In the United States, congestive heart failure (CHF) is a cardiac condition with increasing hospitalization and rehospitalization burden to patients, families, and the healthcare system. This chronic condition is expected to affect more than 8 million people by 2030; however, not much is known about the relationship between risk factors and hospital readmissions once CHF patients are discharged to a skilled nursing facility (SNF). Applying a systems theory unbounded systems thinking, coupled with a systems-thinking approach the purpose of this quantitative, retrospective cohort study was to examine CHF hospital readmissions from SNFs within a 90-day period using a secondary data set of gender, age, race, SNF geographic location, length of SNF stay, and home health use risk factors. A binary logistic regression analysis revealed that out of 238 episodes, 99 patients were readmitted; however, no statistically significant relationship between the risk factors and readmission was found. Findings suggest that CHF readmissions from the SNF are not attributed to only quantifiable risk factors. Based on these findings, further research can support social change through multifaceted quantitative and qualitative systemic analyses to identify and inform how healthcare organizations can better assist the elderly population with CHF and improve future post-acute community-based health education and prevention programs.

Residents who fall in SNF either sustain significant decline to quality of life or die from their injuries. The average fall costs about $34,000 per incident. On average, 19.8% of residents fall at least once per month. The purpose of this project was to assess, identify, and advance nursing practice to decrease falls by evaluating current facility standard of practice, fall policy, procedures, and protocol. The objective was to create actions that would close the communication gap between clinicians and residents. This project encourages clinicians to intertwine resident feedback and strategies into the plan of care to help reduce fall risk. A focus group was conducted with 11 residents with previous fall experience. Through structured discussion, several important gaps in communication related to residents' plan of care were identified. Examples identified include, 10 of 11 residents indicated they were never asked to participate in their plan of care, 10 of 11 residents indicated staff did not listen to them, and 11 of 11 stated they did not know they could change the plan of care that staff had put in place. Further feedback from the focus group demonstrated residents desire to be involved in their care however, they were largely excluded from this process in the past. This project contributes to positive social change by identifying ways to close the communication gaps and reduce risk for falls by intertwining clinician and resident fall practices. A highly recommended fall committee was established at the project facility to encourage staff buy in, advancement of nursing practice and resident involvement in reducing falls.

Readmission of skilled nursing facility (SNF) residents has become a financial and quality-of-care concern for facility leaders. SNF administrators do not know whether nurse staffing levels are impacting readmission rates. The Affordable Care Act included measures to monitor and improve quality and to penalize SNFs that have high readmission rates. The purpose of this quantitative correlational study was to examine the relationship between SNF nurse staffing levels and readmission rates using the Skilled Nursing Facility Readmission Measure (SNF RM). The theoretical framework for the study was Donabedian's structure, process, outcome model. The research questions addressed the relationship between nurse staffing levels and rehospitalization percentages for SNFs, and the relationship between RN staffing levels and rehospitalization percentages. A quantitative methodology was used to analyze publicly reported secondary data from Centers for Medicare and Medicaid Services staffing files and SNF Value-Based Purchasing (SNF VBP) program data. Pearson's correlation was used to examine the relationship and strength between nurse staffing levels and the SNF RM. The sample included 374 SNFs across Georgia that participated in the SNF VBP program. Findings from the multiple regression analysis and analysis of variance indicated no statistically significant relationship between nurse staffing levels and SNF RM rates. Facility characteristics across Georgia showed some variations in staffing levels and SNF RM rates. Findings promote positive social change by providing SNF leaders with needed information to make decisions about staffing needs when considering staffing above the state averages. Health care leaders and policymakers might use the findings when considering recommendations for staffing regulations.

