<p> The purpose of this qualitative grounded theory study was to understand nurses&rsquo; perceptions of care that supports patients&rsquo; dignity during hospitalization at the end of life, and to propose a theoretical foundation consistent with these perceptions as a guide to practice. The research involved analyzing perceptions about processes that can explain how nurses perceive care that supports patients&rsquo; dignity at the end of life during hospitalization. The aim of the research in this study included a focus on the general problem that patients&rsquo; dignity is not always respected by healthcare providers according to the review of the literature and the acknowledgment of the lack of theories related to nurses&rsquo; perceptions of care that supports dignity during end-of-life care. A grounded theory design offered a systematic approach to developing a theoretical model from data that takes into consideration the complexities of nurses&rsquo; perceptions of care that supports dignity during hospitalization at end of life. Semistructured interviews were conducted with 11 experienced registered oncology female nurses from the northeastern region of the United States. The research involved analysis of the perceptions of nurses caring for cancer patients admitted to the hospital during end of life. The development of a beginning model for dignity care stemmed from the emergence of three major categories, which were communication, support, and facilitation. The identified subcategories were education, workshops, course curriculum, in-services, being an advocate, listening, being present, physical needs, emotional support, compassion, honoring wishes, respect, and being treated as human. The emergence and development of a dignity model may offer a process that can serve as a valuable reference in providing care that supports the dignity of patients during hospitalization at end of life.</p>

Sub-Saharan African immigrants represent a rapidly growing racial subgroup in the United States. These immigrants have an increased Type 2 diabetes mellitus (T2DM) prevalence as well as diabetes complications occurring after they have lived in the U.S. for three years or more. Diabetes self-management among Sub-Saharan African immigrants with T2DM is poorly understood; diabetes data for Sub-Saharan Africa immigrants are interspersed among data of Blacks or African-Americans. The purpose of this qualitative descriptive study was to describe Sub-Saharan African immigrants' health-illness transition experiences associated with T2DM self-management. The framework for the study was the middle-range nursing theory of transitions. Purposive and snowball sampling were used to recruit participants. The primary investigator conducted face-to-face semi-structured in-depth interviews with 10 Sub-Saharan African immigrant men and women with T2DM, and used qualitative content analysis to analyze the data. Domains were selected apriori to respond to each research question, and categories and subcategories were elicited through the immersion and crystallization of thematic units. Four overarching domains selected apriori describing the health-illness transition experiences the participants had with T2DM self-management: 1) Knowledge of T2DM Self-Management Behaviors 2) Current T2DM Self-Management Behaviors 3) Inhibitors of T2DM Self-Management 4) Facilitators of T2DM Self-Management. Health professionals should be equipped with an understanding of the properties and conditions of health-illness transition necessary to build a foundation that facilitates healthy adaptation to the T2DM transition. The knowledge from this study will lead to the development of culturally tailored interventions to decrease inhibitors of and encourage self-management in daily diabetes care for Sub-Saharan African immigrants with T2DM.

<p> <i>Polypharmacy</i> is the concurrent use of multiple medications. Polypharmacy presents increased health risks and increased hospitalizations due to its synergistic effects particularly in the elderly population. In addition, there is a significant increase in health care spending. Polypharmacy is of special concern among elderly individuals because this practice can lead to other health risks, hospitalization and increased healthcare cost. The Centers for Medicare and Medicaid Services (CMS) estimates that polypharmacy costs the nation&rsquo;s health plans more than $50 billion annually. Polypharmacy is linked to higher incidence of adverse drug reactions (ADRs), falls, hospitalization and behavioral incidents among the elderly especially if one or more of the medications is a psychotropic medication. The CMS has therefore established a guideline for the gradual dose reduction (GDR) of psychotropic medications. The aim is to reduce the negative effects of these medications on patients and thereby improve their general quality of life. This evidence based project examined the effects of the gradual dose reduction among residents between the ages of 65-75 living in a long-term care facility in the inner city of North-East Bronx. The project also evaluated the facility&rsquo;s policy regarding GDR within this population and proposed ways to enhance the policy improve patient safety and reduce medication cost.</p>

<p> Dying with dignity in the critical care unit (CCU) is a difficult process to define and limited information is available to assist with that definition. The purpose of this descriptive phenomenological study was to explore the critical care nurses lived experiences of caring for the dying patient in CCU. Understanding nurses&rsquo; perceptions and lived experiences of the phenomena will contribute to nursing knowledge, new insights for nurse leaders, and the possible development of a nursing model to guide nurses who are providing care to the dying patient. A qualitative, descriptive phenomenological methodology was used to guide this study. Twelve critical care nurses were recruited and interviewed, exploring their lived experiences of caring for the dying patient in the critical care setting. Three board questions comprised the interview guide allowing each nurse an opportunity to share their lived experiences of caring for the dying patient. Five themes emerged from the data: communication, family, technology, lack of education, and dying with dignity. Recommendations included early discussions with patients and families regarding end-of-life wishes as well as, strategies for nurses providing end-of-life care. The study participants also noted the need for increased awareness and education for patients, families and health care providers regarding end-of-life care, dying with dignity, and palliative and hospice referrals. Community education was also noted as an integral part of the awareness process. For nurses and physicians, the education should start during their basic education program and continue throughout their career especially those working in high acuity areas in health care. As in life, death and dying are important aspects of all of health care providers. Facilitating quality end-of life care could relieve pain and suffering for the dying patient and assist family members with allowing their loved one, the patient to die with dignity.</p>

<p> Electronic textbooks are a relevant technology for higher education to achieve active engagement in the learning process at a lower cost to students. However, as a learning resource, electronic textbooks may not be a suitable learning resource for all students. Academic success in a nursing program requires large amounts of reading and the use of learning resources that maximize acquisition of knowledge and comprehension of nursing concepts. Failure to grasp foundational concepts could result in increased attrition rates and sub-standard licensure exam results for nursing programs and poor patient outcomes for entry-level graduate nurses. Currently there is no nursing education research exploring the learning experiences of nursing students using electronic textbooks. The purpose of this study was to explore the perceived learning experiences of associate degree nursing students using electronic textbooks. A qualitative research design using a descriptive survey and focus groups was used to explore the perceived learning experiences of first semester associate degree nursing students using an electronic textbook. Survey findings revealed that students did not perceive electronic textbooks as a useful learning resource. The students&rsquo; perceptions of ease of use were inconclusive. Focus groups reported advantages and disadvantages, adjustments, concerns, and suggestions about using electronic textbooks for learning. Overall, the majority of students preferred a printed textbook for academic learning.</p>

<p> Louisiana&rsquo;s primary care provider (PCP) shortage is becoming increasingly evident and is projected to accelerate over the next decade. A growing body of evidence has linked the shortage of PCPs and decreased access to primary care services as contributing factors to poor health outcomes. Research findings illustrate Nurse Practitioners (NPs) provide safe, quality, and cost-effective care. Use of Louisiana NPs to the fullest extent of their education and training (full practice authority) is a readily available, viable, cost-effective resource and may be one solution to the growing need for PCPs. Use of NPs in this capacity is often impeded by an antiquated legislative mandate, one that requires NPs to enter into a collaborative practice agreement (CPA) with a physician. The complexities of initiating and maintaining such an agreement represent a barrier to full practice authority, which inadvertently decreases access to primary care services. This DNP Synthesis Project resulted in the creation of a white paper comprising evidence-based rationales for the removal of the CPA. A summary of the background and significance of the problem, a proposed solution, the benefits of CPA removal, and a call to action for all stakeholders was addressed. The white paper was presented for organizational adoption to the Board of Directors of the Louisiana Association of Nurse Practitioners (LANP). Upon adoption, the paper was electronically posted to the LANP website to reach a broader audience. Further propagation was accomplished through presentations conducted at various organizational meetings throughout the state. Additionally, the white paper was submitted via electronic communication to Representatives and Senators currently serving on the state&rsquo;s Health and Welfare committee. Finally, the tenants of the white paper were used as the foundation for bill authorship. Two bills were written addressing removal of the CPA and have been dropped, one in the House and one in the Senate, for consideration during the 2016 Louisiana Legislative session. Keywords: Nurse Practitioner, Scope of Practice Barriers, Physician Opposition, Full Practice Authority, Louisiana, Access to Care, Collaborative Practice Agreement, White</p>

<p> The increase in obesity among America&rsquo;s youth has resulted in an increase in the prevalence of prehypertension and hypertension (Becton, Shatat &amp; Flynn, 2012). The Louisiana Department of Health and Hospitals developed guidelines for high blood pressure screening and are mandated for all school-based health centers in the state of Louisiana to help address this issue. Prior to the implementation of this synthesis project, these guidelines had not been implemented at the school-based health center at Northside High School. The purpose of this project was to implement these guidelines into the aforementioned school-based-health center. A process was developed to facilitate guideline implementation of these screening guidelines. This process included educating the school-based health center staff on the screening guidelines and use of each tool that was used in the process. One hundred eighty-four students visited the school-based health center for acute episodic care during the implementation phase of this project. The goal of this project was to screen each of these students according to the Louisiana Department of Health and Hospital guidelines. The implementation of this process resulted in a significant increase in the number of students screened for hypertension according to the screening guidelines, with an increase from less than 1% to 92%. There were four students identified with prehypertension and two with a previous diagnosis of hypertension, each of whom were referred to their primary care physician. The implications of following the screening guidelines are that prehypertension and hypertension can be detected early in adolescents. Early detection and reduction of BP reduces the risk of cardiovascular disease and improves long-term individual health outcomes.</p>

