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(1 - 12 of 12)
- Title
- INTERVENTIONS FOR CHILDHOOD OBESITY: EVALUATING TECHNOLOGICAL APPLICATIONS TARGETING PHYSICAL ACTIVITY LEVEL AND DIET.
- Creator
-
DiPietro, Jessica, Norris, Anne, University of Central Florida
- Abstract / Description
-
Overweight and obese children have increased risks for multiple preventable diseases and conditions which can impair their physiological health and significantly increases the overall cost of their healthcare. Free mobile applications and technology for weight loss, dietary tracking, and physical activity may be quite useful for monitoring nutritional intake and exercise to facilitate weight loss. If so, nurses are well positioned to recommend such tools as part of their efforts to prevent...
Show moreOverweight and obese children have increased risks for multiple preventable diseases and conditions which can impair their physiological health and significantly increases the overall cost of their healthcare. Free mobile applications and technology for weight loss, dietary tracking, and physical activity may be quite useful for monitoring nutritional intake and exercise to facilitate weight loss. If so, nurses are well positioned to recommend such tools as part of their efforts to prevent childhood obesity and help children and parents better manage childhood obesity when it is present. However, there are no guidelines that nurses can use to determine what applications or technologies are most beneficial to children and their parents. The purpose of this project is to develop such guidelines based on a review of the scientific literature published in the last 5 years. Articles regarding healthy-lifestyle promoting mobile applications and technological approaches to health and fitness interventions were identified by searching articles indexed by CINAHL, Psychinfo, Medline, ERIC, IEEE Xplore, and Academic Search Premier. Identified articles were assessed using Melnyk's hierarchy of evidence and organized into tables so that implications for research and suggestions for practice could be made.
Show less - Date Issued
- 2014
- Identifier
- CFH0004616, ucf:45255
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004616
- Title
- ADDRESSING NEED FOR RESEARCH-FOCUSED NURSES BY INCREASING INTEREST AND SOCIALIZATION AT THE UNDERGRADUATE LEVEL.
- Creator
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Thomas, Sarah, Norris, Anne, University of Central Florida
- Abstract / Description
-
The U.S. shortage of qualified nursing teachers and researchers is affecting national health care outcomes. Methods such as fast-tracking Baccalaureate nurses into graduate programs and embedding leadership development early into nursing curricula have been proposed to address faculty and research shortages. Early interest in nursing research careers increases likelihood of enrollment in graduate education. One way undergraduate nursing students may develop an interest in research careers is...
Show moreThe U.S. shortage of qualified nursing teachers and researchers is affecting national health care outcomes. Methods such as fast-tracking Baccalaureate nurses into graduate programs and embedding leadership development early into nursing curricula have been proposed to address faculty and research shortages. Early interest in nursing research careers increases likelihood of enrollment in graduate education. One way undergraduate nursing students may develop an interest in research careers is through a mentored apprenticeship with research-active faculty. In this thesis, the author uses an autoethnography methodology to examine the benefits that a mentored research apprenticeship model brought to her undergraduate experience. Her experience incorporated a variety of roles in an adolescent intervention program with Dr. Anne Norris (PI) at the University of Central Florida College of Nursing. Several themes about the experience were defined in the results. Early research exposure that socializes a student to the nursing research world may provide a means for addressing the nursing faculty shortage. This socialization can generate interest in a research career and promote undergraduate students with the essential tools and insights needed to pursue this career pathway. However, findings from this study suggest a student-mentor relationship early in the undergraduate education experience is essential.
Show less - Date Issued
- 2014
- Identifier
- CFH0004594, ucf:45232
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004594
- Title
- IDENTIFYING PATIENTS AT RISK FOR OBSTRUCTIVE SLEEP APNEA IN PRIMARY HEALTH CARE: CAN OBESITY IN COMBINATION WITH OTHER HIGH-RISK DIAGNOSES BE USED FOR SCREENING PURPOSES?.
- Creator
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Lima, Clelia, Norris, Anne, University of Central Florida
- Abstract / Description
-
Obstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia,...
