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2019

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Articles 121 - 150 of 207

Full-Text Articles in Health Policy

Reframing The Conversation On Patient Experience: Three Considerations, Jason A. Wolf Phd, Cpxp Apr 2019

Reframing The Conversation On Patient Experience: Three Considerations, Jason A. Wolf Phd, Cpxp

Patient Experience Journal

In experience, every voice matters, and each of those individual voices are contributing to an ocean of ripples that are positively impacting countless lives. In experience, no one organization owns, nor should claim to own all the answers, but many contribute to the possibilities found in elevating the human experience in healthcare. In experience, when we ensure this is a true strategic focus at the heart of healthcare we will find our way to achieving all the outcomes we aspire to achieve and know are possible in healthcare. This issue helps frame that reality through contributions from around the world …


From Beshear To Bevin: The Rise And Fall Of The Aca In Kentucky, Ellen Baker Apr 2019

From Beshear To Bevin: The Rise And Fall Of The Aca In Kentucky, Ellen Baker

Annual Undergraduate Conference on Health and Society

No abstract provided.


Fostering University Collaboration And Building Capacity To Respond To Coastal Resilience Challenges In Virginia: Findings From The Rotating Resilience Roundtables Workshop Spring 2019, Wie Yusuf, Michelle Covi, Anamaria Bukvic, Tom Allen, Taiwo Oguntuyo Apr 2019

Fostering University Collaboration And Building Capacity To Respond To Coastal Resilience Challenges In Virginia: Findings From The Rotating Resilience Roundtables Workshop Spring 2019, Wie Yusuf, Michelle Covi, Anamaria Bukvic, Tom Allen, Taiwo Oguntuyo

Presentations, Lectures, Posters, Reports

[from Background and Overview]

Communities in coastal Virginia, particularly in the urban region of Hampton Roads and the rural Eastern Shore peninsula, are experiencing the impacts of climate change as part of everyday life. Among the most apparent impacts are sea level rise and associated flooding, but increasingly residents of the region are observing changing ecosystems, health impacts and complex social challenges are made more difficult. The region is experiencing the fastest rate of relative sea level rise on the U.S. east coast due to interactions between ocean currents, global sea level rise, high-water tables and ground subsidence (Adapt Virginia …


Restricted Access And Delays To Hcv Treatment Among Medicaid Patients In Louisiana, Morris M. Kim, Keanan M. Mcgonigle Apr 2019

Restricted Access And Delays To Hcv Treatment Among Medicaid Patients In Louisiana, Morris M. Kim, Keanan M. Mcgonigle

Journal of Health Disparities Research and Practice

Background: Many people living with chronic Hepatitis C Virus (HCV) have seen delays in accessing treatment or been denied entirely due to Medicaid restrictions requiring patients to meet certain criteria prior to receiving approval for medication pre-authorization.

Methods: This study identified a cohort of Medicaid-insured patients with chronic HCV infection within New Orleans, LA. Patient medical records were reviewed and information regarding HCV care was gathered. This study sought to determine the degree to which HCV care was delayed for this population and describe common reasons for prior-authorization denials for direct-acting antiviral (DAA) medications.

Results: For this population of Medicaid-insured …


Regulatory Disclosure Policies And Potential Induced Changes In Behavior: An Outcome Evaluation Of Santa Clara County’S Enhanced Food Safety Program Elements, Christian Cruz Apr 2019

Regulatory Disclosure Policies And Potential Induced Changes In Behavior: An Outcome Evaluation Of Santa Clara County’S Enhanced Food Safety Program Elements, Christian Cruz

Master's Projects

Despite countless advances in food microbiology and public health regulations, foodborne illness continues to be a major strain on public health outcomes and a costly economic burden. In the United States, many agencies are responsible for ensuring the quality of food, both domestically produced and imported. States and localities are delegated the responsibility of identifying and ensuring sound practices in the latter stages of the food production process, namely the retail distribution of food products to consumers.

Regulatory policies across the nation have only recently incorporated the evidenced-based principles of hazard risk management (Law, 2003). Still, food-related acute gastrointestinal illnesses …


Activating Nursing To Address Unmet Needs In The 21st Century, Patricia Pittman Apr 2019

Activating Nursing To Address Unmet Needs In The 21st Century, Patricia Pittman

Health Policy and Management Faculty Publications

No abstract provided.


