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EVALUATION OF THE ANTECEDENTS OF CULTURAL COMPETENCE
Title
EVALUATION OF THE ANTECEDENTS OF CULTURAL COMPETENCE.
Creator
Harper, Mary, Byers, Jacqueline, University of Central Florida
Abstract / Description
Purpose: The threefold purpose of this research is to identify the essential antecedents of cultural competence as identified by international nurse researchers, to compare the content of the extant cultural competence instruments to these antecedents and to potentially identify gaps in their conceptualization. A secondary aim of this research is to initiate validation of Harper's model of ethical multiculturalism. Conceptual Basis: The model of ethical multiculturalism depicts the...
Show morePurpose: The threefold purpose of this research is to identify the essential antecedents of cultural competence as identified by international nurse researchers, to compare the content of the extant cultural competence instruments to these antecedents and to potentially identify gaps in their conceptualization. A secondary aim of this research is to initiate validation of Harper's model of ethical multiculturalism. Conceptual Basis: The model of ethical multiculturalism depicts the attributes of ethical multiculturalism as the fulcrum of a balance between two ethical philosophies of fundamentalism and relativism. The attributes of moral reasoning, beneficence/nonmaleficence, respect for persons and communities, and cultural competence form the pyramidal fulcrum. The antecedents form the base of the pyramid and include cultural awareness, culture knowledge, cultural sensitivity, cultural encounters, cultural skill and understanding of ethical principles. Methodology: An on-line Delphi method was conducted with 35 international nurse researchers identified through published research, university directories, and professional organizations. Consensus was reached after two rounds. Following the Delphi rounds, sixteen members of the expert panel participated in an on-line focus group to validate results of the Delphi and discuss cultural competence in the international arena. Findings: Eighty antecedents of cultural competence were identified. Focus group discussion validated findings of the Delphi. Consensual thematic analysis of the focus group transcripts resulted in six themes: chimerical, contact, contextual, collaboration, connections, and considering impact. The Transcultural Self-Efficacy Tool (TSET) contained the most antecedents identified by the expert panel. Conclusions: Cultural competence is a process, not an outcome, and must be considered from the perspective of the recipient of care or research participant. Nurses must strive to deliver culturally acceptable care. The model of ethical multiculturalism is revised to include cultural desire as an antecedent. Nurses must understand the impact of globalization on individual health and care delivery. Implications for Nursing: Further testing of cultural competence instruments is needed to determine the correlation of self-efficacy with behavior, self-assessment with client assessment, and cultural competence with client outcomes. In education, research is needed to determine the most effective methods of teaching cultural competence. Increased recruitment of minorities into nursing programs is warranted. In practice, nurses must be prepared to provide language assistance as needed, recruitment and hiring of minorities must be increased, and minority thresholds must be used to determine cultural knowledge content for organizations.
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Date Issued
2008
Identifier
CFE0002046, ucf:47600
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0002046
THE IMPACT OF MUSIC ON POSTOPERATIVE PAIN AND ANXIETY
Title
THE IMPACT OF MUSIC ON POSTOPERATIVE PAIN AND ANXIETY.
Creator
Allred, Kelly, Byers, Jacqueline, University of Central Florida
Abstract / Description
Objective: The objective of this study was to add to the body of knowledge about the impact of music on postoperative pain and anxiety. The specific purpose of this research study was to determine if listening to music and/or having a quiet rest period just prior to and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety, or impact mean arterial pressure, heart rate, respiratory rate, and/or oxygen saturation in patients following a total knee arthroplasty....
