the phenomenon of student athletes developing a "Superman" complex and seeking to solve their depressive symptoms on their own, usually with alcohol or substance abuse. While in-school counseling services are suggested, there must be a greater focus on preventing the increasing prevalence of depressive symptoms among the student athlete population.</p>

<p> The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated <i>Primary Care Homeless Organizational Assessment Tool </i>(PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information to inform future strategies. </p><p> The researcher conducted a mixed-method study of key informants and organizations receiving federal health care for the homeless funding. The study used eight key informants to refine the initial PC-HOAT. The researcher distributed the final instrument through a web-based survey to determine reliability and validity of the PC-HOAT. Data analysis included descriptive statistics, factor analysis, and regression analysis. </p><p> The study yielded a 7-factor scale, 34-item tool focused on evaluation and delivery of primary care services, organizational structures relevant to effective delivery of care, and patient and family centeredness. In particular, the scale describing access and quality of care provided a positive statistical association with the proportion of patients with controlled hypertension. The study yielded results that provide a better understanding of the vital organizational characteristics that contribute most appropriately to the design of health care for the homeless organization.</p><p> Keywords: homeless, primary care, organizational assessment, reliability, validity, factor analysis</p>

<p> <b>Background:</b> Electronic personal health records (ePHRs) are consumer-centric tools that enable consumers to securely access, manage and share their health information with health care providers. Although the potential for ePHRs to improve healthcare is significant, there is no available evidence on health care professionals' use of ePHRs for their own health management. Nurses have a tremendous opportunity to assist and educate patients in ePHRs. Research has shown that ePHR adoption among patients were influenced by perceived usefulness and ease of use using the technology acceptance model (TAM). This study expanded the TAM adding perceived data privacy security protections and health promoting role models for the ePHR acceptance model. </p><p> <b>Purpose:</b> This study examined (1) characteristics associated with ePHR use by nurses: health, technology experience, and attitudes about privacy of electronic health information, (2) psychometric properties of the measures in the research model, (3) association of ePHR acceptance constructs: perceived usefulness, ease of use, data privacy and security protections, and health promoting role model with ePHR use, and (4) moderating effects of nurses characteristics: age, chronic illness and/or medication use, providers use of electronic personal health record (EHR) on the relationships between ePHR acceptance constructs and ePHR use. </p><p> <b>Methods:</b> Registered nurses working in hospitals and members of the nursing informatics community (NIC) completed an anonymous online survey in the Fall of 2013 (n=847). Differences between groups were examined using t-tests and &chi;&sup2; tests. The associations between nurses' characteristics and ePHR use were examined via multiple logistic regression models that also held constant possible confounding covariates and interaction terms. </p><p> <b>Results:</b> Less than half (41%) of the hospital nurses were ePHR users. The odds of ePHR use was significantly greater among those with chronic medical conditions/medication use (OR=1.64, 95% CI=1.06-2.53) and those whose health care providers used EHRs (OR=3.62, 95% CI=2.45-5.36) controlling for age, marital status, current positions and specialty area. ePHR use was more common among NIC nurses (72%). The odds of ePHR use was also increased among NIC nurses with providers that used EHRs (OR=5.99, 95% CI=1.40-25.61), but users were 70% less concerned about privacy of health information online than nonusers (OR=0.32, 95% CI=0.14-0.70) controlling for ethnicity, race and practice regions. The majority of both ePHR users and nonusers would grant access to their primary care providers. However, fewer ePHR users in both nursing groups granted permission to designated family members or friends, other care providers who care for them, or pharmacists to view ePHRs than nonusers who answered hypothetically. Sufficient reliability for usefulness, ease of use, and privacy and security protections, and health promoting role model scales were found (all Cronbach alphas>0.70). Three constructs contributed significantly to ePHR use after adjusting nursing group, age, chronic illness and medication use, and health care providers use of EHR (usefulness, OR=0.87, 95% CI=0.85-0.89; data privacy and security protection, OR=1.04, 95% CI=1.01-1.07; and health promoting role model, OR=1.07, 95% CI=1.04-1.11). Significant interactions existed between perceived data privacy and security protections and providers EHR use, and between perceived health promoting role model and age on ePHR use (p&lt;0.05). </p><p> <b>Conclusion:</b> The study findings suggest practical insights for nurses. With the experience of using ePHRs, nurses can leverage use of ePHRs for patient education on chronic illness and medication management. Nurses in NIC can also play an important role in practical ePHR design to enhance functionality and security in ePHR with their specialties in nursing informatics.</p>

<p> The purpose of this quantitative ex-post facto study was to determine if the level of satisfaction is increased over hospitals that do not incorporate PCC services. The study involved the use of archival data from HCAHPS (n.d.) satisfaction surveys analyzed during the first quarter of 2013. The respondents of the study included using archival patient satisfaction survey data from 113 hospitals within the State of Michigan. Fifty-two of these hospitals were identified as providing some level of PCC services to patients, and 61 of the hospitals were identified as not providing PCC services to patients. For each of the research questions, a two-sample t-test was used to compare the mean percentages between hospitals that have implemented PCC services and hospitals that have not implemented PCC services. The use of a two-sample test with all of the research variables did not reject any of the hypotheses for this study. This outcome could indicate that HCAHPS (n.d.) patient satisfactions scores may not be directly linked to PCC services. Although the results for this study did not demonstrate a favorable outcome regarding HCAHPS (n.d.) satisfaction scores and PCC services, the literature review for this study validates the importance for leaders within the health care community who have established PCC services to find other measurements to assess the effectiveness of PCC services, and those who do not to consider the implementation of Patient-Centered Care (PCC) services within their hospitals.</p>

<p> Although many studies may have been conducted to gain greater insight into the experiences of chemically impaired nurses, few, if any, studies focused on understanding and explaining the experiences of administrators who have hired, fired, or supervised chemically rehabilitated professionals. Imogene King&rsquo;s conceptual system and theory of goal attainment forms the framework for this study because the model is focused on three interacting systems identified as personal, interpersonal, and social systems. King views people as dynamic human beings whose discernment of persons, events, and objects guide their behaviors, social interactions, and physical well-being. In this qualitative phenomenological study, the lived experiences of administrators, supervisors, and managers who have hired, fired, or supervised recovered chemical dependent nurses as well as managers&rsquo; perceptions and attitudes about professionals rehabilitated from chemical dependency re-entering practice are explored. Each member of the purposefully selected sample participated in audiotaped open-ended interviews. The information was analyzed according to Colaizzi&rsquo;s procedural steps. The major themes that emerged included demonstration of compassion, concern for the assignment of duties, the influence of personal values (forgiveness, acceptance, and respect for others), and eligibility for employment and the successful completion of the Impaired Nurse Program (IPN). Results from the study add to existing nursing literature and may assist leaders to construct a work setting conducive to meeting the goals set forth by health administrators as well as provide insight into and acceptance of the rehabilitated professional in the work setting.</p>

<p> The purpose of this project is to create fun and educational lesson plans for before and after school childcare providers of children in kindergarten through fifth grade. The lesson plan will incorporate aspects of physical activity and nutrition into the basic curriculum for this age group. The nutrition and physical activity curriculum contains four themed weekly lessons. Each lesson incorporates a nutrition discussion, an activity related to the discussion, and one group game. The lessons and activities were designed to incorporate minimal materials so that any facility could easily incorporate them. A committee of nutrition professionals and educators reviewed the curriculum and improvements were made based on their recommendations.</p>