bluuebunny/crossref_metadata_2025 huggingface dataset:
دخول (ال) على الفعل
Authors: Burhan Ali
Published: February 2018

Many linguists agree that (أل ) belongs to important articles in Arabic language. أل is usually used in isim (noun), but sometimes it also can be used in fi’il (act). This condition usually can be found in some poems. This study aims to describe the position of أل in fi’il (act). The conclusion of this article is that أل can be used in fi’il butonly in fi’il mudhari’. However, it belongs to rarely used words in Arabic language, so that it cannot be used as formal standard in supporting theory of language.
TATHWIR MADDAH MAHARAH AL KALAM ALA ASAS TANDUR FII MARKAZ TARQIYATI AL LUGHAH BI JAMIATI SULTHAN SYARIF QASIM AL ISLAMIYAH AL HUKUMIYAH RIAU
Authors: Huda Khoirul
Published: February 2018

Ideally, students of Arabic Education Program can speak Arabic fluently. In fact, there are some students of UIN Suska Riau lack speaking skill in Arabic that may caused by lack of practice in their daily communication. Therefore, in this study, the researcher wants to develop a new teaching method as a solution in improving students’ speaking skill. This study uses Research and Development method which focused on the development of a new teaching method called TANDUR. The development of this method is done by analyzing the needs of students, developing the components of the method, presenting it in front of experts, having a field testing, and revising it based on the advice given by the experts. The result of this study shows that Tandur method brings positive effect in improving students’ Arabic speaking skill.
ILM AL DALALAH WA DAURUHU FI FAHM AL NUSHUSH AL ARABIYYAH
Authors: Jaeni Muhamad
Published: February 2018

One of the most difficult things in learning Arabic language is understanding the structure of the text. It may caused by the complication of its structure and also the complex meaning of each word. Consequently, knowing the meaning of a word is very important in understanding an Arabic language text. Therefore, there is a branch of Arabic language which specifically discusses about meaning, called semantics. One of the discussions is about the field of meaning such as synonym, antonym, polysemy, etc. They have important role in understanding sentence structure of a text. Therefore, learning semantics is an obligation for those who want to be able to understand Arabic language text well.
HURUF AL ATHF WA TADRIJAH AT TARBIYAH FI SURAT LUQMAN 12 19 DIRASAH NAHWIYYAH
Authors: Nuha Ulin
Published: February 2018

Nahwu was the basic science for understanding the Arabic language especially the holy Quran. There were many investigations of grammatical character. The controversy arises between the scholar interpretation because of this grammatical character. And from this grammatical character, the author want to look at huruf 'athaf and their meanings to the degree of education in surah Luqman 12-19. The author used the library research. The problems were considered ini terms of normative aspect to teach the order of huruf 'athaf in surah Luqman 12-19. He analyzed all the data in a descriptive way and he describe what was mentioned in surah Luqman 12-19. This is also inductive method. In the verses 12-19, There were waw 'athifah used for the unification, fa' 'athifah used for the arrangement and the time limit, summa 'athifah used for the arrangement, au 'athifah used for detail. This research found the teaching method and teaching material with its gradation from Luqman for developing students learning.
Probing effective language development programs in Indonesian Islamic higher education: a case of IAIN Pekalongan
Authors: Kholis Nur
Published: February 2018

Language development programs in higher education institutions have been facing concurring obstacles. A great part of these obstacles are caused by low proficiency level of students. The fact that prospective students are considered to have adequate experience in learning foreign language does not necessarily make the programs design undemanding. In order to cope with this challenge, higher education institutions need to perform thorough and careful processes of designing language development programs. This article argues that determining realistic goals, keeping up with latest research findings, and creating supportive environments will greatly contribute to effectiveness of these programs.
Influence Tax Amnesty Payment of Tax Compliance SMEs Batik Moslem In District Pekalongan
Authors: Arisnawati Nurfani , Khayati Sri , Zulfa Novia
Published: February 2018

This study aims to examine the effect of tax amnesty on taxpayer compliance level in paying taxes. The essence of the tax amnesty is tax forgiveness. This policy is expected to increase the willingness to pay taxes from taxpayers. This study uses primary data obtained with questionnaires for taxpayers at SMEs Batik Moslem in Dostrict Pekalongan by using random sampling systematically. This research analyzed data by using simple linear regression. The result of this research is tax amnesty have positive effect to the awareness of paying taxes, tax amnesty have positive effect to knowledge and understanding of taxpayer about taxation and tax amnesty not affect to perception about tax system effectiveness.
Altruism Models In Islamic Consumption System
Authors: Muflih Muhammad
Published: February 2018

