While the concept of medical futility has existed for as long as medicine has been practiced, it remains a controversial issue that has become more clouded as medicine has advanced. This thesis will explore futility in the most technologically rich and emotionally charged of settings, the intensive care unit. The complex interactions of biology, ethics and the law, with their competing and sometimes conflicting interests will be explored. Disputes between patients, families and health care workers over life-sustaining interventions occur most often in the ICU, and the factors that influence this dynamic, such as lack of communication, time constraints, media-driven misconceptions and value-conflicts, will be examined. Attempts to address futility through advance health directives and conflict resolution policies will be critiqued. But most importantly, this thesis will explain, by appealing to the proper goals of medicine, why limitations should be placed on end-of-life care, and why physicians have an important role to play in making these determinations.

The purpose of this prospective cohort study was to describe the profile and outcomes of geriatric trauma care patients treated in level I trauma centers in Quebec. The study also evaluated the quality of care provided to geriatric trauma patients and identified predictors of outcomes which focused on mortality. / A total of 4934 trauma patients over the age of 65 were admitted for the treatment of injuries in three level I trauma centers in Quebec. The majority of the patients were injured in falls and had a low injury severity score. Male gender, older age, thoracic and abdominal injuries, burns, and delayed emergency room stays were identified as significant predictors of mortality. Inferior quality of care was observed with increased age and fall-related injuries. / The observed association between longer emergency room stay and falls with increased risk of mortality along with inferior care for patients injured in falls would suggest that level I trauma centers are inefficient and potentially harmful in treating elderly trauma patients. Further studies would be helpful in confirming these conclusions.

<p> This retrospective study was conducted to evaluate whether culturally competent resources, such as Vietnamese-speaking healthcare providers, one-on-one public health nurse (PHN) education session(s), and free healthcare services would affect the results of the following questions: (a) Will the 114 study subjects achieve HbAIC reduction at 6-month and 12-month periods? (b) Is there a correlation between HbA1C reduction and the number of the provider visits? and (c) Is there a significant HbA1C reduction for the one-on-one PHN education participants compared to the non-participants? The result findings were analyzed using the Chi-Square tests and the two-sample <i>t</i>-tests. On average, the 114 subjects achieved HbA1C reductions of0.57% and 0.63% at 6-month and 12-month periods, respectively. However, there was no direct correlation between the HbA1C reductions and the frequency of provider visits. Furthermore, the PHN education session(s) did not significantly affect the rate of HbA1C reduction for the attendees. In conclusion, future studies on culturally competent interventions should be studied in the Vietnamese patients diagnosed with diabetes mellitus.</p>

<p> Research has shown that people with mental illness who seek treatment from mental health services have improved quality of life. The objective of the study was to evaluate the influence of stigma on people with mental illness, and how stigma can affect the person's decision to seek treatment for his or her mental condition.</p><p> The objected was assessed using secondary data from the 2009 Adult California Health Interview Survey. The initial filtering of the respondents was unable to be performed because Human Subjects Protection laws protect sensitive information from being released in public use data files. I redeveloped my study, focusing primarily on the association between respondents with feelings of depression and whether or not they have health insurance coverage for mental health services.</p><p> The results of the analysis proved to be statistically significant, which led to speculation that, even with mental health insurance coverage, the low rates of mental health service utilization was most likely attributed to the impact of stigma. Future research should be conducted on the effects of primary care mental health integration, and how this increased parity impacts the utilization of mental health treatment options.</p>

<p> The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.</p>

<p> The problem addressed was the low job satisfaction levels of nurses and subsequent nurses' decision to leave the organization. The quantitative correlational survey study involved determining whether a relationship exists between nurses&rsquo; perceptions of nurse managers&rsquo; leadership style and nurses&rsquo; job satisfaction. Eighty-three fulltime medical surgical intensive care nurses in two hospitals in Phoenix, Arizona, completed the Job Description Index for Jobs in General (JID/JIG) and the Multifactor Leadership Questionnaire (MLQ, Form 5X). The results suggest a significant, positive correlation between job satisfaction and perceptions of nurse managers' leadership style by nurses. Nurses with the highest satisfaction scores in three of the six subscales perceived their managers used the transformational leadership style. The mean score for nurses whose managers were rated as transactional was higher than the mean score for nurses whose managers were rated as passive-avoidant. The promotion and supervision subscales and the job in general scale showed a significant relationship with transformational leadership. Implications for healthcare administrative leaders include hiring transformational managers to increase job satisfaction in nurses and offer nurses opportunities for promotion and training.</p>

