<p> In spite of a decrease globally, the maternal mortality rate (MMR) in Nigeria and its Jigawa State has remained persistently high. Few efforts to address the MMR in Nigeria have been undertaken. The purpose of this study was to investigate the impact of Jigawa State&rsquo;s Free Maternal and Child Health Program (JSFMCHP), education, employment, and parity of pregnant women on health care utilization (the outcome variable), as measured by antenatal care (ANC) visits. Anderson&rsquo;s behavioral model served as the study&rsquo;s theoretical framework. The sample size included 400 antenatal records of pregnant women who were randomly selected from the state&rsquo;s Health Management and Information data collected between 2011 and 2015. Chi-square tests showed a significant association between those who did not participate in the JSFMCHP, education, employment, with ANC. There was no association between parity and the number of ANC visits. The odds ratio suggested that pregnant women who did not participate in the program were 5.53 times as likely to have 4 or more visits compared to those who participated. Furthermore, the recommended number (4 or more) of ANC visits was predicted by tertiary education and employment. This study&rsquo;s findings indicate the need for a reevaluation of JSFMCHP policy, with a focus on ensuring a minimum recommended number of ANC visits for all program participants. These results can influence positive social change if used by policy makers to strengthen policies that have a beneficial impact on maternal morbidity and mortality in Jigawa State, in particular, and Nigeria, in general.</p><p>

<p> Inadequate nurse staffing levels by experienced Registered Nurses (RNs) are linked to higher rates of patient falls, infections, medication errors, and even death. As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside. The purpose of this small exploratory master&rsquo;s thesis research study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, examined the experiences of acute care RNs who regularly maintain nurse-to-patient ratios of 1:5 or greater during a 12-hour shift, and the impact these ratios have on nurse satisfaction and retention at a small rural community hospital in North Carolina through a basic qualitative research methodology. Purposive sampling was utilized, and the inclusion criteria required the participants to have an active unencumbered RN license and work in one of the acute care units at the hospital. If the RNs held any managerial or supervisory role at the hospital, they were excluded from the study. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: the current system at work, what if it goes wrong, working with others, things nurses must do, and things nurses feel. The evidence from this basic qualitative study aligns with the published literature regarding the higher nurse-to-patient staffing ratios and supports making a proposal to the hospital&rsquo;s administration for creating a patient acuity score that allows for a nurse staffing grid based on acuity, to improve patient safety and nurse satisfaction and retention.</p><p>

<p> Within the 21^st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. The materials were found to be clear, accurate, and easy to read by the medical assistants. Four MAs, who worked at the clinical setting, participated in the educational program that taught them to use the toolkit developed for this project. To evaluate the effects of the educational program for the MAs, the results of the pre and posttests were scored and showed that MAs had significantly increased their knowledge of teaching diabetes and obesity self-management for African Americans (pretest mean score 80, posttest mean score 93). An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing education in diabetes and obesity. Positive social change may result as the African American patients who receive education from medical assistants at the clinical site improve their self-management skills to prevent diabetes and obesity or the complications of the disease.</p><p>

<p> Despite concerted efforts to improve the process of shift-to-shift hand-off report (SHR), challenges and barriers continue to threaten the integrity of information shared between nurses. Research studies have demonstrated that vulnerabilities in SHR have been associated with clinical practice demographic factors, lack of a standardized process and tools, and differences in perceived value of SHR. </p><p> A quantitative, descriptive, cross-sectional study was conducted to identify nurse perception of SHR processes, factors that influence nurse perception of SHR, and nurse perception of bedside shift report (BSR) versus alternative SHR methods. Participants included a convenience sample of registered nursing students (n=49) enrolled in RN-BSN or MSN programs at a private southwestern Pennsylvania university. Descriptive statistics, ANOVA, and two independent t-Tests were used to analyze data collected from the Handover Evaluation Scale. </p><p> Study results revealed there was no statistically significant difference between nurse perception of SHR processes, demographic factors that influence SHR, and the locality of SHR (BSR). In addition, the majority of nurses identified a reluctance to change current practice of conducting the SHR process. There was no identified association between nurse perception of the quality of information (<i>p</i>=.22), interaction and support (<i>p</i>=.96), or efficiency (<i>p</i>=.17) of SHR. </p><p> As nurses are key stakeholders in the transfer of crucial up-to-date patient care information, nurse perception of the SHR needs to be further examined and evaluated to improve patient care outcomes. Quality assurance measures are the hallmark of standardized processes to ensure the delivery of safe and effective care.</p><p>

