Traumatic injuries have steadily increased during the last two decades, affecting over 5.8 million persons annually and have become a global public health issue. Since 2008, 80% of all deaths from noncommunicable diseases and trauma, approximately 29 million occurred in developing countries. Sixteen thousand young adults worldwide have died due to traumatic injuries. Additionally, injuries account for over 15% of the global burden of diseases, with approximately 90% of these injuries occurring in developing countries like St. Lucia. The purpose of this qualitative descriptive study was to examine policy gaps in prehospital traumatic injury responses and explore implementing Essential Public Health Functions (EPHF), that were conceptualized by countries in the Caribbean, to strengthen prehospital injury responses in St. Lucia. Using criterion-based sampling, 13 respondents from the St. Lucia emergency room, fire service Emergency Medical Services, and the ministry of health were interviewed. Their responses indicated a general deficiency in the procedures that guide trauma responses. Respondents cited EPHF 1, 2, 3, 4, 6, 10, 11, and sections of 9, as missing, and 1, 2, 3, 5, 8 and 10 as useful to improve prehospital response procedures and policies. These EPHF can be implemented through consultation with the ministry of health once political buy-in is achieved. The results indicate that the use of EPHF as a gold standard could be enforced through quality assurance programs. The findings from this study contribute to the knowledge base of prehospital traumatic injury responses. The study also has the potential to impact social change by providing health education campaigns that sensitize citizens to the perils of unnecessary and improper movement and transportation of injured victims

This qualitative research focused on the emergency preparedness (EP) rule implementation in rural hospitals in the Pacific Northwest. A new law has been implemented that requires hospitals to comply with Medicaid and Medicare law. Learning about the implementation and preparedness process could help rural regions in the Pacific Northwest better prepare for emergencies and comply with the law. The purpose of the study was to gain increased understanding of how the new EP rule of 2016 impacts rural hospitals' preparedness in the Pacific Northwest. The theoretical framework was complexity theory. This study focused on the lived experience of emergency managers who have been working on the implementation of the new EP rule in rural hospitals in the Pacific Northwest. Using a phenomenological approach, 8 in-depth phone and face - to - face interviews were conducted. Selection criteria included working as emergency preparedness managers in rural hospitals in the Pacific Northwest. The verbatim transcripts of interviews were analyzed by first cycle analysis, used concept and descriptive coding to find common themes. The findings of the study included that small rural hospitals working on EP need more support and help that include financial needs, resources, staff preparedness improved communication and more exercises local communities including every individual living in the community are also responsible for their own preparedness. This inquiry could help understand the effects of the new EP rule for rural hospitals; it could identify gaps in research that could support rural hospitals and surrounding communities; it could affect positive social change by applying the research evidence to additional health care settings.

Osteoporosis is a major health problem. The Alaska Department of Health and Social Services reports national rates of osteoporosis at 13-18% of women and 3-6% of men over age 50, but current evidence suggests that osteoporosis rates in Alaska are more equal between sexes. Known risk factors for osteoporosis that are very common among Alaskans include arthritis and low vitamin D and calcium levels. The U.S. Preventive Services Task Force (USPSTF) recommends dual-energy x-ray absorptiometry (DXA) scans of the hip and lumbar spine as the gold standard of screening for osteoporosis; however, DXA scans are expensive, not portable, and not practical for screening small populations. Calcaneal heel ultrasound (CHU) scans are a USPSTF-recognized alternative to the DXA scan and can reach these small populations. Guided by the PRECEDE-PROCEED model, this project sought to evaluate the effectiveness of offering CHU scans at health fairs in Alaska. The de-identified data from the CHU dataset (N = 494) were analyzed to determine any differences in bone health based on sex and age. Alaskans over 50 years of age were significantly more likely to have osteopenia or osteoporosis (X2 = 28.2, df =4) than those < 50 years old. No significant difference in bone health as determined by T-scores was noted between men and women, suggesting that Alaskan men should also be screened. Educational materials on bone health were readily available at the health fairs for anyone interested. Health fair attendees are routinely asked for feedback and their responses related to the CHU scan were summarized and were unanimously positive. This project contributes to positive social change by increasing awareness of osteoporosis in Alaskans.

