Matching Items (26)
Description
Nurses are using health information technology during patient care activities in acute care at an unprecedented rate. Previous literature has presented nurses' response to technology obstacles as a work-around, a negative behavior. Using a narrative inquiry in one hospital unit, this dissertation examines nurses' interactions when they encounter technology obstacles from a complexity science perspective. In this alternative view, outcomes are understood to emerge from tensions in the environment through nonlinear and self-organizing interactions. Innovation is a process of changing interaction patterns to bring about transformation in practices or products that have the potential to contribute to social wellbeing, such as better care. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, multidirectionality, and their actions were influenced by a plethora of sets of rules. Nurses self-organized with co-workers to find a better way to deliver care to patients when using technology. Nurses rarely told others outside their work-group of the obstacles that occurred in their everyday interactions, including hospital-wide process improvement committees. Managers were infrequently consulted when nurses encountered technology obstacles, and often nurses did not find solutions to their obstacles when they contacted the Help Desk. Opportunities exist to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves quality and safety while decreasing cost in the patient experience.
ContributorsLalley, Catherine (Author) / Malloch, Kathy (Thesis advisor) / Fleury, Julie (Committee member) / Danzig, Arnold (Committee member) / Arizona State University (Publisher)
Created2013
Description
Eccentric muscle action (ECC) occurs when the force exerted by a working muscle is less than that of an outside resistance. This is characterized by muscle lengthening, despite actin-myosin crossbridge formation. Research has indicated that muscles acting eccentrically are capable of producing more force when compared to muscles acting concentrically. Further, research has shown ECC muscle actions may have different fatigue patterns that CON actions. The purpose of this study was to determine if a) ECC bench press yields greater strength than concentric (CON) as measured by one-repetition maximum (1RM), b) there is a difference between the number of repetitions that can be completed concentrically and eccentrically under the same relative intensities of 1RM (90%, 80%, 70%, 60%), c) a prediction model may be able to predict ECC 1RM from CON 1RM or CON repetitions to fatigue. For this study, 30 healthy males (age = 24.63 + 5.6 years) were tested for 1RM in CON and ECC bench press, as well as the number of repetitions they were able to complete at various intensities of mode-specific 1RM. A mechanical hoist was affixed to a gantry crane and placed over a standard weightlifting bench. The hoist was connected to 45lb plates that were loaded on a standard barbell, which allowed for mechanical raising and lowering of the barbell. For CON repetitions, the weight was mechanically lowered to the chest and the participant pressed it up. For ECC repetitions, the weight was mechanically raised and the participant lowered it. Paired t-tests showed that ECC 1RM was significantly (p < 0.05) greater than CON 1RM (ECC =255.17 + 68.37lbs, CON = 205.83 + 58.43lbs). There was a significant difference (p < 0.05) between the number of repetitions completed at 90% 1RM (CON = 4.57 + 2.21 repetitions, ECC = 7.67 + 3.24 repetitions). There were no differences in repetitions completed at any other intensity 1RM. CON 1RM and the number of repetitions completed with two different absolute loads (130-150lbs and 155-175lbs) concentrically and eccentrically were valid predictors of ECC 1RM. These data indicate that ECC actions yield increased force capabilities than CON actions, there is no difference in the rate of the fatigue, and ECC 1RM may be predicted from various CON tests.
ContributorsKelly, Stephen B., Jr (Author) / Hooker, Steven (Thesis advisor) / Brown, Lee (Committee member) / Buman, Matthew (Committee member) / Gaesser, Glenn (Committee member) / Swan, Pamela (Committee member) / Arizona State University (Publisher)
Created2013
Description
Research provides increasing support of self-worth, non-physical motives, and body image for predicting physical activity in women. However, no empirical tests of these associations have been conducted. Ecological momentary assessment (EMA) has been recognized as useful for understanding correlates of physical activity. This study tested the feasibility of a novel EMA protocol and explored temporal relationships between daily self-worth and physical activity in middle-aged women. Women aged 35-64 years (N=63; M age=49.2±8.2 years) received text message prompts to an Internet-based mobile survey three times daily for 28 days. The survey assessed momentary activity, self-worth (knowledge, emotional, social, physical, general), and self-efficacy. Women concurrently wore an accelerometer on their non-dominant wrist. Feasibility was assessed via accelerometer wear-time estimates, survey completion rates, and participant feedback. Multilevel models examined the predictive influence of self-worth on daily activity counts. Self-efficacy was also tested due to known relationships with self-worth and physical activity in women. Wear time was high (952.92 ± 100.99 min per day), with only 141 observations lost to non-wear. However, 449 were lost to accelerometer malfunction. Women completed 80.8% of surveys. After excluding missing physical activity data, 67.5% of observations (N=3573) were analyzed. Although women thought the survey was easy to complete, perceptions of the accelerometer were mixed. Approximately 34% of the variance in daily counts was within individuals (ICC=0.66). Average self-efficacy (β=0.005, p=0.009), daily fluctuations in self-efficacy (β=0.001, p<0.001), and daily fluctuations in general self-worth (β=0.04, p=0.003) predicted daily activity. There were significant individual differences in relationships between daily fluctuations in emotional (β=0.006, p=0.02) and general self-worth (β=0.005, p=0.02) and daily activity. The use of text message prompts and an Internet-based mobile survey was feasible for conducting EMA in middle-aged women. Research identifying optimal methods of behavior monitoring in longitudinal studies is needed. Results provide support for small but significant associations among daily fluctuations in self-efficacy and general self-worth and daily activity in middle-aged women. The impact of emotional self-worth may differ across women. Further research examining the transient natures of self-efficacy and general self-worth, improving self-worth scales, and testing momentary strategies to increase women's self-worth and physical activity is warranted.
