Publications

Publications

The Association between Intergenerational Support and Self-Rated Health among Chinese Older Adults: Do Resilience and Gender Matter?

Liu, S., Zhang, W., Zhang, K., & Wu, B. (2023). Journal of Applied Gerontology, 42(1), 111-120. 10.1177/07334648221127882
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Abstract
This study aims to examine the association between intergenerational support and self-rated health (SRH) levels using data collected from Chinese older adults residing in Honolulu, United States (N = 329). We also investigated the mediating role of resilience and the moderating role of gender in the association. We found that receiving emotional support was significantly and positively associated with better SRH for the whole sample. The positive effect of receiving emotional support on health was significant among older women only. In contrast, the beneficial effect of providing economic support on health was significant among older men only. We found that resilience significantly mediated the positive effect of received emotional support on SRH, and this effect was found for the whole sample and among older women. However, resilience did not mediate the positive effect of the economic support provided on SRH among older men.

Exploring the Relationship between Nurse Practitioner Full Practice Authority, Nurse Practitioner Workforce Diversity, and Disparate Primary Care Access

Plemmons, A., Shakya, S., Cato, K., Sadarangani, T., Poghosyan, L., & Timmons, E. (2023). Policy, Politics, and Nursing Practice, 24(1), 26-35. 10.1177/15271544221138047
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In this study, we examine how full nurse practitioner (NP) practice authority affects racial and ethnic diversity of the NP workforce. Specifically, the purpose of our research is to understand the relationship between the racial and ethnic composition of the NP workforce, NP level of practice authority, and the communities they service. In this paper, we compare the ethnic and racial composition of the NP workforce to the composition of the state's population, and then observe if there are any noticeable differences in the patients served by NPs when we compare full practice authority (FPA) and non-FPA states. We also estimate how FPA affects the race and ethnicity of Medicare patients served by NPs.

Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University

Hussain, B. M., Ryan, R., Deierlein, A. L., Lal, S., Bihuniak, J. D., & Parekh, N. (2023). Journal of Hunger and Environmental Nutrition, 18(1), 65-80. 10.1080/19320248.2022.2119119
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Students at universities are experiencing food insecurity, which may be associated with health behaviors. In a pilot study to build a survey that assesses food insecurity and health behaviors among undergraduates, we distributed the survey before (Wave 1; fall 2019) and during (Wave 2; summer 2020) COVID-19. During Wave 1, 41% of students reported food insecurity and 61% met criteria for poor sleep. In Wave 2, 26% reported food insecurity and 49% met criteria for poor sleep. Students experiencing food insecurity were more likely to report poor sleep. This survey will inform recruitment and design of a scaled-up multi-campus study. (100/100 words).

Improving the Validity of Causal Inferences in Observational Studies

Capili, B., & Anastasi, J. K. (2023). American Journal of Nursing, 123(1), 45-49. 10.1097/01.NAJ.0000911536.51764.47

Inclusion of Disability Content in Simulation: An Evaluation of the Learners' Perspective on the Effectiveness of a Pediatric Tabletop Simulation

Ozkara San, E., Marx, K. A., Robertiello, G., Latimer, B., Nahum, J. L., & Pasklinsky, N. (2023). Nurse Educator, 48(1), 24-28. 10.1097/NNE.0000000000001291
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Background: Despite recommendations to include disability content in nursing education, nursing students have little exposure to disability education, which would help to develop necessary knowledge, skills, and attitudes in learning to care for patients with disabilities. Purpose: This study evaluated learners' perceptions of the effectiveness of a tabletop simulation in meeting their learning needs related to nursing care for children with disabilities and their families. Methods: The research design was a descriptive educational intervention study. Nursing students (n = 234) enrolled in the pediatric nursing course attended the simulation as a required part of their coursework. Results: The majority of the students found the tabletop simulation with disability content to be an effective educational intervention. Conclusions: The results obtained from this study indicated that the tabletop simulation was an effective educational strategy for nursing students' learning to provide care for children with disabilities and their families.

The Inclusion of LGBTQ+ Health across the Lifespan in Pre-Registration Nursing Programmes: Qualitative Findings from a Mixed-Methods Study

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Learning from the Past and Moving Forward: Implementing School Nursing Research Priorities

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Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care

Murali, K. P., Yu, G., Merriman, J. D., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2023). Western Journal of Nursing Research, 45(1), 14-24. 10.1177/01939459211041174
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The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer. The “low to moderate CCI and MCC” subgroup included older adults with chronic obstructive pulmonary disease (COPD), cardiovascular disease, congestive heart failure, myocardial infarction, dementia, diabetes, and lymphoma. A “high CCI and MCC” subgroup included individuals with severe illness including liver or renal disease among other MCCs. A “high CCI and metastatic cancer” included all participants with metastatic cancer. This study sheds light on the MCC profile of seriously ill adults receiving palliative care.

