Does Endogamous Marriage Impact Women\u27s Fertility Gaps in India?

This study aimed to measure the possible impact endogamous (within-family) marriage practices could have on women\u27s fertility gaps in India. Fertility gap in this study is defined as the difference between the ideal number of children a woman desires and the total number of children born to a woman at time of interview. In many developing countries ,such as India, it is common for women to be overachieving their fertility - having more children than desired. Data from the CIA.gov (2024) shows total fertility rates to be highest in developing areas across Sub-Saharan Africa, the Middle East, and India. The persistence of overachieving fertility has been linked to low female autonomy and empowerment, lack of family planning knowledge and use of contraceptive methods (Bhat, P. N. M. (2009). Data for this study was collected from the Demographic and Health Survey Program for the country of India for the years 2019-2021, looking at female respondents only. Results from this empirical analysis did not find statistical significance regarding marrying familial relatives and women’s fertility gaps. However, there was significance for women overachieving their fertility when they belong to scheduled caste and live in rural households, along with those who belong to Hindu and Sikh religious groups

The Cost of Prosperity in China, Comparison of Early Development Differences Between Left-Behind Children and Non-left-behind Children in Rural China

This study aims to explore the cognitive development differences between left-behind and non-left-behind children in rural China, specifically in the rural villages of Ya\u27an City, Sichuan Province. Utilizing cross-sectional data from 570 children aged 0-3 years, the children were categorized based on parental presence into four groups: non-left-behind children (both parents present), left-behind children (both parents absent), left-behind children (mother present), and left-behind children (father present). The cognitive development of these children was assessed using the Bayley Scales of Infant Development\u27s cognitive subscale. Regression analyses were conducted, adjusting for village-level clustering, and controlling for demographic variables such as age in months, gender, prematurity, birth weight, and household assets. Additionally, the study analyzed the incremental impacts of complete parental absence and the combined presence of both parents on children\u27s cognitive development. The relationship between parental presence and household economic status was further examined to understand the interplay between these variables. By evaluating these factors, the research aims to provide valuable insights for policymakers to design interventions that improve the cognitive development of left-behind children

Thinking Long-Term: Nursing Education on Long-Acting Injectable Antipsychotics

Schizophrenia cases and their associated healthcare costs have drastically increased over time in the U.S. Antipsychotic non-adherence is a primary contributor to the high rates of relapse and rehospitalization among the schizophrenic adult population. The development of long-acting injectable antipsychotics (LAIs) has positively impacted medication adherence, however, this treatment modality is still underemployed in practice due to barriers, such as physician and patient negative attitudes toward LAIs and lack of education. Nurses are in a great position to address these barriers as they serve as mediators between providers and patients. This literature review aims to discover evidence that LAI education for registered nurses improves overall knowledge, confidence, and attitudes on LAI treatment and its impact on medication adherence and rehospitalization. Despite the limited data on LAI education for nurses, results show that nursing education has a positive impact on nursing knowledge, attitudes, and confidence, as well as patient outcomes. Through LAI nursing education, nurses will become well-versed and confident in sharing their knowledge and advocating for the best course of treatment during shared decision-making moments with patients and providers, potentially opening the door for increasing LAI use in practice

Differential Impacts of COVID-19 Policy Enforcement on Food Security Dynamics

The COVID-19 pandemic has intensified food insecurity in the United States, disproportionately affecting vulnerable populations. This study examines the county-level impact of various COVID-19 policies on food insecurity using data from the U.S. COVID-19 County Policy (UCCP) Database and Feeding America\u27s Map the Meal Gap study. Employing a Difference-in-Difference (DiD) approach and a Two-Stage Least Squares (2SLS) regression with two political instrumental variables to address potential endogeneity concerns, the findings reveal nuanced impacts. DiD estimates did not show significant effects on the rate of change in food insecurity but indicated promising signs for absolute population values. The 2SLS results suggest that policies such as religious restrictions, curfew requirements, and movie theater closings may reduce food insecurity rates but have no significant effect on the absolute population value. The effectiveness of these policies depends on factors like policy duration, support levels, and the specific needs of affected populations. This study highlights the importance of considering differential impacts of COVID-19 policies on food security dynamics at the county level, informing targeted interventions and policies to mitigate food insecurity in future public health crises

Optimization of the Triage Documentation Workflow at an Urban Emergency Department

Problem The rise in triage times at urban emergency departments (ED) across the country is associated with poor patient throughput and clinical care outcomes. Through stakeholders’ feedback, the electronic triage navigator was identified as the potential barrier to timely triage completion at Hospital X ED. Context This quality initiative took place at a large urban Bay Area hospital that serves adult patients with diverse clinical care needs. Intervention The intervention includes redeveloping the triage navigator by eliminating redundant questions, deferring questions deemed ineffective in assigning acuity, and creating a more logical ordering for patient data collection. Measure Triage times was the primary measure used to determine if the project aim of decreasing triage times by 10% from baseline was achieved. Results Due to the time constraints of this project, the intervention was not implemented by the quality team. However, the data gathered through the preliminary and intervention surveys displayed strong interest amongst triage nurses in this evidenced-based practice change and showed that a statistically significant number of nurses were satisfied with the proposed modifications to the triage navigator. Conclusion Future recommendations for this project include gaining input from Hospital X triage task force regarding proposed changes, project continuation by Hospital X leadership and staff to pilot the final triage navigator, administering a post-intervention survey to gain feedback on the intervention, and evaluating for improvements in triage times

Enhancing Pain Documentation in Medical Surgical Units: Integrating Supportive Tools with Pain Nursing Education

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects. Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management. Interventions: A baseline survey provided nurses\u27 understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports. Measures: A post intervention survey evaluated the effectiveness and gathered nurses feedback. Manual chart auditing of the Electronic Health Record (EHR) monitored preliminary improvement and official quarterly report data assessed final compliance rates. Results: The quality report for April, 2024, revealed Unit A pre-assessment compliance at 61.5% and Unit B at 76.7% with post-assessment scores of 89.6% and 88.7% respectively. Unit A saw a 7% pre-assessment decrease and 0.5% post-assessment increase, while Unit B increased by 6.3% and 3.5% respectively. Conclusions: Despite falling short of the targeted compliance rate, the project provided valuable insights, revealing varying success levels between units dependent on participation. Moving forward, aligning hospital policy with the quality data team is essential to enhance clarity, data accuracy, and stakeholder engagement, thus improving patient care and safety in future initiatives

Implementing Diabetic Eye Care Education for Healthcare Professionals

Background: Diabetic retinopathy (DR) is the most common cause of diabetic eye complications and a leading cause of preventable vision loss in American adults. Skaggs et al. (2017) reported that DR screening prevents vision loss by 95%. The evidence reports that only 60% of people with diabetes have attended the recommended DR screenings (Flaxel et al., 2020). Emerging evidence supports patient education about diabetic eye care and its guidelines by health care professionals (HCPs) as the main facilitator to accomplish this goal (Khair et al., 2020; Moinul et al., 2020). Healthcare professionals are pivotal in encouraging or discouraging DR screening attendance. Local Problem: The U.S. Census data 2010 reports that Maine has 60% of the rural state population (World Population Review, 2023). The rural areas have a higher disparity between the number of practicing ophthalmologists and patients with diabetes (AAO, 2020). The number of people with diabetes in Maine is 1.7% higher than the average national rate (CDC - BRFSS 2013 Survey Data and Documentation, 2022). It suggests that rural healthcare challenges in receiving timely care are due to the distance. Methods: Diabetes and Healthy Eyes Toolkit, developed by the National Eye Health Education Program (NEHEP) for health educators, was used to implement a Doctor of Nursing Practice student-led quality improvement change of practice project. It included a PowerPoint and pre-and post-assessment questionnaires distributed to the clinical staff before and after the education presentation to measure the knowledge changes and willingness to change in participants\u27 practice after the presentation. The data collection of both assessment outcomes was entered into Qualtrics with Excel for statistical analysis. Interventions: This DNP student presented the 60-minute educational session on diabetes eye care and its guidelines to ensure early detection and timely treatment to prevent diabetic eye complications. The specific aim was a 10 % increase in knowledge and clinicians\u27 willingness to change practice from the baseline. Results: The knowledge level of the HCPs was 84% (N=27) before and 92% (N=21) after the educational intervention. The HCPs willing to change their practice to educate patients after the presentation were 81%. Conclusions: The education session on diabetic eye complications and its guidelines for clinicians at the project site improved their knowledge and willingness to educate the patients

AN EXPLORATION OF ADULT CHILDREN’S ATTACHMENT TO THEIR PARENTS ACROSS TWO CULTURAL GROUPS: INDIANS IN INDIA AND INDIANS WHO IMMIGRATED TO THE UNITED STATES

Typically, attachment theory has been studied and explored with western populations. Individuals seeking mental health treatment within the United States include western and nonwestern cultural groups and research, theories and interventions that apply to diverse populations are necessary. Attachment relationships are often a part of, or reasons for clients to seek therapy either overtly or covertly, thus allowing research on attachment to better inform treatment plans and practice. An attachment relationship between a parent and child can be influenced by several factors and may change over the course of development, but little is known about this process among Indians who reside in India and Indians who immigrated to the United States. Through exploratory semi-structured interviews, the present study aimed to explore the change and maintenance of attachment relationships from childhood to adulthood from perspectives and narratives of the adult child population. Further, the study aimed to identify the factors that contribute to the change or maintenance of these relationships over time. This study focused on cross cultural differences between Indians in India and Indian migrants living in the United States, to identify between and within group differences. Hypothesized factors such as immigration, religion, career decisions as well as newly identified factors that participants shared were synthesized and analyzed using thematic analysis. Common themes (factors) that impact attachment relationships were identified through data analysis. These themes included immigration experiences, religion, family values, and the impact of siblings on an attachment relationship. An important finding in the study was that individualism and collectivism were not concrete concepts to each group as each participant’s narratives provided insight into how the sample group and population at large may not be entirely individualistic or collectivistic, allowing for a cohesion in values and preferences. The findings from the present study have potential to contribute to future studies on factors impacting attachment relationships, and also provide more insight for clinicians to develop interventions that focus on the impact of family systems, acculturation, migration, religion, communication and other factors on an attachment relationship. Also, the study’s findings are intended to further support clinical interventions and providers to accurately recognize the cultural variations between the two groups, and better serve the two groups in clinical settings

Dream Out Loud

This opinion piece explores priorities and perspectives to help institutions facilitate the actualization of dreams and goals of a diverse faculty body. Moreover, the author relates personal stories and experiences to help transition institutions from surveilling faculty (looking for deficits) to watching faculty with a lens of enhancing professional growth. In all, this piece shares the hope that shifting paradigms at the institutional level will help increase the multitudes of subjects and approaches in the realm of recognized scholarship