This study succeeded in proving that altruism is an inseparable element in the Islamic consumption system because it is able to lead a consumer to the best level of godliness. Just by assuming that , the formation of satisfaction in Islamic altruism cannot be determined by one stage. It is plotted into three stages, namely: (1) compassion utility originating from the spirit of social emotion, enabling it to create as an emblem of emotional satisfaction; (2) rationalizing social-spiritual gain originating from a motivation to reach a religiously promised reward for a sacrifice made by a consumer for the poor and needy, resulting in as an indicator of a consumerâ€™s gains; and (3) God and human relationship originating from the spirit of a consumer to always be close to God absent of reward, symbolized by . What is unique is the three forms of altruism have a one direction altruism pattern unknown to among economists and altruists. This finding is especially contributes to the Islamic Philanthropic Institution in identifying a class of altruism in Muslims. Evidently, their altruism pattern is closely attached to their consumption system.
Voices of the Past: The Study of the Care and Treatment of Children from the Rhode Island State Home and School of the O'Rourke Children's Center
Authors: Hughes Susan
Published: February 2018

Voices of the Past is a research study that will examine data from various areas to analyze the treatment and care of children in the Rhode Island State Home and School and the O'Rourke Children's Center. Oral testimonies of past residents and staff workers will also be analyzed for this purpose. It will be necessary to understand the objectives that were contributory to the development of these institutions for a comparison of the treatment. This study appropriately calls the attention to the importance of the ethical treatment regarding humans in research. For the purpose of this study and possible future studies, a methodology was created that incorporates these principles.
San Francesco D
Authors: Hamill Ann-Frances
Published: February 2018

Examines the works and thoughts of two Italian saints: Saint Francis of Assisi (1181-1226) and Saint Catherine of Siena (1347-1380). Explores the common ideological denominator in the works of these major figures and analyzes their impact on Italian society and culture.
Ordinary Apocalypse
Authors: Villella Anthony
Published: February 2018

Work of short fiction, in which a young man, struggling with contempt for his family and himself, makes a terrible mistake and is forced to deal with who and what he has become.
Dying Gods and Sacred Prostitutes
Authors: Williamson Katherine
Published: February 2018

Explores the ways in which D.H. Lawrence revises and complicates archetypal characters and stories in his fiction. Lawrence's mythic revisions are frequently along gender lines, thus having significant implications for femininst or gendered readings of his works. Focuses mainly on The Rainbow and The Plumed Serpent but also treats some of Lawrence's shorter fiction.
Hiding Hiroshima
Authors: Fernandes Adam
Published: February 2018

Explores the representation of nuclear weapons in Japanese anime and US live action cinema in the 1980's, using methods from cultural studies. Examines, specifically, the silences and contradictions of the selected films to reveal the cultural ideologies of Japan and the United States during the time in which the films were produced. Analyzes the Japanese animated films, Barefoot Gen, Barefoot Gen 2, and Grave of the Fireflies, and the American live action films, The Day After, Testament, and Miracle Mile.
Holy Fools, Liminality and the Visual in Dostoevsky and Dickens
Authors: Lavendier Danielle
Published: February 2018

Studies the themes and motifs of holy characters, spaces and places, and artwork in Dostoevsky and Dickens, highlighting connections between Russian and Western literature through these major authors. Primarily focuses on The Idiot and Bleak House.
Dialogic Visual Literacy
Authors: LaFrenaye Sharon
Published: February 2018

Describes a visual art unit plan in which fifth grade students are taught visual literacy skills. Students first learn to decode a variety of imagery and then learn to encode their own imagery in the form of a narrative story scroll. Includes historical perspectives on visual literacy, along with case studies and commentary.
Come Tomorrow
Authors: Messier Annemarie
Published: February 2018

Collection of five short stories : Foo Foo, Like Father, Birthday Girl, Omens, and Come Tomorrow.
The Rebellious Angel
Authors: Mazzuchelli Pamela
Published: February 2018

Examines Virginia Woolf's writing and her anger in historical contexts, revealing that circumstances dictated that she deflect this volatile emotion. Focuses on the ways in which this deflection of anger illuminates the fictional dynamics of Woolf's autobiographical novel, To the Lighthouse and analyzes the concept of the Angel in the House, posited to be at the root of Woolf's anger. Argues that anger exists on three levels in the novel and that the main character, Mrs. Ramsay, is a victim of the Angel in the House ideology.
The Fabric of Life
Authors: Pichette Jane
Published: February 2018

Presents fiber sculpture inspired by the topic of mother and child created by the author, accompanied by introductory commentary. Most sculpture appeared in a thesis exhibition.
Transgressive Masculinities in Selected Sword and Sandal Films
Authors: Peirce Merle
Published: February 2018

Examines significant films in the ancient epic canon from a queer theoretical viewpoint to survey the extent of atypical gender formations within the genre. Uses the studies of Judith Butler and Michel Foucault, in the main, to establish the basis of these trangressive gender formations and to provide an explanation of their causes and appearances.
British Cinema and the Manipulation of Public Opinion During the Inter-war Years
Authors: Peirce Merle
Published: February 2018