Nurses’ knowledge of heart failure assessment and management: A cross-sectional survey

Wang, Z., Walsh, S., Tocchi, C., Zhang, Y., & Chyun, D. (2023). Heart and Lung, 58, 82-90. 10.1016/j.hrtlng.2022.11.008
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Background: Nurses’ knowledge of heart failure (HF) is highly variable, ranging from expert to poor, potentially leading to inadequate self-care. Objectives: (1) document the knowledge variation of HF assessment and management among specialist and generalist nurses; (2) determine factors that may be associated with nurses’ knowledge; and (3) describe nurses’ views of knowledge deficits and ways to improve nurses’ knowledge to better meet the needs educational interventions. Method: Members of the American Association of Heart Failure Nurses and Registered Nurses were invited to participate in a cross-sectional survey. Independent samples t-test, chi-square, and linear regression were used for quantitative analysis. Text analysis was applied to analyze the themes of qualitative comments. Results: A total of 918 nurses completed the survey. Specialist nurses had higher scores than generalist nurses with statistically significant F-test for diet, fluid, signs/symptoms, medication, and exercise. Both specialist and generalist nurses were least knowledgeable about dry weight, asymptomatic hypotension, and transient dizziness. Being a specialist nurse was associated with higher level of knowledge scores. Years of experience and race were significant factors associated with knowledge scores in generalist nurses. Confidence level and race were significant predictors for specialist nurses. Three themes emerged regarding the cause of nurses’ insufficient knowledge and several approaches were provided. Conclusions: Specialist nurses are not only knowledgeable, but their knowledge levels are less variable compared to generalist nurses. There is a need to identify additional factors that may potentially influence nurses’ knowledge, contributing to the effectiveness of interventions.

Poststroke activity engagement in community dwellers: Association with illness perceptions and perceived environment

Shi, Y., Howe, T. H., Halpin, P. F., & Wu, B. (2023). Clinical Rehabilitation, 37(1), 132-142. 10.1177/02692155221111926
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Objectives: To investigate whether individuals’ poststroke activity engagement is associated with their perceptions of stroke, as well as their perceptions of physical and social environment. Design: Cross-sectional study. Setting: Participants were recruited from eight rehabilitation settings in Beijing, China. Participants: A total of 202 dyads of community dwellers with stroke and their primary caregivers. Main Measures: Activity engagement measured by the Assessment of Life Habits; stroke individuals’ and caregivers’ illness perceptions measured by the Stroke-Specific Illness Perceptions Questionnaire – Revised; and stroke individuals’ perceived social and physical environment measured by the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale. Results: A total of 202 dyads of individuals with stroke and their caregivers participated in the study with mean ages of 61.3 (8.3) and 52.6 (11.6), respectively. On average, stroke individuals scored 7.61 (1.42) on the daily activities subscale, indicating that they completed personal level activities without assistance but with some difficulty. They scored 6.21 (2.21) on the social roles subscale, suggesting that individuals completed societal level activities with assistive devices and with some difficulty. Illness perceptions correlated significantly with personal level activity engagement (change in R-squared = 0.029; p = 0.049), and perceived accessibility and heterogeneity correlated significantly with societal level activity engagement (change in R-squared = 0.025; p = 0.011). Conclusions: Poststroke activity engagement is associated not only with stroke individuals’ performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings may assist clinicians’ decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke.

The power of the language we use: Stigmatization of individuals and fellow nurses with substance use issues

Foli, K. J., Choflet, A., Matthias-Anderson, D., Mercer, M., Thompson, R. A., & Squires, A. (2023). Research in Nursing and Health, 46(1), 3-8. 10.1002/nur.22295

Quality of care in home health agencies with and without accreditation: a cohort study

Ma, C., Dutton, H. J., & Wu, B. (2023). Home Health Care Services Quarterly, 42(1), 1-13. 10.1080/01621424.2022.2123756
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While home health agencies (HHAs) can seek accreditation to recognize their quality of service, it is unknown whether agencies with accreditation perform better in providing care than those without accreditation. Using 5-year data from national data sources, the aims of this study were: 1) to depict characteristics of HHAs with and without accreditation; and 2) to examine the relationship between accreditation status and HHA performance on quality-of-care metrics. This study analyzed 7,697 agencies in the US and found that 1) agencies that were for-profit, urban, not-hospital-affiliated, single-branch, Medicare enrolled only, and without hospice program were more likely to have accreditation; and 2) overall, accredited agencies performed better on the three commonly used quality indicators, timely initiation of care, hospitalization, and emergency department visit, though not all the observed differences were substantial in absolute value. Our results provide unique empirical information to agencies considering seeking accreditation.