Show moreObstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia, arrhythmia, and coronary artery disease) can be used to help PCPs identify adult patients at risk for OSA. Unlike other screening tools, these diagnoses are easy to identify in a routine visit. This study was a retrospective chart review that used a random sample of 220 electronic health records. Seventy percent of the sample was positive for OSA, 69% had obesity, and 33% had two or more high-risk diagnoses. The setting of this study was six sleep centers located in five cities in Central Florida. Logistic regression was used to analyze the data to determine interaction among variables and odds ratios. The variables "obesity" and "two or more high-risk diagnoses" had significant effects on the likelihood of being diagnosed with OSA independently of each other (odds ratio of 4.2 and 4.3 respectively; p<.001). However, there was no significant interaction between these two variables (p=.56). The predictive value for an OSA diagnosis using "obesity" was 83%, and it was 88% using "two or more high-risk diagnoses." These findings argue for the use of high-risk diagnoses to identify patients at risk for OSA. PCPs are in an ideal position to increase the number of patients screened and treated for OSA because they routinely see patients with these diagnoses in their practices. Proper diagnosis and treatment of OSA has the potential to improve patients' outcomes and their quality of life.
Show less - Date Issued
- 2011
- Identifier
- CFE0003620, ucf:48863
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003620
- Title
- DUPLICATED LABORATORY TESTS: A HOSPITAL AUDIT AND EVALUATION OF A COMPUTERIZED ALERT INTERVENTION.
- Creator
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Bridges, Sharon, Norris, Anne, University of Central Florida
- Abstract / Description
-
Background Laboratory testing is necessary when it contributes to the overall clinical management of the patient. Redundant testing, however, is often unnecessary and expensive and contributes to overall reductions in healthcare system efficiency. The purpose of this study is two-fold. First, to evaluate the frequency of ordering duplicate laboratory tests in hospitalized patients and the costs associated with this practice. Second, it was designed to determine if the use of a computerized...
Show moreBackground Laboratory testing is necessary when it contributes to the overall clinical management of the patient. Redundant testing, however, is often unnecessary and expensive and contributes to overall reductions in healthcare system efficiency. The purpose of this study is two-fold. First, to evaluate the frequency of ordering duplicate laboratory tests in hospitalized patients and the costs associated with this practice. Second, it was designed to determine if the use of a computerized alert or prompt will reduce the total number of unnecessarily duplicated Acute Hepatitis Profile (AHP) laboratory tests. Methods This two-phase study took place in an inpatient facility that was part of a large tertiary care hospital system in Florida. A retrospective descriptive design was used during Phase 1 was to evaluate six laboratory tests and the frequency of ordering duplicate laboratory tests in hospitalized patients and to determine the associated costs of this practice for a 12-month time period in 2010. A test was considered a duplicate or an unnecessarily repeated test if it followed a previous test of the same type during the patient's length of stay in the hospital and one in which any change in their values likely would not be clinically significant. A quasi-experimental pre- and post-test design was used during phase 2 was to determine the proportion of duplication of the AHP test before and after the implementation of a computerized alert intervention implemented as part of a system quality improvement process on January 5th, 2011. Data were compared for two 3-month time periods, pre- and post-alert implementation. The AHP test was considered redundant if it followed a previous test of the same type within 15 days of the initial test being final and present in the medical record. Results In phase 1, including each of the six tests examined, there were a total amount of 53, 351 test ordered, with 10, 375 (19.4%) of these cancelled. Out of the total amount of result final tests (n = 42,976), including each of the six tests examined, 4.6-8.7% were redundant. Results of the proportion of duplication of the six selected tests are as follows: AHP 196/2514 (7.8%), Antinuclear Antibody (ANA) 120/2594 (4.6%), B12/Folate level 396/5874 (6.7%), Thyroid Stimulating Hormone (TSH) 1893/21595 (8.7%), Ferritin 384/5171 (7.4%), and Iron/Total iron binding capacity (TIBC) 316/5155 (6.1%). The overall associated yearly cost of redundant testing of these six selected tests was an estimated $419, 218. The largest proportion of redundant tests was the Thyroid Stimulating Hormone level, costing a yearly estimated $300, 987. In Phase 2, prior to introduction of the alert, 674 AHP tests were performed. Of these, 53 (7.9%) were redundant. During the intervention period, 692 AHP tests were performed, of these 18 (2.6%) were redundant. The implementation of the computerized alert was shown to significantly reduce the proportion of AHP tests (Chi-Square: [chi]2 = df 1, p [less than or equal to] 0.001). The differences in the associated costs of duplicated AHP were $5238 dollars in 2010 as compared to $1746 in 2011 post-alert and these differences were significant (Mann Whitney U, Z = -4.04, p [less than or equal to]; 0.001). Conclusion Although the proportions of unnecessarily repeated diagnostic tests that were observed during Phase 1 of this study were small, the associated costs could adversely affect hospital revenue and overall healthcare efficiency. The implementation of the AHP computerized alert demonstrated a drop in the proportion of redundant AHP tests and subsequent associated cost savings. It is necessary to perform further research to evaluate computerized alerts on other tests with evidence-based test-specific time intervals, and to determine if such reductions post-implementation of AHP alerts are sustained over time.
