Workplace stress has become a frequent occurrence in the race for competitive business advantage. This stress leads to negative physiological consequences in the workplace, causing productivity and profitability to suffer. The purpose of this single case study was to explore the stress management strategies that some health care business leaders used to reduce the effects of work-related stress on their employees to improve productivity. The interview process included 3 managers employed at a health care institution in Houston, Texas, with records of implementing successful strategies for mitigating the effects of workplace stress. The conceptual framework was job demands-resources model, pertinent to the research question to shape this study. Data collection occurred through: (a) face-to-face semistructured interviews, (b) document reviews including the policy and procedure manual, employee annual evaluations, returned satisfaction surveys; and (c) direct observations, using observational protocol. Using the exploratory standard data analysis process, coded input of interview transcripts produced emergent themes to reduce workplace stress including: (a) adequate work resources, (b) work-life balance, and (c) sound management responsibilities. Findings from this study indicate that business managers using these themes could mitigate some of the negative consequences of organizational stress. The data from this study may contribute to social change through conveying to healthcare functionaries anti-stress strategies, increasing community awareness, and making members of the communities healthier.

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as a guide to develop veterans' self-management skills. A retrospective chart review was conducted on 26 veterans with CHF enrolled in the CCHT program. Post participation weight and blood pressure were analyzed at 16 weeks to determine whether there was a difference from the pre-participation measures. There was no change in systolic blood pressure, diastolic blood pressure, or weight levels during the 16-week period. Limitations of this project were the small sample size (n = 26), attrition rate (n = 43), no data on nurse interaction, and a short follow-up period. Implications for nursing practice and enhancing the program's efficacy are recommended. This scholarly project has the potential to support social change by expanding veteran's access to care.

More than 10 million people in the United States are known to have latent tuberculosis infection (LTBI), and more than 300,000 begin treatment for LTBI annually. However, many fail to adhere to therapy for numerous reasons. The purpose of this project was to evaluate the impact of a new guideline, Targeted Tuberculin Testing and the Treatment of Latent Tuberculosis, at inner-city tuberculosis (TB) control clinic in the United States. The practice-focused question for the project asked if the implementation of the clinical guideline using a shorter regimen improved LTBI treatment adherence. The health beliefs model was the framework used to guide the project. I analyzed data from deidentified LTBI treatment adherence records of 12 patients before the change to the shorter treatment regimens and 12 patient records 1 year after the change. Results after implementation of the new treatment guideline showed no improvement in adherence. Before the guideline implementation, 75% (n=9) of individuals had adhered to traditional therapy whereas, after the shortened course was implemented, only 66.7% (n=8) of the random sample adhered to treatment. It is important to evaluate new methods of treatment and determine success early to promote health and reduce complications of ineffective treatment of TB. These results can support positive social change by raising awareness of the need to evaluate new treatment effectiveness early. Such knowledge can help providers and clinicians examine the barriers to adherence to the medications used for treating TB and implement appropriate measures to overcome the obstacles.

The expansion of health insurance through health care reform has reduced the number of uninsured. but access to providers has not been addressed. Understanding the relationship between practice choices and aptitude of health policy and delivery is essential to determine other factors or motivators that contribute to the development of health care access policies. This descriptive study explored the value-laden elements of health care reform, such as social constructions, to learn whether there are implicit ways to address the issue of access to health care in the United States. Schneider and Ingrams's conceptualization of policy making through social construction was used as the theoretical lens of this study. The research questions for the study examined the relationship between a provider's choices and their knowledge of health policy and delivery. This non-experimental, quantitative survey study used a convenience sample of 189 providers. The survey was a compilation of 4 existing instruments that were used to capture provider demographics and choices as well as scaled questions to assess knowledge. Data were analyzed through a series of chi-square tests. Significant relationships were found (p < .05) between the variables of specialty, medical licensure, and understanding of health policy and delivery concepts. This study contributes to social change by suggesting the need for health policy and delivery education programs geared towards providers. These changes could improve the level of provider engagement and be a catalyst for generating ideas of how the U.S. health care system could achieve the goal of providing efficient, high-quality care.