Show moreObjective: The objective of this study was to add to the body of knowledge about the impact of music on postoperative pain and anxiety. The specific purpose of this research study was to determine if listening to music and/or having a quiet rest period just prior to and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety, or impact mean arterial pressure, heart rate, respiratory rate, and/or oxygen saturation in patients following a total knee arthroplasty. Methods: An experimental repeated measures design was used. Setting: A postoperative orthopedic unit in a 300-bed community hospital in the southeastern United States. Sample: Fifty-six patients having a total knee arthroplasty, randomly assigned to either a music intervention group or a quiet rest group. Measures: A visual analog scale was used to measure pain and anxiety. Physiological measures, including blood pressure, heart rate, oxygen saturation, and respiratory rate, were also obtained. Results: A repeated measures analysis of variance between and within groups was conducted for pain and anxiety. Statistical findings between groups indicated the music group's decrease in pain or anxiety was not significantly different from the comparison rest group's decrease in pain (F = 1.120, p = .337) or anxiety (F = 1.566, p = .206) at any measurement point. However, statistical findings within groups indicated that when the groups were combined, the sample had a statistically significant decrease in pain (F = 6.699, p = .001) and anxiety (F = 4.08, p = .013) over time. Post hoc analyses showed the significant decrease in pain was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 4.751, p = .000). Post hoc analyses showed the significant decrease in anxiety was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 2.86, p = .006). Additionally, anxiety decreased significantly from time 3 (just after physical therapy) and time 4 (after second period of 20 minutes of music or rest period) (t(55) = 2.222, p = .030). Implications: Results of this research provides evidence to support the use of music and/or a quiet rest period to decrease pain and anxiety when initiated just before and just after ambulation on postoperative day 1 following a total joint arthroplasty of the knee. The interventions pose no risks, and have the benefits of improved pain reports and decreased anxiety. It potentially could be opioid sparing in some individuals, limiting the negative effects from opioids. Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence, knowing there is evidence to support its efficacy.
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Date Issued
2007
Identifier
CFE0001634, ucf:47228
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001634
RESILIENCY IN ADOLESCENT COLLEGE STUDENTS
Title
RESILIENCY IN ADOLESCENT COLLEGE STUDENTS.
Creator
Ahern, Nancy, Byers, Jacqueline, University of Central Florida
Abstract / Description
The construct of resilience has gained considerable attention over the last four decades since researchers observed that children and youth could cope and adapt in spite of adversity. Resilience involves a dynamic process involving an interaction between both risk and protective processes, internal and external to the individual, that can modify the effects of an adverse life event. Adolescence is considered to be a period of vulnerability for most individuals as they often partake in high...
Show moreThe construct of resilience has gained considerable attention over the last four decades since researchers observed that children and youth could cope and adapt in spite of adversity. Resilience involves a dynamic process involving an interaction between both risk and protective processes, internal and external to the individual, that can modify the effects of an adverse life event. Adolescence is considered to be a period of vulnerability for most individuals as they often partake in high risk behaviors. Further, those individuals who are in their early college years are faced with the developmental challenges of this life phase which can be complicated by a variety of stresses. Investigating resilience in college students is of great importance as these adolescents may incur additional stress as they make the transition to adulthood. Empirical evidence indicates that resilience is dynamic, developmental in nature, and interactive with one's environment. A variety of variables have been studied to clarify the concept of resilience in adolescents, yet there continues to be inconsistent findings. Although there is an abundance of literature regarding adolescent resilience, little is known about this process in the healthy well-adjusted adolescent college student. Additionally there are inconsistencies in reported findings about whether resilience is a healthy state. There is also evidence in the literature that contradictions exist regarding the effect of social support on this process. After review of the psychometric properties of existing instruments, the Resilience Scale was determined to have the best reliability and validity use for the study of resilience in the adolescent population. An exploratory model testing design was used to explore the relationships among a set of variables, including personal characteristics, levels of stress, high risk behaviors, and levels of resilience in adolescents ages 18 to 20 years. Institutional Review Board approval was obtained prior to data collection. The study participants attended a community college and met the sample selection criteria. A convenience sampling plan was used. Recruitment of participants followed the college protocol for contacting professors teaching general education classes during the planned data collection time. The study measures included a demographic questionnaire, two perceived stress visual analog scales, the Health Behaviors Questionnaire, and the Resilience Scale. Descriptive statistics were computed for all variables for the total sample (n=166) and recoding performed as needed by the instruments. Model testing was performed using correlations, hierarchical multiple regression, and path analysis to identify the strongest predictive variables. The strongest predictive model was personal characteristics and Health Behaviors Questionnaire Emotional Risk to the visual analog scale Stress in General (R2 = .519, F = 3.13, p = .000). This model was used for path analysis and the significant variables were ethnicity (standardized beta coefficients of .165, p = .036) and Health Behaviors Questionnaire Emotional Risk (standardized beta coefficients of .567, p = .000). These findings are important for health care providers to use as a basis for driving interventions to optimize resilience and reduce stress in adolescents. Further research should focus on ways to enhance coping and adaptation in an effort to reduce emotional risks which potentially increase stress in similar populations. Research regarding resilience and stress can further be expanded to the study of additional populations at risk, including adults and others such as nursing students, war veterans, and disaster victims.
