<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>

<p> Problem: Servant leadership scholars have claimed that servant-led business organizations are more financially viable, but these claims are based on anecdotal evidence. This quantitative study examines the relationship of servant leadership to revenue generation in business organizations by analyzing the predictability of servant leadership attributes on sales performance. This was accomplished by studying salespersons in the healthcare industry. </p><p> Method: One hundred ninety-four study participants completed questionnaires providing quantitative measurements of the seven factors of servant leadership: (a) developing and empowering others, (b) humility, (c) authentic leadership, (d) open participatory leadership, (e) inspiring leadership, (f) visionary leadership, and (g) courageous leadership, utilizing the Servant Leadership Profile&mdash;Revised (SLPR). Sales performance was measured by sales ranking within each respective salesperson's company, and broken down into three categories; (a) Top 20%, (b) 21%&ndash;40% and (c) 41% and below. </p><p> Results: Discriminant function analysis generated two discriminant functions that were significant. The first discriminant function was labeled <i> Voice</i> and had the strongest relationship with the following factors of servant leadership: developing and empowering others, authentic leadership, and visionary leadership. The first discriminant function was a good predictor of sales performance. The second discriminant function was labeled <i> Human Resource Management</i> and had the strongest relationship with the following factors of servant leadership: open participatory leadership, courageous leadership, and inspiring leadership. The second discriminant function predicted membership in the 21%&ndash;40% sales-ranking group, mediocre sales performance. One factor of servant leadership, humility, was eliminated as a predictor of sales performance. </p><p> Conclusions: Developing and empowering others, authentic leadership, and visionary leadership are good predictors of sales performance. Open participatory leadership, courageous leadership, and inspiring leadership predict mediocre sales performance. Humility was eliminated as a predictor of sales performance. Business leaders with high mean scores for developing and empowering others, authentic leadership, and visionary leadership are likely to have a positive impact on the financial viability of a business organization.</p>

<p> The objective is to identify factors associated with patients' decisions to sign advance directives (ADs). Retrospective database analysis was performed on 9,416 current home health patients and hospice discharges patients from the 2007 National Home and Hospice Care Survey (NHHCS). Documentation of ADs continues to rise in America, specifically in home and hospice settings. Do-not-resuscitate order (DNR) and durable power of attorney were the most common types of ADs. Self-pay patients were the population having the highest rate of having an AD. Older age, race (White), sex (male), mental illness and life expectancy were factors influencing the likelihood of choosing an AD. Efforts to improve ADs documentation rates call for consideration of the decision-making associated factors analyzed in this study as well as others such as healthcare professionals or family members.</p>

<p> Asthma is one of the most prevalent chronic diseases in the United States. If diagnosed asthma is highly treatable. However, diagnoses of asthma can be the hardest part of treatment. This study was conducted to examine the characteristics of asthma patients in the emergency room (ER). The dependent variable used use of ER in the past 12 months among was individuals who are currently diagnosed with asthma. I used the following independent variables to determine any characteristics that these individuals might share; age, race, insurance status/type, number of doctors' visits per year, geographic location and whether these particular patients use daily medication to control their asthma.</p><p> Data from the California Health Interview Survey (CHIS) 2009 was used. An association was found between the dependent variables; age, race, insurance status and number of doctors' visits per year. However, no association was found between geographic location and ER usage for individuals who have asthma. </p>

<p> People who commit suicide are often more likely to be suffering from depression and feelings of worthlessness. Different ethnicities have different rates of suicide. There are various reasons for this, including family support or lack thereof, individualistic versus collectivist cultural norms, and stress. This study looks at the relationship between feelings of depression among various ethnic groups, and whether one ethnic group has a higher prevalence of depression and feelings of worthlessness than the others. Results of this study can be used to help determine the populations that are in need of suicide prevention programs the most, and ways to customize the programs for those high-risk ethnicities.</p>