The inability of business owners to hire skilled employees affects the profitability of a small business. Small business owners may attain profitability by understanding the value of military veterans and cultivating strategies for the hiring and recruitment process. The purpose of this qualitative multiple case study was to explore strategies that business owners in Fayetteville, North Carolina used to recruit military veterans as a means to acquire skilled employees to maximize productivity, profitability, and sustainability. The conceptual framework of this study included human capital theory and recruitment theory. The purposive sample consisted of 6 participants who were small business owners. Data from interviews and supporting documents were processed and analyzed using data source triangulation to identify 3 emergent themes. Findings indicated that, for these 6 Fayetteville small business owners, job description and transition workshops, resume review and communication, and accommodations and benefits were key attributes related to the successful recruitment of military veterans as skilled employees. Specifically, streamlined hiring processes, relationship building, and access to resources were predictive of a successful hire. Knowledge barriers regarding hiring processes prevented efficient communication between small business owners and military veterans, but business owners cultivated strategies to help with hiring military veterans. The implications for positive social change include the potential for business owners to capitalize on the skills that military veterans bring to the civilian workforce, which in turn may improve the economy.

The U.S. manufacturing industry produces products that ship all over the world. Because of the shortage of skilled labor, some manufacturing human resource professionals lack the strategies and processes necessary to acquire and retain skilled employees. Guided by Maslow's hierarchy of needs theory and Herzberg's motivation-hygiene theory, the purpose of this qualitative multiple-case study was to explore the strategies and processes that manufacturing human resource professionals use to acquire and retain skilled employees. Data were gathered from a population of manufacturing human resource professionals in Giles County, Tennessee from individual interviews; focus group; and participants' internal documents, public documents, and websites. Transcribed interview data and focus group data, along triangulated data from other gathered documents, were inductively coded following Yin's approach to analysis. Six themes emerged as key strategies to acquire and retain skilled employees: company culture, succession, benefits, finding new employees, incentives, and employee attraction and retention. These findings may contribute to improving business practices in manufacturing industries or human resource management. The implications for positive social change include the potential for the community to become more attractive for other industries and improve the quality of life for individuals who reside in the community.

O entendimento dos fatores locacionais que afetam a inovação ajuda a compreender a localização das atividades inovativas, dentre os quais há a mobilidade de trabalhadores qualificados (trabalhadores com Ensino Superior ou em ocupações técnicas e científicas). Em razão de o conhecimento estar atrelado às pessoas, a transferência desses trabalhadores para outras regiões impacta nas possibilidades e oportunidades de se compartilhar conhecimento. Assim, o objetivo desta tese é avaliar se a mobilidade de trabalhadores qualificados influencia os resultados da inovação no nível regional. A partir dos microdados da Relação Anual de Informações Sociais Identificada (RAIS ID), foi analisada a mobilidade dos trabalhadores formais entre as microrregiões brasileiras em todo o país entre os anos de 2003 e 2008. Os microdados foram inseridos em um banco de dados relacional (PostgreSQL), o que permitiu a criação de indicadores de mobilidade de trabalhadores, construídos para três recortes de trabalhadores: totais, com Ensino Superior e em ocupações técnicas e científicas. Foram calculadas as mobilidades para todas as atividades econômicas e para atividades econômicas selecionadas (Agricultura, Indústria Extrativa e de Transformação), gerando indicadores, a fim de mapear a mobilidade de trabalhadores no Brasil; em seguida, foram realizadas estimações econométricas baseadas na função produção do conhecimento. Entre os principais resultados, observa-se que, em todas as atividades econômicas e ao serem excluídos movimentos de trabalhadores intrarregiões metropolitanas, a entrada de trabalhadores nas microrregiões é benéfica para a inovação. Já para a perda e para a mobilidade bruta de trabalhadores, verifica-se o efeito dos benefícios gerados pela circulação de conhecimento nesses ambientes. Ao se analisar a mobilidade nas atividades econômicas selecionadas, constata-se a importância da mobilidade de trabalhadores qualificados para a inovação, cujo benefício está relacionado com a importância do conhecimento para as atividades inovativas e com a sua exploração nas atividades econômicas selecionadas. O desenvolvimento de capacidades de absorção em determinadas áreas facilita a assimilação e a acumulação de conhecimentos que podem ser derivados da circulação de novos trabalhadores em uma região. / The analysis of the locational factors that have influence over innovation is the key to understand the localization of innovation. The mobility of skilled workers is one of these factors. The mobility of skilled workers can be important for innovation activities because the knowledge, that is an input for innovation, is embodied in people. So when people move to other location the possibilities to share this knowledge are increased. In this way, the aim of this thesis is to evaluate if the mobility of skilled workers can influence the regional innovation in Brazil. The mobility of workers was analyzed with micro-data of formal workers between the micro-regions of Brazil on the years of 2003 to 2008. The micro-data were inserted in an open source relational database (PostgreSQL). The indicators of mobility were created for workers in general, workers with higher education and workers in technical and scientific occupations and economics activities (Agriculture, Extractive and Manufacturing). With this data it was possible to map the mobility of workers in Brazil. Afterwards the knowledge production function framework at the regional level was used to estimate the impact of the mobility on regional innovation. When the mobility of workers was calculated for all activities and excluding mobility within the same metropolitan region, the empirical approach shows that the influx of workers is beneficial for innovation. Furthermore, for the analysis of the outflow and the gross mobility it was possible to notice the benefits of circulation of people and the benefits of knowledge share. For the evaluation of mobility of workers in selected economics activities, it was possible to notice the benefits of mobility of skilled workers for regional innovation. The benefits of circulation of skilled workers are related with the importance of knowledge in innovation activities and also with the possibilities of exploration of knowledge by local agents. Furthermore, the development of absorption capacity in selected areas ease the assimilation and accumulation of new knowledge derived from circulation of new workers in one region.

