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Improving the Assessment and Care Management of Patients with Diabetes at Risk for Foot Ulcers and Amputations
Get PDFPurpose: To implement guidelines set in 2016, by the American Diabetes Association (ADA), which recommend annual and periodic foot exams for patients with type II diabetes mellitus (T2DM). Background: Uncontrolled diabetes and foot complications can lead to permanent disability, loss of employment often leading to depression and increased morbidities (Szpunar, Minnick, Dako, & Saravolatz, 2014). Significance of Problem: Individuals who are diagnosed with diabetes are at risk for foot ulcers and amputations if not properly managed. Implementation of a foot screening program has been shown to reduce foot ulcers and amputations (Peterson & Virden, 2013). Methods: Annual and periodic foot exams occurred from June 6th through August 12, 2016 at the home of 48 T2DM patients. Early education on how to assess the diabetic foot and document findings was provided to primary healthcare providers and medical assistants with a focus on adherence to ADA recommendations. The outcome of increased ability to assess the feet and document was measured by a chart audit of 48 patient charts. A chart review was conducted for verification of delivery of educational material to the patient along with the completion of foot screening criteria for podiatry referral. Results: Implementation of the ADA guidelines by healthcare providers improved foot care management and documentation by 83% when 40 patients out of 48 received a correct assessment. Conclusions: The Doctor of Nursing Practice project increased adherence to the ADA guidelines improving the diabetic foot screenings and documentation with sustained change and better care to T2DM patients
Pastoral Leadership Experiences and Organizational Outcomes in Contemporary Catholic Communities: The Clerical Perspective
Get PDFThis interpretive qualitative study explored pastoral leadership experiences of 8 Catholic priests serving in the Central Texas area of the United States. The purpose was to understand what their pastoral experiences meant for them as religious leaders and how their various perspectives would portray pastoral leadership in the 21st century Church. Participants were Catholic priests with 5 to 25 years’ experience in the ministry serving as fulltime pastors in parishes. Data collection was through open-ended interviews conducted in conducive locations. One general question was asked that enabled participants to tell their stories about their pastoral experiences since ordination. These were followed up with questions that explored important issues in the stories. This measure provided clarifications that enriched research outcomes in terms of thick description. The data was analyzed using the management (description), abstraction (reduction), and interpretation model (Braun & Clarke, 2006; Merriam et al., 2002; Spencer, Ritchie, Ormston, O’Connor, Barnard, 2014). Credibility was safeguarded through member check and triangulation of data. Analysis of the data resulted in identification of 4 themes. These themes showed that participants understood and embraced the priesthood as a vocation as opposed to profession. Similarly, they understood and undertook pastoral leadership as a ministry of service and commitment, a ministry of complex realities, and a ministry with diverse challenges. The level of commonality among participants in their experiences was 6 out of 8. By examining the themes vis-à-vis views in the literature and leadership theories, it was evident that participants’ pastoral activities positively reflected views in the literature about pastoral leadership in the 21st century. Likewise, their styles exemplified the 4 characteristics of transformational leadership. The research findings have provided a platform for understanding the state of affairs in the Church’s pastoral ministry, albeit, participants’ faith communities. Participants’ description of their pastoral experiences revealed an understanding of Church leadership as a response to God’s call to service. The outcome of this perception was a people-centered engagement that operated on the basis of Christlike qualities. Despite the challenges and setbacks that participants described in their stories, the visionary, creative, motivational, resilient, and collaborative qualities they exhibited resulted in tangible outcomes, namely, organizational growth and wellbeing of members in their parishes
Enabling Change: Faculty and Student Perceptions of Blended Learning
Get PDFThe philosopher Plato in his Seventh Epistle argued that the technology of writing is an insufficient means of society conveying knowledge and obtaining truth (Neel, 1988). Many insights from his rhetorical works however are etched in history by this technology. As society moves further into the information age, the relevance of blended learning in higher education is taking on greater significance (Garrison & Vaughan, 2008). Higher education institutions are on the verge of another significant paradigm shift in the dissemination of knowledge and truth. Understanding the shift to new computer-mediated means of knowledge delivery through blended learning experiences requires an understanding of the perceptions held by both the instructor and student. This quantitative research study used a survey questionnaire to obtain feedback from faculty and students at a private liberal arts university on their perceptions of the use, frequency, readiness, and satisfaction with web-based technology in a blended learning environment. To obtain greater insight to student and faculty perceptions, quantitative and qualitative data was collected through an online survey distributed to faculty and students during the spring semester of 2016. Descriptive data was analyzed using IBM’s SPSS statistical tool and reported out. Results of this study indicate close agreement of student and faculty on perceptions of satisfaction with the frequency, use, and satisfaction with the web-based tools used in the course of a blended learning class. There is however, a significant difference in the way faculty perceived their preparedness with web-based technology used in the classroom and how students perceived faculty’s preparedness
