Many health care stakeholders have expressed concerns with the distribution and availability of primary care physicians (PCP) across the United States. Despite programs such as Healthy People 2010 and 2020 Initiatives, statewide and local health care expansion efforts and policies; access to PCP remains a challenge for health care consumers. The purpose of this mixed method research study was to evaluate the impact of several health care access policies on the practices of primary care providers and assess their perspectives regarding disparities in access. Patton and Sawicki's policy analysis and evaluation process was the framework used in this study as it is a practical framework for evaluating the impact legislation has on primary care providers' practices. 1,050 surveys were mailed to potential participants, and 861 completed surveys were used in the quantitative data analysis. Purposive sampling was used to select 15 PCP to further assess their perspectives on disparities in access. The quantitative data was analyzed using SPSS Statistics Version 21 software program. All evidence that contained text was coded, analyzed to identify patterns and theses, and subjected to data triangulation, and member checking. The findings illustrated that PCP are not involved in health policy development and evaluation processes, do not fully understand some policies, and are dissatisfied with the impact health legislation has on their practices. The findings will help in expanding the PCP workforce, improving access to health care providers, and reducing health disparities. Clinical decisions and practice patterns may also be improved once providers' knowledge and participation in health policy development and evaluation are improved.

The operating room (OR) at the project site was experiencing surgical delays for orthopedic surgical patients due to unavailable instruments, which led to a decrease in the efficiency of OR utilization. The purpose of this project was to decrease operating room delays for the orthopedic surgical patients. The practice-focused question explored whether a multidisciplinary approach to the procurement of instruments and supplies for the orthopedic surgical patient would help to ensure an on-time surgery start, resulting in increased efficiency in the utilization of the OR from 42% to 65% within a 9-month period. Lewin's change model was used to guide the project. Data analysis was conducted using a t test to compare the changes in the mean scores of the OR utilization rate before and after the involvement of a multidisciplinary team. An independent samples t test found no significant effect of the intervention, t (13) = 0.74, p > .05. Because the t test results were not significant at the α = .05 level, results showed no evidence that the multidisciplinary team affected the OR utilization rate. Decreasing surgical delays can have the potential implication for positive social change at the organization level, because delays hinder optimal patient flow, increase anxiety for patient and families, and have a significant negative economic impact on hospitals.

Breastfeeding is the optimal feeding method for infants up to the age of 2. Breast milk is suited to fulfill the nutritional needs of infants while providing immunological and neurological benefits. Breastfeeding rates of initiation and duration are low in the United States, especially in the state of Georgia. The purpose of this cross-sectional study was to investigate how breastfeeding initiation and duration, self-efficacy, perceptions, and community breastfeeding resources differ based on geographical location. The social ecological model was used as the theoretical framework for this study. An online and in-person survey that combined the Iowa Feeding Attitude Scale, Breastfeeding Self-Efficacy Questionnaire and The Breastfeeding in Public Survey was administered to 150 English speaking mothers aged 18 and older with a child 1 year or younger. The research questions were addressed using various statistical analyses (crosstabs, Mann Whitney U-test, and t test). The study results showed no differences in the odds of breastfeeding initiation and duration among mothers in urban and rural Georgia. No differences in breastfeeding perception or the use of breastfeeding community resources were observed. The results of this study contribute to social change by identifying the need to develop breastfeeding interventions that will address breastfeeding perceptions, community resources, and breastfeeding self-efficacy in urban and rural areas.

