PhD Graduates – 2024

Nursing educators are challenged to find strategies that will develop critical thinking and clinical judgment abilities in students. As technology has advanced, the use of virtual simulation platforms has increased in use in nursing courses. This study examined the effect of a pilot virtual simulation intervention on critical thinking and clinical judgment abilities in Associate Degree Nursing students. A convenience sample of thirteen students from a community college in Northern New Jersey participated in this pre-test, post-test study. The increase in critical thinking and clinical judgment test scores were not statistically significant, yet there was a noted increase in group mean and several individual scores. No noted correlation was observed in the critical thinking and clinical judgment test scores post virtual simulation cases. Age, gender, ethnicity, and prior experience in healthcare were not significant predictors of critical thinking and clinical judgment abilities post virtual simulation cases. The increase in mean and individual test scores showed promise for feasibility for testing this intervention on a larger scale. As virtual simulation is being used more in nursing education, additional research is warranted to examine the impact of this teaching strategy on critical thinking and clinical judgment abilities.

Background: Problems previously identified in the implementation of person-centered care in Saudi Arabia include communication barriers, work environment factors, and cultural discordance between patients and nurses. Some have questioned whether Western person-centered care concepts are even applicable in a non-Western setting. In a nation where the majority of nurses are international migrant workers, better understanding is needed of what person-centered care means to nurses and how they manage to enact it in practice.

Purpose: To explore nurse perceptions of person-centered care in inpatient units in Saudi Arabia and identify what nurses regard as facilitators and barriers to person-centered care.

Methods: Qualitative descriptive design using purposive sampling with maximum variation. Twenty-one nurses were recruited from two hospitals serving clinically complex patients in the capital city. One hospital was Magnet-designated. Participants included native-born (n=9) and migrant nurses (n=12) from different nations. Individual semi-structured interviews were conducted via Zoom. Transcripts were thematically coded using a constant comparative method combining inductive and deductive elements.

Results: Regardless of cultural background, nurses described extensive efforts to provide individualized, empathic, developmentally appropriate, culturally sensitive care enabling patients and families to access information and participate in decisions. Perceptions of person-centered care aligned with established definitions. However, nurses did not separate descriptions of care from challenges encountered at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate translation services,
cultural beliefs limiting certain nurse-patient interactions, patient hostility toward foreign-born nurses, differential treatment of migrants, and occasional violence. Interviewees reported confronting these challenges with creativity, patience, knowledge, time, teamwork, and emotional self-regulation. All shared the values of person-centeredness regardless of place of work, but the Magnet and the non-Magnet settings differed in the challenges nurses reported. High workloads and staff shortages were reported in both settings. Nurses in the non-Magnet hospital were more likely to report supplies shortages, shortage of Arabic-speaking staff, and a sense that leadership support was lacking. The presence of few Saudi nurses was said to impact timeliness and accuracy of communication, impacting nursing workload burdens when nurses less fluent in Arabic needed to rely on Arabic-speaking coworkers to facilitate interpretation and ease patient or family distress. Nurses in the Magnet hospital reported that access to nursing aides and patient care assistants enhanced their opportunity to focus time and attention on patient care.

Conclusion and Implications: New definitions of person-centered care might enhance the understanding of care delivery in a non-Western setting. Person-centered care can be understood in the Saudi context as “situation-responsive” care — doing one’s best to achieve professional nursing values while navigating a complex and distinct landscape of opportunities and constraints. This more nuanced characterization can guide Saudi policymakers to focus on addressing the specific challenges nurses face as they endeavor to provide empathic, individualized, respectful and responsive care.

Abstract Background. Burnout among registered nurses (RN) is an ongoing nurse workforce issue. Yet, there are no quantifications of the impact of RN staffing, perceived workload, and practice environment on burnout among registered nurses in emergency departments (ED). Purpose: This study examined the interrelationships among RN staffing, perceived workload, practice environment, and burnout among hospital-based ED nurses in New Jersey (NJ).

Hypotheses: Six hypotheses were tested: 1) Low RN staffing is significantly associated with high burnout; 2) High perceived workload is significantly associated with high burnout; 3) Unsupportive nurse practice environments are significantly associated with high burnout; 4) Low RN staffing, high perceived workloads, and unsupportive practice environments are independent predictors of high burnout; 5) Unsupportive practice environments mediate the relationship between a) RN staffing and burnout, and b) perceived workload and burnout.