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Date Issued
2007
Identifier
CFE0001627, ucf:47177
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001627
EVALUATING NEONATAL FACIAL PAIN EXPRESSION: IS THERE A PRIMAL FACE OF PAIN?
Title
EVALUATING NEONATAL FACIAL PAIN EXPRESSION: IS THERE A PRIMAL FACE OF PAIN?.
Creator
Schiavenato, Martin, Byers, Jacqueline, University of Central Florida
Abstract / Description
Pain assessment continues to be poorly managed in the clinical arena. A review of the communication process in pain assessment is carried out and the hierarchical approach often recommended in the literature –with self-report as its "gold-standard," is criticized as limited and simplistic. A comprehensive approach to pain assessment is recommended and a model that conceptualizes pain assessment as a complex transaction with various patient and clinician dependant factors is proposed....
Show morePain assessment continues to be poorly managed in the clinical arena. A review of the communication process in pain assessment is carried out and the hierarchical approach often recommended in the literature –with self-report as its "gold-standard," is criticized as limited and simplistic. A comprehensive approach to pain assessment is recommended and a model that conceptualizes pain assessment as a complex transaction with various patient and clinician dependant factors is proposed. Attention is then focused on the pediatric patient whose pain assessment is often dependent on nonverbal communicative action. The clinical approaches to pain assessment in this population –mainly the use of behavioral/observational pain scales and facial pain scales, are explored. The primal face of pain (PFP) is identified and proposed theoretically as an important link in the function of facial pain scales. Finally, the existence of the PFP is investigated in a sample of 57 neonates across differences in sex and ethnic origin while controlling for potentially confounding factors. Facial expression to a painful stimulus is measured based on the Neonatal Facial Coding System (NFCS) and applying an innovative computer-based methodology. No statistically significant differences in facial expression were found in infant display thereby supporting the existence of the PFP.
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Date Issued
2007
Identifier
CFE0001808, ucf:47373
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001808
FACTORS RELATED TO BIRTH TRANSITION SUCCESS OF LATE PRETERM INFANTS
Title
FACTORS RELATED TO BIRTH TRANSITION SUCCESS OF LATE PRETERM INFANTS.
Creator
Wright, Karen, Byers, Jacqueline, University of Central Florida
Abstract / Description
Problem: Identifying the factors effecting birth transition success of late preterm infants may improve early recognition of newborn compromise. Multiple explanatory variables may be associated with birth transition success or failure. The purpose of the study was to determine the prevalence of, and clinical-epidemiological and demographic predictive factors for birth transition success of late preterm infants. Methods: A retrospective case-control chart review was used to compare the...