Show less - Date Issued
- 2011
- Identifier
- CFE0003934, ucf:48701
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003934
- Title
- Front-Line Registered Nurse Job Satisfaction and Predictors: A Meta-Analysis from 1980 - 2009.
- Creator
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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.
Show less - Date Issued
- 2012
- Identifier
- CFE0004592, ucf:49220
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004592
- Title
- Development and Evaluation of an Instrument to Measure Mother-Infant Togetherness After Childbirth.
- Creator
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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.
Show less - Date Issued
- 2012
- Identifier
- CFE0004567, ucf:49200
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004567
- Title
- Perceptions Influencing School Nurse Practices to Prevent Childhood Obesity.
- Creator
-
Quelly, Susan, Covelli, Maureen, Bushy, Angeline, Norris, Anne, Lieberman, Leslie, University of Central Florida
- Abstract / Description
-
Approximately one-third of children in the United States are overweight or obese with increased risks for numerous physical and psychosocial comorbidities. Schools are ideal environments to address this serious health crisis and school nurses are uniquely positioned qualified healthcare providers to actively participate in childhood obesity prevention (COP). A review of the literature provided findings to identify a gap in the knowledge regarding the association between school nurse COP...
Show moreApproximately one-third of children in the United States are overweight or obese with increased risks for numerous physical and psychosocial comorbidities. Schools are ideal environments to address this serious health crisis and school nurses are uniquely positioned qualified healthcare providers to actively participate in childhood obesity prevention (COP). A review of the literature provided findings to identify a gap in the knowledge regarding the association between school nurse COP perceptions and practices. A modified theoretical framework based on Bandura's health promotion by social cognitive theory guided this study. The purpose of this study was to identify the key perceptions (self-efficacy, perceived benefits and perceived barriers) influencing school nurse participation in COP practices and determine associations between school nurse characteristics and COP perceptions and practices. Preliminary research was conducted to determine content validity for modified perception scales, clarity of instructions and questions, data collection and retrieval procedures, and refinement of recruitment strategies. Adequate reliability and validity was determined for modified scales measuring school nurse self-efficacy, perceived benefits, perceived barriers, and COP practices targeting individual children (child-level) and the entire school population (school-level). Florida RN school nurses (n = 171) completed self-administered anonymous questionnaires from an emailed weblink or a paper version offered at two Florida Association of School Nurses conferences. School nurses with characteristics reflecting more education engaged in more COP practices (p (<) .05) than those without education-related characteristics. School nurses with (>) 8 hours of COP education reported higher COP self-efficacy than those with none (p (<) .01). Linear regressions showed that a model comprised of self-efficacy, perceived benefits, and perceived barriers significantly explained 12.0% of the variance in child-level practices (p (<) .001) and 9.1% of school-level practices (p (<) .001). Self-efficacy explained the most variance of school nurse child-level and school-level practices (p (<) .001), and perceived barriers were inversely associated with child-level practices (p (<) .05). Four series of regressions showed that only perceived barriers partially mediated the influence of self-efficacy on child-level practices. Data analyses indicated self-efficacy and perceived barriers were key determinants of school nurse COP practices. Therefore, policy changes and educational interventions to increase self-efficacy and reduce perceived barriers may be effective in mobilizing school nurses to actively engage in COP practices.
Show less - Date Issued
- 2012
- Identifier
- CFE0004585, ucf:49188
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004585
- Title
- Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed with Diabetes.
