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Evidence-based practice

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Articles 151 - 180 of 252

Full-Text Articles in Nursing

Improving Nursing Attitudes Toward Suicide Prevention In The Emergency Department: The Implementation Of An Adolescent Suicide Risk Screening Tool, Julie A. Simpson Apr 2017

Improving Nursing Attitudes Toward Suicide Prevention In The Emergency Department: The Implementation Of An Adolescent Suicide Risk Screening Tool, Julie A. Simpson

Evidence-Based Practice Project Reports

The Center for Disease Control ranked suicide as the second leading cause of death for American adolescents (2015). This crisis of adolescent suicide warrants evaluation and improvement of current suicide prevention practices. The Emergency Department (ED) offers 24-hour services and may be the only organized healthcare for utilized by some individuals. Nurses are the front-line provider of care in the ED and this role offers opportunity to identify an adolescent with increased suicide risk. The purpose of this EBP project is to evaluate nursing attitudes toward suicide prevention by implementing the best practice screening tool for adolescent suicide risk assessment. …

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Improving Lgbt Cultural Competence In Senior Nursing Students, Hallie Orgel Apr 2017

Improving Lgbt Cultural Competence In Senior Nursing Students, Hallie Orgel

Evidence-Based Practice Project Reports

LGBT (lesbian, gay, bisexual, transgender) health care is considered a national priority by The Institute of Medicine (IOM, 2011) and HealthyPeople 2020 (2013). The shortage of LGBT culturally competent health care providers is a top contributor to the oppression and discrimination affecting LGBT health (2013). The purpose of the evidence-based practice (EBP) project was to improve the cultural competence of nursing students by improving their knowledge, attitudes, and skills in working with the LBGT population. A multi-method intervention was provided to seniors in a baccalaureate program. The project took place at a private Midwestern university and utilized a pretest/post-test design. …

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The Effects Of A Hpv Educational Intervention Aimed At Collegiate Males On Knowledge, Vaccine Intention, And Uptake, Mary A. Knudtson Apr 2017

The Effects Of A Hpv Educational Intervention Aimed At Collegiate Males On Knowledge, Vaccine Intention, And Uptake, Mary A. Knudtson

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States (US). In 2013, approximately 6% of 19 to 26-year-old males had received at least one dose of the HPV vaccine (Richman, Maddy, Torres, & Goldberg, 2016). Currently there is no known cure for HPV, however a prophylactic vaccination provides an efficacious method for protection against HPV related diseases. The purpose of the evidence-based project was to provide a HPV educational intervention to collegiate males and examine the effects of HPV knowledge, intention to vaccinate, and receipt of vaccination. The Health Belief Model was selected to …

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Effects Of Therapeutic Music On Pain In Spinal Surgery Recovery, Michael Poulsen Apr 2017

Effects Of Therapeutic Music On Pain In Spinal Surgery Recovery, Michael Poulsen

Evidence-Based Practice Project Reports

Pain is one of the most common experienced symptoms reported by more than 80% of postoperative patients. Approximately 77-98% of postoperative patients report pain following their procedure with 40- 80% having moderate to severe pain. Pain is shown to elevate stress levels manifesting in increased heart rates, blood pressures, and oxygen demand. Inadequate pain control can develop into surgical complications causing surgical failure, blood clots, pneumonia, and chronic pain. Complimentary and alternative medicine such as music can be used in combination with opioid medication help improve pain control leading to successful surgical outcomes. The purpose of this evidence-based practice project …

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Influencing College Influenza Vaccination Through A Multi-Component Campaign, Heather Strickler Apr 2017

Influencing College Influenza Vaccination Through A Multi-Component Campaign, Heather Strickler

Evidence-Based Practice Project Reports

Multiple influenza strains exist and college aged students are the most affected population from the H1N1 strain. The H1N1 influenza pandemic had high attack rates reported on campuses from 25% to 73% (Benjamin et. al., 2016; Uddin et. al., 2009). Only 8% to 40% of college students are vaccinated against influenza despite a target goal of 50% set by the American Healthy Campus 2020 (Benjamin et. al., 2016; Poehling, et. al., 2012). The purpose of this evidence based project was after implementing a multi-component influenza vaccination campaign to determine changes in intent to receive the vaccine among college students. To …

