Browsing by Author "Stallones, Lorann, advisor"
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Item Embargo An attachment perspective on human-equine relationships: the development of the Human-Equine Attachment Questionnaire(Colorado State University. Libraries, 2023) Zaker, Ashleigh, author; Stallones, Lorann, advisor; Gibbons, Alyssa, committee member; Peters, B. Caitlin, committee member; Tompkins, Sara Anne, committee memberThis research aimed to develop and validate the Human-Equine Attachment Questionnaire (HEAQ), a self-report scale to assess attachment within the human-equine bond. Attachment to animals, particularly horses, presents unique dynamics that require specialized measurement. This study explored attachment styles in human-horse relationships, focusing on secure, insecure-anxious, and insecure-avoidant dimensions. The HEAQ underwent rigorous psychometric evaluation, which included confirmatory factor analysis and an assessment of construct validity. The data revealed that attachment within the human-equine bond is multifaceted, aligning with attachment styles observed in human-human relationships. Participants exhibited three distinct attachment styles – secure, insecure-anxious, and insecure-avoidant. This alignment confirms the existence of an attachment bond between humans and horses, which is complex and nuanced, featuring both secure and insecure attachment patterns. It is important to acknowledge that the internal reliability scores fell below recommended thresholds on the refined model. This is partly attributed to the reduced number of items within each factor post-misfit item removal, emphasizing the need for further scale refinement in order to enhance internal reliability. The study also explored the validity of the HEAQ by assessing convergent and discriminant evidence. Correlations between the HEAQ subscales and established scales, including the Pet Attachment Questionnaire (PAQ), Adult Attachment Scale (AAS), The Experiences in Close Relationships-Revised Scale (ECC-RS), the Big Five Inventory (BFI), and the Positivity scales, provided insights into the HEAQ's relationship with similar and distinct constructs. These findings highlighted the distinctive features of attachment within the human-equine bond and underscored the need for a specialized attachment scale tailored to the unique dynamics of the human-equine bond. This research contributes to understanding the human-equine bond, with implications for the equine industry and Equine-Assisted Interventions (EAIs). The HEAQ's continued development will lead to a comprehensive assessment tool, facilitating further research into the dynamics of attachment within the human-equine bond and its potential impact on well-being in diverse contexts. Future research should focus on refining the HEAQ, examining item wording, exploring the attachment bond from the equine side, and assessing its applicability in various cultural and socio-economic contexts.Item Open Access Depressive symptoms, drinking patterns and farm-work injury among Colorado farm residents(Colorado State University. Libraries, 2008) Leff, Marilyn Grace Petersen, author; Stallones, Lorann, advisorIntroduction. Farm-work injury is a major occupational health problem. The purposes of this study were to (1) describe farm residents who are heavy drinkers with high depressive symptoms and (2) assess the association between farm-work injury and depressive symptoms, farm-work injury and drinking pattern, and farm-work injury and the interaction of these two in cross-sectional and prospective analysis. Methods. A population-based sample of farm residents within Colorado was followed for three years. Information on socio-demographic and health related variables were gathered including farm-work injuries, depressive symptoms, and alcohol use. Multinomial logistic regression was used to describe differences and similarities between farm residents with high depressive symptoms and heavy drinking, high depressive symptoms only, and heavy drinking only compared to those without either. Poisson regression with repeated measures was conducted to estimate the effect of depressive symptoms and alcohol use and the interaction between the two variables on farm-work injury. Results. An association between smoking and co-occurring heavy drinking and high depressive symptoms was found (OR 3.69, 95% CI 1.0, 13.1) that was not seen among those with heavy drinking only or high depressive symptoms only. Time spent in farm work was also associated with depressive symptoms and with co-occurring heavy alcohol use. In both the cross-sectional and prospective regression analyses, no association was found between drinking pattern and injury for men or for women. After adjusting for age and smoking status, high depressive symptoms was associated with farm-work injuries among women (OR 3.6, 95% CI 1.8-6.9) in the cross-sectional analysis but not in the prospective analysis. No association between farm-work injuries