Medical care

Digital transformation is rapidly changing the healthcare industry, and artificial intelligence (AI) is a critical component in this evolution. This thesis investigates three selected challenges that might delay the adoption of AI in healthcare and proposes ways to address them successfully. Challenge #1 states that healthcare professionals may not feel sufficiently knowledgeable about AI. This is addressed by Contribution #1 which is a guide for self-actualization in AI for healthcare professionals. Challenge #2 explores the concept of transdisciplinary teams needing a work protocol to deliver successful results. This is addressed by Contribution #2 which is a step-by-step protocol for medical and AI researchers working on data-intensive projects. Challenge #3 states that the NIH All of Us Research Hub has a steep learning curve, and this is addressed by Contribution #3 which is a pilot project involving transdisciplinary teams using All of Us datasets.

Tensions exist between the ideology of caring as a nursing practice ideal, and the corporately managed health care settings in which nurses work. The objective of this critical feminist ethnography was to understand these tensions by grounding them in nurses' experiences and perceptions. Data was gathered through ethnographic interviewing and participant-observations of a nurse key informant and her co-workers in the pediatric unit of a corporately managed acute care hospital. The data were analyzed according to the coding procedures and comparative method described by Strauss and Corbin (1990). Four characteristics of the corporate health care culture that conflict with nurses' practice ideals were identified: The Corporate Productivity Motive; The Priority of a Medical Regime Over Nursing Care; The Tolerance of Risk to Patient Safety; and The Hospitality Perspective. A critique of the patriarchal value structure that influences the health care system and recommendations for nursing practice, education, and research is provided.

The purpose of this hermeneutic phenomenological study was to understand the essence of the lived experience of women after having an abnormal prenatal ultrasound. One hundred years ago, health disciplines had limited therapies for prenatal and neonatal disorders. During this period, the eugenics movement influenced leaders to involuntarily sterilize individuals who were sought to be "unfit" to prevent disorders in offspring. ... One of these contemporary reproductive genetic technologies is the use of ultrasound and serum bio-medical markers for detection of congenital, chromosome, and genetic disorders. When ultrasounds reveal abnormal findings, the perceived perfect pregnancy vanishes and gives way to feelings of shock, disbelief, fear, guilt, loss, and threats to self and their unborn baby. Twelve women who had an abnormal ultrasound were interviewed within the context of their cultural values and beliefs. The method of van Manen's hermeneutic phenomenology illuminated the meaning for these women in their life worlds. ... They endured this experience through their own coping mechanisms, but often felt uncertainty and emotional turmoil until the birth. The women also sought comfort through their cultural values, beliefs, and traditions. In coping with the risks found on this abnormal ultrasound, women often selected silence or blocking perceived threats. With these coping methods, they were alone in their suffering. ... Health providers, in not recognizing these women's misunderstandings and emotional fears, abandoned them in their psychosocial and cultural needs. The significance reveals that nurses and health providers need to infuse human caring ways of being, knowing, and doing within advanced technological environments.

Approximately 1.76 million men and women have served in the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military campaigns since October 2001. The transition from living in a war zone to resuming a fulfilling life at home is often difficult for veterans. The purpose of this mixed methods study was to gain understanding of the issues that complicate health for veterans and approaches veterans used to resolve complicating health issues associated with the challenge of coming home from war. Qualitative data collection and analysis was guided by story inquiry method. Quantitative data was collected using the 36-item Short-Form Health Survey, Version 2 (SF-36v2) and analyzed using QualityMetric Health Outcomes[TM] Score Software, Version 4.0. Seven OEF/OIF veterans who had completed at least one tour of duty in Iraq since October 2001 participated in this study. Three themes emerged from the qualitative data that capture the complicating health issues that participants encountered when coming home from war: flipping the switch, figuring out how to belong, and living the stress of a new normal. Two themes emerged from the qualitative data that capture approaches used to resolve complicating health issues associated with returning home from war: connecting with others and choosing a positive attitude. Quantitative data revealed that the majority of participants scored at or above general population norms on three of the subscales that measure physical health, as well as on two of the subscales that measure mental health; however a significant percentage scored below norms on the subscale that measures social functioning (57%) and on the subscale that directly measures mental health (43%).

The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care.