In this article, we review the limited but growing body of research on international skilled migrants and examine to what extent knowledge generated in adjacent research streams-specifically, work on assigned and self-initiated expatriates-can be meaningfully applied to aid our under- standing of the challenges, coping strategies, and acculturation dynamics of skilled migrants. We develop a framework that explains how variables and processes at multiple levels (individual, organisational, and societal) influence migrant acculturation and coping and result in integration-related outcomes in the domains of personal/family life and workplace/career. We discuss directions for future research and implications for practice.

This thesis examines and explains multinational employers' experiences of localized shortages of skilled process workers in Suzhou Industrial Park (SIP), China. It explains three challenges facing SIP employers in accessing sufficient skilled process workers and their responses within HRM to such challenges. These three challenges are employers' experiences with vocational education and training (VET) deficiencies in students' skill development, employers' experiences of poaching of skilled process workers by other companies, and employers' experiences of provision of workplace training for skilled process workers in their own companies. In response to these challenges, SIP employers have adopted various HRM measures that include differing combination of recruitment and selection, employee retention, training and development, and employment relations management. These policies and practices represent the different ways that SIP employers have attempted to meet the challenges of localized skill shortages in the context of their own business strategies.

The Skillmax Program was launched by the New South Wales State Government at the end of 1988 as a result of concern about the underutilisation of the skills of overseas qualified and experienced immigrants in the labour force. The program is administered by the NSW Adult Migrant English Service. The aim of this study is to evaluate how well the Skillmax Program is achieving its aim of assisting non-English speaking background immigrants to maximise the use of their overseas experience and skills within the NSW labour market. The main source of data for the evaluation was a questionnaire distributed to all students who had studied in the program from July, 1993 to June, 1994. Those in the final program intake surveyed had just completed courses, those in the first intake surveyed had completed courses nine months previously. The questionnaire was sent to 458 ex-students in August, 1994 and 217 questionnaires were returned. Additional data was obtained from a literature search, a survey distributed to Skillmax program staff and a focus group meeting of the Skillmax Program's teachers, educational and vocational counsellor and program manager. Key research findings are: 71.9% of all respondents had found employment since enrolling in the Skillmax Program and 67.7% were still employed when the study was conducted; 84.9% of those respondents who had completed or partially completed courses ending from six to nine months before the study was conducted had found employment and 78.5% were still employed when the study was conducted; 66.7% of those respondents in employment had found employment at the same occupational level as in their countries of birth; 52% of all respondents were either unemployed (28.1%) or underemployed (23.9%); 85.9% of those respondents in employment considered that the Skillmax Program had contributed significantly to their success in finding employment. The study compares the findings of the current study to those from a previous Skillmax Program evaluation concluded in 1992 (Mograby & Eddie, The Skillmax Program Evaluation Report, 1992). Employment outcomes of participants in the current study are significantly better than those in the previous study. The study argues that improvements in employment outcomes can primarily be attributed to program improvements made since the 1992 evaluation. The study concludes that the Skillmax Program is achieving its aims. Recommendations for program improvement and future directions for the program are made.

