Development of ``HealthServe'': A measure of customer service orientation in healthcare

An assessment tool designed to measure a customer service orientation among RN's and LPN's was developed using a content-oriented approach. Critical incidents were first developed by asking two samples of healthcare managers (n = 52 and 25) to identify various customer-contact situations. The critical incidents were then used to formulate a 121-item instrument. Patient-contact workers from 3 hospitals (n = 102) completed the instrument along with the NEO-FFI, a measure of the Big Five personality factors. Concurrently, managers completed a performance evaluation scale on the employees participating in the study in order to determine the predictive validity of the instrument.^ Through a criterion-keying approach, the instrument was scaled down to 38 items. The correlation between HealthServe and the supervisory ratings of performance evaluation data supported the instrument's criterion-related validity (r =.66, p $<$.0001). Incremental validity of HealthServe over the Big Five was found with HealthServe accounting for 46% of the variance.^ The NEO-FFI was used to assess the correlation between personality traits and HealthServe. A factor analysis of HealthServe suggested 4 factors which were correlated with the NEO-FFI scores. Results indicated that HealthServe was related to Extraversion, Openness to Experience, Agreeableness, Conscientiousness and negatively related to Neuroticism.^ The benefits of the test construction procedure used here over the use of broad-based measures of personality were discussed as well as the limitations of using a concurrent validation strategy. Recommendations for future studies were provided. ^

Women graduates' academic resilience and their personal strategies for doctoral success

This study explores women's perceptions of what made them successful doctoral students and what strategies they used to cope and succeed in the academic environment of an off-campus program in South Florida. The study's theoretical framework was built on Bandura's (1997) theory regarding ways self-efficacy influences choices made and effort expended; and Gilligan (1982), Belenky et al. (1986) and other feminists' theories concerning how women learn. ^ The study included data obtained from individual, semi-structured interviews with 10 participants, documents spanning the 10 years of the program and interviews with founding faculty members. For each, academic resilience was built on (a) viewing that working on the degree was personally fulfilling; (b) believing she possessed a strong sense of academic confidence; (c) priding herself on having self discipline; (d) seeing herself as a role model; and (e) being motivated by a personal or career goal. ^ Strategies the participants used to overcome roadblocks included (a) time management—finding time for personal, professional, and academic duties; (b) focus—making the dissertation a priority; (c) collaboration—utilizing both personal and programmatic assistance; (d) and advocacy—acting on their individual needs. ^ Results of the study indicated that the program at the satellite campus provided structural resources that satisfied basic needs and strengthened the students' self-efficacy. This helped them become successful doctoral graduates. The women had personal fortitude and strong self-efficacy to complete the doctoral journey. They understood that their success was primarily based on the support they received from people: families, peers, and their major professors. Participants suggested that successful women students ascertain whether they have time and resources to devote to an extended study, an understanding family, and the resilience to overcome roadblocks along the way. ^

Using Critical Race Theory: An Analysis of Cultural Differences in Healthcare Education

This paper is a literature review of articles published from 1992 to 2002 in the American Journal of Health Education using critical race theory as a lens of analysis of culture differences in healthcare.

Risk and resilience factors associated with delinquent behavior among African -American adolescent males

Juvenile crime is a social problem of increasing concern to many citizens in the United States. In 2000, there were an estimated 2.4 million juvenile arrests for a variety of crimes ranging from misdemeanors to violent felony offenses. African American males are disproportionately represented among juvenile offenders in the United States. In 2000, black youth were approximately 16% of the U.S. population between the ages of 10–17; however, they accounted for 42% of juvenile arrests for violent crime. ^ This study explored putative factors associated with juvenile offending among a sample of African American adolescent males. The independent variables in this study were academic achievement, religiosity, parenting styles and discrimination. The dependent variables were delinquent behavior and arrest. The data used in this study were from a larger NIDA funded longitudinal study that included approximately 425 African American youths. The data collection method involved structured interviews and questionnaires. The participants for the original study were selected via random sampling from all students attending middle school in Miami-Dade County. The study examined the hypotheses that African American males retrospectively reporting (a) high academic achievement, (b) high religiosity, (c) authoritarian parenting and (d) low perceptions of discrimination are less likely to be involved in delinquent behavior and are also less likely to be arrested. ^ Results indicated that among African American adolescent males, delinquent behavior had a significant relationship (p < .05) with academic achievement, perceived discrimination and the interaction between perceived discrimination and experienced discrimination. Arrest was significantly related to academic achievement (p < .001), religious perception (p < .05), and church attendance (p < 05). Neither dependent variable was significantly related to parenting styles. ^ The findings indicated that experimental studies are needed to clarify cause and effect relationship among the variables associated with juvenile offending among African American males, which may differ from those associated with juvenile offending among other groups. ^