Little notice has been paid to the British film industry and the way in which it was able to effect changes during the inter-war years, in particular 1930-1939. Members of the Foreign office and the Special Intelligence Services were able, through the subtle choice and influencing of specific filmic texts, to bring the British populace from a pacifist attitude, to one of resigned acceptance of the inevitability of war and the need for re-armament in the face of a growing German menace.
Weeds
Authors: Mekvedijian Tamar
Published: February 2018

This is a short story collection about a family. The stories are linked but aren't necessarily connected, with family members appearing in more than one story. It is about the bonds of family, and the struggle we have against the health of our bodies.
Digital Brushstrokes
Authors: Tavano Michelle
Published: February 2018

Digital painting enables the traditional painter to paint using new technology without experience in traditional painting. But few digital painters are able to transcend the technology to create aesthetically pleasing compositions that address traditional design elements and content. This thesis examines digital painting's place i an evolving digital culture by focusing on six digital painters, the digital audience and how new media theory applies.
Distorsionados Por La Opresion
Authors: Cambra Leonard
Published: February 2018

The investigation will be carried out through a detailed analysis of the Book: Retahilas by Carmen Martin Gaite and will show both the author's affinity with the past and her rupture with it to demonstrate that it is only in self knowledge as the result of suffering that one can begin to authentically communicate with others.
Along the Horseshoe
Authors: Beaulieu Maurice
Published: February 2018

This thesis is a major component towards a completed short-story cycle. The author’s work uses a multi-faceted aspect of storytelling by employing its many characters and isolated chapters in a mosaic form. All stories operate independently while simultaneously linking together through familiar characters and setting. Every story involves characters who reside on the same suburban cul-de-sac, which forces them to interact with each other and influencing their lives. By having these characters return, sometimes by a brief presence only and other times by mention of their name, creates a concrete social atmosphere. The author’s work provides several glimpses into the lives of characters who struggle with their past and future decisions. As a collective text, this work echoes themes of family turmoil, grief, dependency, and forgiveness. Moments of broken friendships, teen angst, and infidelity reconcile through character introspection as witnessed from the psychic distance of a third-person limited narrator. Each story leaps to a different month in 1994, creating a non-linear time line of self-contained narratives. References from that year, such as music, film, and important events help construct the character’s fictional universe.
Folk River
Authors: Miller Rhonda
Published: February 2018

America’s technology-infused society is cluttered with torrents of information and often scarcity of facts. Many people never bother to check where information is coming from, whether the sources have been documented and if the presentation is fair, balanced and worthy of our democratic nation. Hundreds of experienced journalists have left or been forced out of newsrooms due to financial pressures in the industry and monumental changes in technology. These experienced journalists have been dedicated to serving as the eyes and ears of citizens who do not have time to attend hours of meetings, question those in authority, analyze details from multiple sources and request documents through the freedom of information process. Journalism is the ‘fourth estate,’ charged with maintaining a watchdog presence over the executive, legislative and judicial branches of government. As newspapers, radio and television lean toward entertainment and sports programming, a vital stream of diverse voices comes through folk music. Long a channel for commentary on war, peace, work and social issues, folk music is a valuable, and increasingly critical, element for preserving a healthy democracy.
Exploring a "Mor-In-Touch" Approach to Art Teaching
Authors: Morin Micaela
Published: February 2018

How can students be more in touch with their artistic process through materials, decisions, social interactions, and environment when creating a work of art about identity for a collaborative mosaic relief installation?

This thesis explored an opportunity for my students to work together to create a collaborative art installation in our high school. This was important to do because the school had just been recently renovated and the new environment felt devoid of any art or personality that once reflected its former students. The important factors behind the installation design were to bring the visual dialogue of community into the new space and provide an opportunity for the current students to reflect their personal identities. The term “Mor-iIn-Touch,” which I developed in my research phase, can be described as an art-teaching philosophy. It is my belief that being or becoming more in touch or “Mor-in-Touch” will bring deeper meaning and personal connection to the artistic process.
TRFLP Analysis of the Effect of a Forest-to-Gap Ectone on Soil Microbial Diversity
Authors: Smith Ronald
Published: February 2018

To investigate how soil microbial diversity is influenced by the formation of an experimental edge-creating gap within a southern New England oak-hickory forest, I used a molecular fingerprinting technique known as terminal restriction fragment length polymorphism (TRFLP). Sequence variability in the 16S ribosomal RNA (rRNA) gene in soil bacterial communities is detected by differences in the length and abundance of fragments produced by digesting PCR products amplified from rRNA genes. The different patterns observed are assumed to represent unique phylotypes.

How does the forest-gap ecotone influence soil bacterial diversity? Based on other studies, I hypothesized that the edge would contain the most diverse bacterial community, followed by the gap, and as distance from the gap into the forest increased, bacterial diversity would decrease.