Quality of Telehealth-Delivered Inpatient Palliative Care During the Early COVID-19 Pandemic

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Sex differences in the mediating role of chronic inflammation on the association between social isolation and cognitive functioning among older adults in the United States

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Stronger than ever: NPs are ready to lead

Newland, J. A. (2023). Nurse Practitioner, 48(1), 4. 10.1097/01.NPR.0000903020.99457.e4

Acculturation and Subsequent Oral Health Problems Among Foreign-Born Older Chinese Americans: Does Neighborhood Disorder Matter?

Mao, W., Wu, B., Chi, I., Yang, W., & Dong, X. Q. (2022). Research on Aging, 44(3), 231-240. 10.1177/01640275211018785
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Objectives: To investigate the relationship between acculturation and subsequent oral health problems in older Chinese Americans and to further test the moderating role of neighborhood disorder in such a relationship. Methods: The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at baseline between 2011 and 2013 and the 2-year follow-up between 2013 and 2015. Stepwise Poisson regressions with lagged dependent variable were conducted. Results: Behavioral acculturation was protective against subsequent oral health problems, and the protective role was stronger among individuals reporting lower levels of neighborhood disorder. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems. Discussion: To reduce oral health symptoms and related burdens, it is important to consider, in practice and policy, the role of acculturation and the neighborhood on subsequent oral health outcomes.

Acculturation, Discrimination and 24-h Activity in Asian American Immigrant Women

Park, C., Larsen, B., Kwon, S., Xia, Y., Dickson, V. V., Kim, S. S., Garcia-Dia, M. J., Reynolds, H. R., & Spruill, T. M. (2022). Journal of Immigrant and Minority Health, 24(4), 1005-1012. 10.1007/s10903-022-01361-5
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Abstract
Asian American immigrant (AAI) women may have suboptimal 24-h activity patterns due to traditional gender role and caregiving responsibilities. However, little is known about their objectively-measured activity. We measured AAI women’s 24-h activity patterns using accelerometry and examined cultural correlates of time in sedentary behavior (SB), light intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA) and sleep. Seventy-five AAI women completed surveys on acculturation (years of U.S. residency and English proficiency), discrimination, and sleep quality, and 7 days of wrist- and hip-accelerometer monitoring. Linear regression was conducted controlling for age, BMI, and education. We also compared activity patterns across Asian subgroups (East, Southeast, South Asians). On average, AAI women had 33 min of MVPA, 6.1 h of LIPA, 10 h of SB, and 5.3 h of sleep per day. South Asian women had the longest SB and the shortest sleep and MVPA hours. English proficiency was negatively related to MVPA (p = 0.03) and LIPA (p < 0.01). Years of U.S. residency was positively related to SB (p = 0.07). Discrimination was related to shorter (p = 0.03) and poorer quality sleep (p = 0.06). Culturally-tailored programs targeting SB and sleep and integrating coping strategies against discrimination could help optimize AAI women’s 24-h activity patterns.

Adapting a palliative care-focused cancer self- and family management intervention for use in Israel

Schulman-Green, D., Feder, S. L., Collett, D., Aaron, E. M., Haron, Y., Eilon, Y., & Admi, H. (2022). International Journal of Palliative Nursing, 28(8), 378-387. 10.12968/ijpn.2022.28.8.378
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Background: In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal. Aims:This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel. Methods: The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis. Findings: Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific. Conclusion:The MCC tool is acceptable to potential users, warranting further pilot-testing.

Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study

Zisberg, A., Lickiewicz, J., Rogozinski, A., Hahn, S., Mabire, C., Gentizon, J., Malinowska-Lipień, I., Bilgin, H., Tulek, Z., Pedersen, M. M., Andersen, O., Mayer, H., Schönfelder, B., Gillis, K., Gilmartin, M. J., & Squires, A. (2022). International Journal of Nursing Studies, 134. 10.1016/j.ijnurstu.2022.104283
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Background: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor. Objectives: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile. Design: Cross-cultural instrument translation and content validation study. Setting and participants: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile. Method: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations. Results: CVI scores for relevance and translation were all in the “good” to “excellent” range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94. Conclusion: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.