A meta -analysis of empirical research studies on resilience among students at -risk for school failure

Being at-risk is a growing problem in the U.S. because of disturbing societal trends such as unemployment, divorce, substance abuse, child abuse and neglect, and the new threat of terrorist violence. Resilience characterizes individuals who rebound from or adapt to adversities such as these, and academic resilience distinguishes at-risk students who succeed in school despite hardships. ^ The purpose of this research was to perform a meta-analysis to examine the power of resilience and to suggest ways educators might improve academic resilience, which was operationalized by satisfactory test scores and grades. In order to find all studies that were relevant to academic resilience in at-risk kindergarten through 12th-grade students, extensive electronic and hardcopy searches were conducted, and these resulted in a database of 421 articles. Two hundred eighty seven of these were rejected quickly, because they were not empirical research. Upon further examination, another 106 were rejected for not meeting study protocol criteria. Ultimately, 28 studies were coded for study level descriptors and effect size variables. ^ Protective factors for resilience were found to originate in physical, psychological, and behavioral domains on proximal/intraindividual, transitional/intrafamilial, or distal/extrafamilial levels. Effect sizes (ESs) for these were weighted and the means for each level or category were interpreted by commonly accepted benchmarks. Mean effect sizes for proximal (M = .27) and for transitional (M = .15) were small but significant. The mean effect size for the distal level was insignificant. This supported the hypotheses that the proximal level was the source of most protective factors for academic resilience in at-risk students followed by the transitional level. The distal effect size warranted further research particularly in light of the small number of studies (n = 11) contributing effect sizes to that category. A homogeneity test indicated a search for moderators, i.e., study variables affecting outcomes, was justified. “Category” was the largest moderator. Graphs of weighted mean effect sizes in the physical, psychological, and behavioral domains were plotted for each level to better illustrate the findings of the meta-analysis. Suggestions were made for combining resilience development with aspects of positive psychology to promote resilience in the schools. ^

Global Assemblages, Resilience, and Earth Stewardship in the Anthropocene

In this paper, we argue that the Anthropocene is an epoch characterized not only by the anthropogenic dominance of the Earth's ecosystems but also by new forms of environmental governance and institutions. Echoing the literature in political ecology, we call these new forms of environmental governance “global assemblages”. Socioecological changes associated with global assemblages disproportionately impact poorer nations and communities along the development continuum, or the “Global South”, and others who depend on natural resources for subsistence. Although global assemblages are powerful mechanisms of socioecological change, we show how transnational networks of grassroots organizations are able to resist their negative social and environmental impacts, and thus foster socioecological resilience.

The effects of resilience and social influences on preventing repeat adolescent pregnancies in parenting adolescent mothers