and depressive symptoms was found for men. No interaction between drinking pattern and depressive symptoms in relation to injuries was seen in either men or women. Discussion/Conclusions. The association between smoking and co-occurrence of heavy drinking and high depressive symptoms may provide useful information for smoking cessation efforts. Depressive symptoms were more likely a result of farm-work injury in women rather than a cause. Future studies are needed to understand the impact of farm-work injuries in the context of differences in the roles of men and women farmers.Item Open Access Double consciousness: the negotiation of the intersectionality of identities among academically successful Black women(Colorado State University. Libraries, 2014) Dickens, Danielle D., author; Chavez, Ernest, advisor; Stallones, Lorann, advisor; Foster, Michelle, committee member; Jennings, Louise, committee memberDue to educational and professional obstacles, as well as the psychological tolls associated with racism and sexism, Black women may feel pressured to present a self to the world that is viewed as acceptable to others. Through identity negotiation, a conscious process of shifting one's worldview and/or cultural behaviors (Jackson, 2004), Black women may adopt multiple identities that appease both the White and Black community. The need to investigate the collective identities among Black women using a non-White ideology, such as Black feminist model, is critically needed. The purpose of this investigation was to understand the effect of the negotiation of race, class, and gender identities on Black women's self-perception, specifically as it relates to their participation in the workforce, and personal and professional relationships. Data were collected using semi-structured interviews and the sample consisted of ten academically successful Black women. To be eligible to participate in this study, co-researchers must have met the following criteria: 1) self-identify as a Black/African American woman, 2) recently obtained bachelor's degree in the past 5 years, 3) currently working in a predominantly White environment, and 4) living in a majority Black urban area. Data from the interviews were classified through identified themes, and interpretative phenomenological analysis. Themes constructed from the data include: a) the complexity of the intersectionalities of race, gender, and class identities, b) negotiation of identities in predominantly White social and work environments, c) negotiation of identities in a predominantly Black environments, d) triggers for the negotiations of race, class, and gender identities, and e) conflicted anxieties towards negotiating identities. The results of this study may be utilized to develop intervention programs that promote positive self-worth, and the development of academic and personal success among Black women aspiring to enter the evolving workforce.Item Open Access Feasibility of a mindfulness-based stress reduction intervention on health care safety(Colorado State University. Libraries, 2016) Valley, Morgan Anne, author; Stallones, Lorann, advisor; Graham, Daniel, committee member; Fisher, Gwenith, committee member; Zimmerman, Toni, committee memberOccupational injuries represent a significant and costly social and public health problem, especially among health care workers, whose well-being impacts patient safety and quality of care. Mindfulness training, which teaches individuals to bring awareness and acceptance to the present moment, could decrease occupational injury rates while improving worker well-being. Mindfulness training has been proven effective in improving the health and well-being of clinical and healthy populations, but it has not yet been tested as an intervention to improve worker safety. Using a randomized waitlist controlled trial design with a mixed methods approach, the current study sought to: 1) conceptualize hospital health care workers’ experiences in adopting mindfulness practices within the context of an established health behavior theory; and 2) assess the impact of mindfulness training on safety outcomes among hospital health care workers. Hospital health care workers involved in direct patient care at two hospitals in Colorado were recruited to participate in the study. Participants were randomly assigned to a group that participated in an 8-week Mindfulness-Based Stress Reduction (MBSR) course first or to a waitlist control group, which completed the MBSR training after the first group completed the course. The MBSR intervention included eight 2.5-hour group sessions of meditation, yoga, and group discussion and one 7-hour silent session to train participants to incorporate the skills in their daily lives. All participants completed questionnaires measuring covariates and safety outcomes at baseline, post-intervention, and six months after they completed the training. Participants also answered open-ended questions about their experiences when adopting