Where Do We Go From Here?: Two Key Informants' Perspectives On How To Address Conscientious Objection In Top Provision In South Africa, Talia Parker Apr 2019

Where Do We Go From Here?: Two Key Informants' Perspectives On How To Address Conscientious Objection In Top Provision In South Africa, Talia Parker

Independent Study Project (ISP) Collection

This perspectives research endeavor examines the barriers to TOP access that arise from conscientious objection through the conflicting network of rights and legislation in South Africa. While previous research has evidenced the demonstrable barriers to accessing TOP care in South Africa, this project aims to push the existing literature and the field as a whole one step further to interrogate how to move forward within the realities of conscientious objection.

To do so, I conducted interviews with key informants in the field of reproductive healthcare provision, research, and activism in Cape Town on their perspectives about the practice of conscientious …


Z4, A Slow Puncture: An Autoethnographic Exploration Of Language, Embodiment, And Meaning-Making, Charlotte Rose Samuels Apr 2019

Z4, A Slow Puncture: An Autoethnographic Exploration Of Language, Embodiment, And Meaning-Making, Charlotte Rose Samuels

Independent Study Project (ISP) Collection

In my ISP, I explored language as it relates to the ways in which people living in Cato Manor make sense of HIV/AIDS in their community. With 7.1-7.2 million people living with HIV (PLWHIV) in South Africa, individuals across the country are either infected or affected by illness. KwaZulu-Natal (KZN), the province with the highest rate of HIV, is also the province that was surveyed with the disproportionately highest internal stigma rates for PLWHIV. High prevalence of HIV, particularly in KZN, calls for a constant contextualization of life in the presence of illness.

Throughout the world, metaphor and symbolism is …


From The American People: An Autoethnographic Exploration Of South African Ngos' Perceptions Of Pepfar, Antonia Asher Apr 2019

From The American People: An Autoethnographic Exploration Of South African Ngos' Perceptions Of Pepfar, Antonia Asher

Independent Study Project (ISP) Collection

The aim of this research was to understand what the ideal partnership would be between United States (US) governmental aid agencies and South African non-governmental organizations (NGOs), specifically concerning HIV/AIDS programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR), from the perspective of NGOs. PEPFAR is the largest relief fund for a single disease; thus, I additionally sought to deeply reflect upon myself as a US citizen in South Africa, a country that has received trillions of dollars from taxpayers such as myself.

To accomplish this, I interviewed NGO staff about the nature of current partnerships, outcomes …


Characterizing Systems Of Reporting And Mitigating Anthrax Outbreaks Near Mto Wa Mbu, Monduli District, Tanzania, Megan Levy Apr 2019

Characterizing Systems Of Reporting And Mitigating Anthrax Outbreaks Near Mto Wa Mbu, Monduli District, Tanzania, Megan Levy

Independent Study Project (ISP) Collection

Northern Tanzania has experienced several anthrax outbreaks in the recent past. In Monduli district, an outbreak in 2016 prompted an organization of district officials to create an updated outbreak response action plan. The pastoralist community is often affected by these outbreaks due to their frequent direct contact with cattle and herds’ proximity to wild species potentially affected by the disease. This characterization of the existing systems of reporting and mitigating anthrax outbreaks was accomplished through structured interviews with ward and village officers, local veterinarians, and members of the pastoralist community in Monduli district near Mto wa Mbu. The purpose of …


Vaccine Hesitancy In The United States And Switzerland, Anna E. Lunderberg Apr 2019

Vaccine Hesitancy In The United States And Switzerland, Anna E. Lunderberg

Independent Study Project (ISP) Collection

Vaccine hesitancy (VH), or the reluctance or refusal to participate in vaccination programs, is a complex phenomenon with far-reaching impacts on society. VH can impact vaccine uptake and facilitate subsequent outbreaks, as seen with the case of measles. Perceptions of vaccination are similar in the United States and Switzerland, and misinformation in each country contributed to VH through impaired parental risk-benefit analysis; parental analysis and subsequent VH is associated with both anti-vaccination messages gaining prominence and a decrease in the public perception of the health risk from vaccine-preventable diseases (VPDs). There are many proposed strategies for addressing VH on both …