<p>Bakgrund: Migration är ett vanligt förekommande fenomen idag vare sig den är ofrivillig eller frivillig. Mycket forskning har gjorts om den ofrivilliga flyktingmigrationen men ytterst lite forskning har fokuserat på den frivilliga migrationen, då i synnerhet gällande högutbildade individer med special kompetens. </p><p>Avgränsningar: Vi har begränsat oss till att studera de mer rationella orsakerna till inflödet av utländsk kompetens, vilka anses vara lättare för en stat att påverka. Vidare så har vi fokuserat oss mot de individer som anses vara högutbildade eller inneha en speciell eftertraktad kompetens. Studien är också begränsad till att studera migration av högutbildad arbetskraft mellan i-länder. </p><p>Syfte: Syftet med denna uppsats är att undersöka orsakerna till det nettoinflöde av utländsk kompetens till ett visst land vilka kan påverkas av statliga åtgärder. I vårt fall har vi använt oss av Nederländerna som ett studieobjekt i vår undersökning för att se vad den nederländska staten gjort för att attrahera utländsk kompetens. Genomförande: Uppsatsen baseras på empiriska resultat som insamlades under en veckas uppehåll i Nederländerna. Vi har också använt oss av litteratur och artiklar angående migration av högutbildade. Viss statistik data angående Nederländerna har också använts. </p><p>Resultat: Vi har funnit att orsakerna till migration av högutbildade individer styrs av både rationella och irrationella faktorer som mer eller mindre kan påverkas av statliga åtgärder. Vad gäller Nederländerna så har man inte tagit några åtgärder med det explicita syftet att attrahera utländsk kompetens. Detta har blivit en positiv konsekvens av den nederländska statens försök att attrahera utländska direktinvesteringar. Slutligen har vi funnit att"brain drain"inte nödvändigtvis är en negativ företeelse på lång sikt.</p> / <p>Background: It is a common phenomenon for people today to leave their country of origin to move to another country. Involuntary movements have been the focus of much research, however little has been done to explain why voluntary migration takes place specifically amongst highly skilled individuals.</p><p>Purpose: The purpose of this report is therefore to investigate the reasons for the net inflow of foreign skilled workforce to a country, which a government can influence. In doing so we have made use of the Netherlands as a case study. </p><p>Limitations: We have focused on the inflow of foreign competence for more rational reasons, which a country's government could have some influence upon. Furthermore, we will concentrate on those individuals who are considered to be highly educated or specialists. The study is limited to the migration of skilled labour from one industrialised country to another. </p><p>Manner of Proceedings: The report is based on empirical results collected during a weeks visit to the Netherlands. We have also made use of literature and articles treating the brain drain-brain gain phenomenon. Some use of statistics regarding the Netherlands has also been used. </p><p>Results: We have found that the reasons for the migration of highly skilled labour is dependent on both rational and irrational factors of influence. The possibility for a government to influence any of these issues varies. Regarding the Netherlands nothing has been done with the explicit intent of attracting foreign competence, this has been a positive side effect in the attempt to attract FDI. Finally we have found that brain drain is not necessarily a bad phenomenon in the long run.</p>