Purpose/Aims: The aim of this study was to understand the health issues of a rural Southeastern Arizona border community. More specifically, this study used community assessment with ethnographic principles to: 1) Conduct a community assessment centered on definitions of health, access to care, quality of care, and health needs in a rural Southeastern Arizona border community; and 2) Compared the findings of this study to previous studies, models, and theories of rural nursing and rural health.Background: It is important to understand that each community has a unique set of health priorities that are dictated by these factors; making every rural community different. Much of the work that has been done in rural America has been performed in the Midwest, Southeast, or Northern states. There is limited information regarding Arizona or even Southern US border communities and whether previous work can be generalized to areas that have not been studied.Sample and Methodology: This study utilized community assessment with ethnographic underpinnings through the use of focus groups, key informant interviews, participant observation, and secondary data analysis of existing community data. Sampling for the focus groups and key informants was purposive. Focus groups included: 1) participants who use local health services and 2) participants who do not.Analysis: Lincoln and Guba's (1985) guidelines for rigor in qualitative studies was utilized. Thematic analysis and thick description were used to analyze data. Theoretical triangulation was performed between individual, group, and community level data with theoretical linkages made to community capacity theory and rural nursing key concepts.Implications and Conclusions: The location of this project, rural Arizona community, near the US-Mexico border, posed an interesting contrast to the proposed concepts widely being used today. From this study, healthcare leaders in this community are better equipped to provide relevant, high-quality, and safe services; but an informed community emerged that has an interest in promoting the health and well-being of the community as a whole.

Community health nurses, like all other health professionals, are being called to develop new clinical practices based on collaboration and are faced with the demands of working both interprofessionally and interorganizationally (D’Amour et al., 2008). In Capital Health, public health nurses (PHNs), family practice nurses (FPNs) and nurse practitioners (NPs) are all working in different aspects of breastfeeding support and promotion. However, there is no formal structure for collaboration of services, despite the strong desire of these nurses to work together to improve breastfeeding outcomes. The purpose of this study was to explore the roles of PHNs, FPNs and NPs who work in breastfeeding support and promotion in Capital Health and the structures and processes needed to support the development of collaboration amongst these groups of nurses. Through the analysis of semi-structured focus group interviews and follow-up focus group interviews with a purposeful sample (n=10) of four PHNs, four FPNs and two NPs, four major themes and sub themes were identified that represented the nurses experience with collaboration between public health and primary care in breastfeeding support and promotion. The data generated revealed that participants had not experienced active collaboration, rather developing or potential collaboration (D’Amour et al., 2008). The first theme, Establishing Interpersonal Relationships, provided an overview of the precipitators and barriers to forming relationships and the outcomes of interpersonal relationships between public health and primary care nurses. The second major theme, The Organizational Context: Structures and Processes in the Everyday Work Environment outlines the impact of the organizational context of the nurses work environment on the development of collaboration. Benefits of Collaboration was the third theme identified in the study. Consistent with other studies on collaboration between primary care and public health nurses, the nurses interviewed believed that the development of collaboration in breastfeeding support and promotion would benefit health care professionals and the clients that they serviced. The last theme, Development of New Practices Grounded in Collaboration, described new initiatives or innovations that the participants explained were needed for the development of collaboration between PHNs, FPNs and NPs. Implications for practice include organizational support for PHNs, FPNs and NPs to work to the full scope of their competencies and providing them with opportunities to meet and establish relationships to facilitate joint planning initiatives related to breastfeeding support and promotion. Additionally, exploration of flexible roles and funding structures as alternatives to fee-for-service should be explored in primary care organizations. The development of a communication infrastructure is necessary for future development of collaboration between public health and primary care in breastfeeding support and promotion. Future research is needed in this area with a broader, more diverse sample, exploring organizational structures needed to improve breastfeeding outcomes and optimize FPN and NP roles. PHNs, FPNs and NPs have the opportunity to impact the model of care for breastfeeding families in the Capital Health District of Nova Scotia, optimizing their capacity to address issues in practice and ensuring that breastfeeding support and promotion activities address the complex social factors that influence the breastfeeding experience.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