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Cancer-Related Fatigue Clinical Guideline And Protocol For Hospitalized Oncology Patients: A Quality Improvement Project, Sulotte Valcin Amilcar Jan 2017

Cancer-Related Fatigue Clinical Guideline And Protocol For Hospitalized Oncology Patients: A Quality Improvement Project, Sulotte Valcin Amilcar

Student Theses, Dissertations and Capstones

Background: Cancer-related fatigue is one of the most common symptom experienced by cancer patients throughout their cancer trajectory. However, very little effort has been made within many oncology practices to assess this clinical problem and to provide timely nursing interventions to reduce its impact. While there have been tremendous advancements in the treatments of the disease aspects of cancer in term of medicine and advanced technology, basic assessment of related physiological concerns, such as fatigue, have not seen the same progress. Purpose: The purpose of this quality improvement project was to develop an evidence-based cancer-related fatigue assessment guideline and a …

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Telephone Follow-Up To Reduce The Readmission Rate In Gynecologic Oncology Surgery Patients, Karla Kenyon Fernandez Jan 2017

Telephone Follow-Up To Reduce The Readmission Rate In Gynecologic Oncology Surgery Patients, Karla Kenyon Fernandez

Nursing Theses and Capstone Projects

Unplanned hospital readmissions are commonly viewed as a marker of poor quality care and result in increased costs for both healthcare institutions and patients. Factors associated with readmission for gynecological oncology patients can be related to the radical surgical interventions required for the management of their disease, as well as complex comorbidity profiles, surgical complexity, cancer stage, and perioperative complications. The purpose of this study was to explore and examine the impact of nursing-led telephone follow up on the reduction of the readmission rate in gynecologic oncology abdominal surgery patients following initial discharge post-operatively. A cross-sectional research study was used …

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Nursing Leadership Influence On Evidence-Based Practice Culture And Integration, Natalie Kay Lenhart Jan 2017

Nursing Leadership Influence On Evidence-Based Practice Culture And Integration, Natalie Kay Lenhart

Walden Dissertations and Doctoral Studies

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap …

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Improving Fall Prevention Strategies In An Acute-Care Setting, Sylvia B. Boye-Doe Jan 2017

Improving Fall Prevention Strategies In An Acute-Care Setting, Sylvia B. Boye-Doe

Walden Dissertations and Doctoral Studies

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program …

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Translating Evidence Of Skin-To-Skin And Rooming-In To Practice, Francisca Njoku Jan 2017

Translating Evidence Of Skin-To-Skin And Rooming-In To Practice, Francisca Njoku

Walden Dissertations and Doctoral Studies

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to …

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Frequent Fall Risk Assessment Reduces Fall Rates In Elderly Patients In Long-Term Care, Omokhele Rosemary Aliu Jan 2017

Frequent Fall Risk Assessment Reduces Fall Rates In Elderly Patients In Long-Term Care, Omokhele Rosemary Aliu

Walden Dissertations and Doctoral Studies

Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to signiï¬?cant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall …

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Development Of A Guideline For Hospice Staff, Patients, And Families On Appropriate Opioid Use, Trenika Alexander-Goreá Jan 2017

Development Of A Guideline For Hospice Staff, Patients, And Families On Appropriate Opioid Use, Trenika Alexander-Goreá

Walden Dissertations and Doctoral Studies

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand …

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Improving Provider Adherence To Guidelines In Addressing Childhood Overweight And Obesity In A Primary Care Setting, David Hernandez Dec 2016

Improving Provider Adherence To Guidelines In Addressing Childhood Overweight And Obesity In A Primary Care Setting, David Hernandez

Doctor of Nursing Practice

The purpose of the quality improvement project was to improve BMI measurement, screening, identification, documentation, and assessment of childhood overweight and obesity among children ages 3 to 18 years old in a primary care setting. Primary care providers continue to fail to address childhood overweight and obesity and have a positive impact on this issue. Delay in early identification and assessment of childhood obesity and overweight may affect patients’ qualify of life and the efficiency of health care. Over the last 30 years, the rates of childhood overweight and obesity have consistently escalated despite the existence of recommended guidelines and …

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Home Visiting Programs For Families Of Children Who Are Deaf Or Hard Of Hearing: A Systematic Review, Nannette Nicholson, Patti Martin, Abby Smith, Sheila Thomas, Ahmad A. Alanazi M.Aud. Nov 2016

Home Visiting Programs For Families Of Children Who Are Deaf Or Hard Of Hearing: A Systematic Review, Nannette Nicholson, Patti Martin, Abby Smith, Sheila Thomas, Ahmad A. Alanazi M.Aud.

