Publications

Abstract

Institute of Medicine reports have identified gaps in health care professionals' knowledge of palliative and end-of-life care, recommending improved education. Our purpose was to develop and administer a Web-based survey to identify the educational needs of multidisciplinary health care professionals who provide this care in Connecticut to inform educational initiatives. We developed an 80-item survey and recruited participants through the Internet and in person. Descriptive and correlational statistics were calculated on 602 surveys. Disciplines reported greater agreement on items related to their routine tasks. Reported needs included dealing with cultural and spiritual matters and having supportive resources at work. Focus groups confirmed results that are consistent with National Consensus Project guidelines for quality palliative care and indicate the End-of-Life Nursing Education Consortium modules for education.

Abstract

Background: Attentional fatigue is experienced as a decreased ability to concentrate, engage in purposeful activity, and maintain social relationships when there are competing demands on attention. Breast and prostate cancer are the 2 most common cancers in women and men, respectively. Most previous studies on self-reported attentional fatigue evaluated patients with breast cancer. Objectives: The objectives of the study were to determine if self-reported attentional fatigue differed in patients with breast cancer and prostate cancer before radiation therapy (RT) and to determine the relationships between attentional fatigue and other symptoms in these 2 groups. Methods: Patients (n = 155) completed questionnaires before RT. Descriptive statistics, Pearson correlations, and analysis of covariance were used for data analyses. Results: After controlling for age, patients with breast cancer reported significantly higher levels of attentional fatigue. In both groups, more attentional fatigue correlated significantly with more anxiety, depression, sleep disturbance, and physical fatigue. These correlations were stronger for patients with breast cancer. Conclusions: The present study is the first to identify differences in self-reported attentional fatigue between these 2 groups before RT. Additional research is warranted to determine factors that contribute to these differences, as well as mechanisms that underlie the development of attentional fatigue. Implications for Practice: Clinicians should consider the capacity of their patients to direct attention when learning about RT and other treatments. It is important to simplify confusing healthcare terminology and reinforce teaching that is most important both verbally and in writing. Appropriate interventions for anxiety and depression may decrease attentional fatigue in these patients.

Abstract

Objectives: To compare differences in self-rated oral health among community-dwelling Black, Hispanic, and White adults aged 60 and older. Method: A total of 4,859 participants in the National Health and Nutrition Examination Survey (1999-2004) provided self-report information on oral health. Results: Blacks and Hispanics reported poorer self-rated oral health than Whites. In separate dentate and edentulous groups, socioeconomic status, social support, physical health, clinical oral health outcomes, and dental checkups accounted for much of the difference in self-rated oral health in Blacks, but significant differences remained for Hispanics. Discussion: The study findings may have important implications for health policy and program development. Programs and services designed for minority populations should target treatments for dental diseases and include components that take into account subjective evaluations of oral health conditions and perceived dental needs of the individuals.

Abstract

Context: Little is known about the occurrence and severity of sleep disturbance and fatigue between patients with common cancer diagnoses. Objectives: Study purposes were to evaluate for differences in the occurrence rates of sleep disturbances and fatigue; evaluate for differences in the severity of sleep disturbance using both subjective and objective measures; and evaluate for differences in the severity of self-reported fatigue in patients with breast and prostate cancer at the initiation of radiation therapy (RT). Methods: Patients with breast (n = 78) and prostate (n = 82) cancer were evaluated before the initiation of RT using the Pittsburgh Sleep Quality Index, General Sleep Disturbance Scale, Lee Fatigue Scale, and wrist actigraphy. Differences in sleep disturbance and fatigue between groups were evaluated using independent sample t-tests and Chi-square analyses. Results: Occurrence rates for sleep disturbance (P < 0.0001) and fatigue (P = 0.03) were significantly higher in patients with breast compared with prostate cancer. Patients with breast cancer self-reported significantly higher levels of sleep disturbance (P = 0.008) and fatigue (P = 0.005) than patients with prostate cancer. However, using actigraphy, patients with prostate cancer had poorer sleep efficiency (P = 0.02) than patients with breast cancer. Conclusion: Based on self-report, patients with breast cancer experience sleep disturbance more frequently and with greater severity than patients with prostate cancer. Objective measures of sleep disturbance suggest that prostate cancer patients have more severe sleep disturbance than breast cancer patients. All the patients experienced poor sleep quality and fatigue, which suggests that oncology patients need to be assessed for these symptoms.

