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An affinity for alignment: Spontaneous convergence of stance-taking in topical conversations
Get PDFAlignment in stance-taking is a foundational behavior in conversation, but few studies have quantified the degree to which conversationalists converge in their attitudes toward a topic. We attempted to quantify this convergence in terms of three parameters related to alignment: intensity (low to high), prevalence (percentage of time in alignment), and content (use of open-ended versus closed-ended statements). To examine the utility of these parameters, we compared the content of conversations between unacquainted dyads in either a free conversation condition or a topical condition in which the individuals were mismatched for their attitude toward the topic to maximize disalignment between them. The results revealed that, paradoxically, the dyads in the topical condition showed a higher degree of alignment along all three parameters than did the dyads in the free condition. This finding may reveal a general tendency for people to seek out common ground during first-contact encounters
Interpersonal Violence Within Same-Sex Relationships: Survivors’ Perspectives of Counselor Competency
Get PDFSurvivors of same-sex intimate partner violence (IPV) face negative mental health consequences. A lack of research exists on how social support, emotional and coping regulation, and counselors’ behaviors, knowledge, and skills affect the help-seeking behaviors and therapeutic outcomes of survivors of same-sex IPV. Addressing the gap is important because recent studies report an increase in same-sex IPV but low levels of help-seeking behaviors in response. If unaddressed, IPV can affect the well-being and safety of those partnered individuals. The purpose of this qualitative hermeneutic phenomenological study was to explore the experiences of same-sex IPV survivors who received therapeutic counseling. The theoretical foundation for this study was hermeneutic phenomenology and minority stress theory. The research question sought to answer what the lived experiences of the same-sex survivors of IPV are, their perceptions of counselor competencies, and whether the therapeutic relationship affected the outcome of therapy. The six participants were same-sex IPV survivors. Data was analyzed using thematic analysis. Minority stress was found to be related to the abuse. The results of this study suggest that individuals who experience same-sex IPV have numerous challenges when trying to acquire help. The findings substantiate the need to improve counselor competency in working with same-sex IPV survivors. Recommendations for future research include the use of a larger sample size, a mixed-methods approach, and a cross-sectional or longitudinal design. The study may lead to positive social change for individuals in same-sex relationships who have experienced IPV by showing areas of need for counselor improvement
Effect of Stages of Prehospital Hypertensive Crisis and Length-of-Stay on Acute Stroke Readmission
Get PDFStroke is the second leading cause of mortality and the third leading cause of disability, affecting over 800,000 Americans annually. Traditional stroke research has focused on in-hospital settings, but not on prehospital stroke admissions, despite evidence that over 75% of acute stroke cases managed by emergency medical services involve prehospital hypertensive crises (HTN-C). HTN-C is classified into three systolic blood pressure (SBP) stages: Stage 1 (140–159 mm Hg), Stage 2 (160–179 mm Hg), and Stage 3 (≥180 mm Hg), the latter associated with organ damage. Hypertension correlates with longer hospital stays and more intensive interventions in hospitalized patients, but HTN-C alone is not associated with 30-day hospital readmissions. To date, there is no available research on the role of HTN-C and LOS on 30-day hospital readmissions in prehospital stroke cases while controlling for age, race, gender, and diabetes as a comorbidity. Secondary data consisting of 527 prehospital stroke cases from a Midwestern hospital between 2018 and 2022 were extracted from the Get with the Guideline Stroke database and predictors of 30-day hospital readmissions were analyzed using a binomial logistic regression model with SPSS v29. The study was guided by the patient-centered care model and Donabedian’s conceptual framework. The results indicated that length of stay (OR = 1.072, 95% CI [1.011, 1.136], p = .019) was a positive predictor of 30-day hospital readmissions when controlling for patient age (OR = 1.019, 95% CI [1.001, 1.037] whereas HTN-C was not significant. These findings may help inform modifications to traditional in-patient stroke care interventions based on predictors specific to prehospital stroke admissions and create positive social change
A Clinical Practice Guideline for Screening for Insomnia in College Students
Get PDFInsomnia and sleep deprivation are highly prevalent issues among the U.S. college student population, contributing to a significant health care gap due to the inconsistent performance of routine clinical screening. This Doctor of Nursing Practice (DNP) project sought to determine the rigor and applicability of a Clinical Practice Guideline (CPG) designed for the early identification of insomnia in college students using a best-evidence screening tool within a rural health clinic. The primary practice-focused question was: In a rural health clinic, will a CPG for implementation of a screening tool based on best evidence for early identification of insomnia in college students be approved by a panel of experts using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool? The CPG centered on the implementation of the Insomnia Severity Index (ISI-7). The guideline was evaluated by a panel of experts using the AGREE II instrument. Analysis of the AGREE II data demonstrated high methodological quality, with domain scores ranging from 6.45 to 6.67 out of a maximum of 7, yielding an overall approval result of 6.67 out of 7. These robust validation scores support the formal adoption of the ISI-7 as a standardized screening tool within the clinical setting. The project recommends the immediate formal implementation of the ISI-7, comprehensive training for clinic staff on its use, and the development of a clear follow-up and referral protocol to improve patient outcomes and address this critical student health disparity