Methods: This study used a cross-sectional, correlational, survey design. Using a publicly available list of RNs licensed in NJ, potential participants were recruited via an email invitation that included a link to the electronic survey. A single-item measure of burnout was used. RN staffing was assessed as patient-to-RN ratios with a single item: How many patients were assigned to you on your last day of work? The Perceived Workload subscale of the Individual Workload Perception Scale was used to measure RN workload. The Practice Environment Scale was used to measure practice environment support.
Results: One hundred eighty-eight hospital-based ED RNs comprised the study sample. Seventy-two percent of participants reported moderate to complete burnout. One out of three nurses (34%) reported sustained or complete burnout. Patient-to-RN ratios were not significantly associated with burnout. Perceptions of high workloads and unsupportive practice environment ratings had significant independent direct effects on the odds of high burnout. An unsupportive practice environment significantly mediated an indirect relationship between high perceived workload and high burnout. The practice environment did not mediate an indirect effect of patient-to-RN ratios on burnout.

Conclusion: To reduce burnout among hospital-based ED RNs, findings from this study point to a pressing need for hospital and emergency department leadership to implement strategies designed to improve the practice environment and decrease RN workloads.

Background:  Significant gaps exist in understanding the relationship between patients’ attitudes towards methadone, social determinants of health (SDOH), substance use factors as indicators of perceived behavioral control (PBC), and the intention to remain in methadone treatment.  This study examined the influence of methadone attitudes and assessed the interaction effects of SDOH among people who use opioids (PWUO) in New Jersey substance use clinics.  The effects of substance use factors on the intention to remain in methadone treatment among this population were also explored.  Methods:  Utilizing data from the “New Jersey Opioid Overdose Study,” generalized linear regression and a series of simple moderation analyses were used to assess the main and interaction effects of methadone attitudes and SDOH on the intention to remain in methadone treatment.  Multiple linear regression analyses were used to examine the predictor effects of substance use factors on intention to remain in methadone treatment.  Results:  Survey responses from 290 participants were analyzed in the study.  Positive methadone attitudes were significantly associated with the intention to remain in methadone treatment (p<.001).  SDOH, including ethnicity, employment status, and marital status, revealed a significant interaction relationship with methadone attitudes and intention to remain in methadone treatment (p=0.013, p=0.025, and p<.001, respectively).  The intention to remain in methadone treatment increased as positive attitudes toward methadone increased for non-Hispanic, full-, part-time, and unemployed participants.  Marital status (married/ever married and never married) also positively enhanced the relationship between positive methadone attitudes and intention to remain in methadone treatment.  Multiple linear regression indicated that prior methadone and buprenorphine treatment (p=0.004) and positive methadone attitudes (p<.001) had significant positive associations with intention to remain in methadone treatment.  Negative associations existed between heavy smoking (smoking a pack of cigarettes or more per day), opioid use in the last 30 days (p=0.003 and p=0.009, respectively), and intention to remain in methadone treatment.  Conclusions:  Methadone attitudes, substance use factors, and SDOH shape intention to remain in methadone treatment.  Assessing factors influencing intention can aid in supporting patients’ goals of remaining in methadone treatment.  Healthcare providers and policymakers can use these associations to implement targeted interventions, particularly for diverse and underserved PWUO, and address issues related to methadone retention.

Keywords:  methadone attitudes, substance use, social determinants of health, retention in methadone treatment, people who use opioids

Primary care must connect emergency care services to communities through communication, transportation, and referral channels for integrated people-centered service delivery. Patients with acute care need frequently access the healthcare system via lower-level regional clinics or remote rural health posts. The mixed-methods research study utilized an exploratory sequential design, in three phases, guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety.

Phase one utilized a qualitative descriptive approach, semi-structured interview with a purposive convenience sample of 26 registered nurses from four remote, isolated rural health districts in Botswana. The study explored nurses’ experiences with emergency transportation of patients from rural health posts and clinics to the higher-level clinics and hospitals for further management.

The interviews’ content and thematic analysis were conducted using a combined deductive and inductive coding procedure. The two main themes that emerged under ‘person’ are: infringement of the scope of practice and violation of professional conduct; three subthemes were identified, including practicing outside the scope of practice, inadequate knowledge, and skills, and restricted from making decisions. The themes that emerged under the organization include ineffective clustering of health care facilities, lack of support, and poor communication between health facilities. Four subthemes identified under lack of technology and tools, included lack of transport, lack of equipment, shortage of medications, and inadequate and inefficient use of time as a resource. The central theme that emerged under the environment concerns working under highly deplorable conditions.
Phase two utilized the Delphi technique for item generation and establishing content validity guided by the Systems Engineering Initiative for Patient Safety (SEIPS) Model. The items were generated and synthesized from an extensive literature review and the qualitative descriptive study exploring nurses’ experiences in rural emergency patient transportation. The initial item pool consisted of 84 items.