Abstract

Purpose: This study compared the occurrence rates for and severity ratings of sleep disturbance in patient-family caregiver (FC) dyads. Patients and Methods: In total, 102 dyads were recruited from two radiation therapy (RT) departments. Patients and their FCs completed the Pittsburgh Sleep Quality Index (PSQI) and the General Sleep Disturbance Scale (GSDS) and wore wrist actigraphs to obtain subjective and objective measures of the occurrence and severity of sleep disturbance at the initiation of RT. Match paired t tests were used to evaluate for dyadic differences. Results: No differences were found in the occurrence of clinically significant levels of sleep disturbance between patients and their FCs that ranged between 40% and 50% using subjective and objective measures. Few differences were found in the severity of any of the sleep-wake parameters between patients and FCs using both the subjective and objective measures of sleep disturbance. Conclusion: The findings from this study suggest that patients with cancer and their FCs experience similar levels of sleep disturbance and that both groups could benefit from interventions that aim to promote restful sleep. In addition to routine and systematic assessment of sleep disturbance by oncology clinicians, interventions are needed that take into account the specific needs of the patient and the FC as well as the potential for partners' sleep patterns to influence one another.

Abstract

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.

Abstract

Cognition, memory, safety, mental health, and weight are all affected by inadequate sleep. Biological studies indicate significant changes in sleep architecture during adolescence, such as changes in melatonin secretion, and a need for greater total sleep time. Yet, social contexts and cultural values impinge on these changing biological sleep needs making adolescents vulnerable to the dangers of insufficient sleep. Sleep hygiene practices are purported as potential mediating factors between biological sleep needs and the sociocultural context of sleep. The purpose of this literature review is to highlight biological and social factors contributing to insufficient sleep in adolescents, to explore the evidence of several recommended sleep hygiene practices, and to stimulate further research about how adolescents negotiate their shifting biological sleep needs amid increasing social demands.

Abstract

The hypothesis that probiotic administration protects the gut surface and could delay progression of Human Immunodeficiency Virus type1 (HIV-1) infection to the Acquired Immunodeficiency Syndrome (AIDS) was proposed in 1995. Over the last five years, new studies have clarified the significance of HIV-1 infection of the gut associated lymphoid tissue (GALT) for subsequent alterations in the microflora and breakdown of the gut mucosal barrier leading to pathogenesis and development of AIDS. Current studies show that loss of gut CD4+ Th17 cells, which differentiate in response to normal microflora, occurs early in HIV-1 disease. Microbial translocation and suppression of the T regulatory (Treg) cell response is associated with chronic immune activation and inflammation. Combinations of probiotic bacteria which upregulate Treg activation have shown promise in suppressing pro inflammatory immune response in models of autoimmunity including inflammatory bowel disease and provide a rationale for use of probiotics in HIV-1/AIDS. Disturbance of the microbiota early in HIV-1 infection leads to greater dominance of potential pathogens, reducing levels of bifidobacteria and lactobacillus species and increasing mucosal inflammation. The interaction of chronic or recurrent infections, and immune activation contributes to nutritional deficiencies that have lasting consequences especially in the HIV-1 infected child. While effective anti-retroviral therapy (ART) has enhanced survival, wasting is still an independent predictor of survival and a major presenting symptom. Congenital exposure to HIV-1 is a risk factor for growth delay in both infected and non-infected infants. Nutritional intervention after 6 months of age appears to be largely ineffective. A meta analysis of randomized, controlled clinical trials of infant formulae supplemented with Bifidobacterium lactis showed that weight gain was significantly greater in infants who received B. lactis compared to formula alone. Pilot studies have shown that probiotic bacteria given as a supplement have improved growth and protected against loss of CD4+ T cells. The recognition that normal bacterial flora prime neonatal immune response and that abnormal flora have a profound impact on metabolism has generated insight into potential mechanisms of gut dysfunction in many settings including HIV-1 infection. As discussed here, current and emerging studies support the concept that probiotic bacteria can provide specific benefit in HIV-1 infection. Probiotic bacteria have proven active against bacterial vaginosis in HIV-1 positive women and have enhanced growth in infants with congenital HIV-1 infection. Probiotic bacteria may stabilize CD4+ T cell numbers in HIV-1 infected children and are likely to have protective effects against inflammation and chronic immune activation of the gastrointestinal immune system.

