Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Maintaining Sexual Desire in Long-Term Relationships: A Systematic Review and Conceptual Model

The most universally experienced sexual response is sexual desire. Though research on this topic has increased in recent years, low and high desire are still problematized in clinical settings and the broader culture. However, despite knowledge that sexual desire ebbs and flows both within and between individuals, and that problems with sexual desire are strongly linked to problems with relationships, there is a critical gap in understanding the factors that contribute to maintaining sexual desire in the context of relationships. This article offers a systematic review of the literature to provide researchers, educators, clinicians, and the broader public with an overview and a conceptual model of nonclinical sexual desire in long-term relationships. First, we systematically identified peer-reviewed, English-language articles that focused on the maintenance of sexual desire in the context of nonclinical romantic relationships. Second, we reviewed a total of 64 articles that met inclusion criteria and synthesized them into factors using a socioecological framework categorized as individual, interpersonal, and societal in nature. These findings are used to build a conceptual model of maintaining sexual desire in long-term relationships. Finally, we discuss the limitations of the existing research and suggest clear directions for future research.     

Relationship building and message planning: An exploration of media challenges and strategies used during school crises at the P-12 level

Schools at the P-12 level increasingly face crises related to school shootings, violence, and other tragedies. Understanding the communication challenges schools face is paramount to assisting schools with communication before, during, and after crisis events. The current study focuses on the challenges created by media interest in such crises and the strategies implemented to overcome these challenges and provide responsible information to stakeholders. Interviews conducted with 21 school crisis teams at the P-12 level revealed that sensationalism, seeking alternative routes to information, and framing were key challenges in working with the media. In light of these challenges, administrators focused on creating media plans, building relationships with the media, being accurate but guarded, and communicating reassurance and reunification. Implications are discussed for school districts nationally.     

From Foster Care to Adoption and Guardianship: A Twenty-First Century Challenge

For nearly four decades, child welfare policy and practice have focused on the achievement of legal permanence for children in foster care. Although federal child welfare policy has resulted in the movement of children from state custody to legally permanent adoptive or guardianship families, little is known about the quality and enduring nature of these placements. A significant challenge of the twenty-first century child welfare system is how to ensure the well-being of children currently living with adoptive parents or guardians. This paper discusses child welfare policy and trends related to post-permanency well-being, including the decrease in Title IV-E foster care caseloads nationwide and the simultaneous increase in Title IV-E adoptive and guardianship caseloads. We highlight the needs of a twenty-first century child welfare system, including increased federal efforts to ensure child permanence and well-being after legal adoption or guardianship has been achieved, as well as more rigorous longitudinal and interdisciplinary research focused on the post-permanency adjustment of children and their families.     

The Influence of Career Planning on Career Thoughts in STEM‐Interested Undergraduates

Undergraduate career planning courses have shown efficacy in decreasing students’ negative career thoughts; however, universities have minimally applied these courses to science, technology, engineering, and math (STEM) populations. This study compared the influence of a STEM‐focused career planning course for undecided STEM students with a seminar course for decided STEM majors. An analysis of covariance with covariate adjustment revealed that undecided career planning students had lower adjusted mean scores on a measure of negative career thinking than the decided STEM majors after the first semester of college. The results provide support for the efficacy of STEM‐focused career planning courses and measuring negative career thoughts with STEM undergraduates.     

The ‘First Generation’ in Historical Perspective: Canadian Students in the 1960s

Over the past few years a number of studies have focused on the disadvantages confronted by students who are the first in their families to attend university. Their liabilities include relatively low levels of preparedness, a lack of involvement in campus activities, and low levels of academic achievement. Rather than accepting the universality of this characterization, in this article, these negative characteristics and experiences were viewed as one ‘ideal type.’ Using this ideal type as a reference point, the current study focused on a period in Canadian history in which first generation students were the norm. In an examination of Glendon College, York University, located in Toronto Canada, in the mid 1960s, it was found that the experiences of the first generation did not fit the ideal type. Those who likely were the first in their families to attend university were prepared for their studies, involved in campus activities, and earned good grades. Possible explanations for this deviation from the ideal type include the buoyancy of the economy in the mid-sixties, an expanding university sector, the size and relative intimacy of the College, the way in which high schools prepared students for university, and stringent admission requirements.     

Women–Family in Quality Perspective

Bringing together women and family in quality perspective bring about interesting discussions in this paper. By integrating previous studies and considering expert opinions, we determinate the variables and dimensions with respect to women’s existence regarding their roles both in the family and at work. Many activities carried out by women represent the consumer aspects of their role. Women undertake these activities to fulfill their needs, which can be classified in the order of preference using Maslow’s Hierarchy of Need. Women success can be measured based on their ability to perform their roles successfully. We identify women’s performance by using quality approach of Personal Quality Maintenance (PQM), which is widely applied in many organizations in order to maintain the service delivery, which meets the customer satisfaction. The effort to enhance women’s satisfaction for their success in playing the multirole in the family and at work is our main consideration. This study may contribute a new point of view regarding for the women’s welfare and existence.     

FOR MONEY OR GLORY? COMMERCIALIZATION,COMPETITION, AND SECRECY IN THE ENTREPRENEURIAL UNIVERSITY

Scholars have grown concerned that the commercialization of academic science is increasing secrecy at the expense of cooperation and information sharing. Using data from comparable surveys of academic scientists in three fields (experimental biology, mathematics, and physics), we test whether scientists have become more competitive and more secretive over the last 30 years. We also use the recent survey to test a multivariate model of the effects of scientific competition and commercialization (patenting, industry funding, and industry collaboration) on scientific secrecy. We find that secrecy has increased, and has increased particularly for experimental biologists. Only 13 percent of experimental biologists in 1998 felt safe discussing their ongoing research with all others doing similar work. Our multivariate analysis shows that this secrecy is most related to concerns about being anticipated (scientific competition). We find that patenting is associated with increased secrecy among mathematicians and physicists, but not for experimental biologists. We find that industry funding is associated with more secrecy, while industry collaboration is associated with less secrecy, across fields. Our results suggest that the recent concern over increasing scientific secrecy has merit. However, this increased secrecy seems to result from a combination of increasing commercial linkages and increased pressures from scientific competition. Our research highlights the central role that scientists' competition for priority plays in the system of science and that, while such competition spurs effort, it also produces negative effects that recent trends toward commercialization of academic science seem to be exacerbating.