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The Relationship Between Body Mass Index, Fitness, Socioeconomics, and Academic Accountability School Rating: A Texas Study
Get PDFBetween 1980 and 2000, obesity rates in the United States have doubled for adults and tripled for children (Centers for Disease Control [CDC], 2015). In addition, Texas, the second largest state, ranks 10th for the highest percentage of obesity among youth age 10-17 (CDC, 2015). Nationally, the United States falls behind other countries in high school and college completion rates (Greenstone, Harris, Li, Looney, & Patashnik, 2012), and since 2001 when the No Child Left Behind Act (NCLB) began, school administrators have reduced physical education, art, music, and recess by 44% to increase the time students spent in reading and math courses preparing for standardize tests (Kohl & Cook, 2013). While standardized testing helps measure student learning, it may be that it also contributes to the growing obesity epidemic among youth in America. This study examined the school-level relationship between body mass index (BMI), fitness, socioeconomics, and academic accountability school rating in Texas for 3 separate school years (2010-2011, 2012-2013, and 2013-2014). A significant relationship between BMI, fitness, and academic achievement was found. However, the relationship was inconsistent. This study adds to existing research and uses the most recent data to date
An Initiative to Improve Primary Prevention of Heart Disease in Adults With Type II Diabetes Based on the ACC/AHA (2013) and ADA (2016) Guidelines
Get PDFHeart disease is the leading cause of death in the United States and in Texas. Hyperlipidemia is a precursor to cardiovascular disease and is a highly manageable and treatable acute and chronic disease in the outpatient primary care setting. This project is designed to increase clinicians’ adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (2016) clinical practice guidelines for the prevention of heart disease in 40 to 75 year old adults with type II diabetes through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a primary care setting. The objectives were to initiate assessment of atherosclerotic cardiovascular disease risk scores, improve diet/exercise counseling, and increase use of statin therapy when applicable. Key activities included interactive meetings, open discussions with staff, resources including the guidelines, and weekly performance emails. The electronic alert was implemented as a reminder to assess the target group. Three outcomes were analyzed. Atherosclerotic Cardiovascular Disease risk score assessment increased from 0% to 76.7%, diet and exercise counseling documentation increased from 85% to 100%, and statin therapy application increased from 55.1% to 72.2% in eligible adults 40 to 75 years old with type II diabetes. The interventions were successful in improving clinician adherence to the clinical practice guidelines. This initiative helps to build the body of evidence regarding useful interventions to improve primary prevention of heart disease by improving provider adherence to the clinical care guidelines for 40 to 75 year old adults with type II diabetes
A Systems Intervention for the Transition of Postpartum Women to Primary Care
Get PDFThe Institute of Medicine (2001) describes the United States’ healthcare system as poorly organized and difficult for patients to navigate. Patients are often lost during the transition between providers, failing to establish subsequent care (Thomas, 2015). Gaps in care lead to worsening conditions that result in billions of dollars in healthcare costs (National Quality Forum, 2016). Following discharge from the care of the obstetrician, postpartum women should establish care with a primary care provider (American College of Obstetrics and Gynecology, 2016). The American College of Obstetrics and Gynecology recommends that postpartum women transition to a primary care provider within the year following childbirth (Pai-jong, Nakashima, Yamamoto, Ngo, & Kaneshiro, 2011). Less than 33% of women nationally adhere to this recommendation (John Hopkins Medicine, 2014); less than 5% of women within the host clinic transitioned to a primary care provider. This project aimed to improve the transition of postpartum women, ages 18 to 44, to a primary care provider. The primary objective was to increase the number of postpartum women who scheduled and attended a primary care provider appointment within 2 months of delivery. The intervention included patient information material, staff training, and a process for establishing care with a primary care provider. Between June 12, 2016, and August 15, 2016, 27 women met the inclusion criteria. Following the intervention, 23 women (82%) scheduled a primary care provider appointment, and 12 women (44%) attended the appointment. Results suggest that a combination of provider counseling, patient education, and assistance with the transition process can influence patient adherence to expert recommendations for establishing subsequent care
Implementation of Quality Improvement Interventions to Increase Provider Adherence to Standards of Medical Care in Diabetes