Public Housing Professionals Perspectives on Mobile Food Unit Location and Accessibility for Children
Get PDFPoor nutrition is a major contributor to death in the United States, and residents of public housing face disproportionate challenges in maintaining adequate nutrition. Public housing is the nation’s oldest housing subsidy program, providing more than one million units for millions of residents, many of whom are women, minorities, and unmarried individuals with incomes below the poverty line. The purpose of this generic qualitative study was to explore public housing professionals’ perspectives on using a mobile food unit located within housing communities to help reduce food insecurity. Feminist intersectionality theory provided the framework for this study, emphasizing how overlapping systems of inequality, including racism, classism, and sexism, shape access to resources such as food. Semi-structured interviews were conducted with 13 public housing professionals across five southern states. Thematic analysis produced six key theme findings: (a) Food insecurity exists in public housing. (b) Everyone needs food, not just children. (c) Food subsidy programs are not enough. (d) In addition to income, large family sizes and access to the internet are challenges to accessing food. (e) There are multiple ways people get access to food. (f) Mobile food units are needed to reduce food insecurity. These findings may support social change by guiding nonprofit, human and social services providers, faith-based, and governmental organizations in developing strategies including mobile food units to decrease food insecurity in public housing communities
Telepsychiatry for Veterans Who Are Homeless
Get PDFThis project was a clinical practice guideline (CPG) for mental health providers to expand telepsychiatry services to veterans who are homeless in a day treatment center. The practice problem was the lack of a standardized approach to increase access to mental health care. This CPG supports nurses in implementing evidence-based interventions to reduce mental health disparities and promote equitable care delivery for veterans who are homeless. The guideline was aimed to ensure safe, effective, and coordinated mental health care through integration with interprofessional teams. The project question was: Does the evidence support development of a CPG for provision of telepsychiatry services for veterans who are homeless that receives a quality score using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and is approved for use in the practice setting by end users? The purpose of this project was to develop a CPG for providers on use of telepsychiatry to improve mental health care delivery for veterans who are homeless. I used the Johns Hopkins evidence-based model to collect, organize, and analyze the 22 items of evidence that supported this project. An expert panel evaluated the quality of the CPG across six domains using the AGREE II instrument. Domain scores from the two members of the expert panel ranged from 94.4% to 100%, resulting in a high-quality score. The global assessment scores were 97.4% and 96.4%, confirming high methodological quality and recommendation for use without modification. The development of a CPG for telepsychiatry enhances access to equitable, evidence-based mental health care for veterans who are homeless at the project site. This project contributes to reducing mental health disparities, promoting health equity, and advancing social justice for vulnerable and marginalized populations
Staff Education to Peri Operative Registered Nurses
Get PDFThis Doctor of Nursing Practice (DNP) project implemented a staff education initiative to enhance perioperative nursing adherence to evidence-based practices for preventing surgical site infections (SSIs). SSIs remain among the most prevalent healthcare-associated infections, affecting 2%–5% of surgical patients and contributing to extended hospital stays, higher costs, and preventable morbidity. The practice-focused question guiding this project was: In adult surgical patients, how does the implementation of a perioperative nursing education program on SSI prevention, compared to standard practice, affect SSI incidence rates over a 2- to 4-month period? The project applied the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model to guide literature review and decision-making and the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) framework to structure educational design and evaluation. Ten perioperative registered nurses participated in the intervention, which consisted of interactive PowerPoint sessions, competency demonstrations, audit feedback, and staff confidence surveys. Data were collected using validated pre- and post-knowledge assessments, competency checklists, and infection-control audits. Following the intervention, perioperative nurses demonstrated significant improvements in knowledge, competency, and confidence in SSI prevention. Knowledge scores increased from 65% to 90%, competency validation improved from 60% to 100%, and staff confidence rose from 50% to 90%. Most importantly, SSI incidence decreased by 50% during the 2- to 4-month evaluation period. These findings confirm that structured, nurse-led education programs can effectively improve adherence to SSI prevention protocols and patient safety outcomes. The initiative positively impacted the organization by strengthening compliance with accreditation standards and reducing preventable harm. Recommendations include expanding the education program to additional perioperative units, integrating it into annual competency training, and maintaining compliance through real-time audit feedback. This project underscores the critical role of advanced practice nurses in translating evidence into practice, fostering interprofessional collaboration, and advancing social change through equitable, standardized infection-prevention strategies
