Matching Items (11)
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
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
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
Description
Sedentary behavior has recently been recognized as a widespread, independent risk factor for increased morbidity and mortality from chronic conditions including diabetes, cardiovascular disease, and cancer. Midlife women (age 40-64) are known to have high levels of sedentary behavior and corresponding cardiovascular disease risk. Currently, little is known about mechanisms involved in reducing and maintaining reductions to sedentary behavior in midlife women. Theory-based nursing interventions are needed which reflect process, personal meaning, person-environment interaction, and incorporate a strength-based perspective. Wellness Motivation Theory guided the research, conceptualizing behavioral change processes within culturally and environmentally relevant contexts, while recognizing bidirectional influences of personal and environmental factors on behavioral patterns. The Wellness Motivation Theory addresses social support and norms, community and material resources that influence behavioral choices, individual motivation and goals, and the behavioral change processes of self-knowledge, motivational appraisal, and self-regulation. A qualitative descriptive approach was used to explore social contextual resources and behavior change processes leading to action as decreasing sedentary time in midlife women. The maximum variation sample included 31 midlife women, employees of Arizona State University. Participants attended a one-hour focus group to discuss their experiences with sedentary behavior, and their efforts to sit less and move more. Midlife women characterized social support as: Raising Me Up, Timing Time and Walking and Talking. Support from contextual resources reflected themes of Seeking Place, Stepping Up, and Walking the Talk. Women experienced self-knowledge as Envisioning the Future, Taking Inventory, and Considering Possibles. Motivational appraisal was characterized as Reevaluating Priorities, Wayfinding, and Going All In. Self-regulation was reflected as Recounting Benefits, Keeping On Track, and Creating New Ways. A deeper understanding of motivational processes central to reducing sedentary behavior in midlife women fosters identification of leverage points for future theory-based intervention research which provides primary prevention opportunities to lower cardiovascular disease risk, and promote successful aging.
ContributorsSherman, Tanie (Author) / Fleury, Julie (Thesis advisor) / Belyea, Michael (Committee member) / Komnenich, Pauline (Committee member) / Arizona State University (Publisher)
Created2018
Description
ABSTRACT
The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals.
The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals.
ContributorsThakur, Ramesh Devi (Author) / Fleury, Julie (Thesis advisor) / Shearer, Nelma (Committee member) / Belyea, Michael (Committee member) / Arizona State University (Publisher)
Created2017
Description
The number of refugees experiencing displacement is 25.9 million worldwide, with the majority in the last 7 years from Syria. While international government organizations and researchers have called for assessment of refugee health and wellness, research in this vulnerable population is limited. This dissertation is built around humanizing refugee research on health and wellness. The introduction in Chapter 1 provides an overview for the three resulting chapters which are (a) a grounded theory study to gain insight into the lives of Syrian refugees living in displacement; (b) a systematic literature review on wellness in Syrian refugees in displacement; and (c) a concept analysis to examine wellness from the perspective of Syrian refugee women within the context of displacement. Chapter 5 includes the summary, discussion, and recommendations for future research.
Chapter 2 consists of three themes which shaped the lives of Syrian refugees during displacement: (a) assets and deficits; (b) official obstacles and supports; and (c) unofficial obstacles and supports. Health emerged as a priority for the refugees which included many dimensions related to the quality of their health and health needs. The results of Chapter 2 precipitated in using wellness as a holistic lens to view Syrian refugee’s health and health needs in Chapter 3. The results of Chapter 3 added a more holistic view of Syrian refugee health, while highlighting the need for improved research methods addressing wellness in Syrian refugees. Chapter 4 clarifies and defines wellness from the perspective of Syrian refugee women.
Chapter 2 consists of three themes which shaped the lives of Syrian refugees during displacement: (a) assets and deficits; (b) official obstacles and supports; and (c) unofficial obstacles and supports. Health emerged as a priority for the refugees which included many dimensions related to the quality of their health and health needs. The results of Chapter 2 precipitated in using wellness as a holistic lens to view Syrian refugee’s health and health needs in Chapter 3. The results of Chapter 3 added a more holistic view of Syrian refugee health, while highlighting the need for improved research methods addressing wellness in Syrian refugees. Chapter 4 clarifies and defines wellness from the perspective of Syrian refugee women.
ContributorsWofford, Danielle (Author) / Komnenich, Pauline (Thesis advisor) / Fleury, Julie (Thesis advisor) / Klimek, Barbara (Committee member) / Arizona State University (Publisher)
Created2020