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- All Subjects: Nursing
- Creators: Todd, Michael
- Creators: Coon, David W.
Description
ABSTRACT Caregiving studies generally do not focus on the post-caregiving phase of care, or African Americans post-caregivers (AAPCGs). This mixed-methods study guided by the Transitions Theory, explored the experiences of 40 AAPCGs residing in Los Angeles, California and Phoenix, Arizona, whose loved ones died within the last 10 years. Data collection tools included individual interviews, demographic questionnaire, CES-D, Brief Cope, and Social Support. Findings present the specific aims of the study. Aim 1 dealt with the types, patterns and properties of post-caregiving transitions (PCT). Many AAPCGs experienced multiple, simultaneous transitions that continued to impact their lives many years after caregiving ends. Aim 2 dealt with factors that facilitate or inhibit healthy PCT. Facilitators include: Being satisfied with care provided; fulfilling death-bed promises; living out the legacy of the deceased; deep spiritual beliefs in God and support of family, friends and church. Inhibitors include: Experiencing a deep sense of loss, confusion, depression, loneliness, and guilt; physical challenges such as fatigue and exhaustion, breathing problems, dizziness, fainting, cognitive difficulties, pain, headaches, hypertension and insomnia; family conflicts, job or home loss that linger long after PCT. Aim 3 involves process indicators including: connectedness with family, friends, co-workers, church and God; returning to work or school. Coping strategies that helped AAPCGs include: productive ventures, family mementoes, reminiscing, new baby, or visiting cemetery. Appropriate coping led to outcome indicators of mastery such as new environment; making decisions; taking actions; readying oneself for another caregiving role; preparing for one's own life and death; or caring for self. Fluid integrative identities include: Sense of balance, peacefulness and joy, fulfillment, compassion; remembering without pain; or new identity. Implications for practice, policy, education and research include: Care providers and policy makers must ensure that AA caregivers receive adequate EOL and hospice information and support for adequate preparation of loved one's death. Geriatric educators must design and implement curricular programming that includes the post-caregiving phase as a very important phase of caregiving. Researchers should design culturally-congruent assessment tools or improve the checklist developed in this study to appropriately measure PCT; and also develop culturally-relevant interventions to facilitate healthy PCT.
ContributorsUme, Ebere Peace (Author) / Evans, Bronwynne C. (Thesis advisor) / Coon, David W. (Thesis advisor) / Keller, Colleen S (Committee member) / Arizona State University (Publisher)
Created2013
Description
The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management.
The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research.
The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research.
ContributorsO'Brien, Anne Marie (Author) / Marek, Karen D. (Thesis advisor) / Coon, David W. (Committee member) / Evans, Bronwynne C. (Committee member) / Arizona State University (Publisher)
Created2014
Description
The purpose of this study is to identify the needs of older adults with Alzheimer's disease (AD) and related dementias (ADRD) admitted to a rehabilitation setting where they are expected to physically and mentally function to their optimal level of health. To date, no studies have identified the needs and concerns of ADRD patients in rehabilitation settings. The Needs-Driven Dementia-Compromised Behavior (NDB) Model, the researcher's clinical experience, and the state of the current scientific literature will help guide the study. An exploratory qualitative research approach was employed to gather data and discover new information about the ADRD patient's needs and related behavioral outcomes. The qualitative findings on the discrepancies and similarities in perceptions of ADRD patient needs were obtained by examining formal and informal caregivers' perceptions. The researcher recruited registered nurses and certified nurse assistants (RNs and CNAs, formal) and family/friends (informal) who have provided care to patients in inpatient rehabilitation facilities to participate in focus groups and individualized focused interviews. The data were collated and analyzed using a thematic analysis approach. The overarching theme that developed as a result of this approach revealed discordant perceptions and expectations of ADRD patients' needs between the formal and informal caregivers with six subthemes: communication and information, family involvement, rehabilitation nurse philosophy, nursing care, belonging, and patient outcomes. The researcher provided recommendations to help support these needs. These findings will help guide the development of nurse-lead interventions for ADRD patients in a rehabilitation setting.