Strategies to Improve Employee Retention and Organizational Performance in Healthcare
Get PDFA lack of effective strategies to improve employee retention and organizational performance is a concern for healthcare leaders. Without such strategies, organizations may incur costs through recruitment and training, reduce productivity due to workflow disruption and knowledge gaps, damage employee morale by increasing workloads for remaining employees, and harm the organization’s reputation, potentially affecting patient relationships, hindering growth, and eroding any competitive advantage. Grounded in Penrose’s resource-based view theory, this qualitative pragmatic inquiry was to identify and explore the effective strategies healthcare leaders use to improve employee retain and organizational performance. Participants were six leaders of healthcare organizations located in the southern United States with at least 5 direct reports and 3 years of management experience. Data were collected through semistructured interviews and analyzed using Braun and Clarke’s six-step thematic analysis. Four key themes were revealed: (a) listening to employees, (b) recognizing and rewarding employees, (c) investing in employee development and growth, and (d) cultivating a trusting, supportive work environment. Key recommendations include actively listening, provide meaningful recognition and opportunities for learning and career advancement, and cultivating a supportive and trusting workplace culture. The implications for positive social change include the potential for healthcare leaders to retain their employees, reduce turnover and its associated costs, and foster stability, productivity, and innovation, thereby enhancing the quality of services delivered to the community through a higher performing organization
Development of an Evidence-Based Clinical Practice Guideline for a Comprehensive Care Partner Program for Postpartum Women
Get PDFThis doctoral project focuses on the development of a clinical practice guideline (CPG) aimed at addressing a critical gap in postpartum care, particularly postpartum depression (PPD), inconsistent follow-up, and low breastfeeding continuation rates, which disproportionately affect African American women and other underserved populations. These gaps contribute to preventable morbidity, poor maternal experiences, and health inequities, making this issue a priority for nursing and public health. The guiding practice-focused question asked if an interdisciplinary team would achieve consensus on a clinical practice guideline for the development of a comprehensive care partner program for postpartum women. Analytical strategies included a systematic evidence review using the Johns Hopkins Evidence-Based Practice (JHEBP) model and synthesizing research and non-research evidence. The draft CPG was reviewed by an interdisciplinary panel of four expert reviewers, one each from obstetrics, nursing, behavioral health, and social work. They used the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool, which is a validated instrument used to evaluate the quality of clinical practice guidelines. Expert reviewers demonstrated a mean of 6.45/7 on the six AGREE II domains, with reviewers recommending the guideline for clinical use. The project has important implications for nursing, advancing equity, and reducing racial disparities in healthcare. By emphasizing diversity and inclusion to ensure culturally competent care for all postpartum women, the guideline fosters trust between healthcare providers and patients while enhancing maternal health outcomes
Effective Strategies for Business Leaders of Homeschool Consulting and Testing Services to Attract New Clients and Sustain Operations
Get PDFBusiness leaders of homeschool consulting and testing services are experiencing a critical challenge in attracting new clients, which threatens their ability to sustain operations. Grounded in the Baldrige excellence framework and the diffusion of innovation theory, the purpose of this qualitative single case study was to explore effective strategies used by one business leader of a homeschool consulting and testing services organization in North Carolina to attract clients and sustain operations. Data sources included (a) semistructured interviews, (b) organizational archival records and documents, (c) public data such as reports and websites, and (d) literature including peer-reviewed articles and books. Findings from thematic analysis revealed themes of process strengths, process opportunities, results strengths, and results opportunities. A key recommendation was for educational consulting leaders to adopt targeted digital marketing integrated with performance excellence frameworks to enhance client acquisition and operational sustainability. Implications for positive social change include the potential for expanding access to tailored educational services, strengthening parental capacity, and promoting educational equity and long-term student success in underserved communities