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Liberty or Equality? A Comparative Approach to Welfare in the United States and France
Full text linkCaregiver’s Perspectives of Community Acceptance Before and After Surgical Treatment for their Child’s Disability
No full textBackground: In Tanzania, about 600,000 children and adolescents between the ages of five and twenty-four years old have a disability. Individuals with disabilities in Tanzania face numerous obstacles due to the social stigma and exclusion they face. The purpose of this formative evaluation is to assess how caregivers of children with correctable disabilities in Tanzania perceive their community’s acceptance of their child before and after surgical treatment.
Methods: A qualitative study was conducted. Interviews from 86 caregivers of children (ages … with disabilities treated at The Plaster House in Arusha, Tanzania were qualitatively analyzed using content analysis to assess for thematic grouping. Interviews assessed for caregivers’ feelings on their child’s medical challenges and experiences of stigma in their community. Caregiver experiences of stigma were categorized as “Positive”, “Neutral”, and “Negative” categories before and after surgical treatment.
Results: Content analysis resulted in five themes: stigma and acceptance (pre-treatment), stigma and acceptance (post-treatment), medical baseline (pre-treatment), medical progress (post-treatment), and emotional impact. These themes indicated that caregivers and their children experienced a range of emotional impacts before and after treatment, more severe stigma before treatment, and overall better medical status after treatment. Frequency analysis of caregiver experiences indicated that negative acceptance/stigma experienced by children and their families decreased from 74.39% before surgical treatment to 1.2% after surgery.
Discussion: Surgical intervention and post-surgical rehabilitation of physical disabilities mitigated experiences of social stigma for both children and their caregivers in their communities. Findings support the development of community-based rehabilitation programs
Improving Care Transitions and Nurse Satisfaction: A Discharge Planning Tool Quality Improvement Project
No full textStaff nurses in a Midwestern metropolitan hospital experienced dissatisfaction with the discharge process due to complexities and lack of readily available information. By creating a discharge planning tool that is centrally located within the electronic health record, this quality improvement project aimed to improve nurse satisfaction with the discharge process while positively impacting the length of stay and discharges before noon. Pre-intervention and post- intervention surveys were created using a 5-point Likert scale; surveys were distributed to the nurses via e-mail and as paper copies. The data for the discharges before noon and length of stay was extracted from existing dashboards in three-month increments for pre-intervention, during the project, and post-intervention. Descriptive statistics were used to evaluate the data. Results of the nurse satisfaction post-intervention surveys indicated a 17% increase in “always” or “almost always” satisfied with the discharge process. Based on the information that was pulled from the dashboards, length of stay decreased from an average of 5.17 days pre-intervention to 4.63 days post-intervention. There was a decreased number of discharges before noon in the post-implementation data, but there was also a sharp increase in the total number of discharges that took in the post-implementation time frame. The benefits of this project include a user- friendly discharge planning tool, and the findings contribute to easily accessed content for discharge planning for a systems-level, multidisciplinary care transitions overhaul within the hospital, as well as a culture change in the hospital to consistently include the staff nurse in the discharge planning process
The Effects of Phonics Instruction on Reading Fluency in an Elementary Classroom
Full text linkThis action research study aimed to determine the impacts of daily explicit phonics instruction and the impacts on reading fluency levels in a first-grade classroom. The intervention took place over ten weeks and included whole and small-group phonics instruction and independent practice. Seventeen six and seven-year-olds in a suburban elementary school participated in multisensory phonics activities for 20 to 30 minutes daily. Data was collected using seasonal benchmark assessments, teacher observations, and student self-reflections. Findings suggest that explicit phonics instruction increased reading fluency scores, but not significant enough to say it was the sole reason. Further research is needed to determine the effectiveness of phonics instruction over an extended period and for students with other learning needs, such as English language learners and special education students with academic goals
The Impact of Social-Emotional Learning Strategies on Performance Anxiety in the Fourth-Grade Music Classroom
Full text linkAdvanced Mental and Behavioral Health: Community-Based Practice
Full text linkThe purpose of this Masters project was to emphasize community psychosocial practice through collaboration with a local mental health organization by conducting a needs assessment, implementing a project at the community site, and evaluating the outcomes. Prior to collaboration with the organization, a literature review was conducted analyzing the role of occupational therapy working with individuals with serious mental illness. From this, it was found that occupational therapists can work with individuals with serious mental illness to engage in meaningful occupations, increase a sense of accomplishment, competence, and satisfaction, and participate in community living. Additionally, it is within occupational therapy\u27s scope of practice to provide resources and equip individuals with serious mental illness with the tools necessary to engage in social participation, community engagement, and leisure. From the information gathered in the literature review and needs assessment, it was determined to create and implement an activity resource binder and activity leader board to increase community engagement and leisure participation and provide leadership opportunities for the residents living at the community site. Overall, the resource binder and leader board received positive feedback from the stakeholders. It is anticipated that the community site will continue to use the activity resource binder and activity leader board for the long-term as we believe it will increase their leisure participation in diverse activities in their community and with one another
Implementation of a Staff Development Project to Impact Faculty Use of a Clinical Judgment Model Across the Pre-Licensure Nursing Curriculum
No full textBackground: Clinical judgment is an essential component of safe nursing practice and is often developed in nursing school. The National Council of State Boards of Nursing (n.d.) created the Clinical Judgment Measurement Model, as a framework for the valid measurement of clinical judgment and decision making within the context of a standardized, high-stakes examination, but little is known about how this framework can be used to guide faculty in teaching clinical judgment.
