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The nurse navigator role developed in the 1990s to support African American female oncology patients' access to services. Successful in oncology, the role has expanded to support patients with diabetes, heart failure, and chronic obstructive pulmonary disease. A unique cost-effective opportunity exists for nurse navigators to fill the gap in transitional care, between the acute care setting and home, for chronically ill and other at-risk patients who are often readmitted within 30 days for treatment of the same disease. The purpose of the project was to refine the job description of the nurse navigators in a Midwestern acute care hospital. The Rosswurm and Larrabee model for evidence-based practice change supported the work. The key research question involved identifying the tasks, knowledge areas, and skills necessary for inclusion in a hospital-wide nurse navigator job description, to promote best outcomes for chronically ill and at-risk patients. Using the Oncology Nurse Navigator Role Delineation Study as the starting point, the project applied a qualitative design in reviewing the 13 nurse navigator job descriptions. The percent of nurse navigator job descriptions containing the job expectations from the delineation study was calculated and additional expectations were identified from the hospital job descriptions and the literature to create a new standardized job description containing 3 categories of job expectations: tasks, knowledge areas, and skills. Positive social change may result from nurse navigator role clarity in the hospital by decreasing service duplication, improving care collaboration, and ensuring role accountability.

Following implementation of the Patient Protection and Affordable Care Act, hospitals have seen a reduction in Medicare reimbursement for 30-day post-discharge readmissions of acute myocardial infarction patient. The purpose of this project was to develop a plan for a navigator program to improve a patient's health status post discharge and reduce readmission rates. The Johns Hopkins nursing evidence-based practice model and guidelines were used in determining the quality of obtained experimental and non-experimental studies with or without meta-analysis and popular source articles. The literature revealed the most successful programs involved providing best practices for a navigator program allowed better patient education, discharge planning, safety and quality of care, improved communication and post-discharge follow-up, and improved facility finances to achieve positive results for the patient and the hospital. Watson's caring theory was used as the theoretical framework since it incorporated the aspect of caring to create a good working nurse-patient relationship. A navigator program training module, job description, objectives, program forms, mission and goal statements, and a health care team were developed and seen as crucial to the success of the program and its evaluation process. Using navigator practices, based on evidence, formed the infrastructure and management process for the facility and health care providers, thereby increasing the quality of patient care. The resulting social change was positive, benefiting the patient, family, the organization, and the region served. With implementation, this project was anticipated to reduce 30-day readmissions and increased facility reimbursement.

Poorly executed transitions between health care settings can lead to poor outcomes and greater use of health care resources for older adults. Older adults with complex needs often receive care from many health care providers in multiple care settings, and face greater risk of experiencing fragmented care. System navigation roles have been suggested as an innovative strategy to address these challenges, yet there is a lack of consensus on the desired characteristics and effectiveness of the role. The goal of this research is to develop a framework for a system navigation role to enhance coordination of formal and community-based services to older persons with chronic disease through health care transitions. This research gathered information from multiple perspectives and a variety of data sources, including a systematic literature review, focus group interviews and in-depth interviews with a variety of health care consumers and providers. A critical analysis of collected data, using a frame derived from content analysis, sought to understand how older adults navigate the health care system, and subsequently to explore the potential of a “system navigator” role to facilitate successful transitions across care settings. Finally, following a grounded theory approach, a model was empirically derived to reflect what role system navigators may have on the experience of older adults navigating the health care system in Waterloo Wellington. This research study aimed to describe optimal care coordination practices across the continuum of care for complex, high-risk individuals, such as those with chronic disease or hip fracture. Ultimately, this study may lead to improved patient care coordination, safety and satisfaction during transitions and in accessing community services, which may assist patients to achieve a higher quality of life.

Due to the delving range of shipping market is virtually contain entire economy of all developed & developing countries, this research merely picks out the ship owner how to spread their fleet and achieve economics of scale. This study was verified and analyzed by following documents, and secondary data: 1. The flows of shipbuilding. 2. The improvement of manufacture procedure. 3. The attentive matters from new ship order. 4. How to utilize resources, to create strategies for accelerating fleet expansion. The conclusion of the said investigation expressed following management prospect. 1. Integrate ship working process and adopt destructive innovation working way which are the key performance of shipbuilders¡¦ competence. 2. The navigator is established from developing countries, which assisted by joint operation and merge, to enlarge fleet in duly time. That strengthens their competence. 3. The shipping company exerts their facility, promote achievement, and product new core competence.