mindfulness practices taught in the course. In the qualitative portion of the study, a theory-driven thematic analysis approach was used to analyze the qualitative data with the key constructs of the Health Belief Model acting as the framework for the analysis. In the quantitative portion of the study, mean scores were calculated for each participant on the study variables at each time point. Univariate repeated measures analyses of variance (RM ANOVA) time X group interaction effects with alpha level .05 were used to compare the baseline and post-intervention scores on the outcome variables between groups. Paired-samples t-tests were used to examine the stability of the intervention effects from both groups’ post-intervention time point to the 6-month follow-up data collection on the significant outcomes for all participants. Hospital health care workers from a university hospital system in Colorado volunteered to participate and were randomized to the immediate MBSR intervention (n=11) or waitlist control group (n=12). The majority of participants were female and nurses. Qualitative results highlighted the benefits of mindfulness practice among health care workers, which included enhanced awareness and improvements in social relationships and interactions with patients and colleagues. Participants described the lack of healthcare-specific recommendations for incorporating mindfulness practices at work and minimal discussion of evidence supporting mindfulness training as barriers to adopting and adhering to mindfulness practices. Viewed within the context of the Health Belief Model, these qualitative findings may help practitioners design and tailor workplace mindfulness programs to fit the needs of health care workers. Quantitative results of the study indicated that mindfulness training can decrease workplace cognitive failures and increase safety compliance behaviors among hospital health care workers. The qualitative and quantitative results contribute to the novel understanding of the role mindfulness practice plays in health care worker occupational safety and health and can support future larger-scale studies testing the longer-term impacts of mindfulness on health care safety.Item Open Access Identifying factors associated with bicycle helmet use behavior among college students(Colorado State University. Libraries, 2008) Kakefuda, Itsumi, author; Stallones, Lorann, advisorTraditional college age students belong to age groups which are at high risk of bicycle-related traumatic brain injuries and are known to be less likely to wear bicycle helmets compared to with other age groups. The study aimed to examine behaviors, attitudes, subjective norms, past bicycle helmet use, bicycle-related injury, and risk perceptions with regard to bicycle helmet use among student bicycle riders at Colorado State University. The long-term goal for the research is to develop bicycle helmet promotion programs targeted at this high risk group. A questionnaire was developed based on the Health Belief Model and the Theory of Reasoned Action, with the Stages of Change Model serving as a tool to classify bicycle riders into groups in accordance with current bicycle helmet use behaviors and future intentions to use. A total of 315 responses were collected. The study included data from 199 students who used bicycles for commuting and for recreation in the 30 days preceding the date of survey. Among the student bicycle riders, 37% wore bicycle helmets every time for recreation; however only 9% used bicycle helmets for commuting. Differences in study variables among groups with different bicycle helmet use patterns were examined. Psychosocial factors associated with bicycle helmet use deferred between two bicycle use purposes, commuting and recreation. The analysis revealed that bicycle riders acknowledged the importance of bicycle helmet use in terms of traumatic brain injury prevention regardless of current bicycle helmet use and intentions to use helmets in the near future. However, bicycle helmet non-users and inconsistent users were less likely to think that they needed to wear bicycle helmets for short distance bicycle riding including commuting to school, compared to riders who wore bicycle helmets every time they rode. Implications of the study suggest changes in methods currently used in bicycle helmet research. The study provided important information for the development of interventions among college-aged students.Item Open Access Life in the field: migrant farm workers' perceptions of work related injuries(Colorado State University. Libraries, 2008) Rosales, Monica S., author; Stallones, Lorann, advisor; Borrayo, Evelinn, advisorA majority of migrant farm workers in the United States are of Latino descent. Agriculture is a hazardous occupation that puts workers at risk for occupational injuries. While migrant farm workers provide an indispensable service they comprise a disadvantaged group. Migrant farm workers' views of work related