Soil samples were collected along 40m transects perpendicular to the northern edge of the gap. DNA was extracted from each sample, PCR was used to amplify the 16S rRNA gene, and DNA fragments were cut by restriction enzyme digestion and separated via electrophoresis. The DNA fragments were analyzed by TRFLP.

Environmental variables (soil pH, soil temperature and soil gravimetric moisture) were different in the gap compared to all other distances, but not significantly so. Phylotype richness and diversity (Simpson’s index) was greatest at the edge. Canonical Correspondence Analysis (CCA) produced a phylotype-by-distance ordination that supports my hypothesis and shows that the edge is an ecotone (transitional zone) between the gap and forest.
An Exploration of Identity
Authors: Céspedes Marie
Published: February 2018

The genre of the personal essay in creative nonfiction affords the writer an opportunity to explore identity, not only by depicting the various roles that the writer plays in life, but also through the literary device of persona, a version of the writer specifically created to narrate the essay. Identity is ever-changing and impossible to render completely. Despite the elusiveness of identity, writers and artists still attempt to recreate it on the page. In this collection of essays, I explored my own identity through both the experiences that have shaped me and the personae I have created to express those experiences.
Visual Attention and Behavior Under Positive Stereotypes
Authors: Chau Sathiarith
Published: February 2018

Afrocentricity bias occurs when Black individuals with dark skin, wide nose, and large lips are associated with certain negative and positive traits (e.g., criminality and athleticism) compared to those with Eurocentric features (i.e., light skin, narrow nose, thin lips). In racial bias research, inhibition of biased responses is common. The current study employed positive stereotypes associated with Blacks and Whites (physical and verbal ability, respectively) in order to link implicit behavior (visual attention) to explicit behavior. Participants selected, from an array of two faces, the best candidate for a team requiring either physical strength or verbal ability. Stereotypes did not affect visual behavior and choice; rather, Afrocentric features did. Visual attention to highly Afrocentric Black faces was greater when with White faces. In terms of choice, when present with two Black faces, the more Eurocentric face was more likely to be selected. Selections did not vary for White and highly Afrocentric Black candidate pairs. Eurocentric Black faces were selected more often when paired with a White candidate. Trait rating data showed that highly Afrocentric features resulted in higher ratings of agility and strength, whereas Eurocentric features resulted in higher ratings for verbal and grammatical skill. Although participants rated Blacks as predicted by Afrocentricity Bias, their behavior did not reflect the bias.
A Pre-Service Art Educator
Authors: Woratzeck Emily
Published: February 2018

This research was meant as an exploration of design education from a variety of angles. These investigations informed me, a pre-service art educator, in how I can teach design within my curriculum as well as advocate for design education in my professional career. I focused on two aspects of design: designed products representing the human made world that surrounds us, sometimes referred to as applied arts; and the design process, or design thinking, a reflective process. In an attempt to get a full view of the importance of and applications for design in the art education classroom, I researched through both literature and practice.
A Tale of Two City Schools
Authors: Proulx Jill
Published: February 2018

The study examined how leaders in both schools define successful reform, perceive high-stakes testing, perceive a need to raise student achievement, and implement reforms in response to high-stakes testing. The study combined qualitative interview data and survey methodology to examine differing perceptions and to identify the factors most strongly associated with different levels of reform success.
Girl Talk
Authors: Bledsoe Carey
Published: February 2018

This dissertation is a qualitative study of an all-girls’ advisory in a coeducational,

urban middle school located in a mid-sized city in the northeast.

The advisory group met daily over the course of the 2010-2011 academic year.

Drawing from data collected over one year of fieldwork--including participant

observation, analysis of discourse, dynamic interviews, and the analysis of

social constructs --this study explores how a group of mostly African

American and Latina students created a caring community in order to increase

their academic and social success.
Investigating Predictors of Academic Success in a Foundational Business Mathematics Course
Authors: D Brooke
Published: February 2018

Research reveals that the majority of students are unprepared in making the transition from high school to college mathematics. Many students choose majors outside of STEM and business fields to pursue degrees with less rigorous mathematics requirements. According to recent findings, it is likely that over 25% of all freshmen will fail their first mathematics course. Few studies examine student success in business mathematics courses, and business is currently the most popular major in the United States. Thus, the purpose of this research was to examine what factors predict success in a foundational business mathematics course (BUS 111) at a large Northeastern university.