<p> Multiple national authorities recommend breastfeeding, as it provides both maternal and infant health benefits (Johnston &amp; Esposito, 2007). However, the portion of infants in the United States who are ever breastfed has yet to meet the Healthy People 2020 Maternal Infant and Child Health Objectives (Chapman, &amp; Perez-Escamilla, 2012; Healthy People2020, 2015). Many women of childbearing age are returning to work or school in the postpartum period, which contributes to a decrease in breastfeeding initiation and continuation rates (Johnston &amp; Esposito, 2007; Mills, 2009; Seabolt, 2012). Assisting women in removing workplace and school barriers may increase breastfeeding rates and also has the added benefit to employers of increasing the productivity and loyalty and decreasing absenteeism and healthcare costs of their employees of childbearing age (LBC, 2010-2015a). The Patient Protection and Affordable Care Act &sect; 4207 mandates workplaces to provide time and space for the lactating mother to express breast milk (United States Federal Government, 2011).The purpose of this project was to create and implement a campus lactation policy at the University of Louisiana at Lafayette, to set up at least one lactation area at the University, and to attain the Lactation Friendly Workplace Champion designation for the University. Through collaboration with key stakeholders, the project was successfully implemented and the lactation policy was accepted by the university. Three lactation rooms were opened, and the university received the Breastfeeding-Friendly Workplace Champion designation from the Louisiana Breastfeeding Coalition. Evaluations indicated that nursing mothers who used the lactation rooms were satisfied with the lactation support services available and they made recommendations were made for additions to the services, which are being considered at this time. As support from the University and the community continues it is planned for services to be improved and enhanced in the near future.</p>

<p> <b>Background:</b> One of the most pressing global issues in health care settings is patients&rsquo; safety. In an effort to decrease medical errors and improve the quality of patient care, many health care organizations have adopted an electronic medical record (EMR) system. The federal government supported this widespread EMR implementation with multi-billion dollar financial support. However, to date, the lived experience of the nurses transitioning to EMR is not clearly understood. Purpose: The purpose of this study was to explore the lived experience of nurses transitioning to EMR usage. </p><p> <b>Philosophical Underpinnings:</b> This qualitative study followed van Manen&rsquo;s phenomenological perspectives under the naturalistic (constructivist) paradigm with the research question, &ldquo;What is the experience of nurses transitioning to electronic medical records (EMRs) usage?&rdquo; </p><p> <b>Methods:</b> A qualitative phenomenological methodology was used for this study. A purposive sample of 15 nurses who have experienced transitioning to the EMR usage was selected to explore the lived experience of nurses transitioning to electronic medical records (EMR) usage with the overarching question: What is the lived experience of nurses transitioning to EMR usage like? Data collection occurred with in-depth, semi-structured interviews using open-ended questions. Each individual interview was tape-recorded, transcribed verbatim, and member checked. Data analysis was guided by Max van Manen&rsquo;s (1990) phenomenological method, which includes describing, interpreting, textual writing and rewriting. Data analysis resulted in a rich and thoughtful representation and increased understanding of what it is like for nurses transitioning to EMR usage. </p><p> <b>Results:</b> Four core themes <i>Doubting, Struggling, Accomplishing,</i> and <i>Embracing</i> emerged. Three subthemes emerged: <i>Balancing time between computer and patients</i> and <i> Increasing workloads and responsibility,</i> which are subthemes of <i> Struggling,</i> and <i>Leaving human interaction behind,</i> a subtheme of <i>Accomplishing.</i> These themes illuminated the lived experience of 15 nurses transitioning to EMR usage. Thomas Kuhn&rsquo;s (1996) process of scientific inquiry provided a framework to gain a deeper understanding of this phenomenon. </p><p> <b>Conclusions:</b> This study explored the lived experience of nurses transitioning to EMR usage in hospital settings. The results of the inquiry highlighted the essence of participants&rsquo; experience by revealing their doubt about the EMR&rsquo;s functionality, struggle with transitioning and using the new EMR system, accomplishment of successful transition to the EMR system, and finally acceptance of technology in their daily work practice. The findings of this study contributes to the debate about EMR usage in nursing practice to engage nurses to ponder how they provide quality, patient-centered care while using the EMR system to reach the common goal of provision of quality care.</p>

This study explored the time relationship of life change events in young adult patients with minor injuries for which medical attention was sought in an emergency department (ED). Life change events are those occurrences in life which require an alteration in a person's adaptive and coping responses to ease the discomfort associated with the change. Too much change without an increase in adaptation responses may cause loss of control. The manifestation of loss of control under evaluation in this study was the occurrence of a minor injury.