Globally, great strides have been made in developing essential strategies and knowledge necessary to prevent vertical transmission of HIV. Retention in the Prevention of Mother to Child Transmission (PMTCT) programme is essential for the achievement of this aspiration. The study applied Mixed Method Sequential Explanatory Design to explore the factors that underscored the retention decisions of newly diagnosed HIV positive pregnant women. The study was set in the PMTCT programme in the Takoradi Government Hospital, Ghana, a lower middle income country. PMTCT records were retrospectively reviewed. Subsequently, the Appreciative Inquiry process using the 4Is terminology was applied to unearth the experiences and aspirations of mothers (n=12), midwives and Community health nurses (CHNs) (n=12) engaged in the programme. Ethical approval was granted by University of Cape Town Faculty of Health Sciences Human Ethics Research Committee and Ghana Health Service Ethics Review Committee. Retention rate at six weeks postpartum was 67.4%. Retention stories of women enrolled in the PMTCT programme reflected a life-enhancing experience in the face of a life-threatening diagnosis. Four themes were generated: Transitioning to the ‘new’ woman, Journeying with committed companions, Glimpses of triumph and Tying up the loose ends: A daring new path. The study highlighted development of hope in a seemingly hopeless situation, supportive network of family, healthcare professionals and religious leaders, and the commitment and companionship of the midwives and CHNs that culminated in the successes of the programme. ‘Healthy’ HIV-infected mothers and ‘exposed’ infants who tested negative to HIV at the end of the mother-infant pair’s journey in the PMTCT programme was evidence of the diligence of mothers, midwives and CHNs. A collaborative discussion resulted in the development of action plans to improve service delivery, enhance clients’ experiences and improve retention. The study recommends that PMTCT services should be structured to promote hope and empowerment for the clients through shared clients and healthcare professionals’ designed improvement programmes, instituting programmes that promote the emotional health of the health practitioners to sustain the programme, and promptly addressing health system challenges that contribute to disengagement.

During this time of nursing shortages, hospitals that want to maintain the competitive edge must seek ways to recruit and retain a competent nursing staff. This study was conducted in a large hospital that strives to be the primary health care provider and employer of choice in its geographic region. The purpose of the study was to assess new nurses' perceptions of nursing practice and their expectations for meeting professional goals. Sixty-seven new nurses from 13 hospital departments were interviewed. Comprehensive orientation, continuing education, and mentoring were important values identified by this group of nurses. Communication with physicians and fear of causing accidental harm to patients were expressed concerns. Data from this survey will be used by the organization to change orientation policies to better meet the needs of the nursing staff and improve recruitment and retention of nurses.

The grounded theory presented in this study describes practices elementary principals utilize in influencing new teachers to remain in education. Eleven teachers and three elementary principals from one school division in Virginia participated in this study. Interview data were collected, elementary principals were shadowed, and documents were analyzed. Thematic categories and sub categories were formed through data analysis. The grounded theory that resulted from this study is: principals who create an atmosphere of trust, of mutual respect, and of service to children within a school foster teachers who state they feel successful, valued, safe, loyal, and professional and want to and expect to continue teaching. New teachers reported three themes that created their sense of success, value, safety, loyalty, and professionalism. Those themes are: (a) support; (b) communication; (c) first year success stories. Principals stated they employed a variety of practices to create the climate identified by the new teachers. The practices are: maintaining an open door policy, utilizing positive communication, developing leadership teams, encouraging professional development, designing and implementing support structures, providing opportunities for professional development, participating in decision making, encouraging and expecting peer collaboration and child centered instructional and behavioral programs. / Ed. D.