Show moreProblem: Identifying the factors effecting birth transition success of late preterm infants may improve early recognition of newborn compromise. Multiple explanatory variables may be associated with birth transition success or failure. The purpose of the study was to determine the prevalence of, and clinical-epidemiological and demographic predictive factors for birth transition success of late preterm infants. Methods: A retrospective case-control chart review was used to compare the characteristics of successful and unsuccessful birth transition of 35 and 36 week gestational age late-preterm infants delivered in a large tertiary-care center during calendar year 2007. A mixture of categorical and numeric variables related to maternal, birth, and physiologic constructs were analyzed for their effects on birth transition as a binary outcome variable (success or failure). Results: Of 22 variables tested, four predictor variables were associated with birth transition failure: labor (OR = .42, p = .014), 5-minute Apgar score (OR = 1.79, p = .043), gender (OR = .47, p =.003), and respiratory rate (OR= 2.08, p = .001) as tested by logistic regression. The model was able to accurately assign transition failure and success at a rate of 66.7% and 74% respectively. The overall model was statistically significant (likelihood ratio chi square = 38.97(4), p <.001). The Hosmer & Lemseshow test indicated that the model estimates fit the data at an acceptable level (X2 = 7.72, p = .358). Discussion/Implication: The absence of labor was identified as a risk factor for transition failure in this population. Male preterm infants were nearly twice as likely to fail transition as females in this population. The case group had a higher frequency of lower 5-minute Apgar scores, resulting in significantly lower mean scores. The failed transition group had more than twice the number of newborns with abnormally high respirations than the control group. These findings indicate that identification infants at risk for birth transition failure begins with the recognition of the absence of labor as a significant risk factor for birth transition failure of late preterm infants.
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Date Issued
2011
Identifier
CFE0003655, ucf:48818
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0003655
Front-Line Registered Nurse Job Satisfaction and Predictors: A Meta-Analysis from 1980 - 2009
Title
Front-Line Registered Nurse Job Satisfaction and Predictors: A Meta-Analysis from 1980 - 2009.
Creator
Saber, Deborah Anne, Norris, Anne, Andrews, Diane, Byers, Jacqueline, Bowers, Clint, University of Central Florida
Abstract / Description
Front-line registered nurses (RNs) make up the workforce that directly affect the care of patients in a variety of different healthcare settings. RN job satisfaction is important because it is tied to retention, organizational commitment, workforce safety, patient safety, and cost savings. The strongest predictors have been difficult to determine because workplaces differ, numerous tools to measure satisfaction exist, the workforce is diversified by generations and work positions, and ongoing...
Show moreFront-line registered nurses (RNs) make up the workforce that directly affect the care of patients in a variety of different healthcare settings. RN job satisfaction is important because it is tied to retention, organizational commitment, workforce safety, patient safety, and cost savings. The strongest predictors have been difficult to determine because workplaces differ, numerous tools to measure satisfaction exist, the workforce is diversified by generations and work positions, and ongoing policy changes directly impact the work of the front-line RN. The strength and stability of the workforce depends on an accurate understanding of the predictors of job satisfaction for the front-line RN. The purpose of this study was to comprehensively, quantitatively examine predictors of front-line RN job satisfaction from 1980-2009 to provide overarching conclusions based on empirical evidence. Of interest was: the (1) estimation of large, moderate, and small predictor summary effect sizes; (2) assessment of predictor differences among decades (i.e., 1980s, 1990s, and 2000s); (3) identification of causes for predictor differences among studies (i.e., moderators); and (4) investigation of predictor differences between generations (i.e., Baby Boomers, Generation X, and Millennials).A non-a priori meta-analysis approach was guided by inclusion and exclusion criteria to review published and unpublished studies from 1980(-)2009. The search process identified 48 published and 14 unpublished studies used for analysis. Within the studies that met inclusion criteria, 27 job satisfaction predictors met inclusion for analysis. Studies were coded for Study Characteristics (e.g., Year of Publication, Country of Study) that were needed for moderator analysis. Predictors were coded for data that were necessary to calculate predictor summary effect sizes (i.e., r, n). Coding quality was maximized with a coding reliability scheme that included the primary investigator (PI) and secondary coder. A random-effects model was used to guide the calculation of summary effect sizes for each job satisfaction