Eight independent variables were examined: gender, high school GPA, mathematics SAT score, score on the university’s placement exam, student attitudes using the Attitudes Towards Mathematics Inventory (ATMI), anxiety using the Mathematics Anxiety Scale (MAS), number of hours per week spent on mathematics, and number of classes missed. The dependent variable was BUS 111 final average. All students (n = 247) enrolled in BUS 111 were invited to participate during the Fall 2015. Upon completion of pre- and post-surveys, multiple regression was used to determine which variables were significant predictors. Statistical findings revealed that placement score, high school GPA, a combination of ATMI/MAS scores, and number of classes missed were the best predictors of BUS 111 average overall (R2 = 44.2%, p = 0.000). Different models are presented for comparison and examination. Significant correlations found between perceived instructor effectiveness and student attitudes, anxiety, and course grades are also presented. Overall, combinations of non-affective and affective measures serve as the best predictors of success in business mathematics.
Planned Cesarean Delivery and Urinary Retention Associated With Spinal Morphine
Authors: DiBlasi Susan
Published: February 2018

Cesarean delivery (CD) is the second most commonly performed surgery in the United States. As such, prevention of complications associated with this procedure is a top priority in nursing care. Nurses at the study insti- tution perceived that postcesarean patients experienced increased uri- nary retention after use of spinal morphine for postoperative pain relief. This observation prompted a review of the literature indicating that limited research had been conducted in this area. The purpose of this study was to explore the relationship of postelective CD urinary reten- tion and dose of spinal morphine. A retrospective, quasi-experimental, three-group design was used. Records of 150 patients, ages 17 to 39, undergoing elective primary or repeat CD were examined. Morphine doses included 100, 150, and 200 mcg. No statistically significant differ- ences were found between the three groups.
Evaluation of the Patient Sitter Assessment Tool
Authors: DeSousa Tamara
Published: February 2018

Maintaining the safety of hospitalized patients is a top priority in healthcare. Evidence has demonstrated that most patient injuries associated with falls are preventable. Despite major, sustained national initiatives related to fall prevention, fall rates continue to be problematic in acute care settings. Patient sitters are often used to observe/and or assist those that are identified as at a high risk for falls; however evidence to support the effectiveness of this intervention in reducing fall risk is lacing. A committee charged with revising the sitter policy in an acute care facility discovered inconsistencies by nurses when assessing this patient population. A literature review revealed common contributing factors to a change in cognition and delirium, both having strong relationship to patient falls. A Patient Sitter Assessment tool was developed and pilot tested on a 27 bed medical surgical telemetry unit. The purpose of this process improvement project was to determine the ease of use,utility, and staff satisfaction of the tool. Evaluation from 12 staff nurses who participated were favorable. Overall, nurses indicated satisfaction with the tool, and provided feedback that more education on delirium and contributing factors that impact cognition was needed. It is expected that use of the tool will result in earlier detection and treatment of change in cognitive status and improved sitter use. Implications and recommendations are presented and discussed.
Development and Implementation of a Certified Neuroscience Registered Nurse Exam Review Program
Authors: Walsh Joan
Published: February 2018

Rhode Island Hospital (RIH) is currently striving to attain Magnet® status; specialty certification of registered nurse (RN) staff plays an important role in achieving that goal. Unit based nursing leadership and RN staff identified neuroscience certification as both important and desirable. One of the barriers identified by the staff RNs was the lack of a study support program to assist in preparation for the certification exam. A certified neuroscience registered nurse (CNRN) exam review program motivates and supports the RN staff to seek certification and successfully sit for the exam. The primary purpose of this program was to increase the number of CNRNs on the neuroscience units at RIH, with a secondary goal of CNRN staff participation throughout the initiative. The development of a formalized process allowed the program to be repeated biannually and helped to establish a unit culture where certification is the standard to which to aspire.
Contributing Factors to Hospital Readmissions
Authors: Amalfitano Susan
Published: February 2018

Aims and objectives. To investigate the elderly patient’s perspective about the reasons
for discharge to home being unsuccessful, resulting in rehospitalization.
Background. Elderly patients have a high rate of readmission to the hospital within 30
days of discharge. Starting in October of 2013, hospitals having a high rate of
readmission of patients with heart failure (HF), myocardial infarction (MI), and
pneumonia (PNA) will face financial penalties. Evidence indicated that by utilizing risk
prediction tools and incorporating transition interventions the risk of a hospital
readmission may be reduced.
Design. A qualitative, descriptive design was used.
Methods. In 2013, a student investigator interviewed elderly patients over the age of 65
who were readmitted to the hospital with the diagnosis of HF, MI, PNA or chronic
obstructive pulmonary disease (COPD) within 30 days of discharge. A total of six (N=6)
patients and/or surrogates participated in the interviews. Data were collected using semistructured
interviews and subjected to thematic content analysis.
Results. Three major themes emerged: discharge readiness, communication, and
education.
Implications for the advanced practice registered nurse (APRN). Practicing in an
APRN role provides the opportunity for the nurse to facilitate the appropriate transitional
care of elderly patients placing them at less risk for hospital readmission within 30 days.
Improving Nurse Satisfaction and Knowledge of Therapeutic Hypothermia Using a Staff Education Program and Evidence-Based Protocol
Authors: Goldstein Laura
Published: February 2018

