<p> People living with HIV/AIDS (PLWH) experience stigma that creates barriers have the net effect of limiting access to care and decreased quality of life. This study seeks to identify, quantify, and measure mechanisms that produce the negative outcomes of provider-based stigma in regards to PLWH. The study employs the Health Care Provider HIV/AIDS Stigma Scale (HPASS), a new instrument based on a tripartite model of measuring prejudice, stereotyping and discrimination as developed by Wagner et al. in 2014. The study shows stereotyping is prevalent in the sample as a whole while prejudice was statistically significant in both correlations and comparisons made among groups. The study concludes that stigma is both frank and occult in its operation within the healthcare delivery model and recommends concrete and targeted interventions suitable for the setting where the study takes place.</p>

<p> <b>Background:</b> Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. </p><p> <b>Purpose:</b> The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. </p><p> <b>Methods:</b> In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. </p><p> <b>Results:</b> The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.</p>

The purpose of this study was to examine the relationship between adolescents' exposure to violent and non-violent traumatic life events and psychological factors and the effects of demographic and prosocial resiliency factors on this relationship. A secondary analysis of data from a study with a large sample of white and black adolescents (grades 9th and 10th) from three high schools was performed. Of the total eligible population, 89% participated in the survey (N = 1684). The adolescents' ages ranged from 13 to 18 years; 54% were black and 46% white; and 50% of the adolescents were female. One out of five adolescents was exposed to violence as a victim of a violent traumatic life event and there was greater exposure in black and male adolescents. The overall mean exposure to non-violent traumatic life events was 4.95. These data suggested that there is a relationship between traumatic life event exposure and anger total, depression, and mental distress in a large diverse sample of adolescents. Victimized female and white adolescents reported more depressive and mental distress than male and black adolescents. Exposure to violent traumatic life events in adolescents was a significant predictor of anger total $(p<.01),$ depression $(p<.01),$ and mental distress $(p<.01).$ Prosocial resiliency factors (self-efficacy, social support, and hope) moderated the exposure to violent traumatic life event exposure. Higher self-efficacy and social support and more hopeful about the future were protective and ameliorated the detrimental effects of exposure to violent traumatic life events in adolescents. These findings support the importance of identifying adolescents exposed to violence and intervening to address the associated psychological symptoms. Further, prosocial resiliency can be used to decrease the deleterious effects and are potential avenues for prevention strategies.

<p> Centers for Disease Control (2011a) Surveillance report revealed African American women comprised 63% of new HIV cases among women; 65% of African American women were infected with HIV transmitted by heterosexual sex; yet represent 13% of the female population in the United States. An existing data set was examined from a sample of 761 African American women with a history of drug use at high risk to acquire or transmit HIV and/or STDs to determine 751 women&rsquo;s knowledge and attitudes about risky sexual behaviors, factors influencing a decision to HIV test, and the influence of sex trading on the decision to HIV test. Binary logistic regression predicted a small percentage of women&rsquo;s decision to HIV test was influenced by knowledge of risky sexual behaviors (Naegelkerke R2, = .100). There were significant difference in the number HIV tests for women who reported cheating on a steady sex partner (M = 4.25, SD =7.49) versus women who did not cheat (M = 3.28, SD = 4.67), t(747) = - 2.19, p = .03. Binary logistic regression predicted a minor percentage of women&rsquo;s decision to HIV test was influenced by women&rsquo;s attitudes about risky sexual behavior (Nagelkerke R2 = .043). Women who agreed with the statement, I have risky drug behaviors that need changing were predicted twice as likely to be HIV tested Exp [B] = 1.829, 95% CI [1.018, 3.288]. Binary logistic regression predicted an increased 15.3% variation in the decision to HIV test is influenced by women&rsquo;s knowledge to prevent HIV and attitudes about risky sexual behavior (Nagelkerke R2 = .153). Women who agreed with the knowledge item, asked their partner if they were HIV positive, were 1.3 times more likely, and women who agree with the knowledge statement, I have risky drug behaviors that need changing, increased to 1.9 times more likely to HIV test. There were significant differences in number of HIV tests for women who engaged in sex-trading versus women who do not engage in sex-trading. Tailored strategies that determine unique needs of African American women to reduce risky sex an increase HIV testing are recommended.</p>

In this study, systematic reflection in professional practice is seen as a dynamic process towards socio-political action, negating a navel-gazing critique. Positioned within nursing, the pioneering narrative inquiry approach will be highly valuable in medicine, education and other health fields. When I embarked on this study, research to guide me in homeless health care was limited and there is, even yet, insufficient evidence to demonstrate the effectiveness of advanced nursing practice in England particularly with homeless people. Through its reflexive narrative nature that research gap is addressed in a profound journey that illuminates my transformation over a three year period of being and becoming a Specialist Public Health Nurse (homelessness). The methodology draws dynamically on an eclectic, philosophical framework which includes reflective practice/guidance, narrative inquiry, hermeneutics, aesthetics, critical social science theory, storytelling, performance-ethnography and ancient wisdom. The Six Dialogical Movements (Johns, 2009) provides coherence to the twenty-one practice experiences that adequately marked my transformation towards my practice vision. I used the Being Available Template (Johns, 2009) as a reflexive framework which became the metaphoric net of my practice, showing where and how homeless people fall through the net of care, and my role in weaving a stronger net. I also drew on the work of Belenky et al's (1986) voice perspectives to show empowerment in my specialist role. Within the narrative, each story illuminates complexity and brings new knowledge about homeless health care. The study tangibly links childhood trauma to adult homelessness; it illuminates suffering in homelessness, showing where and how mainstream health professionals contribute to suffering when they do not grasp their role within the net, perpetuating homelessness. Appreciating precarious engagement in four quadrants: health services, homeless services, the homeless person and my SPHN role, is a concept that illuminates the precariousness of the net. The study concludes with a SPHN Homeless Health Care Model. Towards an ensuing social action through dialogue, I use the term 'audiencing' rather than transferability of findings. Hearing stories from 'street to boardroom' - making the invisible visible - has been profound in health services as evidenced in the narrative.

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, which measured independent variables such as transformational leadership and attitudes toward evidence-based practice. Vaccination intent was the dependent variable. The results showed that transformational leadership was positively related to vaccination intent r(353) = .16, p < .01. There was no relationship between transactional leadership and vaccination intent r(353) = .01, p > .05 nor between attitudes toward evidence-based practice and vaccination intent r(353) = .09, p > .05. The implication of the study is that the effects of transformational leadership constitute a predictive tool to identify how an organization can increase vaccination rates among RNs. Implementing the recommendations of the study could promote social change by providing nursing leadership with tools to facilitate increased vaccination rates among health care personnel. Increasing vaccination rates for healthcare personnel will decrease vaccine-preventable illnesses and improve outcomes for hospitalized patients.

Purpose &lt;br&gt;The purpose of this study was to provide an understanding of the self-perceived physiological and psychosocial needs of persons living in communities which have been exposed to environmental contamination, and to provide an understanding of how forensic nurses can be utilized in these communities. &lt;br&gt;Background &lt;br&gt;This study was conducted to provide an opportunity for forensic nurses to advance their profession by finding ways that they can move beyond their traditional roles. Dixon and Dixon's Integrative Environmental Health Model was the theoretical framework. &lt;br&gt;Research Design &lt;br&gt;This cross-sectional triangulated study used quantitative and qualitative methods. The Community Environmental Health and Rights Assessment Tool (CEHRAT) was used to elicit quantifiable responses. One-on-one qualitative interviews were then conducted. &lt;br&gt;Participants and Data Collection and Analysis &lt;br&gt;Questionnaires were completed by 198 participants (109 from Ellenville, New York, and 89 from South Plainfield, New Jersey). For the qualitative phase, six residents were interviewed. &lt;br&gt;All persons who completed the questionnaire received a $5 gift card and an environmental resource pamphlet. The quantitative data was analyzed using SPSS. The qualitative data was managed with Weft QDA. &lt;br&gt;Results &lt;br&gt;The majority of participants in each community were `Somewhat satisfied' with the environmental information they receive (32.4% for Ellenville and 53.5% for South Plainfield). Two-thirds of the respondents in both communities said they know little or nothing about environmental contamination in their community. Over ninety-six percent of respondents indicated that they would trust nurses to provide environmental information if the nurses were experienced in such matters. Over ninety-eight percent of respondents stated they would trust forensic nurses. Eighty-five percent of respondents wanted educational information so they could protect themselves from contamination. The qualitative data revealed themes that buttressed the quantitative results: a lack of knowledge; the negative impact of politics, economics, and personal finances on remediating contamination; the need for outside help; and the belief that nurses can help affected communities by providing education, treatment, and investigation. &lt;br&gt;Conclusions &lt;br&gt;Forensic nurses can benefit communities that have been environmentally contaminated. In addition to advancing their profession, forensic nurses can be catalysts for change. / School of Nursing / Nursing / PhD / Dissertation

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (Ph. D.)--Teachers College, Columbia University, 1968. / Typescript; issued also on microfilm. Sponsor: M. Frances Frazier. Dissertation Committee: Vivian P. Gourevitch. Includes bibliographical references (leaves 148-153).

Thesis--St. John's University, N.Y. / Vita. Includes bibliographical references.