<p> There exists a blatant need in the Gateway City region of Los Angeles County to serve the Hispanic population in their caregiving needs. In serving a prominently Hispanic population, La Paz Home Care Agency will be distinctive as it will present specialty, expertise, and cultural sensitivity to clients&rsquo; home health and caregiving needs. As with national trends, there exists a growing demand for home health providers in the Los Angeles County and Orange County metropolitan region. Home health care services allow a person with special needs stay in their home as they are getting older, are chronically ill, recovering from surgery, or are disabled. Laz Paz Home Health Agency will meet the growing demand for caregiver services by providing services like bathing, dressing, meal preparation, assistance with self-care such as grooming, using the toilet, assisting with ambulation, transfer, light housekeeping, laundry, errands, medication reminders, escorting to appointments, hobby engagement, and supervision for someone with dementia or Alzheimer&rsquo;s disease. In this business plan a detailed account of La Paz Home Care&rsquo;s competitive environment, aims, and operations will be covered in detail.</p><p>

<p> While adolescent endurance runners are at risk for energy deficiency, limited studies have evaluated the effect of a nutrition education intervention. We evaluated the effect of a 4-week nutrition curriculum on adolescent cross-country runners&rsquo; nutrition knowledge, dietary behaviors, and self-efficacy to optimize intake of nutrient-dense carbohydrate foods, using a quasi-experimental, pretest-posttest design. Runners (<i>n</i> = 45; <i>n</i> = 26 F, <i>n</i> = 19 M; age 15.7 &plusmn; 0.2y) attended 4 weekly 30 to 60-minute lessons. Baseline body weight and composition were measured using bioelectrical impedance analysis. Paired samples t-tests measured difference in nutrition knowledge and self-efficacy scores, before and after each lesson. Mean nutrition knowledge scores significantly increased from pre- to post-test for lessons 1 and 2 (<i>p</i> &lt; .001). Mean self-efficacy scores significantly improved pre- to post-test for all lessons (<i>p</i> &lt; .001). Findings suggest a benefit of the curriculum to increase nutrition knowledge, self-efficacy, and support dietary behaviors promoting increase in nutrient-dense carbohydrate intake among adolescent runners.</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>

nÃo hà / A Visita DomiciliÃria (VD) à um cenÃrio que permite tornar evidentes as relaÃÃes sociais, que podem fortalecer o potencial de saÃde na famÃlia. No entanto, essas mesmas relaÃÃes podem contribuir no processo de adoecimento dos indivÃduos, incluindo os adolescentes. Com base no entendimento de seu papel como integrante da EstratÃgia SaÃde da FamÃlia (ESF), os trabalhadores de uma Unidade de SaÃde, localizada na Regional VI em Fortaleza/CE, vÃm desenvolvendo diversas atividades educativas com grupos heterogÃneos de usuÃrios. PorÃm, observou-se uma inquietaÃÃo por parte destes profissionais devido à baixa adesÃo dos adolescentes aos processos coletivos de construÃÃo do saber, alÃm da falta de empoderamento para cuidarem de si mesmos. A partir deste contexto o objetivo do estudo à compreender a atividade de atenÃÃo à saÃde do adolescente durante a VD na perspectiva do profissional da ESF com enfoque na EducaÃÃo em SaÃde. Os objetivos especÃficos foram: conhecer a realidade da atenÃÃo à saÃde do adolescente no contexto da visita domiciliÃria e identificar possÃveis dificuldades e facilidades que possam existir na atenÃÃo ao adolescente durante a VD. Trata-se de um estudo exploratÃrio-descritivo de abordagem qualitativa, realizado em agosto a dezembro de 2013. Os instrumentos de coleta foram: entrevista semiestruturada com os profissionais da equipe, lista de observaÃÃo utilizada durante a VD e diÃrio de campo. Os agentes sociais da pesquisa foram 19 profissionais da ESF (12 Agentes ComunitÃrios de SaÃde (ACS), 1 tÃcnica de Enfermagem, 1 CirurgiÃ-Dentista, 3 Enfermeiras, 2 MÃdicos). A anÃlise dos dados foi realizada mediante percurso analÃtico e sistemÃtico. Resultados: sobre o perfil dos trabalhadores, os ACS foram os mais contemplados com curso de capacitaÃÃo voltado para o adolescente. Mesmo entre esses profissionais, ficou clara a dificuldade que as equipes tÃm em lidar com essa fase do ciclo vital. Os entrevistados, de forma livre, relataram que se sentem co-responsÃveis por nÃo priorizar a atenÃÃo aos adolescentes e que, em parte, isso, se deve à falta de capacitaÃÃo durante sua formaÃÃo acadÃmica e profissional. Quando se perguntou sobre a EducaÃÃo em saÃde voltada para o adolescente a escola foi citada como ambiente mais propÃcio para se realizar aÃÃes de educaÃÃo em saÃde. Alguns entrevistados comentaram que a promoÃÃo da saÃde por meio da visita domiciliÃria à um grande desafio em qualquer fase do ciclo vital relacionado principalmente a violÃncia. A proximidade com o adolescente, que a visita domiciliÃria oportuniza, numa perspectiva que valorize suas experiÃncias, anseios e diferentes saberes articulados aos saberes dos profissionais da saÃde e da educaÃÃo, torna o setor educaÃÃo, alÃm de importante na interface com a saÃde, um potencial parceiro, na construÃÃo de ideias e prÃticas interligadas e efetivas. Considera-se que as visitas domiciliÃrias realizadas pela equipe de saÃde ao adolescente podem ser uma alternativa de espaÃo que deve ser valorizada para a implementaÃÃo de estratÃgias educativas adequadas à realidade da comunidade, bem como fortalecer o vÃnculo junto a esta populaÃÃo a fim de acessarem mais os serviÃos de saÃde. A relevÃncia do estudo, a partir dessa realidade, encontra-se no fortalecimento da relaÃÃo entre usuÃrio do SUS e equipe multiprofissional sob uma Ãtica educativa, realizada por meio da VD, a qual tem possibilidade de ser direcionada alÃm do cuidado aos usuÃrios acamados, mas principalmente como espaÃo para realizaÃÃo de atividades de EducaÃÃo em SaÃde envolvendo o cenÃrio familiar.