predictor. Publication bias was examined using funnel plots and Rosenthal's Fail-safe N. An analysis of variance (ANOVA) was used to evaluate predictor differences among decades (i.e., 1980s, 1990s, and 2000s). Heterogeneity among studies was calculated (i.e., Q-statistic, I-squared, and Tau-squared) to guide the need for moderator analysis. Moderator analyses were conducted to evaluate Study Characteristics as sources of predictor differences among studies, and to investigate the influence of Age (i.e., generation) on predictor effect sizes.The largest effect sizes were found for three predictors: Task Significance (r=.61), Empowerment (r=.55), and Control (r=.52). Moderate effect sizes were found for 10 predictors (e.g., Autonomy: r=.44; Stress: r=-.43), and small effect sizes were found for nine predictors (e.g., Wages: r=.23; Staffing Adequacy: r=.19). Significant heterogeneity between studies was present in all of the 27 predictor analyses. Effect size differences were not found between decades or generations. Moderator analysis found that the sources of the difference between studies remain unexplained indicating that unknown moderators are present.Findings from this study indicate that the largest predictors of job satisfaction for the front-line RN may be different than previously thought. Heterogeneity between studies and unidentified moderators indicate that there are significant differences among studies and more research is needed to identify the source(s) of these differences. The findings from this study can be used at the organizational, state, and national level to guide leaders to focus efforts of workplace improvements that are based on predictors that are most meaningful to front-line RNs (i.e., Task Requirements, Empowerment, and Control). Future research is needed to determine contemporary predictors of job satisfaction for the front-line RN, and the causes of heterogeneity between studies. The findings from the current study provide the critical synthesis needed to guide educational and practice recommendations aimed at supporting job satisfaction of front-line RNs, thereby, maintaining this integral component of the healthcare workforce.
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Date Issued
2012
Identifier
CFE0004592, ucf:49220
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004592
Development and Evaluation of an Instrument to Measure Mother-Infant Togetherness After Childbirth
Title
Development and Evaluation of an Instrument to Measure Mother-Infant Togetherness After Childbirth.
Creator
Lawrence, Carol, Norris, Anne, Byers, Jacqueline, Sole, Mary, Leon, Ana, University of Central Florida
Abstract / Description
No existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale...
Show moreNo existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale (MITS) was developed based on a review of the literature and conceptual framework of Mother-Newborn Mutual Caregiving. The MITS is a 35-item instrument composed of four subscales that measures the timing, duration, and intensity of togetherness of the mother-infant dyad during entire hospitalization. The purpose of this multiphase study was to obtain support for the validity of the MITS. Phase 1 determined the content validity at the scale (S-CVI), subscale, and item level (I-CVI) with a panel of expert judges. The final sample for the content validation consisted of 7 judges from medicine (n = 2), maternal-child nursing (n = 1), nursing research (n = 3), and social work (n = 1). Judges were instructed to use a 4-point Likert scale to rate the relevance of each item (I-CVI) to the construct of togetherness. The S-CVI was calculated from the mean I-CVI scores. The CVI-S of .88 was just slightly below the desired CVI-S ((>) .90). Of the four subscales, all had adequate CVI ((>) .90) at the subscale level except the delivery affective subscale (CVI = .74) and postpartum affective subscale (CVI = .89). The delivery events and postpartum events subscales had satisfactory CVI scores (CVI (>) .90), 1.00 and .94, respectively. The CVI-I results identified a total of seven items on the affective subscales that did not meet the desired I-CVI ((>) .78). Phase 2 pre-tested the readability and understandability of the MITS among eight postpartum women. During the interviews, the women were asked to complete the MITS and provide opinions about the readability and understandability of the directions and items. The audiotapes were transcribed word for word, reviewed for thematic content, and revisions made to the study instrument accordingly. This same sample of postpartum women participated in the content validation of the delivery affective subscale (items #4a-j) and postpartum affective subscale (items #17a-j). The I-CVI results identified that a total of six items on the affective subscales had a CVI-I of .75, just slightly below the desired I-CVI ((>) .78). Scale items were deleted or revised and the instrument retested until the desirable CVI at the scale and subscale level was achieved. Phase 3 used a descriptive study design to examine women's ability to accurately self-report birth events on the MITS delivery events subscale at 4 weeks postpartum, as compared to observer-collected data obtained at delivery to determine the most valid mode of