<p>The predicted future operating room nurse and surgical technologist shortages may have significant implications for the healthcare industry. Improving the job satisfaction of operating room personnel could promote retention and provide adequate staffing in operating rooms. The job satisfaction of operating room nurses and surgical technologists can result in positive or negative work environments. The purpose of the qualitative phenomenological study was to explore the perceptions of job satisfaction of operating room nurses and surgical technologists to discover how job satisfaction influences the intent to leave or remain in the work environment of the operating room. A purposive selection was made of 12 registered nurses and 12 surgical technologists who had varying degrees of experience in the healthcare field, and were working part time or full time in the operating room of a pediatric medical center in North, Texas. Interviews were audio-recorded and the seven steps were used from Moustakas van Kaam analysis to reveal themes and patterns from the research data. Six themes emerged from the research study that included teamwork, recognition from surgeon, working with pediatric patients and their families, staff appreciation, work environment, and executive leadership. Based on the findings, further research is needed to ascertain strategies that would improve operating room registered nurses and surgical technologists&rsquo; job satisfaction and retention. </p>

<p> Caring is a complex phenomenon that has been described and linked to several other concepts such as competence, compassion, presence, intention, interconnectedness, detachment, coping, trust, reassurance, empathy, and advocacy. The significance of exploring the patients&rsquo; lived experience of caring can provide a framework for achieving the benchmarks evaluated during a hospitalization by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The higher the scores on the patients surveys provide better the feedback on the HCAHPS, which in turns increases the funding received from Centers for Medicare and Medicaid Services (CMS). The HCAHPS are one measure used to calculate incentive payments with the Value-Based Purchasing program being the other measure. This hermeneutic phenomenological study was to explore the patients&rsquo; lived experience of caring during a minimum of a two night stay in the hospital. Watson&rsquo;s caring theory was the guiding framework of this study to illuminate caring, and building relationships between the nurse and the patient. Fifteen adult patients over eighteen years of age who were hospitalized for a minimum of a two-night stay were interviewed in their private occupancy room. Following the data analysis using Van Kaam&rsquo;s methods and NVivo software, two themes emerged: (1) being helped by someone who demonstrates presence and (2) being helped by someone with competence. Based on data analysis, patients expect their caregivers to demonstrate presence; this involves being available to meet their needs and providing care with competence knowing how to perform the skills and performing with proficiency. </p>

<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> Early public health efforts in the United States addressed social conditions that contributed to poor health, with public health workers playing a role in large scale societal reforms, such as passing housing and sanitation laws, which led to diminishing deaths from infectious diseases. As chronic diseases became leading causes of death, public health research and practice became more focused on individual behaviors, widely thought to be the primary cause of chronic diseases. However, health inequities along the lines of place, race, class, and other forms or marginalization are still prevalent. A substantial body of research illustrates how social, political, economic, and environmental factors affect multiple health outcomes, including chronic diseases, and contribute to health inequities. </p><p> In public health practice, some local health departments (LHDs) and organizations that support their work have called for broader public health interventions that address social policies that contribute to health inequities in addition to providing direct services to individuals. With continued research and support, the approximately 2,800 LHDs nationwide can play a central role in reducing health inequities. However, engaging in this complex work necessitates new approaches, skills, frameworks, and organizational infrastructures for LHDs. The recent foreclosure crisis, which stands to increase racial and health inequities, provides a lens to examine whether and how LHDs can move from a rhetorical commitment to addressing social determinants of health (SDH) into actual public health interventions that reduce health inequities. </p><p> Through this dissertation, I examine LHDs&rsquo; role in the foreclosure crisis through three related papers. My aim is provide insight into how LHDs responded to the deep and fundamental shifts in access to stable and quality housing and wealth created by the foreclosure crisis that disproportionately impacted African-American, Latino, and some Asian/Pacific Islander communities. Through all three papers, I incorporate a focus on challenges and approaches to addressing the racialized causes and outcomes of the foreclosure crisis. My overall aim is to help advance local public health practice within LHDs to more effectively target the causes of health inequities, including gaining a better understanding of LHD approaches and needs related to addressing SDH through local policy. </p><p> In the first paper, <i>A National Survey on Local Health Department Engagement in Addressing the Foreclosure Crisis</i>, I describe the results of a national survey on LHD engagement in the foreclosure crisis, which includes LHD approaches to addressing foreclosure and barriers to engagement. Responses followed a diffusion of innovation pattern, with innovator, early adopter, early majority, late majority, and lagging LHDs. Respondents expressed a high level of interest in adopting innovative approaches to addressing SDH and described a need for models of how other LHDs are preventing or mitigating the impacts of foreclosure, especially through local policies. </p><p> In the second paper, <i>Adopting an Innovative Public Health Practice to Address Foreclosure: A Case Study of Alameda County Public Health Department </i>, and the third paper, <i>Policy Entrepreneurs, Agenda-Setting, and Communication: An Exploration of How a Local Health Department Engaged in Addressing the Foreclosure Crisis</i>, I describe findings from qualitative interviews with current and former ACPHD staff and partners. In the second paper, I identify factors that 1) differentiate ACPHD&rsquo;s innovative approach from traditional LHD activities; and, 2) contributed to ACPHD being an innovator among LHDs. </p><p> Finally, in the third paper, I focus on ACPHD&rsquo;s role as a policy entrepreneur in agenda-setting, including their communication approach. While the second paper focuses on how ACPHD developed into an innovative LHD in the area of local housing policy, the 3rd paper focuses on how in this role, ACPHD interacted in the local policymaking process. This case study also examines how the role of policy entrepreneur can be shared across two organizations (ACPHD and Causa Justa::Just Cause) and provides another way to conceive of entrepreneurism.</p>

