<p> Healthcare systems are under pressure to eliminate disparities of care. Communication methods used with Limited English Proficiency (LEP) patients was presented in the literature as an essential component to deliver quality and equal care. Several strategies have been implemented to assess and target the communication methods between patients and health care teams. The challenge for health systems workers is to address communication barriers to eliminate disparities of care and medical errors. The purpose of the present qualitative case study was to explore if communication barriers affect the understanding of LEP research participants while participating in the informed consent process during clinical trials. Communication barriers during the informed consent process may affect clinical trial outcomes. In the study, the use of a triangulation data gathering method was associated with a qualitative case study. Data regarding barriers of communication during the informed consent process were gathered by performing semistructured interviews. The study population included six principal investigators, five interpreters, and nine LEP research participants. Data analysis involved reviewing the emerging themes from participants&rsquo; responses. Results indicated four major themes supporting communication challenges. The themes included authority figure, cultural sensitivity, communication barriers, and education. The study suggested the need for further research regarding communication barriers during the clinical trials process.</p>

<p> The purpose of this paper is to evaluate external factors in relation to their effect on adolescent smoking. The author measured smoking rates against variables of family and peer influence, community and school programs, and celebrity role models and the media. Three hypotheses were developed: (1) the less adult supervision there is after school, the higher chance adolescents have of smoking; (2) adolescents with lower levels of school support are more likely to smoke; (3) adolescents with entertainer role models have a higher chance of smoking. The ANOVA test was used to evaluate data from the California Health Interview Survey 2012. The results from this study produced slight but not statistically significant relationships except for celebrity role models and adolescent smoking rates. Studies such as these need to continue in order to decrease the percentage of teens that use tobacco and prevent them from continuing to smoke into adulthood.</p>

<p> Patient safety is a prominent issue in health care as evidenced by the staggering statistics of deaths and harm due to preventable medical errors. As front line clinical leaders, charge nurses (CNs) have key roles in keeping patients safe. There is a gap in knowledge of the specific actions and processes CNs implement to keep patients safe. This study attempted to narrow this gap by exploring actions and processes CNs implement to keep patients safe using a grounded theory design and generating a substantive theory that can inform CN job descriptions, serve as the basis for CN orientation and training, and empower CNs to promote patient safety in practice. This study utilized purposive sampling of CNs on medical-surgical units with data collected through 11 interviews and six observations. The substantive theory that emerged was <i>Navigating through Chaos: CNs balancing multiple roles, maintaining a watchful eye and working with and leading the health care team to keep patients safe</i>. This study contributes to the knowledge base of the CN role related to patient safety. Recommendations to maximize the potential of the CN role in promoting patient safety include clearly defining CN role responsibilities, addressing staffing shortages, and providing CNs with the necessary information to complete their work. The specific actions and processes identified in this study can be incorporated into course content on clinical nursing leadership. The substantive theory can also guide further research to study relationships between specific CN actions and processes and patient safety outcomes.</p>

<p> Health is a multidimensional, holistic, concept integrating physical and mental health. In childhood, the most common cause of physical disability is Cerebral Palsy (CP). For individuals with CP, health and well-being is impacted by the complex interactions among their physical impairments, activity, participation and environmental barriers. Although CP is considered non-progressive, secondary conditions (pain and fatigue) and their functional consequences have been found to worsen as the individual with CP ages. While preliminary evidence shows that many of the physical impairments (pain, fatigue, depression) reported in adults with CP begin during late adolescence, there is little information about the role personal and environmental factors, impairments, activity limitations, and participation restrictions have on health and well-being of young adults with CP. </p><p> To understand the health and well-being of young adults with CP, the International Classification of Functioning, Disability and Health (ICF), a World Health Organization framework, guided the selection of survey instruments for this study. Surveys were sent to 610 young adults (18-30 years) with CP. 95 surveys were returned, 55 were self-reported and 40 were completed by proxies. Increasing severity of impairment was associated with decreased participation in daily activities and social roles, while loss of ambulatory ability, pain, fatigue, depression, and activity level did not differ by severity of impairment. Environmental barriers restricted the level of participation only for the self-report participants. Health status was decreased in those who self-reported increased pain, fatigue, and depression; offset by emotional support. Life satisfaction was decreased by depression and poor health; offset by emotional support. </p><p> Addressing the physical impairments, activity limitations, participation restrictions, personal factors and environmental barriers impacting young adults with CP requires coordinated efforts among the medical, educational and vocational systems. These efforts need to begin early with appropriate assessment and treatment of impairments, provision of assistive technologies and augmentative communication, and adaptation of the environment to facilitate participation in activities and social roles. The health and well-being in young adults with CP can also be improved with enhanced emotional support beyond the family unit through peer support groups, mentors, and other adult role models.</p>

