Environmental and Occupational Health Sciences Institute
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Reduction of antipsychotic medications in long-term care patients with dementia
No full textPurpose of the Project: The project was a Quality Improvement (QI) initiative for Long-Term Care (LTC) nurses on the reduction of antipsychotic medications (APM) in patients with dementia through the implementation of person-centered, NonPharmacological Interventions (NPIs) as first line in the gradual dose reduction (GDR) and discontinuation of antipsychotics within 8 weeks.
Methods: The study population consisted of patients (N=43) who were identified in a LTC facility in New Jersey. A total of 21 nurses were recruited for the project. Training workshops were conducted for the nurses on the implementation of NPIs and included the use of massage therapy, animal-assisted, and pet robot interventions as well as patient-customized strategies. Results: For patients’ data postintervention, n=5, 11.6% patients were successfully discontinued on APM. 11.6% (n=5) patients passed away during the period of the project, 11.6% (n=5) patients have appropriate diagnosis for use, and 65.1% (n=28) continued on APM with GDR in place, however, these results were not statistically significant. Nurses showed an improvement in knowledge from pre to post using Wilcoxon Signed Ranks test (z = -4.064, p <.001). Confidence and attitudes became more positive pre to postintervention (z=-3.263 p =.001).
Implications: The implementation of person-centered NPIs as the first line in the management of BPSD, with GDR, and discontinuation of APM changed practice at the site. This change supports an improvement in quality measures and quality of life of the patients.
Keywords: reduction of antipsychotic medications, person centered interventions in dementia care, and nonpharmacological interventions, reduction of antipsychotic medications in dementia patients, and educating nurses on reduction of antipsychotics in dementia patients.D.N.P.Includes bibliographical referencesIncludes vit
Implementing Mindfulness-Based Stress Reduction for Nurses: A Quality Improvement Project
No full textAbstractPurpose of Project: The purpose of the project was to implement a brief mindfulness-based stress reduction (MBSR) protocol before the start of the shift to reduce acute care nurses’ stress levels and increase resilience.
Methodology: For 4 weeks, MBSR was introduced in the shift huddles. The nurses were guided through various therapeutic techniques and listened to positive affirmations. The sample was composed of 40 acute care nurses in total. Before and after the program, the nurses were assessed on their stress and coping skills using the Perceived Stress Scale (PSS) and Brief Resiliency Scale (BRS).
Results: The results of the PSS and BRS showed that MBSR caused a significant increase in stress reduction and resilience, While the average PSS pretest score was 18.13 (moderate stress), the average posttest score was 13.18 (low stress). The nurses’ resilience increased as well, with the average BRS score increasing from 3.57 to 3.88.
Implications for Practice: The nurses who participated in the project intend to continue implementing mindfulness during huddle to be more relaxed and resilient to stress. This project shows the potential of mindfulness as a cost-effective, easily accessible, and sustainable way to reduce stress and anxiety.
Keywords: mindfulness-based stress reduction, nurses, stress, anxiety, resilience, patient care.D.N.P.Includes bibliographical referencesIncludes vit
Impact of a transition of care program on hospital readmission of patients with acute myocardial infarction
No full textPurpose: This project evaluated the acute myocardial infarction (AMI) specific transition of care program (TOC) and two components aimed at reducing unplanned 30-day readmission (scheduled outpatient follow-up and HMG-CoA reductase inhibitors prescription).
Methodology
The design used was a retrospective program evaluation of all patients enrolled in the AMI TOC program at an urban academic hospital from July 2021 to December 2021. Fisher's exact test was used to analyze the effect of the AMI-specific TOC program on unplanned 30-day readmission and the association of HMG-CoA reductase inhibitor prescription to hospital readmission. Frequency and percentage were used to examine the relationship between scheduled follow-up appointments and 30-day readmission.
