A well-known fact relating to health care in the 1990s is the delimma being faced by small rural hospitals across the United States. They are now at a crossroads between survival and closure. This thesis addresses the influence that effective marketing strategies can have on the outcome of rural hospitals if such strategies are targeted to the right populations Although the patients, the community, and the physicians are important target groups, this thesis addresses the impact marketing can have on the employee population and how that population can, in turn, affect community perception. This is the first study to be done at Caverna Memorial Hospital to indicate employee perception as a result of marketing, and careful research of available literature shows that it may well be one of the first done in a rural hospital in Kentucky on this particular relationship An important premise to this study is the fact that employees need to know that their success as an employee is dependent upon the hospital and, just as important, the hospitals survival can be dependent upon the employees' influence on potential customers. The study concentrated on outpatient services and took place in a 30-bed hospital located in south central Kentucky. This hospital has economic problems and conditions that make it typical of small rural hospitals across the country. The instrument utilized for this study is a pretest and posttest questionnaire presented to the entire employee population before and after a period of time when marketing endeavors were undertaken by the hospital. To test the difference of scores between the pretest and posttest, repeated measures Analysis of Variance was used to compare means of both groups. The principle finding was that employees viewed the hospital and its' outpatient services in a more positive light after marketing endeavors had been undertaken. Since effective marketing endeavors do have the potential of positively influencing employees in a small rural hospital setting, and since hospital employees have the potential of influencing potential customers, hospital administrators may do well to consider budgeting for marketing and directing such marketing tactics to the often forgotten employee population.

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. The purpose of this study was to determine the effects of the new version of Bingocize® on QOL and fall risk in community-dwelling older adults (N=36; mean age 73.63 ± 6.97). Participants were clustered and randomly assigned to (a) experimental (n=19; participating in Bingocize® program, which included the bingo game, exercise, and health education) or (b) control (n=17; only played bingo). Each group completed a 12-week intervention that consisted of two 45-60 minute sessions per week. Pre and post data assessments included the TUG, 30-second chair stand, 4-staged balance, handgrip strength, WHOQOL-BREF, PANAS, and a health knowledge quiz. A mixed design analysis of variance (ANOVA) was used to compare intervention effects. There were no significant interactions for any of the variables, with the exception of positive affect (PA) (F (1,34) = 5.66, p = 0.02, 𝜂𝑝 2 = 0.15, power = 0.64) and handgrip strength (F (1,34) = 8.31, p = 0.007, 𝜂𝑝 2 = 0.196, power = 0.80).. There was also a significant main effect for time for health knowledge. Post hoc analysis using independent samples t-tests were conducted on PA (t (33) = 2.39, p = 0.023, two-tailed) and handgrip strength (t (34) = 2.85, p = 0.007, two-tailed). Participating in the Bingocize® health promotion program can produce a meaningful and detectable change in handgrip strength and PA in community-dwelling older adults.

Despite the many weight loss options available, the majority of overweight and obese individuals who try to lose or maintain weight loss are unsuccessful. This lack of success has been the focus of extensive research. In an attempt to develop more effective modalities, researchers have identified several predictors of weight loss success. However, the efficacy of diets is still limited. For many, this lack of weight loss success may be due to issues such as depression, loneliness, anxiety, lack of support, or other environmental factors that may be imperceptibly related to food and exercise. Repeated dieting failures may produce feelings of deprivation, low self-esteem, reduced self-efficacy, and dietary rebellion. For these individuals, a more holistic approach to addressing weight-related issues may be more effective and is the impetus for the development of this project. This project was developed utilizing several previously identified predictors of weight loss success, holistic and weight loss models, along with several self-help lay publications. This resulted in the development of a unique, holistic, self-care guide that is easily individualized and based on personal weight management needs. Individuals can potentially identify their unique physical, emotional, and spiritual motives for overeating or lack of physical activity, and design their own plan of action; potentially providing themselves with a new level of health and happiness not previously realized.