Get PDFPurpose: To improve a South Texas primary care clinic’s diabetes management system by implementation of a quality improvement intervention to help staff and medical providers increase adherence to the American Diabetes Association standards of care related to screening referrals and orders for urine microalbumin, in order to improve self-care and health outcomes for adult patients with diabetes. Background and Problem: Diabetes is the 7th leading cause of death in the United States and the cause of vision loss, amputations, and end-stage renal disease. The patients at the Wellness Center do not consistently receive routine screenings for neuropathy, retinopathy, nephropathy, microalbumin, and diabetes self-management education as recommended. Methods: The Doctor of Nursing Practice student conducted a quality improvement project introducing practice-aids to reinforce adherence to the American Diabetes Association recommended diabetes guidelines for screening and referrals. Pre and post intervention evaluation methods were employed. Results: Provider adherence to diabetes guidelines was measured through documentation in patient records before (N = 50) and after (N = 50) the interventions. The number of referrals to ophthalmologist increased from 48% to 100%, podiatry from 60% to 100%, diabetes selfmanagement education from 10% to 98%, microalbumin screening from 24% to 98%, and inspection of patient feet from 0% to 100%. Nine other quality improvement indicators were also significantly improved. Conclusions: Practice aids were effective in increasing adherence to the recommended American Diabetes Association diabetes treatment guidelines
Quality Improvement Programs’ Contribution to Successful Clinical Practice Changes
Get PDFThere is a great deal of healthcare literature on the importance of QI programs and the significant contributions they make toward patient safety and patient satisfaction; however, documentation of outcome measures and predictors of success remains challenging. This study examined the experiences of physician participants who attended a state supported South Texas medical school’s CSE course to gain an understanding of QI education, demonstrate the need for formal QI education, and determine if a change in clinical practice occurred as a result of attending a structured QI course. Kirkpatrick’s (1967) four-level evaluation model was used as a framework to guide the study in two key areas. The model was used to examine the experiences of the CSE physician participants to gain a better understanding of quality improvement, and it was used as a self-assessment instrument to determine baseline data of the physicians’ knowledge to help identify if a change in clinical practice occurred after graduating from the CSE course. Thirteen one-on-one interviews were conducted through self-evaluation questions. Participants shared their experiences and perceived outcomes about their own understanding of the quality principles learned in the CSE course and the framework in which they continued the CSE project’s implementation for their department or division. An adopted framework from Labov’s (1972) structural analysis and Kirkpatrick’s four-level evaluation model (1967) was used to help determine the effectiveness of the program and ways in which improvements could be made within the CSE physician graduates’ clinical practice. Through their shared experiences, the participants demonstrated the need for QI education and its ability to change clinical practice behavior. Results also revealed positive physician learner experiences. These positive experiences helped change how the physicians practiced within a clinical scope, helped shape the culture for the organization, and helped produce a progressive culture of self-development. Some of the physician learners expressed concerns in time management, funding, and support of leadership. In this study, the participants’ experiences were important to the success of QI initiatives within a healthcare system. If the system wants to practice effective QI efforts that provide a deep impact on clinical practice changes, the clinic leaders and administrators within the institution need to remain a fundamental component of the equation and most importantly of the education. The participants expressed a need to feel supported by their respective institution both monetarily and with designated protected time for QI initiatives. The participants often shared dual responsibilities as both administrators and clinicians, allowing them to provide a meaningful frontline perspective, which was instrumental in the change in clinician behavior. In addition, providing a QI course to all faculty, staff, and administrators established the tone and culture for the institution’s current and future goals
Saudi Women Studying in the United States: Understanding Their Experiences