injuries have not been fully evaluated. Therefore, this study examined migrant farm workers' views and perceptions of work related injuries. The method of analysis consisted of an ethnographic content analysis of migrant farm workers perceptions and views of occupational injuries. Interviews from twelve Colorado migrant farm workers were analyzed. The analysis led to the identification of five main themes (1) Concerns about safety, (2) Characteristics of injuries, (3) Factors contributing to injuries, (4) Injury prevention strategies, and (5) Injury accountability. Each theme was organized into three sub-themes. The findings from this study suggest that the safety level of the working environment needs to be improved.Item Open Access Promoting psychosocial health and empowerment among female sex workers in Nepal: a pilot peer education intervention(Colorado State University. Libraries, 2016) Menger, Lauren Marie, author; Stallones, Lorann, advisor; Fisher, Gwen, committee member; Kaufman, Michelle, committee member; Ryan, Elizabeth, committee memberAcross contexts, female sex workers (FSWs) may be exposed to varying degrees and combinations of risks in their work, including but not limited to long hours, poor working conditions, disease transmission, unplanned pregnancy, violence, drug and alcohol use and abuse, debt, and various forms of harassment, discrimination, and exploitation. It is likely that the risks associated with sex work are greater in developing countries where sex workers have a low and stigmatized status, minimal capacity to earn an adequate income, limited level of control regarding clients accepted and services rendered, and restricted access to sufficiently resourced health and other services and support structures. The sex industry in Nepal is synonymously referred to as the entertainment sector. Women in the entertainment sector (WES) in Nepal are vulnerable to an array of occupational risks, which compromise their psychosocial health and empowerment, in turn limiting their ability to thrive and engage in protective behaviors. The present study involved the pilot test of a peer education intervention in collaboration with a non-governmental organization (NGO) to empower and promote the psychosocial and occupational health of WES in Kathmandu, Nepal. Ten WES were trained as peer educators (PEs) and, through formal and informal teaching opportunities, reached over 140 FSWs with psychosocial health promotion messages. In addition to a detailed literature review, method, and discussion, this dissertation comprises three manuscripts. The first manuscript presents results from a quasi-experimental pre/post evaluation with 160 WES, including those who were (n = 96) and were not (n = 64) exposed to the PEs, to assess the impact of the program on psychosocial and occupational health and empowerment outcomes. Results indicate that WES who were exposed to the psychosocial health promotion messages of the PEs reported significantly improved psychosocial health knowledge and perceived self-efficacy, ability to access resources, happiness, and job control compared to WES who were not exposed to the PEs. The second manuscript presents results from a mixed-methods evaluation to assess the feasibility of the program and its impact on the psychosocial and occupational health and empowerment of the 10 WES trained as PEs. PEs were surveyed at baseline, immediately post intervention, after 2-months, and after 10-months to evaluate psychosocial and occupational health, empowerment, and peer education efficacy. Upon completion of the program, one-on-one exit interviews were conducted with nine of the PEs and two field staff from the partner NGO to solicit more in-depth feedback about the program. PE survey results indicate the program had a significant impact on some aspects of psychosocial health and empowerment, with positive trends on many other variables. Exit interviews revealed additional positive impacts of the program, including enhanced confidence and communication skills and increased self-awareness and self-care behaviors. Overall, the findings presented in these two manuscripts suggest peer education is both a feasible and promising means to enhance the psychosocial and occupational health and empowerment of WES in Nepal. The third manuscript details the processes implemented in this pilot study. Peer education methods have been established as a promising way to reach FSWs and other vulnerable and hard-to-reach populations with health promotion programming; however, there is scant published information about how such programs are designed and implemented. This lack of process information contributes to poor clarity regarding how to effectively develop and execute peer education programs and increases the propensity for repetition among failed strategies. Using this pilot program as an example, this manuscript offers an in-depth vantage point into the black box of peer education by outlining the specific steps taken