Research focused on health behaviors of online graduate students is sparse. Health psychology graduate training prepares individuals to share health information with others; the information may be more credible if they present a healthy appearance. The present study tested concepts from social cognitive theory (general perceived self-efficacy) and self-determination theory (autonomy, competence, and relatedness basic needs) to determine predictive value for graduate students’ engaging in health behaviors. Participants were 121 (29 health psychology group, 92 other programs group) online graduate students who lived in the United States and attended the same online university, recruited from multiple social media sources. The study used a static comparison quasi-experimental design to examine data from an online survey. Data were analyzed using Pearson correlation, chi-square tests for independence, independent samples t-tests, ANOVA, MANOVA, and binary logistic regression. The health behaviors did not differ between the two graduate student groups. General perceived self-efficacy, autonomy, relatedness, and competency mean scores did not predict engaging in health behaviors. A significant negative correlation for the total sample was found between autonomy and body mass index. Positive social change may result from research focused on the best means to encourage health psychologists to regularly engage in health behaviors to the extent of Centers for Disease Control and Prevention recommended levels. By internalizing and modeling good health, health psychologists will add credibility to their message and help to mitigate the connection between premature death from chronic disease due to lack of engaging in a voluntary healthy lifestyle.

Previous healthcare professionals researched the effects of treating and healing pressure injuries within long-term care facilities. This study was conducted to explore the stress clinicians face when treating pressure injuries in the long-term care setting. This qualitative study provides information for the need to educate nurses about treating and healing pressure injury. It was derived from a phenomenological study that incorporated real life perspectives of individuals responsible for treating and healing pressure injury. This study was guided by Castles and Ferguson’s conceptual framework related to employee perceptions on pressure injuries, employee level of education and knowledge about improving quality initiatives can impact treatment protocols on pressure injuries. This study was conducted in 3 nursing facilities in California using data collected voluntarily using the Pressure Ulcers Knowledge Test by Pieper and Zulkowski tool. Data were collected from surveys with 24 participants and2 interviews. The demographic information and narrative interviews were transcribed through use of NVIVO to identify themes and coded for analysis of these phenomenological perspectives. The pressure injury data was analyzed using SPSS. The analysis reflected that Registered Nurses are key to treating and healing pressure injuries. Education and reduction of stress during the treatment of pressure injuries improves outcomes. The study results showed participants felt satisfaction when they minimize pressure injuries to residents within long-term care; clinicians stress also decreased through increased education for them and systematic changes with early education during clinical rotations to impact social change with leaders in long-term facilities.

African American women are more likely than White women to be diagnosed with breast cancer after the disease has progressed to advanced stages. Further, African American women experience higher breast cancer mortality rates than White women at all stages of cancer diagnosis. The purpose of this quantitative comparative study was to examine differences between implementation of the Affordable Care Act (ACA) and 5-year breast cancer survival rates among African American and White women. The independent variable was African American women and White women who were survivors of breast cancer after the ACA implementation; the dependent variables were breast cancer survival rates after ACA implementation. Data were gathered from the Surveillance, Epidemiology, and End Results (SEER) program for the time period between 2010 and 2015. The theoretical foundation for this study was Penchansky and Thomas’s concept of healthcare access. This quantitative study followed a retrospective design using cohort data from the SEER program. Data were analyzed via independent samples t-test and chi-square test of association. Results indicated that White women had a higher 5-year survival rate than African American women; the association between race and survival was significant. White women survived also survived breast cancer for more months, on average, than African American women. Findings indicate that racial disparities in breast cancer survival have endured, post ACA. The primary social change implication is that more research is needed to improve the breast cancer survival rates of African American women. The ACA may be working to help reduce the racial disparities in breast cancer survival, but providing access to healthcare is not necessarily enough.