Background: Inequity in general practice workforce distribution remains a significant issue despite the increasing numbers of general practitioners (GPs) in the UK. Problems with recruitment and retention in England are particularly evident in urban deprived areas. The aim of the current study was to explore affinity for working in urban deprived areas, focusing on practitioners’ background, values and care orientation. Methods: There were two stages to the research: 1) semi-structured qualitative interviews with 25 GPs and practice nurses to explore their background, values and care orientation in relation to location; 2) questionnaire survey with approximately 1200 GPs and practice nurses to determine the association between affinity factors and current location. The sample of practitioners was drawn from general practices located in the most and least deprived areas in the northwest region of England. Results: 25 qualitative interviews were conducted and the data analysed using a framework analysis approach. The analysis indicated that location preferences were formed early in practitioners’ careers. While an overt affinity for deprived areas was more likely among GPs, pragmatism could dominate location decisions for all. The narrative of practitioners in deprived areas suggested benevolent, universalistic and stimulation personal values, and a patient-centred care orientation. Satisfaction derived from making a difference, having a challenge, addressing social injustice, and having a sense of belonging. Coping strategies included: structure and organisation, support from colleagues, emotional detachment, reassessment of expectations, and distraction. The response rate to the postal questionnaire survey was 30.9% for GPs and 41.2% (practice level) for nurses. Although there were few differences in the personal values of practitioners working in deprived and affluent areas, there were more differences in specific work values. Stepwise logistic regression showed that for GPs, determinants of working in a deprived area included: having trained in a deprived area; not being influenced by the convenience of the location in choosing their current practice; and valuing control in decision-making. For nurses, determinants included: having worked in a deprived area before; not being influenced by quality of care in the practice when choosing their current practice; and not valuing being respected by practice colleagues. Subgroup analyses suggested different predictors for practitioners with different role status: GP principals were more likely to work in a deprived area if they valued providing care to those in greatest need of help, in addition to having trained in a deprived area. Discussion: The training location of GPs was a consistent factor in determining current location. This differs from the literature on location choice in rural and remote areas, for which childhood exposure is considered to be the dominant factor. Differences in personal values were reflected more clearly in specific work values. Future research should look at how GPs choose their training practice and how such experiences could be exploited to enhance recruitment to underserved urban areas. Strategies to aid retention could look to the coping strategies employed by practitioners to deal with the demands of working in a deprived area.

Simulation as a pedagogy is used extensively to educate healthcare professionals in both academic and clinical arenas with the intent to improve the delivery of care and patient outcomes. Advanced practice nursing (APN) programs use simulation as a pedagogy even though APN accreditation and certification organizations prohibit substituting simulation hours for the minimum 500 clinical hours. The purpose of this qualitative study was to explore faculty perceptions of educating APN students using simulation. Focus groups were conducted with a convenience sample of APN simulation faculty. Disruptive innovation theory was used by the researchers to guide the data analysis. Themes emerging during analysis included: 1) extrinsic tension and pressure in the midst of chaos, 2) internal vulnerability, and 3) passion and tenacity to remain resilient. The study results provide clarity to understand integration of APN simulation in the current environment, and introduce the impact of simulation as a disruptive innovation.

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to a SNF. This project evaluated the effectiveness of this intervention using the Donabedian quality framework. The Donabedian quality framework consists of 3 concepts: structure, process, and outcome. Sources of evidence were obtained through the electronic medical record systems at both facilities. Total of 1,009 patients were seen by the cardiac APN from 2012 to 2016. Results showed a steady decline in readmissions from 47% to 6%. This supported the conclusion that collaboration between hospitals and SNFs post hospital discharge is essential to improve the management and readmissions of HF. Specialized APNs, such as the cardiac APN in this study, may be more effective in the management and coordination of care for a specific patient population. Implications of this successful collaboration include better working relationships between nonaffiliated health care facilities, improved patient care outcomes, decreased readmissions for HF patients, and an improved community health care system.

Professional organizations offer nurses services and resources for professional growth throughout their careers; yet, membership has declined over the past 10 years. Accordingly, this study was to understand the barriers in membership and identify positive changes that will increase membership and retain members. A quantitative descriptive design was employed within a convenience sample of 150 advanced practice registered nurses (APRNs) who were past or nonmembers of a professional organization. Exchange theory was applied and the Professional Association Membership Questionnaire (PAMQ) was administered to assess the barriers to APRNs participating in a specific professional organization. Statistical analysis included mean scores for each of the PAMQ's 34 questions with groupings by benefits and barriers using a 7-point Likert-type scale. Study results indicated 71% (n = 106) of 150 participants ranked continuing education as the most important benefit when considering joining a professional organization. Although prior literature frequently reported cost as a barrier to membership in professional organizations, fewer than 50% (n = 56) of participants in this study ranked cost as a barrier to membership. Professional organizations can bring about positive social change by providing accessible continuing education to membership. To do so will improve the quality of nursing services through evidence-based practice, education, and leadership. Membership in a professional organization allows the nurse to maintain current awareness of health care changes and policies. Significant membership is necessary in order for the organization to have a major impact in the profession.

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Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed by the American Heart Association for the treatment of patients with low risk for chest pain was adopted by the NP service. The project was guided by both the Donabedian model of quality care and the Aday and Anderson theory of access to medical care. The project design proposal is a comparative study using retrospective data obtained from the medical records of LOS pre- and post-implementation of the project. Implications for social change include improvement in patient care on a national level, not only for patients with low risk for chest pain, but also for patients with other chronic diseases. Streamlining care will improve the financial standing of hospitals as well as provide care that is equal and equitable regardless of race or financial status. The findings of this project have strengthened the role of the APN globally as a social advocate for change, actively participating in designing and implementing programs to improve patients' outcomes.