Previous research examining high-risk sports participation has yielded discrepancies between the role assigned to risk and the perceptions of climbers regarding risk. Risk, as it applies to high-risk sport participation, has not been sufficiently defined in the literature. The current study sought to develop, by means of a grounded theory approach, a new, dynamic operational definition of risk as it applies to rock climbers, and to examine the role of risk management as a modifying factor in the perception of risk and its impact on motivation and participation. Nineteen subjects (twelve male and seven female) averaging 14.7 years of climbing experience were interviewed. A model for the processing of risk in high-risk sports participants is presented in which risk is perceived by the participant as operating on three levels: actual risk, assessed risk, and mental or perceived risk. The exposure to actual and assessed risk does not appear to be a goal of the climbers interviewed, but does provide meaning to decisions made by the participant, as well as defining limits and boundaries. Mental or perceived risk serves to provide a mental challenge to be overcome by the climber, and may provide a thrill or "adrenaline rush" that is sought out by some participants. The elimination of risk would change most participants' perceptions of climbing. Motivation would be negatively affected in most cases. The model presented describes a process of risk awareness, assessment, acceptance, mitigation, results, and consequences that is situation specific. The perception and assessment of risk varies from individual to individual, as well as across time. Individual climbers have a well defined risk threshold: a point at which the risk to which they are exposing themselves becomes too great and the decision will be made to reject risk. This threshold is stable and does not shift as the result of experience. It is suggested that future research which seeks to examine the role of risk in high-risk sports participation focus on the process by which risk is identified, evaluated, and accepted, as this will be of the most benefit to the participants.

Ki, Japanese for living energy (Chi in Chinese), is at the absolute core of the Oriental model of medicine and wellness. Complementary to this model, many Oriental martial art exercises have evolved to cultivate Ki for optimal health. However, the concept of Ki remains poorly understood and relatively unexplored in traditional Western health and medical literature. Further, the health focus of martial art research has remained primarily concerned with the arts' contribution to psychological health. This has left a significant gap in our understanding of the other health benefits that these arts and Ki have to offer. To begin closing these gaps, Moustakas' phenomenological research method was used to develop an enhanced understanding of Ki. Twelve advanced practitioners of the traditional martial art of Aikido were asked to illuminate how they perceive and describe the experience of Ki in their lives. Aikido was an excellent art through which to study Ki because of the art's focus on developing the Ki of its practitioners and its recognition in the literature as psychologically beneficial. The co-researchers described Ki as a force that they perceived to be influencing their lives in multiple ways. They believed that the Ki they developed through their Aikido practice enhanced the health of their minds, bodies, and spirits. Ki was described and explained through its perceived immediate and long term effects. They expressed Ki as an integrated part of their beings that enhanced physical and psychological health and well-being, and fostered calmness and clarity of mind. Ki was also perceived as a tool for recove1ing from injuries and illness and for achieving personal goals. Further, over time they perceived that Ki engendered great trust in the universe and that Ki protected their health. Several key differences between the traditional definition of Ki and the co-researchers' everyday experience emerged from the analysis. These were the differentiation between the long and short term effects of Ki, the description of Ki as a tool, and the attribution to Ki of the feelings of trust in the universe.

Effects of hydraulic fracturing (HF) have become a controversial public health issue in the United States. The purpose of this qualitative case study was to explore community members' perceptions of economic, health, and environmental effects of HF in Gibson County, Indiana. The conceptual framework was adapted from the health belief model and was named the HF health impact belief model (HFHIBM). Data were collected from stratified purposeful non-randomly selected 32 Gibson community members, using semi structured questionnaires, complete observations, and existing documents. Stratification was based on factors influencing perception, such as, gender, race, level of education, age or technology exposure, and level of media use. The observed community showed no economic boom or prevalent diseases, with functional and few abandoned pump jacks located on some of the farmlands. Data collected from the returned questionnaires were analyzed using hand coding and software. The results revealed that 72% of participants lacked awareness of HF, 90.6% reported lack of involvement in the decision-making process to locate HF near their community, and 21.6% of the 40.6% of participants with awareness reported that HF should be continued if the benefits outweigh the negative effects. Based on the constructs of HFHIBM, the low awareness of HF has implications on the community's acceptance of HF, and the use of sustainable and environmentally safe alternatives may result in better acceptance of HF. Increased awareness of HF may lead to the development of environmentally friendly, sustainable preventive actions, better community health outcomes such as reduced morbidity and mortality rates, and improved drinking water quality in neighboring communities.