African Americans 65 and older have had varied experiences due to losing immediate access to nearby hospitals for urgent treatment for emergency medical conditions. This phenomenological study was conducted to explore the lived experiences of those residing in areas after a rural hospital closure occurred. The hospital was the primary and nearest facility for receiving immediate access to urgent treatment. The research questions focused on the encounters experienced by the participants after the hospital closure. The Health Belief Model was the conceptual framework used for this study. The method and data analysis procedures included interviews, field notes, a life-course chart, and specified demographic information. Eight African Americans 65 and older from Webster and Stewart County Georgia were interviewed. The other inclusion criteria were the participants' previously being treated for an emergency medical condition at Stewart Webster Hospital at least 1 year before the hospital closure and at another hospital at least 1 year after the hospital closure. The results of this research were that the participants encountered negative experiences on a higher level than positive experiences with accessing immediate treatment. Also, participants encountered and needed to make various, and undue changes to receive treatment for the critical medical condition treatment. The positive social change significance included providing information on experiences encountered by the participants after rural hospital closures and suggestions for others in rural areas to prepare for hospital closures. Moreover, this research could help state, local, and federal agencies provide alternatives for immediate treatment for emergency medical conditions in other rural towns after hospital closures occurred.

Depression is one of the most common mental health disorders in the United States. Although it can be treated, it may go unidentified for a long period of time. The World Health Organization (WHO) anticipates that, by 2020, depression will become responsible for more disabilities than a combination of other conditions, excluding heart conditions. The prevalence of depression among the general population is higher in patients who seek emergency healthcare services. The purpose of this project is to develop an evidence-based educational module for nurses to screen for depression in an acute care setting using the PHQ-2 and PHQ-9 depression screening tools. The design and the implementation of this educational module were directed by Bandura's social learning and self-efficacy theories. The research question focused on how a staff training education module can improve nurses' knowledge of depression screening. A total of 10 nurses participated in the educational program and completed the pre and post-test surveys. The results showed a statistically significant difference between the pretest score of (36%) with a P-value of < 0.64 and post-test scores of (99%) and a P-value of < 0.001. This confirms a significant improvement in the nurses' knowledge of using PHQ-2 and PHQ-9 for depression screening. The project outcome facilitated a significant increase in the use of best practices by reducing the prevalence of undiagnosed and untreated depression in acute care clinics. The implementation of the project can affect social change by improving nurses' knowledge towards performing depression screening, decreasing the incidence of undiagnosed and untreated depression among adults, and prevent health-related complications associated with depression.

Researchers have found that postpartum depression (PPD) affects 10 to 15% of new mothers in the U.S. and minority groups experience more depressive symptoms than most of the U.S. population. In Maricopa County, Arizona, research studies of PPD suggested that Mexican women had the highest PPD rate when compared to African-American, Cuban, and Puerto-Rican women. The purpose of this qualitative interpretive descriptive study was to explore what experiences Mexican women in Maricopa County had with PPD, their perceptions of factors such as low-income, cultural beliefs, intimate partner violence, social support, and healthcare services, and to explore barriers that may prevent Mexican women in Maricopa County from receiving diagnostic care for PPD. The theoretical basis for this study was Engel's biopsychosocial model of perinatal mood. Ten Mexican women living in Maricopa County with PPD were interviewed to help gain a deeper understanding of past experience with PPD. The key findings in this study were that socioeconomic status, social support, cultural beliefs, and intimate partner violence were associated with PPD in Mexican women before and after childbearing. The participants in this study stated that lack of public transportation, illegal status, and spouse deportation to Mexico were associated with their PPD. A better understanding of these experiences with PPD could lead to policies and practices that address those women at greater risk of PPD. A social change implication of this study could be the implementation of early diagnostic testing for PPD prevention for Mexican women in Maricopa County.

The HIV/AIDS epidemic continues to be a challenge in the men who have sex with men (MSM) population. Initiatives to decrease rates of new HIV infections have proven less than optimal. Despite evidence-based interventions to curtail the prevalence and incidence rates of HIV infection, Black MSM have been most impacted with increased HIV incidence. The purpose of this quantitative correlational study was to explore the relationship, if any, between age, online and physical venues attended by participants within the last thirty days, neighborhood's perceived social environment, and HIV incidence in the non-Hispanic Black MSM population in a metropolitan statistical area (MSA) in Southern U.S. Social cognitive theory was used to frame this study. Secondary datasets from the Involve[MEN]t database were used in this study and included 810 Black and White MSM living in a MSA. Ages of the participants ranged between 18 and 39. Original data were collected through online questionnaires. Chi-square, independent samples t test, and logistic regression model were used to analyze data. Chi-square analysis showed a significant main effect (p = 0.006) for online venue Facebook and HIV incidence but no significance differences identified between age, online venues CraigsList and Black Gay Chat, physical venues (including bars and restaurants, gyms, and bath houses), and neighborhood's perceived social environment (including neighborhood attachment, self-esteem/morale, and personal safety). Positive social implications of the study findings could include tailoring existing interventions with strategies to address self-esteem and morale, explore selected online and physical venues, and develop social and behavioral structured policies in the Black MSM population.