Investigation of the Enviromental Factors Associated With the Temporal Abundance of Lutzomyia Anthophora on a Ranch Near Poth, Texas
Get PDFLeishmaniasis is caused by infection with protozoan parasites within the genus Leismania transmitted by the bites of female sand flies within the genus Lutzomyia in the New World. This study investigated the seasonal abundance of sand flies and evaluated the correlation of temperature with abundance data. Sand flies were collected at the Garrison ranch near Poth, Texas (28° 57’ 10” N; 98° 7’ 28” W) from May in 2014 through October, 2015. Recorded highest abundance of sand flies in 2014 was in October, 2 females Lu.anthophora and 5 males Lu.anthophora were captured producing 0.58 sand flies /trap night, while, mean ambient air temperature was 23.35°C, and mean temperature of the woodrat nest was 23.57°C. In 2015, recorded highest abundance of sand flies was in July, 7 female and 4 males Lu. anthophora were captured, producing 0.91 sand flies /trap night. While mean ambient air temperature was 29.17°C, and mean temperature of the woodrat nest was 27.74°C. during the given data of 18 months, strongest positive correlation with ambient air temperature and woodrat nest temperature and sand fly abundance. Increased sand fly abundance was associated with an increase in ambient air temperature and woodrat nest temperature. In Texas small changes in temperature can expand the geographical area in which the Leishmania is able to replicate, allowing increase in endemic areas
Blended Learning: Institutional Frameworks for Adoption and Implementation
Get PDFBlended Learning in education is the future for higher education. The rapid changes in technology combined with a demand for a more agile environment is transforming the traditional classroom and challenging learning models. Higher education has been adapting by moving classroom time into purely online environments. However, the literature suggests the new wave of learning is extracting the best practices from traditional and online models and infusing them into a blended environment. The agility and use of technology allows the non-traditional student to balance a professional career and life demands while still gaining the benefits of face-to-face time in the physical classroom. Universities also benefit from these models by staying competitive in student recruitment and the ability to increase class demands by forfeiting classroom space. The definition of blended learning for this study is combination of face-to-face instruction (25-75%) with online (various technological) self-guided modalities. The purpose of this study is to analyze frameworks for blended learning adoption and implementation among U.S. business schools that are accredited through the AACSB and ACBSP. The goal was to understand the overall blended learning framework of US business schools and the maturity of these options. A quantitative data collection instrument was adapted from the qualitative BLAF study by Graham et al. (2013) and administered to a total of 814 AACSB or ACBSP accreditation business schools during the summer of 2016. The total response rate was 55% and after omitting incomplete responses, a sample size of 227 was analyzed. The overall results indicated that BL is available throughout various levels within business schools, however due to lack of institutionalization; the respondents lacked the knowledge to gauge the maturity of BL options within their university. Finally, results from the study demonstrate an emerging trend and confirm that before assessing BL maturity, institutions should adopt a common framework for comparison to other institutions as a way to measure success and growth
Personal Decision Factors Considered by Information Technology Executives: Their Impacts on Business Intentions and Consequent Cloud Computing Services Adoption Rates
Get PDFDuring its infancy, the cloud computing industry was the province largely of small and medium-sized business customers. Despite their size, these companies required a professionally run, yet economical information technology (IT) operation. These customers used a total value strategy whereby they avoided paying for essential, yet underutilized, resources (e.g., full-time IT personnel and computing equipment with excess capacity) by outsourcing most, if not all, of their entire IT function. Since that time, the cloud industry has expanded the breadth of its service offerings greatly and the economies of scale have reduced the unit price point. In addition, research suggests other factors are believed to exist that make a decision to execute a wholesale “rip and replace” of legacy systems difficult for today’s IT executives. Accordingly, this study sought to identify factors that affect the decision-making process of IT executives when evaluating conversions of applications to cloud-based solutions. While theories such as diffusion of innovation (DOI) theory, transaction cost theory (TCT), and agency theory influenced this research, motivation theory and the technology, organization, and environment (TOE) framework made the greatest contributions to the foundation of the study. The exploration of personal factors that influence current business intentions to adopt cloud computing services is an important research topic for several reasons. There is an implication of a strong academic and industry interest in the area from the considerable research conducted and published concerning IT strategies related to cloud computing. Most prior research has been limited to the benefits and basic strategies behind cloud computing and related operational and financial considerations. Nuseibeh and Alhayyan’s (2014) recent extensive literature review identified personal factors that contribute to the adoption of cloud computing services as a gap in current research. Prior research has not explored the personal challenges and barriers to broader acceptance of cloud technology. Furthermore, little research has addressed the specific barriers to acceptance or the specific factors considered in the decision-making process. This study found several personal decision factors influence the decisions of IT executives regarding the selection of cloud computing services. Data collected from 189 respondents