Results
The comprehensive TOC program tailored and adopted for AMI patients by the project site resulted in a statistically significant reduction in 30-day all-cause readmission (p = 0.047). On the other hand, the prescription of HMG-CoA reductase inhibitors did not show a statistically significant improvement in hospital readmission (p = 0.530). A comparison of readmitted and not readmitted patients with scheduled follow-up appointments did not show a significant difference, with results favoring the patients with no scheduled follow-up appointments (100% vs. 99%).
Implication for Practice
The results indicated that the AMI TOC program implemented by the project site positively impacts 30-day all-cause readmission. Promoting and investing in a comprehensive TOC program may decrease morbimortality rates and costs and may facilitate better health outcomes. However, the components included in the current program may need to be recalibrated and redesigned to improve further the project site's readmission rates.D.N.P.Includes bibliographical reference
The impact of psychosocial resources on understanding others’ emotions
No full textThis dissertation examines how psychosocial resources affects people’s use of their own emotions to perceive others’ emotions. Study 1 tested whether emotional disclosure increased positive emotions and decreased negative emotions while viewing emotionally ambiguous, COVID-related social images. Results indicated that emotional disclosure versus emotional suppression increased the positive emotions that these emotionally ambiguous social images aroused, and did so by increasing feelings of self-affirmation. Study 2 was a replication and expansion of the Study 1. It tested whether emotional disclosure about a negative event, as opposed to disclosure about a neutral event or suppression about a negative or neutral event, affected felt emotions while viewing ambiguous social images and neutral facial expressions. Study 2 did not replicate the results from Study 1. Instead, feelings of affirmation increased even in the neutral writing conditions, and felt positive emotions were not greater in participants who disclosed about a negative event. However, feelings of self-affirmation, induced through disclosure increased both positive and negative emotional reactions to images, suggesting that affirmation can lead to a greater range of felt emotions. This increased emotional range may assist in understanding other people’s emotions. Study 3 tested whether bolstered self-worth increases the use of one’s own emotions to perceive the emotions of others. Participants’ self-worth was affirmed, depleted, or unchanged. Participants then viewed images of people in positive or negative emotional states. Participants rated the emotions of these people as well as their own emotional reactions to them. Results partially supported the hypothesis that self-worth increases the use of one’s own emotions to understand others’ positive and negative emotions in certain contexts.Ph.D.Includes bibliographical reference
One-size-fits-all? the diffusion of policing models in Latin America
No full textThis dissertation investigates the diffusion and adoption of community policing (CP) and hot spots policing (HSP) models in Chile, Colombia, Honduras, and Uruguay between 2000 and 2020. It aims to understand how these policing models, primarily developed in the Global North, are adapted to Latin American contexts. This translates into the following set of specific research questions: How were the dominant models adopted in Chile, Colombia, Honduras, and Uruguay? What are the key actors and their roles in the diffusion process of community policing and hot spots policing? What were the underlying mechanisms that facilitated the adoption of both models? Furthermore, what were the implementation challenges involved in adopting both models at the operational level?The study employs a comparative, multi-method approach, drawing on archival data such as policy documents, laws or reports (n=137), a sample of evidence-based practices available in two electronic repositories (n=93) and semi-structured interviews conducted to key informants (n=67) —government officials, senior police officers, experts, and international organization officials—.
Findings reveal that both models undergo significant adaptation to fit local conditions, resulting in hybrid forms. While international organizations and Global North
experts play a crucial role in disseminating HSP, CP is more reliant on regional and local expertise. The research highlights the importance of direct and indirect learning mechanisms in knowledge transfer. However, the success of implementation hinges on local factors such as institutional capacity, political will, and community engagement. The study concludes that while these models offer potential benefits, their effective implementation requires a deep understanding of local contexts and careful adaptation.
By examining the diffusion and adoption of policing models in Latin America, this research contributes to the broader understanding of policy transfer and its implications for crime prevention, public safety and police reform.Ph.D.Includes bibliographical reference
Investigating the spillover effects of parental leave as an intervention to improve gender selection in organizations
No full textGender gaps in representation persist in organizations. While the predominant organizational equality interventions (e.g., diversity training, DEI values, quotas) have incrementally improved female representation, more effort is needed to improve gender parity on teams throughout organizations. In this dissertation I make the case for less heavy-handed forms of gender equal treatment, such as equal parental leave, as a means to improve selection outcomes for women. Additionally, I examine the conditions under which these selection effects may be more influential and attempt to unpack the reasoning behind some interventions being more helpful than others. This research seeks to expand the scope of gender equality interventions and provides researchers and organizations alternative approaches to improving selection outcomes for women.Ph.D.Includes bibliographical reference
Essays in applied economics on firm performance
No full textThis dissertation consists of three essays that each offer an empirical investigation into unique drivers of firm performance. The first essay focuses on the use of carbon offsets and renewable energy certificates (RECs) by firms to mitigate their greenhouse gas emissions. It investigates the impact of these investments on firms' environmental scores, GHG emissions, and financial performance using data from firms in North America and Europe from 2012-2022. Employing a propensity score matching (PSM) as well as instrumental variables approach, the findings suggest that firms purchasing carbon offsets or RECs may engage in greenwashing behavior, as they exhibit higher environmental scores and GHG emissions. These purchases also lead to higher sales, profitability, and assets, while lowering Tobin’s Q for REC buyers. Additionally, the essay finds that a greater presence of women on the board does not lead to greater purchases of carbon offsets or RECs. The second essay focuses on the surge of acquisitions by firms from developing countries in developed countries over the last twenty years. It examines the impact of these acquisitions on the performance of target firms from developed countries during 2000-2019. Using a PSM and difference-in-differences (DID) approach, the findings reveal that acquisitions by developing countries do not have a favorable impact on the financial performance of target firms, showing a negative effect on sales growth, profitability, assets, and employment in the five-year post-acquisition period. The third essay explores the significance of firms’ environmental, social, and governmental (ESG) performance in M&A deals, specifically focusing on the effect of acquisitions on the sustainability performance of target firms in developed markets. Combining a PSM and event study DID approach, the analysis shows that target firms’ ESG improves after being acquired by firms with higher ESG ratings. Additionally, there is a positive long-term impact on the intangible assets of target firms for up to five years post-acquisition. These findings highlight the value of strong ESG practices as a transferable resource that can be learned and exchanged between acquirers and target firms to enhance their sustainability performance.Ph.D.Includes bibliographical reference
Impact of mindfulness on 1st term nursing students
No full textPurpose of Project: Nursing students experience higher stress levels when compared to other major. Nursing students, especially in first year have been found to function at a constant moderate or high stress level. The purpose of this project was to assess perceived stress level after 4-week mindful program among first year nursing students Methodology: This was a quality improvement project that used a quasi-experimental design. Study interventions included implementing a 4-week Mindfulness program for 25 minutes before class to a purposeful sample of 21 1st year nursing students. Perceived Stress Scale (PSS) was used to assess perceived stress level. There are two subscales within the PSS, including perceived helplessness and lack of self-efficacy. Descriptive statistics were used to describe sample characteristics. Wilcoxon rank-sum test was used to compare two related samples of perceived stress levels of students pre and post a 4-week mindfulness intervention, along with the two subscales, perceived helplessness and lack of self-efficacy Results: The perceived stress score significantly decreased from M=23.10 ± SD 6.75 at pretest to M=19.14 ± SD 6.12 at post (Z = -2.649, p < 0.01). The perceived helplessness score significantly decreased from M=15.95 ± SD 4.59 at pretest to M=13.38 ± SD 3.99 at post (Z = -2.864, p < 0.01). The perceived lack of self-efficacy scores significantly decreased from M=7.14 ± SD 2.76 at pretest to M=5.76 ± SD 2.62 at post (Z = -2.358, p < 0.05). The student satisfaction survey on mindfulness scores significantly increased from M=16 ± SD 2.93 at pretest to M=22.52 ± SD 1.94 at posttest (Z = -4.021, p < 0.001). Implications for Practice: Incorporating a mindfulness practice in nursing schools can have positive and lasting effects on student’s academic success, enjoyment and satisfactions of their journey along with emotional & mental well-being. This could prime them to become a less burnout or stressed nurse in the future, assisting a change in the nursing shortageD.N.P.Includes bibliographical reference
Reducing workplace incivility among nurses in long term care facility at veterans affairs medical center: a cognitive rehearsal quality improvement project
No full textPurpose of the Project: Workplace incivility is one of the severe problems that affects the nursing profession both nationally and globally. The purpose of the project was to help nurses at the Veterans Affairs Medical Center (VAMC) in Somerset County, New Jersey, recognize and reduce workplace incivility by implementing an evidence-based educational session that incorporates cognitive rehearsal techniques. In essence, nurses will be able to recognize and successfully deal with several issues relating to workplace incivility with minimal impact.
Methodology: This quality improvement project used a paired samples t-test to compare the Workplace Incivility Training Evaluation Tool with mean knowledge scores at pre and post-implementations. The overall mean score was computed for each participant at the pre-and post-workshops. Descriptive statistics were used to analyze descriptive data, including frequencies and percentages for age, gender, race, professional nursing experience and highest degree earned.
Results: The results showed a statistically significant improvement in workplace incivility knowledge from pre- (M = 3.46, SD = .72) to post-intervention (M = 6.32, SD = .38), t (37) = -27.54, p = .001. The p-value is less than .05, which supports statistical significance. Participants reported that participation in the educational session (1) increased their awareness of workplace incivility.
Implications for Practice: Workplace Incivility negatively impacts nurses, organizations, patient safety, and outcomes. Addressing incivility through education can help promote a safe and trusting environment. Workplace incivility education with cognitive rehearsal can help alleviate and manage the harmful effects of incivility among nurses.D.N.P.Includes bibliographical reference
Type 1 diabetes mellitus following COVID-19 vaccination: a systematic review and meta-analysis
No full textObjective: The purpose of this systematic review was to describe the clinical-epidemiological characteristics of patients who developed Type 1 Diabetes Mellitus (T1DM) post-COVID-19 (Coronavirus Disease 2019) vaccination and determine the T1DM prevalence among COVID-19 vaccine recipients.
Introduction: COVID-19 vaccines reduce the rate of hospitalizations and death from COVID-19 infection. Emerging evidence of the development of T1DM post-COVID-19 vaccination poses concerns. It is imperative to determine the prevalence of T1DM among vaccinated individuals and describe patient characteristics in order to help patients and providers make informed shared decisions regarding COVID-19 vaccination.
Inclusion criteria: This systematic review included case reports/series and observational studies that reported the incidence of T1DM following COVID-19 vaccination among participants of all ages and sexes.
Methods: Seven databases were searched to find published and unpublished literature. Two independent reviewers performed the screening of articles, critical appraisal, and the extraction of data. Meta-analysis using the JBI SUMARI (Joanna Briggs System of the Unified Management of the Assessment and Review of Information) was conducted to determine the prevalence of T1DM among COVID-19 vaccine recipients. Clinical-epidemiological characteristics of patients who developed T1DM following COVID-19 vaccination were synthesized narratively.
Results: 27 studies were included in this systematic review. Based on four studies included in the meta-analysis the prevalence of T1DM post-COVID-19 vaccination is 1%. Individuals who developed T1DM exhibited distinct genetic markers, had a history of autoimmune diseases, or were undergoing treatment with biological agents.
Implications for practice: Clinicians should counsel patients that T1DM is rare after COVID-19 vaccination. Clinicians need to monitor people who have autoimmune conditions and/or receiving biological treatments after receiving COVID-19 vaccines for T1DM symptoms.
Conclusion: The prevalence of T1DM following COVID-19 vaccination is low, which should not be a barrier to vaccination. Clinicians and patients with distinct genetic markers or a history of autoimmunity should be aware of this potential complication, enabling them to make informed decisions.D.N.P.Includes bibliographical reference