<p> The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner&rsquo;s novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.</p><p>

<p> Access to safe abortion care has been linked to better maternal and child health outcomes (Sedgh et al., 2012) and identified as essential for advancing women&rsquo;s economic and social equality (Lang, 2013; Bengsch, 2015). Around the world, nurses, including nurse practitioners (NPs) and certified nurse midwives (CNMs), are integral members of the health care teams that provide care to women considering or electing to have an abortion. Evidence supports NPs and CNMs as safe and effective providers of comprehensive early abortion care, and acceptable to patients (Barnard, Kim, Park, &amp; Ngo, 2015; Kallner et al., 2015; Weitz et al., 2013). </p><p> Currently in the United States (US), almost one million women have an induced abortion each year (Jones &amp; Jerman, 2017). National abortion data reveal significant disparities in rates, and inequities in access (Jerman, Jones, &amp; Onda, 2016). An inconsistent legal and regulatory landscape precludes NPs and CNMs from providing comprehensive abortion care in many states, including some where there are few providers. Vermont and New Hampshire comprise two of the four states where laws and practice regulations allow NPs and CNMs to perform aspiration abortion, and across New England. These advanced practice nurses (APRNs) are extensively involved in providing and managing the care of women undergoing medication abortion. </p><p> Little literature describes nurses&rsquo; experiences providing comprehensive early abortion care around the world, including in the US. The aim of this qualitative, exploratory, descriptive research study was to explore the experiences of NPs and CNMs who provide comprehensive early abortion care in New England. Data were collected through in-person individual interviews with seven NPs and one NP/CNM. Providing comprehensive early abortion care was generally a positive experience for most participants, though it did include challenges. Critical influences to becoming an NP or CNM who provided comprehensive early abortion care included the era in which participants came of age, values of their family of origin, exposure to feminism, reproductive rights and social justice during emerging adulthood, having a role model or mentor, and a personal experience of having an abortion were. Support at every level from interpersonal to societal was found to be a key enabling or constraining factor. Laws and regulations at the societal level were also noted to facilitate or impede abortion care provision by NPs and CNMs in the study. Finally, participants offered words of wisdom to others considering providing comprehensive early abortion care that ranged from clinical pearls to inspirational statements. They were universally encouraging in recommending this as a service to incorporate into clinical practice. This study has a number of implications for the future including the need for further research on NPs and CNMs experiences providing early abortion care in other regions of the US, and to remove state legislative and regulations that constrain practice for clinicians in this area of reproductive health care.</p><p>

<p> Better Health is an organization focused on improving patient care and healthcare outcomes through health care quality improvement methods to provide better services at lower cost. With the average cost of a surgical site infection(SSI) estimated at around $34,400 and the average of 1 in 25 patients in a US acute care hospital having a healthcare-associated infection (HAI), improving patient safety and reducing costs are paramount. This business plan will detail reasons for the need for these services, and will do this by working alongside departments in hospitals to help them reduce their rates of HAI&rsquo;s and improve their care processes through retraining and education. With improvements such as these, hospitals can not only reduce their costs and increase their profits, but also play a part in reducing the financial burden the American healthcare system is currently under.</p><p>

<p> Healthcare management is an industry where skill sets are incremental, and Registered Nurses (RNs) must gain their clinical skills before they develop their management skills. Professional training for management-bound RNs seldom comprises more than a few disjointed days or weeklong development seminars, which is valuable but inadequate. The purpose of this original basic qualitative study, which employed Husserl and Heidegger&rsquo;s approach of phenomenology, was to explore the lived experiences of staff RNs who transitioned into the Clinical Nursing Supervisor (Nurse Manager) role within a small rural community hospital in North Carolina. Semi-structured interviews using open-ended questions were utilized to collect rich, contextual data until data saturation occurred. Open and axial coding of the data, documented in a code/theme frequency table, facilitated the discovery of central themes within the data including: a lack of orientation to the new role; inconsistent expectations of the new role; the benefits of a formal program or structured orientation for the new role, and a need to focus the hospital administration on formal leadership orientation and succession planning. The evidence from this original basic qualitative study aligns with the published literature regarding the transition from a staff RN role into a nursing leadership role and supports making a proposal to the hospital&rsquo;s administration for a systems-oriented Clinical Nursing Supervisor training opportunity such as a 90-day nursing leadership orientation that included formal classes on budgeting, common human resource management issues, and how to evaluate staff. This formalized training, in concert with one-on-one mentoring with experienced Clinical Nursing Supervisors, would ensure a smoother transition from the staff RN role into a Clinical Nursing Supervisor role and would produce more efficient, more satisfied nursing leadership professionals who are more inclined to stay with the organization that helped their career growth.</p><p>

<p> This dissertation is based on the study of the spirituality of caretakers, mainly physicians and nurses, with regard to its effect on the care of terminally ill patients. Terminally ill patients, in addition to physical symptoms, have many spiritual issues in their final days of life. While historically spiritual care has been available for many centuries it is becoming more and more neglected with the advancement of science and technology. These advances, however, do not significantly alleviate patient suffering related to psychological, spiritual, and social aspects. Now there is a renewed interest in the area of spirituality and people have again become aware of the importance of caring for the dying patients and their families. Numerous studies over the last two decades support the therapeutic effect of spiritual care, but these studies concentrate more on the perspective of the patient and the family members. </p><p> The literature search is based on the historical development of spirituality in various parts of the world. This approach gives a broader perspective on spirituality that goes beyond the limitations of religion and culture. Spirituality is further explored in terms of psychological, philosophical, and sociological contexts. The psychological areas focus on existential themes. The review also incorporates other psychological aspects such as psychodynamic, humanistic, imaginal, and transpersonal principles. Additional areas of the review emphasize and examine the importance of spiritual care relating to elderly patients. </p><p> The current dissertation is based on patients in a cancer hospital who were admitted to the intensive care unit (ICU). The spirituality of caretakers was evaluated by interviews, surveys, and case studies. The evaluation was mainly carried out on experienced physicians in an academic setting and on those involved in the care of the patients in the ICU. The results show that spirituality of caretakers has a beneficial effect on the spiritual care provided to the patients.</p><p>