Problem: Senior level nursing students in this baccalaureate pre-licensure program at a private, urban, midwestern university showed lower exam scores on test items at higher cognitive reasoning levels, along with decreasing NCLEX pass rates. When surveyed, 42% of faculty indicated they lacked confidence in using the National Council of State Boards of Nursing’s Clinical Judgment Measurement Model to guide teaching strategies.
Methods: Surveys administered pre-, post-, and 10-weeks post faculty development allowed for analyses via paired t tests, Wilcoxon signed-rank, and repeated measures ANOVA to measure changes in faculty knowledge, confidence, and anxiety when teaching and evaluating student clinical judgment. A thematic analysis of open-ended qualitative survey responses was used to gain additional outcome data.
Interventions: A 1-hour faculty development session on teaching and evaluating student clinical judgment using the National Council State Boards of Nursing’s clinical judgment model along with the introduction of a clinical judgment model champion to support faculty during the new academic year. A Clinical Judgment Learning and Evaluation Tool was provided as an optional tool for faculty to utilize in their nursing curriculum.
Results: Pre- and post-faculty development session survey results showed statistically significant increases in faculty knowledge and confidence and decreased faculty anxiety when teaching and evaluating clinical judgment and using the National Council of State Boards of Nursing’s clinical judgment model. Qualitative data indicated the Clinical Judgment Learning and Evaluation Tool supported faculty in teaching clinical judgment skills and students in developing clinical judgment.
Conclusions: Faculty development is associated with increases in faculty knowledge and confidence, and decreased anxiety with teaching and evaluating student clinical judgment. Use of the National Council of State Boards of Nursing’s clinical judgment model shows promise for use as a conceptual framework to design faculty development on how to teach clinical judgment. Further research is needed on faculty development using the clinical judgment model and to establish reliability and validity of the CJLET
Assessing for Pressure Injuries Across All Skin Tones: Improving Nursing Knowledge and Confidence
No full textBackground: The prevalence of pressure injuries (PIs) across the country remains significantly higher in dark-skinned individuals compared to light-skinned individuals. As most PIs are preventable, hospitals are required to have protocols and guidelines in place for the prevention and assessment of PIs. Hospitals lack evidence-based guidelines for assessing skin in darkly pigmented individuals.
Local Problem: A large midwestern health system identified this gap as a priority for quality improvement (QI). The purpose of this QI project was to evaluate baseline nursing knowledge and confidence regarding the assessment and identification of PIs among all skin tones, assess the applicability of current evidence-based PI guidelines, and improve nursing knowledge and confidence in PI assessment and identification.
Methods: A QI project provided PI-related education to 45 bedside nurses at local 680-bed hospital. Educational content via a 15- minute PowerPoint was given over a 6-week period.
Interventions: Utilizing evidence-based research and nursing knowledge, a skin assessment tool and PowerPoint presentation was created to help improve identification and assessment of PIs. Posters with the acronym P.I.G.M.E.N.T. were displayed throughout the nursing break room. Survey questionnaires were distributed pre- and post-educational sessions.
Results: A total of 45 hospital RNs received the educational content, and 29 RNs completed both pre-education and post-education surveys. After comparing pre- and post-survey results, a significant increase in nursing confidence of assessing for PIs in darkly pigmented skin tones was observed and a moderate increase in nursing confidence of identifying PIs in lightly pigmented skin was observed. A moderate increase in nursing knowledge of identifying PIs in darkly pigmented skin was observed.
Conclusion: Through education, the long-term goal of this QI project is to see a decrease in the overall incidence of PIs in individuals across all skin tones. Through an educational PowerPoint presentation and the creation of a skin assessment tool, an improvement in nursing knowledge and confidence in identifying PIs among all skin tones was seen
Implementing an Education Program to Increase Advance Care Planning Awareness Among the Native American Population
Full text linkAdvance care planning (ACP) involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes (Jones et al., 2021). Advance care planning rates in the United States are generally low, with significantly lower rates among marginalized groups of Native Americans (Jones et al., 2021). The purpose of this quality improvement project was to implement a culturally appropriate educational intervention that increases participation in completing advance care planning among older Native American residents through individual approaches and easy-to-read educational materials. Twelve residents participated in the quality improvement project, which entailed one-hour meetings with the project manager and faculty. Data was collected immediately before and after education implementation to obtain more accurate results. The finding from the data analysis suggested that integrating health literacy and culturally appropriate health education significantly impacted participants’ enrollments and ACP knowledge improvement from 33.33% to 66.67%
Depolarizing Leaders – A Peacebuilding Approach to Healing the Divide
Full text linkWe are at a critical juncture in an increasingly divisive and partisan United States. Political polarization, with its underlying social divisions, has worsened these past 20 years into extreme ideological and affective polarization – which are having deleterious effects on American government, institutions, and society (Carothers & O’Donohue, 2019b). While the academic literature points to a salient need to disrupt and remedy polarization, little has been written about grassroots approaches to depolarization, and even less about depolarizing leaders themselves. My research addressed this gap. The purpose of this qualitative research project was to explore the work of depolarizing leaders – what they are trying to do, what it takes to do this work, and to what effect. The data for this qualitative research project was collected via semistructured interviews with nine depolarizing leaders in the United States. The findings describe how the study participants are trying to effect transformational individual and societal change via bottom-up grassroots dialogue work in order to build healthy relationships and foster collaboration. They give us a better understanding of what it takes to be a leader in the depolarization arena, explicate the challenges these leaders face, and point to the need for more evaluative studies to gauge the efficacy of their work. The implications of this study are practical – they can be used to inform the work of depolarizing leaders, and the depolarizing arena more broadly, as well as benefit the general public. In addition, they point to potential areas for further research