Recent Research Publications and Funding
June 26, 2016 4:00AM
Background: Our program of research focuses on thermal and circulatory stability in extremely premature infants. In prior studies, we found that infants have long periods of time in which foot temperature (FT) is higher than central temperature. We thus wanted to determine whether blood flow in the foot is increased when FT is elevated. Perfusion index (PI) can be used as a clinical indicator of peripheral perfusion, but reports on use of PI in premature infants are lacking. We employed exploratory methodology to examine foot perfusion and temperature in very low birth weight infants.
Aims: For premature infants after birth: (1) describe foot PI values for the first 2 weeks of life and (2) describe the relationship of longitudinal FT and PI. Study
Design: Case study design with longitudinal FT and PI in 17 infants born at <29 weeks’ gestation with birth weight < 1,200 g for 2 weeks after birth. Results: Infants averaged 851 g at birth and were 24–29 weeks’ gestational age. The mean PI across all infants for 14 days was 1.04, SD ¼ 0.79. Using a repeated measures multilevel model approach confirmed that FT and PI were positively related in these infants.
Conclusions: These findings demonstrate that perfusion is increased in the periphery in extremely premature infants when FT is increased. PI measures can be used as a trend for peripheral perfusion, and these values increase over the first 2 weeks of life in infants weighing more than 750 g.
May 17, 2016 4:00AM
PURPOSE/OBJECTIVES: To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer.
DESIGN: Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity.
SAMPLE: 1,127 female breast cancer survivors (BCSs).
METHODS: Written consents were mailed to the research office. Data were collected via mail and telephone.
MAIN RESEARCH VARIABLES: Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being.
FINDINGS: Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being.
CONCLUSIONS: The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs.
IMPLICATIONS FOR NURSING: Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns.
KNOWLEDGE TRANSLATION: The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.
Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model| March 31, 2016 4:00AM
Background:Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care.
Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact.
Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes.
Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes.
Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.
Supporting Working for Normalcy Post-Treatment: Guidance from a Qualitative Study of Older Cancer Survivors| February 11, 2016 6:00AM
Purpose/Objectives: To develop a better understanding of how older adult survivors of early-stage breast and prostate cancer managed the work of recovery.
Research Approach: Multiple case study design embedded in a larger randomized, controlled trial of a nurse-led patient navigation intervention.
Setting: Community-based research conducted via in-home visits and by phone with participants residing in non-metropolitan areas of a mid-Atlantic state.
Participants: Rural-dwelling adults aged 60 years or older with early-stage breast or prostate cancer and the people who support them (11 dyads).
Methodologic Approach: An approach to grounded theory analysis was used to evaluate the fit between existing theoretical knowledge and case findings and to generate new knowledge about the cancer recovery process.
Findings: Working toward normalcy was a core process of cancer recovery prompted by participants’ internal experiences and external interactions with their environments. This ongoing, iterative, and active process involved multiple concurrent strategies that were not necessarily medically oriented or cancer specific. Working toward normalcy resulted in movement along a continuum of self-appraisal anchored between participants experiencing life as completely disrupted by cancer to a life back to normal. A greater sense of normalcy was associated with higher engagement in valued activities and increased physical and psychological well-being.
Conclusions: In addition to the core process of working toward normalcy, multiple theories from nursing, sociology, psychology, and gerontology helped to explain case findings. This knowledge could serve as a foundation on which to design survivorship care that supports the goals of cancer survivors working toward normalcy post-treatment.
Interpretation: Post-treatment wellness goals can include a desire to reestablish or maintain a sense of normalcy. Nursing actions that promote survivors’ efforts to be perceived as capable, stay engaged in valued activities and roles, maintain a sense of control over their lives and bodies, and make plans for the future may help meet this goal. Existing theories about identity, dignity, inner strength, and the work of illness can inform nursing interventions.
January 11, 2016 6:00AM
Cigarette smoking has been shown to be a health hazard. In addition to being considered a negative lifestyle behavior, studies have shown that cigarette smoking has been linked to genetic underpinnings of hypertension. Because African Americans have the highest incidence and prevalence of hypertension, we examined the joint effect of genetics and cigarette smoking on health among this understudied population. The sample included African Americans from the genome wide association studies of HyperGEN (N = 1083, discovery sample) and GENOA (N = 1427, replication sample), both part of the FBPP. Results suggested that 2 SNPs located on chromosomes 14 (NEDD8; rs11158609; raw p = 9.80 × 10−9, genomic control-adjusted p = 2.09 × 10−7) and 17 (TTYH2; rs8078051; raw p = 6.28 × 10−8, genomic control-adjusted p = 9.65 × 10−7) were associated with SBP including the genetic interaction with cigarette smoking. These two SNPs were not associated with SBP in a main genetic effect only model. This study advances knowledge in the area of main and joint effects of genetics and cigarette smoking on hypertension among African Americans and offers a model to the reader for assessing these risks. More research is required to determine how these genes play a role in expression of hypertension.
January 6, 2016 6:00AM
PURPOSE: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables.
METHODS: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software.
RESULTS: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson's correlations r >.60; p values < .05).
CONCLUSIONS: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.
November 25, 2015 6:00AM
Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors’ recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants’ difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.
September 30, 2015 4:00AM
AIM: The purpose of this manuscript it to disseminate findings from a systematic review of the literature related to the NLN/Jeffries SimulationFramework.
BACKGROUND:This review was initiated by the National League for Nursing to illuminate what is currently known about best simulation practices, research to support these practices, and priorities for future research. It is part of a larger project aimed at further developing the NLN/JeffriesSimulation Framework.
METHOD: Searches using CINAHL, the journal Simulation in Healthcare, and reference lists from key documents yielded 1,533 relevant publications for the period January 2000 to September 2014.
RESULTS: The final review of the literature includes 153 studies. Three themes, along with key issues, gaps, and best practices supported by theliterature, were identified.
CONCLUSION: This systematic review provides empirical support for the major components of the NLN/Jeffries Simulation Framework and contributes to its further development.
Effect of Patient Navigation on Breast Cancer Screening among African American Medicare Beneficiaries: A Randomized Controlled Trial| August 11, 2015 4:00AM
BACKGROUND: There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women.
OBJECTIVE: To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD.
DESIGN: The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010.
SETTING: Community-based and clinical setting.
PARTICIPANTS: The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls.
INTERVENTIONS: Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group).
MAIN MEASURE: Self-reported receipt of mammography screening within 2 years of the end of the study.
KEY RESULTS: The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38).
CONCLUSION: Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.
Optimizing Eating Performance for Older Adults With Dementia Living in Long-term Care: A Systematic Review| June 29, 2015 4:00AM
BACKGROUND: Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance.
OBJECTIVE: To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC).
METHODS: A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, and intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence.
RESULTS: Eleven intervention studies (five randomized controlled trials [RCTs]) were identified, and classified into four types: training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate (four studies were rated as strong, four moderate, and three weak in quality), with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance.
LINKING EVIDENCE TO ACTION: This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance.