<p> The purpose of this research was to identify common adaptations family members make and to identify areas where additional nursing interventions or support might be helpful for families. A qualitative approach using descriptive case studies was applied to study the recipients and their families. The Roy Adaptation Model (RAM) was used as a framework to collect data and to analyze it. The RAM was used to analyze various stimuli and how the family and recipient made adaptations within the four conceptualized areas of the RAM model. Structured interviews were conducted to collect the data. The demographic data and structured interview data was processed with thematic analysis. Data was arranged into categories and then themes after reflection. Recommendations on adaptions families experience and how nursing could contribute to positive adaptations were discussed. Family Transplant Syndrome was identified as a name for common characteristics shared by all the family cases.</p><p>

<p> Student perceptions of academic dishonesty and clinical integrity were explored in this qualitative study, with Bandura&rsquo;s social learning theory utilized as the primary framework for the study and Kohlberg&rsquo;s theory of moral development as the secondary framework. A basic qualitative methodology was employed to answer the research question: what are student perceptions of moral beliefs and their actions related to ethical decision making in a four-year Bachelor of Science in nursing (BSN) program? The target population was junior or senior year nurses in a four-year BSN program. The sample included 17 students who met the inclusion criteria. Participants were asked 17 open-ended interview questions to gain insight into their perceptions of academic dishonesty and clinical integrity. Interviews were digitally recorded and transcribed manually to provide further immersion in the data. Data analysis and collection occurred simultaneously and was inductive and comparative. During data analysis, five themes emerged, each with subthemes which were identified through supporting narrative comments from participant interviews. The five identified themes were used to answer the research question and included: student perceptions of academic dishonesty, student perceptions of clinical integrity, student perceptions of moral beliefs, student perceptions of ethical decision making, and student perceptions of what influenced academic dishonesty. This study adds to the current body of knowledge of nursing literature regarding academic dishonesty and clinical integrity. Results could provide assistance to higher education institutions to solve problems involving academic dishonest behaviors on college campuses. This study builds on the current literature and serves as a foundation for future research to solve this decades old problem. </p><p>

<p> Within the 21^st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. The materials were found to be clear, accurate, and easy to read by the medical assistants. Four MAs, who worked at the clinical setting, participated in the educational program that taught them to use the toolkit developed for this project. To evaluate the effects of the educational program for the MAs, the results of the pre and posttests were scored and showed that MAs had significantly increased their knowledge of teaching diabetes and obesity self-management for African Americans (pretest mean score 80, posttest mean score 93). An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing education in diabetes and obesity. Positive social change may result as the African American patients who receive education from medical assistants at the clinical site improve their self-management skills to prevent diabetes and obesity or the complications of the disease.</p><p>

<p> Despite concerted efforts to improve the process of shift-to-shift hand-off report (SHR), challenges and barriers continue to threaten the integrity of information shared between nurses. Research studies have demonstrated that vulnerabilities in SHR have been associated with clinical practice demographic factors, lack of a standardized process and tools, and differences in perceived value of SHR. </p><p> A quantitative, descriptive, cross-sectional study was conducted to identify nurse perception of SHR processes, factors that influence nurse perception of SHR, and nurse perception of bedside shift report (BSR) versus alternative SHR methods. Participants included a convenience sample of registered nursing students (n=49) enrolled in RN-BSN or MSN programs at a private southwestern Pennsylvania university. Descriptive statistics, ANOVA, and two independent t-Tests were used to analyze data collected from the Handover Evaluation Scale. </p><p> Study results revealed there was no statistically significant difference between nurse perception of SHR processes, demographic factors that influence SHR, and the locality of SHR (BSR). In addition, the majority of nurses identified a reluctance to change current practice of conducting the SHR process. There was no identified association between nurse perception of the quality of information (<i>p</i>=.22), interaction and support (<i>p</i>=.96), or efficiency (<i>p</i>=.17) of SHR. </p><p> As nurses are key stakeholders in the transfer of crucial up-to-date patient care information, nurse perception of the SHR needs to be further examined and evaluated to improve patient care outcomes. Quality assurance measures are the hallmark of standardized processes to ensure the delivery of safe and effective care.</p><p>

<p> <b>Background:</b> Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. </p><p> <b>Purpose:</b> The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services&rsquo;, Joint Commission on Accreditation of Healthcare Organization&rsquo;s, and other professional healthcare organizations&rsquo; guidelines for nurses&rsquo; knowledge of evidence-based discharge practices; determine level of nurses&rsquo; knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. </p><p> <b>Theoretical Framework:</b> The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. </p><p> <b>Methods:</b> Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired <i>t</i> test. An online demographic survey and pre- and posttest surveys were administered to determine nurses&rsquo; knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired <i>t</i> tests. </p><p> <b>Results:</b> A statistically significant difference was found in the pre-posttest survey responses for question 5 (<i>p</i> = 0.046 Wilcoxon; <i>p</i> = 0.041<i>t</i> test), and question 13 (<i>p</i> = 0.022 Wilcoxon; <i>p</i> = 0.018 <i> t</i> test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. </p><p> <b>Conclusion:</b> A standardized diabetic discharge guideline incorporated into the hospital&rsquo;s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses&rsquo; adherence results in effective nursing practices and an informed patient population. </p><p>

<p> Although Filipino and Filipino American nurses represent an impressive share of the nursing workforce, they are not well represented in advanced practice, faculty, and executive leadership positions. Obtaining a graduate degree in nursing has the potential to open a wider range of opportunities to meet the healthcare demands of a population that is growing older, and increasingly becoming more diverse. The purpose of this study was to examine the factors affecting graduate degree pursuit for BSN-prepared Filipino and Filipino American nurses working in the United States. This study provides an in-depth examination into intergenerational perspectives from 33 Filipino and Filipino American nurses from 14 states. Ricoeur&rsquo;s hermeneutical phenomenology was utilized as an interpretive approach and the theoretical underpinnings of career construction theory served as a framework. This study revealed that the determination to provide a better life for their family and a commitment to advancing the profession were incentives to pursuing a graduate degree. In addition, having a reliable network of colleagues and peer mentors was essential to persisting in their programs. Across all generations, finances were a major barrier to educational attainment, specifically for first-generation participants who prioritized sending money back to their family in the Philippines. Other factors were related to English as a second language, communication styles, experiencing discrimination, lack of knowledge of available graduate programs, approaching the age of retirement, friction between generations, and perceived discrimination. Exposure to advanced practice registered nurses in the workforce was a disincentive for some participants and was inspiring to others. These factors were not independent of each other and their impact fluctuated over time. The decision to pursue an advanced nursing degree depended upon the individual&rsquo;s determination that the return on investment of a graduate degree outweighed the sum of all their responsibilities and obligations. Findings from this research can help the Filipino community and professional nursing organizations, higher education faculty and staff, and healthcare system leaders in developing strategic plans to help Filipino and Filipino American nurses overcome barriers and to facilitate robust pathways for those who intend to advance their educational goals and professional nursing careers.</p><p>

<p> Accurate temperature assessment is essential in neonatal patients and allows for prompt recognition of illness. Temperature can be measured by rectum, which is subject to injury, axillary, which is time-consuming, and temporal artery, which is safe and fast. The purpose of this evidence-based practice quality improvement project was to create an educational toolkit for nurses teaching temporal artery thermometers for routine temperature measurement on neonates, to establish the content validity of the toolkit, and to make recommendations for implementation of the toolkit. The format applied was the Kellogg Logic Model that proceeded from the assumption, to planned work, and results. The theoretical framework was Roger&rsquo;s Diffusion of Innovations, which identifies champions as the initial change agents, helps engage the staff, and facilitates the change. The project consisted of a two-phase process. Phase 1 was the development of the toolkit contents by integrating the evidence and applying the framework in the context of working nurses. Phase 2 was the validation of the toolkit by expert nurses and educators with Item-CVI ranging from 0.80 to 1.00 and the scale-CVI at 0.98. The Toolkit for Implementation of Temporal Artery Thermometers for Neonates with three short video presentations was validated. The toolkit is shared on multiple webpages and is available to the public. Adopting the temporal artery thermometer for routine temperature measurement could be a new standard for temperature monitoring that is accurate and fast. Improved family satisfaction would result from a quicker temperature process and a less invasive method resulting in a more comfortable experience for their infant.</p><p>

Thesis (M.S.P.H.)--University of Michigan, 1948.

Thesis (M.S.P.H.)--University of Michigan, 1948.

<p> There is an increasing demand for more baccalaureate- and graduate-prepared registered nurses in the United States, to face the healthcare challenges of the 21st century. As a strategy to meet this need, educational institutions are expanding electronic learning in nursing education; however, technology acceptance in education continues to be a concern for educational institutions. In this context, the goal of the study was to investigate factors that potentially influence registered nurses&rsquo; intentions to adopt e-learning systems. A theoretical model was used to determine whether perceived value, attitude toward e-learning systems, and resistance to change influence registered nurses&rsquo; intentions to use e-learning systems. </p><p> A web-based survey was used to assess the effect of the aforementioned constructs on registered nurses&rsquo; intentions to use e-learning systems. The web-survey instrument was developed as a multi-item questionnaire using Likert-type scales. A 35-item survey instrument was developed using previously validated measurable items. The target population of this study was registered nurses in South Florida. The sample for this study was 323 (over 21% response rate) registered nurses at two hospitals in South Florida. </p><p> Multivariate analysis was conducted using structural equation modeling and robust standard errors with the Satorra-Bentler adjustment. The results revealed that perceived value, attitude toward e-learning systems, and resistance to change influence registered nurses&rsquo; intentions to use e-learning systems. Findings from this investigation may be of interest to educational institutions preparing to make investments in e-learning systems. The information provided in the study will allow administrators in higher educational institutions to make decisions on ways to address the challenges that may be affecting e-learning acceptance by registered nurses.</p>