For the past 60 years, American citizens have turned to international adoption as a way to build their families. Unfortunately, international adoptees often spend the first months or years of their young lives in conditions of poverty and/or institutionalized care. Additionally, current U.S. immigration laws dictate that the children receive only a cursory health screening before arrival. As a result, many of the children adopted by Americans arrive to the United States with significant physical, emotional, behavioral, and developmental health problems. Twelve mothers who had adopted children internationally were interviewed for this study. Their stories of obtaining health care for their newly adopted children were shared in descriptive narratives. The themes that emerged from the data analysis were seeing healthy children despite the challenges, struggling to help the children, needing help, missing lost pieces, being different, and wanting more from providers. The overall essence derived from the mothers' experiences was that seeking health care for their newly adopted children was one of hope to achieve wellness for their children and normalcy for their families within the context of loss and a desire for more support. These findings have significant implications for the health care providers who care for them.

Objectives: This study documented events contributing to historical trauma among American Indian mission boarding school survivors, described residual effects of that trauma, and verified the Dream Catcher-Medicine Wheel model as a culturally appropriate tool that enhanced storytelling. Research Design and Methods: Nine women from two Upper Plains tribes were located through snowball sampling and participant referrals. A descriptive exploratory qualitative approach facilitated them in relating their survival stories. Seven were tape-recorded and two were hand-written on the Dream Catcher-Medicine Wheel, a model specifically designed for this study; this, combined with traditional spiritual grounding ceremonies, enhanced perspective for researcher and participants alike. Data Analysis: Liehr and Smith's (2008) Story Theory guided the methodology in the data gathering and analysis process using the Dream Catcher-Medicine Wheel combined with taped and written storytelling sessions. Major themes were categorized and supported with interview quotes through inductive analysis of the two research questions: What were the health challenges faced by survivors of American Indian mission boarding schools over time?, and, How have American Indian mission boarding school survivors resolved the health challenges they have faced over time? The first theme, subdivided into Breaking and Silencing of Spirit, examined physical, mental, and sexual abuse. The second theme, Survival of Spirit, examined relationships/parenting, coping/substance abuse, and spirituality. Findings: The seven dimensions described in Lowe and Struthers' (2001) Nursing in Native American Culture Conceptual Framework provided the value structure used for interpretation of findings. Implications for practice and research were related to the seven dimensions as culturally appropriate parameters for nursing.

The objective of this study was to determine whether 11 independent variables or combinations of variables help to predict a diabetes-related hospital readmission for patients with diabetes within 60 days from discharge. The variables were categorized into four main groups: (a) patient characteristics, (b) lifestyle, (c) biomarkers, and (d) disease management aspects. A convenience sample of 389 historical medical records of patients who were admitted to a rural hospital in northeastern North Carolina with a diagnosis of, or relating to, diabetes was studied. After comparing predictive discriminant analysis (PDA) and logistic regression (LR), PDA performed better and was chosen to analyze a convenience sample of patients admitted to the hospital for a diabetes-related diagnosis from January, 2004 to December, 2006. The best overall subset accurately classified 27 cases with six predictors that included (a) systolic blood pressure, (b) smoking status, (c) blood glucose range, (d) ethnicity, (e) diabetes education, and (f) diastolic blood pressure. In an effort to simplify the prediction process, the subsets of two predictors were examined. The results of the analysis returned four subsets of 2-predictor variable combinations that correctly classified cases for readmission. Each of the four subsets has two predictors that are statistically and practically significant for predicting readmissions for a diabetes-related problem within fewer than 60 days. These combinations are the predictor subsets of (a) smoking status and being treated by a specialist or non-specialist physician, (b) a religious affiliation or a lack thereof and smoking status, (c) gender and smoking status, and (d) smoking status and ethnicity.

In order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by avoiding duplication. The proposed system is Web-based; therefore it has high accessibility and availability. The cloud computing based architecture is used which will allow consumers to address the challenge of sharing medical data. PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources. This would make information accessible online to anyone who has the necessary electronic credentials to view the information.

In this thesis I explore the circumstances in which pregnant Guatemalan Mayan women in South Florida communities found themselves. A local non-profit organization, the Guatemalan Maya Center (GMC), offered assistance to pregnant Mayan women to secure biomedical prenatal care, yet many continued to underutilize these services. The decision to utilize this form of care largely depended on whether a woman received care from a traditional midwife in the community. Women receiving care from a midwife generally did not seek biomedical care until late in their pregnancies. Women unable to locate a midwife often incorporated biomedical care once they suspected pregnancy. Due to the difficulties accessing the GMC's services prior to enrollment many of these women did not obtain "timely" care. A better understanding of the ways in which Guatemalan Mayan women incorporated biomedical prenatal care into their lives is the first step towards increasing their participation in these services.