while designing, implementing, and evaluating the program. While considering each phase of the project, the challenges encountered along the way as well as the effective strategies implemented to overcome them are reviewed, with a focus on offering practical tips and strategies. Conclusions and a summary of recommendations for those interested in implementing similar programs are discussed. These three manuscripts as a whole can be used to inform future interventions aiming to enhance the psychosocial and occupational well-being and empowerment of sex workers and other vulnerable and hard-to-reach working populations through peer education methods.Item Open Access Strengthening suicide prevention networks: examining the relationship between interorganizational collaboration and tie strength(Colorado State University. Libraries, 2013) Menger, Lauren, author; Stallones, Lorann, advisor; Cross, Jennifer, committee member; Henry, Kimberly, committee memberDespite extensive prevention efforts, suicide continues to be the tenth leading cause of death in the United States (Centers for Disease Control (CDC), 2012). One possible explanation may be lack of coordination between the organizations that provide suicide prevention services. Because client well-being often relies on the integrated actions of multiple organizations, the factors that promote interorganizational collaboration should be identified and fostered. The present study involved structured interviews with agency representatives in the suicide prevention network in one Colorado community. The objective of this exploratory study was twofold: 1) to assess the cohesiveness and pattern of relationships between organizations across seven collaborative domains related to suicide prevention, and 2) to identify the indicators of relationship strength that are most relevant to different domains of interorganizational collaboration and collaborative intensity. Results were examined through a combination of social network analysis and statistical correlation and regression analyses. Overall, organizations reported collaborating more on sharing information and resources and sending and receiving referrals than they did on developing service infrastructure, and coordinating training and screening activities. Across all seven collaborative domains, there was a subset of organizations that was well connected and another group of organizations that consistently played a more peripheral role in the network. Model comparisons revealed that the influence of relationship strength indicators varied across the seven collaborative domains and that trust was the most significant predictor of collaborative intensity. Strategies to improve collaboration among organizations are suggested.Item Open Access The ICER Model© measure of an evidence-based nursing culture(Colorado State University. Libraries, 2012) Craighead, Janet E., author; Stallones, Lorann, advisor; MacPhee, David, advisor; Long, Marilee, committee member; Vacha-Haase, Tammi, committee memberEvidence-based practice (EBP) is defined as the use of current best evidence in making decisions about the care of individual patients. The magnitude of emphasis on EBP within the healthcare industry is articulated in the Institute of Medicine's (IOM) agenda that by 2020, 90% of clinical decisions will be supported by accurate and up-to-date clinical information that reflects the best available evidence. In contrast, medical practice based on best evidence may be as low as 25-50% and even lower within the nursing profession. The importance of objective measures toward fully achieving an evidence-based culture is supported in the IOM's call for the development of measures to "track and stimulate progress" of the EBP quest and in the Magnet Recognition Program® inclusion of empirical outcomes as the foundation of their model for exemplary nursing practice. Yet, no sufficiently comprehensive scales for measuring an evidence-based healthcare or nursing culture are available. Hence, the objective of this study was to develop a reliable and valid measure of the intrapersonal, interpersonal, and organizational predictors (i.e., attitudes, knowledge, social norms, and organizational controls) of the behaviors necessary for achieving an evidence-based nursing culture (EBNC). Using a modified version of the Theory of Planned Behavior, survey statements were developed to represent the predictors associated with each of four essential behaviors embedded within the ICER Model for Achieving an Evidence-Based Healthcare Culture©. Following pilot testing at a medical center, the survey was disseminated electronically to approximately 1500 nurses working at a larger health system. Structural equation modeling analyses conducted on survey responses from 559 nurse participants were used to establish a scale with acceptable internal structure and psychometric properties. This measure offers a diverse range of applications that includes evaluating progress toward