Journal of Early Hearing Detection and Intervention

Prelingual hearing loss greatly restricts a child’s language development, hindering his or her behavioral, cognitive and social functioning. Although technology such as hearing aids and cochlear implants are an option for providing access to sound, they fail to teach the child how to listen or attend, how to process language (whether visual or spoken), or how to produce language and communicate. Home visiting is widely recognized as a cost-effective intervention service delivery model. Home visiting programs for promoting language development in children who are diagnosed as deaf or hard of hearing have been in existence for over 50 years, yet …

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Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga Aug 2016

Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga

Evidence-Based Practice Project Reports

Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU …

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Effect Of Using Culturally Sensitive Education In Increasing Mammogram Use And Breast Cancer Awareness: African Female Immigrants, Gertrude Mumba-Kaunda May 2016

Effect Of Using Culturally Sensitive Education In Increasing Mammogram Use And Breast Cancer Awareness: African Female Immigrants, Gertrude Mumba-Kaunda

Evidence-Based Practice Project Reports

Despite the advances in medical technology, breast cancer is the most common cancer among women and is the second leading cause of death in African-American and Caucasian women in the United States. Mammography has shown to be one of the best methods to reduce late detection of breast cancer. The American Cancer Society recommends monthly self-breast examination (SBE), clinical breast examinations every 3 years, and yearly mammography starting at the age of 40. Despite the recommendations, there is still significant disparity among different racial groups, when it comes to death rates, which can be attributed to low screening rates. The …

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Effect Of An Educational Intervention For Prevention Of Std In Minority Women, Umparrys L. Witherspoon May 2016

Effect Of An Educational Intervention For Prevention Of Std In Minority Women, Umparrys L. Witherspoon

Evidence-Based Practice Project Reports

Historically, African Americans and Hispanics in the United States have been disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), as compared with non-Hispanic whites. Females continue to outnumber males with these diagnoses. Women are generally at greater risk of acquiring HIV and other STDs than men because the female genital tract is more prone to injury and infection resulting from high-risk heterosexual contact (Crepaz et al., 2009). The purpose of the evidence based project was to implement and evaluate an educational intervention for the prevention of HIV and STDs. The Health Belief Model (HBM) was …

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The Effects Of Implementing Best Practice On Clostridium Difficile Infection Treatment, Melissa A. Craig May 2016

The Effects Of Implementing Best Practice On Clostridium Difficile Infection Treatment, Melissa A. Craig

Evidence-Based Practice Project Reports

For many years the number of Clostridium difficile infections (CDI) has steadily risen. This common cause of antibiotic-associated diarrhea can have variable clinical presentations ranging from mild diarrhea to severe cases complicated by the development of pseudomembranous colitis, electrolyte abnormalities, dehydration, sepsis, and even death. The resistant nature of the spores produced by the bacteria and the emergence of hypervirulent strains have made treatment challenging. Previous studies have demonstrated clinician non-adherence to CDI clinical treatment guidelines may result in poor patient outcomes. This evidence-based practice project was implemented at a 311 bed academic medical center in the Midwest. The project …

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Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long May 2016

Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long

Evidence-Based Practice Project Reports

The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and PACU …

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The Effect Of Heart Failure Education On Knowledge And Readmission, Sara A. Golden May 2016

The Effect Of Heart Failure Education On Knowledge And Readmission, Sara A. Golden

Evidence-Based Practice Project Reports

Heart Failure (HF) is a chronic progressive disease affecting over 5 million individuals with an expected increase in incidence as the population ages (Yehle & Plake, 2010). The costs associated with managing HF continue to increase and the Centers for Medicare and Medicaid Services (CMS) have attempted to identify ways to improve patient management of HF to reduce the revolving door of hospital readmissions and decrease expenditures. According to 2006 data, as many as one fourth of the Medicare beneficiaries discharged from acute care to skilled nursing facilities (SNF) were readmitted to the hospital within 30 days and the majority …

