Primary care within the United States’ health care system is evolving to address increases in chronic conditions across the lifespan that impact individuals’ daily lives, and the health care system’s performance and cost. Even as interprofessional primary care teams aim to manage a large majority of health needs over time, these teams often lack the skilled professionals necessary to address function in daily life. Occupational therapy’s distinct value as experts in evaluation and intervention for health-related occupational development, adaptation, prevention and management can address this problem. However, continued education and additional tools are necessary in order for occupational therapists to increase their knowledge of the profession’s role in primary care, increase self-efficacy in promoting occupational therapy to stakeholders, and increase self-efficacy to utilize resources for research and establishing occupational therapy in primary care settings. The proposed online course "Occupational Therapy in Primary Care: What, Why, Where, & How?" is specifically targeted to occupational therapists to addresses these outcomes. Theoretical and historical evaluation of occupational therapy in primary care in the United States and Canada supports understanding the problem and mechanisms that can help navigate efforts to include occupational therapy in primary care. Diffusion of Innovations and Adult Learning Theory guide the course’s two-phases of development and dissemination. This project is a timely contribution to the emerging area of occupational therapy in primary care that supports the Institute for Health Care Improvements’ (IHI) Triple Aim to improve the individual experience of care, health of populations and reduce per capita cost of care.

Hospital administrators face challenges that arise from environmental factors or psychosocial factors, and lack resources to deliver valuable medical services to stakeholders, including patients and employees. A multicase study served to explore experiences and gain a broader perspective of hospital administrators' use of strategies to optimize patient services. Ten hospital administrators from acute care hospitals in Nevada and California were purposefully selected from the population of hospital managers with a minimum of 2 years of documented experience in successfully implementing management strategies to improve patient services. The conceptual framework was Drucker's management theory. Data were collected from semistructured interviews with 10 administrators, from the participants' archival documents, and from hospital archives. Interview transcripts and data from multiple hospital locations were coded and analyzed using methodological triangulation. Five themes identified from data analysis were triple-aim strategy, evidence-based practice, lean methodology, public health strategy, and innovation strategy. Implementing the appropriate strategy in each hospital setting might facilitate identification of elements that are lacking, mitigating, or slowing down the hospital improvement process. The findings of this study might contribute to positive social change by creating platforms for sharing information among patients and providers, payors, pharmacies, and policymakers.

The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson’s Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.

BACKGROUND: Despite large investments in maternity care services, perinatal health outcomes in the U.S. are among the worst compared to other industrialized countries, with documented perinatal health disparities disproportionately impacting racial and ethnic minorities. Midwifery-led freestanding birth centers (FSBC) have emerged as an underutilized model for the safe and cost-effective care of women with low-risk pregnancies. Despite approximately 85% of all US pregnancies being considered low-risk, only 0.5% of all US births occurred in a FSBC in 2016. The goal of the study is to elucidate strategies used to develop and sustain freestanding birth centers (FSBCs) that are seeking to serve high proportions of publicly-insured women and women of color. METHODS: I conducted an embedded unit case study, including semi-structured in-depth interviews and focus groups with 49 stakeholders from three exemplary FSBCs. Supplemental interviews were led with five key informants from three additional FSBCs and a relevant national membership organization. Additional data sources used to complete this case study include, where relevant and permitted, observations of maternity care settings, patient-provider encounters, management meetings, community events, and review of pertinent documents. Qualitative analysis methods were used to identify common themes and variations. FINDINGS: Midwifery-led birth center care can improve the experience and outcomes of maternity care among publicly insured women of color. The study revealed persistent multi-level challenges, as well as the use of common approaches to overcome these organizational, financial, and cultural barriers, resulting in greater, yet still fragile, access to family-centered intrapartum care within the communities in which these FSBCs operate. CONCLUSIONS: The careful integration of FSBCs into health systems such as a Federally Qualified Health Center (FQHC) may contribute to the broad scale-up of this underutilized model of care. While integrating FSBCs into FQHCs may be helpful in expanding equitable access to birth center care, it is not necessary, and also not sufficient. Expansion efforts should include additional deliberate processes and strategies to ensure equitable uptake and sustainability of birth center care. / 2020-10-23T00:00:00Z