<p> My dissertation research aims to provide greater knowledge about the healthcare industry and federal budgets, within the education and infrastructure. The view point of the financials spent in the United States on healthcare is supported by the economic reports and facts dealing with the studies that the current cost is unstainable. It is also likely that rates of EHR adoption increased after the healthcare legislation associated with the administration of President Barack Obama.</p><p> Together, these two pieces of legislation represent a challenge for healthcare providers in the United States, as such providers will have not only to adopt EHR if they have not done so already, but they must also prepare for a torrent of new patients who typically have not had medical care&mdash;especially those eligible for Medicaid benefits.</p><p> One problem raised by the new healthcare legislation, according to Frenkel (2010), is that it unknown how the adoption of EHR will affect smaller healthcare providers financially and in terms of service, especially those that accept Medicaid reimbursement. Most EHR literature addresses circumstances before the passage of the ARRA of 2009 and the PPACA. While there are reliable figures for nationwide EHR adoption, Frenkel (2010) argued that some key questions remain unanswered:</p><p> 1. Are Medicaid providers more advanced in EHR adoption than non-Medicaid providers?</p><p> 2. What are the main obstacles to, and incentives for, adopting EHR in the new era of American healthcare?</p><p> 3. Are obstacles and incentives different from those in the past before the new healthcare legislation, or are they similar to previous obstacles and incentives?</p>

<p> In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve <i>meaningful use.</i> Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a <i>cloud-based</i> EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a <i> cloud</i> or <i>cloud-based</i> environment. </p><p> This study found that the top five critical success factors for the implementation were the following: (1) EHR Training &ndash; implementing a strong training / education process for EHR users; (2) Usability &ndash; practical application of EHR features in a real medical office setting; (3) Reliability &ndash; Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.</p>

<p> This quantitative study of paid home care workers (N=572) used an ex post facto survey design for data collection and structural equation modeling for data analysis in order to explain and predict the relationships among key identity constructs that are inherent in caregiving. The study examined the relationship between predictor variables of (1) role occupancy in caregiving, (2) relational identification within the caregiving dyad, and (3) organizational identification within the caregiving organization as these affected the criterion variable of the caregiving self. A final research question sought to understand (4) how dirty work acted as a moderating variable impacting the relationship between each of the predictor variables and the outcome variable. The outcome variable was measured using the Callero (1985) role merger scale. Predictor variables of relational identification and organizational identification were also measured using scales (Sluss et al., 2012; Mael &amp; Ashforth, 1992). Results supported some but not all of the <i>a priori</i> hypotheses established prior to the research study. Findings supported the hypothesized positive relationships between 1) caregiving role occupancy and the caregiving self, 2) caregiving relational identification and the caregiving self, and 3) caregiving organizational identification and the caregiving self. The hypothesis suggesting the moderating effect of dirty caregiving tasks was partially supported, with findings indicating that higher experience in dirty caregiving tasks moderates the positive association between organizational identification and the caregiving self.</p>

<p> Previous research has supported the notion that significantly more women than men seek help for chronic pain. This study aims to understand gender differences in how, when, and from whom individuals seek help for chronic pain. In particular, many aspects of masculinity have been demonstrated to inhibit help seeking. Participants were a sample of patients seeking treatment at a pain treatment facility. It was hypothesized that there would be a greater discrepancy between pain self-reported on paper versus in person by men than would be by women. It was also hypothesized that higher conformity to masculine norms would be positively related to greater self-report discrepancy. Additionally, the author expected to find gender differences in the amount of time between the onset of pain and disclosure of pain as well as medical help seeking. Again, it was anticipated that greater delays in disclosure and medical help seeking would be related to higher conformity to masculine norms. Moreover, conformity to masculine norms was expected to mediate gender differences in help seeking. The author also hypothesized that the type of people to whom pain is first disclosed would differ based on differences in gender and conformity to masculine norms.</p>

<p> This exploratory research increases knowledge and understanding of blame in the workplace. Attribution theory, moral philosophy, and social cognition provided a theoretical framework to understand individual blame determination as a precursor to understand systemic blame. Systemic blame is informed by complex systems theory and research on "no blame" cultures in a healthcare setting. </p><p> Interpretive description, supported by applied thematic analysis, provided the methodological framework for this qualitative study. The 17 senior leaders interviewed for this research study were selected through purposive sampling, and individually had an average 28 years of experience in healthcare. The semi-structured interviews were designed to gather experiences and stories that informed the participants' perspectives on blame in the workplace. </p><p> Constant comparative thematic analysis of the data resulted in four main findings. First, blame is prevalent in the workplace. Second, blame begets blame through a vicious cycle of blame. In this cycle there is often unwarranted blame. Blame feels bad, which results in fear of blame and avoidance of blame. One way to avoid blame is to blame someone else. This positive reinforcing feedback loop of blame creates a culture of blame. Third, a culture of blame includes characteristics of risk aversion and mistrust. Risk aversion decreases innovation, and mistrust decreases transparent communication. Fourth, blame has an inverse relationship to accountability, where less blame may result in more accountability. These findings both confirm and contradict the current literature. The resulting conclusion is blame is not a game.</p>

<p> For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.</p>