administration. A purposive sample consisted of 45 women having delivered at a community hospital in southwest Florida. The research team completed the MITS delivery events subscale immediately after delivery. Women were sent the MITS for completion 4 weeks after delivery. McNemar Chi-Squares were (?) were calculated from the self-reported MITS delivery events subscale scores and the observer-collected MITS delivery events subscale scores. No significant difference (p (<) .05) was found supporting self-reported mode of administration for the MITS. Phase 4 is in-progress and evaluates the reliability and validity of the MITS subscale and total scale scores. The interim analysis was performed on a sample of 113 postpartum participants (composed of the final sample of 31 participants from Phase 3 and the first 82 participants from Phase 4) having delivered at three of the four participating hospital study sites. Adequate internal consistency reliability was found at the scale level with Cronbach's alpha (? = .89) and split-half reliability results (? = .79 (-) 81, r = .83 - .88). Of the 35 MITS items, 10 items (28.6%) were found to have item-total correlations less than .30, arguing against treating MITS items as a single total scale measure. Good internal consistency was found at the delivery events subscale level (? = .78). Exploratory factor analysis (EFA) identified a two-factor solution. The two factors were named Taking In and Taking Control and had internal consistency reliability.79 and .65, respectively. Additional work needs to be done to improve the internal consistency of the Taking Control factor. The postpartum events subscale also had low internal consistency (? = .58). This subscale was not factor analyzed because the item response data did not meet the criteria for factor analysis. The items on the postpartum events subscale were assessed to be unique, singular, heterogeneous items that did not correlate well with other items. These results are conceptually logical given the nature of what the items are measuring (occurrence/intensity of specific events in time). The delivery affective subscale had good internal consistency reliability (? = .85) and a two factor solution. The two factors, named Feelings At Delivery and Delivery Concerns, had adequate internal constancy (? = .81 and ? = .80, respectively). The postpartum affective subscale had good internal consistency reliability (? = .92) and a one factor solution. Results for known groups testing based on feeding type and mode of delivery found all group differences were in the predicted direction. Higher scores were found for mother-infant dyads who breastfed than for mother-infant dyads who bottle fed. However, only group differences for the events subscales were substantive and statistically significant (p (<) 001.). Higher scores were found for mother-infant dyads who experiencing a vaginal delivery than for mother-infant dyads who experienced a cesarean delivery. Group differences were substantive and statistically significant (p (<) .01) for three of the four subscale scores. A post hoc power analysis on the means and standard deviations from the interim analysis and the between-groups comparison effect size observed for feeding type (d = .50) found a sample of 45 adequate to have statistical power at the recommended beta of .80 and alpha of .05. The post hoc power analysis on the effect size for mode of delivery (d = .75), found a sample of 156 are needed to obtain statistical power at the recommended beta of .80 and alpha of .05. Therefore, the desired sample size of 200 women for the final analysis is adequate to obtain statistical power. A third known group testing for the variable of central nursery availability could not be performed with the interim analysis data because no participants in the interim analysis sample reported this experience. However, this analysis will be performed with the final data set. This is the first study to operationalize togetherness during the entire hospitalization and to include all dimensions of the construct. The findings from this multi-phase study provide initial support for the reliability and validity of the MITS. Although the results from Phase 4 are interim and therefore tentative, they provide preliminary psychometric evidence for construct validity.
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Date Issued
2012
Identifier
CFE0004567, ucf:49200
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004567
Predictors of Immunosuppressant Adherence in Long-Term Renal Transplant Recipients
Title
Predictors of Immunosuppressant Adherence in Long-Term Renal Transplant Recipients.
Creator
Galura, Sandra, Sole, Mary, Allred, Kelly, Byers, Jacqueline, Lawrence, Shawn, University of Central Florida
Abstract / Description
To sustain the health and viability of renal transplants, adherence to immunosuppressant therapy (IST) medications is critical. Studies continue to identify decreased adherence rates as time from transplant increases (Chisholm-Burns, Kwong, Mulloy (&) Spivey, 2008; Chisholm, Lance, Mulloy, 2005; Chisholm, Mulloy, (&) DiPiro, 2005; Nivens (&) Thomas, 2009). While previous research has explored the effect of variables known to influence IST adherence in adult renal transplant recipients,...