Get PDFThe number of students from Saudi Arabia studying in the United States is increasing; this study focused on understanding Saudi women studying in the United States. A qualitative phenomenological approach was used to address the main research question: What are the perceptions of Saudi women on their experiences as international college students in the United States? In an attempt to understand their experiences, eleven Saudi Arabian women were interviewed. Data were collected using a semi-structured interview format. Analysis of the data was conducted via a four-step process that consisted of transcribing the interviews, reduction, horizontalization, and imaginative variation (Merriam, 2002). Analysis of the data revealed four main themes: religion, family, academics, and transformation. 1. Religion: Each participant had a high regard for Islam and how it shaped theirexperiences in the United States. Islam remained at the core of their daily lives and affected everything from scheduling for prayer time to wearing the hijab. 2.Family: A high regard for the family emerged as an important cultural aspect. Familyis an essential component of the collectivist culture and had an impact on the experiences of the Saudi women, ranging from being a mother to the family that accompanies them. vi 3. Academics: All participants in this study confronted challenges and experiences similar to other international students, such as language barriers and adapting to a new and different system of education. 4. Transformation: Lastly, the women indicated some sort of transformation that emerged because of their experience studying in the United States. For example, they gained self-confidence in their abilities and expressed the desire to be change agents in their communities. The Saudi female student experience is multi-layered and their experiences are often, if not always, tied into their religion. Although each participant told a different story, all participants shared common experiences as Saudi female international students
Improving Provider Adherence to Guidelines in Addressing Childhood Overweight and Obesity in A Primary Care Setting
Get PDFThe purpose of the quality improvement project was to improve BMI measurement, screening, identification, documentation, and assessment of childhood overweight and obesity among children ages 3 to 18 years old in a primary care setting. Primary care providers continue to fail to address childhood overweight and obesity and have a positive impact on this issue. Delay in early identification and assessment of childhood obesity and overweight may affect patients’ qualify of life and the efficiency of health care. Over the last 30 years, the rates of childhood overweight and obesity have consistently escalated despite the existence of recommended guidelines and interventions developed by leading authorities. Retrospective chart reviews of 50 encounter notes conducted at pre and post intervention along with educational trainings utilizing components of two evidence-based tool kits that follow American Academy of Pediatrics recommendations, and supplemental resources such as BMI prompts on forms for provider, were implemented to seek improvement in the standard of care processes for overweight and obese children seen at a primary care clinic. The results indicated an improvement in the provider and staffs BMI measurements, screening, identification, documentation and assessment. There also was an improvement in provider documentation of BMIs, diagnosis, lab work, progress notes, recommendations and follow ups. Implementation of educational interventions utilizing tool kits and resources founded on evidence-based guidelines can lead to improvement in the primary care provider’s achievement of delivering care for those overweight and obese children
Involving Youth in Ministries of Service
Get PDFI am currently serving the parish of St. Anthony Marie de Claret as the Director of Religious Education. Prior to outlining this proposal, I assessed the strengths and weaknesses within our catechetical programs, looked at the dynamics of the St. Anthony community, and discussed the project with our pastor to obtain his preferences. The common thread of concern was the lack of involvement and presence of the youth in the life of the parish. I decided to design and implement a pastoral project, using my ninth grade class as the pilot group, which would allow students to serve alongside adult leaders in existing outreach ministries within the parish. In my reading on adolescent spirituality there is agreement that service is important to youth, and it is one of the better ways to positively influence spiritual growth. One of the goals of our confirmation preparation program is to develop in our teens a heart of service. For these reasons, I believe that the most effective area to integrate the youth into the community is to add to the curriculum a service unit in outreach ministry.
My intention is to identify the parish ministries and organizations that perform outreach, invite the leaders of each to come to our class and present an overview of their services, have the students select the ministries in which they are most interested in participating, and then assign them to a ministry for a period of six weeks. Students and parents will be contacted by the leader with details on meetings or events in which they will participate. Both leaders and students will receive forms on which to log participation, and an evaluation form to complete once the project is finished. Students will be given a pre- and post-survey to assess religious attitudes and practices: Class time will be devoted to the Works of Mercy, the scripture from Matthew on the Judgment of the Nations, and Catholic Social Teaching. I have chosen the liturgical season of Lent to provide further emphasis on charity and sacrifice.