Every year, 16 million women aged 15 to 19 years give birth globally. Adolescent births account for 11% of all births globally and 23% of the overall burden of disability and diseases due to pregnancy and childbirth. In the United States, 750,000 adolescents (15-19 years) become pregnant each year, making the United States the developed country with the highest rates of adolescent pregnancy. The economic burden of adolescent pregnancy in the U. S. is $7-15 billion per year. Adolescent pregnancy brings risks associated with pregnancy induced hypertension, preterm infants, maternal and neonatal mortality. Social factors include poverty, low educational levels, alcohol, and drug use. Between 30-50% of adolescent mothers who have a first birth before age 18 years will have a second child within 12 to 24 months. Subsequent adolescent pregnancies compound fetal and maternal risks. Many vulnerable adolescent mothers succumb to external pressures and have a repeat adolescent pregnancy while others are able to overcome the challenges of an adolescent pregnancy and prevent a repeat adolescent pregnancy. This cross sectional survey designed study investigated the effects of resilience and social influences on contraceptive use or abstinence by Black and Hispanic adolescent parenting mothers to prevent a repeat adolescent pregnancy. 140 adolescent mothers were recruited from three postpartum units of a tertiary hospital system in Miami, Florida. The Wagnild and Young Resilience Scale and the Adolescent Social Influence Scale were used to measure resilience and social influences, respectively. Demographic data, length of labor, plan for contraceptive use or abstinence were measured by an investigator developed instrument. Point biserial correlation showed a significant positive correlation between Black adolescent mothers' resilience and contraceptive use (r =.366, p2(11, N=133) = 27.08, p =.004. (OR = .28). These results indicate a need for interventional strategies to maximize resilience in parenting adolescents to prevent a repeat adolescent pregnancy.

Syndemic health disparities and resilience processes related to HIV transmission risk among African American/Black men in south Florida

Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM.^ Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P<0.000), and drugs and sex used in combination (P<0.000), and substance dependence (P<0.000) and lower levels of social support (P<0.024) compared to Caucasian/White MSM. At 12- month follow-up, multi-level statistical models found that African American/Black MSM reduced their frequencies of days high and unprotected sex at greater rates than Caucasian/White MSM (P<0.001).^ Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men's experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5).^ The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.^

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

Risk and resilience factors associated with delinquent behavior among African American adolescent males

Juvenile crime is a social problem of increasing concern to many citizens in the United States. In 2000, there were an estimated 2.4 million juvenile arrests for a variety of crimes ranging from misdemeanors to violent felony offenses. African American males are disproportionately represented among juvenile offenders in the United States. In 2000, black youth were approximately 16% of the U.S. population between the ages of 10-17; however, they accounted for 42% of juvenile arrests for violent crime. This study explored putative factors associated with juvenile offending among a sample of African American adolescent males. The independent variables in this study were academic achievement, religiosity, parenting styles and discrimination. The dependent variables were delinquent behavior and arrest. The data used in this study were from a larger NIDA funded longitudinal study that included approximately 425 African American youths. The data collection method involved structured interviews and questionnaires. The participants for the original study were selected via random sampling from all students attending middle school in Miami-Dade County. The study examined the hypotheses that African American males retrospectively reporting (a) high academic achievement, (b) high religiosity, (c) authoritarian parenting and (d) low perceptions of discrimination are less likely to be involved in delinquent behavior and are also less likely to be arrested. Results indicated that among African American adolescent males, delinquent behavior had a significant relationship (p The findings indicated that experimental studies are needed to clarify cause and effect relationship among the variables associated with juvenile offending among African American males, which may differ from those associated with juvenile offending among other groups.

The Lack of a Structured Universal Healthcare System in the United States: How This Affects the Lives of Millions of Americans and What Can Be Done About It

The purpose of this research is to explore on a deeper level the healthcare system of the United States, its background, and other factors that could provide possible solutions to simplify the fragmented healthcare system. The ultimate goal is the formation of concise ideas that could make the system, which prevents millions of Americans from obtaining adequate medical attention, substantially better. The paper will offer a better insight into the four different models of healthcare insurance found around the world in other developed countries with the purpose of establishing a comparison with that of the United States. The changes implemented by the Patient Protection and Affordable Care Act of 2010 are also analyzed to arrive at the conclusion of whether it has helped more American citizens get access to medical attention. Quality Improvement tools and thorough analysis of different methods from a financial, managerial, legal, and administrative perspective are used to provide valuable information that could aid in the implementation of modifications to the healthcare system of the United States in the near future.