Mild Therapeutic Hypothermia (TH) or Targeted Temperature Management (Nunnally et al.,
2011) is defined as an intentional reduction of a patient’s core temperature to 32°C–34°C (89.6-
93.2° F) following ventricular fibrillation (V-Fib) sudden cardiac arrest (SCA) with return of
spontaneous circula-tion (ROSC), and who remain unconscious, for the purposes of limiting
neurologic reperfusion injury (Polderman, & Herold, 2009). Mild TH is a highly valuable post
cardiac arrest procedure that can result in preservation of neurologic function and reduction of
the inflammatory effects of neurologic reperfusion syndrome following cardiac arrest. This
procedure requires specific educational preparation in order to perform the procedure and
anticipate the potential complications that might occur during nursing care. TH involves the use
of specialized equipment, systematic education, and a team approach to be effective.
Educational needs should be addressed in a variety of presentations over time to provide staff
with the knowledge and confidence to care for these patients. The purpose of this project was to
develop an educational program for critical care and emergency department nurses caring for
patients undergoing TH. Development was guided by review of the literature, theoretical
framework, assessment of need, and reevaluation of learning. This program development project
highlights the role of the CNS in identifying, teaching, an
Booking the Appointment: A Strategy to Reduce Readmissions in Heart Failure Patients
Authors: Moran Lindsey
Published: February 2018

Heart failure (HF) is a chronic condition that is the cause for many hospitalizations in the
United States. Hospital readmission is a common problem in many chronic conditions,
especially heart failure. The purpose of this research was to determine if scheduling a
follow-up appointment with a primary care provider (PCP) or cardiologist prior to
hospital discharge decreases 30-day readmission rates in patients with a primary
diagnosis of HF. A quasi-experimental, two-group study was performed at The Miriam
Hospital, a 247-bed acute care hospital, with a sample of 60 patients. A retrospective
chart audit was performed to determine if 30-day readmission rates were lower in those
HF patients who had a follow-up appointment booked prior to hospital discharge than
those who did not have the appointment booked. Charts were reviewed for patients
discharged during June, July, August and September 2012. Basic descriptive statistics
were performed as well as differences between groups. Thirty-day readmission rates
were lower for those who had a follow-up appointment booked (22.58%) compared those
who did not have an appointment booked (31.03%). The 30-day readmission rate for
those who had an appointment with a PCP was higher than those who followed up with a
cardiologist (33.33% versus 7.69%). These findings suggest that booking a follow-up
appointment for HF patients with a cardiologist prior to hospital discharge may help to
decrease 30-day readmission rates. This simple intervention can be performed by nonclinical,
administrative staff and could save hospitals money if even one HF readmission
were prevented.
Development of an Ambulation Program at Kent Hospital
Authors: Rocheleau Joseph
Published: February 2018

An important aspect of nursing care in a hospital setting is mobilizing patients. Numerous
studies have documented that prolonged bed rest is associated with negative patient
outcomes. An ambulation program can assist patients to maintain functional status during
the hospital stay in preparation for discharge. Nurses are the member of the health care
team with responsibility for mobilizing patients. In order to do this successfully, nurses
require updated knowledge related to implementing an ambulation program. Several
factors facilitate ambulating patients on a regular basis, including adequate staffing,
appropriate equipment, and availability of a mobility protocol. The purpose of the project
was to develop and implement an educational program for nursing staff regarding
ambulation of medical-surgical patients in the hospital setting. First, a comprehensive
needs assessment was conducted; concurrently, a recently formed Task Force developed
a mobility protocol. A two hour educational program was developed based on the
literature and clinical experience, with a focus on the negative consequences of
immobility in the hospital setting, patient assessments in relation to mobility, the benefits
of mobilizing patients, and the role of the nurse and the Physical Therapist with
mobilizing patients. The program was implemented and included administration of pre
and post surveys and a program evaluation. Results indicated a ten point improvement in
knowledge scores from the pre to the post survey, and staff positively evaluated the
program. The Advanced Practice Registered Nurse (APRN), especially the Clinical Nurse
Specialist (CNS) can play a major role in formally and informally educating nursing staff
related to ambulation as well as in development, implementation, and evaluation of a
mobility protocol. Further research regarding what is ‘optimal’ mobility in various health
care settings is critically needed. The CNS is the ideal member of the inter-disciplinary
team to lead quality and legislative initiatives in this area at the local and national level.
Predictive Behavioral Cues of Patient Violence in the Emergency Department
Authors: Roy Jessica
Published: February 2018

