Women in Cameroon as well as those residing in the Maryland-Washington Metropolitan area and the Diasporas suffer a disproportionate rate of cervical cancer morbidity and mortality due to the vast disproportion in the distribution of healthcare services. The widespread human papillomavirus (HPV) vaccination holds promise for helping to attenuate the disproportion in cervical cancer screening and prevention services. Literature from other countries including Cameroon suggests that barriers to the uptake of cervical cancer screening include: culture, religion, the psychological impact of embarrassment, the influence of husbands, cost, discomfort, and vulnerability. The purpose of this study was to gain an understanding of the perceptions of the Cameroonian women regarding cervical cancer prevention, taking into consideration parental attitudes, their knowledge, and their beliefs about the acceptance and usage of the HPV vaccines and other screening services. A survey was designed from a combination of 2 separate instruments as developed, tested, and validated by Kahn et al. (2008) and Griffioen et al. (2012) for this qualitative study. The open-ended survey questions were completed by women who volunteered to participate. Data were collected between April and May, 2015. Eighty women volunteered to participate but only 30 were able to return the completed survey. Using the NVivo software version 10, data were inductively coded, analyzed, and major themes were derived. Results showed that although the women knew about HPV, the vaccines, and Pap test, there was still a need for more education. The results of this study will be provided to law makers in Cameroon to reconsider the educational needs and distribution of healthcare services for women in Cameroon.

Despite knowledge regarding the need for regular physical exercise, little is known about the most effective ways to encourage and maintain regular physical activity among primary care patients. New approaches to education about and support of physical activity are needed for everyone, but especially for groups susceptible to diseases related to sedentary lifestyles. This project evaluated a web-based educational intervention guided by the health belief model to address the lack of regular physical activity among 25 Hispanic patients in a South Florida clinical practice. The physically inactive patients were identified through the clinic's electronic medical records and consented to participate. Quantitative data were obtained before and 8-weeks after the education using the International Physical Activity Questionnaire. The data were analyzed to find the median weekly minutes for each domain on the questionnaire (work domain, active transportation domain, domestic and garden domain, and leisure domain). Participants' median scores increased after the intervention for moderate physical activity at work (1440 minutes to 2400 minutes), vigorous physical activity during leisure time (0 minutes to 1920 minutes), and walking for transportation (0 minutes to 792 minutes). Inferential statistics were not employed, so the statistical significance of these increases were not determined. The social changes that may occur from wider implementation of this educational approach include decreased disability and decreased health care costs for patients at risk of developing diseases linked to a sedentary lifestyle.

Due to changes in health care, along with increasing technological demands, nurse's experiences increased stress. Nurses who are asked to staff another area other than their own have increased stress that can lead to increased nurse turnover, absences, and nursing dissatisfaction scores. The purpose of this quality improvement project was to assess whether limiting what units a nurse works on can reduce nurse stress, improve self-efficacy, and improve nurse job satisfaction. The design of this pilot placed like nursing units within a neighborhood staffing model for floating. The plan-do-check-act model was used as a framework to implement a change in the nurse floating practices. An electronic survey was sent to the nursing team pre and post implementation of the model. Nursing hours will also be tracked during this period of time. Data related to floating after the implementation of the neighborhood staffing model showed a significant increase in floating hours inside (13.1 vs 20.9; t=3.98, p<.001), and there was a significant decrease in hours floated outside the neighborhood (26.3 vs 18.0; t=5.15, p<.000). Self-efficacy results showed an initial decline in the nurses' self-efficacy 4 weeks after the launch and a statistically significant increase over preimplementation levels at 8 weeks (pre 28.46; post 33.51; U=5003, p<.001); on the 3rd administration of the self-efficacy survey, a statistically significant increase was seen (28.5 vs. 33.5; t=12.1, p<.001). Allowing nurses to float to similar nursing areas will result in improved self-efficacy, a precursor to reduced job stress and increased job satisfaction, which represents a positive contribution to social change for the nurses who work in the hospital system.

Diabetes mellitus is a growing healthcare problem in the United States. Diabetes affects 1.4 million Americans yearly, impacting the lives of individuals of all ages. One of the most challenging aspects about diabetes is that many individuals are not aware of the impact of the disease on multiple organs until the progression of the disease has reached latter stages. Prevention and early detection of diabetes is a key component of lifesaving interventions including proper nutrition counseling, exercise regimens, management, and patient compliance with a treatment plan. The purpose of this doctoral project was to create a standardized diabetes management protocol for patients in an inpatient rehabilitation facility. Sources of evidence were obtained from the most current literature, including that published by the American Diabetes Association (ADA). Evidence shows that an interdisciplinary teams approach to diabetes management in the rehabilitation facility contributes to successful patient outcomes. The logic model served as as a framework for program design and was used as a visual representation for all aspects of the program. The quality improvement process was implemented using an interdisciplinary team approach, with each member of the rehabilitation team playing a special part in meeting the educational needs of the diabetic patient and family. Every diabetic patient requires individualized and specific instruction; therefore, staff members must work together in order to evaluate program effectiveness. This project will effect social change by establishing a protocol that equips patients with the knowledge and tools necessary to manage their diabetes when discharged into the community.

Despite the efforts of food safety regulations and rules, food contamination remains a public health concern and prevalent vehicle of pathogens. This study identifies the predictors of food risk in different types of food establishments in Miami Dade County, Florida during the period November 2014 - November 2016. Guided by the epidemiologic triangle model, this correlational study analyzed the log number of risk factor violations and failure rates controlling for US Census sociodemographic data (2010 to 2014) for the food establishment neighborhoods by using linear and logistic regression. Results indicated that most of food entity types are significant predictors of risk violations. Among all the significant predictor food establishments, grocery stores (b = 2.877. p < 0.001) had a higher increase in violations. For the demographic variables, the only significant variable was the number of single parent households (B = .001, p = 0.022). The result reveals a significant association between food entity types and failing inspection (p < 0.005). Among all the entity types, convenience store with significant food service and/or packaged ice (22.2 %) have the highest percentage fail rate within inspection rate outcome. Findings indicate that a risk-based approach to food risk factor violations frequency could reduce the number of violations, particularly in convenience and grocery stores with the most violations and failing rate.

Colorectal cancer (CRC) is a primary cause of cancer-related mortality in the United States. Asian Americans have the highest CRC mortality rates. CRC screening tests can reduce CRC incidence, yet Asian Americans, specifically the subgroup of Vietnamese Americans, underuse CRC screening. The purpose of this phenomenological study was to understand why Vietnamese Americans, ages 50 to 75, underuse CRC screening. The health belief model constructs of susceptibility, severity, benefits, barriers, and self-efficacy were the framework for understanding this population's health-related behaviors. Three research questions focused on how knowledge, language, and cultural beliefs and perceptions affect Vietnamese Americans' CRC screening decisions. Interviews were conducted with 11 participants, and transcribed interview responses were input into NVivo 11 software to maintain a reliable database and to identify emerging themes. Key study findings revealed knowledge and English language gaps as well as adverse cultural perceptions of fear and doubt that influenced CRC screening choices among these 11 Vietnamese Americans. Future researchers might focus on cultural-tailored strategies to minimize these barriers for Vietnamese Americans. An understanding of this study population's perspectives offers the promise of positive social change for health services and public health administrations to develop cultural-tailored interventions that promote healthy lifestyles, prevention, early CRC detection and, consequently, reduce mortality rates and associated health care costs.

With many individuals experiencing multimorbidity, individuals are being prescribed more medications. Although there are benefits to taking medications to manage symptoms and treat disease processes, there are also risks to taking multiple medications. The purpose of this phenomenological study was to explore participants' understanding of the risks associated with practicing polypharmacy. Game theory, credibility theory, and belief bias were the conceptual frameworks used to explain how individuals experienced their care and being prescribed 5 or more medications. Eight participants residing in subsidized housing in a small Midwest city, who were taking 5 or more medications volunteered to take part in semi-structured interviews answering a series of 10 questions. Phenomenological analysis was used to organize the data and to assist with the development of themes regarding the nature of the participants' lived experiences. According to study findings, 7 out of 8 participants stated that they trusted their providers and that their providers used a more directive approach to prescribing medications instead of offering choices to the participants. In addition, participants lacked knowledge of the risks associated with taking all medications collectively, indicating that more education is needed for individuals. Results of the study may be used in both provider training and patient training to stimulate social change that may improve provider patient communication, increase understanding of provider patient interactions, elicit positive patient outcomes by providing knowledge of awareness, communication, and interaction styles, which play a role in patient outcomes.

Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.

Breast cancer is the leading cause of death among Latinas women. Several barriers persist when accessing health care and utilization of healthcare services such as annual mammograms, leading to a late stage diagnosis or death related to breast cancer illness. The purpose of this study was to examine disparities in breast cancer experiences within Latina communities in the United States. The Health Belief Model served as the foundation of this qualitative grounded theory study. The research questions explored; access to breast care services that encourage early breast cancer detection; breast care diagnostics such as exams, mammograms and biopsies; and views of availability to breast care exams, diagnostics and treatment options improving health outcomes. The participants were females who self-identified as Hispanic and 19 years of age or older and resided in north east part of the United States. Participants must have discovered a breast tumor, engaged in the decision-making process to seek biopsy, and had a breast cancer diagnosis. A total of 12 Latina women were recruited for 60 minutes recorded interviews Later, the interviews were transcribed.. Findings of the study showed the participants perceived the disease as serious leading to death; cultural context, insurance status may not have contributed to susceptibility to the disease. This study benefits Latina women, and other vulnerable female populations in the United States diagnosed with breast cancer. The social change implications of the study can influence program initiatives that seek to improve equitable access to care, breast care services and the quality of life. It provides insight to practice approaches regarding access to care, service utilization, and development of program initiatives.

The nurse navigator role developed in the 1990s to support African American female oncology patients' access to services. Successful in oncology, the role has expanded to support patients with diabetes, heart failure, and chronic obstructive pulmonary disease. A unique cost-effective opportunity exists for nurse navigators to fill the gap in transitional care, between the acute care setting and home, for chronically ill and other at-risk patients who are often readmitted within 30 days for treatment of the same disease. The purpose of the project was to refine the job description of the nurse navigators in a Midwestern acute care hospital. The Rosswurm and Larrabee model for evidence-based practice change supported the work. The key research question involved identifying the tasks, knowledge areas, and skills necessary for inclusion in a hospital-wide nurse navigator job description, to promote best outcomes for chronically ill and at-risk patients. Using the Oncology Nurse Navigator Role Delineation Study as the starting point, the project applied a qualitative design in reviewing the 13 nurse navigator job descriptions. The percent of nurse navigator job descriptions containing the job expectations from the delineation study was calculated and additional expectations were identified from the hospital job descriptions and the literature to create a new standardized job description containing 3 categories of job expectations: tasks, knowledge areas, and skills. Positive social change may result from nurse navigator role clarity in the hospital by decreasing service duplication, improving care collaboration, and ensuring role accountability.