<p> Radiation oncology has evolved as an advanced tool in treating chronic diseases from a mere experimental application of X-rays. These advances were made possible due to combined efforts of physicians, clinicians and information technology professionals. The Radiation Oncologist depends on clinical and information technology disciplines to solve complex health conditions. This creates demand for consulting work for information technology professionals who can design, customize and deploy software applications that are used in radiation oncology departments at hospitals. Hri-Tech Consultants, LLC a consulting firm, intends to offer consulting services to medium sized hospitals in Orange County area in design, development and deployment of radiation oncology software applications. The firm&rsquo;s unique strength in Radiation Oncology workflow coupled with Lean Six Sigma and ITIL processes will be rarely matched by other providers in the target market.</p><p>

<p> With advances in technology and science, life expectancy is increasing, but most of the elders must take care of themselves or live in assisted home. Between 2015 and 2060, the U.S. Census Bureau predicts that the population adult aged 65 to 84 will grow to 89%; meanwhile, the number of adult 85 and older are expected to more than triple and about 11 million people age sixty-five and older are predicted to live alone, which is almost a third of the American population. They may have problems to receive essential medications because they are unable to drive or do not have access to public transportations. The FlyMed Pharmacy will assist the elderly by providing home delivery services such as emergency or maintenance medications. Consultations and advice will be provided through a mobile app, DeliverMyMed.</p><p>

<p> Abstract Emergency medical services (EMS) for nonemergent or low-acuity calls is a new normal. EMS agencies spend a majority of time providing primary care services through the 911 system. They are utilized currently to fill the primary care gap subconsciously. The EMS system is activated as a patient navigator for primary care services. EMS agencies in the state where the research occurred have responded to the gap in care management by creating innovative programs such as community health emergency medical services (CHEMS). Creation of CHEMS programs have become one of the most monumental concepts for change in the field on both a state and national level. EMS has sought ways to meet the goals of the Triple Aim by exploring CHEMS as the state transitions to value-based care. Leaders are searching for innovative ways to close the gap in the primary health care system through a patient-centered medical home (PCMH) model. The action research study stimulated innovative thinking to support coordinated care across the evolving continuum of the health care system. The study captured the current awareness from community health care leaders who have had a recent opportunity to explore the idea of integrating EMS into the PCMH model through semi-structured interview sessions. Major findings in the thematical analysis discovered the current way both EMS and a PCMH function in a silo system that could potentially utilize each other to effectively provide managed care. Joint efforts could offset overutilization of EMS services for calls that have no apparent life threats. EMS would allow for a PCMH to conform to the Patient Protection and Affordable Care Act standards of care management, contributing to the integration of Triple Aim objectives. Collaboratively, EMS and an established PCMH will impact the delivery of preventative, quality and cost-efficient care. The theory of organizational culture change is based on three common characteristics: culture is shared, is intangible, and affects human behavior. The conceptual framework of the research study was based on the chronic care model. Patients with comorbidities potentially utilize the health care system more than a healthy patient to seek reassurance that their health is managed.</p><p>

<p> Considering the expanding populace of elderly in the United States of America, there has been a significant growth in demand for home healthcare organizations which serve to deliver continuous quality care. Home healthcare organizations guarantee to support our economy and decrease healthcare costs to a huge level. This marketable business plan inspects the business capability of a home healthcare services startup located in San Diego Downtown. </p><p> This business plan has been broken down into several compartments where chapter 1 accounts on the market analysis of our business providing marketing strategies and intricate details of our company and its analysis, services provided, services in demand, customer and competitor analysis, marketing potential and demand. Chapter 2 deals with feasibility and SWOT analysis, to evaluate pros and cons, and to get a better idea of the organizational structure of the business plan. In Chapter 3, we talk about the legal aspects concerning State and Federal laws. Chapter 4 explains about the financial assumptions and analysis, annual expenditures as well as monthly expenses with the overall potential of home healthcare services to survive market competition. </p><p> We conclude that WeCare home healthcare services plan showed great potential to withstand the competitive market and drive towards success.</p>

<p> In the state of California, about one in six adults suffer from some sort of mental illness and about one in twenty of those suffer from a serious mental illness (SMI). In the County of Los Angeles, about 4.5% of the county&rsquo;s roughly 9.8 million residents suffer from a serious mental illness. Through most of history, mental health care and primary health care have represented two independent systems. The two independent systems have resulted in a double standard of quality of care, accessibility of care, and social stigmas of care. The disconnect leaves mental health care inferior to physical care, where mental illnesses are easily overlooked carrying negative social stigmas with little access. MindLink Coordinators, LLC, a not-for-profit mental health care coordinating organization, looks to bridge a major gap between mental health care and primary health care through care coordination and technology. In conjunction with care coordination, MindLink will provide various services for patients with mental illnesses. MindLink&rsquo;s purpose will start with serving the Los Angeles County area with the hope of eventually serving patients throughout the state of California.</p>