More people are likely to be diagnosed with cancer and the number of people living with cancer is expected to increase, which means that patients live longer with cancer and different treatments. All patients in Sweden should have access to a nurse navigator to facilitate the cancer trajectory. The purpose of this literature review was to delineate patients' experiences of the care given by the nurse navigator. The result is based upon twelve scientific articles included in this review. The results show that the experiences of the patients can be divided into four different categories: emotional support- being present and offering supportive talks, support for physical symptoms- counseling and relief from symptoms due to illness and treatments, educational support- receiving information and knowledge about the disease and cancer trajectory and coordination support- collaboration with other healthcare professionals involved in patients´care. The result shows that the experiences of the patients were mainly positive and they received the care that was the aim of introducing nurse navigators in Sweden. It is important to continue doing research of the care given by the nurse navigator to ensure that patients with cancer are receiving evidenced based care. / Antalet människor som drabbas av cancer och som lever med cancer förväntas öka, vilket innebär att patienter lever längre med cancersjukdom och olika behandlingar. Alla patienter med cancer skall i Sverige ha tillgång till en kontaktsjuksköterska för att underlätta för patienten genom vårdprocessen. Syftet med litteraturstudien var att beskriva patienters erfarenheter av kontaktsjuksköterskans omvårdnad inom cancervården. Tolv vetenskapliga artiklar inkluderades och ligger till grund för resultatet. Resultatet visade att patienternas erfarenheter av kontaktsjuksköterskans omvårdnad kunde delas in i fyra kategorier: emotionellt stöd - att finnas till hands och ge stödjande samtal, stöd vid fysiska besvär- råd och lindring av symptom på grund av sjukdom och behandling, kunskapsstöd - information och utbildning om sjukdom och vårdprocessen och samordningsstöd - samarbete med andra vårdgivare delaktiga i patientens vård. Resultatet visade att patienternas erfarenheter av kontaktsjuksköterskans omvårdnad i huvudsak var positiva och att de fick den omvårdnad som var syftet med införandet av kontaktsjuksköterskefunktionen i Sverige. Fortsatt forskning om kontaktsjuksköterskans omvårdnad inom cancervården ses som betydelsefullt för att säkerställa att evidensbaserad omvårdnad erbjuds patienter med cancersjukdom.

Poorly executed transitions between health care settings can lead to poor outcomes and greater use of health care resources for older adults. Older adults with complex needs often receive care from many health care providers in multiple care settings, and face greater risk of experiencing fragmented care. System navigation roles have been suggested as an innovative strategy to address these challenges, yet there is a lack of consensus on the desired characteristics and effectiveness of the role. The goal of this research is to develop a framework for a system navigation role to enhance coordination of formal and community-based services to older persons with chronic disease through health care transitions. This research gathered information from multiple perspectives and a variety of data sources, including a systematic literature review, focus group interviews and in-depth interviews with a variety of health care consumers and providers. A critical analysis of collected data, using a frame derived from content analysis, sought to understand how older adults navigate the health care system, and subsequently to explore the potential of a “system navigator” role to facilitate successful transitions across care settings. Finally, following a grounded theory approach, a model was empirically derived to reflect what role system navigators may have on the experience of older adults navigating the health care system in Waterloo Wellington. This research study aimed to describe optimal care coordination practices across the continuum of care for complex, high-risk individuals, such as those with chronic disease or hip fracture. Ultimately, this study may lead to improved patient care coordination, safety and satisfaction during transitions and in accessing community services, which may assist patients to achieve a higher quality of life.

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abstract: Nursing school can be challenging for undergraduate students, largely because they do not know what to expect in terms of the demands of the rigorous academic program. Students who enter the program with unrealistic expectations of the demands, such as underestimated time needed for studying for exams or preparing for clinical and class time, as well as the emotional toll of time away from family and friends are often challenged with being adequately prepared for the day-to-day experience of nursing school. Once students have been in the program a few semesters, they begin to get the flow of the expectation as well as an understanding of how to manage their time. Unfortunately, if their adjustment period is not quick enough, they can academically or voluntarily withdraw due to the pressures of the demanding curriculum. In order to combat this phenomenon and give students a perspective that can assist them in their adjustment period, a Student Navigator Program (SNP) was implemented at a local community college. Data was collected from experimental and control groups using a mixed methods research design - comparing final grade percentage, performance on a standardized exam, and use of support services. The quantitative data suggest there is no statistical significance in participation in the SNP with the exception of a few select cohorts. The qualitative data suggest the SNP program is helpful at the beginning of the first semester of nursing school. Taken together, the data suggest the SNP can be helpful in the beginning of the semester for willing participants to assist with managing the unknown. Data from this study guides nursing programs as they aim to retain current nursing students through the first semester and progress through the program. / Dissertation/Thesis / Doctoral Dissertation Educational Leadership and Policy Studies 2019