<p> Racial and ethnic health disparities are highest in communities of color; providing culturally competent care could address these disparities. Culturally competent communication between the healthcare provider and the patient is an essential behavior that may improve health in racially and ethnically diverse women. A quality improvement project was completed with guidance from the 5 constructs of the Campinha-Bacote model as the conceptual framework, and the method used was the Consumer Assessment of Healthcare Providers and Systems survey. The perspective of 20 Mexican American and 20 African American women in El Paso, Texas between ages 45 and 72 with menopausal symptoms was surveyed to determine if culture had an impact on the presence or absence of communication with their healthcare providers. Results showed women&rsquo;s perceptions of positive and negative communication behaviors with their healthcare providers was inconclusive; however, results showed that provider communication about health promotions, use of alternative medicine, and shared-decision making regarding health management needs improvement to promote adherence to medical regimen and feelings of mutual respect. Integrating cultural competence into existing evidence-based care can positively impact the delivery of services and help improve the quality of care. Healthcare providers can impact positive social change through the lessening of burdens associated with the lack of diversity in the workforce by including cultural competence training into the curriculum of nursing and medical schools.</p><p>

<p> Each year, approximately 10,000 baby boomers will reach age 65. The baby boomer generation encompasses 26% of the total U.S. Population. As members of the baby boomer generation reach older adulthood, they continue to experience mental health issues such as depression, anxiety, as well as medication and alcohol abuse. These mental health conditions are associated with higher rates of health care usage. In addition, an older adult may jointly suffer from a lower quality of life, increased complex illnesses, disability, and mortality/increased risk of suicide. If an older adult does not have the appropriate mental health support services, he or she may overuse the healthcare system. Obtaining mental health services is still considered taboo for some, while for others the services may not be accessible. Conversations from Home Telemental Health aims to employ innovative technology in telehealth to improve mental health delivery services for the baby boomer population. Its mission is to provide accessible and effective evidence-based therapy designed to engage baby boomers, address their mental health needs, and minimalize premature institutionalization. Conversations from Home&rsquo;s goal as a non-profit organization is to become a leading provider of telemental health services to individuals aged 50 and older in the Westside of Los Angeles and the South Bay. This proposal will provide a detailed evaluation of how Conversations from Home will accomplish these objectives.</p><p>

<p> This qualitative, explanatory case study addressed one primary research question: How do interprofessional healthcare teams adapt in response to an adverse event? There were two subquestions: How does employing the components of change enable interprofessional healthcare teams to adapt? and How does employing the components of team enable interprofessional healthcare teams to adapt? Despite knowledge of the benefits of interprofessional teams, flawed teamwork is often to blame for adverse events (Manser, 2009). Unfortunately, most studies have not identified what aspects of teamwork need to be improved to prevent adverse events. In addition, Bowie, Skinner, and de Wet (2013) concluded from a study of healthcare root cause analysis (RCA) conducted after adverse events that only 82% of changes suggested by the RCA were implemented fully or partially. Literature that addresses how teams adapt after an adverse event is limited. </p><p> This study examined three interprofessional healthcare teams within a large academic medical center. Data gathered from document review, supervisor interviews, focus groups, and team member interviews were used to explain how teams adapted in response to an adverse event by examining factors related to change and teams. The contributions of factors of change and teams to team adaptation were also revealed. </p><p> The study offered the following broad conclusions. First, it is important to capture ongoing learnings from teams beyond the RCA. Second, the type and pace of change contribute to how ambiguity manifests. Third, a common mental model focused on the patient enables teams to make changes to reduce harm. Fourth, strong communication and leadership can help reduce ambiguity resulting from change. Fifth, team learning is robust when relationship conflict is minimal and psychological safety is strong. Lastly, team adaptation is composed of cognitive and behavioral adaptations, which are enabled by change and team factors, respectively. The study concludes with implications for theory and practice, as well as recommendations for further research.</p><p>