<p> Pneumoconiosis is a chronic and slowly progressive parenchymal lung disease. Estimates suggest that about 68,000 ex-miners in Botswana will develop or have already developed pneumoconiosis. However, most of these cases do not know they have the disease because of the poor quality of care in primary healthcare settings and weak implementation of the Occupational Diseases in the Mines and Works (ODMW) Act. </p><p> This dissertation was a health service research framed from the systems approach using the chronic care model as a theoretical tool. The study employed a concurrent, convergent parallel mixed method research which combined quantitative and qualitative methods of inquiry. The quantitative arm of the study evaluated whether the Botswana primary care settings meet &lsquo;reasonably good standards&rsquo; of the pneumoconiosis quality of care measured on the chronic care model. The chronic care model measures quality of care on a 0 to 11 scale, where &ldquo;0&rdquo; denotes lack of quality care and &ldquo;11&rdquo; stands for optimal quality of care. Reasonably good quality of care comprises scores between 6 and 8 on the scale. The qualitative arm of the study assessed the implementation of the ODMW Act in the Botswana primary healthcare settings. The study mixed quantitative and qualitative results at the interpretation stage to determine the extent to which quality of care for pneumoconiosis and the ODMW Act implementation promote equitable access to pneumoconiosis services among ex-miners in Botswana. (Abstract shortened by ProQuest.) </p>

<p>Touch 3D Bionics is a start-up prostheses company that will use additive manufacturing methods to produce prosthetic limbs. The company will provide patients with affordable, sustainable, customized, and durable 3D printed robotic prosthetics. Additive manufacturing usage can offer several benefits, such as personalized and modified medical devices and products, lower cost, improved throughput, and improved teamwork. </p><p> Furthermore, there are, approximately, 2 million amputees living in the United States. Therefore, the target market of the company will be state-approved hospitals all around California. The company will contract with hospitals in California and provide hospitals&rsquo; patients with more affordable options of prosthetic limbs. Engineers will use plaster impression of limbs, reverse engineer the impression to form a 3D model of the limb and, eventually, print the limb using additive manufacturing methods. Due to very small market competition, the company seeks to make significant profit from the new additive manufacturing techniques. </p>