Cancer Management In Kenya - Awareness And The Struggles Patients Face To Access Treatment, Care & Support, Ashley Nmoh Apr 2019

Cancer Management In Kenya - Awareness And The Struggles Patients Face To Access Treatment, Care & Support, Ashley Nmoh

Independent Study Project (ISP) Collection

The amount of cancer cases in Africa, and Kenya specifically, are rising at an alarming rate. This study was conducted to determine the challenges that patients with cancer in Kenya face to access treatment, care and support. Thirty-nine cancer patients were interviewed and thirty cancer patients filled out a questionnaire about their experiences of having cancer in Kenya. In addition, twenty key informants were interviewed including doctors, caregivers, cancer NGO executives, a researcher, a psychologist, a National Health Insurance Fund official and a director from the Ministry of Health. A breast cancer awareness survey was also administered to fifty-nine women …


Nationalizing Services For The Trans-National: How Sub-Saharan Migrants Navigate Healthcare Access In Tunisia, Batoul Hasan Apr 2019

Nationalizing Services For The Trans-National: How Sub-Saharan Migrants Navigate Healthcare Access In Tunisia, Batoul Hasan

Independent Study Project (ISP) Collection

The right to human health and the resources that empower this state is an entitlement recognized under international law. With the circumstances surrounding their journeys, migrants face increased risks and vulnerabilities that necessitate social protections. Nations of reception, due to exclusionary policies or lack of capacity, may fail to guarantee these protections. This study investigates how this phenomenon unfolds in Tunisia, a middle-income nation undergoing a host of political and economic changes, but one that’s nonetheless become an alluring destination for migrants, specifically those from sub-Saharan African nations. The analysis proceeds from an assessment of the public health situation in …


Exploring Mobility Help-Seeking Behavior Among People With Physical Disabilities: A Case Study Of Jaipur Foot, Alex Podell Apr 2019

Exploring Mobility Help-Seeking Behavior Among People With Physical Disabilities: A Case Study Of Jaipur Foot, Alex Podell

Independent Study Project (ISP) Collection

It is estimated that as many as 90 million people living in India experience some sort of disability (The World Bank, 2007). As India’s population keeps growing and aging, not only will the medical aspects, but also the societal impacts of disability need to be brought to the forefront of discussion, developmental strategy, and policy implementation. This study sought to analyze factors influencing the process of seeking help from formal and informal sources for people with physical disabilities. Data was collected from 10 people with physical disabilities receiving a variety of mobility aids from the NGO, Bhagwan Mahaveer Viklang Sahayata …


El Rol De Los Agentes Sanitarios Para Mejorar El Acceso A La Salud Sexual Y Reproductiva Para Mujeres En San Carlos, Mendoza. / The Role Of Agentes Sanitarios In Improving Access To Sexual And Reproductive Health For Women In San Carlos, Mendoza., Laura Hult Apr 2019

El Rol De Los Agentes Sanitarios Para Mejorar El Acceso A La Salud Sexual Y Reproductiva Para Mujeres En San Carlos, Mendoza. / The Role Of Agentes Sanitarios In Improving Access To Sexual And Reproductive Health For Women In San Carlos, Mendoza., Laura Hult

Independent Study Project (ISP) Collection

Introducción: Es evidente que Argentina tiene un enfoque que atiende a la salud sexual y reproductiva, dado que tiene cobertura universal y la ley de Programa Nacional de Salud Sexual y Procreación Responsable que establece un estándar de cuidado para toda la población. Sin embargo, cobertura universal no implica acceso universal, el cual que está determinado por el transporte, el idioma y la cantidad de recursos de la región. En lugares como San Carlos, Mendoza, donde no hay transporte regular y hay pocos recursos, existe inequidad en la salud, lo que puede aumentar las tasas de embarazos no intencionales y …


Los Microcosmos De La Interculturalidad? Una Mirada Al Cómo Los Trabajadores De La Salud Biomédica De Orígen Indígena Relacionan Con Los Modelos De Salud Tradicional Y Occidental, Taylor Lord Apr 2019

Los Microcosmos De La Interculturalidad? Una Mirada Al Cómo Los Trabajadores De La Salud Biomédica De Orígen Indígena Relacionan Con Los Modelos De Salud Tradicional Y Occidental, Taylor Lord

Independent Study Project (ISP) Collection

Research Question: How does a biomedical health professional with indigenous roots in Chile relate the biomedical model of healthcare with the alternative indigenous model in their practice?

Objectives: The primary objective of this study was to understand how and if a biomedical health professional with indigenous roots relates and integrates two models of healthcare in their daily practice. A Secondary objective was analyzing if integration affects philosophy of care in relation to patients in critical conditions. In sum, it looked to study biomedical health professionals with indigenous roots as potential microcosms of interculturality that can demonstrate the benefits of a …


Is Technology The Key To Prevention Of Falls Among The Elderly In Rapidly Aging Societies? A Case Study Of Kunming, China, Phoebe Kiburi Apr 2019

Is Technology The Key To Prevention Of Falls Among The Elderly In Rapidly Aging Societies? A Case Study Of Kunming, China, Phoebe Kiburi

Independent Study Project (ISP) Collection

As the aging society rapidly becomes more dominant in the world, there is a pressing need for different stakeholders to tend to the needs of the aging sufficiently. This is crucial in ensuring the robustness of the healthcare system as a whole; given that it can only be as strong as its weakest link. This study focuses on one of the areas of need of the ageing society: fall prevention.

Numerous studies have been done on interventions by the government, private entities, elderly people and their caregivers to prevent occurrence and recurrence of falls. However, most of these have been …


Health On The Move: Health-Seeking Behavior Of Changpa Nomads In Ladakh, India, Maya Lubeck-Schricker Apr 2019

Health On The Move: Health-Seeking Behavior Of Changpa Nomads In Ladakh, India, Maya Lubeck-Schricker

Independent Study Project (ISP) Collection

The goal of this study is to understand the health-seeking behavior of Changpa nomads in the Changthang region of Ladakh, India including what health issues these communities face, what they do when they fall sick, any preventative health behavior they implement, as well as the health infrastructure available to them. Very little literature exists on the health seeking-behavior of people in South Asia in general, much less among nondominant lifestyles such as that of nomadic or semi-nomadic people. As such, this research hopes to move towards closing that knowledge gap by conducting and analyzing 26 in depth semi-structured interviews and …


Walk N’ Roll (Wnr) San Jose: An Initiative To Promote Active Transportation And Safe Routes To School For Children In San Jose, California, François Xavier Hans Voltaire Apr 2019

Walk N’ Roll (Wnr) San Jose: An Initiative To Promote Active Transportation And Safe Routes To School For Children In San Jose, California, François Xavier Hans Voltaire

Master's Projects

How effective is the Walk n’ Roll (WnR) program in promoting active transportation near school zones in San Jose, California? The intent of this research question is to discern the effect of the City of San Jose’s WnR program in encouraging children to actively travel to school (walking/cycling) and using other means such as scooters and skateboards. This research will use data from 2012-2018 to measure the efficacy of the program. This project strives to discover whether the tools and strategies that the program is using impact the augmentation level of the number of students who actively travel and transport …


Ecological Determinants Of Respiratory Health: Examining Associations Between Asthma Emergency Department Visits, Diesel Particulate Matter, And Public Parks And Open Space In Los Angeles, California, Jason A. Douglas, Reginald S. Archer, Serena E. Alexander Mar 2019

Ecological Determinants Of Respiratory Health: Examining Associations Between Asthma Emergency Department Visits, Diesel Particulate Matter, And Public Parks And Open Space In Los Angeles, California, Jason A. Douglas, Reginald S. Archer, Serena E. Alexander