<p> Healthcare industry faces major challenges in providing care to the aging American population. Strong leaders are needed to address the chaotic, changing healthcare environment. The specific problem is the increasing lack of leaders to address healthcare organization issues involving aging, baby boomer workforce retiring. High-stress jobs and retirements create a leader gap. Succession planning and management (SPM) become significant to healthcare organizations to ensure an appropriately developed pool of internal candidates is available to move individuals forward as leadership positions become available. Leadership development (LD) is critical to SPM processes. Individuals require specific training and mentoring to develop skill sets to meet healthcare industry challenges. The purpose of this qualitative multiple case study was to obtain senior healthcare leaders&rsquo; perceptions on leadership practices and SPM processes; and explore if there was a link between LD practices and SPM in an integrated healthcare delivery system to query lived experiences for in-depth understanding. A sample of 11 interviews conducted with multi-levels of senior leaders from corporate to regional and local areas in Southern and Central California. Senior leaders guide SPM processes and implement LD practices. Three research questions guided interviews to seek senior leader perspectives on SPM processes and LD practice in healthcare organizations. NVivo, a computer-assisted data quality analysis software provided the ability to perform coding process following manual coding. Six themes identified involving the need for formal, structured SPM and leadership development to ensure the right person is in the right leader role. The selection process should begin at the employment interview for specific criteria. Measurable outcomes are needed on LD and SPM to ensure success and sustainability. The findings from the study are important in application to healthcare organizations to support an integrated, linked system of SPM and LD to ensure a pipeline to fill leader gaps successfully by identifying individuals from employment interview and through career movement. Future research is needed to enhance the study in various healthcare organization milieus. Qualitative research measuring outcomes would address effectiveness and sustainability of SPM and LD. Qualitative study with lower level leaders&rsquo; perceptions would corroborate importance of linking the concepts.</p><p>

<p> The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have been completed that pertain specifically to behavioral health-care clinicians. The study purpose was to examine the relationships that may exist between behavioral health-care clinician perceptions of usefulness and ease of use and demographic variables on adoption of the EHR. Regression analyses were performed to test the relationship between behavioral health-care clinician personal characteristics, their perceived ease of use and usefulness of EHR, and their attitudes toward adoption of the EHR. The study utilized licensed marriage and family therapists as participants. The Physician&rsquo;s Survey Questionnaire Form was adapted to the needs of this study and utilized as the survey instrument. The study was embedded within the frame of Roger&rsquo;s diffusion of innovations theory and the technology acceptance model. The findings of the study suggest that older clinicians are less likely to perceive the EHR as useful in their professional practice. The results also demonstrate that behavioral health clinician perceived ease of use and usefulness of EHR is positively associated with attitude toward adoption of the EHR. The findings indicate that to improve the adoption of the EHR for behavioral health clinicians, the EHR needs to be viewed as useful. Interpretation of the results and suggestions for future research are offered. </p>

<p> <b>Background:</b> Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. </p><p> <b>Purpose:</b> The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services&rsquo;, Joint Commission on Accreditation of Healthcare Organization&rsquo;s, and other professional healthcare organizations&rsquo; guidelines for nurses&rsquo; knowledge of evidence-based discharge practices; determine level of nurses&rsquo; knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. </p><p> <b>Theoretical Framework:</b> The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. </p><p> <b>Methods:</b> Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired <i>t</i> test. An online demographic survey and pre- and posttest surveys were administered to determine nurses&rsquo; knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired <i>t</i> tests. </p><p> <b>Results:</b> A statistically significant difference was found in the pre-posttest survey responses for question 5 (<i>p</i> = 0.046 Wilcoxon; <i>p</i> = 0.041<i>t</i> test), and question 13 (<i>p</i> = 0.022 Wilcoxon; <i>p</i> = 0.018 <i> t</i> test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. </p><p> <b>Conclusion:</b> A standardized diabetic discharge guideline incorporated into the hospital&rsquo;s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses&rsquo; adherence results in effective nursing practices and an informed patient population. </p><p>