ContributorsEhlers, Diane K. (Author) / Huberty, Jennifer L (Thesis advisor) / Todd, Michael (Committee member) / Vreede, Gert-Jan de (Committee member) / Hooker, Steven (Committee member) / Buman, Matthew (Committee member) / Arizona State University (Publisher)
Created2014
Description
Introduction: Several faith-based or faith-placed programs have focused on the physical dimension of wellness in efforts to improve health by increasing physical activity and improving diet behaviors. However, these programs were not designed to intervene on the mental dimension of wellness which is critical for stress reduction and health behavior change. Purpose: To evaluate the feasibility of a spirituality-based stress reduction and health behavior change intervention using the Spiritual Framework of Coping (SFC) model. Methods: This study was a quasi-experimental one group pretest posttest design. The study was a total of eight weeks conducted at a non-denominational Christian church. Participants were recruited from the church through announcements and flyers. The Optimal Health program met once a week for 1.5 hours with weekly phone calls during an additional four week follow-up period. Feasibility was assessed by the acceptability, demand, implementation, practicality, integration, and limited efficacy of the program. Analysis: Frequencies for demographics were assessed. Statistical analyses of feasibility objectives were assessed by frequencies and distribution of responses to feasibility evaluations. Limited efficacy of pretest and posttest measures were conducted using paired t-test (p <.05). Results: The Optimal Health Program was positively accepted by participants. The demand for the program was shown with average attendance of 78.7%. The program was successfully implemented as shown by meeting session objectives and 88% homework completion. The program was both practical for the intended participants and was successfully integrated within the existing environment. Limited efficacy changes within the program were mostly non-significant. Conclusion: This study tested the feasibility of implementing the Optimal Health program that specifically targeted the structural components of the Spiritual Framework of Coping Model identified to create meaning making and enhance well-being. This program may ultimately be used to help individuals improve and balance the spiritual, mental, and physical dimensions of wellness. However, length of study and limited efficacy measures will need to be reevaluated for program success.
ContributorsWalker, Jenelle R (Author) / Swan, Pamela (Thesis advisor) / Ainsworth, Barbara (Committee member) / Chisum, Jack (Committee member) / Fleury, Julie (Committee member) / Hooker, Steven (Committee member) / Arizona State University (Publisher)
Created2012
Enhancing motivation for physical activity to reduce fall risk among community dwelling older adults
Description
Unintentional falls among community dwelling older adults are a common, serious and potentially preventable public health problem. In the United States, the annual incidence of fall related injuries per 100,000 persons was 4,616 in 2001, rising to 5,252 in 2008. The annual incidence of fall related deaths per 100,000 persons was 29.3 in 2000, rising to 41.86 in 2006. Older adults are particularly vulnerable to falls as they age. Potential consequences include fractures, emergency room, hospital and nursing home admissions, dependence, confusion, immobilization, depression, and death. Significant modifiable fall risk factors include muscle weakness, gait problems, and balance problems. While researchers have demonstrated the positive effects of balance and leg-strengthening physical activities, the majority of older adults do not engage in them, and the rate of falls continues to increase. Older adults participate in regular physical activity and fitness activities less often than younger populations; disparities are greater among those who are poor and living in rural communities. While knowledge about causes, risk factors, and efficacious physical activity to prevent falls has grown exponentially in the last several decades, bridging the gap between research and practice continues to be a challenge. As a strategy to address the gap between research and practice, this feasibility study utilized a tested theory, the wellness motivation theory, to address motivation for behavioral change in combination with instruction for physical activities proven to reduce fall risk. The study sample included rural, community dwelling older adults at risk of falls. The study included an innovative mobile computer to measure physical activity behavior and to augment motivational content of the intervention. Specific aims of this feasibility study were to: (a) examine the acceptability, demand, and implementation of the wellness motivation intervention (WMI) as well as the technology augmenting the WMI; and (b) evaluate the efficacy of the WMI to influence awareness of social contextual resources, behavioral change processes, physical activity, and fall risk. The WMI delivered in combination with proven multicomponent balance and strength activities was feasible and effectively increased motivation for behavioral change (social support from friends, awareness of social contextual resources, behavioral change processes) and physical activity behavior, and decreased fall risk among rural, community-dwelling older adults at risk of falls in this study. This study is the first step in a program of research focusing on enhancing motivation for physical activity that reduces falls and frailty among older adults.