ContributorsAllen, Angela Marie (Author) / Coon, David W. (Thesis advisor) / McCarthy, Marianne (Committee member) / Uriri-Glover, Johannah (Committee member) / Arizona State University (Publisher)
Created2014
Description
This body of research sought to explore relationships between parenting practices, physical activity resources, and Hispanic children’s physical activity. Guided by the Family Ecological Model (FEM) and the Ecological Model of Physical Activity (EMPA) this study examined the influence of parents on children’s physical activity through an integrative review. A cross sectional study was conducted to investigate potential relationships between parental perception safety at school, gender, and children’s physical activity. A cross sectional study was also utilized to examine potential correlations between parenting practices, physical activity resources, and children’s physical activity. Parental role modeling of physical activity and parental support for physical activity emerged as parenting practices that have considerable potential to impact children’s physical activity. Gender differences among children’s physical activity were also a key finding of this study with boys participating in more physical activity than boys. While quality of physical activity resources did not have significant associations with parenting practices or children’s physical activity, more research is needed to determine how resources for physical activity may impact parenting practices, and children’s physical activity.
ContributorsHutchens, Amy (Author) / Lee, Rebecca E (Thesis advisor) / Todd, Michael (Committee member) / Lyles, Ann Marie (Committee member) / Holtzclaw, Barbara (Committee member) / Arizona State University (Publisher)
Created2017
Description
Job burnout, a prolonged reaction to job stress, includes mental and physical aspects of exhaustion related to professional work life. Linked to individual health-related problems, decreased job satisfaction, poor organizational commitment, and higher turnover, burnout poses a problem for both employees and organizations. The nursing profession identifies the prevalence of burnout and the resulting harmful effects in many settings, yet until now, rural critical access hospital settings have not been considered. To build and maintain a competent, healthy rural nursing workforce that responds innovatively to growing healthcare needs, it is important to examine burnout levels in rural nurses and to identify factors that might be associated with mitigating burnout.
This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.
Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.
This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.
Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.
ContributorsMcCay, Rebecca (Author) / Larkey, Linda K (Thesis advisor) / Kelly, Lesly (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2019
Description
Purpose: The purpose of this study is to examine perceptions of medical-surgical nurses of alcohol-abusing patients admitted to an acute care facility Background: Studies report that many nurses have negative feelings about substance-abusing patients (Neville & Roan, 2014). It has been found nurses report a lack of knowledge about substance abuse disorders, as well as a view that substance abusing patients are more emotionally challenging and dangerous, often leading to decreased motivation and lower levels of job satisfaction (van Boekel, Brouwers, van Weeghel & Garrestsen, 2013). However, studies have found that additional education can positively impact nurses' perceptions (Arthur, 2001). Methods/Approach: This study is a descriptive design using a 17-question 2-part survey. The first part of the survey includes seven demographic questions pertaining to the participants' characteristics and experiences. The second part of the survey is adapted from the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), a valid and reliable instrument used to assess healthcare providers' attitudes toward working with alcohol-abusing patients. Results: Eighty four medical-surgical nurses participated in the study. Over half reported having four hours or less of continuing education on alcohol abuse disorder. Regression analyses identified positive relationships between factors, particularly continuing education, on perceptions of alcohol-abusing patients. Conclusions/Implications: Results of this study can be used to determine what factors contribute to nurses' perceptions of alcohol-abusing patients in the medical-surgical unit, therefore aiding in identifying and developing effective policies, protocols, and interventions aimed at improving quality of patient care in this specific patient population.
ContributorsScalise, Bailey Nicole (Author) / Hosley, Brenda (Thesis director) / Baumhover, Nancy (Committee member) / Todd, Michael (Committee member) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
Description
Exclusivity and duration of breastfeeding and the provision of human milk in the United States is suboptimal. In the absence of adequate banked donor human milk for distribution to all infants in need, many families choose to engage in the practice of Private Arrangement Milk Sharing (PAMS), partially facilitated through social media, to procure human milk for their infants. Evidence regarding the participant and infant characteristics and risk abatement practices is incomplete. This dissertation describes and explores the characteristics of recipient participants and infants, family constellation, donor screening practices, and related risk abatement strategies. Data was collected via on-line survey as a sub-group of a larger data set including donor participants and international participants. Binary logistic regression modeling of factors that contribute to consistent screening and risk abatement practices and important antecedents to engaging in PAMS was conducted. Results are contextualized within a tailored socioecological framework of factors affecting infant feeding practices. Tailoring was accomplished via qualitative descriptive analysis of participant responses applied to an existing breastfeeding framework. Participants in this sample were predominantly white, married, with a mean age of 32.9 years, with at least some college education and above median income. Risk abatement and screening practices were influenced by support of a healthcare provider during decision-making, college education, infant age and health status, having lactation support, birth type and birth attendant, and the duration and sources sought for learning about milk sharing.