Streams are constantly subject to downstream movement of materials. The role of fallen leaves in resisting downstream transport of particulates is largely unquantified. The litter exclusion study at Coweeta presented the opportunity to study a stream without litter input. I expected removal of leaf litter to reduce the capacity of the stream to retain fine particulate organic matter, FPOM. However, leaves are also a major source of FPOM. I studied the effect of leaf exclusion on FPOM transport by field sampling and by generating computer simulations of particle transport in the stream. Sampling of suspended particles during storms showed that although litter inputs and subsequent particle generation were greatly decreased (Wallace et al. 1997), storm exports did not differ significantly from those of the reference stream. This suggested that the effect of litter exclusion was to reduce FPOM retention. Although there was no new organic matter entering the stream during the exclusion period, entrainment of stored material compensated for it. The computer simulations predicted higher concentrations of FPOM for storms after litter exclusion than I actually measured except during heavy rains that greatly increased discharge. These results suggested that after litter exclusion, low-intensity storms exported lower concentrations than before exclusion. However, after exclusion, intense storms that greatly increased discharge entrained higher concentrations of FPOM. Both field studies and computer models indicated that stability of the litter-excluded streambed was lower compared to the reference and pre-treatment streams, and stability was further reduced with increased discharge. / Master of Science

Erosion, transportation, and deposition of sediment into receiving waters can have substantial environmental and economic impacts. Sedimentation basins are a remediation technique used to limit sediment transport from earth disturbance activities. Retention efficiency is used as a measure of a sedimentation basin's effectiveness. Several factors influence retention efficiency including the type of principal spillway used. The most common spillway is the perforated riser which dewaters the basin throughout its entire vertical profile. However, a relatively new outlet device, the skimmer, has been developed, which dewaters the basin from the water surface. A laboratory study was conducted to compare the skimmer with the perforated riser for three different soil types and determine if there were any significant differences in the trapping efficiencies of the two outlets. The test basin dewatered over a three hour period. The parameters observed were dewatering rate, effluent sediment concentration, sediment loss rate, and retention efficiency. The skimmer treatments consistently had higher values of sediment retention efficiencies. A statistical analysis performed on the retention efficiency data showed that retention efficiency was not influenced by any combination of outlet and soil type and that outlet was significant at the 5% level. Overall, the skimmer outperformed the perforated riser for all soil types tested. Additionally, retention efficiencies were predicted for shorter dewatering times. The results indicated shorter dewatering times may have smaller impacts on the retention efficiency of basins where the skimmer is utilized rather than the perforated riser. / Master of Science

The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic and competencies on TFL for unit charge nurses. A team approach was used for the project. Incorporating the American Organization of Nurse Executives recommendations on effective leadership, the curriculum encompassed the importance and management of TFL intertwined with the power, motivation, and characteristics of the transformational leader. Competencies governing TFL in practice were a significant part of the curriculum. The curriculum was evaluated by 4 content experts using a 12-item yes or no response for each of the criteria. One of the criteria was answered no in the learning objectives section and the design of the criteria was revised All other criteria were met. A recommendation was made for a change to the evaluation format for the leadership style identification portion of the curriculum. This project has important implications for social change as unit charge nurses strive to act on best practices in leadership, thus positively impacting the well-being and satisfaction of their patients and fellow nurses.

In an Idaho-based hospital, the registered nurse (RN) turnover rate in the float pool was excessively high. The purpose of this project was to examine the effect of Appreciative Inquiry (AI) on a RN's sense of community (SOC) in a float pool and an RN's intent to stay employed after attending an AI event. Although much had been written about nursing retention, AI, and SOC separately, there was nothing on how AI could be used to increase a RN's SOC or intent to stay employed. AI is a change management framework that has been used to engage employees in a meaningful way. The goal of this project was to engage RN float staff in a 6-hour AI workshop to generate ideas on improving the work environment. The SOC theory by McMillan and Chavis provided the context for measuring RN perception. It was anticipated that participation would lead to an increased SOC and an increased likelihood of staying employed in the float pool. The Sense of Community Index 2 survey was administered pre and postworkshop to a convenience sample of RNs (n = 22) recruited from the float pool. Additionally, RNs were asked before and after the workshop how likely they were to leave their current position in the next 12 months. Data analysis was a paired t test based on a 1-group pretest and posttest design. Demographic data were collected to describe the sample population. The results, although not statistically significant, showed both an increased SOC and an increased intent to leave following the AI workshop. The findings show that AI may be useful for increasing SOC. However, as a tool for nursing retention, both AI and SOC require better understanding. It is hoped this study will provide leaders with a starting point for further investigation into how AI and SOC can be used to improve the nursing work experience.

