The purpose of this study was to investigate the time of admission to a Neonatal Intensive Care Unit (NICU) and its association with in-hospital mortality among a cohort of neonates at a regional perinatal center. Two different time points were considered: admissions on the weekend versus the weekday and admissions during the nighttime shift versus the day shift. The secondary purpose of the study was to investigate if registered nurse staffing affected this association between NICU admission day or admission time and in-hospital death. Three separate databases were used which contained information on NICU admissions, hospital deliveries and nurse staffing. These databases were linked resulting in data for each individual mother-infant pair for each separate admission to the NICU. Readmissions to the NICU, NICU admissions which could not be linked with the delivery data, admissions from the Newborn Nursery and transfers from other hospitals were excluded from the study. The final study population consisted of 1,846 admissions from October 1, 2001 through December 31, 2006. Weekend admissions were lower than weekday admissions (29.6% versus 70.4%) and nighttime admissions were lower than day admissions (43.2% versus 56.8%). Infants admitted at nighttime were more likely to be low birth weight, have lower Apgar scores and less likely to be delivered by cesarean section. Weekend admissions did not differ significantly from weekday admissions, except weekend admissions were more likely to be Black (33.6% versus 28.6%, p=.30). After adjusting for infant's acuity and other covariates using multivariate logistic regression, the odds of dying on the weekend was not significantly different than weekday admissions (AOR=1.06, 95% CI=.653-1.721) and were not significantly different for nighttime admissions (AOR=1.14, 95% CI=.722-1.79). Nurse staffing was not a significant covariate. Covariates which were significant risk factors for death prior to discharge were non-Black race of the infant, Apgar score of less than 7 at five minutes, presence of a fetal anomaly, and use of ventilation during the stay. Infant's birth weight was a significant protective factor.

Disruptive behavior within classrooms is a major concern for teachers and parents. Positive Behavior Interventions and Supports (PBIS) provides a multi-tiered framework for schools to provide supports to students, which are matched to each student's needs. Whereas most students are successful with the school-wide supports provided to all students, approximately 20% of students are likely to require additional supports. Group contingencies have an established basis of support as effective Tier 2 interventions; however, these contingencies vary in a variety of dimensions that may influence their efficacy and acceptability. The purpose of this study was to evaluate the relative impact of four different group contingency types (independent, interdependent, dependent, and randomized) on class-wide appropriate and disruptive student behaviors as well as how implementation of a teacher's preferred contingency may enhance student behavioral outcomes. Three general education teachers and their students participated in the study. All four group contingency types resulted in reduced disruption and increased appropriate behavior across all three classrooms. No patterns of differentiation were observed in any classroom. Teacher preference was assessed with two teachers selecting independent and two teachers selecting dependent contingencies as their preferred reward system. Implementation of the preferred contingency resulted in further improvements in both class-wide behaviors. Some evidence of generalization and maintenance was noted in all three classrooms.

Cervical cancer is the most common human papilloma virus (HPV) -associated cancer and is the second leading cause of death in the world. Vaccination against HPV is essential to reduce the incidence of HPV and subsequent morbidity and mortality. According to the Centers for Disease Control and Prevention (CDC), approximately 79 million Americans are currently infected with HPV. The site for this DNP project was a 163-bed facility with inpatient and outpatient services in the southern United States. The vaccination rate at the site was 48%. The facility lacked educational interventions to prepare and remind providers to offer HPV vaccine. The purpose of this DNP project was to address a significant gap by increasing clinician knowledge through the development of educational materials, the design and implementation of training sessions for staff, and the development of protocols that require providers to offer the vaccine to every eligible patient and to call the patient and remind them of appointments for vaccine injections. The academic center for evidence-based practice star model was used to translate knowledge into nursing practice to improve outcomes change. For this project, a panel of 10 experts from the facility was formed to conduct a formative and summative evaluation of the educational materials and protocols. The findings of the study showed an acceptance of the plan suggesting the importance of the educational materials and the educational process to increase HPV vaccination rates, which can thereby reduce death and disease associated with HPV through the empowerment of the clinicians to provide necessary and appropriate care.

