The nursing field is beginning to emerge as a profession with curricula that emphasis nursing as a discipline distinguished from a medically dominated paradigm. This changing focus places emphasis on professional competence upon graduation and entry into practice to foster fitness for purpose within an environment of continuously changing expectations of the nurse by society. Despite a growing body of research on transition into practice, a gap exists as to when this transition occurs and how this finding may influence educational preparation of nurses. This qualitative, exploratory study examined nurses’ perceptions of their transformation from novice to professional practitioner by examining a pivotal moment in their practice that affected their self-reported professional competence, Twenty-five nurses who had worked in a hospital setting between 2 and 5 years were interviewed. The primary research question sought to address whether a common thread became apparent after conducting interviews that may have implications for nurse educators to enhance or change their curriculum. Analysis of the interviews was conducted utilizing a constructivist approach. The data collected were analyzed using ATLAS.ti, Using participants’ words that described people, settings, themes and ideas that appeared in the data, coding was done acknowledging that some codes were based on the research questions and the initial review of the data. A common theme emerged from analysis that respondents felt that what they were taught in school was not valid in real life. Nurse educators need to re-envision their social responsibility and interrogate the traditional principles that have guided the curricula to prepare and train nurses’ for the holistic welfare of all individuals in society. This is necessary to meet the needs of a changing social structure within the nursing profession and society as a whole.

Research has suggested that providers of health services must be aware of health literacy tools as elements of communication with patients. Poor health literacy is an epidemic that affects quality of care. The purpose of this study was to examine the functional health literacy of associate-degree nursing (ADN) students and their awareness of patients' health literacy needs. This correlational study was designed to examine the relationship between the functional health literacy of ADN students and their awareness of their patients' health literacy needs using the asset model and the health literate care model. A convenience sample of 131 ADN students in their last 2 semesters of nursing school completed the Test of Functional Health Literacy in Adults (TOFHLA) and the Knowledge and Skills Survey. Pearson correlation, linear regression, multivariate analysis of variance, and Spearman correlation were used to analyze the demographics of students, TOFHLA, and Knowledge and Skills Survey scores. The Pearson correlation indicated that the functional health literacy of ADN students and their awareness of the need to identify patients with low health literacy were statistically significant (p = .017). The results supported the need for improved training and support for students on the topic of health literacy along with opportunities for further research. The implication of social change directly relates the area of nursing education by further identifying associations between education and the application of health literacy, which leads to further discussion on organizational policy and curriculum changes. These types of analysis will lead to more patient-centered care and improved patient outcomes.

Correctional officers occupy an important societal role in maintaining safety and assisting in the rehabilitation of inmates; however, both their performance and mental health are highly susceptible to fatigue because of working in a high stress environment. This study investigated the relationship between correctional officers' demographic factors (level of education, marital status, gender, and race/ethnicity) and their psychological resilience. The Connor-Davidson Resilience Scale 10 (CD-RISC-10) was used to measure correctional officers' resilience when responding and or coping with stress. This study utilized the stress-vulnerability model as a framework to investigate protective factors against and risk factors for psychopathological symptoms. Participants included 52 individuals who were over the age of 18, employed as correctional officers, and who worked for either the California Department of Corrections and Rehabilitation or the Texas Department of Criminal Justice. Two tests measured the outcome variable of correctional officers' psychological resilience. The first factorial 2-way analysis of variance revealed no significant differences in correctional officers' levels of psychological resilience by gender and or race/ethnicity. The second factorial 2-way analysis of variance revealed no significant differences in correctional officers' levels of psychological resilience by marital status and or educational level. The information gained from this study implies that the development of programs that improve correctional officers' resilience and prevent the onset of psychopathology should be focused on factors other than races/ethnicities, genders, marital statuses, and levels of education.

Many companies have used perceptions of their employees to understand how sleep disorders affect their working environment. Sleep disorders have had an undesirable effect on employee performance and often result in employee modifications to accommodate their condition in the workplace. Though information is available concerning employees' experiences pertinent to working with sleep disorders, research focusing on how employees with narcolepsy perceive their work environment appears to be missing from the literature. The purpose of this study was to gain understanding of perceptions of employees with narcolepsy about their work environment and strategies that may influence others to promote positive health maintenance of narcolepsy in the workplace. The repair and restoration theory of sleep and the disability theory guided this study. Fifteen employees with narcolepsy participated in this descriptive phenomenological study by sharing experiences of their working contributions to become or remain employed. Giorgi's data analysis strategy revealed thematic employee reports of declines in work performance as a factor for being employed with narcolepsy. Study findings established that participants believed sleep attacks and inability to multitask were barriers in the workplace. Scheduling naps and changing work tasks offset barriers to help the participants remain successfully employed. The results of this study may benefit the health services industry as it relates to knowledge and understanding about productivity, schedules, and tools of the work environment for employees with narcolepsy. Positive social change implications include improved work environments and accommodations for employees with narcolepsy.

The persistent and chronic nursing shortage presents an urgency to understand the root causes of nurses' increasing mobility and movement within and outside of the nursing workforce. A key to understanding nurses' dissatisfaction is to explore the work environment in which they practice. The purpose of this heuristic, phenomenological study was to understand nurses' experiences of oppression and the power dynamics in the hospital setting, which may provide insight to nursing turnover. The conceptual framework was Harvey's civilized oppression theory. Data were collected from semistructured interviews of 9 registered nurses by phone that met inclusion criteria of having more than a year of experience in a hospital setting. The data were analyzed for codes and themes. Study findings showed all participants had perceptions and experiences of civilized oppression and claimed that power and ability to influence their work environment resided with groups other than nursing. Lastly, participants also had a perception of an ideal work setting with shared governance and civility at all levels and all nursing roles within the nursing profession. This study has a direct impact on strategies to address population health, community wellness and global health as the nursing workplace plays a role in shifting the paradigm of care from a sickness model to a wellness model.