ContributorsBond, Angela Bowen (Author) / Reifsnider, Elizabeth G. (Thesis advisor) / Keller, Colleen (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2016
Description
This manuscript option dissertation elucidates the role of patient-provider interactions in keeping HIV positive Black women in medical care. Since 2012, the Arizona State Department of Health has acknowledged that women of African descent are disproportionately affected by HIV and die at higher rates from AIDS-related complications than other women. The dissertation includes three manuscripts covering a feature of this topic. The first paper is a scoping review of literature on what is known about the influence of patient-provider relationships on adherence and viral suppression among Black women living with HIV in Arizona. The second is an empirical study built upon interviews with Black women living with HIV analyzed through constructivist grounded theory to understand women’s perspectives of provider actions that keep them in care. The third offers practice recommendations based on the interviews with Black women living with HIV, dialog with HIV advocates, and proceedings of the Phoenix Fast Track Cities ad hoc committee to end HIV as an epidemic. Together, the three manuscripts integrate the voices of women, advocates, and past research to support best practices and future steps for HIV retention strategies.
ContributorsHassan, Kenja (Author) / Coon, David W. (Thesis advisor) / McCarthy, Marianne (Committee member) / Uriri-Glover, Johannah (Committee member) / Arizona State University (Publisher)
Created2021
Description
This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2 presents an investigation into the relationship between walking for AT and cardiometabolic health among adults through systematic review. Chapter 3 presents an exploration of the cross-sectional relationships of AT and moderate-to-vigorous physical activity (MVPA) with cardiometabolic health among African American (AA) and Hispanic/Latina (HL) women from Texas. Chapter 4 presents an investigation into the cross-sectional relationship of AT on cardiometabolic health and physical activity among primarily HL women.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
ContributorsLorenzo, Elizabeth (Author) / Lee, Rebecca E (Thesis advisor) / Todd, Michael (Committee member) / Shin, Cha-Nam (Committee member) / Arizona State University (Publisher)
Created2019
Description
Spousal bereavement is one of the most stressful life events, resulting in increased morbidities and mortality risk. Negative health outcomes include depressive episodes, anxiety, sleep disruption, and overall poorer physical health. The older adult population is rapidly increasing and over 30% of the US population 65 years and older are widowed. Current studies regarding older adults and spousal bereavement treatment have been limited to psychological and educational interventions. Meditative movement practices (e.g. Tai Chi) have shown benefits such as mood elevation, anxiety reduction, and other physical function improvements. A feasibility study applying an 8-week Tai Chi Easy intervention was examined to address the sequelae of spousal bereavement among adults 65 and older. Grounded in geriatric nursing as a discipline that addresses the unique needs of older adults' psychological and physiological health needs and related theoretical constructs, this project also draws from exercise science, mental health, and social psychology. Theoretical premises include Orem's Self Care Deficit Theory (nursing), Stroebe and Schut's Dual Process Model (thanatology), and Peter Salmon's Unifying Theory (exercise). Aims of the study examined feasibility as well as pre-post-intervention changes in grief, and the degree of loss orientation relative to restoration orientation (Inventory of Daily Widowed Life). A trend in the direction of improvement was found in measured subscales, as well as a statistically significant change within the loss orientation subscale. Based upon these encouraging findings, effect sizes may be used to power a future larger study of similar nature.
ContributorsNseir, Stacey C (Author) / Larkey, Linda K. (Thesis advisor) / Mcclain, Darya B. (Committee member) / Coon, David W. (Committee member) / Arizona State University (Publisher)
Created2012