Show moreTo sustain the health and viability of renal transplants, adherence to immunosuppressant therapy (IST) medications is critical. Studies continue to identify decreased adherence rates as time from transplant increases (Chisholm-Burns, Kwong, Mulloy (&) Spivey, 2008; Chisholm, Lance, Mulloy, 2005; Chisholm, Mulloy, (&) DiPiro, 2005; Nivens (&) Thomas, 2009). While previous research has explored the effect of variables known to influence IST adherence in adult renal transplant recipients, limited studies have explored these variables in a population of renal transplant recipients with longer time posttransplant intervals. The purpose of this study was to examine demographic variables, time posttransplant, immunosuppressive agents, health beliefs, social support, and symptom experience and test their relationship to adherence in a population of long-term renal transplant recipients.A cross-sectional correlational design was used to collect data from a convenience sample of 98 adult renal transplant recipients who were three or more years from transplant. Participants completed five instruments: 1) demographic survey, 2) the Beliefs About Medicines Questionnaire (BMQ), 3) the Medical Outcomes Study (MOS) Modified Social Support Survey (&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172;(&)#172; (MSSS), 4) the Basel Assessment of Adherence with Immunosuppressive Medication Scales (BAASIS), and 5) the Modified Transplant Symptom Occurrence and Symptom Distress Scale-59R (MTSOSD-59R). A composite adherence score (CAS) consisting of a self-report measure of adherence (BAASIS), nontherapeutic serum drug assay, and collateral report of adherence as provided by two transplant clinic professionals was used to determine final adherence group classification (adherent/nonadherent). Analysis of the relationship between all independent variables and adherence was conducted using Spearman's rho correlation coefficient. Mean scores for medication complexity, health beliefs, social support, and symptom experience were compared between age, gender, and time posttransplant groups using independent-samples t tests. A logistic regression prediction of probability was conducted to determine which of the variables that demonstrated a significant relationship to adherence were most predictive of adherence.Of the total sample population (N = 98), 39.8% (n = 39) were classified as adherent and 60.2% (n = 59) were nonadherent. Results demonstrated no significant relationship between age (continuous variable), time posttransplant, immunosuppressant medications (measured by a medication complexity index), health beliefs, symptom experience, and adherence. Weak, but significant relationships between age groups (r = -.213, p=.035), tangible social support (r = .215, p =.017), emotional informational social support (r = .274, p = .003), positive social interaction support (r = .199, p = .025), total overall social support (r = .274, p =.003) and composite adherence group classification were found. Older participants ((>) 55 yrs) were significantly less adherent than younger ((<) 54 yrs) participants. Mean scores for emotional / informational (EMI), positive social interaction (POS), and total social support (MSSS) were significantly lower in nonadherent participants. Regression results indicated the overall model of two predictors (age grouped [(<) 54 yrs; (>) 55 yrs] and EMI social support subscale) was statistically reliable in distinguishing between adherent and nonadherent participants (-2 Log Likelihood 116.244; Goodness-of-Fit x2 (2) = 13.664, p = .001), correctly classifying 69.1% of the cases. Findings from this study contribute to the body of research exploring predictors of immunosuppressant adherence in long-term renal transplant recipients. Data suggest both younger age ((<) 55) and categories of social support predict adherence in long-term renal transplant recipients. Healthcare providers caring for renal transplant recipients long-term should consider annually assessing older participants for adherence as well as for changes in social networks.
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Date Issued
2012
Identifier
CFE0004203, ucf:49013
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004203
An Exploratory Study of Physiologic Responses to a Passive Exercise Intervention in Mechanically-ventilated Critically Ill Adults
Title
An Exploratory Study of Physiologic Responses to a Passive Exercise Intervention in Mechanically-ventilated Critically Ill Adults.