Abstract

Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they apply to communication in clinical care and discuss principles of effective communication and conflict management in maternity care. Effective clinical communication is respectful, clear, direct, and explicit. We use a clinical scenario to illustrate an historic style of nurse-physician communication and demonstrate how communication can be improved to promote trust and patient safety. Consistent execution of successful communication requires excellent listening skills, superb administrative support, and collective commitment to move past traditional hierarchy and professional stereotyping.

Abstract

To increase HCV-related support for patients in substance abuse treatment programs, we implemented an on-site staff training in 16 programs throughout the United States. It aimed to increase participants' self-efficacy in assisting patients with their HCV-related needs. Findings indicate that participants' self-efficacy increased both 1 and 3 months posttraining, resulting in providers' perceptions that they were better able to support patients regarding HCV. Implementing an engaging and interactive HCV training for social workers and other substance abuse treatment program staff has the potential to increase their HCV knowledge, self-efficacy, and the HCV-related assistance provided to patients both in the short and longer term.

Abstract

This study examined diverse older adults' (n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos, and Vietnamese Americans. All groups mentioned benefits of social interaction. All groups, especially Chinese and African Americans, mentioned benefits of community engagement. Participants in all groups expressed their belief that mental stimulation, particularly reading, promoted cognitive health; African Americans and Whites were especially likely to say that mental exercises (e.g., puzzles) were useful. Results suggest opportunities for education about potential cognitive health benefits of being socially connected through senior center activities and volunteer programs.

Abstract

Process evaluation of community-academic partnership function and fidelity to principles of community-based participatory research (CBPR) is essential to achievement of intermediate and long term partnership goals. This article describes the evaluation of B Free CEED, a community-academic partnership created to address hepatitis health disparities in Asian American and Pacific Islander (API) communities. A mixed methods approach with an online survey and qualitative key informant interviews was conducted with all partnership members at baseline and follow-up, 18 months later. Survey findings showed stability over time, with some consistent differences in community and academic perspectives. Academic members were somewhat more satisfied with the partnership functioning. Key informant interviews provided contextual data key to further defining partnership functioning. Conducting ongoing partnership evaluations is necessary to reassess and align processes and protocols to enhance partnership functioning and strengthen group cohesion.

Abstract

Background: There has been increasing attention paid to quality assessment in hospice as the industry has grown and diversified. In response, policymakers have called for standardized approaches to monitoring hospice quality. The experiences of a set of hospices involved with the National Association for Home Care & Hospice (NAHC) Quality Assessment and Performance Improvement Collaborative, which was designed to test the use of a standardized patient symptom assessment tool as an exemplar of efforts to standardize symptom assessment in hospice, were examined. Methods: Transcripts of semistructured telephone interviews with 24 individuals from eight of the nine participating hospices, which were conducted in July-August 2007, were analyzed using the constant comparative method. Interview questions centered on the collaborative's impact on the process of quality assessment at the hospices. Findings: The collaborative activities influenced several hospices' quality assessment processes, most beneficially by prompting greater attention to quality assessment processes, by promoting the adoption of quality assessment tools, and by creating a supportive community. Challenges included the limits of distance communication technology, participants' misconceptions about data to be received, and potential lack of support and resources for quality assessment. Conclusions: The experiences of the participating hospices in the NAHC collaborative are intended to inform the design of future interorganizational learning efforts to promote quality assessment initiatives within hospice settings. Future hospice collaboratives should use multiple methods of communication to build a close participant network and be clear about collaborative goals and participant expectations and about the reciprocal relationship of the collaborative and the participants.