In this thesis, I focus on Southern African peer educators' experiences in facilitating HIV/AIDS education activities within the Kicking AIDS Out network. By utilizing Foucault's (1975) conception of "subjugated knowledges," I work towards four main objectives. In chapter one, I aim to surface a sample of young people's subjugated knowledges pertaining to the "lack of evidence" discourse of sport for development. In chapter two, my objective was to understand better what tools peer educators need to be more effective in their HIV/AIDS education efforts in a sport environment. Chapter three suggests steps to encourage knowledge exchange on sport for development across geographical and cultural boundaries to further national HIV/AIDS education and health goals with Aboriginal communities. I meet my fourth objective, to provide recommendations to the Kicking AIDS Out network regarding the training and support needs of peer educators in a field report, which is not contained in this thesis.

<p> In 2004, the Institute of Medicine (IOM) called for academic health centers (AHCs) to adapt and change through collaboration between their many separate groups of healthcare professionals. Research on collaboration in healthcare organizations to date has concentrated on how collaboration impacts patient care and organizational efficiency. Research has not focused on whether collaboration among healthcare professionals, influences learning for individuals or the organization. Socio-cultural learning theory, which takes into account the individual, the organization and the larger system, emphasizes that &ldquo;collaborative learning&rdquo; is an important component of the learning process. It also emphasizes that problem solving facilitates the development of insights and solutions. On this basis, the link between collaboration and learning needs to be explored. This research focused on exploring the association between collaboration and learning as perceived by clinician educators and other healthcare professionals with whom they have collaborated in AHCs. In-depth interviews were conducted with 21 healthcare professionals who had participated in collaborative activities in the past 18 months, and who had familiarity with relational coordination (RC) as a framework for collaboration. Interview questions elicited interviewee descriptions of positive and challenging collaboration experiences. Data were analyzed using an inductive analysis approach and coded to identify implicit and explicit learning outcomes from those experiences. Findings indicated that all participants had extensive experience of informal collaboration with professional colleagues and learning resulting from their collaboration experiences. Four categories of learning outcomes were identified; process and quality improvement, professional relationships with colleagues, emotional awareness, and growth in technical and adaptive knowledge and skills. The majority of learning outcomes in each of the four categories were implicit, indicating that participants did not recognize the learning that was occurring through their participation in collaborative activities. Learning appears as a currently invisible outcome of collaboration as described by the participants in this study. Further research is needed to determine the potential value of the learning for the individual and the institution.</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> Asthma is an inflammatory disorder (Koterba &amp; Saltoun, 2012) and a common chronic condition of childhood (McCowan, Bryce, Neville, Crombie, &amp; Clark, 1996) that can cause children to experience poorer academic outcomes (Stingone &amp; Claudio, 2006), a lower quality of life (Everhart &amp; Fiese, 2009), hospitalizations, and in some cases death (Center for Disease Control, [CDC], 2017). This mixed methods study explored the relationship of asthma, school attendance, grades in mathematics and reading, and the quality of life in predominantly minority children with asthma and in those without asthma. Data for this study was collected at the Children&rsquo;s National Health Systems (CNHS) in the District of Columbia. A total of 36 children without asthma and 30 children with asthma enrolled in the study at the hospital&rsquo;s Emergency Department (ED) and the Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) clinic. The children were in grades three to five, 8 to 11 years old, and attended schools in the District of Columbia Public Schools (DCPS) during the 2015&ndash;2016 school year. Descriptive statistics, t-tests, ANCOVA, ANOVA, Spearman ranked order correlations, and hierarchical multiple linear regression were used to analyze the data. </p><p> The quantitative analysis indicated children with asthma visited the ED significantly more frequently than those without asthma (<i>p</i> &lt; .001, <i>d</i>= 0.8). The quality of life scores were lower for children with asthma compared to those without asthma. Further, as asthma severity increased, the quality of life scores decreased. In addition, children without asthma reported more unexcused days and absence from school than those with asthma. Lastly, children without asthma achieved a lower GPA in mathematics and reading than those with asthma. The findings indicate asthma impacts the quality of life scores in children, and that further research is warranted to determine how asthma impacts academic performance in children. </p><p>

<p> Healthcare spending in the United States has reached an all-time high in recent years, with an estimated $3.2 trillion spent, without any significant impact on patient outcomes because of this excessive spending. Whether the excess be attributed to over-utilization, fee-for-service payment methodology or medical errors, there is an immediate need to mitigate these issues and greatly reduce healthcare costs. </p><p> Epic Systems Corporation has developed a widely-adopted health management software that provides functionality to accomplish such goals. It applies a fully-integrated methodology to all of its different applications that support different healthcare business and clinical functions. Epic is a leader in the health management software industry. </p><p> ALLTAP Solutions, LLC provides high quality, efficient custom solutions to its clients, by applying healthcare industry expertise and Epic technical knowledge to increase efficiency and reduce costs. The market analysis that is to be presented will provide an overview of the target market, key players, the demand for these services and growth potential.</p><p>