It is my hope that this project will become an annual addition to the ninth grade year in religious education, and that through it teens will feel an increased sense of belonging to their parish. Participation in this outreach ministry project will give the youth an opportunity to serve the poor, the incarcerated, the elderly, and others in need of assistance. Through this experience in applied learning they will see faith in action-both in ministry leaders and themselves
How the Transformational Leadership Style of Superintendents is Associated With Employees’ Organizational Commitment via the Mediating Effect of Extrinsic Motivation Within Nursing Homes for Disabled People in Taiwan
Get PDFIn 2013, about 4.8% of Taiwanese people qualified as having a disability; a disability is classified as having mild, moderate or severe, and in some cases, extremely severe intellectual disabilities or having multiple disabilities (Ministry of the Interior, Department of Statistics, 2013; Tseng, 2013). In 2013, there were 254 nursing homes for people with disabilities that were registered with the Social and Family Administration at the Ministry of Health and Welfare in Taiwan (Lee et al., 2013; Tseng, 2013). The current problems in Taiwan’s nursing homes for the disabled include overworked employees, employees with a poor work-life balance and excessive job stress, ineffective leadership, poor communication among administrators, and little or no staff support (Lee, 2007; Lin, 2008; Tseng, 2013). This results in a low sense of job accomplishment, a low sense of belonging, low morale, and lack of cohesiveness (Lee, 2007; Lin, 2008; Tseng, 2013). This negative cycle has led to high turnover rates and minimal retention and has had crippling effects on the organizations (Chou, 2005; Lee, 2007; Lee et al., 2013). According to the Taiwan Council of Labor Affairs, there is nearly a 50% turnover rate of professional employees at these institutions (Lee et al., 2013; Tseng, 2013). The purpose of this study was to measure the degree to which the superintendents at nursing homes for disabled people in Taiwan demonstrate transformational leadership and how this is associated with employees’ organizational commitment via the mediating effect of extrinsic motivation. Data for analysis, using the Multifactor Leadership Questionnaire (MLQ), the Work Preference Inventory (WPI), and the Organizational Commitment Questionnaire (OCQ), were collected from full-time employees who were randomly selected from 70 nursing homes for disabled people. An SPSS program was used to analyze the data and descriptive statistics, Pearson correlation coefficients, and sequential multiple regression analysis were used to answer the research questions. This study’s findings showed that gender was not associated with organizational commitment and that superintendents should recruit married employees and employees with college degrees in order to promote more organizational commitment. The findings also indicated that physical care employees’ commitment, compared with the commitment of social workers, special education teachers, and other professionals in nursing homes of Taiwan, was low. Superintendents, therefore, should conduct official self-assessments and unofficial sessions with them to understand which factors lead to their stress and, ultimately, their intention of leaving the organization. The data further showed that deploying transformational leadership practices would be an inevitable trend in order to increase organizational commitment and lower turnover rates aggressively. Lastly, the findings showed that transformational leadership contributed to the variability of organizational commitment significantly and that extrinsic motivation was the important factor of shared variability of organizational commitment. This means that transformational leaders of nursing homes should not only use strategic techniques to develop future innovations and offer high quality services but also take into consideration extrinsic motivation to promote organizational commitment
Values Education in Bangladesh: Understanding High School Graduates\u27 Perspectives
Get PDFValues education is a subject that may be neglected in some educational settings. An absence of values education may lead to dysfunction in society. Scholars have only recently become interested in the importance of values education (Koh, 2012). Although the National Education Policy in Bangladesh has long emphasized the inculcation of values in educational institutions (Ministry of Education, 1974, 2010), recent research has revealed the inadequate implementation and practice of values education (UNICEF Bangladesh, 2009). The purpose of this basic interpretive qualitative study was to understand the high school graduates\u27 perspectives regarding values education and the values they learned while attending a Catholic Church-sponsored school in Bangladesh. The research protocol comprised semistructured, open-ended interviews and a focus group discussion with 12 participants. The participants were purposefully selected and were interviewed in sessions lasting 40-75 minutes. Data was analyzed using an inductive and constant comparative process. Analysis revealed seven values education related principal themes that were relevant to the study’s purpose and research questions. The values education related themes were: (1) learning specific values through relationships, (2) learning values through school culture, (3) long-term impacts of school experiences, (4) benefits of co-curricular activities, (5) necessity of values education, (6) school\u27s duties in implementing values education, and (7) acquired values that conflict with societal norms. In addition, analysis also provided information about the participants’ meaningful memories and experiences during their 8 years of schooling that connected to learning values in school. Five recommendations were proposed for further research to gain an in-depth knowledge of current practices in values education: (1) duplication of qualitative research with teachers as participants, (2) a qualitative research with female or mixed participants, (3) a similar qualitative research with participants of general schools, (4) a qualitative study with current students as participants to understand the current practices, and (5) a quantitative study to investigate the correlation between learning values and co-curricular activities and school programs. Three recommendations were proposed for the institution that the participants were associated with: (1) the findings of this study should be shared with faculty and administration, (2) the school should assess and explore ways to enhance cultivating values and what might be done differently in cultivating values, and (3) efforts should be made to emphasize integrating values education into the curriculum for inculcating values in school