This Delphi study utilized purposeful sampling to recruit experts from various specialists in emergency medicine, trauma surgery, trauma, emergency nursing, nurses, paramedics, and emergency medical technicians. A two-round modified Delphi method with experts was used to generate additional items and validate the content. Sixteen experts were invited to participate in both rounds. In the first Delphi round, 29 items were accepted for the final item set, 12 items were revised, 17 new items were added, and 26 items yielded a content validity index (CVI) of <0.8 and were thus eliminated; therefore, 58 items remained for analysis in phase two. In round two of the Delphi phase, 56 items were accepted for the final item set, one new item was added, and one (1) new item yielded a CVI of <0.8 and thus eliminated; therefore, the final item set for a scale to measure effective rural emergency patient transport (RET) in rural health facilitiesconsisted of 58 items.
Phase three of the study evaluated the psychometric properties of 58 items scale, using a cross-sectional study design among a sample of 302 nurses in rural clinics and health posts undertaking emergency patient transport in four health districts. The RET total Cronbach Alpha value was 0.980. A categorical principal components analysis identified three components explaining 63.35 % of the total variance. The factors, technology, tools, personal knowledge and skills, and organization accounted for 27.32 %, 18.15 and 17.88% of the total variance, respectively. The reliability of the three factors, as determined by the CATPCA’s default calculation of the Cronbach Alpha, was 0.960, 0.946, and 0.956, respectively, indicating that the variables from each factor correlate.

The perceived ineffective emergency transfer of patients was associated with work system shortfalls. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance of patient transport. the findings from the present study offer a preliminary instrument to measure effectiveness of rural emergency transport (RET) and can be used to better understand and improve clinical practice.
 

Veterans within the Veterans Health Administration (VHA) experience higher rates of chronic disease and poorer health than non-veterans (Balbale et al., 2016). The implementation of the Patient Aligned Care Team (PACT) in 2009 aimed to improve care coordination and mitigate cost concerns. However, recent literature suggests that veterans feel that Registered Nurse Care Managers (RNCMs) are overburdened and struggle to provide high-quality care coordination (Flynn & Krause-Parello, 2019). Moreover, the VHA faces a high nursing turnover rate, with many facilities experiencing nurse shortages (Office of Healthcare Inspections, 2018).  This study examines the effects of burnout, job satisfaction, and workload on RNCMs’ ITL and the veterans’ perception of the quality of care coordination they deliver. Utilizing the Nursing Organization and Outcomes Model (NOOM; Aiken et al., 2002) and the Care Coordination Conceptual Framework (McDonald et al., 2007; Van Houdt et al., 2013), a secondary analysis of cross-sectional survey data from RNCMs and veterans across the United States was conducted. The results show that RNCM job satisfaction and burnout significantly predict ITL among VHA medical centers, and burnout, workload, and job satisfaction significantly predict the quality of care coordination at the VHA. Retaining experienced RNCMs within the VHA is crucial to ensure quality care for veterans. This study provides valuable insights for nursing practice and future research, aiming to reduce RNCM burnout and ITL, enhance job satisfaction, and improve veterans’ perception of care coordination quality. 

The gut microbiome plays an essential role in human well-being and influences the development of chronic conditions, from metabolic ailments to gastrointestinal disorders and colon cancer. Human genetics shape the gut microbiome and together they influence metabolic phenotypes. The gut microbiome, also referred to as the microbiota, is composed of the microorganisms that live in the digestive tract of humans. The microbiome changes over time due to aging and is influenced by changes in the environment and by the presence of disease.

We have only recently begun to acknowledge the importance of microbial organisms and the symbiotic connection which permits our health maintenance and survival. Advanced Practice Nurses (APNs) have assumed an increasingly important role as providers in the health care system in the inpatient setting, as well as in primary care and specialty practices, particularly for underserved populations. APNs provide effective and high-quality patient care and have an important role in improving the quality of health care in the United States. Because of their advanced role, APNs need to have an appreciation for the impact of the microbiome on an individual’s health and the efficacy of treatment. Although the importance of genetics and genomics in nursing education has been widely recognized, surveys carried out in several countries show that these subjects are still not adequately addressed in nursing undergraduate and graduate programs (Jenkins & Calzone, 2017). This paper aims to investigate APNs’ knowledge, attitudes, and perceptions regarding the role of the microbiome in health and illness. Specifically, it will investigate the knowledge level of primary care APNs regarding microbiome pathophysiology, appropriate testing and diagnosis, and evidence-based treatment for microbiome-related symptoms.

Mentoring is believed to be crucial for faculty professional development and retention, yet little is known about the actual mentoring experienced by nursing faculty during their first years following transition from clinical practice or about the impact of mentoring on decisions about staying in the academic role. Contingent (non-tenure-track) employees account for the vast
majority of faculty in undergraduate nursing education. Retaining them is key to addressing the current faculty shortage, and their professional development is crucial for the future of nursing education, research, and practice. The purpose of this study was to understand the mentoring experiences of new non-tenure-track full-time nurse faculty teaching in four-year undergraduate nursing programs and explore how these mentoring experiences impact their decisions about staying on the job.

A qualitative descriptive study design was developed to answer four research questions: How do new contingent nurse faculty who have recently transitioned from clinical practice describe their experience of the nature of the mentoring process? How do mentoring experiences contribute to their self-reported personal and professional development? How do they describe their experiences with mentoring structure(s) and processes? And how does the experience of mentoring influence their intent to continue in a full-time academic educator role? Individual semi-structured interviews were conducted with 23 full-time non-tenure-track faculty from ten different higher education institutions in seven U.S. states. All recently transition from clinical
practice and were in the first three years of work in a four-year-undergraduate nursing program.

Five core themes emerged: (1) a work environment characterized by chaos, unpredictability, and very little mentoring or support of any kind; (2) a “DIY” system, with faculty piecing together an uneven patchwork of available structures and processes to meet basic teaching needs; (3) reliance on existing personal social networks; (4) yearning for better support; and (5) mentoring experienced did not appear as important as other factors in plans about staying on the job. The study reveals a gap between the recommendations often made about mentoring and the actual reality of mentoring. Meaningful and intentional mentoring structures must be implemented so that new non-tenure-track nurse faculty can become effective educators.

There is a recognized need to develop debriefing facilitator skills to use simulation as an effective teaching tool to promote learning with the goal of safety, effectiveness, and efficiency in healthcare services. Despite the pronounced need for facilitator skill development in simulation, there is little evidence to support, understand, and advance training, particularly in relation to debriefing methods. The study purpose was to gain an understanding of the experience of simulation debriefing facilitators, their training, perceived expertise, and perspectives on how their debriefing practices affect learning. This research examined the experience of simulation debriefing facilitators and simulation program leaders from pre-licensure baccalaureate nursing programs in the New Jersey, New York, and Pennsylvania area. Qualitative description was used to explore the experiences, perceptions, and events using language from the data collected through audio-recorded individual interviews, documents, and memos. Audio recordings were transcribed verbatim and thematic analysis occurred. Twenty-six participants (14 debriefing facilitators, 12 program leaders) described their role and responsibilities, experiences of their training, perceived expertise, debriefing practice, competency assessment, perspectives on student learning, and experience during the COVID-19 pandemic. Four major themes with subthemes and subcategories emerged from the data analysis. The first three themes reflect their experiences enacting debriefing and their perceptions of simulation: 1) becoming and being a simulationist, 2) co-creating the learning experience, 3) supporting and maintain a successful simulation program. However, the fourth theme, the COVID pivot, emerged from the impact and implications of the COVID-19 pandemic on simulation learning. Most debriefing facilitators shared they did not receive formal training, support, or feedback despite SSH recommendations and INACSL standards of best practice. Facilitators reported a passion for simulation, the learner experience and nursing education, but faced barriers in providing high quality standardized debriefing sessions. Barriers were identified as role ambiguity, minimal support or mentorship from supervisors and administration, inadequate staffing, and lack of funding for professional development. Study findings may be helpful in designing debriefing development programs for facilitators and other faculty. Future national research using quantitative and mixed methods is needed to evaluate simulation learning outcomes, as well as debriefing methods, evaluation, and training.
 
 

Aim: The overarching aim of this research was to identify factors associated with negative nurse
outcomes and then analyze the fundamental pathways/mechanisms responsible for job
dissatisfaction and intention to leave among NJ acute care nurses during the post-COVID era.
Purpose: Determine relationships among (a) nurse staffing levels, (b) work environment
support, (c) the psychological impact of the COVID event, (d) occupational burnout, (e) vaccine
hesitancy, (f) aversion to vaccine mandates, (g) job dissatisfaction, (h) intentions to leave the
current job, and (i) intentions to leave the profession of nursing.

Method: Cross-sectional survey methods produced a sample of 856 RNs currently employed in
New Jersey acute care hospitals and who were also employed in acute care hospitals during the
COVID-19 pandemic. Analyses included the estimation of logistic and linear regression models
as well as mediation analyses using the Hayes PROCESS bootstrapping methods.

Results: Findings indicated that 64% of RN respondents were experiencing occupational
burnout, 50.6% screened positive for symptoms of PTSD, 50.5% reported dissatisfaction with
their current jobs, and 41.9% reported that they plan to leave their current jobs. Patient
workloads, non-supportive work environments, the negative psychological impact of the COVID
event, and longer work shifts were associated with job dissatisfaction and intent-to-leave. The
effects of occupational burnout and the psychological impact of the COVID event on nurses’
intentions to leave their current jobs were mediated by job dissatisfaction.

Conclusion: Findings from this study may inform the design and prioritization of strategies
aimed at improving nurses’ psychological well-being, job satisfaction, and retention in the
current post-COVID era.