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Accurate Evaluation and Management (E&M) billing and coding is an essential skill for medical clinicians. Consequences of incorrect E&M billing and coding include delayed patient treatment, delayed reimbursements from third party payers, and even charges of insurance fraud. The accuracy of billing and coding is especially salient in practices whose patient population is covered primarily by Medicare/Medicaid, as is the case in many Northeast Tennessee clinics. Despite the importance of accurate E&M billing and coding, recently graduated physicians moving into their first year of residency are often under-informed regarding proper billing and coding. Much of their knowledge about the process is picked up piecemeal over the course of their residency. The purpose of this study is to educate incoming post-graduate year one (PGY1) medical residents on the E&M billing and coding system for a rural Family Medicine clinic. During their first month as PGY1 resident physicians, participants were given a survey to assess their knowledge of E&M billing and coding for outpatient encounters. Participants then attended an educational session on this topic and received handouts that they could reference in the future. The participants were then surveyed again. Data analysis is currently underway. A repeated measure t-test will be utilized to determine if the educational session and informational handouts led to a statistically significant increase in PGY1 resident knowledge of E&M billing and coding. It is expected that participants will show significant knowledge gains as a result of the educational training. This research has important implications for medical resident training, particularly in rural practices that treat large populations covered by Medicare/Medicaid.

Previous research has shown that 45% of malpractice claims are due to insufficient and late follow-up of test results and limited communication methods provided to patients. This study explored the preferred communication methods between a patient and a healthcare provider. The technology acceptance model served as the conceptual framework. A quantitative research design was used to examine patients’ perceived usefulness, attitude, perceived ease of use, and adaptability regarding mobile technology. The primary means of data collection was the use of a survey questionnaire. Participants included a random sample of 118 women seen in a local health department in the women’s clinic and sexually transmitted disease clinic. The research questions focused on exploring test result notification using an electronic mobile device. A chi-squared test was used to answer each research question. The results of the chi-squared analysis revealed no significant association between the use of text messaging and communication with a health provider. There was a significant difference in the mean score in the preferred method of communication of an abnormal test result and a normal test, and that there is not a significant association between the use of a mobile device (IV) and response rate (DV) to test result notification with a health provider. The results from this study offer public health departments a better understanding of patients' preferred test notification method, which untimely creates a positive social change by reducing untreated sexually transmitted diseases.

Diabetes is a devastating disease in American. The disease can cause chronic health comorbidities, and untreated diabetes has negative consequences for individuals and on our nation's economy. Newly diagnosed diabetics often have a lack of knowledge about the disease process. The purpose of this project was to design and implement a diabetes educational program to enhance participants' knowledge about diabetes management and self-care using the Health Belief Model. Diabetes Self-Management Education (DSME) is critical in improving patient outcomes and the prevention of diabetes related complications. Participation in a standardized diabetic educational intervention will improve patient knowledge, as measured by a reliable and valid pretest and posttest questionnaire. The objective was to develop a DSME curriculum that will be recognized and approved by the American Diabetes Association. A one group pretest /posttest method was employed with ten participants. A sample of ten participants between the age of 22 years old through 65 years old included eight women and two men all identified as African American. Upon completion of the 5-week DSME program, participants were noted to have started participating in weekly exercise or increased the number of days of exercise from 2 days to 3 days per week. Participants also noted a decrease in their systolic and diastolic blood pressure reading. Participants noted on average a 2-3 pound weight loss. Significant improvements were shown on both the knowledge scale and confidence scale of the modified Diabetes Project Participation Questionnaire. Results from this project indicated that participants applied knowledge from the DSME program to improve their own health status.

Chinese immigrants (CIs) had low colorectal cancer (CRC) screening rates. Macro-level health determinants may affect CIs' CRC screening; however, this is not well established. Thus, this research looked at the macro-level social factors of CRC screening among CIs. The POET theoretical framework guided this study, which includes four components: population (P), organization (O), environment (E), and technology (T). A convergent mixed method was used to investigate whether sociodemographic, acculturation, religious social capital, and mobile media-based cancer information seeking may predict CIs' endoscopic screening, and how these variables impact it. A validated survey and an interview covering the same factors were utilized to collect quantitative and qualitative data from three local Chinese American churches. 101 church-going CIs completed questionnaires and 29 were interviewed. The three macro-level determinants of screening behavior were modeled using logistic regression. The interview data were analyzed using a framework analysis, which included familiarizing with the data, establishing a coding framework, coding, organizing categories and quotes, and mapping and interpretation. The majority of participants were over 50, employed, married, insured, well educated, and earning over $50,000/year. 54.46% of participants had Endoscopic screening. Doctor recommendation, higher Sunday worship attendance, and mobile media-based cancer information seeking were all significantly associated with endoscopic screening (p < .05). The qualitative investigation showed that a doctor's recommendation was essential. Mobile media eases endoscopic screening fear and empowers participants. The endoscopic screening was less impacted by high religious social capital among churchgoers. The findings show that improving endoscopic screening among CIs requires multilevel interventions. Doctors should provide culturally and linguistically appropriate screening recommendations. Chinese American churches may help by sharing endoscopic screening information and emotional support. Mobile media should be used to raise CI screening awareness and ease screening fears.