<p> The goal of this study was to determine the frequency of horizontal violence in the Perinatal Service line and its affect on patient outcomes. A link to a 24-question survey instrument entitled "Horizontal Violence in Perinatal Nursing" was distributed to the Perinatal Discussion List with permission from its host. The sample included 63 nurses of which 61 completed the survey in its entirety. These results were collected from January 28, 2013 through February 11, 2013. The results indicated that Labor and Delivery does experience a higher frequency of horizontal violent behaviors than other perinatal units. It also showed that the Mother Baby unit demonstrates a higher frequency of recipient or victim behaviors. A relationship between horizontal violence and ineffective communication was shown as well as a relationship between horizontal violence and poor patient outcomes or near misses. These results show that horizontal violence is present on Perinatal units and are having a negative impact on our nurses and the patient care they give. Additional research is needed to study the work environments and all the factors that contribute to horizontal violence developing and becoming the accepted behaviors. </p>

<p> The objective of this dissertation was to examine the association between patients' race and receipt of National Comprehensive Cancer Network guideline-adherent and timely colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) care in the Veterans Affairs (VA) healthcare system. Data were from the External Peer Review Program (EPRP) Special Study on CRC and NSCLC, originally purposed for performance monitoring, examined in an observational, retrospective study design. The sample consisted of African American (AA) and Caucasian patients diagnosed with CRC between 2003 and 2006 or NSCLC between 2006 and 2007 at VA hospitals nationwide. Statistical analysis approaches included multivariate logistic regression and survival analysis methods. </p><p> Our first analysis used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for Stages II-III; fluorouracil-based adjuvant chemotherapy for Stage III; surveillance colonoscopy for Stages I-III). There were no significant racial differences in receipt of guideline-concordant CRC care. Our second analysis examined associations between race and CRC care timeliness. There were no racial differences in time to chemotherapy initiation (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). Caucasian race was protective for shorter time to first surveillance colonoscopy (HR 0.63, p=0.02). On average, the difference in time to colonoscopy was sixteen days. Our third analysis examined associations between race and NSCLC care timeliness. There were no racial differences in time to initiation of treatment (72 days for AA versus 65 days for Caucasian patients, HR 1.03, p=0.80) or palliative care or hospice referral (129 versus 116 days, HR 1.10, p=0.34). However, the adjusted model found longer survival for African American compared to Caucasian patients (133 versus 117 days, HR 1.31, p=0.00). </p><p> In these data there were minimal statistically significant racial differences. We identified no clinically meaningful racial differences in cancer care quality, timeliness, or patient outcomes. This suggests that VA may be a leader in providing equitable cancer care. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.</p>

<p>The general problem is Native American tribes have high prevalence rates of diabetes. The specific problem is the failure of IHS sites to adopt EHR may cause health care providers to miss critical opportunities to improve screening and triage processes that result in quality improvement. The purpose of the quantitative correlational study was to explore a possible correlation between electronic health record use and reductions in diabetes co-morbidities. The study involved examining over 10 years of ex post facto data, with over one million patient encounters, from the Resource and Patient Management System database. Electronic health records containing key components such as clinical decision support with clinical reminders, evidence-based guidelines, template-driven protocols, and algorithmic modeling changes clinical provider behavior resulting in quality improvement. The study identifies the theoretical constructs from over 50 years of literature that converge to support quality improvement using electronic health records. Quality improvement theory and the unified theory of acceptance and use of technology were examined to explore relationships between process changes and behavioral modification. Results revealed a significant positive correlation between total blood pressure control screenings and the diagnosis of hypertension for fiscal years 2005 &ndash; 2009 <i>r</i>(4) = .947, <i>p</i> = .007. A significant positive correlation also existed between blood pressure control screenings with values >130/80 and diagnosis of hypertension for fiscal years 2005 &ndash; 2009 <i>r</i>(4) = .909, <i>p</i> = .016. The study concludes with a rejection of the posited null hypotheses, revealing a statistically significant correlation between use of a comprehensive electronic health record and health care quality improvement. </p>