This study was designed to identify possible risk factors about physical activity in middle-aged disabled African American women (AAW) aged 45 to 64 years. Disabled middle-aged AAW has a disproportionate prevalence of obesity and chronic illness than nondisabled women. Most disabled middle-aged AAW leads a sedentary lifestyle, and they do not meet the recommended physical activity (PA) guidelines. Little is known about this group, and a social ecological model was used to explain PA patterns. Data were extracted from the 2009 Behavioral Risk Factor Surveillance System (N = 1,599) for women who responded yes to indicate that they needed specialized equipment. This cross-sectional quantitative study used univariate and multivariate analysis to assess the relationship between age, education, and income among middle-aged disabled AAW. A general linear model revealed younger disabled AAW (ages 45 to 54) engaged in more physical activity time per week than did their older counterparts (estimate = 76.012, p = .001). Individuals with less education reported more minutes of physical activity than college graduates (estimate = 142.522, p = .001). Respondents with annual incomes from $35,000-$49,999 (estimate = 184.590, p = .000) were more physically active than their more affluent counterparts. Smoking, demographic variables, and emotional well-being did not affect minutes of moderate physical activity. This research may contribute to positive social change by suggesting that programs intended to increase physical activity among disabled AAW be targeted toward those who are older, are more educated, and have higher incomes.

Exposure to traumatic events is rare for the general public but common for first responders. However, there is little proactive emotional health care occurring inside the first responder community. No preventive treatment for depression, anxiety, stress, and PTSD exists. The purpose of this study was to determine the efficacy of a psychological readiness training intervention on 361 police officers and firefighters in a medium-size Midwestern city. A combined positive psychological capital and cognitive behavior therapy approach was used to frame the study. This study used a pretest, posttest quasi-experimental design. The participants were a convenience sample of 119 volunteers from a population of 361 first responders. The participants were first administered pretests using the DASS-21 and the Civilian PTSD Self-Report Scale which measured depression, anxiety, stress, and posttraumatic stress. They were then exposed to the psychological readiness training (PRT) intervention, after which the same posttests measuring depression, anxiety, stress, and posttraumatic stress were again administered. T-test results indicated a significant decrease in all 4 symptom categories post training intervention. Implications include providing first responders with the tools needed to process traumatic events to maintain mental health throughout their careers.

Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently, end-user satisfaction and understanding of CPOE and electronic health record (EHR) functionality are vital to avoid error omissions. CPOE initiatives should be refined post system implementation to improve clinical workflow, medication processes, and end-user satisfaction. The purpose of this quality improvement project was to refine CPOE system initiatives and develop an e-learning educational module to facilitate end-user understanding of and satisfaction with CPOE. The Iowa model of evidence-based practice, Lean methodology, and Provider Order Entry User Satisfaction and Usage Survey (POESUS) were used to guide the study. An e-learning module was implemented to increase staff understanding of the newly implemented CPOE system, and a plan was provided for ongoing data collection and investigation of end-user satisfaction and medication inadequacies with the CPOE system. A mixed-method design was recommended to key stakeholders to identify the impact of the e-learning course and refined CPOE initiatives on both end-user satisfaction and patient outcomes in the medical-surgical ICU. Findings from the study informed the impact of e-learning educational modules with CPOE system implementation. Those in organizations implementing advanced technology such as CPOE and EHR systems in critical care settings will find this paper of interest.

School nurses who transition from hospital or clinic-based settings to a school-based work environment often lack sufficient transitioning skills and orientation to cope with the roles and responsibilities of school-based nursing. The result is a high attrition rate among school-based nurses. School nurses may leave their positions due to experiences of marginalization, including isolation, role confusion, and barriers to practice. In this phenomenological study, the lived experiences of 12 school-based nurses who transitioned from hospital or clinical settings were explored. Bandura's self-efficacy and Spreitzer's psychological empowerment theories were used in interpreting the findings. Data were collected via face-to-face individual interviews with nurses residing in the State of Maryland. The study findings revealed the difficulties experienced by these nurses during the initial years of their transition to school nursing. Multitasking was very challenging at the initial stage of transition for nurses who were new to school-based-practice. For nurses who were learning to navigate the school system, adhering to educational standards and protocols while setting appropriate priorities to provide quality nursing care for students was difficult. The nurses' understanding of health and wellness shaped and influenced their decision to continue with school nursing to help students reach their maximum health and academic achievements. This study may lead to positive social change by helping readers to better understand the transition process for hospital-based nurses who enter the school environment. With an improved understanding of this population, it may be possible to lower attrition and burnout rates among school nurses.

Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.

Glioblastoma multiforme (GBM) is a destructive brain cancer that results in death 12 to 15 months after diagnosis. The purpose of this retrospective study was to determine if variations in tumor size at diagnosis, treatment options, and survival rate occur in GBM patients living in urban and rural areas of the United States. Using the behavior model of health services as the theoretical framework, this study used secondary data sets of GBM cases reported from 1988 to 2011 from the Surveillance, Epidemiology, and End Results program. Tumor size was measured in millimeters; treatment was evaluated by ascertaining the number of GBM patients who had surgical resection of their tumors, radiation, and chemotherapy; and survival rate was evaluated using Cox Regression analysis. With a sample size of 33,202 cases, data were examined using descriptive and multivariable analyses with SPSS. Results showed statistically significant differences in tumor size at diagnosis in rural patients compared to urban patients (p = 0.0085; p = 0.018), more urban patients were treated with radiation compared to rural patients (p < 0.001), and rural patients had poorer survival rates than urban patients (p < 0.001). Finally, when controlling for region, race, age, gender, education, and income, longer survival time was associated with urban status, female cases, and higher family income (p < 0.0001), and greater age was associated with reduced survival time (p < 0.0001). Study results could promote positive social change by identifying predictive variables associated with health outcomes of GBM patients. It may also educate providers on the risk of rurality of patients diagnosed with GBM, and inform lawmakers responsible for the creation of healthcare policy and the equitable allocation of healthcare resources.

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in Vitamin D levels after supplementation corresponds with significant changes in CD4 count/percent in a cohort of African American, HIV-infected men who attended an HIV clinic in southeast Michigan (N = 70). The conceptual framework was based on the role of Vitamin D in regulating the immune responses through Vitamin D nuclear receptors on the CD4 cells. It postulated that an increase in Vitamin D level might enhance immune function, promote cellular anti-inflammatory state, and decelerate CD4 destruction. Data analysis included descriptive statistics, bivariate correlation, logistic and linear regression, t test, repeated measures ANOVA, and ANCOVA. Findings of the study did not support the hypotheses of significant correlation between Vitamin D and CD4 count (p = 0.458) and percent (p = 0.776), or of any impact of supplementation on CD4 count (p = 0.216) and percent (p = 0.918). Social change implications include providing health professionals, researchers, and policymakers with knowledge to tailor health promotion interventions aiming to reduce Vitamin D deficiency in favor of improving the overall health of HIV patients, especially high-risk groups such as African American HIV-infected patients.

Patient nonadherence to physicians' prescribed therapeutic regimen is the greatest challenge in the effective treatment of patients with diabetes worldwide. Scientific evidence has revealed that nonadherence to prescribed medication could result in diabetic complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathic diabetic foot ulcers. The purpose of this study was to explore predictive relationships between levels of adherence to antidiabetic medications, patient HbA1c levels, and diabetic complications among Jamaicans, an understudied population. The research question that guided this study was: Do the patient level of adherence and HbA1c levels have any predictive relationship with the severity of diabetic complications (cardiovascular disease, retinopathy, nephropathy and neuropathic foot ulcer) among Jamaicans after controlling for age and gender? The theory of planned behavior was used to guide the study. Data regarding diabetic complications were collected from 119 records during a cross-sectional review of patient dockets. Level of adherence was determined from an interviewer-administered Morisky 8-item adherence scale. A multiple regression analysis revealed that lower levels of patient adherence to treatment and higher HbA1c levels predicted greater severity of cardiovascular disease (p = .000; p = .000), retinopathy (p = .009; p =.090), nephropathy (p =.007; p =.001) and diabetic neuropathic foot ulcers (p =.027; p =.001). Findings from this study will contribute to the knowledge base on diabetic medication nonadherence and may encourage health care professionals to advocate for better medication adherence strategies among people with diabetes.

Hospice services provide a holistic approach to end-of-life care to terminally ill patients though there is some evidence to suggest that African American military beneficiary populations may not access hospice care as often as expected. The purpose of this nonexperimental study was to evaluate reasons for the low use of hospice care among the terminally diagnosed members of this population, between the ages of 18 and 64. Kolcaba's comfort theory provided the theoretical framework for this study. The research explored whether a statistically significant difference exist among African Americans military beneficiaries population as compared to non-Hispanic Whites pertaining to their knowledge of hospice care, attitudes and beliefs about hospice, distrust in the health care system, and advanced care plans. This study used a simple random sample of 32 participants (18 African Americans and14 non-Hispanic White) from a military ambulatory care setting in Maryland. Johnson, Kuchibhatla, and Tulsky's End-of-Life Care survey was used to collect data from the 2 groups of participants. Data were analyzed using a one-way multivariate analysis of variance. The results indicate that there are not statistically significant differences between the groups in terms of knowledge of hospice care, attitudes and beliefs about hospice, distrust in the health care system, and advanced care plans based on race. Based on the results of this study, further research is recommended to replicate using a larger sample size to include other minority groups at more than one medical treatment facility. The implication of this study may open up an avenue to policy makers and administrators who are responsible for disseminating information about hospice benefits to focus on improving the quality of the end-of-life for terminally ill patients.

In Swaziland, cases of cervical cancer among Human Immunodeficiency Virus (HIV)-positive adolescent girls and young women (AGYW) are increasing, but there is low uptake of cervical cancer screening. This study was conducted using the systems thinking theory to explore the relationships between the uptake of cervical cancer screening among HIV-positive AGYW in Swaziland and the availability of trained health providers, cervical screening services, and the provision of referrals for cervical screening. The study also investigated any differences in uptake of cervical screening based on age group. For this quantitative cross-sectional study, secondary HIV program data that were collected routinely between January 2016 and March 2018 were accessed. Data were described with univariate analysis while relationships were tested using bivariate analysis and logistic regression. Most facilities (97%) had staff who had been trained; facilities with greater numbers of trained staff were more likely to have a higher uptake (OR: 30.3, p = 0.000). Facilities with cervical screening services were also more likely to have a higher uptake (x2 = 16.94, p = 0.000), and facilities with all the core components for screening had the highest uptake (p = 0.002). AGYW who had a positive screen were referred equally but the referral rate was low (20.45%). There was no difference in uptake by age group. The results of the study can increase knowledge of the institutional factors that contribute to the low uptake of cervical cancer screening among HIV-positive AGYW and has implications for social change by informing interventions for improving cervical cancer screening uptake in HIV-positive AGYW in similar settings, ultimately reducing the high costs, morbidity, and mortality related to cervical cancer in this population.