Type 2 diabetes impacts the lives of adults in the low-income, middle-income, and high-income brackets in the United States and globally. More research was needed on how adults 45 years and older in Marion County managed their diabetes and the care they received based on their income. This case study involved investigating how adults 45 years and older in Marion County self-managed their diabetes and the quality of care they received based on their income. The health belief model supported the conceptual framework for the study. Data were collected through face-to-face and telephone interviews with 15 purposefully selected participants. Data were analyzed using the open-coding technique to reveal categories and themes. Results of the study indicated that adults in Marion County engaged in diabetes self-care practices but lacked the collective knowledge of the importance of self-care measures. Results also revealed that individuals had access to quality care including medication therapy, diet, exercise, and blood glucose monitoring. However, results indicated that within the 3 income groups (low, middle, and high), low-income individuals saw a doctor less frequently due to cost and out-of-pocket expense. Also, social support played an important role in access to health care and self-care management. The study results could provide educators and health care providers with insight on how people in Marion County are self-managing their diabetes and empower them to implement more programs to provide the needed education to these adults with Type 2 diabetes mellitus. The positive social change because of this study includes bringing more awareness about the importance of diabetes self-care management to individuals, families, and communities.

Many individuals with multiple sclerosis (MS) are classified as having relapsing-remitting MS (RRMS), a form of the illness that requires constant symptom management for suffers to achieve optimum outcomes. There are only a few community-based educational programs that exist to help RRMS sufferers cope with their illness; the effectiveness of those that have been fielded has not yet been adequately assessed. The research questions of this study were to determine if an online training development module would increase the coping skills of those affected by RRMS and if the online educational module would be more effective at improving the coping skills of mild RRMS sufferers versus severe RRMS sufferers. The theoretical foundation was based on a stress-coping model commonly utilized for chronic disease management. The research design employed 2 groups, nonrandom selection, and use of a pretest/posttest applied to the target population from the Georgia MS Chapter. SPSS was used to perform statistical analysis as well as to perform the Mann-Whitney test on study data/results. According to findings from this quantitative study, the application of the online education development module to RRMS sufferers does provide a mechanism of significantly improving their coping skills. This positive social change improvement of coping strategies helps the patients as well as family, friends, and coworkers, and this module would serve as the complement to augment coping strategy improvement efforts for RRMS suffers. This study supports improvement of RRMS sufferer coping skills in the short term, and a future area of research focus would address the long-term improvements in coping skills for RRMS sufferers from the application of this online module.

In 2014, the individual mandate of the Affordable Care Act (ACA) came into effect. More than 7 million Americans paid a tax penalty for not carrying insurance during the previous tax year. Millions of others were forced to purchase a health insurance plan to avoid that penalty. This study filled a gap in public health policy research by incorporating qualitative data to offer narratives along with statistical data that could help explain health outcomes to make successful policy changes in 2019. The purpose of this study was to research the use of market competitive theory by learning people's lived experiences and how they made the decision to participate in the ACA. The theoretical foundation was based on the social justice theory when mandating that citizen's purchase or pay. The method for this research was a qualitative interpretive phenomenological thematic approach with triangulation using the snowball effect and the hermeneutic circle method of analysis. The sample size included 6 volunteers who identified as either purchasing health insurance or paying the individual mandate penalty during a recorded interview. The findings answered the first research question by showing that the 6 participants found reason to carry health insurance based on their lived experiences and desire to maintain wellness overall. Findings for the second research question indicated that the individual mandate penalty did not increase the likelihood that the 6 participants would purchase healthcare insurance based on their lived experiences. This study supports the need for continued ACA qualitative research to identify more themes on how people make decisions regarding their health care that could provide positive social health policy change for the future.

Providing competent, high-quality, and person-centered care is important in the healthcare environment, including the care for the aging and training of those who provide care. A knowledge gap in dementia-specific training was identified at an assisted living facility. The purpose of this project was to answer the question whether a dementia-specific educational staff training program would improve staff members' knowledge and application of dementia-specific competencies as well as caring behaviors. Watson's theory of human caring, the theory of planned behavior, and Leininger's framework of culture care were used to inform this project. The educational project evaluated the success of implementing nurse caring behaviors and a dementia-specific training program. Data collection included analysis of the responses of 20 facility personnel to a survey validating the needs assessment. Results of pre- and posttesting of each educational module demonstrated a statistically significant improvement (p =.0001), and observation of staff-resident interactions demonstrated 100% achievement on the competency checklist across all project participants. Qualitative analyses of data gathered from participants' discussions resulted in 4 themes: (a) the characteristics of dementia care, (b) individual caregiver attitudes, (c) knowledge deficit, and (d) the importance of caring behaviors. Educational training methods were found effective to elicit nursing staff behavior change and improve understanding of the dementia patient and requisite care, which represents a significant positive social change and enhanced care for the dementia patient in the assisted living facility.