- Creator
-
Lamanna, Jacqueline, Bushy, Angeline, Norris, Anne, Wink, Diane, Gammonley, Denise, University of Central Florida
- Abstract / Description
-
Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by...
Show moreOver 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: (")the daily stuff is difficult("); (")engineering care at home is difficult("); (")life is stressful(") and (")difficulty managing complex health problems(").Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project.Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274,df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p (<) .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early post-discharge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p (<).001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the post-discharge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.
Show less - Date Issued
- 2013
- Identifier
- CFE0004875, ucf:49652
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004875
- Title
- The Early Postpartum Experience of Previously Infertile Mothers.
- Creator
-
Ladores, Sigrid, Aroian, Karen, Chase, Susan, Norris, Anne, Renk, Kimberly, University of Central Florida
- Abstract / Description
-
The lived experiences of previously infertile mothers in the early postpartum period have not been previously studied. The purpose of the research was to explore the experiences of previously infertile mothers during their early postpartum period.Colaizzi's (1978) approach to descriptive phenomenological inquiry was used to analyze the interview data obtained from twelve first-time, previously infertile mothers. These new mothers, aged 27 to 43 years, were interviewed twice. The first...
Show moreThe lived experiences of previously infertile mothers in the early postpartum period have not been previously studied. The purpose of the research was to explore the experiences of previously infertile mothers during their early postpartum period.Colaizzi's (1978) approach to descriptive phenomenological inquiry was used to analyze the interview data obtained from twelve first-time, previously infertile mothers. These new mothers, aged 27 to 43 years, were interviewed twice. The first interview focused on eliciting descriptions of new motherhood in the early postpartum period after overcoming infertility. The second interview validated the interpretations from the first interview and provided additional information and reflection. Two main themes emerged that described the early postpartum experience of first-time, previously infertile mothers: 1) Lingering Identity as Infertile; and 2) Gratitude for the Gift of Motherhood. Participants reported that their lingering identity as infertile and immense gratitude for the gift of motherhood propelled them to establish unrealistic expectations to be the perfect mother. When they were unable to live up to being the perfect mother, they censored their feelings of inadequacy, guilt, and shame. Findings from this study sensitize healthcare providers to the difficulties faced by previously infertile women during their transition to motherhood.
Show less - Date Issued
- 2013
- Identifier
- CFE0005365, ucf:50489
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005365
- Title
- Improving Chronic Kidney Disease Care with Group Visits.
- Creator
-
Montoya, Vicki, Sole, Mary, Norris, Anne, Wink, Diane, Abbott, Lionel, University of Central Florida
- Abstract / Description
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First year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self...
Show moreFirst year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self-manage CKD negatively influence a patient's ability to follow provider recommendations. The group visit (GV) intervention has demonstrated improvements in disease-related outcomes through increased levels of patient knowledge, self-efficacy, and disease self-management for other chronic diseasses such as diabetes and congestive heart failure (CHF). No data are available for the use of GVs in CKD.The purpose of the study was to develop and test a nurse practitioner-facilitated chronic CKD GV model versus usual nephrology care for Stage 4 CKD patients (knowledge, self-efficacy/self-management, physiological data, and satisfaction). As classified by the National Kidney Foundation's (NKF) staging system, Stage 4 CKD is considered severe kidney disease, with a decrease in the functional capacity of the kidney as determined by a glomerular filtration rate (GFR) of 15-30 ml/min. It is common for patients with Stage 4 CKD to progress to Stage 5 CKD/end-stage renal disease (ESRD), requiring dialysis or transplantation to survive.Preliminary instrumentation and feasibility studies were conducted prior to a pilot study of a CKD GV model. The development and validation of the Stage 4 CKD Knowledge Instrument was completed with 59 Stage 4 patients. Findings supported reliability (Kuder-Richardson-20 [KR] = .89) and content validity (I-CVI = .97, S-CVI= 1.0) Feasibility of the CKD GV model was assessed with a single group, pretest-posttest design using a convenience sample of eight Stage 4 patients. Results demonstrated an improvement in knowledge of CKD from a median of 69% to 86% (p =.012). No improvements were noted in self-efficacy scores (p = .230). GV satisfaction ranged from very good to excellent. Feasibility was supported by a high retention rate (100%). No barriers to participant recruitment or GV implementation