achieving, and the accuracy and efficiency of interventions designed to promote, an EBNC.Item Open Access Understanding the association between the Abbreviated Injury Scale score for the head region and outcomes following traumatic brain injury, Colorado 1998-2000(Colorado State University. Libraries, 2007) Gujral, Indira Beatrice, author; Stallones, Lorann, advisorAnnually, an estimated 1.4 million Americans are affected by traumatic brain injury (TBI). It is the leading cause of morbidity and mortality among trauma individuals. While advances in medicine have helped to decrease mortality from TBI, less is known about the long-term outcomes following TBI. The goal of this research was to further ourunderstanding of long-term outcomes following TBI by identifying associations betweenone anatomical coding system and one-year outcomes following TBI. The Abbreviated Injury Severity Score is an anatomical scoring system used by injury researchers throughout the United States and the world to characterize individual injury. One attribute of this measure is the ability to independently characterize injury severity for one body region, for this study, specifically, the head region. Although the Abbreviated Injury Severity Score for the Head region (HAIS) is ananatomic measure of TBI severity, no study has assessed the inter- and intra-rater agreement of HAIS between trauma registrars at hospitals and trained state coders. Further, no studies have specifically assessed the association between HAIS and longterm outcomes following TBI using population-based data. The objectives of this study were to utilize data from two Colorado population-based studies containing HAIS scores to investigate the reliability of HAIS and its ability to predict long-term physical and cognitive outcomes after traumatic brain injury. The purposes of this study were: 1) to describe the intra-rater reliability of HAIS scores by having a trained coder employed by the Colorado Department of Public Health and Environment recode HAIS scores for traumatic brain injured cases from the Colorado Traumatic Brain Injury Surveillance system for the years 1999-2000; 2) to describe the inter-rater reliability of HAIS scores by comparing HAIS scores from cases in the Colorado Traumatic Brain Injury Surveillance system for 2000 to HAIS scores from trauma registrars at hospitals throughout Colorado; and, 3) to use HAIS scores to evaluate functional outcomes of traumatic brain injured individuals in Colorado who were enrolled between 1998 and 1999 in the Colorado Traumatic Brain Injury Registry and Follow-up System. Cases were defined using the International Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes for TBI (800 - 801.9, 803 - 804.9, or 850 854.1, and 959.01) and included Colorado residents who were either admitted to hospitals or died prior to reaching the hospital from a TBI. To assess inter- and intra-rater agreement, data was selected from the Colorado Traumatic Brain Injury Surveillance system for years 1999 - 2000. A sample of 250 cases was randomly selected to assess intra-rater agreement. Approximately 624 cases were selected to assess inter-rater agreement. Weighted and non-weighted kappa statistics were used to assess inter- and intra-rater agreement, respectively. Landis and Koch (1977) cut points were used to interpret agreement findings. To identify long-term outcomes following TBI, 1,802 cases were used from the Colorado Traumatic Brain Injury Registry and Follow-up System (CTBIRFS), 1998 - 1999. Outcomes selected for this study were based on the conceptual model of function and disability developed by the World Health Organization. Logistic regression models were used to determine the association between TBI severity categories (HAIS) and one-year activity and societal participation outcomes. Logistic regression was used to determine the association between HAIS and cognitive outcomes one-year following TBI. All statistical analyses were conducted using SAS 9.1©. Results of this study found intra-rater agreement of HAIS to be “almost perfect” while inter-rater agreement between the trained state coder and the hospital trauma registrars was “substantial.” This finding was surprising given that individuals performing the coding often have varying levels of education and training, experience,and use and knowledge of database systems. Factors that potentially affect agreement thatwere not tested include injury factors such as impact forces, multi-system trauma, pharmaceutical drug usage, and use of personal protective equipment, such as helmets. Future studies should be conducted to identify the role of these factors when coding HAIS. In order to accurately assess function and disability following TBI, the severity of the TBI must be taken into account. Using HAIS categories mild, moderate, and severe TBI, individuals with moderate TBI (5.04 [95% confidence interval (1.67, 15.6)]) and severe TBI (4.08 [95% confidence interval (1.29, 12.7)]), were five times as