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National Institute Of Health Stroke Scale (Nihss) Inter-Rater Reliability And Confidence Among Nihss Certified Nurses: Implementation Of A Standardized Patient Simulation, Kelly J. Trieglaff May 2016

National Institute Of Health Stroke Scale (Nihss) Inter-Rater Reliability And Confidence Among Nihss Certified Nurses: Implementation Of A Standardized Patient Simulation, Kelly J. Trieglaff

Evidence-Based Practice Project Reports

The National Institute of Health Stroke Scale (NIHSS) is the most common stroke assessment used by nurses. Nurses certified on the NIHSS do not consistently demonstrate inter-rater reliability nor are they confident when assessing stroke patients using the tool (Josephson, Hills, Johnston, 2006). This EBP project evaluated a standardized patient simulation for maintaining inter-rater reliability and confidence in NIHSS certified nurses. A literature review showed that a decrease in inter-rater reliability occurs within four weeks to three months of NIHSS certification. A single cohort of intensive care nurses and emergency department nurses used the NIHSS tool in a standardized patient …

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Impact Of Emergency Department Sepsis Policy, Lynette Rayman May 2016

Impact Of Emergency Department Sepsis Policy, Lynette Rayman

Evidence-Based Practice Project Reports

Sepsis is a serious concern of key healthcare stakeholders due to high incidence, mortality, and cost. The objectives of this evidence-based project were to 1) identify potential sepsis patients early during the emergency department (ED) triage process and 2) implement Sepsis Order Sets. Kotter’s change model and the Stetler model of evidence-based practice guided this project. An extensive literature search was undertaken to find best practice evidence regarding care of sepsis patients. Recommended care includes a protocolized format utilizing a screening tool and point of care lactate levels for early identification of sepsis, and early treatment with antibiotics and fluid …

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The Effects Of Continuing Education On Nurse Knowledge Of Safe Haven Laws In Illinois, Lindsay Thiemkey Gordon May 2016

The Effects Of Continuing Education On Nurse Knowledge Of Safe Haven Laws In Illinois, Lindsay Thiemkey Gordon

Evidence-Based Practice Project Reports

Illegal and often fatal infant abandonment is a pervasive public health crisis. Safe Haven Laws (SHLs) help to prevent illegal infant abandonment by allowing specific professionals, including nurses, to accept unharmed newborns within statutorily defined parameters. SHLs have existed for nearly two decades, yet many healthcare workers are not knowledgeable about these laws: this implies that initial efforts to educate healthcare workers about SHLs have been ineffective. Continuing education supports lifelong learning which is a basic tenet of nursing practice. The purpose of this evidence-based practice (EBP) project was to teach nurses about SHLs through evidence-based continuing education. Literature firmly …

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The Effect Of Standardized Patient Encounters On Undergraduate Nursing Student Empathy And Self-Efficacy In Therapeutic Communication, Alana M. Urness Apr 2016

The Effect Of Standardized Patient Encounters On Undergraduate Nursing Student Empathy And Self-Efficacy In Therapeutic Communication, Alana M. Urness

Evidence-Based Practice Project Reports

Therapeutic communication between the nurse and patient is an essential component of optimal nursing care. Current evidence supports the use of standardized patient (SP) encounters to assist students in learning therapeutic communication skills. In addition to offering students an opportunity to practice in an environment free of clinical consequence, SP encounters have been shown to increase clinical knowledge and skill, improve diagnostic reasoning, and improve communication skills and interviewing skills. The purpose of this evidence-based practice project was to assess the effect of SP encounters on undergraduate nursing student empathy and self-efficacy related to therapeutic communication. Secondary outcomes included participant …

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Implementation Of A Nursing Workload Tool To Reduce Nurse Burnout, Nicole K. Greives Apr 2016

Implementation Of A Nursing Workload Tool To Reduce Nurse Burnout, Nicole K. Greives

Evidence-Based Practice Project Reports

Nursing burnout and workload is a complicated issue with far-reaching effects. Nursing burnout and inappropriate nursing workload have been linked to increased risk of urinary tract infection, respiratory infections, decreased patient satisfaction, decreased quality and safety of care, and increased mortality. The purpose of the project was to decrease nursing burnout on a Medical Progressive Care Unit (MPCU) by moving patients with high workloads and medical instability to a higher level of care. Within this project, Rosabeth Kanter’s Theory of Structural Power was used for the theoretical framework, and the Stetler Model guided the implementation. The intervention consisted of a …