<p> The purpose of this grounded theory study was to develop a construct that describes the motivations of physicians to lead multidisciplinary prostate cancer clinics (MPCCs). Medical leaders play a key role in increasing the number of MPCCs, which are not yet widely available to patients in the United States. Understanding what motivates these physicians to lead is an important dimension of developing, recruiting, and retaining MPCC leaders. </p><p> This study collected qualitative, empirical data from 12 MPCC medical leaders located throughout the United States. Utilizing theoretical sampling and constant comparison, the data derived from face-to-face interviews were used to create a new construct of MPCC medical leaders' motives called <i> Leader-Stage Motivation</i> (LSM). </p><p> In the LSM construct a physician experiences 11 motivational factors while leading a multidisciplinary prostate cancer clinic. These 11 factors are grouped into 5 motivational patterns: mentored self-efficacy, purpose-driven goal, multidisciplinary relatedness, time-moderated challenge, and achievement-driven goal. Each of these 5 patterns is directly related to the leader's role during 3 stages of MPCC development: leader-creator, leader-sustainer, and leader-renewer. </p><p> The LSM construct is distinct from other leadership motivation theories such as leadership motive pattern (McClelland, 1975), role motivation theory (Miner, 1978) and motivation to lead (Chan &amp; Drasgow, 2001). Unlike these previous theories LSM establishes a relationship between the leader's motivations and changing leadership roles during the life cycle of an organization. The LSM construct also provides a new model of leadership motivation that is specific to medical leaders. </p><p> This study contributes to leadership motivation research by modeling physicians' motivations to lead in one type of multidisciplinary, patient-centered environment. The LSM construct gives health care providers a development, recruitment, and retention framework for future multidisciplinary prostate cancer clinic medical leaders. Results of this study may also contribute more broadly to an understanding of what motivates physicians to lead their peers. </p>

<p> The current study served to provide new knowledge that may benefit future researchers, policy makers, health care leaders, and health care professionals who aspire to improve the delivery status for quality end of life care. A missing link in the hospice care continuum was identified as the need for the use of music listening by patients and caregivers as a low cost viable non-invasive alternative intervention that can be effectively utilized in real life situations. The researcher chose the current study's generic qualitative design to enhance understanding of how informal hospice patients' caregivers perceived music listening as a means for the patients to accept the state of a good death. Generic qualitative research design offered the researcher with an opportunity to hear and inductively analyze the hospice patients' vulnerable voices per their caregivers. Data was collected during a semi-structured face-to-face interview process and was reflective of the perceptions of hospice caregivers (<i>N</i> = 4). The researcher incorporated an axial coding process with the use of NVivo 9 software to analyze the data. A <i> priori coding</i> method incorporated the use of four predetermined themes: three domains for the concept of a good death and one for music and a good death. Overall, the findings indicated that music listening had a positive effect on the hospice patients, according to their caregivers' perceptions. The study limitations reflected the use of a small sample size from one Southwestern city that consisted of four female caregivers and the study results were dependent upon the perceptions of these caregivers. Consequently, due to the study's limitations, health care researchers and health care administrators should cautiously generalize the study's findings and decide for themselves if the study benefits outweigh its limitations. Further studies are indicated to enhance and supplement the knowledge presented in this study. One suggestion to further research is to broaden the scope of recruitment to include younger hospice patients, including children, who receive care either in their own home or in a medical facility. Another suggestion to further research would be to compare the effects of different types of music preferred by hospice patients.</p>

<p> The qualitative phenomenological study described herein examined the meaning and essence of the lived psychospiritual and felt-sense experiences arising in individuals who are living with a life-threatening illness. The purpose of the study and the research question are described in this dissertation along with definitions of important terms, the theoretical lenses through which the research was conducted, and an autobiographical reflection describing the motivation behind the research. A historical background of early medical and spiritual practices and beliefs provides context for the study and precedes a review of pertinent literature. The literature review discusses existing germane research studies that support the need for the study. Research methods used to conduct this study are described, along with participant qualifications, recruitment processes used, and ethical considerations undergirding this study. This document includes references for the many citations appearing throughout this research, a chapter that discusses the results that arose from an examination of the data, along with a discussion of findings. It is my sincere hope that my words inspire greater interest in this topic and open a sacred space for the study to have deep and lasting meaning within the wider transpersonal and scientific community.</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>