<p> Autism spectrum disorder (ASD), once thought to be rare, is now considered prevalent, with 1 of every 68 children diagnosed nationwide (Salley, 2016). There is no treatment for ASD, but early therapeutic interventions can help children with ASD live a higher quality of life and achieve major developmental milestones such as language development (Dreyer, 2016). Because ASD can challenge all members of a family, early identification and intervention is vital. This process improvement project was created to enable higher rates of detection for ASD and other developmental delays. The major process improvement intervention was implementing universal screening for ASD during all well-child exams between 18 and 24 months. A guideline was created to help providers know when to screen, what screening tool to use, and how to respond if the screening is abnormal. An educational seminar for all staff involved in the care of pediatric patients also occurred. A chart audit of the guideline and algorithm&rsquo;s clinical use was done to evaluate the successes of the project. To further evaluate outcomes, a staff and provider basic ASD knowledge survey was conducted before and after the education was provided. Finally, steps were taken to work with IT from the electronic health record (EHR) to integrate documentation prompts for providers to ease the use of ASD screening and appropriate billing. With the conclusion of this project, all data acquired indicated the clinical guideline, algorithm, and educational platform were a success. Screening for ASD increased after the implementation. Furthermore, provider and staff knowledge regarding ASD and ASD screening was enhanced. Further work with this type of process improvement project should be conducted, as indicated with the findings of this study. </p><p>

Pregnancies in teens ages 15 and younger are increasing, despite a variety of prevention efforts. Children's Defense Fund stated that qualitative research is needed to gather information from the teens' perspectives to fill gaps in the literature and increase understanding of the phenomenon. This research addressed the following questions: (1) What are the perceptions of young pregnant teens about themselves and their relationships with their families and male partners? (2) What commonalities and differences exist among young pregnant teens' descriptions of themselves and their relationships with their families and male partners? (3) Which of the perceptions of young pregnant teens correspond to, and which differ from findings in selected literature about teen pregnancy? Jessor's Problem Behavior Theory was used as a framework. This theory indicated many variables which may result in proneness to engaging in problem behavior, including teen pregnancy. From among variables designated by Jessor's framework, those of self, family, and male partner emerged as probably relevant to teen pregnancy and as foci for data collection. Fourteen questions were delineated and used as a guide to data collection. A convenience sample of ten pregnant teens ages 14 and 15 was recruited from urban and rural schools and clinics. One interview was conducted with each subject. Data were analyzed with the assistance of an interdisciplinary team of reviewers, and responses to the interview questions were determined. Findings included the facts that many in the sample were good students who valued education, were involved in athletics, and had educational plans which included high school and college. They had a strong preference for the alternative school setting. The maternal grandmother apparently played a key role in the family; many of the teens' relationships with their male partners were tense before the pregnancies occurred; several of the male partners had problems with alcohol, violence, and the law; and there was a variety of family support available for the teens. All of the subjects had information about sex and birth control. The prevalence of the dysfunctional family typified in the literature was also a theme for this sample.

<p> Health care organizations typically have a hierarchical structure, with physicians dominant and nurses subordinate. The challenge to open and honest communication between doctors and nurses is real, and communication errors contribute significantly to undesirable patient outcomes. Nurse executives (NEs) have a responsibility to help lead transformation of health care organizations to support nurses to speak up and communicate all critical information.</p><p> NEs are challenged to improve safety and quality, decrease costs and increase access to care. Combining health care expertise with business ability can support these goals. Rooke and Torbert found correlations between successful business leaders and postconventional action-logics, or world-views. Action-logics can be developed to make leaders increasingly effective.</p><p> The Magnet Recognition Program recognizes health care organizations that have achieved high quality care and excellence in nursing practice. The purpose of this study was to determine what action-logics the NEs demonstrate who have led their organizations to Magnet designation or re-designation in the Veterans Healthcare Administration. The study also sought to determine what actions NEs took to support nurses speaking up about their concerns, the barriers that impede those efforts, and the sources of influence these NEs implemented to support nurses speaking up. This exploratory study used a mixed methods design and each participant completed the Maturity Assessment Instrument (MAP) and an interview.</p><p> The study demonstrated, in contrast with other business leaders, that conventional action-logic was sufficient for the NE to bring an organization to Magnet status. However, the study found specific limitations those possessing conventional action-logic have to support speaking up, and that those possessing postconventional action-logic have transcended these limitations. This strength of the postconventional action-logic is very important to support speaking up in health care. The use of multiple sources of behavioral influence by Magnet NEs was confirmed, as was the existence of a culture of organizational silence. Multiple speaking up behaviors were required to address every single barrier encountered to speaking up, and strong emotion routinely accompanied speaking up. The absence of sources of behavioral influence in an organization was determined to be a barrier to speaking up.</p>