Exacerbation of chronic obstructive pulmonary disease (COPD) is the leading cause of hospital admissions and an estimated 120,000 deaths among older adults in the United States. In the community health clinic that served as the project site, more than 80% of patients with a COPD diagnosis had frequent exacerbations, with a hospital readmission rate of 23.2%, which was higher than the national benchmark of 21%. The clinic did not have a COPD discharge education plan with a teach-back tool for staff to teach patients. The purpose of the project was to develop an evidence-based COPD educational packet for staff on self-management using the teach-back method and an evidence-based COPD educational plan for patient self-management. Guided by Orem's self-care theory and Rosswurm and Larrabee's model of evidence-based practice, the project focused on whether the literature supported the use of the teach-back method of teaching for COPD self-management. Participants reviewed the packet and evaluated the content using a Likert-type scale with 1 =strongly disagree to 5 = strongly agree. Ninety percent of the clinic's stakeholders and staff agreed/strongly agreed to all factors evaluated, and the educational packet was recommended for use on the unit. The teach-back method and educational packet for COPD might bring about positive social change by decreasing exacerbations, improving health-related quality of life, and improving stewardship of healthcare investments thus improving the human condition.

The purpose of this study was to assess the association between hospital readmission and demographic variables (age, BMI, gender, income, marital status, comorbidities, and smoking history), and size and type of tracheostomy among African American chronic obstructive pulmonary disease (COPD) patients with tracheostomies. The Andersen model was the theoretical framework for this quantitative study. Secondary data were obtained from a long-term acute care facility. The sample comprised 438 African American adult patients admitted between 2010 and 2017. Logistic regression was used to analyze each research question and assess the odds of 30-day hospital readmission. The results indicated that the odds of readmission did not differ based on age, gender, marital status, income, smoking history, BMI, sepsis, congestive heart failure, hypertension, stoma cellulitis or size of tracheostomy. There was a significant relationship between the type of tracheostomy and odds of readmission, diabetes diagnosis, and odds of readmission. These findings suggest when controlling for length of stay, there is no association between age, gender, marital status, income, smoking history, BMI, sepsis, congestive heart failure, hypertension, stoma cellulitis or size of tracheostomy and hospital readmissions among African American COPD patients with tracheostomies. The results of this study provide information that may be useful for discharge planning and program implementation research. Such planning and research might help to reduce rates of hospital readmissions and as a result lower healthcare costs for African American COPD patients with tracheostomies.

The factors associated with the decision of African American women to undergo/forego breast reconstruction after mastectomy has not been well researched. The purpose of this quantitative, correlational study was to determine the extent to which certain factors (age, religion, confidence level, and education) were associated with the decision to forgo or undergo breast reconstruction after mastectomy among African American women. Using the social-cognitive theory as the framework, the study focused on the decision-making process regarding breast reconstruction after mastectomy among African American women in Florida. The research questions for this study were to determine to what extent age, religion, confidence level, and education are associated with the decision of African American women to forego or undergo breast reconstruction after mastectomy. Data were collected using the Decision Self-efficacy and Religious Coping Activities scales from 88 African American women living in North Central Florida who had a mastectomy. Data were analyzed using Chi-square test and logistic regression. The results showed a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant a significant relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (relationship (p = .042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the.042) between the confidence level of decision-making and the decision to forego or undergo breast reconstruction after mastectomy. It was important to examine the extent to which certain factors contributed to decision-making about breast reconstruction after mastectomy in African American women as this can provide an opportunity to cultivate positive social change by being able to tailor support services for African American women after mastectomy based on the role various factors may play.