There is a growing need for healthcare teams within the Veterans Administration (VA) healthcare system to effectively collaborate and communicate to improve patient outcomes. The need to improve patient care in the Patient Aligned Care Team (PACT) has been well established. The scholarly literature does not provide evidence whether using the primary care PACT model on communication and teamwork by an interdisciplinary medical team ameliorates these communication breakdowns. Bronstein's design for interdisciplinary collaboration provided the overarching framework for this study. The purpose of this qualitative case study was to investigate the use of the PACT model on communication and teamwork by an interdisciplinary medical team as well as the perceived processes and results that the interdisciplinary collaborative approach has on production data. 18 participants consisted of licensed medical professionals and other licensed and non-licensed support personnel who were part of the PACT team. There were several challenges associated with the model, such as (a) a lack of clearly defined roles, (b) lack of communication and collaboration, and (c) division between the clerical and medical staff that created a hostile work environment. Other participants felt there were benefits associated with the PACT model, included (a) improved communication between team members, (b) increased collaboration among team members, and (c) enhanced care for patients using a comprehensive team approach. These findings may help leaders create policies, improve patient care, and create perceived processes to affect successful long-term programs for the future implementation of the PACT model.

Men are underrepresented among nursing faculty, providing few role models for male students who might benefit from interaction with male faculty. Male nursing faculty may face barriers similar to those faced by women in male-dominated professions. Diehl and Dzubinski's model of gender-based barriers served as the framework for this quantitative study conducted to identify disparities between male and female nursing faculty that may prevent men from entering, continuing, and advancing in nursing education. The association between the percentage of male nursing faculty with geographic region; institution type (i.e., public, private secular, or private religious); and 4 career variables (i.e., education level, rank, tenure, and administrative position) were investigated in this study. Data were obtained from 20,953 faculty from the American Association of Colleges of Nursing 2017 Annual Survey of Baccalaureate and Graduate Nursing Programs. Chi square analyses indicated significant associations between the percentage of male nursing faculty with both the 4 geographic regions and with institution type as well as with several career variables. Post hoc tests revealed a lower percentage of male nursing faculty in religious institutions in the North Atlantic region; significant associations between the percentage of male nursing faculty and faculty education level, specifically in public institutions in the South and private secular institutions in the West; academic rank in public institutions in the South and West; and tenure status in private secular institutions in the North Atlantic and in public institutions in the South and West. Uncovering these discrepancies could lead to an increase in male nursing faculty which, in turn, would provide more role models for male students and may aid in attenuating the shortage of nurses.

In 1999, the Institute of Medicine released its report on building a safer health system. Since then, safety in patient care has become a paramount interest. Given the growing support for increasing patient safety, simulation training has become a common part of novice nurses' orientation program. This simulation training is designed to mimic situations in the acute care setting where novice nurses can practice in a patient safe environment. In this DNP project, a stroke simulation scenario and supporting patient chart was developed as an addition to a novice nurses' orientation program. The National League for Nursing simulation template was used to ensure successful incorporation of the League's standards and evidence-based practices. Five local experts were chosen to review the developed stroke simulation and corresponding patient chart. After reviewing, the experts were given a Likert-types evaluation survey to complete. The results of these surveys revealed that all experts strongly agreed that the simulation scenario was easy to follow and that the simulation patient chart provided the supporting information needed for the scenario. All experts strongly agreed that the simulation scenario would be easy to incorporate into the existing simulation programs and that the simulation scenario would enhance the critical thinking and decision making of the novice nurse. Lastly, all five of the participants strongly agreed the simulation scenario would increase patient safety when novice nurses are faced with similar situations in the acute care setting. The products of this project have been made available to the local healthcare facility for incorporation into its existing orientation program for novice nurses. The purpose of developing this simulation training is to improve the novice nurse ability and confidence to make a positive social change.

