Sudden cardiac arrest continues to be a major cause of firefighter deaths during training due to a lack of individual firefighter adherence to National Fire Protection Association (NFPA) standards. These standards identify requirements for fire departments to create and maintain fitness programs. Existing research has not identified any relationships between training fatalities and individual firefighter adherence to NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members. Using self-determination theory as the foundation, the purpose of this cross-sectional correlation study was to investigate whether individual firefighter adherence to NFPA 1583 has a measurable effect on training fatalities. Survey data were collected from 441 paid firefighters from 7 fire departments located in a rural county in a southern U.S. state. Data were analyzed using multiple linear regression. Results indicated that adherence to NFPA 1583 has a statistically significant relationship with reduced firefighter training fatalities (p = .000). Recommendations include examining adherence policies to all elements of the NFPA 1583 standard, not just chapters 5 through 8 in the publication. These include chapter 1 administration, chapter 2 referenced publications, chapter 3 definitions, and chapter 4 program organization specifications. The study results may be used by fire department training divisions to improve the health and safety of firefighters.

During the past few decades, holistic education has increasingly emerged in academia. However, limited research has been conducted on how holistic education impacts instructional practices in real life situations like the well-being of cancer patients. The purpose of this qualitative study was to explore how a holistic education program impacts instructional practices designed to improve the well-being of cancer patients. The conceptual framework was based on transformative learning theory and learner-centered teaching. This single case study was conducted at a non-profit cancer center in the Western United States which emphasizes multiple dimensions of well-being for cancer patients, including holistic education. Participants included four instructors at the center. Data were collected from individual interviews with these instructors, reflective journals that they maintained, and documents and archival records related to the center and its education programs. Data analysis involved line-by-line coding and categorization to identify patterns and themes. Results revealed that holistic education improves the knowledge, comfort, self-efficacy, and empowerment of cancer patients. Results indicated that it would be useful to conduct more studies to explore the impact of holistic instructional practices on patients with cancer. This study contributes to social change by providing instructors and health professionals with a deeper understanding of holistic instruction and how it can be used to improve whole-person healing.

The Medicare Annual Wellness Visit (AWV) has been available to Medicare beneficiaries since 2005; however, most eligible individuals have not taken advantage of this benefit. The literature supports that patients are willing to schedule and complete an AWV if urged to do so by their primary care provider; however, providers are reluctant to advise patients to pursue the AWV due to the lack of perceived value and overall health benefit. The integrative theory of health behavior change was used as the theoretical framework for the project. By increasing patient self-management skills through education, engagement, and support, the project was designed to create a positive impact on the overall health of individuals eligible for the AWV, as demonstrated by evidence of a long-term decrease in chronic conditions and related complications. A retrospective chart review was conducted to evaluate the number of preventive care measures completed in 2 patient populations: -¬those with a completed AWV in 2017, and those without a completed AWV in 2017. The number of completed preventive screenings for colon cancer, breast cancer, fall risk, and depression was as much as 41.6% higher among patients that had completed an AWV. The project's findings will be used to educate providers and patients about the usefulness of Medicare AWVs. Finally, the project findings support positive social change through enhanced patient activation in preventive health strategies.

United States high school student obesity rates have doubled in the past 30 years to 13%, threatening the health of millions of adolescents. To mitigate the epidemic, Congress passed the Healthy, Hunger-Free Kids Act (HHFKA) in 2010, which mandated significant changes to school nutrition and physical education. From a public policy perspective, the HHFKA changed school nutrition and exercise policy to affect obesity rates by changing intake and energy expenditure at school, though no study using national-level data examined this relationship. As such, the purpose of the study was to examine whether HHFKA policy compliance had a statistically significant effect on high school obesity rates. The theoretical framework for this study was the energy imbalance theory (EIT), as developed by James Hill, Holly Wyatt, and John Peters. The research questions focused on the relationship of HHFKA nutrition changes and childhood obesity rates. The study used Pearson's Product-moment correlation to test for a simple correlation between Compliance Scores and High School obesity rates. Findings revealed no statistically significant correlation between state high school student obesity rates and HHFKA compliance scores. Future research is needed to validate the findings after more time has passed with the HHFKA mandates in effect. The implications for social change include informing the debate over the efficacy of implementing the HHFKA as currently written to mitigate childhood obesity.