Nurses are often subject to violence at the hands of their patients. The Emergency Department (ED) has become the area most vulnerable in the hospital setting, with contributing factors including the rise of polysubstance drug abuse, the increasing psychiatric population, and overall stressors related to the economy. The ED is the “gateway” to the availability of shelter, medications, and resources for many people that pass through every year. Accurate and timely identification of the most common and easily identifiable precursors of violence is essential in order to develop and implement effective de-escalation techniques that have the potential to reduce actual events. The purpose of this research project was to demonstrate the usefulness of a behavioral cue assessment tool in providing a simple predictor for potential violence in the ED setting. The methodology included a behavioral assessment checklist containing 17 cues developed by Wilkes, Mohan, Luck and Jackson (2010). Nurses completed the 17 item behavioral assessment on all patients being treated in the ED during a three-week time period. All 17 behavioral cues demonstrated a positive predictive factor for violence based on statistical analysis. Given the simplicity, cost effective nature, and predictability, the checklist appears to be feasible to use to potentially reduce healthcare costs related to injuries and emotional distress of nurses at the hands of violent patients. Further research is indicated. This study further exemplifies the qualities of an advanced practice registered nurse (APRN), including research, education, cost containment, and improved patient care.
A Palliative Care Program Evaluation
Authors: Robinson Kathleen
Published: February 2018

Palliative care is a growing field in response to the healthcare needs of people suffering
with the consequences of serious health issues. As an evolving specialty, palliative care
needed criteria to denote and measure quality. National leading specialist in palliative
care have developed and promoted standards for care and excellence in this field,
however, it is critical for palliative care programs to evaluate the manner and extent to
which these standards are incorporated into their care. A program evaluation of an
existing Palliative Care Program at a VA hospital was undertaken. National guidelines
and standards, that specify preferred structures and practices for quality palliative care,
were compared to the VA Hospital’s Palliative Care Program implementation and
operationalization. The program demonstrated and met most of the attributes and
characteristics identified as essential markers of a quality palliative care program.
Strengths of the program and opportunities for growth and development were discussed
as well as implications for future programs including the role of the advanced practice
nurse in this important specialty.
Nurse Perceptions of Influenza Vaccination
Authors: Brown Leslie
Published: February 2018

The purpose of this research study was to determine the perceptions of influenza vaccine of registered nurses who decline the annual influenza vaccination. Influenza is a serious public health issue because it is a highly contagious virus that is associated with considerable morbidity and mortality. The topic of making annual influenza vaccinations mandatory for health care workers remains controversial. A comprehensive review of the literature surrounding influenza vaccinations was explored and discussed. The data for this study was obtained via anonymous voluntary surveys with one open-ended and 14 closed-ended questions. A mixed method design was used to analyze the voluntary responses from acute and critical care registered nurses employed at Rhode Island Hospital and Hasbro Children’s Hospital who declined the influenza vaccination during the 2013-2014 influenza season. The results were examined and disseminated to provide insight and possibly modify future educational campaigns to promote increased annual influenza vaccination rates among registered nurses and health care workers overall. APRNs have the opportunity to serve as leaders by advocating for annual vaccinations, providing evidence based education, and supporting policy changes to positively impact patient outcomes, institutions, communities, and overall population health.
Nurses' Knowledge Related to Heart Failure Essentials
Authors: Garris Ann
Published: February 2018

Heart Failure is a complex syndrome which continues to be a major health issue in the United States and worldwide. Strategies and educational interventions implemented by hospitals to reduce hospital admissions and readmissions for this costly chronic disease have not been consistently successful. Patient education is an important strategy for the management of HF to improve quality of life, optimize patient outcomes, and reduce the use of healthcare resources by reducing readmissions. The purpose of this program development was to increase nurses’ knowledge regarding HF education to be provided to HF patients prior to discharge from the acute care setting. A quasi-experimental program design with a pre and post-test intervention was performed on a 38 bed medical telemetry unit at RI Hospital a Level 1 trauma center in Providence, RI. Registered nurses were asked to complete a pre and post-test survey, Nurse Knowledge of Heart Failure by Albert et al (2002). Nine RNs out of thirty two (28.8%) agreed to participate and completed the pre-test, attended one of the HF education classes followed by completion of the post-test. Pre-tests scores ranged from 60-90 out of possible 100, with a mean score of 73.3%. Post-test scores ranged from 70-95 out of possible 100, with a mean score of 86.1%, an increase of almost 13%. These findings suggest that providing HF education can be successful in increasing nurses’ knowledge regarding HF education provided to HF patients prior to discharge from the acute care setting.
Alarm Fatigue: A Technology Hazard
Authors: Lopes Iracena
Published: February 2018