Sport-related injuries (SRI) can be foreseen and averted when mechanisms and risk factors are completely understood. An appreciation of the relationship between sport-related concussion (SRC) and lower extremity musculoskeletal injuries (LEMI) is emerging amid professional and collegiate athletes. However, findings of such a relationship in adults may not be generalizable to younger populations, and the literature has not addressed this relationship in adolescents. The purpose of this cross-sectional quantitative study was to examine the relationship between SRC and LEMI in high school athletes. The dynamic model of etiology in sport injury provided the study's conceptual framework. A de-identified secondary dataset of high school athletic injuries was obtained from the Athletic Training Practice Based Rehab Network and analyzed with descriptive and inferential statistics. Concussions, knee sprains, and ankle sprains represented about 12%, 17%, and 70%, respectively, of the 1,613 cases in the dataset. Chi-square tests revealed that SRCs, and the number of SRCs, were associated with knee sprains [(p < .001), Cramer's V = .148] and ankle sprains [(p < .001), Cramer's V = .545]. This study may promote positive social change by prompting further retrospective and prospective studies to clarify whether a relationship exists between SRC and LEMI in high school athletes, and if so, whether this relationship is causal in nature. New knowledge may be used to guide practices and policies to reduce sports injuries in high school athletes, which may lead to fewer SRIs among adolescents, fewer school absences, more physical activity, and better health and well-being throughout the lifespan, thereby promoting a more active, productive, and healthy society.

The purpose of this study was to explore healthcare providers' awareness and perceptions of complementary and alternative medicine (CAM) use in providing systemic lupus erythematosus (SLE) care. This phenomenolgical study was built upon existing research indicating SLE patients' need to foster better communication about CAM use. Participants were recruited from the Long Island Rheumalogical Clinic in the State of New York. Individual in-depth semistructered interviews were conducted to explore the awareness and perceptions of a purposive sample of 10 healthcare providers who care for patients with SLE. Transcripts were analyzed, and categorical themes were developed. Guided by the use of the shared decision-making model and self-efficacy theory, 5 themes emerged: varied knowledge and experiences with CAM varied, participants' personal experience and perceived effectiveness led to patient guidance and advice, perceived benefits of CAM use, participants as patient advocates, and initiatives for further research. Study findings revealed that the knowledge, attitudes, and beliefs of health care providers regarding the use of CAM shed light on the importance of health promotion to guide future research, both within and beyond CAM. Strategies are recommended to increase awareness and understanding of CAM use through proper education and advocacy. This research may lead to positive social change in that providers may use the information in this research to break down barriers to communication between patients and professionals regarding CAM usage.

The homeless population in Anchorage, Alaska faces many unique challenges. Over the past several winters, a number of homeless individuals have succumbed to the effects of exposure despite available cold weather services. This study investigated individual experiences within the homeless population of Anchorage, Alaska during times of inclement winter weather. Self-determination theory was used to explore motivations of behaviors of the population and to uncover the reasons why this population does not use cold weather services offered by the Municipality of Anchorage. The research questions addressed participant awareness of available cold weather services, survival strategies during inclement winter weather, and barriers to cold weather service use. This phenomenological study examined those lived experiences. Purposeful sampling was used to recruit eligible individuals (n = 14) at a local soup kitchen, and participants engaged in semistructured interviews. Data analysis procedures used McCormack's lenses and horizontalization to reveal emerging themes. Key findings included a lack of knowledge of emergency services, various survival strategies, and self-imposed barriers to services. The implications of these emerging revelations may positively influence public health providers to modify education delivery methods and interventions used to reach the homeless population in Anchorage, Alaska, with the ultimate goal of preventing wintertime mortalities.

Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records drawn from the Linked Infant Births and Deaths registers. Chi-square and logistic regression analyses were performed. Results indicated hurricane exposure was not a predictor of preterm birth (OR = .723, 95% CI = [.452, 1.16]; p = 1.76) or low birth weight (OR = .608, 95% CI = [.329-1.13]; p = .113). However, an association was observed between tornado exposure and preterm birth (OR = 1.68, 95% CI = [1.19-2.39]; p = < 0.05) and low birthweight (OR = 1.91, 95% CI = [1.27-2.87]; p = < 0.05). Findings suggest pregnant women are vulnerable to natural disaster storms, and are at risk for adverse pregnancy outcomes. The implications for social change include informing preparedness efforts to reduce vulnerability to increased pregnancy risk factors and adverse birth outcomes, consequential to hurricane and tornado disasters.