ContributorsMcMahon, Siobhan (Author) / Fleury, Julie (Thesis advisor) / Belyea, Michael (Committee member) / Shearer, Nelma (Committee member) / Wyman, Jean (Committee member) / Hekler, Eric (Committee member) / Arizona State University (Publisher)
Created2012
Description
Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
ContributorsFloegel, Theresa A (Author) / Buman, Matthew P (Thesis advisor) / Hooker, Steven (Committee member) / Dickinson, Jared (Committee member) / DerAnanian, Cheryl (Committee member) / McCarthy, Marianne (Committee member) / Arizona State University (Publisher)
Created2015
Description
Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group.
ContributorsJohnson, Kari Elizabeth (Author) / Fleury, Julie (Thesis advisor) / Shearer, Nelma (Committee member) / McClain, Darya (Committee member) / Arizona State University (Publisher)
Created2015
Description
Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely to participate in physical activity and experience a greater burden of CVD compared to younger adults. Despite knowledge of motivators and barriers to physical activity, the challenge to reduce cardiovascular risk in the older adult population remains unmet. Older adults face unique and complex barriers to physical activity, including limited social contextual resources and behavioral change processes. Interventions to enhance wellness motivation have demonstrated potential in promoting health behavior change among older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
ContributorsBarrows, Jennifer Leigh (Author) / Fleury, Julie (Thesis advisor) / Komnenich, Pauline (Committee member) / Belyea, Michael (Committee member) / Arizona State University (Publisher)
Created2018
Description
The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge.
The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans.
The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.
The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans.
The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.
ContributorsHamilton, D. Kirk (Author) / Lamb, Gerri (Thesis advisor) / Fleury, Julie (Committee member) / Gurses, Ayse (Committee member) / Arizona State University (Publisher)
Created2017
Description
ABSTRACT
This qualitative descriptive study described caregiver recognition of personal and social contextual resources guiding purposeful participation in self-care and well-being. This research builds on health empowerment theory, which conceptualizes health empowerment as an inherent, relational and ongoing process, expressive of health patterning of well-being (Shearer, 2009). By 2060, Americans 65 years and older will number nearly 98 million, more than double that in 2013. The number of older adults aged 85 and older will double from 6 million in 2003, to 14.6 million by 2040 (Health & Human Services, 2014). Sixty-five million adults serve as informal caregivers, many themselves suffering from chronic conditions (National Alliance for Caregiving & AARP, 2009). Current research has examined the burden of caregiving, but little is known about caregiver strengths and resources that foster personal self-care and well-being. Twenty-one older adult informal caregivers participated in focus groups or individual interviews. Length of time as caregivers ranged from one year to more than ten years; 24% of the participants were men. Seventy-six percent of the participants reported having one or more chronic condition. Themes generated from qualitative content analysis provided a basis for validating and extending the health empowerment theory among older adult informal caregivers. Across participants, empowerment reflected recognition of strengths and resources, as well as growth consistent with valued goals facilitating new health patterns and well-being. The health empowerment theory perspective provided a relevant basis for theory-based intervention focused on promoting strengths, abilities and potential among older adults, limiting vulnerability to diminished health and well-being.
This qualitative descriptive study described caregiver recognition of personal and social contextual resources guiding purposeful participation in self-care and well-being. This research builds on health empowerment theory, which conceptualizes health empowerment as an inherent, relational and ongoing process, expressive of health patterning of well-being (Shearer, 2009). By 2060, Americans 65 years and older will number nearly 98 million, more than double that in 2013. The number of older adults aged 85 and older will double from 6 million in 2003, to 14.6 million by 2040 (Health & Human Services, 2014). Sixty-five million adults serve as informal caregivers, many themselves suffering from chronic conditions (National Alliance for Caregiving & AARP, 2009). Current research has examined the burden of caregiving, but little is known about caregiver strengths and resources that foster personal self-care and well-being. Twenty-one older adult informal caregivers participated in focus groups or individual interviews. Length of time as caregivers ranged from one year to more than ten years; 24% of the participants were men. Seventy-six percent of the participants reported having one or more chronic condition. Themes generated from qualitative content analysis provided a basis for validating and extending the health empowerment theory among older adult informal caregivers. Across participants, empowerment reflected recognition of strengths and resources, as well as growth consistent with valued goals facilitating new health patterns and well-being. The health empowerment theory perspective provided a relevant basis for theory-based intervention focused on promoting strengths, abilities and potential among older adults, limiting vulnerability to diminished health and well-being.
ContributorsBlank, Laura Jeanne (Author) / Fleury, Julie (Thesis advisor) / Kommenich, Pauline (Committee member) / Belyea, Michael (Committee member) / Kennedy, Teri (Committee member) / Arizona State University (Publisher)
Created2018