This research project sought to investigate the impact of alarm fatigue on nurses in an inpatient adult acute care setting at an academic and magnet medical center in the Northeast. The project methodology included a 12-question survey containing 9- likert and 3 open ended questions, designed by the student researcher. The survey was administered to 48 registered nurses on two telemetry-monitoring units. The survey explored whether nurses are aware of alarm fatigue, and also how their daily workflow was impacted by alarm fatigue. Surveys were anonymous and confidential. Descriptive statistics were performed on the study variables, and responses from three open-ended questions analyzed. The questions did not lend themselves to determining themes. Several respondents did request further telemetry monitoring system review and education. The survey results established that nurses from both units were experiencing alarm fatigue as well as workflow disruption as a result of frequent nuisance alarms. Implications for nursing practice are complex and of great importance given the patient safety implication. Nurses must spearhead initiatives to tackle and mitigate alarm fatigue. Participation at a system level is necessary to review current practice standards and policies in order to drive changes necessary to improve the patient care environment. End users of monitoring systems are in a unique position to work with vendors in order to create monitoring devices with sophisticated capabilities for monitoring which decrease nuisance alarms.
A Comparrison of Two Emergency Departments
Authors: Blais Erin
Published: February 2018

Urosepsis accounts for approximately 25% of all cases of sepsis in the developed world. The mortality from urosepsis is high and the financial burden is exorbitant. Research has established that a patient’s survivability from sepsis is inversely proportional to time to antibiotic administration. The initial care of patients with urosepsis often occurs in the chaotic setting of the Emergency Department and obtaining a urine specimen is a key element of patient care. The purpose of the project was to compare two emergency departments door-to-urine time with a focus on urine procurement technique. Urine procurement may occur by straight catheterization, Quik® catheterization, indwelling urinary catheterization, or mid stream clean catch collection. One department has access to Quik® catheterization technology that is unavailable to the other department. Exclusion criteria are patients already diagnosed with UTI and patients taking antibiotics on arrival to the emergency room. A retrospective chart review was conducted on 60 records. Data collected included gender, age, chief concern, method of urine procurement, door-to-urine collection time, door-to antibiotic administration time and urinalysis results. Results showed that catheterization was not always faster than midstream clean catch collection. There were an insufficient number of Quik® catheterizations performed during the time frame of the study to establish a link between the technology and expedited urine collection or antibiotic administration. The study does suggest that greater awareness and more research is needed concerning care of the uroseptic patient in the ED.
Overdose Education and Naloxone Distribution: Implementation in the Acute Care Setting
Authors: Daniell Emily
Published: February 2018

The number of opioid related overdose deaths has increased significantly over the past ten years. In order to combat this problem, many drug treatment programs have implemented Overdose Education and Naloxone Distribution programs as a harm reduction technique. While these programs are fairly new, initial research demonstrated effective reduction in the number of opioid overdose related deaths. The risk of overdose deaths increases when an opioid addicted person is abstinent for a period of time and loses tolerance. Individuals who have been incarcerated, completed inpatient detoxification, or who have been admitted into an acute care setting face the risk of losing tolerance as a result of being opiate-free for a period of time. This decrease in tolerance significantly increases the risk of overdose when they resume using opioids. The purpose of this program was to develop and implement an educational program on the epidemic of opioid overdose and the safe administration of Naloxone by lay people. This program was aimed at Registered Nurses working on an inpatient medical/surgical telemetry unit within a small, academic medical center. A needs assessment was performed and a 20 minute educational program was offered during a scheduled staff meeting. Pre and post surveys based on knowledge content were collected and results were analyzed. Program evaluation was conducted in order to define the strengths and weaknesses of the developed program. Conclusions and implications for APRN practice were presented to the organization’s Nurse Practice Council as well as Rhode Island College.
Perceived Barriers to Health Promotion Behavior of Women in Early Recovery from Alcohol Use Disorder
Authors: Graham Renee
Published: February 2018

Women with Alcohol Use Disorder (AUD) have a higher risk of chronic illness and a mortality rate that is 50 to 100% greater than men’s (National Institute on Alcohol Abuse and Alcoholism, 2008). Lifestyle changes in the recovery from AUD include adopting behaviors that foster health and identifying women’s barriers to health promotion behavior is important to fostering a healthy lifestyle. The purpose of this study was to explore perceived barriers to health promotion behavior of women in early recovery from AUD. Participants were women (N = 50) who attended 12-step recovery meetings for alcoholism, of which: 86% were 26 to 57 years old; 72% had greater than a ten year history of consumption; 80% had less than six months of sobriety; 50% had relapsed three or more times. Results indicated some women perceived certain barriers to be very troublesome but generally barriers were only a moderate challenge. Greatest perceived barriers cited were financial aspects, fatigue, time management issues, selfefficacy concerns, and communication difficulties. Implications for practice include conducting research on the nature of the most concerning barriers and the impact that severity of disease, culture, ethnicity, or demographics has on these barriers. Increasing awareness of women’s barriers, lobbying and supporting policies and systems processes that reduce barriers and support access to preventative services, early intervention, gender specific programs, and addressing patient-specific barriers will improve outcomes. Utilizing a comprehensive approach will have the greatest impact on the health promotion behaviors of individuals and the population health status of women with AUD.