Health Sciences and Kinesiology Faculty Articles

Los Angeles County (LAC) low-income communities of color experience uneven asthma rates, evidenced by asthma emergency department visits (AEDV). This has partly been attributed to inequitable exposure to diesel particulate matter (DPM). Promisingly, public parks and open space (PPOS) contribute to DPM mitigation. However, low-income communities of color with limited access to PPOS may be deprived of associated public health benefits. Therefore, this novel study investigates the AEDV, DPM, PPOS nexus to address this public health dilemma and inform public policy in at-risk communities. Optimized Hotspot Analysis was used to examine geographic clustering of AEDVs, DPM, and PPOS at the …


How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss Mar 2019

How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss

Social Policy Institute Research

This brief is the third and final brief in a series exploring the financial well-being of low- and moderate-income (LMI) households in the United States. The first brief in this series explored how financial well-being differed between LMI households and the general population.1 The second in the series examined how financial well-being changed over time in a sample of LMI respondents.2 This brief uses longitudinal survey data paired with administrative tax data to assess how different household experiences—including the use of alternative financial services, the experience of material and medical hardship, and improvements in physical and financial health—correspond …


Assessing The Short-Term Stability Of Financial Well-Being In Low- To Moderate-Income Households, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Sam Bufe, Michal Grinstein-Weiss Mar 2019

Assessing The Short-Term Stability Of Financial Well-Being In Low- To Moderate-Income Households, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Sam Bufe, Michal Grinstein-Weiss

Social Policy Institute Research

A growing body of research demonstrates that U.S. households experience a high degree of volatility in their finances. This volatility can take the form of large swings in month-to-month income, spells of unemployment, and incurring unexpected expenses.1 Beyond being difficult to predict, these income and expense shocks are costly as well, with one survey finding that the most expensive shock experienced by the median U.S. household cost roughly half of one month’s income.2This financial volatility disproportionately affects low- to moderate-income (LMI) households;3 a population that often lacks the resources to manage this volatility. For example, research from the Survey of …


How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss Mar 2019

How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss

Social Policy Institute Research

This brief is the third and final brief in a series exploring the financial well-being of low- and moderate-income (LMI) households in the United States. The first brief in this series explored how financial well-being differed between LMI households and the general population. The second in the series examined how financial well-being changed over time in a sample of LMI respondents. This brief uses longitudinal survey data paired with administrative tax data to assess how different household experiences—including the use of alternative financial services, the experience of material and medical hardship, and improvements in physical and financial health—correspond to the …


We Should Promote Harm Reduction To Combat The Opioid Overdose Crisis, Alexandra Punch Mar 2019

We Should Promote Harm Reduction To Combat The Opioid Overdose Crisis, Alexandra Punch

Population Health Research Brief Series

Over 70,000 people in the U.S. died from drug overdoses last year, and the U.S. continues to struggle with how to address this crisis. This issue brief explains the concept of harm reduction, describes various types of programs that fall under the harm reduction model, and discusses the promises these approaches hold for helping to combat the current opioid crisis.


Knowledge And Practice In Household Waste Management, Agnes Fitria Widiyanto, Suratman Suratman, Nisrina Alifah, Tri Murniati, Oktafiani Catur Pratiwi Feb 2019

Knowledge And Practice In Household Waste Management, Agnes Fitria Widiyanto, Suratman Suratman, Nisrina Alifah, Tri Murniati, Oktafiani Catur Pratiwi

Kesmas

Declining environmental quality is one of population caused by household consumption behavior. Some of the highest contaminant contributions are domestic waste, waste, and company waste. Waste contamination will lead to dead fish, decreased water quality and disease transmission. Community approach can be done to solve the waste problem, especially at the household level. This study uses quantitative methods to analyze the effect of intervention and waste management training on changes in household waste management knowledge and practices. This type of research uses quasi experiment with one group of pre and post test design. The results showed that there was an …


Exclusive Breastfeeding And Decrease Of Upper Respiratory Infection Incidence Among Infants Aged 6-12 Months In Kampar District, Riau Province, Musfardi Rustam, Renti Mahkota, Nasrin Kodim Feb 2019

Exclusive Breastfeeding And Decrease Of Upper Respiratory Infection Incidence Among Infants Aged 6-12 Months In Kampar District, Riau Province, Musfardi Rustam, Renti Mahkota, Nasrin Kodim

Kesmas

Upper Respiratory Infection (URI) is a major cause of morbidity and mortality of infants and toddlers in developing countries. The high infant morbidity and mortality rates in Indonesia are associated with the low exclusive breastfeeding ability. Breast milk is a natural drink for newborns in the first month of life that is beneficial not only for the babies, but also for mothers. The aim of study was to determine exclusive breastfeeding and decrease in incidence of URI among infants aged 6-12 months. This study was conducted by using case control design. Samples were taken by using cluster random sampling. Subject …


The Consumption Of Fresh Vegetables From Street Food And Sanitation Of Street Stalls At Four Locations In Bogor City, Donna Fujie Rahaditha Utami, Winiati P. Rahayu, Lilis Nuraida Feb 2019

The Consumption Of Fresh Vegetables From Street Food And Sanitation Of Street Stalls At Four Locations In Bogor City, Donna Fujie Rahaditha Utami, Winiati P. Rahayu, Lilis Nuraida

Kesmas

The consumption of fresh vegetables at the stalls needs serious attention. This research aimed to estimate the exposure probability due to fresh vegetables consumption of street food consumers, to measure sanitation level of street stalls that serving fresh vegetables, and to recommend a mentoring program for the stalls at four locations in Bogor City. This research was conducted at 16 stalls located at four locations in Bogor City. The number of respondents surveyed was 293 people and determined by stratified sampling method. Food frequency questionnaire was used as a tool in the survey. The survey showed that men consumed more …


Perception Of People Living With Hiv/Aids On Social Stigma Of Hiv/Aids In Sukoharjo District, Titik Haryanti, Wartini Wartini Feb 2019

Perception Of People Living With Hiv/Aids On Social Stigma Of Hiv/Aids In Sukoharjo District, Titik Haryanti, Wartini Wartini

Kesmas

The stigma of wrong society about HIV / AIDS is one of the obstacles to prevention and control of HIV / AIDS in Sukoharjo District. This study aims to determine the relationship of characteristics, causal factors and duration of HIV / AIDS with the perception of people living with HIV to the stigma of society about HIV / AIDS in Sukoharjo District. The research used is analytical descriptive with cross sectional approach. The population is all people with HIV / AIDS until April 2016 amounted to 256 with a sample of 156 people with sampling technique quota sampling. Bivariate analysis …


Prediction Models For Descreasing Visual Acuity In Wig Makers, Nur Ulfah, Siti Harwanti, Ngadiman Ngadiman Feb 2019

Prediction Models For Descreasing Visual Acuity In Wig Makers, Nur Ulfah, Siti Harwanti, Ngadiman Ngadiman

Kesmas

One of the occupational diseases that can arise for workers with high accuracy is a decrease in their visual acuity. Therefore, it is necessary to study the risk factors of decreasing visual acuity in workers with high accuracy, such as in wig makers. This study aimed to examine the correlation between age, working period, lighting intensity, fatigue, and nutritional status with visual acuity, and to observe the main risk factors that can be used as a reference for predicting decreasing visual acuity. This study was an observational study that used a cross-sectional design. The population number for this study was …


Relationship Model For Occupational Safety And Health Climate To Prevent Needlestick Injuries For Nurses, Ketut Ima Ismara, Adi Heru Husodo, Yayi Suryo Prabandari, Widodo Hariyono Feb 2019

Relationship Model For Occupational Safety And Health Climate To Prevent Needlestick Injuries For Nurses, Ketut Ima Ismara, Adi Heru Husodo, Yayi Suryo Prabandari, Widodo Hariyono

Kesmas

The risk of accidents and disease transmission when working at hospitals is quite high, especially in Indonesia. This study aimed to analyze the relationship model between the Occupational Safety and Health (OSH) climate and behavior intention in OSH performance to prevent needlestick injuries (NSI) based on a theory of planned behavior. A mixed approach using qualitative and quantitative methods was applied. Data were obtained from Structural Equation Model questionnaires, observation, and documentation, and interviews were analyzed qualitatively. The population was 1,042 nurses at Dr. Sardjito General Hospital in Yogyakarta. The sample consisted of 289 respondents determined by purposive random sampling …