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Affecting Tdap Vaccination Rates Among Women: A Multifaceted Intervention, Soneka Wynter Apr 2016

Affecting Tdap Vaccination Rates Among Women: A Multifaceted Intervention, Soneka Wynter

Evidence-Based Practice Project Reports

Despite the availability of a preventive vaccine, the incidence of pertussis in the United States has continued to increase over the past two decades and it is now considered the most common preventable infectious illness. Highly contagious in nature, it is estimated that about 50 million people are infected each year, and approximately 300,000 deaths occur worldwide (Centers for Disease Control and Prevention [CDC], 2012). In 2013, Indiana reported 616 cases (Indiana State Department of Health [ISDH], 2014). In spite of CDC recommendations on strategies that can improve vaccine delivery, rates of immunization remain low nationwide (CDC, 2014). The purpose …

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The Effects Of Education On Compassion Fatigue Experienced By Oncology Nurses, Ina Wilson Apr 2016

The Effects Of Education On Compassion Fatigue Experienced By Oncology Nurses, Ina Wilson

Evidence-Based Practice Project Reports

Oncology nursing is widely viewed as a rewarding and emotional challenging specialty. Oncology nurses witness terminal illness, death, physical, and emotional suffering which increases their risk of developing compassion fatigue. The purpose of this evidence-based practice (EBP) project was to increase awareness of compassion fatigue among oncology nurses by providing them with knowledge, effective coping skills, and self-care management skills. The Theory of Human Caring was used as the theoretical framework to support this EBP project and the intervention was guided by The Iowa Model of Research-Based Practice to Promote Quality Care. The project used a pre-test and post-test design. …

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Breastfeeding Education For Fathers: An Intervention To Increase Breastfeeding Rates, Jill Marie Frisz Apr 2016

Breastfeeding Education For Fathers: An Intervention To Increase Breastfeeding Rates, Jill Marie Frisz

Evidence-Based Practice Project Reports

If every infant were breastfed within an hour of birth, exclusively breastfed until six months, and given breastmilk up to two years, almost 800,000 lives would be saved annually (who, 2014). Nationally, breastfeeding rates drop significantly from three to six months. A search of literature yielded significant evidence as fathers for facilitators to increase breastfeeding rates. The purpose of this evidence based practice (EBP) project was to determine the effects of best practice measures to educate fathers about breastfeeding to increase anytime breastfeeding rates. The social support theory and ACE Star model guided the literature search and implementation of this …

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The Effect Of Reduced Carbohydrate Diet Education On Hemoglobin A1c In Patients With Type 2 Diabetes, Lauren Parker Apr 2016

The Effect Of Reduced Carbohydrate Diet Education On Hemoglobin A1c In Patients With Type 2 Diabetes, Lauren Parker

Evidence-Based Practice Project Reports

Type 2 diabetes (T2D) is characteristically the result of modifiable risk factors, impacting the health and well being of all ethnic backgrounds across the lifespan. Research has indicated that despite the many risk factors associated with T2D, alterations in dietary macronutrient composition can lead to improvements in disease management and resultant complications. Therefore, the purpose of this evidence-based practice (EBP) project was to provide individuals with reduced carbohydrate (carb) diet education to promote greater glycemic control and reduce associated risk factors through macronutrient modification, specifically carb intake. An integration of the most current evidence obtained from the critically appraised literature …

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The Effect Of A Multifaceted Reminder Intervention On Nursing Documentation Completeness, Meredith A. White Apr 2016

The Effect Of A Multifaceted Reminder Intervention On Nursing Documentation Completeness, Meredith A. White

Evidence-Based Practice Project Reports

Nationwide, nurses must withstand growing patient assignments and increased workloads. The consistency between nursing documentation and technical nursing interventions performed indicates that registered nurses provide much more care than they record. This incongruence has the potential to impact patient safety, but also has significant financial implications, since reimbursement is linked to documented services. The purpose of this EBP project was to implement a multifaceted reminder intervention (including a 10-minute PowerPoint and visual reminder) in an IMCU setting to assist the nursing staff (n = 38) in completing the HAPU documentation components. John Kotter’s Eight-Stage Process and the Iowa Model of …

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