Addressing Challenges in Recruiting Diverse Populations for Research: Practical Experience from a P20 Center

Wright, F., Malone, S. K., Wong, A., Melkus, G. D., & Dickson, V. V. (2022). Nursing Research, 71(3), 218-226. 10.1097/NNR.0000000000000577
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Background Improving the recruitment and retention of underrepresented groups in all research areas is essential for health equity. However, achieving and retaining diverse samples is challenging. Barriers to recruitment and retention of diverse participants include socioeconomic and cultural factors and practical challenges (e.g., time and travel commitments). Objectives The purpose of this article is to describe the successful recruitment and retention strategies used by two related studies within a P20 center funded by the National Institute of Nursing Research focused on precision health research in diverse populations with multiple chronic conditions, including metabolic syndrome. Methods To address the complexity, biodiversity, and effect of metabolic syndrome and multiple chronic conditions, we developed culturally appropriate, multipronged recruitment and retention strategies for a pilot intervention study and a longitudinal observational pilot study within our P20 center. The following are the underlying principles that guided the recruitment and retention strategies: (a) flexibility, (b) active listening and bidirectional conversations, and (c) innovative problem solving. Results The intervention study (Pilot 1) enrolled 49 participants. The longitudinal observational study (Pilot 2) enrolled 45 participants. Women and racial/ethnic minorities were significantly represented in both. In Pilot 1, most of the participants completed the intervention and all phases of data collection. In Pilot 2, most participants completed all phases of data collection and chose to provide biorepository specimens. Discussion We developed a recruitment and retention plan building on standard strategies for a general medical population. Our real-world experiences informed the adaption of these strategies to facilitate the participation of individuals who often do not participate in research - specifically, women and racial/ethnic populations. Our experience across two pilot studies suggests that recruiting diverse populations should build flexibility in the research plan at the outset.

Addressing the Health and Wellness of LGBTQI+ Individuals in Nursing School Curricula

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Adult Day Services, Health Equity for Older Adults With Complex Needs, and the COVID-19 Pandemic

Sadarangani, T. R., Gaugler, J. E., Dabelko-Schoeny, H., & Marx, K. A. (2022). American Journal of Public Health, 112(10), 1421-1428. 10.2105/AJPH.2022.306968
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Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of "big data" because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable "age-friendly" care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421-1428. https://doi.org/10.2105/AJPH.2022.306968).

Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration

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Adverse childhood experiences in relation to comorbid cardiovascular diseases and diabetes among middle-aged and old adults in China

Zhang, K., Wu, B., & Zhang, W. (2022). Geriatrics and Gerontology International, 22(1), 12-18. 10.1111/ggi.14312
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Aim: To examine whether various aspects of adverse childhood experiences (ACEs) are associated with comorbid cardiovascular diseases (CVDs) and diabetes among middle-aged and old adults in China. Methods: Using the 2018 China Health and Retirement Longitudinal Study survey and the 2014 Life History survey, in total, 17 115 respondents aged ≥45 years were included. Logistic regressions were applied to estimate the relationship between aspects of ACEs and diagnosis of both CVDs and diabetes while adjusting for adulthood demographics, health and health behaviors. Results: Childhood hunger (OR = 1.75, P < 0.01), childhood socioeconomic status (OR = 1.45, P < 0.05) and abuse from father (OR = 1.50, P < 0.05) were significantly associated with greater odds of comorbid CVDs and diabetes above and beyond adulthood characteristics. In addition, the effects of these ACEs on comorbidity were stronger than their effects on the single chronic condition. Conclusions: Our findings suggest that, for middle-aged and old Chinese adults, ACEs could have long-lasting impacts on multiple chronic conditions in later life. Public health interventions should focus on the early life stage as the protective childhood conditions might help in warning of later clustering chronic diseases. Geriatr Gerontol Int 2022; 22: 12–18.

Aliviado Mobile App for Hospice Providers: A Usability Study

David, D., Lin, S. Y., Groom, L. L., Ford, A., & Brody, A. A. (2022). Journal of Pain and Symptom Management, 63(1), e37-e45. 10.1016/j.jpainsymman.2021.07.019
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Context: Evaluation of usability and mobile health content is critical for ensuring effective implementation of technology utilizing interventions tailored to the needs of hospice care providers for people living with dementia in community-based settings. Objectives: To evaluate the usability, content, and “readiness to launch” of the Aliviado mobile health app for interdisciplinary team members participating in the Hospice Advanced Dementia Symptom Management and Quality of Life. Methods: Usability of the Aliviado app was assessed in 86 respondents with an adapted IBM Computer Usability Satisfaction Questionnaire following Hospice Advanced Dementia Symptom Management and Quality of Life training and implementation of the mobile app. Results: More than half of users receiving training employed the mobile app in practice. Users reported use as: Daily-6.3%, Weekly-39.6%, monthly-54.2%. The highest measured attributes were usefulness, value, and effectiveness. Over 90% deemed the app “ready to launch” with no or minimal problems. Conclusion: This study shows that a newly-developed mobile app is usable and can be successfully adopted for care of people living with dementia.