likely to report needing help with Activities of Daily Living throughout the study period as compared to those with mild TBI, after adjusting for identified potential confounders. Similarly, subjects with moderate and severe TBI were more than 60% as likely to report needing help with Instrumental Activities of Daily Living throughout the study period as compared to those with mild TBI. The odds ratios for moderate and severe TBI were 1.90 [95% confidence interval (1.01, 3.57)] and 1.62 [95% confidence interval (0.81, 3.26)], respectively. Adjusting for identified potential confounders, subjects with moderate and severe TBI were more than 50% as likely to report diminished societal participation throughout the study period as compared to those with mild TBI. The odds ratios for moderate and severe TBI were 1.72 [95% confidence interval (1.18, 2.51)] and 1.58 [95% confidence interval (1.01, 2.47)], respectively. However, moderate and severe TBI were not associated with cognitive dysfunction. The results of this study indicate that HAIS is a good predictor of function and disability at the individual and societal levels, as measured by the activities and participation domains. The study failed to find an association between HAIS and cognitive disability. The results of this study support the need for individuals with a moderate and severe TBI (HAIS score greater than three) to participate in some form of rehabilitation to increase function and reduce disability following TBI. The objective of this study was to use data from the CTBIRFS and the CO TBI Surveillance system to expand upon the literature regarding outcomes following TBI. Specifically, the purpose of this study was to increase understanding of the Abbreviated Injury Scale for the head (HAIS) - an anatomical scoring system that potentially could be a predictor for long-term outcomes following TBI. As medicine advances and more individuals survive TBI, demands on rehabilitation resources will rise. The results of this study indicate that HAIS is a reliable scoring system that is associated with one-year outcomes following TBI. Using HAIS to assess severity of TBI will allow clinicians to identify and target rehabilitative efforts for TBI individuals and help individuals receive the rehabilitation services they need. Future research is needed to expand upon these findings to identify barriers to rehabilitation, such as cost and access to care, and to assess the role of rehabilitation on quality of life following TBI.Item Open Access Workplace sleepiness: organizational antecedents and consequences(Colorado State University. Libraries, 2007) DeArmond, Sarah, author; Chen, Peter, advisor; Stallones, Lorann, advisorThe current research consists of two studies which investigate possible antecedents and consequences of workplace sleepiness experienced by Certified Nursing Assistants (CNAs) working in long-term care facilities. The first study explored the relationship between resident aggression (an occupational stressor) and workplace sleepiness. Resident aggression is a subtype of workplace aggression commonly experienced by CNAs working in long-term care facilities. Theory suggests that resident aggression may be associated with workplace sleepiness because resident aggression may lead to subsequent workplace sleepiness but also because workplace sleepiness may lead to subsequent resident aggression. To examine the causal nature of this relationship, this study assessed the relationships between resident aggression and subsequent workplace sleepiness and workplace sleepiness and subsequent resident aggression over the course of four consecutive work shifts. The results showed limited support for a positive relationship between resident aggression and subsequent workplace sleepiness, and no support for a relationship between workplace sleepiness and subsequent resident aggression. Future research might explore the process that might underlie the relationship between resident aggression and workplace sleepiness. Rumination and attribution were discussed as factors that might play a role in this process. The second study explored relationships between workplace sleepiness and aspects of occupational safety. Theoretically speaking, workplace sleepiness is thought to be associated with negative occupational safety outcomes such as injuries because sleepiness can lead to job performance decrements. In other words, it is thought that workplace sleepiness might lead to decrements in job performance and that these decrements could then lead to increases in occupational injuries. Therefore the second study explored safety performance (the safety related component of general job performance) as a mediator of this relationship. The results of the study suggest very limited support for safety performance as a mediator. This limited support might be the result of inadequacies in measures of safety performance. Some suggestions were offered for improving the measurement of this construct.