The shortage of qualified merchant marines in the United States requires State Maritime Academy (SMA) leaders to develop competitive retention strategies to retain merchant mariners aboard training vessels. The purpose of this single case study was to identify retention strategies that U.S. SMA leaders used to retain mariners aboard training ships. The conceptual framework of this study was Vroom's expectancy theory. The study participants consisted of 5 SMA leaders overseeing the mariners aboard a training vessel. Semistructured interviews and review of SMA documents pertaining to employment strategies provided the study data. The data analysis included collecting and coding data, and using the constant comparative method to identify the themes. Four themes related to successful retention strategies emerged from the data analysis: (a) the monetary value of employment and benefits must be comparable to what is available in the maritime industry, (b) professional development is necessary to maintain maritime industry credentials and improve employee performance within the organization, (c) recognition and understanding of the uniqueness of being a mariner as a profession is important to mariners, and (d) transparency and trust increase communication and improve retention. The findings of this study contribute to positive social change by providing best practices for SMA leaders to integrate retention strategies to improve employment satisfaction, enhance the training of mariners on U.S. waterways, and increase longevity of qualified mariners, which could create a healthy and positive work environment.

Compared to their peers, low-income students are 90% less likely to graduate within 6 years and are more likely to drop out. At the local site, this problem is also evident in that the retention rate for the Fall 2014-15 cohort was 78.3%, but just 60.2% for those defined as low-income students. The purpose of this study was to gain a better understanding of low-income 1st year college students' perceived confidence in their use of technology and how it influenced their decision to stay in college. Understanding the role technology plays in the decision to stay in college will shed light on ways to offer support to increase retention of these students. The conceptual framework that guided the study was Bruno's confidence based learning methodology. This framework suggests there is a connection between knowledge and confidence. A qualitative descriptive design was used collecting data through a series of 10 open-ended interviews with low-income 1st year college students. The central research question explored how low-income 1st year college students describe their confidence in the use of technology as a factor in their retention. Data analysis consisted of manual coding to identify themes from the interview data. The findings suggested low-income 1st year students do not have confidence in their ability to use technology and remain in college. A policy recommendation to reinstate the information literacy policy for low-income 1st year students could affect social change as additional resources help to raise low-income 1st year college students' confidence using technology and supports them to persist in college.

A high attrition rate exists among new music teachers in a public school district in Central Texas. This problem is mirrored by a high attrition rate of music teachers across the United States. The purpose of this qualitative case study was to explore reasons for the attrition of music teachers at the study site, to articulate why some new music teachers have left the profession, and to identify supports that could be influential in retaining new music teachers. The study was grounded in Gardner's theory that administrators have the ability to make policy changes that can influence retention and attrition rates for music teachers. Data were collected through individual interviews with 3 administrators, 3 new music teachers, and a focus group of 3 former music teachers who resigned from their positions at the study site. Data were open coded and thematically analyzed for reoccurring themes. Findings indicated that the high attrition rate of music teachers at the study site may result from unequal treatment of music teachers compared to core content teachers. Another issue noted was the lack of understanding by music teachers and administrators about available supports to new teachers. Recommendations include providing equal opportunities to music teachers to attend subject-specific professional learning communities and professional development activities. This study may contribute to social change through adjustments to the training and mentoring structures for new music teachers in the local district, which may ultimately decrease the turnover of music teachers.