supported five of the seven hypotheses. These hypotheses state that advancement, recognition and satisfaction from accomplishments, top management support, diminishment of personal image, and pattern of technology readiness have a positive influence on business intentions to adopt cloud computing services. The diminishment of personal image finding in the current study warrants additional research to gain an understanding of its business implications. These results may provide insights into the challenges sales organizations that cloud computing service providers face when attempting to market their offerings. Proposals that include strong, viable provisions for mitigating risks (e.g., assigning an experienced project manager to the migration project, means for ensuring data security, provisions for thorough system and performance testing, etc.) have a greater likelihood of acceptance by IT executives. The constructs in this research also contribute additions to the nomological network (a creation of Cronbach and Meehl [1955]) that may support future research into personal influencers of new technology decisions
Improving the Adherence of Providers to the American Academy of Sleep Medicine Guidelines for the Evaluation, Treatment, and Management of Obstructive Sleep
Get PDFThe purpose of this project is to increase the adherence of clinic providers to the American Academy of Sleep Medicine’s Clinical Guidelines for the Evaluation, Management, and Longterm Care of Obstructive Sleep Apnea in Adults. OSA is a chronic condition that effects from 2% to 10% of the U.S. adult population. Implications of undiagnosed OSA include excessive daytime sleepiness, fatigue, irritability, difficulty controlling chronic diseases including diabetes and hypertension, heart arrhythmias, gastroesophageal reflux disease, mood disorders, attention deficit disorder, and an increased potential for dementia if left untreated. A protocol was created to align providers with the clinical guidelines. Provider responsibilities included screening all patients 18 and over for OSA, referring patients with a positive screen for a sleep study, prescribing CPAP when indicated, and providing short-term follow-up. At project completion 293/405 patients (72%) ages 18 and over had been screened, 58 (20%) had positive screens, 53 (91%) with a positive screen were referred for sleep study, 19 (35%) completed the sleep study, 19 (100%) were diagnosed with OSA and prescribed CPAP, and 18 (95%) were scheduled for short-term follow-up. There were no significant differences noted between age distribution and the receipt of a positive diagnosis of OSA, F (3,504) = .066, p = .679. During implementation 19 (7%) patients were identified and treated for OSA. The relationship between using a screening tool to assess risk of OSA and receipt a positive diagnosis of OSA was significant, χ2 (1, 505) = 5.982, p \u3c .05. Only 19 out of 53 patients referred for sleep study completed a sleep study indicating a need for continued work on intervention models that will facilitate patient completion of diagnostic testing with subsequent referral for treatment
A Case for Spiritual Change Readiness: A Correlational Study
Get PDFThe purpose of this quantitative, correlational study was to investigate whether a relationship existed between spirit at work and attitudes towards organizational change among adults working in various industries. The Spirit at Work Scale (SAWS) measured the independent variable and the Attitudes Towards Organizational Change (ATOC) scale measured the dependent variable. Four factors (engaging work, sense of community, mystical experience, and spiritual connection) measured spirit at work. Three factors (cynical attitudes, fearful attitudes, and accepting attitudes) measured attitudes towards organizational change. Three hundred and ten responses were collected via Amazon’s Mechanical Turk online workforce and analyzed. A Pearson’s correlation test revealed a strong, positive, and statistically significant relationship between spirit at work and attitudes towards organizational change at the .01 level. Of the 12 paths (3 factors x 4 factors) explored, 10 of the 12 path coefficients revealed statistically significant relationships at the .05 level. A series of MANOVAs and ANCOVAs also determined religion, industry, and organization type had significant effects on cynical attitudes, fearful attitudes, mystical experience, sense of community, and engaging work. This study indicated employees with a sense of community and engaging work were more accepting of change and organizations would benefit from an intrinsic, spiritual approach to change management. Therefore, a model for spiritual change readiness was offered to guide research and practice
Breaking Television News: Is Social Media Coverage You Can Count On?
Get PDFThis mixed methods study explored how 10 television journalists and photojournalists handled social media’s integration and its impact on television news. A quantitative survey modeled after Moore and Benbasat’s (1991) instrument using the Diffusion of Innovations theory as a foundation measured how participants adopted social media in newsgathering and dissemination. Through qualitative one-on-one interviews, data revealed that participants believed social media was advantageous in collecting and reporting television news. Television journalists were able to locate sources, experts, and visual images. Social media allowed participants to report live from the scene and deliver news quickly. The innovation enabled participants to connect and interact with viewers and promote their personal and professional brands. The use of social media has encouraged station managers to be first with information, albeit adding concerns of releasing false or incorrect information. Both television journalists and photojournalists realized that social media forced them to become more creative storytellers. This study uncovered how social media transformed television news, its impact on the workload of television journalists, and if the use of social media triggered concerns for the quality and accuracy of content. Results from this study explained the need to understand a changing business model, the potential for news to go wrong, and the rise of multimedia journalism