Research on health prevention behaviors of Mexican immigrant mothers regarding immunizations has been limited. As of 2014, Hispanics or Latinos comprised 9.6% of the population of the state of Oklahoma and were the largest minority group within Oklahoma. This minority population has continued to grow at a rapid rate in Oklahoma. The purpose of this study was to explore the perceptions of immunizations held by Mexican immigrants who are mothers residing in Oklahoma. The aim of this study was to identify their perceived risk of contracting a vaccine-preventable disease if not immunized and knowledge of immunizations as a health prevention behavior. The health belief model and the sociocultural theory provided the theoretical underpinnings for this qualitative study. Semistructured interviews were conducted with a purposeful sample of 12 immigrants living in a rural area of Oklahoma. Data were triangulated and analyzed to identify themes and patterns. Findings indicated participants perceived susceptibility of contracting a vaccine-preventable disease if not immunized, with the severity of the disease having the potential to cause death. Identified barriers in immunization uptake were language barrier, lack of immunization information in Spanish, and fear of deportation. Recommendations include public health outreach providing culturally, linguistic appropriate immunization information to immigrants within communities. Findings provide health psychologists and other health care professionals the ability to formulate interventions targeting immunizations in female Mexican immigrants. These interventions could promote positive social change by decreasing immigrants' and their children's risk of morbidity and mortality related to lack of immunization uptake.

The problem addressed in this phenomenological study was the lack of documentation that supported the lived experiences of crisis intervention team (CIT) trained police officers related to their encounters with persons with mental illnesses (PwMI). The purpose of the study was to explore the lived experiences of officers among CIT-trained police officers to address the problem. Using the Giles's communication accommodation theory and Rogers's protection motivation theory (PMT), the purpose of this study was to examine the perceptions of CIT-trained police officers of PwMI during CIT encounters. Rogers's PMT was aligned closest with the teachings of CIT training as described by the study's participants. Participants provided data which was comprised of completed questionnaires and transcribed interviews. The method of analysis used was a combination of inductive coding and theme analysis that established the results of this study. Key findings of the study identified a significant amount of frustration expressed in the lived experiences of the CIT-trained police officers. Pushback from the public mental health facilities helped with the frustration experienced by CIT-trained police officers who applied the fundamentals of PMT and attempted to navigate treatment with the limited resources available to help PwMI in crisis. The positive social change produced from this study includes recommendations to police leadership and mental health advocates to encourage certain CIT training-related practices that directly impact CIT field encounters with PwMI in crisis. Specialized training may promote improved departmental outcomes, assist with injury reductions, and enable police officer accountability and reliability.

Previous research has suggested that physical exercise can play a role in not only improving functional performance, but also cognitive function. In this study, adults age 60 and older participated in a health promotion intervention that included two groups: (a) a Bingocize® group, who exercised and learned about relevant health information while playing bingo, and (b) a control group who only learned about relevant health information while playing bingo. The intervention was completed over the course of 10- weeks at community senior centers. Cognitive function, functional fitness, and health knowledge were assessed before and after the intervention to test for improvements. Through the course of the intervention, both the experimental and control groups showed improvements in several areas of cognition as well as functional performance. However, on a few tasks the experimental group showed improvement while the control group did not; specifically, on an updating (cognition) task, and two functional performance tasks (repeated chair stands and arm curls). Both of the groups also showed improvement in knowledge of relevant health information and a measure of patient activation (how confident a person feels in maintaining their personal health). From this, it is suggested that the Bingocize® program may be a promising approach to improving select aspects of cognition and functional performance in older adulthood.

This study was a replication of a study by Hosp et al. (2003), which looked at items on behavior rating scales to determine if they can be used to plan and monitor positive behavior interventions. For this study, ten forms of commonly used behavior rating scales were selected, and the so what and dead man tests were applied on each scale. Each item on the scale was placed into one of four categories: positive action, negative action, lack of positive action, and lack of negative action. Then, these categories were used to rate each scale to determine which subscales survived, or were deemed useful for measuring increases in positive behavior. Eight of the ten scales were found to contain a majority of negative action items and some lack of action items, neither of which are useful in measuring positive behaviors. Only two scales, the parent and teacher versions of the BERS-2, were found to contain all positive action items, and therefore were the only scales to fully survive the dead man test. The results of this study show that the majority of commonly used behavior rating scales today still do not contain primarily positive action items, and therefore have not majorly improved in the last fifteen years, although all of the behavior rating scales contained subscales that could have potential to plan and monitor positive behavior interventions.

Due to socioeconomic disparities and geographic isolation, rural Kentucky residents bear a greater burden of poor health compared to national averages. Specifically, rural Kentucky residents are at greater risk of becoming obese and suffering from comorbidities of obesity such as type 2 diabetes, hypertension and cardiovascular disease. The purpose of the present study was two-fold. First, we the barriers to nutrition and physical activity unique to rural Kentucky counties which high proportions of obese adults (< 40%) were examined and extrapolated. Second, this information was used to develop a health and wellness app tailored to rural Kentucky counties. The objective was met via a formative assessment regarding causes for obesity in three rural Kentucky counties using focus groups. From these discussions, two major themes arose: barriers to good nutrition and physical activity, and desired web‐app features. From this assessment, FitFaceoff was developed and released into the same counties. Usage and user interaction were assessed using GoogleAnalytics™ software. Analysis revealed poor user liking and unsuccessful implementation of FitFaceoff, however further qualitative research is needed to evaluate poor user reception of FitFaceoff and possible future directions.

Youth who have experienced maltreatment (abuse, neglect, exposure to violence) typically exhibit worse life outcomes (lower graduation rates, higher incident of substance use, unplanned pregnancies, etc.). Effective therapeutic interventions are important to combat these negative effects. Animal Assisted Intervention (AAI) is a popular and growing field. Anecdotal evidence abounds on the efficacy of AAI, however, there is a lack of quantitative and qualitative research and evidence-backed models of treatment particularly with youth. This study sought to increase the amount of quantitative evidence on AAI by specifically focusing on evaluating the Power Tools for Living Equine Assisted Psychotherapy (EAP) model with youth who have experienced maltreatment. This study analyzed secondary data collected from Special Spirit Inc., an equine therapy center. Three groups of youth placed in out-of-home care at residential treatment facilities in Los Angeles County participated in the Power Tools for Living EAP program. Prior to and after the intervention the youth’s guardian or clinician filled out a Youth Outcomes Questionnaire (YOQ). This data was analyzed but no statistical significant associations were yielded from the analysis. Analysis of the data does provide suggestions for further study that may potentially establish the Power Tools for Living EAP model as an effective intervention for youth who have experienced maltreatment, particularly younger participants and those with higher YOQ scores prior to treatment.

Animal‑Assisted Intervention (AAI) is used to significantly reduce pain, lower blood pressure, decrease anxiety, and help ease depression in people with a range of health problems; however, it is not readily used in the hospital setting. Research involving the Human‑Animal Bond (HAB) is well established, yet most social workers receive no special training or coursework about this topic as it applies to working with patients or consumers. This study sought to understand the beliefs about AAI among medical social workers in healthcare settings in order to gauge what knowledge and degree of exposure they may have had to AAI. Eighteen randomly selected social workers, holding MSW, ASW, LMSW or LCSW credentials, employed from 6 months to 26 years in hospital or cancer clinic settings across the United States were interviewed by phone, recorded, and their comments transcribed. Nine specific themes were identified. Fifteen of the 18 medical social workers had no formal training, workshop or class discussion during undergraduate or graduate school training. No one had any on the job training, unless they purposefully sought it out, as three did. All participants agreed that they would like to know more about AAI to incorporate into their workplace in order to better inform patients, doctors, nurses and staff about the benefits of animals as a natural healing modality.