<p> Health care organizations typically have a hierarchical structure, with physicians dominant and nurses subordinate. The challenge to open and honest communication between doctors and nurses is real, and communication errors contribute significantly to undesirable patient outcomes. Nurse executives (NEs) have a responsibility to help lead transformation of health care organizations to support nurses to speak up and communicate all critical information.</p><p> NEs are challenged to improve safety and quality, decrease costs and increase access to care. Combining health care expertise with business ability can support these goals. Rooke and Torbert found correlations between successful business leaders and postconventional action-logics, or world-views. Action-logics can be developed to make leaders increasingly effective.</p><p> The Magnet Recognition Program recognizes health care organizations that have achieved high quality care and excellence in nursing practice. The purpose of this study was to determine what action-logics the NEs demonstrate who have led their organizations to Magnet designation or re-designation in the Veterans Healthcare Administration. The study also sought to determine what actions NEs took to support nurses speaking up about their concerns, the barriers that impede those efforts, and the sources of influence these NEs implemented to support nurses speaking up. This exploratory study used a mixed methods design and each participant completed the Maturity Assessment Instrument (MAP) and an interview.</p><p> The study demonstrated, in contrast with other business leaders, that conventional action-logic was sufficient for the NE to bring an organization to Magnet status. However, the study found specific limitations those possessing conventional action-logic have to support speaking up, and that those possessing postconventional action-logic have transcended these limitations. This strength of the postconventional action-logic is very important to support speaking up in health care. The use of multiple sources of behavioral influence by Magnet NEs was confirmed, as was the existence of a culture of organizational silence. Multiple speaking up behaviors were required to address every single barrier encountered to speaking up, and strong emotion routinely accompanied speaking up. The absence of sources of behavioral influence in an organization was determined to be a barrier to speaking up.</p>

<p> Background</p><p> Approximately half of adults in the U.S. fit the criteria for use of anti-obesity pharmacotherapy, but only 2% of those receive such treatment. This is in sharp contrast to the 8.4% of adults diagnosed with diabetes, with 86% of those receiving anti-diabetes pharmacotherapy. In 2012-2014, the first medications in 13 years were FDA approved for long-term management of obesity. In 2013-2014, the newest class of anti-diabetes pharmacotherapy, subtype 2 sodium-glucose transport protein inhibitors (SGLT2s), were FDA approved.</p><p> Methods</p><p> A retrospective analysis of extracted data from the IMS Health National Prescription Audit&trade; and Xponent&trade; assessed adoption rates of anti-obesity pharmacotherapies and SGLT2s using univariate linear regressions. Volumes of new and continuing prescriptions were compared using ratio analyses. Prescriber groups were compared by descriptive proportions according to prescription volumes, medical specialty, geographic region, and prescriber-drug overlap. </p><p> Results</p><p> The entire anti-diabetes market was 15 times the entire anti-obesity market. The anti-obesity market share was: 74.0% phentermine and 18.6% new anti-obesity pharmacotherapies. The mean increase in prescriptions per month were: 25,259 for SGLT2s (95% CI 23,133-27,383 p&lt;.0001), 5,154 for new anti-obesity pharmacotherapies (95% CI 4,800-5,507 p&lt;.0001), and 2,718 for phentermine (95% CI 1,345-4,089 p=0.0003). Medical specialties prescribing the majority of the analysis medications were Family Medicine/General Practice and Internal Medicine. Endocrinology had the highest prevalence of prescribers of any sub-specialty.</p><p> Conclusions</p><p> The adoption rate of SGLT2s was nearly exponential, while the adoption rate of new anti-obesity pharmacotherapies was linear. Considering the relative prevalence of obesity to diabetes and that obesity is a major cause of diabetes, these results are paradoxical and suggest biases against the prescribing of anti-obesity pharmacotherapies. The under-prescribing of anti-obesity pharmacotherapies is widely acknowledged, but this is the first prescription data to demonstrate its extent in the U.S.</p>

<p>Federal healthcare reform has been a major driver for the widespread shift towards high-quality, value-based care at healthcare organizations in the United States. With increased emphasis on quality and value in healthcare, process and performance improvement have been identified and capitalized upon as methods by which to achieve higher quality clinical outcomes, increase patient safety and satisfaction and improve care coordination. For past several decades, lean management and related doctrines and principles have been widely adopted among healthcare organizations in the United States for process and performance improvement purposes. This business plan proposes a lean management consulting firm for healthcare organizations of all sizes and delivery models in the Greater Los Angeles area with a mission to deliver state-of-the-art lean education and training to management and staff of all backgrounds and roles. The aim of the proposed firm is to train, develop and empower its clients to ensure continuous quality improvement and eventually become one of the biggest lean consulting players in the market. </p>

<p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>