Calciphylaxis is a deadly disease seen primarily in patients with end stage renal disease. Literature indicated that improved patient outcomes are seen with routine screenings. Many dialysis providers lack fundamental knowledge that would enable early identification of calciphylaxis in patients with renal disease. The purpose of this project was to design a screening instrument and develop a staff education program that would transform calciphylaxis management by promoting early identification and treatment of the disease. Knowles's theory of andragogy was used as the theoretic framework for the project. Dialysis center staff (n = 26) participated in the education. The number of participants was based on the number of staff working at the partner dialysis site. There were no exclusions as all members of the interdisciplinary team play an important role in calciphylaxis management. Surveys conducted following the education were used to determine whether dialysis staff believed they had acquired the knowledge and skills necessary to identify early signs of calciphylaxis. Descriptive data collected by the surveys indicated 60% of participants were not at all comfortable identifying patients at risk for developing calciphylaxis prior to attending the education presentation. Following the presentation, 68% of participants felt very comfortable identifying at-risk patients, an increase of 82.3%. This project exemplified that calciphylaxis detection is a secondary prevention nursing intervention that has potential for promoting positive social change by improving patient outcomes, reducing mortality rates in the end stage renal disease population, and providing empirical data to inform evidence-based therapies for at-risk patients.

Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature makes it clear that rate of road traffic death is related to country income and governance indicators, so first those variables needed to be equalized. My conceptual framework for this cross-sectional correlation study was the Haddon matrix, which organizes injuries by temporal (pre-event, event, and postevent) and epidemiological (host, agent, and environment) factors. Using World Health Organization data on road traffic injury and country income, World Bank data on governance indicators, and a literature search of 67 countries' prehospital response profiles, significant negative correlations (p > 0.001) were found for road traffic deaths and income, r (65) = -0.68, and governance indicators, r (65) = -0.646. No significant difference in the rate of road traffic death was found between physician and nonphysician prehospital staffing. Because increasing countries' income and improving governance are long-term, ambitious goals for developing countries, training nonphysician prehospital responders appears to be the most effective social change to decrease the burden of road traffic deaths.

Sexually transmitted diseases (STDs) continue to remain a public health concern in the United States, especially among young people. Levels of knowledge with regard to STDs have been investigated in prior research; however, these investigations have been limited primarily to older adolescents and young adults. Grounded in the social cognitive and subjective culture theories, this quantitative, cross-sectional study assessed STD knowledge (other than HIV/AIDS) among 7th grade students attending a public middle school in the United States. Demographic differences (age, gender, and ethnicity) in STD knowledge were examined to determine if these demographic variables predict STD knowledge scores and if the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) is a valid and reliable instrument among this study population. Chi-square analysis demonstrated that STD knowledge scores significantly differed by age only: Twelve-year-olds had higher STD scores than did 13-year-olds, contrary to research in older adolescents, which may be the result of confounding factors that warrant further investigation. Multiple regression analysis showed that age, gender, and ethnicity were not associated with STD knowledge scores. The STD-KQ was found to have face validity as well as high consistency and reliability among all questions related to STDs other than HIV/AIDS using Crohnbach's alpha. Content validity for individual STD-KQ items was shown using Lawshe's content validity ratio and subject matter experts. Results of the study support positive social change and highlight the need for earlier STD education, other than HIV/AIDS, with middle school children and the need to examine other factors that may impact STD knowledge within this age group.

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura's social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and what could be supplemented to improve outputs and health outcomes? An integrated review of the literature, observation of the site, regulatory investigation, and focus group sessions were the methods of data collection. The precede-proceed model provided the analytical strategies to assess initiatives and resources, and to determine supplementary initiatives and resources. Results showed that environmental, educational, administrative, and policy resources were available but limited and not well promoted. Conclusions were that health promotion, wellness staffing, and education exist, but are underutilized, under promoted, and funding is necessary. Recommendations include a wellness program, increased activity initiatives, case management, grant funding, and increased community partnerships. The contribution to nursing is to fill a gap-in-practice for health planning in 2-year colleges. The implications for positive social change are improved knowledge, sustained health behaviors, decreased amount of obesity, improved health outcomes and quality of life, decreased chronic diseases, and lower healthcare costs.