Health promotion and disease prevention are a focus of population health management. Without ongoing and rigorous evaluation, these programs may be in jeopardy of continuing. The purpose of this project was to conduct a descriptive population health- focused evaluation of a large-scale health system's employee health and wellbeing program. Guided by the Center for Disease Control and Prevention (CDC) framework for program evaluation in public health and National Center for Organization Development guidelines, a nurse-led evaluation was conducted using 5 specific data sets emphasizing organizational structure, employee health offerings, employee surveys, Pathway to Excellence survey, and program contributions. A descriptive analysis was applied towards interpreting the organizational structure, and identifying all contributions to employee wellness. Inferential analysis was applied to identify correlations between survey results. The findings of the evaluation were mixed. The organizational structure of the program complied with CDC wellness program guidelines; of the 97 service departments surveyed, results revealed an 83.51% improvement in engagement, disengagement, satisfaction, best places to work, and customer satisfaction. The Pathway to Excellence survey results revealed a supportive organizational structure for a culture of wellness. The program contribution analysis showed that the health system provided accessible wellness and health promotion opportunities. Positive social change may result from this evaluation as the program is reinforced and the focus on employee wellness, health promotion, and disease prevention services are continued. As a result, the lives of employees, their families, and communities might be improved.

Wellness is defined as an individual's lifestyle, choices, and habits as a way to achieve optimal health and well-being. Professional organizations and literature in the counseling field underscored the importance of enhancing personal wellness of professional counselors and counselors-in-training. The assumption underlying this movement was that counselors' personal wellness would be directly translated into their effectiveness with clients in counseling practice. However, this assumption has received little empirical attention. In addition, the review of counselor wellness literature illustrated the need for addressing potential moderators in the relationship of counselor wellness to counseling effectiveness as an attempt to provide an elaborated knowledge base for wellness interventions in counselor training. Thus, this study investigated the relationship of Korean counselors' personal wellness to their clients' perceptions of counseling effectiveness and the moderating effects of counselor empathy on this relationship. Participants in this study were 133 counselor-client dyads who had engaged in face-to-face individual counseling at university counseling centers or youth counseling institutes located in Seoul and Gyeonggi Province, South Korea. Survey measures for counselors were used for the assessment of personal wellness, empathy, and social desirability. Client survey measures were used to assess counseling effectiveness variables: (a) satisfaction with counselors' in-session behavior, (b) evaluation about the session impact, and (c) perception of the working alliance. The results from correlation and multiple regression analyses indicated that Korean counselors' personal wellness scores were not significantly related to their clients' ratings of counseling effectiveness. However, a series of hierarchical regression analyses revealed that Korean counselors' cognitive empathy moderated the relationships of their personal wellness to client-perceived counseling effectiveness. Specifically, the findings suggested that, for Korean counselors with lower levels of cognitive empathy, wellness in Essential Self had a positive influence on client-perceived session smoothness, but wellness in Coping Self had a negative effect on client-rated working alliance. Also, wellness in Creative Self was found to have a negative influence on client-perceived session smoothness only among Korean counselors with higher levels of cognitive empathy. These findings call into question the supposition that well counselors are more likely to be effective with their clients, suggesting that a more complicated interplay between counselor wellness and other potential moderators should be considered as a determinant of counseling effectiveness. Future research is warranted to see if this study's findings are replicated with American counselor samples. Limitations are presented with a focus on range restrictions on the counseling effectiveness variables and small effect sizes associated with the interactions. In light of these limitations, future research directions are also discussed.

The purpose of this dissertation study was to increase understanding of licensed mental health professionals' experiences as they have encountered and navigated through compassion fatigue (CF). CF is a complex construct with an attendant constellation of secondary stress responses. In order to examine the complex and varying factors associated with experiencing CF, the research was conducted using a grounded theory, qualitative approach and methodology. Nine licensed mental health professionals across the disciplines of marriage and family therapy, mental health counseling, professional counseling, psychology, and social work were individually interviewed three times, for a total of at least 180 minutes. All interviews were recorded, transcribed and analyzed. As a result of the analyses, four main categories emerged, experiencing internal dissonance, recognizing and processing the effects, becoming intentional, and creating ongoing changes. Becoming intentional is the central category because of its central and pivotal relationship to the whole process of participants' experience of encountering and navigating through CF. This fulcrum punctuates participants' experiences leading up to becoming intentional and those which came after as delineated in the other three categories of the theory. Prior to becoming intentional, participants experienced internal dissonance, which escalated to distress or crisis. When this distress or crisis reached a point where it became untenable, participants recognized and processed the effects. One of the effects which participants came to recognize was a loss of internal locus of control. Becoming intentional served as a catalyst for participants to take action and recapture their locus of control. The process of becoming intentional is reflected in three practices, transforming perceptions, developing support, and making professional changes. These findings are applicable to a variety of models of counseling, supervision, counselor education, and clinical practice in either a single or interdisciplinary setting. / Graduation date: 2013

Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2007.

Thesis (M.A. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2007.

Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2008.