Abstract

Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.

Abstract

OBJECTIVES: To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older. DESIGN: Secondary data analysis of combined data subsets. SETTING: Five prospective, longitudinal oncology nurse-directed clinical studies conducted at three academic centers in the northwest and northeast United States. PARTICIPANTS: Three hundred sixteen community-residing patients diagnosed with digestive system, thoracic, genitourinary, and gynecological cancers treated primarily with surgery. MEASUREMENTS: Functional status, defined as performance of current life roles, was measured using the Enforced Social Dependency Scale and the Medical Outcomes Study 36-item Short-Form Survey (using physical component summary measures) after surgery (baseline) and again at 3 and 6 months. Number of symptoms, measured using the Symptom Distress Scale, quantified the effect of each additional common cancer symptom on functional status. RESULTS: After controlling for cancer site and stage, comorbidities, symptoms, psychological status, treatment, and demographic variables, functional status was found to be significantly better at 3 and 6 months after surgery than at baseline. Factors associated with better functional status included higher income and better mental health. Factors associated with poorer average functional status were a greater number of symptoms and comorbidities. Persons reporting three or more symptoms experienced statistically significant and clinically meaningful poorer functional status than those without symptoms. Persons reporting three or more comorbidities were also found to have poorer functional status than those without comorbidities. No significant relationship existed between age and functional status in patients aged 65 and older. CONCLUSION: Factors other than age affect recovery of functional status in older adults after cancer surgery.

Abstract

OBJECTIVE - To estimate baseline cardiovascular risk of 1,123 participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study and to assess cardiac event rates and the effect of screening on outcomes in these higher-risk participants. RESEARCH DESIGN AND METHODS - Baseline cardiovascular risk was assessed using four established methods: Framingham score, UK Prospective Diabetes Study (UKPDS) risk engine, criteria of the French-Speaking Association for the Study of Diabetes and Metabolic Diseases, and the presence or absence of metabolic syndrome. Cardiac events (cardiac death or nonfatal myocardial infarction) were assessed during the 4.8-year follow-up in participants with intermediate/high cardiovascular risk. RESULTS - By various risk-stratification approaches, 53-75% of participants were defined as having intermediate or high cardiovascular risk. The prevalence of inducible ischemia on screening in these individuals ranged from 21 to 24%, similar to lower-risk participants (19-23%). Cardiac event rates were greater in intermediate-/high- risk versus low-risk groups, but this was only significant for the UKPDS risk engine (4.2 vs. 1.2%, P=0.002). The annual cardiac event rate was <1% in all risk groups, except in the high-risk UKPDS group (∼2% per year). In intermediate-/high-risk participants randomized to screening versus no screening, 4.8-year cardiac event rates were similar (2.5-4.8% vs. 3.1-3.7%). CONCLUSIONS - A substantial portion of the DIAD population was defined as having intermediate/high baseline cardiovascular risk. Nevertheless, their annual cardiac event rate was low and not altered by routine screening for inducible ischemia.

Abstract

Although evidence-based practice (EBP) improves health care quality, decreases costs, and empowers nurses, there is a paucity of intervention studies designed to test models of how to enhance nurses' use of EBP. Therefore, the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration (ARCC) model on nurses' EBP beliefs, EBP implementation behaviors, group cohesion, productivity, job satisfaction, and attrition/turnover rates. A 2-group randomized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York. The ARCC group versus an attention control group had stronger EBP beliefs, higher EBP implementation behaviors, more group cohesion, and less attrition/turnover. Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes.