Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the study was the healthcare utilization model. Interviews were conducted with 10 women participants, ages between 18 and 45. The data collected through semistructured interviews were analyzed using NVivo 11 and the Colaizzi 7-step processes to identify themes and subthemes. Study findings revealed systemic challenges that affected healthcare access which need to be adequately addressed to reduce maternal and child mortality among women of child-bearing age. The study findings could foster social change by improving the development of healthcare standards, as well as illustrating methods of increasing the level of access to healthcare services among women of childbearing age.

Heroin addiction is a growing epidemic in the United States. The need for proper treatment programs accessible by heroin users who wish to or are mandated to participate in recovery programs is a growing need, and pathways to sobriety for ex-offenders have presented in literature as understudied. The purpose of this study was to examine heroin-addicted offenders' experiences prior to and after release on their paths to sobriety. This study followed a qualitative phenomenological approach based on the theory of personal causation, which posits that individuals see events in life as either driven by themselves or caused by others, both of which affect internal motivation. An empirical phenomenological approach was used to explore how this group of individuals perceived or experienced heroin addiction and their subsequent attempts at sobriety A purposeful sample of 15 heroin-addicted offenders were interviewed in a jail in a rural county of Wisconsin. Upon re-entry, 4 participants completed follow- up interviews. The results showed that external motivators such as social and treatment factors were separate from internal factors, although external motivators could influence the way a person makes internal choices. Results were obtained by performing coding on the semi-structured interviews both by hand and within the Atlas-ti analysis program. The theory of personal causation supports and is supported by the findings of this study. Implications for positive social change include a better understanding of the needs of heroin-addicted offenders moving from incarceration to release in treatment program development, thereby reducing harm to the heroin user, family members, and communities by decreasing relapse, recidivism, and chances of overdose and death.

Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans' perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans' perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population's perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans' participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi's strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans' health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines' answers on the PDHRA. An understanding of the study's findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.

Individuals diagnosed with 22q11.2 deletion syndrome (22q) have many barriers and quality of life issues associated with the condition. Without an obvious anomaly, affected individuals may live years without a proper diagnosis. The purpose of this qualitative case study research was to explore perceptions of caregivers of individuals with 22q. Uncertainty in illness theory was used as it describes the inability to find answers with unpredictable medical issues. The central research question focused on at how challenges associated with a 22q diagnosis are addressed. Interviews were conducted with 10 caregivers. Guided by the uncertainty in illness theory, data analysis was conducted by coding through NVivo to find themes. Themes identified included, but were not limited to: (a) age and symptoms at diagnosis; (b) usage of the internet for answers; (c) future transition uncertainties; and (d) lack of provider knowledge. Five out of 10 participants had a child with a known heart condition at birth, which led to a 22q diagnosis. Five out ten individuals with 22q were diagnosed at a later age following a manifestation of other serious conditions. A greater index of suspicion could have led to a more timely diagnosis of 22q. All individuals expressed the desire for a more prompt and thorough diagnosis. The positive implications for social change include influencing physicians and policy makers through education and implemented policies that can lead to more timely diagnoses and treatment for better health outcomes. This social change can influence the target population through scholarly publications in medical journals. It may also be influenced through policy proposals influencing early detection screenings at birth. The addition of caregiver advocates may also bring about change within the 22q community.

The number of medication errors associated with preventable deaths in healthcare facilities remains at a high rate for healthcare leaders. Practices of medication delivery remain similar to those 10 years ago. Hospitals that have implemented barcoding medication administration systems have reported a decrease in medication errors ranging from 60% to as high as 93%. Despite this utility of barcoding, only 50% of U.S. hospitals have implemented barcode medication administration. This comparative case study explored the strategies hospital leaders used to implement barcode medication administration systems, utilizing the sociotechnical theory for a conceptual framework. Face-to-face, semistructured interviews were used to identify experiences from a purposive sample of 20 hospital leaders from Minnesota and Iowa. The research question guiding this study addressed strategies hospital leaders used to implement barcode medication systems to reduce preventable medical errors. After analyzing the interview transcripts using inductive analyses, 4 themes emerged. These themes include the strategic organizational communication, technology and end user support, hands-on training, and application of audit reports. Hospital leaders might benefit from the study findings when developing strategies to implement barcode medication systems. The implication for positive social change includes the potential of decreasing patient medication errors and reducing loss of life caused by medication errors with hospital leaders accelerating the adoption of barcode medication systems in hospitals. Other health care providers may explore how the findings might help reduce medication errors in their facilities.

Lack of employee commitment affects the overall practice in healthcare organizations and can cause a disruption in the lives of people with intellectual disabilities who are receiving care. Researchers have demonstrated that increasing employee commitment and decreasing employee turnover are related to employee commitment in healthcare organizations. The purpose of this single case study was to explore strategies that leaders of an intermediate care facility for individuals with intellectual disabilities in the northwestern United States used to enhance employee commitment. Meyer and Herchovitch's model of employee commitment was the conceptual framework for this study. Data were collecting from semistructured interviews with 2 home managers and 1 area supervisor of a healthcare facility with experience in employee commitment. Data were transcribed, analyzed, and coded for themes and subthemes; data validity was established using member checking of the findings for accuracy and credibility. Three main themes emerged from the data analysis: organizations' healthcare insurance, bonuses, and teamwork. Healthcare leaders might implement the findings of this study to increase and develop employee commitment, improve profitability and sustainability, improve patient care, and improve safety to bring about a positive and effective social change to benefit patients, families, and communities.

International Classification of Diseases the 10th Revision (ICD-10) was implemented October 1, 2015, and there was little knowledge how the transition to ICD-10 would impact the revenue cycle for intraoperative neurophysiological monitoring medical practices in Oklahoma. This correlational quantitative study examined the changes in dependent variables of reimbursements due to the change from ICD-9 to ICD-10 for independent variables of intraoperative neurophysiological monitoring procedure codes. The reimbursements from 2014 were compared to reimbursements from 2016. Prices were adjusted for inflation to 2016 dollar values. Annual reimbursements decreased for all intraoperative neurophysiological monitoring procedures examined except the remote monitoring code. The intraoperative neurophysiological monitoring procedure with the greatest mean annual decreases in reimbursement was the lower somatosensory evoked potentials. The intraoperative neurophysiological monitoring procedures with the least annual reimbursement decreases were transcranial electrical motor potential monitoring and electromyography. The findings of the budget-impact analysis and cost-effectiveness analysis indicated that reimbursement for procedures has steadily decreased from 2014 to 2016, causing a negative effect on practices' revenue cycle management. The findings of this study could benefit intraoperative neurophysiological monitoring companies in Oklahoma by supporting adjustments essential for healthcare leaders to maintain a financially sustainable intraoperative neurophysiological monitoring medical practice.

In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.

Pressure ulcers were a continuing concern among the nonverbal developmentally disabled population of a state institution. The lengthy use of wheelchairs, the inability to body shift, and physical and mental impairment were attributes of the target population that have been cited in the literature as contributing to pressure ulcer. The purpose of this quasi-experimental pretest/posttest project was to evaluate the effectiveness of an education intervention for direct care staff on the prevention treatment, and eradication of pressure ulcers among patients with developmental disabilities. Orem's self-care deficit theory, particularly the emphasis on the need for nursing staff to perform self-care activities for persons who are unable to manage the activities themselves, was the theoretical basis of the project. The Iowa model of evidence-based practice provided the evidence translation direction for the project. All licensed practical nurses and healthcare technicians employed by the institution were invited to participate in the education. Participants completed a pretest on pressure ulcer prevention and management knowledge before the education was presented, and after the educational component of the project concluded. Statistical significance of the differences in pretest to posttest scores was not calculated because the sample size was small (n = 37); however, all participants achieved 100% correct answers on the posttest up from a 50% mean score among licensed practical nurses and a mean score of 30% among health care technicians. Social change was evaluated within the institution by a decrease in new pressure ulcer cases to zero in the week following the education, and a commitment from the director of nursing to provide pressure ulcer education to all new direct care employees and refresher courses for continuing employees.

Nearly half of all frontline leaders in U.S. federal agencies during 2015 were unprepared to improve employee engagement. The lack of successful strategies to improve employee engagement in federal government agencies has led to decreased operational performance. Guided by the employee engagement theory as the conceptual framework, the single case study design was selected to explore the successful strategies that frontline leaders use to improve employee engagement at a federal agency in central Maryland. Data collection involved face-to-face, semistructured interviews with 4 frontline leaders and federal agency documents indicating employee engagement. The data analysis process included Yin's 5-step method and revealed 2 major themes: effective organizational communication, and enhancing employee development. Employee engagement improves if frontline leaders use strategies that involve effective organizational communication and enhancing employee development to promote open, transparent communication, teamwork, collaboration, skills development, incentives, rewards, and improved work-life balance. The implications for social change include the potential to implement successful engagement strategies in the federal agency, because employees who are more engaged generate better performance and productivity, build valuable work relationships, enhance career, and increase wages to improve the well-being and prosperity of themselves and their families. Improved performance and productivity could help to lower operating cost at the federal agency; thus, creating opportunities to reinvest savings into local community outreach programs that contribute to healthy living, well-being, and economic prosperity.