Faculty

Victoria Vaughan Dickson

Victoria Vaughan Dickson

CRNP FAAN FAHA FHFSA PhD RN

Associate Professor
Director, Pless Center for Research

1 212 998 5300

433 First Avenue
Room 742
New York, NY 10010
United States

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Professional overview

Dr. Dickson is an Associate Professor in the Rory Meyers College of Nursing with extensive clinical and research experience in cardiovascular and occupational health nursing. Her research program focuses on investigating the bio-behavioral influences on self-care in patients with cardiovascular disease including heart failure and multiple comorbidity; and evaluating the effectiveness of self-care interventions on health outcomes. Her work has led to an improved understanding of the sociocultural influences of self-care among vulnerable populations including older workers, women, and ethnic minority groups; and the development of innovative theory-based interventions. Dr. Dickson is recognized as an international expert in qualitative research techniques and mixed methods research and has conducted training to interdisciplinary teams locally, nationally and internationally. Dr. Dickson holds a clinical appointment as an advanced practice nurse in the division of cardiology at the NYU Langone Medical Center and the Bellevue Hospital. Currently, Dr. Dickson is the Program Director of the NIOSH-funded doctoral training program in Occupational and Environmental Health Nursing.

Education

PhD, University of Pennsylvania
MSN, University of Pennsylvania
BSN, Temple University

Honors and awards

ENRS President-Elect (201620172018)
Associate Editor to Circulation, Cardiovascular Quality & Outcomes (2016)
Fellow in the Heart Failure Society of America (FHFSA) (2016)

Specialties

Non-communicable disease
Cardiology
Gerontology

Professional membership

American Academy of Nursing
American Heart Association
Heart Failure Society of America
Eastern Nursing Research Society
Gerontological Society of America
Council on the Advancement of Nursing
European Society of Cardiology
American Academy of Nurse Practitioners
American Association of Occupational Health Nurses
Sigma Theta Tau, XI Chapter
Sigma Theta Tua International Honor Society
The New York Nurse Practitioners Association
American Nurses Association

Publications

Publications

A mixed methods study of symptom perception in patients with chronic heart failure

Riegel, B., Dickson, V. V., Lee, C. S., Daus, M., Hill, J., Irani, E., Lee, S., Wald, J. W., Moelter, S. T., Rathman, L., Streur, M., Baah, F. O., Ruppert, L., Schwartz, D. R., & Bove, A. (2018). Heart and Lung: Journal of Acute and Critical Care. 10.1016/j.hrtlng.2017.11.002
Abstract
Background: Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. Methods: We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. Results: In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. Conclusion: Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.

Self-care among Filipinos in the United States who have hypertension

Ea, E. E., Colbert, A., Turk, M., & Dickson, V. V. (2018). Applied Nursing Research, 39, 71-76. 10.1016/j.apnr.2017.11.002
Abstract
Background Despite the strong literature on the influence of self-care on hypertension (HTN) diagnosis, there is a notable lack of studies that explore self-care among Filipino immigrants in the United States (US) who have HTN. Aim To determine the levels of and relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care among first generation Filipino immigrants in the US who have HTN. Design A cross-sectional correlational design was used to determine the relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care using the Transactional Model of Stress and Coping. One hundred and sixty-three community-dwelling first-generation Filipino immigrants participated in the study. Methods Data on HTN self-care, acculturation, acculturative stress, HTN self-efficacy, and patient activation were collected. Results The study results revealed that HTN self-efficacy and patient activation significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further analysis revealed that patient activation had a mediating role between HTN self-efficacy and HTN self-care. Conclusions Findings from this study revealed that HTN self-efficacy and patient activation were associated with self-care behaviors associated with HTN management for this sample. Clinical relevance Findings from this study highlight the importance of addressing HTN self-efficacy and patient activation in improving HTN self-care for this population.

Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?

Maurer, M. S., Horn, E., Reyentovich, A., Dickson, V. V., Pinney, S., Goldwater, D., Goldstein, N. E., Jimenez, O., Teruya, S., Goldsmith, J., Helmke, S., Yuzefpolskaya, M., & Reeves, G. R. (2017). Journal of the American Geriatrics Society. 10.1111/jgs.15124
Abstract
Background/Objectives: Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device (LVAD) would decrease frailty. Design: Prospective, cohort study. Setting: Five academic medical centers. Participants: Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male). Measurements: Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B. Results: After 6 months, three subjects had died, and one had undergone a heart transplant; of 19 subjects with serial frailty measures, the average number of frailty criteria decreased from 3.9 ± 0.9 at baseline to 2.8 ± 1.4 at 6 months (P = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty. Conclusion: Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study.