were encountered.The pilot study used a two-group, repeated measures experimental design, with a sample of 30 Stage 4 CKD patients from two office locations of an outpatient nephrology practice. Patients were randomized to the GV intervention or to usual nephrology care. CKD-knowledge, self-efficacy, and self-management scores were collected at baseline, six months, and nine months. Physiological data were measured at baseline, six months, and nine months. GV satisfaction was obtained after the completion of GVs (six months). Nephrology practice satisfaction was obtained from by both groups at nine months. MANOVA for repeated measures was calculated for data collected at the three time points.Twenty-six of 30 patients completed the study, with four patients ineligible to complete the study due to progression to ESRD and dialysis initiation. GV attendance was 92%. CKD knowledge was statistically improved for both groups (F(1.498, 34.446) = 6.363, P = .008). While not statistically significant, a favorable upward trend in the mean scores for the subscales of self-management (communication, partnership in care, and self-care) was demonstrated in the GV patients, with a lack of improvement found in the usual care group for these subscales. Self-efficacy scores revealed a non-significant improvement in mean scores for the GV patients during the GVs, not seen with usual care patients. GV satisfaction was again high with the vast majority of patients requesting use of GVs in their future nephrology care. Current methods of intervention in the Stage 4 CKD population have made little impact on reducing first-year ESRD mortality and morbidity rates. Opportunities to intervene in the poor outcomes begin in the predialysis care of Stage 4 patients. Based on the documented success of multidisciplinary approaches in predialysis care, of GVs in other chronic diseases, and of chronic illness care based on the CCM, a high probability for success exists with the application of GVs in CKD. Although limited by a small sample size, promising improvements in the subscales of disease self-management, self-efficacy, CKD knowledge, and high satisfaction with the GV model for GV participants were revealed in this study. Further research is warranted for the CKD GV model on a larger randomized sample in other locations. Much needed data would be provided on which to base decisions for use of the CKD GV intervention in the predialysis care of Stage 4 patients.
Show less - Date Issued
- 2013
- Identifier
- CFE0004724, ucf:49827
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004724
- Title
- Impact of Cancer-Specific Advance Care Planning on Anxiety, Decisional Conflict, and Surrogate Understanding of Patient Treatment Preferences.
- Creator
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Waser, Lynn, Aroian, Karen, Chase, Susan, Norris, Anne, Loerzel, Victoria, Buckey, Julia, University of Central Florida
- Abstract / Description
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ABSTRACTPatients with life-limiting cancer and their families face unique challenges that interfere with their ability to make decisions or adequately express their health care preferences about end of life (EOL) treatment. As a result, patients at EOL often receive aggressive unwanted treatment that nationally costs billions of dollars and results in surrogate distress about not honoring patient wishes. Respecting Choices(&)#174; DS-ACP is a disease-specific Advance Care Planning (ACP)...
Show moreABSTRACTPatients with life-limiting cancer and their families face unique challenges that interfere with their ability to make decisions or adequately express their health care preferences about end of life (EOL) treatment. As a result, patients at EOL often receive aggressive unwanted treatment that nationally costs billions of dollars and results in surrogate distress about not honoring patient wishes. Respecting Choices(&)#174; DS-ACP is a disease-specific Advance Care Planning (ACP) intervention that is designed to overcome barriers associated with ACP and potentially decrease the incidence of unwanted, overly aggressive treatments at EOL. The intervention is delivered to patient-surrogate dyads by a trained facilitator who provides an opportunity for patients to identify values and goals that support their EOL choices and communicate these values and goals to their surrogates before they are in a medical crisis. Although Respecting Choices(&)#174; DS-ACP has been effective with other populations, it has not been evaluated for patients with life-limiting cancer. Thus, the purpose of this study was to evaluate the Respecting Choices(&)#174; DS-ACP intervention with patients with life-limiting cancer to determine if the intervention increases patient-surrogate congruence about the patient's EOL wishes and reduces decisional conflict without causing anxiety.Study design was a Phase I clinical trial. A volunteer sample of 15 patients with a diagnosis of life limiting cancer and their matched surrogates participated in the study. The Statement of Treatment Preferences for Life-Limiting Cancer Form, the Spielberger State-anxiety Scale Form Y-1 (STAI) and the Decisional Conflict Scale (DCS) were administered pre- and post-intervention. The Quality of Communication about End of Life Care Form was administered at post test. Descriptive statistics were used to describe the sample. McNemar Chi-square and Binomial tests were conducted to investigate whether the