Creator
Amidei, Christina, Sole, Mary, Byers, Jacqueline, Covelli, Maureen, Smith, Gerald, University of Central Florida
Abstract / Description
Muscle weakness is the most common and persistent problem after a critical illness. Early mobilization of the critically ill patient, beginning with passive exercise and progressing to ambulation, may mitigate muscle effects of the critical illness. However, mobilization may produce adverse effects, especially early in the illness when risk for physiologic deterioration is common. If safe, introducing a mobility intervention early in the illness may facilitate ventilator weaning, shorten...
Show moreMuscle weakness is the most common and persistent problem after a critical illness. Early mobilization of the critically ill patient, beginning with passive exercise and progressing to ambulation, may mitigate muscle effects of the critical illness. However, mobilization may produce adverse effects, especially early in the illness when risk for physiologic deterioration is common. If safe, introducing a mobility intervention early in the illness may facilitate ventilator weaning, shorten intensive care unit and hospitals stays, and improve functional status and quality of life for mechanically ventilated critically ill patients. The aim of this study was assess the cardiopulmonary and inflammatory responses to an early standardized passive exercise protocol (PEP) in mechanically ventilated critically ill patients. Using a quasi-experimental within-subjects repeated measures design, mechanically ventilated critically ill adults who were physiologically stable received a single standardized PEP within 72 hours of intubation. The PEP consisted of 20 minutes of bilateral passive leg movement delivered by continuous passive motion machines at a rate of 20 repetitions per minute, from 5-75 degrees, to simulate very slow walking. Physiologic parameters evaluated included heart rate (HR), mean blood pressure (MBP), oxygen saturation, and cytokine levels (IL-6 and IL-10), obtained before, during, and after the intervention. The Behavioral Pain Scale (BPS), administered before, during and after the intervention was used as a measure of participant comfort. The study sample was comprised of 18 (60%) males and 12 (40%) females, with a mean age of 56.5 years (SD 16.9 years), who were primarily Caucasian (N=18, 64%). Mean APACHE II scores for the sample were 23.8 (SD 6.2) with a mean predicted death rate of 48.8 (SD 19.8), indicating moderate mortality risk related to illness severity. Number of comorbidities ranged from 1-10 (X=4). All participants completed the intervention with no adverse events. Using repeated measures analysis of variance (rmANOVA), no significant differences were found in HR, MBP, or oxygen saturation at any of the four time points in comparison to baseline. BPS scores were significantly reduced (F(2.43, 70.42)=4.08, p=.02) at 5 and 10 minutes after the PEP was started, and were sustained at 20 minutes and for one hour after the PEP was completed. IL-6 was significantly reduced (F(1.60, 43.1)=4.351, p=.03) at the end of the intervention but not at the end of the final rest period. IL-10 values were not significantly different at any of the three time points, but IL-6 to IL-10 ratios did decrease significantly (F(1.61, 43.38)=3.42, p=.05) at the end of the PEP and again after a 60 minute rest period. Passive leg exercise was well tolerated by study participants. HR, MBP, and oxygen saturation were maintained within order set-specified ranges during and for one hour after activity, and patient comfort improved during and after the intervention. A downward trend in HR was noted in participants, which is contrary to usual HR response during exercise, and may represent clinical improvement in this population related to reduction in pain. Reduction of mean IL-6 values at the end of the PEP, but not after the rest period, suggests that the PEP was responsible for the initial IL-6 improvement. Improvement of IL-6 to IL-10 ratios from the end of the PEP to the end of the final rest period suggests that IL-10, although non-significant, may have had some effect, indicating that IL-10 increases may occur later than the time period of study.Passive exercise can be used as an approach to facilitating mobilization in mechanically ventilated critically ill adults until they are ready to participate in more active exercise. It could be that more frequent and aggressive exercise, such as passive cycling at faster rates, four times daily, will be tolerated in this population. While the understanding of clinical significance of cytokine profiles in critically ill patients is still evolving, cytokine levels may be useful in explaining benefits of mobilization in this population. Further study is required to replicate the impact of passive exercise on pain, and it may represent a novel approach to pain management in critically ill patients.
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Date Issued
2012
Identifier
CFE0004350, ucf:49424
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004350