Cross-cultural Adaptation of the Self-care of Hypertension Inventory Into Brazilian Portuguese

Silveira, L. C., Rabelo-Silva, E. R., Ávila, C. W., Beltrami, L., Dickson, V. V., & Riegel, B. (2017). Journal of Cardiovascular Nursing. 10.1097/JCN.0000000000000442
Abstract
BACKGROUND:: Lifestyle changes and treatment adherence still constitute a challenge to healthcare providers involved in the care of persons with hypertension. The lack of validated instruments measuring the ability of hypertensive patients to manage their disease has slowed research progress in this area. The Self-care of Hypertension Inventory, originally developed in the United States, consists of 23 items divided across 3 scales: Self-care Maintenance, Self-care Management, and Self-care Confidence. These scales measure how well patients with hypertension adhere to treatment and manage elevated blood pressure, as well as their confidence in their ability to perform self-care. A rigorous cross-cultural adaptation and validation process is required before this instrument can be used in other countries. OBJECTIVE:: The aims of this study were to translate the Self-care of Hypertension Inventory into Brazilian Portuguese with cross-cultural adaptation and to evaluate interobserver reliability and temporal stability. METHODS:: This methodological study involved forward translation, synthesis of forward translations, back-translation, synthesis of back-translations, expert committee review, and pretesting. Interobserver agreement and the temporal stability of the scales were assessed. RESULTS:: The expert committee proposed semantic and cultural modifications to some items and the addition of guidance statements to facilitate administration of the scale. Interobserver analysis demonstrated substantial agreement. Analysis of temporal stability showed near-perfect agreement. CONCLUSIONS:: Cross-cultural adaptation of the Self-care of Hypertension Inventory successfully produced a Portuguese-language version of the instrument for further evaluation of psychometric properties. Once that step is completed, the scale can be used in Brazil.

Prognostic utility of the braden scale and the morse fall scale in hospitalized patients with heart failure

Carazo, M., Sadarangani, T., Natarajan, S., Katz, S. D., Blaum, C., & Dickson, V. V. (2017). Western Journal of Nursing Research, 39(4), 507-523. 10.1177/0193945916664077
Abstract
Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and allcause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

Reduce noise: Improve the nation's health

Lusk, S. L., McCullagh, M., Dickson, V. V., & Xu, J. (2017). Nursing Outlook, 65(5), 652-656. 10.1016/j.outlook.2017.08.001

Self-care for the prevention and management of cardiovascular disease and stroke: A scientific statement for healthcare professionals from the American heart association

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Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Understanding organizations for runaway and homeless youth: A multi-setting quantitative study of their characteristics and effects

Gwadz, M. V., Cleland, C. M., Leonard, N. R., Bolas, J., Ritchie, A. S., Tabac, L., Freeman, R., Silverman, E., Kutnick, A., Dickson, V. V., Hirsh, M., & Powlovich, J. (2017). Children and Youth Services Review, 73, 398-410. 10.1016/j.childyouth.2017.01.016

Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: Results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study

Ekman, I., Wolf, A., Vaughan Dickson, V., Bosworth, H. B., & Granger, B. B. (2017). European Journal of Cardiovascular Nursing, 16(7), 646-654. 10.1177/1474515117707669
Abstract
Background: Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure. Methods and results: Patients (n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments). Conclusions: These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.

"We're Almost Guests in Their Clinical Care": Inpatient Provider Attitudes Toward Chronic Disease Management

Blecker, S., Meisel, T., Dickson, V. V., Shelley, D., & Horwitz, L. I. (2017). Journal of Hospital Medicine, 12(3), 162-167. 10.12788/jhm.2699
Abstract
BACKGROUND: Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital.METHODS: We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis.RESULTS: Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in-hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital-system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management.CONCLUSIONS: Providers perceived benefits to in-hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains. Journal of Hospital Medicine 2017;12:162-167.