The Centers for Disease Control (CDC) and the World Health Organization (WHO) estimate that there are approximately 1.4 million cases of hospital acquired infections (HAIs) at any given time worldwide. Recent reports indicate that 722,000 patients acquire HAIs, with 75,000 or more succumbing to the infections and dying. This quality improvement project focused on the value of re-educating practicing nurses on hand hygiene practices as an approach to reduce the incidence of HAIs. Pre-intervention rates of HAIs were compared with post-intervention rates of HAIs across 2 units (Unit A and Unit B) in an acute care setting to determine if re-educating nurses about hand hygiene was a plausible strategy in reducing HAIs in the acute care setting. The pre-intervention mean rate of Unit A was 0.146% and the post-mean rate was 0.00%. A Wilcoxon signed-rank test showed that the educational intervention did not elicit a statistically significant change in infection rates (z = -1.63, p > 0.05). Similarly, the pre-intervention mean rate of Unit B was 0.12% and the post-mean rate was 0.00%. A Wilcoxon signed-rank test showed that the educational intervention did not elicit a statistically significant change in infection rates (z = 1.732, p > 0.05). Despite the lack of statistical significance, there was a reduction in the mean rate to 0.00% following the educational intervention. The results of this quality improvement project suggest a value in re-educating nurses on the importance of hand hygiene as a strategy to reduce and prevent HAIs in health care organizations in order to promote positive patient outcomes.

Nurse-driven guidelines existed for the management of sedation in adult population; however, there is a lack of guidelines for the critically ill children. Nurses play significant roles in the management of sedation for mechanically ventilated patients in the Pediatric Intensive Care Unit (PICU), nonetheless, comprehensive guidelines for the management of sedation does not exist. The purpose of this systematic literature review was to evaluate and synthesize evidence-based research that can be used to adapt a pediatric clinical guideline for sedation management. The ACE star model and the evidence-based practice model were used as a framework to guide this review. The practice question focused on investigating the available best practices that can be used to support the nursing management practice of sedated patients in the PICU. This is important because inadequate sedation management can lead to multiple adverse outcomes for patients. The design of this project was a systematic literature review method. The sources of the data were gathered from Medline, PubMed, CINAHL, Joanna Briggs institute and Google Scholar. This review included 17 studies, of which 84.2% showed improvement with positive patient outcomes such as decreased sedation use, decreased length of stay, and improved nursing practice. The results also support recommendations for evidence-based practice guidelines in the clinical nursing practice setting. In conclusion, despite the recommendation for the use of sedation guidelines, this systematic review found that there are few studies comprehensively evaluating the impact of nurse-driven sedation management in the PICU. The social implication of this review is that more studies involving pediatric patients utilizing nurse-driven sedation protocol is needed, before it can be adopted in the PICU.

Handing over patient care at the end of a shift is a complex part of nursing practice that is commonly fraught with challenges. Ineffective communication continues to be the leading cause of sentinel events in the hospital setting. In response to this practice problem, this project involved the implementation of a standardized bedside reporting protocol in a surgical unit in line with the best available evidence. The overarching goal of this project was to determine how an end of shift reporting tool would impact communication, involvement of patient in care provision, and continuity of care at the bedside. The protocol was implemented in 2016, and involved the use of pre-test and post-test surveys to determine its effectiveness. The quasi-experimental project was guided by the Lewin's change theory concepts including unfreezing, change, and refreezing. An analysis of the findings of the survey revealed improvement in bedside reporting practices. The nurses had strong and positive perceptions of the program in improving communication, promoting patient safety, upholding nurse accountability, and promoting involvement of patient. There is a need for future projects to determine the impact of the program in improving patient satisfaction in various care settings. The positive social change of the current project results from improving bedside reporting practices to provide safe and patient-centered care in the health care agency.