intervention increased congruence for five different situations on the Statement of Treatment Preferences for Life-Limiting Cancer Form. The Zar's Multiple Comparison Test of Differences was conducted to investigate the proportion of congruence observed across the five situations. A paired-sample t test was conducted to evaluate post-intervention changes in anxiety (STAI) and decisional conflict (DCS). Frequencies and percentages were conducted for the five items on the Quality of Communication about End of Life Care Form to evaluate patients' and surrogates' satisfaction with the intervention. Anecdotal comments about timing were content analyzed and summarized.Congruence between patients and surrogates improved significantly in all five situations (range of p =.001 to .031), decisional conflict lessened significantly (t (14) =4.49, p (<) .001), and anxiety did not change (t (14) = 1.75, p = .102) pre- and post-intervention. Participants reported satisfaction with the intervention, including its delivery and timing.Findings from this study provide guidance on how to assist patients with life limiting cancer and their surrogates with EOL decision making. Study findings also support making the Respecting Choices ACP intervention part of usual care for patients with life limiting cancer and timing the intervention so that it is delivered before a medical crisis occurs. The lack of change in post-intervention anxiety scores suggests that ACP does not add to patient distress when ACP is conducted by a trained facilitator. This finding can be used to persuade health professionals to refer their patients for ACP. Additional research is needed to determine if increased patient-surrogate congruence leads to patients' wishes being followed and reduces surrogate decisional conflict and distress at EOL. Future research is also needed to determine if the Respecting Choices DS-ACP intervention is equally effective with racial and ethnic groups whose reluctance to engage in EOL discussion has been documented in the literature or if the intervention needs to be culturally adapted.
Show less - Date Issued
- 2012
- Identifier
- CFE0004615, ucf:49944
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004615
- Title
- Family Care Giver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults with Cancer.
- Creator
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Geddie, Patricia, Loerzel, Victoria, Sole, Mary Lou, Gammonley, Denise, Norris, Anne, University of Central Florida
- Abstract / Description
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Unplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated...
Show moreUnplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated with unplanned hospital admissions in older adults under treatment for cancer. A conceptual framework based on the literature and this researcher's clinical experienced guided this study. The purpose of this study was to explore the factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions of older adults with cancer. A convenience sample of 129 dyads of older adults with cancer and their family caregivers were approached and enrolled in the adult oncology outpatient infusion centers and inpatient units within a community cancer center in central Florida. Patient demographic and clinical data were obtained through a retrospective medical record review. Family caregiver demographic and side effect knowledge data was collected prospectively during interviews with family caregivers using a newly developed tool, Nurse Assessment of Family Caregiver Knowledge and Action Tool (NAFCKAT). The NAFCKAT contains 11 items to determine baseline knowledge about side effects and plan for managing side effects. A fever subsection consists of 4 knowledge and 2 action questions and a dehydration subsection consists of 2 knowledge and 2 action questions. Preliminary research was conducted to determine reliability and validity of the NAFCKAT. Excellent inter-reliability was found for the tool and preliminary support for validity was determined for the fever subscale. Descriptive statistics and logistic regression analyses were used to evaluate data collected from patient medical records and NAFCKAT scores. Study findings revealed that unplanned hospital admissions were more likely to occur when older adults had the presence of impaired function prior to treatment initiation and/or experienced side effects of infection /fever and vomiting/diarrhea during treatment. The presence of impaired function and family caregiver support (knowledge and availability) did not moderate the relationship between side effects and unplanned hospital admissions. Findings suggest that the presence of impaired function and side effects of infection and fever, and vomiting and diarrhea, predict unplanned hospital admissions in older adults during the active cancer treatment phase. Nurses should advocate for and conduct targeted assessments to identify the presence of functional impairments prior to cancer treatment initiation. In addition, nurses should actively monitor for the presence of cancer treatment-related side effects during the treatment phase of the cancer trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to support older adults and their family caregivers during cancer treatment and reduce the risk for unplanned hospital admissions.
Show less - Date Issued
- 2015
- Identifier
- CFE0005618, ucf:50214
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005618