Since 9/11, little statistical rigor has been placed on identifying the correlates of hospital preparedness. This quantitative study explores the research question: Is there a correlation between the employment of a designated hospital preparedness coordinator and the reported level of preparedness for: (a) general preparedness; (b) chemical, biological, radiological, and nuclear (CBRN) events; (c) pandemic disease outbreaks; (d) mass casualty events; and (e) internal infrastructure failure, as assessed by an online survey. Alternative analysis was conducted to assess the relationship between access to resources and the 5 dependent variables. Using complexity theory as the theoretical framework, point biserial correlation and Pearson's method were used to assess the relations between the dependent and independent variables. Initially, no statistically significant correlative relationship was found using point biserial analysis. However, further analysis found that the correlation between full-time employment of a preparedness coordinator and pandemic preparedness reached significance. Point biserial analysis of the alternative research questions found statistically significant correlations between access to preparedness resources, CBRN, pandemic, and infrastructure failure preparedness. Pearson analysis found a statistically significant correlation between single facility coordinator responsibilities and pandemic preparedness. This identifies at least 2 significant correlates of hospital preparedness. Positive social change can be achieved by identifying strategies that leverage these assets in a fiscally sustainable constructs that maximize hospitals' ability to effectively serve the community in disasters but that do not so heavily rely on government funding and grants in a world of ever-changing priorities.

Despite a large body of literature addressing the issue, questions remain about whether nonprofit hospitals provide more community benefit than do for-profit hospitals. This lack of information impacts governments, hospitals, and the healthcare industry, as stakeholders attempt to generate requirements to which hospitals should adhere to maintain nonprofit status, and thus tax exemption. This study addressed this lack of information by examining U.S. hospitals through the lens of stewardship theory to determine whether nonprofits are better stewards of the public good than for-profits, and thus likely to provide higher quality and access. The study applied logistic regression to Centers for Medicare and Medicaid Services (CMS) data indicating levels of perceived quality, or patient satisfaction, and American Hospital Association data identifying service mix profitability, an indicator of access. The sample included all 2,701 U.S. hospitals receiving CMS funding. Findings indicated that high quality hospitals were more likely to be nonprofit than for-profit (b = 0.07; Exp(B) = 1.07; p = .000). Neutral access hospitals, those with mid-range service mix profitability, were more likely to be nonprofit than for-profit (b = 1.73; Exp(B) = 5.63; p = .000) as were high access hospitals, those with low service mix profitability (b = .276; Exp(B) = 1.32; p = .04). The R_L^2 for the models was .06 and .03, respectively. Given this limited predictive power, it seems unlikely the added value (access and quality) nonprofits are likely to provide justifies tax exemption. If further research supports this argument for other potentially relevant variables such as technical quality of care, governments could remove nonprofit hospitals' tax exemptions and apply the resulting tax revenue to other policy areas to realize positive social change.

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015   Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap via this quality improvement, pre/posttest pilot project. Multiple frameworks guided the project: the nursing process, Lewin's change management model, the Johns Hopkins Nursing EBP model, and the Five Practices of Exemplary Leadership-® model. A comprehensive literature search validated the design using EBP facilitators: educational interventions, transformational leadership, strategic planning, and a systems perspective. Pre/posttest data garnered from 14 non-direct care nurse leaders on the Organizational Culture and Readiness for System-Wide Integration of EBP Scale, the EBP Beliefs Scale, and the EBP Implementation Scale was analyzed using 2-sample t tests. Individual questions on the scales revealed statistically significant differences correlating to the facilitative interventions, yet overall aggregate scores did not change significantly. The limited findings contribute to the existing body of knowledge, while positive social implications include resolving public health and safety issues, reversing fiscal irresponsibility, and overcoming resistance to change.

Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support the need for the development of a dashboard for staff and to ensure that staff were informed as they developed interventions to improve patient outcomes. Publicly available data published by the Centers for Medicare/ Medicaid (CMS) for the Quality Star Report were explored to inform the project. Workgroups, comprised of volunteers from leadership and staff providing care at the bedside, were formed to implement practice changes based on the dashboard reports. By bringing the data to the attention of nurses within the organization, improvements were made in the overall score for safety of care from below national average (25th percentile of the reported 3,647 hospitals across the nation) to the same as national average (47th percentile) as reported by CMS. Through staff involvement, social change occurred as strategies were hardwired to improve categories of the Quality Star Report and ultimately patient care. The project showed that quality improvement tools can assist in empowering staff to understand the data needed to implement process improvement strategies.